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As an add on to my recent blog, I thought you might find this other detail about prolactin levels (PRL) interesting.  Several studies including a one published in 2009, have demonstrated a positive correlation between PRL and increased CVD risk in both men and menopausal women.  This correlation, which is believed to be the result of PRL’s vasoconstrictive effects, was evident while PRL levels remained well within range!

Women in early menopause with a PRL level just > 170 mIU/L (or 12.6 ng/mL) had 100% sensitivity in predicting a high peripheral blood pressure.

These researchers concluded that “Prolactin may play a role in accelerated arteriosclerosis in early menopause by affecting central/peripheral blood pressure and arterial stiffness.”  Similarly an earlier study in men, again found PRL in the slightly upper end of a ‘normal’ range correlated with increased blood pressure and hypertension rates.

So keeping an eye on PRL levels may also be a good inclusion in CVD risk monitoring and again, lowering even slight elevations, could prove highly beneficial according to the study by Sowers et al 1981.  Good food for thought perhaps.

It’s Friday…I thought you might need some reading matter for the weekend 🙂

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Back a few weeks ago I had the pleasure of presenting at the Integria Symposium and the even greater pleasure of listening to some of the fabulous speakers …you see I’ve heard my stuff before! 😉 The ‘Mosaic of Autoimmunity’ was delivered by the very funny and knowledgeable Professor Yehuda Shoenfeld, who reiterated the sequence of events now well recognised to precede and precipitate autoimmunity: genetic susceptibility + endocrine context + environmental trigger –>autoimmunity.

Clinicians know that overwhelmingly women dominate when it comes to autoimmune disease epidemiology and most understand that this is a consequence of oestrogen’s immunostimulatory effects.  Professor Shoenfeld, described the female, or E2 dominant, immune system as being ‘super charged’ and that increased rates of autoimmune diseases were a reflection of this. Sometimes practitioners do initially great work with a/immune clients – clearing up the diet & gut, ensuring vitamin D adequacy etc and then get ‘stuck’ or plateau with antibody levels that ‘won’t budge’.  Going back and checking the hormonal contribution in the case is often indicated. If the patient has an unhealthy E2 dominance and /or impaired detoxification and clearance of this hormone then working on this aspect often kickstarts the next stage of improvement.

A new thing to me (I know I’m a bit slow sometimes 🙁 )  was his mention of the potential link also with high prolactin (PRL).  The literature on this is extensive and hyperprolactinemia (HPRL), even just mild elevations, have been correlated with a very long list of both systemic and organ specific diseases including: (more…)

untitled-design-7While I am a sponge for new information I do have my moments… delusional moments when I think, ‘I am done learning’. These are usually very short lived, maybe an hour, half a day?  Inevitably, patients and the practitioners I have the honour of mentoring snap me out of that complacency real fast.

In the mentoring sessions I run, I am surrounded by like-minded beings: passionate practitioners (naturopaths, GPs, psychologists, physios), who challenge themselves every day to learn more & grow more in order to help more…of the people who walk through their door.  

And guess what?  That means that I have to keep learning and growing too, so we can grow together. Based on this incredible growth in knowledge and confidence I have witnessed in my group mentees this year and over the past 4 years, I’m excited to be opening up applications for 2017 group mentoring right now!

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explosionDoes your brain feel like it’s going to explode, spilling brain-juice everywhere, when you do 2 weekend conferences in a row? Or is that just me?  I have returned to my desk after the Integria Symposium and then the Australasian Society of Lifestyle Medicine conferences with ants in my pants.  I can barely sit still.  No caffeine required.  

Right now I want to talk ASLM because it’s fresh in my mind from the weekend but geez where to start?  I was testing the water going to this one.  What would a conference about ‘Lifestyle Medicine’ pitched primarily at doctors look like? Would it be a bit light? Would it be token lip service to CAM with no recognition of the need to also make a paradigm shift?  Well strap yourselves in guys because what I heard from their outstanding keynote speakers (Mark Wahlqvist, Michael Berk, Bob Brown…yes you heard right..I said Bob Brown!) were some of the most holistic naturopathic teaching points about individual, population and global health that I have heard in a long time.  These 3 speakers in particular were mesmerising – to naturopaths (yes there were a smattering of nats there) as well as to GPs, specialists and other attending allied health professionals (more…)

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Most practitioners are pretty knowledgeable about Zinc and are quick to recognise a deficiency and the opportunities for zinc supplementation as an effective therapy and those same practitioners are often plagued by nagging questions that come up, in spite of loads of clinical experience, like:

  • Are plasma and serum zinc levels interchangeable?
  • What does zinc adequacy look like?  Is it just a single number on a page or do we always have to factor in copper levels and get the ratio right as well?
  • What can I expect from zinc supplementation in terms of changes to the patient’s plasma zinc?
  • What should I do when a patient’s zinc marker is refractory to the intervention?
  • Is there really a significant difference between the different supplemental forms available?

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japanese-garden-437289_960_720Probably not news to anyone but I tend towards busy then bust!  If I lived in the pages of a Vogue Living magazine, I would of course have a stunning Japanese water feature located somewhere centrally in my work space & abode to antidote this very Western madness but alas… instead what I have is one very slow water filter tap!!

I can hear  my disgruntled kids filling their water bottles everyday, exclaiming loudly about how slow the tap is, finding clever ways to prop up their bottles at precarious angles underneath it so they can continue to multi-task in the midst of the morning rush.  In sharp contrast, I find that the long full 2 minutes it takes me to refill my glass at the sink, offers an unexpected oasis, 2 minutes of stillness, a cognitive break in the broadcast in an otherwise frantic schedule.

I like to just stand and wait.   (more…)

 

While the positive ripple effect of the ANS is still being felt (and – yes the video package is just about to be released, so prepare for another big ripple!!), there is another inaugural education event trailing hot on its heels!  Hopefully you’ve already heard about the conference being run by the Australasian Society of Lifestyle Medicine in Melbourne in a few weeks.  The subtitle of this conference is, ‘It’s time for change: reframing medicine, clinical practice and health policy’ and offers an extraordinary eclectic mix of speakers and topics including: (more…)

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I became interested in working in mental health not entirely of my own free will.  I guess you could say, it had made it’s way into my world via family members and friends as well as my own problems when I was younger. So when I was at uni and I came across any information about mental illness, whether it was pathology or prescription, it was when I undoubtedly resonated most strongly with what I was learning. I’ve had some great opportunities throughout my career to feed my interest, met some wonderful mentors and some other powerful teachers who were often my patients. It’s now become a running joke among my teenage children that all my friends are either psychologists or have some sort of mental health diagnosis, ‘…and what does that say about you?’ they love to add teasingly.  Well it says a lot probably: that I enjoy people who are comfortable talking about the psychology of our lives and ourselves, that I deeply appreciate that to be human is to suffer and we all suffer it’s just a question of degrees and the bravest of us share that with others.  Lastly, I think it tells you that I live in the real world with real people 🙂 (more…)

 

As an organiser of the Australian Naturopathic Summit I wasn’t immune to the content.  In fact, like so many other practitioners we keep hearing from, I think I am forever changed…and that’s not just my adrenals talking!!  All the speakers’ insights continue to gestate in my brain. Suddenly with running narratives from Leah, Jason, Charmaine, Cyndi etc. my head and my workspace seem to be not such lonely places.  This sense of a community that we could all take home with us, is just as we had hoped for.

One voice that frequently pops up in my personal post summit narrative is that of Charmaine Dennis (co-founder of The Fertile Ground Health Group), who so eloquently talked about the business of being a naturopath (or any other integrative health professional).  She suggested that the health bloggers are currently being more effective at attracting and holding the attention of the general public than us qualified praccies and proposed that this results from bloggers being clear and able to communicate their ‘WHY’ in contrast to the majority of professionals who are stuck on focussing and promoting their  ‘WHAT’. (more…)

bonesRecently, while I was touring around the country talking all things Acid Base (!), I spent a bit of time talking to practitioners about the limitations of our current protocols and assessment tools for detecting ‘Bad Bones’.  I was surrounded by a sea of nodding heads and when I offered a solution in the form of additional bone health markers, I could see light bulbs going on all over the room 🙂

 We all appreciate that osteoporosis develops over a lifetime not overnight, yet the current screening recommendation in most countries suggests that women at the ripe old age of > 65yrs and men >70yrs undergo their FIRST (!) BMD scan!  The only exception to this rule is that they recommend an earlier scan in those individuals at high risk…ahem….does anyone here not have their hand up??   (more…)

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Anyone who knows me will tell you that unlike many praccies, I don’t double as Food Diva.  I cook yes…in abundance and I have been told on may occasions my food is ‘delish’ and no one leaves hungry but I focus my energy on preparing food that is super easy, highly nutritious and can feed masses fast!  I have little interest or time for cleaning up, sometimes let alone plating up (or even touching up this pic to delete the mess)!

Some people are naturally gifted in the kitchen. My mum and sister have the gift…the Food Diva gene I may have inherited must have a SNP! In particular, I abhor the whole Masterchef culture – where cooking has never been made to look so difficult and so out of reach of the mere mortal.  I know this issue can divide a room, many believe passionately that these are gifted individuals who use cooking as art etc.  I am on the side of ‘get over it people…make edible food easier!’  Sorry 😉 (more…)

mountain-biking-1268276_960_720The structure of the recent, wonderfully received, Australian Naturopathic Summit came to me when I was riding my bike along one of the beautiful back roads of Mullumbimby, freewheeling downhill in the glorious sunshine.  Like the cartoons, the format of the ANS simply appeared like a light bulb above my head.  

I had been feeling dissatisfied with the education being offered Australian naturopaths for some time and I liked the idea of a new wave of education and professional community building but my thoughts hadn’t progressed or crystallized any further. I was still stuck focusing on the problem. (more…)

detective-156647_960_720I like to fancy myself as a bit of Supplement Sleuth!  I love working with herbs, nutrients and nutraceuticals rather than pharmaceuticals but I am not blinded to the fact that manufacturers and suppliers, whatever their form of medicine, are large competitive businesses that ultimately need to sell product and want to sell more.  Often practitioners & patients are surprised when I say things like, ‘It’s vitamin C not something sophisticated – go buy something cheap as long as it ticks these boxes…”.  In contrast, there are some nutrients and nutraceuticals at the other end of the spectrum, that evoke my compete attention around form, delivery method etc. and I would never send my patient out the door to get these anywhere else.

A few times recently, I’ve been asked by praccies, ‘What’s the deal with CoQ10 and ubiquinol V ubiquinone/ubidecarenone forms?’ and I can hear in their tone that they posses a healthy skepticism when being sold the latest and greatest supplement! ‘Should all my patients be using the ubiquinol form or just some?’, ‘Is it really worth the premium price?’.  Great questions all of them 🙂 (more…)

 

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Fresh faced students, new graduates and seasoned practitioners alike, are forever reminding me of the challenge we experience as practitioners when it comes to instigating real change in our patients health related behaviours … the change we KNOW will make a difference to their health and wellbeing.  ‘If only they actually listened to us!?!’ has been screamed by the novice and seasoned practitioner alike. With an overwhelming desire to share our wealth of knowledge, the discovery that information ≠ change can lead us to despair at times.

In a recent interview with Dr. Azita Moradi (Consultant Psychiatrist) as part of our Access the Experts webinar series, I was quite surprised (and pleased) to hear that Azita sometimes spends a whole session with a patient discussing the possibility of change, before even touching on the reality of change. Azita’s discussion surrounding the neuroscience of change and the challenges this may pose in the therapeutic relationship was fascinating, and certainly resonated with the practitioners taking part in the webinar.  Azita’s interview was full of clinical gems reminding us that just as in other settings, if we give a man a fish he eats today but if we teach a man to fish we feed him for life.  Hand and in hand with this, we need to have a strong understanding and appreciation of how to engage clients in making positive changes to their lives, often when it seems most difficult to do, such as in mental health patients.

Knowing how to improve behavioural change in patients generally, is integral to everyday practice, and its value cannot be underestimated. (more…)

microbe-1279146_960_720All health professionals are aware of increasing resistance in bacteria as a result of our overuse of broad spectrum antibiotics in both prescriptions and our livestock industry but increasingly we’re hearing about evidence of resistance in microbes of a variety of flavours – take the recent report on head lice that featured in the national news just this week.   I am also frequently hearing from mentees about patients being affected by bugs that traditionally have been relatively easy to resolve e.g. helminths, candida spp, tinea spp, that are proving in some clients very hard to budge!  A praccie  said to me just yesterday, when discussing a patient with recurring resistant oral thrush who was otherwise young, fit and well (!) – ‘Is it possible that these pathogens are actually getting harder to treat.’?..Absolutely! (more…)

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Cheesy I know! 😉  However, recently the issue of knowing when to use Withania somnifera & when not to, came up again in mentoring so I thought it’s probably a good one to share.  Withania, aka Aswagandha or Indian Ginseng, has become a favourite adaptogenic prescription for many practitioners, myself included.  I remember learning specifically (about a million years ago!!) that this herb is ‘warming’ & ‘nourishing’, thanks in part to its iron content. In a traditional medicine context, it’s used for those particularly vulnerable populations such as children, the pregnant, the elderly and the malnourished, boiled in milk as a tonic.  These ideas always stayed with me, and lead me to only use Withania in similar patients and presentations with good results. (more…)

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I’ve always been a bit of a fan of Vitamin A but this has grown again in the last year or so, having seen some great responses to short term high dose treatment during active infections or when trying to break a cycle of chronic reinfection.  For me, and I think probably for others as well, I previously would get a bit twitchy around even briefly exceeding the UL (upper tolerable limit) for retinol  as set by the NHMRC.  This was because the potential toxicity of vitamin A, especially for certain vulnerable populations such as children, pregnant women and individuals with liver disease, had been burnt into my brain during my undergraduate training.  

As a result, I think many of us have become over-concerned about risks associated with Vitamin A therapy and need to refresh our perspective about the difference between long term high intake above the UL, which does have established risks, and short term equally high doses with have enormous therapeutic potential and extremely low risks if we exclude the most vulnerable patient groups.

We don’t have to look too far for support of this idea, with numerous RCTs employing 5000IU per day ‘until discharge’  to young children inflicted with measles to successfully reduce morbidity and mortality or whopping one off doses of 200,000 IU to treat  recurrent urinary tract infections in adults etc.

Of course the therapeutic potential of vitamin A is not limited to an immune one, but it does star in this role. The first identified feature of a vitamin A deficiency was an increased susceptibility to infections and compromised ability to resolve these, regardless of the microbial origin.  How often do we see this picture?  Frequently…and while our first reflex might be zinc (as of course my bias was for a long time), more often now I am looking for evidence of concurrent or even stand alone suboptimal vitamin A  that may also explain this.

In terms of being forgotten, I think many of us need a quick reminder also about the limited distribution of retinol in our diets and that the common exclusion of dairy foods, reduces this further down to a very small handful of foods with any significant amount. 

This means that a decent bunch of our patients are going to be at risk of suboptimal vitamin A.  Why can’t carotenoids or  foods rich in provitamin A always fill this gap?…well you might have to listen to the latest Update in Under 30 to find out! 😉

Vitamin A deficiency is more common than you think and understanding the reasons behind suboptimal intake & status help us to identify those of our patients most at risk.  In terms of therapeutic potential, acute high dose retinol supplementation can produce dramatic resolution of infections or break the cycle of recurrent infections in immune compromised individuals. For many clinicians, however, retinol has either been forgotten or become feared due to its toxicity profile.  This Update in Under 30 recording, sharpens our focus around not only recognising those who need it but also how to use retinol effectively without the risks.

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I think most of us visualise the clearly malnourished young woman, when we think of eating disorders however, while anorexia nervosa is something to be on the watch for, our patients are presenting increasingly with more unusual, atypical patterns of disordered eating, that are easier to miss.  Some of you for example, will be familiar with the term ‘orthorexia’ which is an emerging diagnosis characterised by an obsessional approach to only eating those foods deemed by the individual as healthy, ‘pure’, ‘good’.  Gluten-, Dairy-, Soy-, Grain-,  FODMAP-, Sugar free organic cookie anyone?

Are we likely to see people afflicted with this…absolutely!  As practitioners who deal extensively in food and health related behaviours we are really sitting in the hot seat when it comes to eating disorders – likely to see more of these clients than many other practitioners and also walking a fine line when giving restrictive dietary advice to patients, so as not to trigger this sort of unhealthy thinking. (more…)

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From the giddy holiday highs to the lows!  As you know we kicked off these school holidays with a birthday celebration at Stradbroke Island…time travel forward just a short distance to the end of school holidays and you’ll find us we’ve now taken up residence in the paediatric ward of a local major hospital!  Because mucking around with mates and a soccer ball is as worthy way as any apparently to break your tibia AND fibula! Yep! Teenage Boys!!!

Anyway.  We’ve been through the heart fluttering dash to emergency, the bone chilling reduction in A&E, the prep for theatre, the truly jaw dropping…’I can’t believe this is how our Friday night turned out, now I’m sleeping on a chair fully clothed in a kids’ ward listening to my precious boy cry out in unmedicatable pain’ (yes apparently his break defied standard pain relief!). (more…)

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The understanding that certain infections produce mental health presentations is not a new one. However, based in part on observations of some of the features of tick borne diseases (TBD) such as Lyme like illness, a reawakening of the role for infection in psychiatry is underway.

‘Microbial madness’ is not limited to TBD. There is a large body of evidence linking a long list of pathogens to possible mental ill health. Our role then is to be able to quickly recognise the clinical course and the blood markers that flag this as a possible driver then support the body in its attempts to resolve, not just the infection, but the unchecked inflammation secondary to this.

 Ever had a patient where all the arrows point to a microbial burden but you can’t find or name the little blighter!? I have.

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