That little meanie, the voice in my head, would keep bugging me each time I wanted to start new projects and take on new opportunities in my career.

Each time I wanted to work on my professional growth, there was a need to silence that voice down so I could reach my dreams and goals, and that was truly exhausting.

My achievements still became a reality despite feeling imposter and not enough, but the price I paid was a little too high, since I was fighting with that little meanie in my head, while conquering life and my pharmacy career.

Being a foreign-trained pharmacist, all I remember in my early career was a lot of suffering with every achievement. I had to take the English language proficiency exam and multiple tests to qualify for NAPLEX, while being pregnant and a young mom, and feeling not enough.

My imposter was fueled by my own personality, being shy and introvert. I constantly justified to myself that being a foreign-trained pharmacist is not any less credentialed or inferior.

Starting my second school for Doctorate in Pharmacy in 2014 at MCPHS, Boston, while already working as a licensed pharmacist for a retail chain was the next step to fulfill the dream to become enough and equal to others, although I learned and gained superior clinical skills and expertise during that time.

The revelation I had in 2020 was I am more than enough. One and a half years of active coaching and working on my limiting beliefs helped me realize success is not measured by degrees and credentials but by my own inner confidence.

Imposter syndrome among any highly educated professionals and especially women in healthcare is real!

If someone demeans our skills and expertise the way we do it to ourselves, can easily lead to feeling harassed or bullied. Yet we’re more likely to inflict that indignity upon ourselves: Seventy percent of women and men unfortunately doubt themselves despite compelling professionalism and achievements. Imposter phenomenon affects minorities, women of color in a much greater way, literature suggests.

Dr. Clance and Dr. Imes first referred to this phenomenon in 1978, and it gained significant public attention in their 1985 published book. Interestingly, the syndrome is present in high-achieving, successful and well-regarded professionals who, on the outside seem extremely confident and prosperous, but truly struggle with each professional move and feel they don’t deserve the recognition.

Important to note, impostor syndrome is not yet included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and it seems that professionals rarely seek mental health support solely for this reason, but a large body of literature suggests it is a root cause for many comorbidities such as anxiety and depression.

Studies researching the imposter phenomenon among women health care professionals describe how much it affects job performance, creates fear to seek promotion at work, contributes to higher level of burnout, lowers job satisfaction, and leads to departure from the workforce in some cases.

Considering all the available evidence, it is incumbent on employers to recognize the burden of this phenomenon on productivity by training, mentoring, and coaching employees to counter the ill effects of the imposter syndrome. Employers who are focused on growth, leadership, and equality at workplace, must provide their employees self-paced learning materials, access to therapy and resilience training on this.
Giving health care workers the opportunity to be heard and using de-identified assessments will normalize and hopefully destigmatize imposter syndrome among them and help cope with the syndrome rather than ponder leaving the profession.

My own advice that helped me recover from imposterism is to start vocalizing your feelings and find a group of supportive and like-minded women professionals who share your experience.

A final thought - you are best valued by the quality of care you give to your patients and the positive impact you have on their lives, far more than your credentials, degrees, and recognition from superiors.

Articles

Ani Rostomyan PharmD, BCPS, APh, talks about imposter syndrome for women in healthcare and how they can conquer it 

Imposter syndrome among women in healthcare and how to conquer it!

Pharmacists have become the healthcare paradigm shifters in the last 45 years, in addition to elevating the profession we have moved on to exploring and leading towards more and more nontraditional roles and endeavors. The last 2 years we continued our consolidated efforts and became essential team players as frontline healthcare leaders and went above and beyond our professional and human capacities to help tackle the Pandemic. Pharmacists no longer are considered “pill counters”, “just put a label on it and give to patient personnel” or “hospital basement workers”. Pharmacists have been successfully creating entrepreneurial careers in health care space and the best is yet to come.

Nutrigenomics will be the future of how we eat! Let’s just say personalized diets are the future!

Nutri what?... I was a little confused, reading about Nutrigenomics as an emerging science in one of the renowned scientific journals just a few years ago.

I didn’t give it much significance, back then my clinically trained mind was frantically looking for new data and guideline updates mostly pertaining to drug-disease recommendations.

My first real interest in Nutrigenomics was sparked after watching the “The Dynamic Genome” documentary and how much our nutrition, lifestyle and genes are intertwined and involved in predisposition, or risk mitigation for certain chronic disease states, moreover how pivotal is epigenetics’ role in this paradigm.

Learning more about alleles, single nucleotide polymorphisms (SNP’s), genome, haplotypes, coding and non-coding regions of DNA, and precision nutrition wasn’t on my bucket list after graduating Pharmacy School, and only in recent years I dove into precision medicine and precision nutrition to understand why some of my chronic disease patients weren’t benefiting from same healthy nutritional recommendations according to ADA and MyPlate. My conclusion “One size does not fit all” soon became a reality and an aha moment!

Chronic disease epidemic is real! We, as a society must change the way we approach to nutrition, otherwise chronic disease statistics predictions are grim. Obesity constitutes a significant health burden worldwide, becoming root cause of large number of health problems, such as dyslipidemias, type 2 Diabetes, non-alcoholic fatty liver disease, some types of cancers, causing health, social and economic burden across the globe.

Knowledge on how food interacts with our genes, and how our body responds to these interferences, along with epigenetic factors, is what Nutrigenomics’ promise consists of. This rapidly evolving scientific field is tailoring the framework for the genotype driven dietary recommendations, evidence-based solutions to dietary interventions and hopefully tackling chronic disease epidemic worldwide.

Regarding type 2 Diabetes, there’s robust and growing evidence, showing some food component and genes’ beneficial interaction. For instance, bioactive substances such as quercetin, genistein, resveratrol, catechins, curcumin and anthocyanins have shown beneficial and protective effects related to type 2 Diabetes. Through affecting insulin secretion and signaling, inflammatory processes, oxidative stress, glucose and lipid metabolism, the interaction of these active substances and relevant genes produces beneficial effect in the prevention and management of type 2 Diabetes.

Nutrigenomics connects nutrition to genome and studies the bidirectional interactions between genes and our diet, specifically exploring the genetic relationship of the food we eat, environmental factors, lifestyle and its correlation to prevention and treatment of chronic diseases. After the completion of Human Genome Project (1990-2003), where the DNA sequence of the entire human genome was mapped out, the era of precision medicine took off and nutrient-gene interplay concept was born.


Imagine if your diet is not optimal and is more of like SAD (Standard American Diet), you will most likely have variety of nutritional deficiencies sending those poor signals to your genes to not function at an optimal level. Even more fascinating discovery to me was learning about DNA methylation as a crucial epigenetic mechanism.

 essentially is all the structural and chemical changes made to our DNA through methylation and what DNA methylation does is pretty much keeping your DNA curled in and protected in the nucleus, and not exposed, since more exposure will make more errors happening and higher chances of chronic disease occurrence.


Minimally processed foods, fresh fruits and vegetables and balanced meal plans are good for everyone. Food and Nutrition guidelines designed by government agencies cover large groups of general population, but precision nutrition as a crucial part of individualized or personalized approach to health, takes into consideration genomic differences, epigenetics, patient’s age, gender, comorbidities, microbiome, and environmental influences as well.

The bottom line: Your Genes Are Not Your Final Verdict

It is evident that Nutrigenomics and personalized medicine are paving the way and creating evidence based scientific insights for the prevention, treatment and management of chronic diseases and hold the promise of the ability to reduce risk factors for chronic illnesses regardless of our genetic blueprint. Using the power of Nutrigenomics/epigenetics, human microbiome, and our individual characteristics we can control our genetic destiny, negotiate with ‘’ poorly working’’ genes utilizing precision nutrition as an additional tool in the arsenal of personalized health approach. It is important to note that Nutrigenomics testing is not a stand-alone diagnostic tool to detect, diagnose and manage disease, rather it’s another helpful approach to manage subpopulations, who carry significant polymorphisms altering their ability to metabolize nutrients in an efficient way.

Now how can Pharmacists position themselves as Nutrigenomics experts and stand out in our ever-evolving profession?


Here are 5 ways you can help your patients and educate health care providers to understand the unique interconnection between nutrition -chronic disease-and their genes.

1. Help patients know their genetic blueprint; the technology is advanced and now is available to consumers.

By becoming a certified Nutrigenomics consultant, you can educate your patients on this new emerging field and be of great information source to dig deeper and understand how food choices react with their genes and environment and contribute to prevention or formation of various chronic disease states.

2. You can help your patients learn their SNPs.

You can educate patients to learn more about genetic polymorphisms or SNPs, or in other words different “traits” and whether these changes in their genes are making them essentially ‘faster’ or ‘slower’ metabolizers. Also, help patients understand micronutrients and macronutrient’s role in genes’ function. Patients feel lost looking at the Nutrigenomics report, you can absolutely use your expertise and guide them through the summary of recommendations, increase their awareness and help change their diet and health behaviors.

You can educate your patients and tailor personalized diet plans for them, based on their Nutrigenomics report in conjunction with other non-medicinal approaches to bettering their health

Ask your patient what does their diet look like? Are they eating a lot of processed carbohydrates or foods that may affect their gene expression? For example, some nutrients like bioavailable vitamin B12 are only obtainable from animal proteins, so for patients following mainly plant-based diets, you may want to ensure they are getting enough vitamin B12 for proper methylation, which is needed to keep disease-causing genes switched ‘off.’



4. You can help address your patients’ unique epigenetic factors.

Identify and address the epigenetic factors that are affecting their genetic expression and current health status. This includes things like acute or chronic stress, mold exposure, dysbiosis, diet, sleep, and many other lifestyle and environmental factors in their life.



5. Become the Nutrigenomics expert, stand out in the crowd, and educate health care providers as well!

Patients are becoming increasingly aware of the Pharmacogenomic and Nutrigenomic testing availability and may even order these through variety of Direct-to-consumer companies, which are not easy to understand for majority of people.


You, as a forward-thinking Pharmacist, certified in Nutrigenomics, can start serving your patients in a more meaningful way to help them first use food as medicine and eat what’s right for them.

Importantly, your advice to patients should not be based solely on Nutrigenomic test results but use Nutrigenomics as an additional tool in your expert toolbox to find unanswered questions to health concerns that your patient may have been looking for years. Remember, health care providers don’t typically talk about diet, nutrition, and personalized medicine with their patients due to existing health care model in our country, where patient-provider interaction time is very limited. You can be the greatest support tool and expert Nutrigenomics consultant for many primary care physicians who will greatly appreciate your expertise.

How I started my non-traditional career as a Nutrigenomics consultant.

Ani Rostomyan

Articles from author

Imposter syndrome among women in healthcare and how to conquer it!

5 ways you can help your patients through Nutrigenomics consulting services!