While I did diagnose this one correctly, I didn’t get 100% in this quiz – Can you? Speaking of the devil, Medscape, has this great little visual quiz to test your knowledge about physical signs & other hidden clues of nutritional deficiencies.
While we all know there can be a lack of specificity when it comes to some deficiency signs…like glossitis…eyeyiyi..naming a nutritional deficiency that doesn’t include this sign would be a tougher question 😉 but what a great reminder of some quirky things you may have forgotten or in fact deficiency features you may not have even known about.
A gem I love and apply frequently, is about zinc the ALP levels…watch out for the that later in the slideshow quiz.
Also note the distinct difference in opinion when it comes to vitamin D adequacy – with Medscape citing blood vitamin D result < 75 nmol/L unequivocally associated with osteoporotic change…in contrast to the …’anything over 50 nmol/L is a bonus’ line we’re being fed here in Aus and NZ! While we may not ever see some of these severe deficiency presentations walking through our doors – you can’t be so sure…given the reported resurfacing of scurvy in good ol’ Sydney just last year!
Is it just me? I love going back to nutrition 101. So tomorrow with your cuppa…test yourself and then let us know how you go 😉
Are you keen to keep developing your naturopathic knowledge in areas of diagnostics and nutrition? Rachel has a range of services that can help accelerate your learning. From the long list of great downloadable recordings in the store, that help fill your ‘knowledge potholes’ in a fun and engaging way that really brings these topics to life, to our Update in Under 30 Subscription: 30 mins of power-packed up-skilling delivered to your inbox every month, as well as our individual and group mentoring programs! There’s content galore and a delivery format to suit every clinician – come check out what’s on offer.
Watch the gap! You know I love a good diagnostic test probably (way!) more than the next person but I am slow to come around when there’s suddenly a ‘new-kid-on-the-block’ that every functional testing company wants to offer you. This is how I felt about serum zonulin testing as marker of intestinal permeability too. In spite of Fasano’s important work, identifying this molecule and its role in the reversible opening of tight junctions in the small intestine – I didn’t embrace the test. Why not? Didn’t I love Fasano’s ability to add this piece to the jigsaw that had been missing til now? Well I did. Does that make it an accurate and reliable marker of intestinal permeability in every client with any kind of digestive issue…? Well heck no! That’s not how science works friends and I suspect we may have really jumped the gun a little on this one. (more…)
Yet another sensational week of group mentoring last week. Holy guacamole…these cases just get more and more tasty! So much to talk about on every case presented, we all learnt buckets from a smorgasbord of conditions including: sudden onset thyroiditis (with a T4 of 45!!), azoospermia secondary to methylation and possible mitochondrial dysfunction and a 60 something female with chronic sleep issues, severe leg cramping with a differential ddx of intermittent claudication.
Just wanted to share this incredible resource related to one of the other cases from last week – a female client with a long history of interstitial cystitis, bladder pain and pudendal neuralgia. One of the striking aspects of the case was the high frequency of acute onset UTI sx which, in site of being ‘culture negative’ on repeat analyses, respond favourably to UTI specific antibiotics. We’ve all come across these ‘ghost infection’ situations…not a trace to be found of the offending organism or even infectious markers on urinalysis but without a doubt an infectious driver – the problem has long been convincing other practitioners of this!..and sometimes ourselves!! (more…)
At the end of last week I spent 3 days engrossed in intensive ANS planning for 2018. As you can probably imagine these planning days are incredibly exciting, creative, stimulating processes. If everyone involved had brain PET scans performed during these discussions, I think the disco lighting effect in our results would be noteworthy (!) and distinctly different from the stimulation that comes from most of our other work pursuits. Does anyone do disco all the time though? Not many of us. This prompted me to reflect back on a little graph I drew for myself this last month – that depicts the various ways all my different forms of work & how they contribute either money or meaning, or better still both!
Diversification of income streams is a key business catch cry, right?
And this is especially pertinent to clinicians.
But work variety may also be important in meeting our multiple values and need for meaningful engagement. (more…)
This year I’ve given up sitting & I couldn’t be happier or more annoying. I’ve become one of those evangelical people that wants to now spread the word as far as possible. I bought a standing desk and it’s radically improved my energy at the end of every work day and, as a result, how I feel about and interact with my work.
I’m sure you’ve heard that ‘sitting is the new smoking’, so ask yourself… who on earth would still be smoking in this day and age right?! Or sitting all day, right?!
So…the good news is that standing desks are no longer the exclusive domain of ‘arty Apple users’ who live in lofts, work in graphics and have $ to burn (or was that just my impression?)…Standing desks are so mainstream & accessible they have made it even into an Officeworks near you!! (more…)
May was the month of teenage girls presenting with severe digestive problems, especially ‘food intolerances’, leading to avoidance of specific foods and at times significantly reduced food intake overall. As integrative health practitioners, validating and creating insight for clients on the nature and source of their food reactions is our bread and butter, right? Is it wheat? Dairy? Gluten? FODMAPs? Salicylates? Oxalates? We are not surprised by how many ‘sick’ patients we see in spite of a theoretically ‘healthy diet’ – healthy for others perhaps but not for the individual in front of you, right? But what if I told you that each of these teenage girls had a BMI < 18 kg/m2, does that change your opinion about your role? Would you assess, monitor and manage these teenage girls differently? You should.
Take the example of one of my clients: 14yo female with a BMI 16.3, who had her first confirmed food reaction under 2yo with failure to thrive, which was attributed by a paediatrician & dietitian at the time to severe salicylate sensitivity. She underwent jejunal biopsy at 3yo for suspected coeliac disease, due to ongoing concerns and a primary relative with CD but it was NAD. In the 11 years since, there have been a couple of other digestive diagnoses based on solid evidence, such as mainstream stool PCR testing. So surely, the fact that she is underweight & that she skips lunch at school due to digestive discomfort is proportionate and explained by her organic digestive issues. Or is it? (more…)
This year has been a steep learning curve but this is exactly as I had hoped and planned for. I strapped myself in for my roller-coaster ride, a series of intensive upskilling initiatives undertaken with mentors and experts in specialist areas, and I haven’t hurled yet or screamed loud enough to make the operator stop the ride (seriously this happened to me in about 1997 on a Pirate Ship in Rosebud!)…but I have come close 😉
One of the really big lessons has come from getting more into the science behind pyrroluria and urinary pyrrole testing again. What motivated me to tackle this spikey beast? Well, like many people who have been introduced to the concept of pyrrole testing and pyrrole driven mental health presentations – I had a lot of questions that hadn’t been adequately answered. Those gaps left me with some uncertainty about the validity of this investigation and about the interpretation of the results. I also have introduced this pyrrole theory to many naturopaths and hence feel a responsibility to polish up my knowledge on this and set the record straight.
Last but not least, in our local area we reputedly have a ‘pyrroluria plague’ at play – every man woman and their dog is getting this diagnosis and it had added not only to my misgivings about testing but also my concern about misdirected & unsafe treatment. (more…)
Whenever I talk to practitioners about thyroid health, like I recently did at MINDD, I can guarantee I’m going to get 2 questions:
- Shouldn’t we aim for the high iodine intake of Japanese?
- Can we use the patch test for testing iodine levels in our patients?
I am so glad you asked. The answers are no and no.
I am a nutter for minerals and iodine just won’t go away right now. Too little = a problem, too much = often the same problems. To boot we are faced with radically contrasting views on assessment and dosage and just about everything iodine related. It’s not you – it’s iodine. Trust me it’s a complex little mineral that requires some extra thought and caution. If you imagine the Japanese have no thyroid problems – correct that big myth right now by reading this scientific paper that refers to health problems that result from too much dietary iodine. It also explains that the typical first step in treating hypothyroidism in Japan is to reduce their iodine intake! (more…)
I’ve been given a lot to think about. With ACNEM Science of Nutrition Conference and then MINDD both this last week, I’ve heard a lot. Not all of it good, useful or accurate of course. ‘Beware the Spin!’ I would say to anyone wondering how to sift through the potentially overwhelming volume of info being directed our way. What do I mean?…well while I might be regarded by many as an extrovert and I certainly can talk people into a coma when I get excited, I am always wary of presenters who primarily seem to use the platform to demonstrate their own superior knowledge, or just their own superiority full stop! I feel a very strong responsibility as an educator – to meet people where they are starting from (as much as you can in a room of 200 individuals!), start at the beginning but end up at a clear destination (not in the wilderness!!) e.g. a few tips, some new practice skills that everyone can use tomorrow – making sure you help everyone connect up as many dots along the way as possible. I think being an educator is really a privilege and if we fail to do these things we fail all those who came to learn.
What I look for and resonate with in presenters is a) a good mix of work experience (being a clinician is not always imperative but having contact with the real world outside your lab or your invisible podcast audience is essential), b) authenticity (I always say, ‘if you feel like you’re being sold to, you probably are!’) and c) lack of bias – we need to see more sharing of conflict of interests please! (more…)
I was typing notes furiously throughout the ACNEM Science of Nutrition conference last weekend. So many gems, so many gems, from researchers & clinicians – I just got so much out of it. I love the slightly awkward mismatch between the research world, aka ‘don’t prescribe anything til you have a high quality meta-analysis to say it works!’ and the clinical reality, aka, ‘I prescribe things every day in the absence of even one RCT because otherwise we just have to completely write off this generation with all their ‘atypical’ ‘unfixable’ debilitating illnesses!’ Both perspectives are valid and both groups of presenters had some absolute gold to contribute to the current practise and understanding of integrative medicine.
The sound of my manic tapping on the keyboard was only accompanied by the constant narrative in my head, saying ‘there has to be a way to share this with everyone who’s not here…quickly!’
Being the progressive technology head that I am (not) I immediately thought…what’s that Twitter thing? That social media platform old orange face uses from his golden throne to get his message out? Surely if he can – I can! @RANutrition!! (more…)
Make the most of this special offer! If you become a 12 month subscriber before the end of the week you will pay less than $13 per edition. Save more than 50% than if you were to buy the podcasts individually. Stay up to date with the latest in integrative nutritional medicine in less than 30 minutes.
And just so you know what we have in store for you as an Update in Under 30 Subscriber this month: Rachel delves into the “Must knows about Mo”. ‘Molly” seems to have become everyone’s best friend recently, prescribed often in combination with zinc for high copper or ‘sulphur issues”, especially in autism, but what do you really need to know about this trace element? How strong is the evidence for its clinical use, how likely is a deficiency, what are the key signs of inadequate levels and importantly what are the risks associated with too much? – new evidence points to some cause for concern and caution. In this timely update Rachel talks Molybdenum literally from the ground up…to the supplements on your shelf and the absolute must knows for every clinician. (more…)
‘How much does the Update in Under 30 podcast subscription cost?’ I hear you ask…about 1/4 of a packet of Activated Almonds per month, that’s about 1 activated almond per day I reckon. This is a Byron Shire joke, the idea being that Activated Almonds are the highest value currency in our community to which we compare all other costs and expenses 😉
But seriously, I did forget to mention the price in my last blog because I was busy being impassioned about the purpose, so the lowdown is these podcasts costs less than $13 a month.
That’s with the current 15% discount that is available for just the next 7 days. (more…)
So you’ve heard part of that BIMA story…now here’s the rest. To be honest, I was pretty surprised to win anything given I’ve spent the last 20 years ‘agitating’, challenging the misinformation and strongholds of the big companies etc. Funnily enough, in my post award ceremony interview, my interviewer dished up the biggest compliment of the evening when he said, “Rachel, we all know you can’t be bought!”
Nutritional & naturopathic medicine is an exciting dynamic field that is growing its evidence base every day but we need to be vigilant about our sources of information, their credibility etc. I know that what motivates me the most to share what I know is the desperate need for independent voices, free from commercial bias that can help us move our medicine forward on solid ground. (more…)
Psssssssssssst….just thought I would share a special moment from a couple of weeks ago when I received the BIMA for Lecturer of the Year.
Thanks to all those practitioners who nominated me for Lecturer, Nutritionist & Researcher of the year! It was really special to be acknowledged in this way for my role in education. I am so grateful to have had the support of so many throughout my career – from my own exceptional teachers, Sue Evans, Assunta Hunter, Gill Stannard, Helen Margulies, Fay Paxton, and most influential of all, Dr. Tini Gruner, right through to all the fabulous practitioners that I have the privilege to mentor (and secretly learn from at the same time 😉 ) (more…)
There are many different potential sources of satisfaction that come from working in integrative health. The first that comes to most of our minds of course is the deep satisfaction that comes with solving a complex health riddle for someone and knowing that you have helped to change their health trajectory – sometimes for ever. That’s an extraordinary role we can play. I carry many of these patients’ stories with me, very close to my heart, they give me hope and encouragement and light in the dark.
I know this isn’t the only thing that triggers a sense of achievement though. Sometimes there is deep gratificaton in strange places.
Like when a patient comes to see you & you tell them they’re in the wrong place. (more…)
I keep hearing the name, ‘Molly’: “I think I’ll use ‘Molly’ for this patient” or “A bit of ‘Molly’ might go well with the zinc for their high copper”... a moment of confusion on my behalf, (Molly who?) and then the slightly late…’ooooooooh Molybdenum’. Gotta love a trace mineral that is having it’s heyday…right?…right?
There are often jokes made about how little time medical degrees dedicate to teaching nutrition in general – was it 1 lecture or 3? – but let’s be honest, who among any of us really knows the ins and outs of this transition metal. I reckon we spent maybe 15 mins in my undergraduate on it and that was BC (Before Computers!) so I am guessing that 15mins has expanded about a gooooooogle times and we’ve come to a more comprehensive perspective. What do we need to update on? (more…)
Recently, I posted about my very positive experience of the AIMA NZ conference, prior to that I was gabbing on about the upcoming ACNEM Brain Health conference in Melbourne in May and now I am going for the conference hat trick! I want to revisit a really impacting lecture for me at last year’s Australasian Society of Lifestyle Medicine (ASLM) conference, delivered by the Emeritus Professor Mark L. Wahlqvist AO, BMedSc, MBBS, MD (Adelaide), MD (Uppsala), on the relationship between ecology and human health.
Why did I find his talk so impacting? Why should every integrative practitioner take the time to watch this? (more…)
Just back from a truly wonderful Australasian Integrative Medical Association (AIMA) conference in NZ. I don’t know what it is about the land of the long white cloud but they seem to produce some of the loveliest, most earnest health practitioners and this conference reflects this, setting itself apart each year as a result of its very organic mix of speakers (general practitioners, naturopaths, nurses, specialists) who are all equally embraced and lauded. To boot we had medical students invited to attend this year and guess what, these 20 or so med students…they stayed for the full weekend much to everyone’s surprise(!), loved it and want more. Really. At the AIMA NZ conference, on the two occasions I have spoken, I feel a sense of coming home…no I don’t mean I am about to move there (too cold!!) but I mean coming home to integrative medicine. (more…)
Duck duck GOOSE! Do you know this game? That’s how I’m feeling with oestrogen – high-high-high-LOW!-of late. Likely similar to your experience, the majority of my female clients battle with oestrogen dominance, therefore I get so used to looking for it, expecting it: the high Cu, the profoundly elevated SHBG, maybe a raised ESR. So much so that sometimes the low ones can catch you out, especially of course when it happens in women way way before menopause.
We’re so resolved to hear bad press about oestrogen and to be armed ready to saturate our patients with broccoli extracts of the highest order – do we remember the clinical features and markers of an oestrogen deficit and know what to do with those women who simply don’t have enough? (more…)
Got any patients on Natural Thyroid Extracts (NTE)? Me too…and I am finding it’s on the increase. What’s the deal? What do we need to understand about this form of thyroid replacement therapy to best monitor and manage those patients already on it or contemplating taking it? Does it really offer advantages to all hypothyroid patients or just to a subset of those and how would we recognise these people who might benefit the most?
NTE are marketed as being superior to synthetic thyroxine primarily based on the fact that they provide the patient with some T3 as well as T4 and in addition to that, being extracts of pig thyroid glands, there are other thyroid and iodine based actives e.g. mono and diiodotyrosine, present in the extracts. So in essence this is giving us more iodine and more of the other ingredients we need to make our own thyroid hormones. Based on this, many proponents of NTE say this is a major advantage over synthetic thyroxine replacement because it is more ‘holistic’ and it supports the patient’s gland in its own hormonogenesis. (more…)