This is. 

 I think we’re all going to scream when the next patient says, ‘I’ve got an MTHFR’, right?!

Congratulations, I want to say, because you would be in much more serious trouble if you didn’t have a copy…

‘Oh, sorry, you mean you have a mutation on at least one allele encoding for the MTHFR enzyme…Oh, I hate to tell you but contrary to popular (online) belief, you’re not special.’

<Ouch> (more…)

“I always give some Glutamine to heal their leaky gut”

Cue pained expression on my face.  No, I’m not a fan.  I take that back, I have no problem with the amino acid itself and I’m still in awe of its incredible multifaceted role in the gut.  What I do have a giant issue with is the mismatch between everything we are being told Glutamine is going to help our patients with, and the dosages that apparently will do that, and the reality.   I know, I’m attacking the Holy Grail of Gut Health 101….right? But it’s time to set the record straight. Firstly, where’s the evidence at in terms of Glutamine interventions in GIT pathology, particularly in relation to reducing excessive intestinal permeability and improving lining integrity  Well if you’re a rat – Good news!  Rats’ GITs have a greater dependence on Glutamine than ours, a deficiency of this amino produces clear reproducible negative effects and supplementation fixes these brilliantly!

But if you’re treating humans not rats – well – the evidence & the case for Glutamine for the Gut is not so straight forward or impressive. (more…)

They’ve just come from the immunologist, having presented with extensive vitiligo in dad and early stage vitiligo now in their primary school aged son.  The immunologist, without running a single blood test, told them, ‘Bad news, you both have autoimmune issues and watch this space because the vitiligo is just the first presentation, there will be more to come’.  Slightly unsatisfied with this dead-end conclusion and non-existent management plan, the family then presents at a long established naturopathic clinic to see Anna Sangster, a fabulously sleuth-like detective, who takes her patients’ health very seriously and has the knowledge and skills that make her one of the best at what she does. I can say that because I’ve been mentoring Anna for a long time & she is one of the clueiest practitioners I know.

For example, she knows about the substantial research demonstrating the overlap between thyroid autoimmunity and vitiligo and, in addition to comprehensive case taking, decides some blood tests may provide valuable insight that would help to understand the degree of self-attack from their immune systems, identify if there are in fact already concurrent autoimmune targets and perhaps even provide a clue as to underpinning drivers. Well, look what she found! (more…)

Just finished talking with the fearless fertility naturopathic specialist, Rhiannon Hardingham, who wanted to let me know that after listening to my Update in Under 30: Silent Reflux she’s had a lot of success treating both GORD and insomnia in her pregnant patients. That calls for double the celebration …YAY! YAY! 

‘What’s the magic answer?’, I hear you ask… (more…)

That’s me…always questioning the ‘status quo’ and Iodine is  the perfect example!  The interview I did on this important subject with Andrew Whitfield-Cook from FxMedicine, covers a lot of key areas of confusion & underscores why it’s so critical all health practitioners get clarity on this topic. ‘It’s just a matter of geography’.

You know, I say to people, we can make vitamins ourselves, we can get all sorts of  other organisms including animals, bacteria and plants to make vitamins for us, and then eat those…but minerals…our source of minerals…well it all comes down to the rocks and the soil our food itself is grown or fed on.  And iodine is profoundly influenced by these factors. (more…)

I promised I would keep all you fellow desk workers posted. Over 6 months has passed since I started standing for work….and I LOVE IT! 

Here are the pros I can wax lyrically about so far:

  • Back ache from long days at the computer, gone…seriously
  • I am more energised about coming to work, starting work, staying at work…because I am not sitting! YAY! I move around…everyone I meet with on Skype will vouch for that!
  • I am fitter & stronger as a result of standing for approx. 35hrs a week ( I know this because it took a while to develop this…after the first 2 slightly grueling weeks!)
  • At the end of a long day/week, my mental fatigue and physical fatigue finally match – which means I am no longer brain-dead but in desperate need of a run around the block! The previous mismatch used to make winding down etc hard
  • I get to actually walk my constant talk to patients about being active, avoiding sitting etc. Soooooo much better than sitting there for client after client and saying…’you know you really should move more!’
  • And at the end of a big day…sitting never felt so good…it’s been restored as the luxury item it should be 😉

Here are the cons I can also attest to: (more…)

No, I haven’t gone crazy for the ‘caped crusader’… but I thought that would get your attention…. oh look it did! 😉
I’m off to Melbourne for the ACNEM Conference May 5-6th and Batmania was one of the interim names of this very cool and happenin’ town before it became known as Melbourne in 1837! Things have certainly changed in nutrition and the environment since then and as practitioners we now need to address sometimes very complex dynamics between genes, gut, nutrition and environmental health.  Which, luckily enough this conference is all about!
This year’s theme for ACNEM is Health for Life – Mastering the Integrated Approach. 
I am fortunate to be included in the exceptional speaker line-up (thanks for lovely sentiments many of you have expressed so far about that 🙂 ) I am presenting on ageing..which many of you know that I am suddenly now very interested in…getting old and all.


Ok now you’re getting mad at me, right? Because how many ‘absolute givens’ can I debunk?! Last Update in Under 30 certainly got people talking…giving iron less often rather than more often to our most iron deficient patients seems counter-intuitive, right?! Wrong.  And as part of the influx of emails I’ve received from practitioners who listened and loved the podcast, came a flurry of great questions – like this one from Michelle Toocaram:

“The Moretti et al study was done on ferrous sulphate which I would never use as it has poor bioavailability. Are there any studies on better forms such as ferrous glycinate etc”

It’s a perfect question – because of course the success of most mineral supplements is largely determined by the form the mineral is presented in – so comparing the same dose of, for example, Calcium carbonate with Calcium citrate is a bit like comparing chalk and yoghurt!  The substances that minerals are bound to, generally play a huge role in determining the amount you will absorb from that product and therefore the degree and speed with which your nutritional status will improve.  But is that the case with iron? Not quite. (more…)

“Researchers followed more than 500 women trying to conceive over about five years and found that, overall, those with moderate to severe iodine deficiency had 46% lower odds, per cycle, of becoming pregnant.”

All researchers dream of generating the kind of results that are ground-breaking but sometimes you read about the latest study’s findings and you  think, ‘Really, you spent all your time & cleverness for years on this and that’s all you have to show for it!’ Like the study that finally confirmed dog’s can feel empathy (at last thank goodness …phew…cos I had my doubts until they crunched the numbers!)

So too a study published this month on the possibility that iodine deficiency is common in women trying to conceive in developed countries and may be connected to increasing fertility issues.

Stop press!  I know…that made you spill your coffee! (more…)

Is this the way of the future for health practitioners interested in patients’ digestion…?

“The team developed an ingestible electronic capsule to monitor gas levels in the human gut. When it’s paired with a pocket-sized receiver and a mobile phone app, the pill reports tail-wind conditions in real time as it passes from the stomach to the colon…The authors are optimistic that the capsule’s gas readings can help clear the air over the inner workings of our intricate innards and the multitudes of microbes they contain. Such fume data could clarify the conditions of each section of the gut, what microbes are up to, and which foods may cause problems in the system. “ (more…)

If you receive the free Medical Observer newsfeeds you’ll know what I’m talking about.  Here are some recent headlines:

I stand accused of rorting Medicare.  This is what it’s like

A GP is sued after doing everything right — except her notes 

After-hours funding shakeup

‘We’re becoming unviable,’ says GP hit with $22K e-PIP repayment

This Christmas I wish for doctors to feel valued again

So the answer is, probably.  Tales direct from the trenches that I hear from GPs, suggest it is increasingly difficult to make a living without adhering to a crazy volume of <10min appts, without being sued (too often) or dragged in front of AMA or APRHA. I hear them and know that the increased pressure is coming from multiple angles and I think it is very sad that previously such a respected and valued role in society appears to be ‘losing its value’.  Don’t get me wrong, I don’t agree with the old ‘Doctor as God’ model and think it ‘s very unhealthy actually for patients, but I feel like GPs with all their extensive training, knowledge and expertise are in urgent need of an Oprahesque ‘new dawn’!  (more…)

Just because most of us have been on holidays doesn’t mean the thyroid knowledge wagon has stopped or even slowed!  Always amazed at what we continue to discover about the complex working of this amazing gland and how its health impacts so much of the rest of the body and of course our babies’ bodies! So I thought I’d give you a quick recap of an important study published while you were at the beach/in the bush/in bed ;)…

  • A Finnish prospective cohort study of over 3000 pregnancies by Heikkinnen et al has revealed that at 16yo, offspring from these pregnancies, had a 1.56 increased rate of unhealthy weight and a 2.5 greater likelihood of meeting criteria for metabolic syndrome, if their mothers were thyroperoxidase antibody (TPO) positive during their first trimester
  • TPO antibodies affect up to 20% of pregnancies but in this study they defined ‘TPO positive’ as those women with levels ≥ 167.7 IU/mL (the 95th centile in this sample)
  • What adds to the noteworthiness of this news is that:
    • More than half (55%) of the TPO positive mothers were classified as euthyroid during their pregnancy, suggesting that the effect was not driven by maternal  hormone concentrations
    • The offspring of mothers with actual thyroid dysfunction did not show any statistically significantly greater risk of cardiometabolic issues
    • The offspring of hyperthyroid mothers in fact demonstrated significantly better insulin sensitivity at 16yo than children of euthyroid mothers
    • Thyroglobulin Abs over the 95th centile (≥ 47.7 IU/mL) did not correlate with any increase in cardiometabolic risks for their children

When we consider the substantial evidence of poorer maternal cardiometabolic outcomes for women who are hypothyroid during pregnancy – it would seem that the abnormal thyroid hormones are most impacting for mum but in fact the TPO Abs the most detrimental for bub! (more…)

I’m getting a sore neck from this, but looking back at 2017 and looking ahead to how I want 2018 to be, is of course perfectly appropriate for this time of year. 

And if we don’t take this opportunity for a little bit of reflection and review then we risk our growth:  both personal & professional.

Looking back, as always there were both highlights and some lowlights  – highlights for me included receiving the BIMA lecturer of the year award,  being asked to speak in Europe and getting out from behind the computer and coming face to face with more and more practitioners as I toured around – sorry webinar junkies…but long live LIVE REAL PRESENTERS & PRACTITIONERS!  Lowlights? Well they included of course the private health insurance reform in Australia…enough said. (more…)

Recognise your own name or someone else’s on this list?

Dear 2017 Group Minties aka Mentees.   I have always struggled with the term, ‘mentees’…seems too American or something and this morning when I was out walking, I had a light-bulb moment – I am proposing a re-branding to something much closer to home (!)… I propose we rename you Minties!! Because you are always fresh and you give me & your fellow Minties always something; cases, questions, clinical conundrums, ethical dilemmas,  every month to seriously get our teeth stuck into!  Cheesy but true 😉

Congratulations on completing your full year of group mentoring – and if this is your 2nd, your 3rd even your 4th year then I bow to you even more deeply.

Thank you for including me on your support team and entrusting me with helping you grow & develop as exceptional practitioners.

You should  be celebrated for your commitment to your own learning & your endeavour to always improve your knowledge and skills. (more…)

And then you don’t, right? Because if my experience is anything to go by, there are some patients that just don’t respond to the usual iron repletion strategies. Depending on how low their ferritin is, this can then precipitate ‘practitioner panic’ (we’ve all had it right?!) where we’re inclined to go higher & higher with the dose and number of doses per day. Typically, this also fails. I hear about this from other practitioners all the time and I see the ‘normal’ doses of iron sneaking up and up.  Remember the days when we couldn’t get a non-pharmacy supplement with over 5mg elemental iron in it and now we have > 20mg?  But still, I hear you say, this fades into insignificance when you think about the standard medical model for iron correction which provides 100-200mg/day and you’re right. 

Gee… after hundreds of years of knowing about this deficiency and being the most common deficiency word-wide, you’d think we had our supplemental regime nailed.  

But that’s where you’d be wrong. (more…)

Are you hearing me?  Yup, it’s been a BIG year..and to think I don’t even have the ANS technically to blame this year!! How about you?

But listening to myself say this to people, in my wrap-up of the year-that-just-was, I am thinking….Has anyone EVER got to the end of year and exclaimed, “Wow! That was a small one?!” 

Not me, not ever, well not in my living memory! But somehow I forget.  I get to December and I think, ‘Geez, I’ve never felt this spent before!  I need to go on holidays and never come back, retire from work and retreat from the world’, until someone who loves me, and who has a longer memory than a goldfish says, ‘Love, you always feel just like this.’  The upside to this annual amnesia is, it pushes me to make very conscious choices for my holidays. (more…)

Following a huge co-ordination and curation effort we have finally confirmed all of our group mentoring positions for 2018 EXCEPT:

Tuesday 10.30am (AEST) Group has 3 positions left!**

Tuesday 1pm (AEST) Group has 1 position left!

Wednesday 10.30am Group has 3 positions left!

**Note this 1st group is only offered to those individuals who have previously undertaken mentoring, either group or individual sessions with Rachel (more…)

No this is not a joke. The room they enter happens to be the clinic space of a practitioner I mentor.  The older women are friends, both originally from the UK and they sit in on one another’s consultations sharing many of the same experiences: grief over loved ones lost, memories, laughter and both describe waking in the morning with a sense of dread, because they’re tired, feel they’ve lost their oomph, their motivation, their chutzpah…that’s mostly why they’ve come today.

But know what else these two have in common?  (more…)

Standing at the podium, I looked down at my notes & slowly read out the title of my presentation to the hundreds of people attending, ‘Paediatric Digestive Issues & Neurocognitive Abnormalities’ and briefly froze thinking, Holy Heck (!) this is someone else’s presentation!  Seriously. No, this is not one of my work stress dreams.  This happened. I thought…oh my how am I going to deliver this, it sounds very complex and lofty and scary!!

Then I saw my scribbled hand notes on the page, the unofficial name I had affectionately given this presentation as I researched, compiled my case studies and brought it into being, months prior and I instantly relaxed…oh…Kids’ Guts Are Mental…now that I have some serious experience with and something to say about! (more…)

Have you been a bit vitamin D trigger happy?  Does a patient’s low blood 25(OH)D test result have you reaching for a vitamin D supplement like the rest of us?  Yes…you might need to listen up then. Sunshine doesn’t come in a bottle.  That’s right, if your patient’s problem stems from inadequate sun exposure, have a guess what the best remedy is.  I’m not meaning to sound flippant but I think in all my ‘complex highbrow nutritional understanding’, occasionally (ahem), I have lost sight of the simple truths. (more…)