Chronic coughs, rhinitis, postnasal drip or even asthma? Have you ruled out silent reflux? Aka laryngopharyngeal reflux. Patients experiencing silent reflux don’t present with heartburn or any typical GORD features but ultimately suffer from a similar failure of the lower oesophageal sphincter (LOS) – with their complications manifesting higher up, into the upper digestive and respiratory systems. An overlooked and under-recognised condition, medical opinion has fluctuated about its name, prevalence, significance, management…you name it…however there is now a strong body of evidence that says this condition should be diagnosed and investigated as a cause of many of these otherwise unexplained chronic symptom pictures.
Take this case from group mentoring last month: (more…)
I had the privilege of presenting at the Integria GIT Symposium last weekend. For those of you who attended, you’ve gone back to your clinic with a bunch of new ideas and inspiration I hope…oh and a new respect, terror and watchfulness for threadworm thanks to me! In my presentation I outlined the many presentations of this infestation, what to watch for and the risk of chronic recurrence due,in particular, to a reduced ability for some individuals to produce chondroitin sulfate which renders the GIT environment hostile to worms.
Chronic threadworm is a huge & grossly under-recognised issue in paediatrics, often presenting as behavioural & cognitive disorders (and these can be severe), bruxism, enuresis etc. of course, but another presentation typically missed is vulvovaginitis, vulval pain or UTI like sx in young girls. (more…)
Can you help me out here? My memory has failed me. Someone, somewhere (Mel? Syd? Auckland? Online during a mentoring session? In a Mullumbimby supermarket?!), in the past month asked me for this paper documenting the increased pain perception reported by subjects given IV saline with a slightly acidic pH compared to a neutral preparation. Quite an extraordinary illustration of the potency of small pH changes in the ECF and the impact this can have on our pain perception. This study is one Professor Vormann has previously talked about and as I’m touring with the fabulous German Professor right now I said, ‘Sure!’…then seemingly instantly erased from my mind who made this request! Is it you?
This month is a fabulous blur of travelling & speaking, getting back face to face with everyone at a bunch of seminars & conferences, which I love but I do forget some days where I am, who I am and exactly what I have promised and to whom! (more…)
I’ve been known to give calcium more attention than most and now I feel vindicated. Serum calcium, of course is not a reflection of your calcium intake, calcium losses nor overall calcium status. In this regard it is totally useless. But my fixation is about what even slight variations away from healthy levels of this mineral can reveal.
You’ve probably heard me openly scorn the parathyroid glands
“How hard can it be? These glands have just 1 job: keep the blood calcium in range! Snort!”
And that is exactly why it is so meaningful when this appears to be a ‘big ask’ and the serum calcium slips under 2.2 mmol/L or over 2.45 mmol/L & so potent given the huge chain of physiological reactions that follow from such a small shift – producing profoundly negative effects on vascular dynamics, neurological function etc. (more…)
…Chronic Kidney Disease (CKD) that is! That’s the ad we really need broadcast on prime time tv. On par with osteoporosis and other conditions that ‘seemingly appear out of nowhere’ in people’s 60s and beyond, there’s a potent combination of ignorance (patients) and denial (health professionals) at play it seems, when it comes to discussing the earliest signs of CKD that typically start decades before you’ll ever get a ‘diagnosis’. Being specialists in preventative health care – this is something we need to have firmly on our radar in terms of early identification and also in our repertoire when it comes to risk reduction. Most of us know about water intake and all the medical risks for renal impairment but are we equally onto the critical role that mild acidosis plays in driving this condition?
It’s not just me. Promise.
Check this out. (more…)
Another young female presents in my clinic with a newly diagnosed thyroid cancer and has been recommended urgent thyroidectomy. Her story is increasingly common. If you’re not seeing it in your clinic, you will, because thyroid cancer, and almost exclusively papillary thyroid carcinoma (the form my patient and most young patients have), is dramatically increasing. Since the 1970s there has been a 67% increase in the incidence in women and a 48% increase in men documented in 5 continents (Peterson et al 2012). Australia, though less up to date with its data collection, found a similar increase between 1982-1997 (Burgess 2002). The question begging to be answered is why.
Increased screening and more effective detection of smaller tumours was the going theory for years. New research rejects this absolutely and concludes instead this is a ‘true increase in occurrence’. Increased radiation exposure? Mutation studies say no. Many researchers are pointing to is a ‘new environmental chemical and/or dietary factor’ and EDCs (Endocrine Disrupting Chemicals) that target the thyroid such as perchlorates, phthalates, parabens and phenols are the likely suspects. And, more than likely, with iodine deficiency to explain the increased susceptibility to these EDCs.
But wait there’s more. These ‘new goitrogens’ aren’t only implicated in thyroid cancer, a large number of human studies confirm the higher your urinary metabolites of these, the lower your thyroid function. More worryingly is that they might be doing this ‘without a trace’. With myriad impacts at the receptor level, altered hormone excretion rates, impaired peripheral conversion etc. the data to date suggest these patients TFT results might only look ‘slightly low’ or even ‘normal’ but the reality is they are suffering hypothyroidism. Sound familiar?
There is a HUGE body of scientific evidence we can pull from to understand the role of EDCs in thyroid problems in our patients, how to maximise prevention and minimise impact – even when your patient, like mine, is perhaps already in the full grip of the consequences. I’ve read all the papers and summarised them in this 30min recording: Hypothyroid without a trace – the role of EDCs.
Have you got patients with hypothyroid symptoms but normal results? Or results that suggest the HPT axis just seems to be broken? Could it be the result of a combination of Endocrine Disrupting Chemicals (EDCs)? How do you assess for these ‘new goitrogens’, which act more potently and more insidiously, inducing hypothyroidism ‘without a trace’. How do you maximise prevention for all of your clients and the most at risk sub-populations or minimise impact for those already in the full grip of their consequences.
This latest Update in Under 30 audio comes with 3 key related scientific articles and a bonus larger powerpoint presentation that Rachel presented at the ASLM 2017 conference.
Last week I threw down a challenge. Following on from the ruffling of many feathers regarding Jason Hawrelak’s report that dietary saturated fat increases uptake of endotoxins from the gut, I provided his reference list in support of this claim, effectively saying, “if you don’t like his findings, then make your own informed conclusions but make sure you read all the evidence first”. I offered a prize to everyone who made an attempt and a year’s free subscription to Update in Under 30, to the person who produced arguably the best summary.
I’ve said it before and I will say it again, and again, and again: Our professional community abounds with extraordinary individuals.
People’s response to this challenge proved that once again. (more…)
Ever wondered where on earth (or Mars?!) I came from? As much as I can’t keep quiet on some topics, my personal journey to here has been a bit of closed book to many. Recently during an interview with Andrew Whitfield-Cook from FxMedicine, which was supposed to be strictly about postgraduate education paths and the desperate need for mentoring, internships etc for naturopaths, the sneaky devil got me to spill the beans on a whole lot more!
Having been involved in so many aspects of naturopathic and integrative health care education over the past 15 years, of course I do have a lot of ideas about how practitioners can best accelerate their learning and development, the need for more independent education and the importance of fostering critical thinking.
I think you already know that I feel passionately about this but do you know the whole story? Who I have been mentored by and how I continue to tread the path of the ‘student’? (more…)
In an ASLM Tweet I shared this weekend, I mentioned our own ‘Gut Guru’, Jason Hawrelak reported dietary saturated fat (including coconut oil) increases GIT endotoxin uptake and boy did that stir the pot! The social media switchboard lit up! It’s ok I know there isn’t a switchboard anymore…but I am old school 😉 This got just about everybody talking on Twitter & Facebook…and thinking out there in the real world…which is good, right? And if you read to the end you will find prizes galore for those of you that want to add to this discussion 🙂 (more…)
I’ve been travelling a lot for work lately, so in my absence my teens have been under the influence of others and as a result they’ve returned with new & improved habits. This one is gold:
1 egg + 1 banana
beat egg & add to mashed banana
pour into a hot pan, coated with small amount of oil
flip and serve with youghurt and fresh berries (more…)
Ever got to the end of a day or a week and felt like this? Or woken up to find your skin looking like this?! Just quietly, me too. When my son was about 3 he was sitting in the back of my car with my mum (she would have been in her early 70s) and he asked how people get wrinkles. We told him it was from having a fun life with lots of laughter, to which he replied out loud while still staring intently at my mother’s face, ‘Wow Grandma! You must have had the best life ever!’ I digress.
I personally am not a crusader of anti-ageing (seen my pics recently?!!) but my recent research into effectively reducing Advanced Glycation End-products (AGE) via the diet, to in turn potentially lower both my risk of tuckshop arms AND just about every other disease you can name (cardiometabolic, neurodegenerative, psychiatric, malignant, you name it), got me sitting up and paying attention! (more…)
One of the many perks of my job is getting to attend the wonderful conferences I am lucky enough to speak at … and something even more special right now and totally unexpected, is that I have been given the opportunity to share half price (!) ASLM tickets with two of you. (more…)
Scrolling through the extensive list of speakers for the upcoming Australasian Society of Lifestyle Medicine conference, I see many familiar names and faces … impressive researchers, academics, health specialists, writers, business leaders … and I’m just talking about the naturopaths!
Yep, out of the 50 speaker’s list for ASLM 2017, alongside neuroscientists, psychiatrists, geneticists (just to name a few!), naturopaths are representing 10% of the line up … and that is important & impressive!
Lifestyle medicine, defined as “the intersection of medicine, healthcare and health policy with behavioural, social, environmental, socioeconomic, & political factors”, should by virtue be a broad conversation among myriad health professionals & stakeholders, and one that naturopaths contribute to. The speaker list for this year covers over 20 specialties and includes a keynote presentation by Professor Tim Flannery…and in the naturopathic corner: Jason Hawrelak, Nirala Jacobi, Tabitha McIntosh, Danielle Fairbrother and myself. (more…)
When I was studying my undergraduate I sat at the front of the class, especially for the medical sciences. My chemistry lecturer tried to talk me into transferring to chemistry. My biochemistry lecturer tried to convince me to become a biochemist. But what I loved was the union of the two: medical sciences and naturopathy. As a student I hogged all Q and A opportunities and I am confident I annoyed many many people. If this sounds familiar, not because you were a classmate and I still annoy you (!), but because you could also be labelled a ‘lab lover’, a ‘pathology perv’ and an EBM evangelist…then this might just be for you. You can find out by answering these Qs…
Felice Jacka is onto something. You might know her as the daughter of Judy Jacka (naturopathic trailblazer who established the SSNT), you might know her as the Australian researcher who really started the bigger international scientific conversation about diet and its potential to prevent or increase individuals’ risk for depression and anxiety. But Felice has moved onto something bigger. You could say she’s moved onto ‘the guts of the problem’.
Under the stewardship of Prof. Michael Berk, Felice has been studiously following the research trail of chronic low grade inflammation’s role in mental health and this trail, together with her findings of the potency of food on mood, has brought her and her research focus, not surprisingly, to the microbiome.
‘Microbiome Madness’ not an entirely new concept to you? Me neither. Naturopaths and integrative practitioners have been pointing the finger in this direction for some time and getting good results with treatment that addresses this. I think, however, when someone as prolific as Felice and as internationally collaborative & respected, puts the microbiome-mood nexus centre-stage – we should all sit up and pay attention, because chances are she’s going to discover something that helps fill the current gaps in our understanding and may even redefine our approach. (more…)
Kia ora tātou!
Yes, that’s right! I’m heading off again to the land of the long white cloud. I’m very excited to be part of the Inaugural Conference that the New Zealand Society of Naturopaths and the Naturopaths of New Zealand are hosting 9-10th September in Auckland.
I’m coming to talk about the wealth of clues hidden in the most common blood tests results your patients already have and as per usual this information will be illustrated by lots of examples from my own patients and (I hope!) a few good chuckles 🙂 I will be doing a couple of presentations over the weekend and here are the times… (more…)
On Sunday there were deafening bells going off in my brain. By Monday they were going off in 11 others.
Alessandra: “Holy s#*t this has just ticked so many boxes for a couple of Rx resistant patients. Thank you!”
Tess: “Me too – finally the gut and pain connection explained”
Let’s play a little word association game:
I say ‘Fibroids’ – you say, ‘Oestrogen’.
I say ‘Cyclic Breast Pain’ and you say, ‘Ouch!’ [because it just slipped out] but then you say, ‘Prolactin’, right? Me too.
Prolactin driven breast pain’s most characteristic form is the premenstrual ‘oh my goodness get these off me!!’ kind, with patients experiencing anything from burning, aching, bruised feelings and acute hypersensitivity to touch, which builds in intensity for days leading up to their bleed. Of course cyclic mastalgia can progress to being full-time mastalgia in women whose breasts start to exhibit structural tissue change in the form of cysts, fibrosis and ultimately fibrocystic breast disease. If you’ve ever experienced even a day of mastalgia it is truly hard to conceive there are so many women (about 50% of premenopausal women!!) living with it daily.
Adding to our concerns about this so-called ‘benign breast disease’ (BBD) is that researchers are now certain it’s a significant risk factor for breast cancer, with women with any form of BBD experiencing at least a doubling of risk of a subsequent breast cancer diagnosis, while those women with proliferative BBD exhibiting a risk of 3.5X that of women without BBD. Castells et al 2015 (more…)
My partner and I have a well rehearsed script whenever he is suffering from man flu, he says, “Am I going to die?” and I say “Yes, just not today.” First world peoples tend to specialise in the denial of several absolutes: like time & death. As Professor David Cameron-Smith, from the University of Auckland says, ‘old’ is something we always define as ‘other’. We are not old but we know people who are! I personally used to define ‘old’ as over 50 until that became rather close and uncomfortable at which point I noticed a completely unconscious increase in the lower limit! Now old is over 75 yrs…and stay tuned for more updates 😉
Similarly none of us are ageing, right? (more…)