It’s no secret I am in the midst of some serious deep-diving through the micronutrient evidence base & at a depth of about 30 metres I struck Boron! Don’t yawn! I saw that. Thinking, ‘boring’, when we hear, ‘Boron’, is almost as bankable as watching everyone reach for their water bottles when you mention anything hydration-related 🤣 But I am here to restore your positive regard for this mineral and remediate its bad (& boring) rep! In preparation for the Nutrient Prescriber’s Program we started each nutrient review with the seminal contemporary nutritional texts and then launched ourselves headlong into the latest & greatest research. By the end of all the Boron bits in all my trusty texts the yawn was not gorn! But the moment I started reading the research I was like, ‘Are we even talking about the same thing?!’Turns out we’re not 😵🤦♀️
You see Boron has been a longstanding victim of identity theft. What we’ve been lead to believe is Boron is weed-killer and ant-poison and look it does give us some of the benefits of Boron but not all. And it possess a pharmacokinetic & toxicity profile that naturally occurring Boron simply does not.
Who decided that the Boron that is ubiquitous in our environment but almost exclusively consumed by us only after biotransformation by plants – could just skip that last bit and still be safe and optimally beneficial?! Probably the same guy that came up with folic acid, may I suggest? Anyway, enough is enough. We all need to relearn Boron – naturally occurring Boron – in the form of Sugar Borate Esters (SBE)- the evidence of benefits for which will blow all of our little minds! Well it certainly blew mine! Looks like this natural form of Boron is going to hit the Australian market in the not-too-distant-future 🐦 can’t wait to see which supplier is sufficiently progressive and research-aware that they bring this to market, having been available as a high grade supplement, employed in numerous RCTS OS for some time. But this little Update in Under 30 is not waiting around for that release date – there is much to be gained from SBEs right now – so make some noise as the real Boron at last takes the stage!🎤
Boron has been the victim of longstanding identity theft and we unknowingly have been interacting with its imposter. Contrary to everything you’ve ever been told about this mineral, naturally occurring Boron is full to overflowing with benefits for our gut, our bones, our brain, our management of other minerals and is safe in large quantities. That ‘bad guy Boron’ you were introduced to and is still present in many of your supplements is a form we never consume in food…and therein lies a world of difference! Come meet the real Boron so you and your patients can get the real benefits!
You can purchase The Boron Deception: How We’ve Been Fooledhere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Still. And yes – like you – I don’t see any slowing down any time soon in this extraordinary paradigm shift occurring in medicine and health. Which for us humans involves one humbling discovery after another.
Here we were thinking we made our dietary choices from a place of free will & individual preferences 🤣🦠
Thinking those microscopic mates, were making those B vitamins, and SCFAs and and and…for us & our benefit 🤣🤣🦠🦠
And while there’s a lotta love going on between our microbes and our micronutrients – in both directions – Pat Benatar said it best, “Love is a battlefield”
(sorry but I feel compelled to insert a link here for the youngsters – you’re welcome 😉)
The tussle over who gets to access those nutrients that are actually essential to both of us (the hostage and the microbiota) is an absolute turf war, peeps, and this battleground has seen some bloodshed! The new new question being raised is how the prescribing of nutrients, especially at the higher doses we tend to use, trickles down to influence and impact those microorganisms who reside in the bowel. Directly – as a selection pressure we have, likely unintentionally unknowingly, introduced. Which species do well when exposed to levels of a vitamin or a macro or trace mineral that are simply unobtainable in the diet? Yes – research answering these questions has begun in earnest revealing some positive ‘prebiotic-like actions’ of some but not of course for all nor in all scenarios. Want to learn more about this latest aspect we need to consider when formulating our nutrition prescriptions? You can either jump in and join us in the Nutrient Prescribers Program which kicks off next week to get across absolutely everything new in nutritional medicine or just dip your toe in here with our latest Update In Under 30: The Micronutrient Microbiota Universe
The world of health science went microbiota-mad a few turns back and there’s no sign of an end. Research continues to reveal the breadth of the GIT microbiota’s positive & negative reach, in particular, & with discovery upon discovery we’ve come to understand how often the microbiota are ‘managing us’. Both in terms of being integral to the success of our digestive, immunological, metabolic etc processes but also in a self-serving way, for example, directing our dietary preferences to satisfy their own needs. This has understandably prompted the question about the impact micronutrient supplementation is unintentionally having as a selection pressure on our gut microbes. Which bugs like which B vitamins when taken in excess of the amounts achievable in the diet? And which microbes flourish and which falter when we radically change their mineral exposure?
You can purchase The Micronutrient Microbiota Universehere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
I’m such a sucker for marketing!…ZoomZoom is from an old Australian car ad – an earworm clearly conveying ‘ the speed of something’, and let me tell you, totally fitting for this little Zinc tale I’m about to tell! Many years ago, I wrote a thesis on Zinc that necessitated me reading every research paper ever written (that’s how it felt anyway!🤪) on this trace mineral. Like everything in nutritional medicine, especially in the area of our burgeoning understanding of micronutrients, this is a highly dynamic space, so regular reviews of what’s new is essential and, since my thesis, part of my regular practice. Well, I just did my latest deep dive, and HELLOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO radical paradigm shift(s)…yep plural!
Zinc supplements should ideally be: Organic amino acid chelates Taken daily – due to the lack of Zinc stores in the body Taken fasting Taken in doses in excess of the RDI to compensate for the smaller % absorbed
Yep – nope. Or in true-blue Aussie: Yeah, nah. Can’t believe what you’re reading right now? Neither could I when I undertook this recent review but the studies are increasingly sophisticated and the resultant paradigm shifts are being echoed, reiterated & reinforced. And these have, in turn, challenged all those old ‘norms’ about how best to administer zinc for those patients with a shortfall. If you’d like to take this little journey for yourself…I suggest you start here! I immediately changed how I take it myself and now my mission is to both spread the word and get us all reflecting and reviewing our prescribing principles around Zinc…and tbh, around all micronutrients! After spending my ‘summer’ doing sufficient reading for a second thesis on everything new in micronutrients…I am armed and dangerously prepared for our upcoming *NEW* program: The Nutrient Prescriber’s Program which kicks off in late Feb for 5 months.
I truly believe that based on all this new information, we can now get so much more out of our medicines.
Nutrition represents such an extraordinary set of tools for us to work with, but it’s time to sharpen those tools in terms of how we apply them!
The Changing Zeitgeist Of Zinc Prescribing
Zinc research is a highly dynamic field and given its relative recency of discovery as being essential to humans, we’re still in the early days of truly getting to know this mineral. In just the last few years, enormous gaps have been filled-in regarding its regulation and roles that look to radically change our prescribing practices. Tune in to this essential update for some serious food for thought about doses and dosing frequency.
You can purchase The Changing Zeitgeist Of Zinc Prescribinghere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Heck yeah. It’s going to take a lot more than 1 push-back post to turn this ship around! Likewise, I was only getting started with my recent Update in Under 30 episode, ‘What’s Hiding Behind Histamine’ 🤓😂 & part 2 has just been released where we unpack the case of a 41yo female with chronic diarrhoea, multiple food reactions, very high stress and very high oestrogen. Sounds like she’s a walking Histamine Headline – except she isn’t.
Right now we really do need to keep this conversation going such that a healthy discourse can help us deconstruct the histamine dogma.
I know I’m showing my age here, but anyone remember when Candida was having a ‘moment in the 90s? Ok, so that ‘moment’ stretched to over a decade of a ‘Candida-contagion’. No one could eat melons or mushrooms, eat ferments or feel joy. It was a bleak time that did our profession some reputational damage. Not only because seeing an ‘alternative practitioner’ became synonymous with being put on an unbearable, unattainable restrictive diet and positioned practitioners as peddlers of punishment but also because it took some time for science, in the form of accessible (& always improving) assessment methods, to come along and save us from the folly of the 1-diagnosis-for-all mentality.
Let me ask you, how many times do you actually see Candida overgrowth on reports from stool testing performed using best practice modern methods?
In my experience – never – not as a stand-alone issue. Occasionally, as part of the overgrowth of a suite of opportunistic organisms where the real-take home is the need to ‘remove the opportunity’ via the promotion of more good guys. So not only was the diagnosis incorrect, the proposed treatment for it was a complete misdirection as well.
Can’t help thinking in the current climate of Histamine Hysteria that history is repeating itself.
How will we all individually, and as a profession, respond this time?
In this follow-up episode we observe how the 3 key elements often hiding behind a histamine intolerance diagnosis: Misunderstandings, Missed Messages & the potential for Mistaken Identity, have played out in the case of a 41yo female who presents with chronic diarrhoea, a long list of problem foods including now a suspicion of ‘histamine foods’. Rachel offers up new ways to approach the patient work-up that cut through the ‘noise’ and enable us to better identify what is hiding behind histamine in similar cases of marked gut dysfunction.
You can purchase What’s Hiding Behind Histamine? – Part 2here. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
You’re invited to attend acnem’s 2023 Annual Conference ‘Long COVID, Navigating the Complexity, A Clinician’s Roadmap’.
Saturday 29th & Sunday 30th July 2023, Melbourne. Both face-to-face and online.
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I can barely bring myself to write the word given how overused it has been of late 🤐🙄😯😕🙃 But I gotta say something! If we have found ourselves currently in a place where every second (or indeed single!) patient has a ‘histamine issue’ then I am afraid that it is we, that have an issue. (more…)
“My 7yo daughter was frequently distressed, telling me she had that ‘throat feeling’.”
As you can imagine, mum offered up a smorgasbord of suggestions to help her try and describe it: Can you swallow ok? Does it burn or taste funny? Where is it? Is it hard, soft, moving, give me a rating out of ten….so many, but she just couldn’t. When it was really bad, her daughter said she also felt it in her sternum. The first doctor attributed it to ‘stress’ & mum understood why. Her 7yo is a bit of a worrier and while the ‘throat feeling’ was distressing, stress, itself, seemed to also perhaps bring this on. But by the time they made an appointment with their regular family GP, mum had noticed her daughter’s sx were worse with heavy, fatty, high meat meals & that she was burping excessively especially with the night time meal also. So, when their switched-on doctor heard these very careful observations, he referred her for a urea breath test (UBT) for H.pylori.
‘Miss 7’ blew 1200 on the UBT the decision limit is 200, to confirm the presence of the bacteria in significant amounts
As I’ve said previously, there are (sadly for ‘Miss 7’ & myself) no prizes for the highest score on this particular test. In fact, I spoke with a gastroenterologist last week who said, really it remains so debateable about the significance of the overall result (?size or virulence of colony) that results should probably be more considered like a pregnancy test: a simple yes or no! But this together with her sx was a clear yes. GP recommended triple antibiotic therapy which sadly produced vomiting in Ms 7 within a few days. GP contacted paediatric gastroenterologists to get some advice, which was: don’t treat unless symptomatic. Back to square 1.
“In the meantime, I had done Rachel’s two UU30 episodes on H.pylori, so I told him what ‘we’ would do (polyphenols plus cranberry juice plus Zn carnosine plus deal with the hypochlorhydria). GP says. “Ok, then let’s do it and then let’s breath test again in 3-6 months.
She has now breath tested at 200 and symptoms are non existent!”
Mum contacts me to relay the success story & give me the credit but mum is completely minimising her extraordinary actions that produced this outcome. Firstly, not resting with the ‘stress’ diagnosis. I have seen several children who present in very similar ways to Miss 7, YES! they are anxious, YES! parents might tell you they are the ‘worrying-type’ but when combined with these upper GIT sx I have found they test positive for H pylori more often than they don’t. And how clever is this mother’s medicine?
“I recognised it was worst after birthday parties where she has eaten too much and done cartwheels or run around (we now talk about recognising when she has a ‘full bucket’. We talk about the fact that her tummy takes a little bit more time to process food it means her bucket fills and she needs a bit of extra time to let it do it’s job before she adds more food to the bucket otherwise it spills over and she feels rubbish. She finds that analogy useful as she can feel her bucket getting full at birthday parties and when she gets the feeling, she knows why and doesn’t freak out.”
H.pylori – Eradicate or Rehabilitate? For a bacteria identified just a few decades ago as being a cause of chronic gastritis, atrophic gastritis and gastric carcinoma, the escalation in the number of antibiotics used to eradicate it (4 at last count + PPI) has been nothing short of breath-taking. A management approach more consistent with both integrative medicine and with an improved understanding of the delicate microbiome focuses on changing the gastric environment to ‘remove the welcome mat’. What do we know about how to do this successfully? It turns out…quite a lot.
And it will. It knocked again on a practitioner’s door last week. She in turn knocked on mine. It turned out to be a very familiar story:
Firstly:Patient presents distressed – recently a nurse applied the term ‘Chronic Kidney Disease’ to HER (note no one has ever mentioned this diagnosis) Secondly:She is in stage 3 of 5 Then: This practitioner is left to have ‘the conversation’ but wants to know where to start, ‘What do I say?’ Next up:And what else can I do for her – are we really able to make a difference?
Familiar to you too? So,1st & 2nd: Yes, this is not uncommon we would have to say and even with age-appropriate reference range adjustment, her GFR consistently in the 50s, flags premature decline. Then: What DO you say? Well this clearly is a delicate area, not only because of the level of patient distress and concern but because, at this stage the practitioner knows nothing more than what the patient tells her and her ELFTs over the last 2 years. This is not enough information, right? Chronic Kidney Disease is a heterogeneous condition, with many different causes, manifestations, comorbid conditions, and factors affecting prognosis (Levey et al., 2009) So while most individuals certainly progress from stage I to II and II to III the rate at which they do this differs dramatically.
Two years of data is not long enough for us to appreciate the trajectory of her CKD & means we are unable to provide the patient with any kind of perspective:
‘With no further decline in GFR or progression in stages over 5 years, you’re doing well, so keep doing what you’re doing!’ Vs ‘Ok, I can see what looks like a little period of accelerated decline – let’s review what’s been happening and how we can turn this around”
“Please sir can I have some more?’ Yes, back to her primary carers to request more information to fill in the gaps, and ideally more labs to calculate & observe the trajectory for yourself. Next Up: What do we have to offer the patient with CKD stage III? Soooooooooooooooooooooooooooooooooo much!! When is adequate hydration helpful? Always, except Stage V! (and these patients are not coming to see us) What are our treatment objectives & our evidence backed medicines to meet these? Hcy lowering (note often referred to as ‘folate refractory’ in renal dx), vitamin D adequacy, lowering the acid load, supporting the microbiome & in turn the Renal-GIT axis…hang on, got to go…someone’s knocking 😅 but hopefully we all can see, when they present to us, they are indeed knocking on the right door ✊
Nutritional or naturopathic support for the kidneys tends to have been over-looked in our training and yet research suggests there is much in our tool kit that can make an enormous difference to this system, in particular, slowing the progression of chronic kidney disease in patients. Rachel talks about what these key evidence based interventions are and also gives you the tools to identify the early pathology markers of renal impairment – the earlier the recognition, the earlier we can make a start on the remedy.
It seems almost farcical to question the merits of hydration for our renal health but is this actually the truism we have been lead to believe? Where does the recommendation of ‘8 glasses a day’ come from and what is the level of evidence to support it and in whom? Or should we in fact be setting our sights on output ie. 24 hr urinary volume, over input. Do all kidneys love water – or does this relationship change with the progressive impairment seen in CKD which affects up to 30% of our middle-aged population? When does hydration become harassment?
Most practitioners graduated with not much more than a few ‘kidney’ herbs and an under-appreciation of the contribution renal health makes to wellbeing. It’s not just about waste and water. In reality, the kidneys are pivotal in just about every major element: blood, bones, pH balance, methylation, control of oxidative stress, the GIT microbiome and more! And we are seeing the impact of this in our patients in all sorts of subtle and not so subtle presentations. This new instalment in diagnostics, brings the renal system into the spotlight so we can confidently identify and better manage its critical contribution. In addition to this, just like with other routine labs such as LFTs, we unpack how these so-called ‘renal markers’ can flag a plethora of other insights into your patients, from reflecting (un)healthy muscle mass, to calculating individual dietary protein adequacy, from key ‘danger and distress’ signals in response to disturbed metabolism, oxidative stress to certain types of GIT dysbiosis! We call this Explained, Expanded and Exploded because these routine labs can deliver XXX sized insights into your patients.
Something’s just come up today again and I think we need to talk about it. A positive result on a stool PCR microbiome test for H. pylori, understandably, might be heard as a clear call to action to go in guns blazing with an eradication approach. But is it? Trust me, I’ve had more than my fair share of battles with this bug & can understand being keen to have it be gone BUT first things first, let’s be clear about what the result speaks to.
Does it say, “Here! Look over here! Here’s the source of your patient’s GIT distress,” or even, “Here’s a pathogen that has taken up residence in their GIT and is a risk for future dx!”
No, not necessarily. It speaks to its presence.
And that may be only fleetingly, as it passes through. I’ve seen it before and so have many other experienced practitioners: a positive stool PCR that is at odds with the results of gold standard H.pylori testing, the UBT, faecal antigens or blood serology, all freely available through the GP. And the reality is, if you have a negative UBT, there’s no urease production, the trademark trouble-making of this bug. If you have negative blood serology, your immune system has never ‘met’ this bug or, in the minority of cases, you’ve tested in that brief early exposure window prior to antibody production (2wks) so you should retest within the month, to confirm or refute. And if you don’t have any faecal antigen…it ain’t in da’ house…so to speak 😅 If there’s something new here, then have a quick read of Medscape’s great work-up summary. So, clearly we need to confirm before we open fire.
We (me included) have been so single-minded about increasing the ‘sensitivity’ with our testing methods, we may have left ‘specificity’, in broader sense, behind & that creates a new problem.
This leads us and the patient down the garden path of false attribution and time and money wasted ‘treating’ a ghost gut issue. And no one wants to be put on a pylori protocol when they really didn’t need to. Trust me 🙄 But if someone does come back confirmed, well then…
For a bacteria identified just a few decades ago as being a cause of chronic gastritis, atrophic gastritis and gastric carcinoma, the escalation of number of antibiotics used to eradicate it (4 at last count + PPI) has been nothing short of breath-taking. A management approach more consistent with both integrative medicine and with an improved understanding of the delicate microbiome focuses on changing the gastric environment to ‘remove the welcome mat’. What do we know about how to do this successfully? It turns out…quite a lot.
I say: Biotin, Broccoli Sprouts & Bone Broth You say….?
If you said: ‘Sulphur’, go directly to the top of the class, passing ‘Go’ & collecting $200 on your way!🤓 If you nervously said…”I don’t know, they all start with ‘B’ ?”, you are not alone. In fact, most integrative health professionals aren’t aware of the Sulphur Strategies they’re using, probably, everyday. But it’s time we all were.
How about this list? Glycosaminoglycans (GAGs for joint, gut etc tissue integrity), Cerebroside Sulphate (Myelin), Metallothionein, Glutathione, Hydrogen Sulphide (H2S), Co-Enzyme A, Lipoic acid, SAMe, are just some things Sulphur is essential for.
I could go on…and on and on. You see Sulphur, in spite of being an essential macromineral (adult dietary requirements > 1g per day) and critical to health, remains largely unseen. Often we don’t know when we’re writing patient prescriptions that actually we’re using a particular vehicle for Sulphur and therefore we’re also not able to discern which, of the very long list of options (dietary and supplements), makes the most sense in this patient at this time. We’re not to blame, not many ‘possess the power’ to see it, it seems. Por old essential, irreplaceable Sulphur doesn’t even have an RDI. But the time has come to take a good look. We need to know how patients are able to meet their needs, who needs more and how, very commonly, someone who is seemingly ‘consuming enough’ may still exhibit a functional Sulphur deficiency with poor musculoskeletal tissue integrity, low white cell replication capacity or higher oxidative stress load etc and in those who do have a shortfall, how to treat successfully & safely. Who needs a top down approach (more protein, methionine, cysteine, bone broth) and in whom would that be a risky path and using ‘downstream’ Sulphur products instead would be a better balance of pros and cons?
Because all Sulphur needs to be handled with care.
That’s right. Like other highly chemically reactive minerals, with reactivity comes risk – a great potency that requires careful consideration of both form and dose, so that we can harness this power for good not…well evil’s a bit strong…but how about, for not-good. I’m a bit of fan of Sulphur and using Sulphur strategies in my patients. I think it has interesting echoes with our past: the ‘healing’ waters of a Sulphur Spring and of course even further back the old ‘brimstone and treacle’ medicine of eons ago. This paper by Nimni in 2007: Are we getting enough sulfur in our diet? got me thinking about Sulphur again in a contemporary context, over a decade ago, I’ve done a lot more thinking, researching and prescribing since then but it seems that Sulphur still remains ‘unseen’ by most. But with the rise and rise and rise of popular Sulphur-based supplements (alpha lipoic acid, GSH, N-acetyl glucosamine, Brassica & Allium extracts and concentrates, N-acetyl-cysteine etc) I think it’s time to talk.
If you don’t have a clear picture of the gross daily requirements, determinants of altered individual needs, sources, regulation & associated deficiency picture of Sulphur, you’re not alone. Turns out this essential macromineral remains ‘unseen’ by most, even though you’re probably writing prescriptions everyday that have Sulphur as their key component. From the simple: Taurine, N-acetyl cysteine, Protein powders, to the sublime: Brassica extracts & concentrates, N-acetyl Glucosamine, Alpha Lipoic acid etc. In order to use these Sulphur strategies successfully and safely, however, we need to fill in the missing detail on its metabolism, the difference between the ‘organic’ and ‘inorganic pools’, how regulation regularly goes wrong, even in those seemingly consuming enough, and how to balance the risks of this reactive medicine with its substantial therapeutic value. This recording comes with a great clinical tool to help you at last see the Sulphur strategy most indicated for your patient.
The latest Update in Under 30 has landed!!!
You can purchase Unseen Sulphur – Time to Take a Lookhere.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.
When I deliver foundational nutrition training to GPs I talk tough. It’s a tough field, right? Compared with the relative certainty of pharmaceuticals, their established pharmacokinetics, their sophisticated delivery systems to ensure high bioavailability…trying to fix micronutrient deficiencies in patients can feel a lot like you’re trying to perform minor miracles. Take iron for something different, its homeostasis pivots on its tight regulation at the gut wall – and this is a wall that is very tight!! At best you get about 10% of a supplement taken up, at worst you get none and the harder you push & the higher you go with your dose…the lower the fractional uptake. Tough stuff, right?!
It’s about at this point in my talk I read their collective minds and say, “I know, you’re thinking, oral supplementation is for suckers – what about we bypass that road block and use IV?!” [Ok, I definitely use nicer words than this]
And then I put up a list of pros and cons about IV micronutrient repletion: ‘100% bioavailable’ & ‘Bypasses the body’s regulatory systems’, go on both! You see, time & time again we discover, when we think we’re outsmarting the body, it still manages to outsmart us. There are some exceptions to this – some nutrients (Vitamin C) and some contexts (late pregnancy iron deficiency) but the broader promise of ‘rapid replenishment’ for everyone, in your lunch break, via an IV infusion..is not realistic, responsible nor without risk. Don’t get me wrong, I am an advocate of appropriate IV Fe use and have encouraged a small fraction of my patients to take this path. However, given the dramatic rise in prescriptions for this since 2013, I think it’s time to stop and seriously review each element: In reality what does it achieve and in whom is it a responsible recommendation; Was a risk benefit analysis performed for & communicated to each individual & was the remaining risk mitigated?
Think anaphylaxis is the major concern? It might be the most lethal but there are more serious concerns due to higher incidence with newer preparations.
So, how well do you know your different IV iron forms, and their predilection for potential problems? And have your answers ready to all the questions raised above? In order for all involved to make an informed choice (both practitioners and patients), we must.
You’re welcome 😉 and hey welcome back to tough talkin’ Tuesday…
While rates of iron deficiency and related anaemia continue to grow, the increase in prescriptions of IV Fe have expanded exponentially in western countries. What is behind this change in practice regarding how we treat iron deficiency and does it match with responsible prescribing? Do the benefits always outweigh the risks? And while we’re on the topic, who is most likely to benefit and what are all the risks? In light of a current class action in the US, relating to a lesser talked about adverse event associated with IV Fe and recent complaints here in Australia against GPs, allegedly due to inadequate information to enable informed patient consent…it’s time to answer these questions and more. When is IV Fe a means of rescue and when is it a risky repletion strategy with no evidence of advantage?
I feel a bit Trumpy…because whenever someone says ‘N-acetyl cysteine’, I want to reply, “Big fan, I’m a big fan”. And yes that’s an uncomfortable awareness. But unlike he who shall not be mentioned, I can qualify my statement and provide supportive evidence, both of the research and real-world varieties. So, of course, can so many of you as well. I know of fertility specialists who place it in PCOS patients’ preconception prescriptions and respiratory specialists who regard it highly in COPD, CF and a range of other conditions. And I am a signed up supporter of its adjunctive use in many psychiatric conditions. Then there’s the biofilm-breaking buffs…
This is where non-believers might be tempted to call ‘Snake-oil!’
How can one very simple tricked-up amino acid possibly contribute to the health of so many systems? Oh, just via the chameleon qualities of its chemistry of course! As a rate limiting ingredient and precursor of GSH, as well as a potent mucolytic agent and and and…we get it. We surrender! But I want us all to back up here just a few steps. As a mucolytic agent…renowned for biofilm busting…hmmm. I prescribe a lot of NAC for a lot of people for a lot of days-weeks-months….because all the research in mental health points to it being a long-term intervention. I’ve heard Professor Michael Berk say, that patients still on it at 2 years had even more improvements than they had experienced at the 6 month mark and of course mental health, for most, is a chronic illness, so no one is surprised.
But we can’t contain its chameleon chemical qualities. Given orally, it will be having effects within the gut of these individuals on the way through…and not all biofilms should be busted, right?!
So what to do? Well thankfully, NAC is not something that patients rely on for short term acute effects, that would then make missing doses problematic – like pharmaceutical psychiatric medications, and some CAM options as well potentially, like SAMe and SJW. So a regular sNAC break is likely to be free from negative impact for those with mental health issues and in fact, beneficial long term. With all this in mind, we’re now using a dosing model of taking weekends off from this supplement – which works for most. Do we have any concrete research to say this makes sense and doesn’t compromise efficacy yet? Well no, and don’t hold your breath, because research can be very reductionistic (you heard it here first LOL) and there is a lack of consideration of the effects on an individual as a whole. The psych researchers are not measuring the impact of all interventions on the microbome of patients (yet!) and the gut researchers not always monitoring the mind. But we clinicians can pioneer the path, fuelled by two old buddies of mine: first do no harm & least medicine, best medicine, right?
Oh and has anyone managed to open a tub of NAC and not accidentally snort some?…I don’t have anything else to add or a solution, I am genuinely asking if this is humanly possible 😂
“There are few complementary medicines that come onto the market with such a bang, opening up genuinely new therapeutic options for the effective management of such a broad range of health complaints. N-acetyl cysteine stands out for this reason and has changed the way I practice” Rachel Arthur
Want to learn more about its diverse applications? Check this out
🍌‘I think I am, B2! It’s time to separate the B12 from the B*S#!’
Ok, if you’re reading this and you’re not from around here you have reasonable grounds to conclude I’m the one who’s gone 🍌 but if you grew up with a show all about 2 adults dressed up as bananas and creatively known as B1 and B2, then we’re all good! Ok now for the next bit, you might need to sit down. Nothing not everything in the wildly popular, and dare I say it populist, doco The Game Changers was scientifically rigorous. I know, I’m loving the strike through a little too much today.
Goodness, when otherwise intelligent friends of mine forced me to watch this, they found the need for both restraints and duct tape over my mouth, to hear or see anything other than me jumping up and down, arms flapping, mouth yapping. People only tend to make this mistake with me once.
Among the many many dubious XXX was a terrible mis-truth about our ‘new modern reliance on animal food or supplements for B12’. Woah…back up there Game Changers Gang, say what?! Does anyone on their research team read any research? So that got me all motivated to go back to the books on our beloved B12, which is simply like no other micronutrient in human physiology or in nature, for many reasons…starting with 1) it contains a metal in the middle 2) it has dietary dopplegangers (plant forms that look just like it but actually are decoys that need to be actively removed from the body so as not to block its actions) and 3) has the most complex and sophisticated pathway for digestion and absorption, which surprising equates to brilliant average bioavailability (much better than most micronutrients)…until it doesn’t! And that’s when the trouble starts. Once you don’t have an intact IF absorption pathway, you’re down to picking up < 1% via simple diffusion, and suddenly we see why patients can be vulnerable to not meeting even the piddly required amount. Not to mention the vegans, of course.I’m on my best behaviour.
But the B*S#! about B12 is far from limited to the documentary. It’s in the words of the Methylation Mystics, making methylation sound like rocket science and in the supplements we’re being sold.
But don’t get me wrong…effective B12 treatment in the right patient is a total wow moment. I’ve literally seen all the lights go on⚡ in some . So what do we need to do to find our way out of the dark? Go back to the solid science. Come on. There’s nothing else you need to do and nowhere else you need to be… we all know it…so start by reading this and this. There’s plenty more of course but these are excellent appetisers. And if you want to cut to the chase and get the lowdown on what’s B*S#! versus what’s the real magic of B12, you can always settle in and listen to my latest Update in Under 30 – complete with a very cool clinical tool to help you choose the best B12 for each individual, but spoiler alert, it ain’t rocket science.🤫
B12 is a routinely under-rated and recognised micronutrient, which is in fact in high demand by many of our patients. As nutritional research pushes back against defining adequacy as simply the prevention of the deficiency-associated disease (macrocyctic anaemia, irreversible neurological damage) we enter a new landscape of more individualised approaches where we’re better able to recognise and treat those at risk of falling below ‘optimal’. But how do we accurately identify this and then choose the ‘best’ B12 (methyl- cyano- adenosyl- hyroxo-) supplement? Does it need to be this complex? Time to sort the B12 from the B*S#!! This recording comes with a bunch of great resources including a very handy clinical tool
The latest Update in Under 30 has landed!!!
You can purchase April’s episode, Separating the B12 from the B*S#! is here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
Have you been told somewhere by someone that the ‘perfect’ TSH is 1.5 mIU/L? This is a wonderful, terrible & wonderfully terrible example of ‘magical numbers medicine’. As a push-back against the published reference ranges we’re given, that are so wide you could drive a truck through them, there has been an over-correction by some, leading to the myth of ‘magic numbers’. We can narrow the reference range substantially for many parameters with good rationale, make no mistake about that but once we start setting ‘aspirational goals’ that are explicitly rigid…well we’ve done 2 things 1) forgotten about the patient to whom this result belongs and 2) disregarded viewing each result as part of a ‘pattern’, that we must piece together and make sense of.
Back to TSH then… if my obese patient had a value of 1.5 mIU/L this in fact would be woefully inadequate.
Also too low for any patient, no matter their size, if their T4 is low and we’d like a higher value as well for risk minimisation in our elderly clients too.
But the same result would be excessively & worringly high in my patient who’s undergone thyroidectomy.
Being given a list of ‘magic numbers’ will never replace learning labs correctly. When we do this, we come to truly know that meaning can only be made of the markers when you can answer the following questions:
What is this (metabolite, analyte, binding agent, plasma protein etc)?
What do I know about its physiological and biochemical context – what is its role and regulation in the blood, what moves it and to what magnitude?
How have the reference ranges been determined for this lab – who am I comparing my patient to?
Therefore, what is the significance of a result that is: ‘normal’, ‘low normal’, ‘high normal’, below or above the range?
Does this value ‘fit’ with my patient?
What else could explain an unexpected result?
How strong is my level of evidence?
What do I need to do from here to confirm or refute this?
And a few more 😉
Realising the full value of any test result in terms of what it reveals about the person sitting in front of you, requires these skills. Unfortunately, in contrast a list of magic numbers will often lead you astray. And building your scientific knowledge about labs will not only help you avoid the pitfalls of pathology but will strengthen your pathophysiology prowess in surprising ways, saving your patients a packet in terms of additional extraneous testing and help you truly personalise your prescriptions…because the ‘invisible (biochemical individuality, oxidative stress, genetic probabilities, subclinical states, imbalanced or burdened processes etc) just became visible’. I started requesting lab results early in my career and years later was lucky enough to be taken under the wing of Dr. Tini Gruner. I found some of our shared notes, from 10 years ago, scribbled all over patient results recently and I was struck by just how lucky I was to have her encouragement to really pursue my interest and how she was a guiding force about learning to recognise pathology patterns over single parameters. A decade on I can confess, much of clinical and educative success has come off the back of this foundational skill-set and I know, this is true for so many I’ve taught too.
“The guidance I’ve received over the years from Rachel in relation to pathology interpretation has been one of the most valuable (and fascinating) investments I’ve made as a clinician. Her teachings have filled gaps in my knowledge base I never knew needed filling and have significantly enhanced my understanding of the inner workings of the body! Rachel has an incredible ability to make the numbers that patient’s so often present us with, both understandable and clinically meaningful. The knowledge I’ve gained by investing in this skillset has paid off in dividends and I’m certain will continue to do so into the future.”
Stacey Curcio – Cultivating Wellness
I hope you’ll join me for the most exciting up-skilling opportunity in learning labs yet. Oh…and all this talk about thyroid testing..that’s just a serving suggestion 😉 this year my MasterCourse is focused on the most routine labs of all: ELFTs, FBE, WCC, Lipid and Glucose Panels…an absolute treasure trove of free integrative health information about your patient!
This skillset has been found by many to be biggest ‘game-changer’ in Integrative Medicine!
There are limited places. To sign up for the MasterCourse: Comprehensive Diagnostics click here. For more information about the program click here.
This year I heard a great quote that hit the spot for me: anyone who offers you a simple solution to a complex problem is lying or misguided, the solution to a complex problem will inherently be complex. Dang! I’m frequently reminded of this in relation to many different aspects of working in integrative health. Or even just answering work-related questions socially. Random-friend-I-haven’t-met- yet, upon finding out I work in nutrition, asks: Is [insert any given food, beverage, macronutrient, micronutrient] good for you? In spite of over 20 years of this happening, I confess, the poker face still requires concentration.
The poker face is necessary of course to
a) conceal my amusement at how predictable humans are and
b) to cushion the blow for them as I tear down the delusion that real nutritional science is simple and can be served up in a soundbyte or
c) lie and infer that it is, just to get out of there faster!
But recently, I’ve had another reminder of that ‘in here’ rather than ‘out there’, about how even as practitioners we long for things to be simpler than they are. This month in mentoring I’ve been talking about the dark side of both zinc and Akkermansia muciniphila (I know wash my mouth out right?!) in neurological issues. What, but we had them on the good guys list?! Remember the answer to a complex problem (and human health surely owns this territory) will inherently be complex, right? Similarly, I’ve been digging deep in research about beta-glucuronidase, that enzyme that undoes our phase 2 detoxification of oestrogen, bilirubin and a long list of nasty xenobiotics, earning it the informal title of ‘bad ass biomarker’…scoundrel! And well, I’ve found some really nice things to say about it…like actually it extends the half life of most of our flavonoids such as quercetin, isoflavones etc etc and that’s a great thing for increasing their positive punch given that their rapid detoxification limits how much we can benefit from them. Turns out, like everything else, even dear old beta-glucuronidase exhibits light and shade.
How I ended up losing a weekend to such papers was because I was trying to resolve some burning questions about Ca-D-glucurate (CDG) that I’ve had for as long as I’ve been recommending it to people who arguably could benefit from a little less beta-glucuronidase activity.
My two most pressing ones were: How much is required to be effective & Where’s the evidence?
And that’s when the fight broke out [just in my head] You see every review I’ve read, every piece of product information too, repeats the mantra CDG 500mg TID but turns out this is based on…not much. More uncomfortable still, is that even our assumption that we can convert CDG into its active form has been strongly challenged. The new research, which is not the work from the 1990s that everyone cites, is a must read…or if you actually have a life, and other ways to spend a weekend then maybe just spend 30 mins with me in my Update in Under 30 this month 😂 I wanted to keep it simple and neat and tidy. I tried I promise. But in the end…wouldn’t you know it…it’s complex.
So to bring everyone up to speed, including myself!, I recorded an UU30 on…
The ABC of CDG We often identify patients who could do with a little glucuronidation first aid: marked dysbiosis, Gilbert’s syndrome, oestrogen excess, cancer risk (especially bowel, breast & prostate) and one of our nutritional go-to’s has typically been Calcium D Glucurate. While there is ample evidence that one of CDG’s metabolites : 1,4 GL – inhibits beta-glucuronidase, is an antioxidant, platelet activation inhibitor and generally all round good guy to have on board, new research strongly challenges that oral CDG will convert to this at levels sufficient to support our detoxification pathways. Sounds like we’re overdue for an update on this supplement and when and where it might be useful in addition to how to find the real deal in real food!
Did someone explain the kidneys are like a really important, not to be forgotten, under-estimated, ignored or under-valued kind of organ in your training as a naturopath?No, me neither. I mean I know Buchu and Uva and Zea (on a first name basis only, clearly!) and …no actually, I’m done. But seriously, it didn’t take too long in practice to stumble across a whole lot of bad when kidneys aren’t getting the attention they warrant and equally to develop a slight obsession with renal markers in all of my patients not just because of their incredible impact on whole health but also because of what ‘lay beneath’.
As you might suspect, I get sent labs all the time from practitioners. Stop no! That is not an invitation!
Often it’s client’s renal markers which I do appreciate because it tells me there is an increasing number of praccies that absolutely have done some post-grad DIY knowledge building about these bean-shaped babies and their critical contribution to health. The results might come with a question like, “What’s going on with their kidneys?!” [insert worried face emoji of choosing]
To which my reply is often… “not much but boy do we need to talk about your patient’s GIT microbiome! [or] mental health! [or] sarcopenia!”
Say what? Yes abnormalities within the renal markers: urea, creatinine and uric acid may be a reflection of renal issues. But if you know where each of these molecules enters the blood,exits the body and all the interesting good & bad they can get up to in between…then the patterns speak less (if at all in some instances) to what’s going down in the kidneys but instead give you an incredible insight into key issues all over the body: from the gut to the brain. But wait there’s more! Want to know what’s the latest and greatest in management of advanced renal disease? Treat the gut to lower the urea. What about managing mania? Add in a gout treatment to lower uric acid. Dang! This is holistic health at its best with those poor kidneys no longer being left out in the cold!
“Who knew urea, creatinine, GFR and uric acid could be such a Goldmine….Mind…officially…blown!” New Graduate Mentee 2019
Most practitioners graduated with not much more than a few ‘kidney’ herbs and an under-appreciation of the contribution renal health makes to wellbeing. It’s not just about waste and water. In reality, the kidneys are pivotal in just about every major element: blood, bones, pH balance, methylation, control of oxidative stress, the GIT microbiome and more! And we are seeing the impact of this in our patients in all sorts of subtle and not so subtle presentations. This new instalment in diagnostics, brings the renal system into the spotlight so we can confidently identify and better manage its critical contribution. In addition to this, just like with other routine labs such as LFTs, we unpack how these so-called ‘renal markers’ can flag a plethora of other insights into your patients, from reflecting (un)healthy muscle mass to calculating individual dietary protein adequacy, from key ‘danger and distress’ signals in response to disturbed metabolism, oxidative stress to certain types of GIT dysbiosis! We call this Renal Markers: Explained, Expanded and Exploded because these routine labs can deliver XXX sized insights into your patients.
How might your patients’ Nickel exposure wreak havoc with their health? What might that look like? It may be lurking behind labels like IBS, non-coeliac gluten sensitivity, contact dermatitis of unknown origin,(with or without alopecia) or even CFS. “Then how does Nickel, which can’t even claim fame as a heavy metal, manage such diverse detrimental effects’? I hear you ask. In 3 easy steps 1) exposure…we’re all exposed, Ni is ubiquitous in our soil, our food, our environment so don’t bother trying to run from it 2) it hits our gut where our microbiome and intestinal lining may constitute the first fallen soldiers 3) exposure to our immune system can lead to sensitisation, and the subsequent development of a hypersensitivity response to each following exposure …and at worst precipitation of an autoimmune process. You got all that?
So therein lies the big question: how can we help patients whose health problems stem from Noxious Nickel? We could run and hide…from our jewellery, our mobile phones, dental interventions, most food (!), but we’d be wasting our time…we’re surrounded!
As always, we go back to the science and we find others have done the work for us. Not google though. Google ‘low nickel diet’ and like ‘low oxalate diet’, you’re likely to get a whole heap of hogwash! How reassuring then that there is a validated dietary scoring tool to assist patients lower their dietary Nickel and that numerous other studies can show us the way in terms of use of mineral balancing strategies, probiotics etc. These resources plus more are all included in the latest Update in Under 30: Noxious Nickel part 2 as well as a discussion of what assessments we have available to confirm nickel as the culprit. But here’s something for free: hair nickel concentration (HTMA) is not by any means diagnostic in these cases, because it’s not necessarily about an issue of overall higher exposure it’s about an aberrant immune response to Nickel at any level. Just saying. You know me….not scared of controversy in the pursuit of improved patient outcomes. Ok a bit scared… 😁
In this instalment it’s time to get down and dirty and detailed about how to best identify those patients who may have Nickel related pathology and presentations. We cover testing options, typical systems affected from GIT to autoimmunity and the most extreme form: Systemic Nickel Allergy Syndrome. We outline Nickel management strategies in a world full of it (!) and we include several key papers for additional resources and support. How noxious is Nickel for some of your patients? Well by the end of this you’ll know and better still, know what to do once that’s established.
Hear all about it by listening to my latest Update in Under 30:
For all Update in Under 30 Subscribers, it’s now available in your online account and if you are not a subscriber you can purchase this individually here.
Ok here’s some tough Tuesday talk..not all tests are valid. Tougher still…not all of the mainstream nor the functional pathology ones. I am talking across the board here. Each and every pathology parameter requires good knowledge about its strengths. limitations and, one of my absolute favourite nemeses, confounders. “How on earth am I supposed to learn all that and everything else I have to know too?!!” I hear you scream at your screen. Btw keep yourself nice if you’re in public while you’re reading this 😉
But rather than imagining you need to have this level of knowledge for all tests, I would suggest you set yourself a hit list of the ones you rely on most, either in terms of frequency or in terms of the degree to which they direct your decisions about patient care…can I mention (ahem) Iron studies here perhaps for us all…but maybe you have a specialist area so you use a particular investigation routinely or at least frequently…
CDSAs? Breath tests for SIBO? Oxalates?
May I please then politely suggest that you get to know these inside and out? Not based purely on the information and assistance that the test provider provides you..but you scrutinise them independently. Top to bottom. Because that’s your business, right? And your diagnoses and treatment decisions are pivoting on these results. Jason Hawrelak gave us all some great examples, including his informal experiment of sending the same stool sample to multiple labs. Don’t know about this and his findings?? If you’re in the business of ordering stool tests, you need to. I am doing this all the time with numerous pathology markers because diagnostics is my passion (alright, obsession)…and recently I put Oxalate Assessment to the test and oh boy!
Here’s something for free:
If you are measuring urinary oxalates to diagnose oxalate overload in your patients and you, 1) are using a lab that does not preserve the urine as you collect it, using acidified containers or providing additional preservatives for take home testing kits….you are wasting your patients money and you are likely getting a lot of false positives, i.e. the result infers the patient has a problem when they don’t!!
And 2) if you are simply following the labs reference ranges for what ‘healthy’ urinary oxalates look like – you’re wasting your patients money again and likely getting false negatives – a failure to show a problem that is actually there! If you’re hunting oxalates…please ensure you have a current effective hunter’s licence…by getting up to speed fast regarding accurate investigation of this. Oh yes…it’s tough-talkin’-Tuesday and I’ve come out firing…watch out this may become a regular feature 🤷♀️
Update in Under 30: Oxalate Overload – Assessment and Management
Oxalates are present in many healthy foods and in all healthy people, but when ‘normal’ levels are exceeded they can spell trouble in a whole raft of different ways due to their extensive distribution across the body. Some tissues, however, have more problems than others, especially the urinary system and soft tissue and joints but now there are also questions about oxalates’ relationship with thyroid and breast issues. We review the latest evidence about the health consequences, blow the lid on accurate assessment for oxalate excess and talk management in this jam-packed update.
When patients present feeling worse every time they DIY a Green Detox, as the practitioner, you’re likely to be sniffing around reduced oxalate tolerance as a differential. Rightly so. But what about the patient with joint pains and disproportionate fatigue who has baffled their rheumatologist, or the one suffering vulvodynia that baffles everyone, or irritable bladder symptoms, or….and they all eat an exemplary colourful high plant food diet, with their only self-confessed sin…darker than dark chocolate between every mouthful? Who doesn’t? While you may have a hunch, given the goodness of those foods, we should check these out objectively rather than unnecessarily restrict or limit someone’s food choices for the rest of their natural life! If dietary oxalate overload is now on your radar for these patients you need to move to the next step. Assessment.
Spot or 24hr urine collection or plasma assay or OATS testing or imaging or joint aspirates? So many choices but which one has the greatest validity depending on your patient’s presentation? Ok how about the most general all-rounder that is truly an option in the real world? – always helpful;) Yep, 24hr urine collection…agreed.
Ok, next step.
You need to wrap around that waist of yours one seriously heavy tool belt for accurate interpretation of their results. That’s right…those random ol’ reference ranges need a serious rethink! How much? Well, given the reference ranges every lab will give you for urinary oxalates typically fail to pick up up to 1/3 of patients with oxalate overload high enough to produce oxalate kidney stones…I think you get the picture. I feel your trepidation now but can hear you pensively ask anyway…next step? Management.
Just google oxalate-rich foods, print out the list for your patient and tell them never to have these (or joy, laughter, sex or a healthy microbiome) ever again.
Not.
The ‘low oxalate lists’ will lead you astray and the ‘high oxalate foods’ should not be tossed away! The research has found greater therapeutic benefits from different dietary approaches, some nutritional supplements and most importantly targeted treatment of the cause…which is all about the…go on, try and say it without screaming…the GUT!!!!!!!!!!!!!!
Oxalates are present in many healthy foods and in all healthy people, but when ‘normal’ levels are exceeded they can spell trouble in a whole raft of different ways due to their extensive distribution across the body. Some tissues, however, have more problems than others, especially the urinary system and soft tissue and joints but now there are also questions about oxalates’ relationship with thyroid and breast issues. We review the latest evidence about the health consequences, blow the lid on accurate assessment for oxalate excess and talk management in this jam-packed update
Hear all about it by listening to my latest Update in Under 30:
For all Update in Under 30 Subscribers, it’s now available in your online account and if you are not a subscriber you can purchase this individually here.
With the increasing weight of evidence pointing to a potent pathogenic portal between our mouths and every other part of the body, whether that be in terms of cardiovascular disease, rheumatoid arthritis, appendicitis, even a growing case for Alzheimer’s disease, we need to ensure we’re not overlooking the condition of each patient’s oral cavity. I got very excited about the recent Medscape article: A rapid non-invasive tool for periodontitis screening in a medical care setting. It’s true, I live a quiet life 😉 But seriously, a validated tool for all non-dentists to accurately pick up on the likelihood of this condition would be a nifty little thing indeed, so we can narrow down just who we quick-march off the dentist as well as understand their whole health story. But then I read the 8 actual questions which included gems such as: Do you think you have gum disease? and Have you ever had treatment for gum disease such as scaling and root planing, sometimes called “deep cleaning”? I thought, ok, this is not rocket (dental) science.
But that’s the point, I guess, right?
So while I encourage you to check out & employ this screening tool by all means, we can also be reassured that just by ensuring that when we ask about someone’s digestion (and when don’t we?!) we start at the very top of the tube, we’re doing a good job!! As my new grad mentees learnt this year…following the patient’s GIT from mouth to south anatomically, is my rather simplistic way of guaranteeing I cover everything digestive..without using formal consultation script. So in the case of the mouth, my questions include things like: last trip to the dentist; any prior dental diagnoses, number of amalgams, implants, root canals etc & their routine dental care techniques, any signs of bleeding on brushing & all foods they avoid for dental or oral reasons? Look, it hasn’t undergone the rigorous validation that the Self-Reported Oral Health Questionnaire has..but I think it’s a good start.
Whether we’re being picky about pathogens and exactly how they got access to the rest of the body (and gums make a great entry point!!) or just concerned about chronic low level inflammation, a ‘gurgling’ CRP between 1-5 in an otherwise ‘healthy adult’, picking up on periodontitis is a pivotal.
Oh and if you’ve ever wondered about possible health implications from mouth metals other than amalgams…don’t worry, soon I’ll be getting to that with a forthcoming UU30.
Want to hear more about how certain microbiota (from the mouth to the south) are being implicated in joint diseases such as rheumatoid arthritis and ankylosing spondylitis and how we can investigate these individuals?Getting to the Guts of Women with Joint Pain is a recent UU30 instalment that gets down & dirty on the detail.
How often were we told this in our training? And how often have we found this to be true in practice? And now suddenly, it seems, the medical researchers (at last!) are rapidly coming around to this core concept?? Our microbiome is suddenly the hottest property on the body block, and it seems every interested party is shouting, ‘Buy!Buy!Buy!’ As integrative health practitioners, of course, we had a major head-start, not just by appreciating the gut’s central positioning in the whole health story (iridology beliefs, maps & teasers aside!!) but also a heads-up about the damage the western diet, our medication exposures and lifestyle tend to wreak upon it. A favourite quote of Jason Hawrelak’s by Justin Sonnenburg, “The western diet starves your microbial self”, underscores the significance of just one element of this impact. And…are we all clear that the increasing number of patients reporting adverse food reactions, once again, overwhelmingly are a response to aberrant processes in the GIT?
Sounds silly it’s so obvious right, but it’s easy to get distracted & misattribute blame…for example, it’s the food that’s the problem. Well yes in a minority of situations interactions between someone’s genes, immune system and a particular food turns something otherwise healthy into something pathological, but for the majority, the food itself & in others is healthy, & could be beneficial to this individual, if only we could resolve their GIT issues…like FODMAPs for example.
Not the problem, just the messenger.
So if the ‘problem food’ is just the messenger, what’s the actual message we need to understand? Is it that this patient has medication, disease or otherwise induced hypochlorhydria, impairing ‘chopping up’ of potential antigens implicated in immune mediated food reactions? Or is that this person’s got fat maldigestion &/or malabsorption so that in addition to not tolerating fats, they may experience dietary oxalate intolerance to boot? Or are the food reactions the result of altered microflora changing what we can and can’t digest (via their critical contribution) & absorb?
So what message does the presence of IgG antibodies to consumed foods send us about the state of someone’s gut? It’s telling us 2 things: this individual exhibits abnormal intestinal permeability & currently in the context of this leaky gut, these foods may constitute a barrier to resolving this & other symptoms as well.
We’ve recently released the mp4 (that’s audio plus the movie version of the slideshow so grab your popcorn…that’s if you don’t have a corn issue!) of A Guide to Investigating Adverse Food Reactions – What’s IgG got to do with it? which details the science behind IgG, including debunking, the incorrect debunking of IgG food antibody testing!! But more than this, it overviews the whole maze of adverse food reactions, articulates a logical investigative path for practitioners through this maze, and helps us to really understand that finding the food(s) responsible for a patient’s symptoms is not the final destination..and can be in fact a distraction, if we don’t cut to the chase and find out the why…and funnily enough…my dear old iridology teachers and colleagues...it almost always comes back to the gut 😉
Confronted with the possibility of adverse food reactions in an increasing number of our patients can be an overwhelming prospect, in terms of accurately identifying and understanding the faulty mechanism underpinning these aberrant responses to healthy foods. Elimination of culprits in most situations is only a short term reliever, not an appropriate long term solution, so to optimise results we need to know the real mechanism of action. The majority of these, of course, stem from the gut, but being able to elucidate exactly which of the many things that can go wrong there, is going wrong and therefore what foods are problematic until we address this, is the key. This 2hr mp4 is all about the bigger picture and helping you find method in the madness that can be the AFR landscape. Along the way, we detail the science of where IgG reactions fit into this and it’s a fascinating story that just might be the missing puzzle in your leaky gut patients.
You can purchase 
