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.
Wow, menopause is really having a moment, isn’t it? Or is that just me (and my mates who are all somewhere on that perimenopausal path)?! But seriously, medical perception of this reproductive transition is undergoing a revolution right now—widening the lens to take in more diverse potential presentations and lengthening the period of impact recognised both ‘before, during, and after’ that last, last…no hang on…last period. But I fear we are at a crucial crossroads. Anything could be related to (peri)menopause, but not everything is or should be.
There are several other conditions whose onset tends to rise or peak at the same age and stage for women, and due to their shared features, they get missed & misdiagnosed, misattributed to that!(more…)
Any steps towards inclusivity in societal & cultural terms are cause for celebration but in medicine, that can come in the form of a ‘diagnosis of inclusion’, the opposite, of course, of a ‘diagnosis of exclusion’ and potentially as slippery and loose as it sounds. That’s the somewhat precarious position we find ourselves presently in with perimenopause and menopause. With greater recognition of just how long health effects can kick in before there are any cycle changes [2-12 years for those of you playing along at home] and the widening lens now taking in the diversity of such health effects, women’s health has had a win. But, I would argue, this is not without a double edge. After all, aren’t we, as a result, more at risk, as women, of having everything attributed to “just ‘the change’, love”, and, in turn, going to be offered sex hormones more often as the solution?
Recently I asked practitioners to tell me where the ‘therapeutic reference range’ many of us were taught for nutrients comes from & no one has been able to answer that.🙄 If you’ve heard me refer to my original naturopathic education before you’ll know I generally hold it in high regard. And I’m forever mindful that there are always things that can be made better. What’s been playing on my mind lately is the recognition that I originally learned nutrition from one (exceptional) individual, and then went on to become the lecturer years later at that same and other institutions. Additionally, I am aware of some of my past students also going on to become the next generation of nutrition lecturers at those same places – and often in fact inheriting their lecturer’s notes, slides, overheads [showing my age!!] with the job. Can anyone else see a problem here? What’s brought this into sharp focus lately are many of the questions I’m endeavouring to answer as part of our much-anticipated Nutrient Prescriber’s Program. How much? How often? When? Which form when? & For how long? Which are the key questions we have to answer with every single nutritional prescription.
To not only source the most rigorous scientific answers to these core critical questions but to also develop a framework that we can all use to answer them for ourselves at the point of any future prescription creation, I have had to go to great lengths.
But as I research & write, I also keep asking myself, ‘How would ‘old-me’ have answered this?’ How did I up until now either consciously or unconsciously answer these sufficiently to make such decisions?
So it’s an ongoing little (& sometimes BIG🧠) internal debate that is raging as I write. And when I ask current praccies these questions they reflect back similar ‘old-me answers’, the vast majority of which were handed to us by our lecturers with plenty of top-up ideas from industry. These answers include things like:
How much? Somewhere within the therapeutic dose range? How often? Depends on lots of things but generally aiming for daily of course!
When? Minerals before food, fat soluble vitamins with or after, magnesium at night etc
Which form when? Now it gets tricky – because there are all these new forms that we weren’t even taught – but maybe ‘active’ – active is always better, right? Or is that natural? The most bioavailable?
& For how long?Ummmmm how long is a piece of string?! Until the signs and symptoms resolve?
Now all of these as general statements are partly correct. And with respect to the level of understanding we need to have when crafting a nutritional prescription for a specific patient, with a specific presentation and for a specific purpose (correction of deficiency Vs supranutritional Vs therapeutic antagonism etc)…well they are plain wrong in the majority of instances. Don’t freak-out in freefall!🪂 The prescribing of nutrients is a wonderful and typically, a wonderfully safe, modality that offers us the potential for extraordinary patient outcomes. When used well. We could all benefit, I believe, from just sharpening our tools so we bring out the very best in our medicines & in ourselves, as prescribers & clinicians. I am neck-deep in writing the 10 modules that can start us all on that journey. Want to join me?
And to be clear, about the educational echo chamber,
In the past I was part of the problem and ever since I have tried to be part of the solution.
With over a decade of mentoring practitioners, Rachel has recognised a need for an educational program that provides practitioners with more structure, more science, and therefore more certainty in navigating each individual prescription. This monthly meet-up is delivered in 5 live sessions and runs from February to June (10 modules). All sessions, encompassing both theoretical and applied learning will run for approximately 2 hrs each.
Let’s play a word association game of minerals & their major roles
I say, ‘Potassium’. Maybe you say, ‘Sodium Potassium Pump’ I say, ‘Magnesium’. You say, ‘Muscles?’ I say, ‘Calcium’. You say, “Bones’….
But I say, Second Messenger. And arguably the most pervasive & potent one, at that. Remind you about second messengers? Well, sure. They are the ones who get sh*t done. Not like a boss (i.e. hormone or neurotransmitter) who shout directives from above but never step foot inside the dirty guts of the engine room itself. It’s the second messengers who run these messages from the outside of the cell to the inside and the engine room, to ensure that the directive is actually actioned! Amazing huh! And free calcium in the blood is, as I said, really a superhero even among the second messengers – with its regular responsibilities including: Insulin, TSH, Adrenaline, Oxytocin, Serotonin receptor activation etc etc
Does, it have a dark side? Well, sure. Don’t most superheroes?
If the available Calcium in blood and the extracellular environment is too high then basically bad sh*t gets done. Including vasoconstriction, clotting, deposition of calcium in the wrong place like arteries and joints and etc etc. That’s why the amount of Calcium in our blood is the MOST tightly regulated of all electrolytes and, in turn, has the NARROWEST of reference ranges. But will a Serum Calcium level always tell you when there is a problem with Calcium regulation? No. You’d need to have measured the major regulator itself, Parathyroid Hormone (PTH). Wait, am I seriously trying to tell you, that Serum Calcium alone can look completely normal in spite of really damaging Calcium dysregulation underway – leading to accelerated BMD loss, increased cardiovascular and renal risks etc.? I most certainly am.
So do you know which of your patients’ really need PTH assessment and why 1 dominant group amongst those, is any woman leading up to and following menopause?
No? Well you better pull up a pew and have a listen and a watch then! Yes this latest Update in Under 30 episode even comes with a little video tutorial!🤓🤯
Parathyroid hormone is a career criminal. In addition to buoying dropping blood calcium levels via legitimate means, it illegitimately achieves this by stealing it from our bones. But you wouldn’t know it – because like all career criminals this occurs completely under the radar. Elevated PTH, however, constitutes the most modifiable risk factor for bone mineral density loss & fracture risk and offers the biggest BMD gains secondary to its normalisation. In addition to this, even within range but ‘high-normal’ PTH correlates with a range of other cardiovascular and urinary presentations & if combined with elevated serum calcium can become a multi-systemic presentation (GIT, Mental health etc) frequently mistaken for other aetiologies. So how can we be alert to this ‘bone thief’? Which of our patients will benefit the most from PTH measurement and monitoring? This recording, resource & video tutorial on how to use a Ca PTH Nomogram answers all!
You can purchase Unmasking Hyperparathyroidism – Menopause & Morehere. 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.
The builder responsible for my reno arrived one day with a frown. When I asked him what was wrong – he said he’d just had his second high PSA result and now the doctor wants him to see a specialist. It was apparent that he felt this was a real cause for concern. Talk about raising a red flag to a bull 🚩🐂 Yes, of course you know what followed. I insisted on reviewing the results myself only to find the reference range provided on his report was not specific to his age – and if we adjusted up for this (as the science supports) his result is just 0.5 ng/mL above the expected value!
Now, remember he is a builder so, ‘0.5’ in his mind might well be on par with 5mm which apparently is a big deal…or so he keeps telling me every time I try asking for some weird unconventional thing for my roof, windows, walls, whatever!! So I still had to provide a little bit more detail for him to get perspective and to understand the true meaning (and lack of scary meaning) of his results.
This however is just a micro-illustration of a big problem in pathology – we all risk a lack of perspective but if we can get it back, aids us to see that seemingly ‘normal’ results are sometimes a concern, and so-called ‘concerning’ ones, non-significant. The incredible patient insights that can be gained from being able to measure & monitor actual quantities of things in our patients; nutrients to novel disease markers, precursors to end-products, all comes down to understanding how their values compare with…with what? With someone of a different sex and age? With ‘all adults 18-108!’? With any other pre-menopausal woman regardless of reproductive or cycle stage? With ‘the average’ adult given that this current definition is overweight & unwell? Who are we comparing ourselves and our patients to?
When I undertook my undergraduate training many moons ago – there was no education in blood test interpretation. But as soon as I got out into practice I found my patients had all these bits of paper filled with magic numbers that I felt certain might offer me insights and a deeper understanding of their whole health – and how to best help them.
I desperately wanted to decipher this foreign language and made it my mission to do so. I was lucky enough to meet and be paired with a kindred spirit, Dr Tini Gruner, who happened to be my supervisor when I returned to undertake my honours thesis. Together we pooled our knowledge, sought out & shared with each other yet more and found that, together with comprehensive case taking, it provided excellent scaffolding to our work-up of patient cases. Better than that, it created this baseline for patients, identified clear treatment objectives and we could measure the success of our interventions based on how their results did (or didn’t) respond to our interventions. It was (and still is) a totally thrilling way to practice.
We talk about there being both an art & science to medicine generally and certainly an integrative approach. Without the benefit of pathology interpretation, I felt too at sea at times, without quite enough of the science to check the accuracy of the ‘art’ and my speculation.
Being able to understand what each individual result represents and reflects, to know how to form meaningful comparisons – with external reference ranges that speak to healthy individuals of the same sex & life stage, derived from rigorous research – and also form a comparison with the patient themselves, to pick up on the most subtle and significant early alerts to an emerging pathophysiological or healing process – is the skill, I believe, we all need in health to complete the toolkit. That’s why I made it my mission to learn the language of labs, from a conventional & integrative interpretative perspective, and then to share this learning with everyone wanting and willing to take this baton from me (& Tini) and run with it 🏃♀️🏃
MasterCourse I: Comprehensive Diagnostics. Click here to read more and here to purchase it.
*Please note that this is the place to start for everyone wanting to add preventive diagnostics to their tool kit. It is also the pre-requisite for MasterCourse II, so make sure you have completed this before continuing with MasterCourse II: Thyroid and Adrenal Diagnostics.
MasterCourse II: Thyroid & Adrenal Diagnostics. Clickhereto read more and here to purchase it and sign up for the Free Watch Party commencing tomorrow, 3rd August 2023 with is included with each purchase of the MasterCourse II.
What level of Serum Ferritin represents ’empty’? As in complete depletion of iron stores?
Is it any value below the minimum of the reference range? e.g. < 30 mcg/L Or does the bottom of the reference range allow for a buffer and ’empty’ is substantially lower than this? Could patients actually be ’empty’ but still have Serum Ferritin values within the normal range? Could the same Serum Ferritin value occur in one patient on ’empty’ but with adequate stores in another?
Rachel: And sometimes emails from practitioners provide me with both the question and their own answer to their question even!
Cameron Barker’s (Ex-student long-term learner & mentee)email arrives titled:Unexpected Source of Iodine in Placenta Caps?!
A 32 yo female with a 12-week-old daughter came to me as she was not feeling well, in particular, she reports fatigue, racing heartbeat, anxiety and loss of appetite. Previously, 2 years ago, I had helped her with her Hashimoto’s. I did not hear from her for a year or so and she fell pregnant and was recommended to take a well-known iodine-containing pregnancy multi.
Just as optimal integration of lab results into our patient work-ups makes ‘the invisible visible’ we thought we might make visible some of the everyday Q & A that we engage in with wonderful practitioners who are fast becoming Diagnostic Divas & Divos.
Praccie email arrives with subject header ‘Graves Help’ (or is that ‘Graves…HELP!’🤔)
Practitioner: I have a Grave’s patient who required Propylthiouracil (PTU) for a few months from late 2022 until Jan 2023 which obviously took her thyroid in the opposite direction (see labs). Following a miscarriage last year, she has conceived and is around 6/40 and her current TSH result has come in at 3.3mIU/L, her TPO Abs > 1000 and she also has low-level Tg Abs (TRAbs not measured this time) and this is what she just said to me:
“I just had my specialist session this morning – and she has put me on thyroxine (50mcg) as my thyroid is quite low. I also asked her about the prenatal vitamin and she said it was safe for me to be on iodine at this time, as the Graves isn’t present and baby needs it for the development of its own thyroid.”
Oh gawd! Preg? Iodine? Graves? Antibodies? Antenatal or postnatal aggravation?!
Is there an UU30 I can listen to to help me understand this?… sorry for the panicked email…
And for weeks now I’ve really been banging 🥁🥁 The 1st drum was me making us all salivate & suffer through my month-long Mediterranean feast The 2nd, my ongoing incurable fixation on the ‘Power of the Ps’ – Protein & Potassium, not just individually, in terms of meeting optimal requirements for each, but relationally, as in, the (im)balance between them & the clear goals that have come from research for best health outcomes.
Maybe now you can hear the individual drumbeats merging to form some sort of chorus rather than a cacophony?! I can🎶 And largely that’s because I decided to put the Ps & Ps principles (Total Protein:Potassium < 1; Animal Protein:Potassium <0.6 etc) into practice, entering my own meals into software to see how often I kicked each goal and how often I missed (& [ouch] kicked myself). Personally, I think thirty years in the game can lead to some laziness around looking in depth at our own dietary habits. As in, I know the ‘rules’ right, back to front, so I’ve told the ref to have the rest of the season off! My meals are both mantra and memory foam. There’s a lot of eat and repeat. Like my heavy lunchtime reliance on my ‘protein power pack’: 2 XL soft boiled eggs on 1 piece of avocado paleo toast and a bunch of asparagus. My (in)famous buckwheat breakfasts loaded with nuts, yoghurt & fruit. My bulk-cooked plant protein heavy, animal protein light, stews, sauces and soups. Even, what I considered my laziest but luscious organic farmers market meal, pan fried lamb rump steak, steamed fresh new season potatoes & a bunch of asparagus. So which of these would you have put your money on for the most Ps& Ps goals kicked? 🤓🤯
The Lazy Luscious Steak & Veg Meal Wins with… Total Protein : Potassium of 0.56! Animal Protein : Potassium of 0.41 Btw that’s because of the Potassium-punch of Potatoes [>2200mg!] and the finale of Figs & dark chocolate [329mg]! Animal Protein : Vegetable Protein of 2 : 1 (ok so you can’t win everything!)
Now obviously I am just looking at each meal individually, but the Protein & Potassium goals are really daily ones, however, I, like most people, don’t lay out the totality of my ideal food intake for the day and then think, now how do I make this all edible?! I think in meals not metadata! So this little exercise was already incredibly rich in insights, checking my assumptions and snapping me out of some misguided mental calculations into the real world, placing a ref back on the pitch! I’m not ditching any of these favourites – just more mindful of what meal goes with others across the day, for better balance. Now all this analysis is time-consuming of course and while various software will do the macro and micro crunch, as far as I know, you still need to do all the Protein and Potassium calculations by hand, Ah yup. So, 1) I’m stopping now & 2) I’m thinking about creating a little spreadsheet that auto-calculates a lot of these targets once you’ve obtained that basic elemental data to input, for easier use in the future – would you use it?? [insert answer here 🙋♂️]
And then you can show me your kick arse protein/potassium combo! Because clearly even us ‘experts’ apparently need data to double-check our assumptions!
Now where’s the other 🥁 in all this, that Mediterranean one, I hear you ask? It’s in the figs! My lamb dinner actually just missed reaching the targets for protein and potassium balance…until my fig finale! And remember, what the Greeks say, ‘A few figs a day keep the chronic-mild-metabolic-acidosis at bay!’ 😂 Just jokes…
To prevent or minimise our slow but steady march towards sarcopenia, the need for dietary protein adequacy to fuel muscle maintenance is a no-brainer – but how does ageing affect this? We get less bang for our buck. We have to eat more, to get the same ‘amount’ but do you know why this is? Add to this, that also as we age, we experience a greater acid burden from a lower acid dietary load. And given that a higher acid load (PRAL), has been shown to have a negative effect on muscle and bone markers in the past, clearly to ensure optimal health of our bones and muscles as we age, we have a riddle, or two, we need to solve. How do we use Protein and Potassium intakes to benchmark our patient’s diet quality and musculoskeletal risks and can we modify their consumption of either, to drive therapeutic gains in terms of both BMD and muscle?
You can purchase The Protein & Potassium Riddle of Ageing – Muscles and Boneshere.
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.
How much? How often? When is the best time & timing? do you know about friends, foes and frenemies? Which form, when? e.g. building blocks or bioactives? And for how long? aka are we there yet…?
These are the kind of questions that one would imagine nutritional prescribers can always answer – but can you? Yet this is the goal, right? So that with each and every unique individual who needs supplements – we have a clear, consistent go-to framework to guide & direct these prescriptions. One that makes scientific sense, offers optimal outcomes and removes the uncertainty.
From my interactions with thousands of practitioners, however, I know many of these key questions plague practitioners & they feel, at times, as if they’re flying without a net, or without a strong systematic approach, or at the very least without all the answers to these questions.
I’ve had so much good fortune & so many others to thank for providing me with this foundation. Fay Paxton – my nutrition lecturer in my under-grad who indoctrinated me with a systematic approach. Dr. Tini Gruner – my principal supervisor at SCU, who shared & further fuelled my passion for biochemistry and reading labs to extract insights into each individual. And thanks also to all the pharmacists I’ve delivered education to over the years, who, as a result of their grounding in the principles of pharmacokinetics, always ask the best questions – questions that if I don’t know the answer I know I need to know the answer! So I made it my mission to find out!
While we dip into these aspects of nutritional prescribing in our regular mentoring groups on an ‘as needs’ basis, I’ve decided the time has come to create a year-long program dedicated to sharing this information and building this skill-set in practitioners.
This monthly meet-up is delivered live (max 1.5hr) and runs from Feb to November with the following currently proposed format *subject to change dependent upon the needs of the group
Feb Factors Affecting: digestion, absorption (host, form, dose)
March What happens to what gets left behind? e.g. enhanced enterocyte micronutrient concentrations & their effects plus unabsorbed nutrients & their interactions with the colonic environment
April What happens to what’s absorbed e.g. distribution, hierarchy of needs, activation and deactivation
May The pharmacokinetics of prescribing
June Where do our ideas on dosing come from? e.g. Physiological Vs Pharmacological dosing & actions. The basis & believability of maximal intake boundaries?
July Bioefficacy V Bioequivalence. Beyond building block nutrients: Is ‘Bio’ (-active, -peptides, -materials) always better? e.g. GABA Vs Glycine, NAC Vs GSH, PLP Vs Pyridoxine, Niacin Vs Niacinamide riboside ——————————————————————Aug month off—————————————————————————
Sept How often & for how long? Are we there yet? And how would we know? Plus Fast Vs Slow Nutritional therapeutics
Oct Strategies for Supplement Success e.g. friends, foes and frenemies in nutrition underpinning principles with examples; compliance changers for clients
Nov Live attendance & opportunity to participate in a case-based mentoring session
This monthly ‘live’ meet up will be delivered as part of 2023 Group Mentoring as The Nutritional Prescribing Program Group Mentoring applications open 17 October 2022.
To join the waiting list and be notified when applications are open, email the team at [email protected]
Find out more about what groups are available for Group Mentoring in 2023 here.
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 – so too a child at any weight.
And we expect a higher value as well in our elderly clients too and this level there may be, in fact, increased mortality.
But the same result would be excessively & worringly high in my patient who’s undergone thyroidectomy.
Realising the full value of any test result in terms of what it reveals about the person sitting in front of you, requires these more thinking and more thoughtfulness. Unfortunately, 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 concede, much of my 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..this next MasterCourse series is focused on revolutionising your understanding of thyroid, adrenal, HPT & HPA markers based on the very latest research & findings & marry these together with everything you learned in MasterCourse I (ELFTs, FBE, Lipids & Glucose) to understand the ‘whole story’.
…an absolute treasure trove of free integrative health information about your patient!
DEEP DIVE INTO REAL CASE STUDIES TO DEMONSTRATE EACH PATHOLOGY PATTERN IN ACTION. ]\
There are limited places. To sign up for Rachel’s LIVE Series – MasterCourse II: Thyroid & Adrenal Diagnostics and for more information click here.
I’ve spent the best part of about 4 months recording my *NEW* Advanced Thyroid Assessment training. I told my team this would be easy and quick, given it was to be based on a great little 2-part, 2hr updated presentation I delivered just last year for ACNEM!! Sixteen weeks (like seriously…most of it) numerous rewrites and retakes later, our final product is 4 parts that goes for over 12hrs in total & has a bonus Adrenal recording! And yeah my team are impressed but unimpressed too if you know what I mean?!🙄🤪
Every time another, ‘Oh wow!’, or ‘No way!’, escaped my lips, it was a source of personal celebration, as another deeper layer of learning revealed itself.
But to the wonderful, somewhat weary and definitely wary Sally, who does all my powerpoints, it was met with, ‘Oh boy!’, because it meant many multiple new slides to build full of visual metaphors, animation acrobatics, if not an entire new Part!*#@^
Her sage advice along the infinite research road I’ve been travelling was : ‘Stop. You’re going to have to stop.’
So I didbut now I am this meme. Everything I see currently through the lens of thyroid health, I talk in tongues TFTs and my brain is one giant neural network of integrative endocrinological circuits! I have fallen in love with this topic, this neuroendocrine axis and its ‘first responder’ role all over again! Hence our little thyroid character below – all ‘antennaed’ up – is one of the many tools we’ve developed for this training, to teach us that ‘bad thyroids’ per se are extremely rare – but bad scenarios are common (too much or too little of any macronutrient, key micronutrients, a change in the internal or external environment etc etc) and this little fellow and his board of directors (no – not the hypothalamus or pituitary!) – well it’s their job to ‘read the room’, right?!
In the absence of this key understanding we risk: A lot of lazy labelling in thyroid health – ‘You have a bad thyroid – that’s why you…[can’t lose weight, feel tired, have SIBO etc]’ Misdirected treatment & especially a tendency to overload the butterfly with ‘thyroid’ nutrients – which can do more harm than good
I’ve said many times, ‘perfect number pathology is a myth’ but it runs rife in practitioners’ beliefs about TFT results with complete disregard of the person those labs belong too! Did you know, for example, that your TFTs should all be higher if your BMI is? That your T4:T3 ratio should never be 3:1 if you are on replacement, have hot nodules, are pregnant or are acutely unwell etc etc etc? How about how low your Selenium or Iron levels need to be before this factor will influence the actual levels of thyroid hormones measurable – & what the impact of these deficiencies are well before then that is far more sinister and serious? Yep…you see here I am, pouring just some of the tiny take-homes of Advanced Thyroid Assessment ALL over you!
Watch this space my new Thyroid training is just around the corner!
An increasing number of our patients have thyroid concerns but unbeknown to many of us the most likely explanation of all is thyroid nodules, whose incidence is on the rise globally. The development of nodules has always been primarily viewed as a nutritional disease. Traditionally attributed to chronic iodine deficiency but recently novel nutritional causes have emerged. Benign nodules come in 2 flavours: hot and cold and while patients can present with a mixture, it is the presence or absence of a hot nodule that radically changes what complementary medicines you can and can’t use and what an effective treatment plan looks like. The pointers, as is often the case, are there for us in the patient’s presentation and pathology, so knowing the difference is no longer a guessing game. This UU30 comes with a great visual clinical resource and includes key papers on the nutritional management of nodules.
Ever been guilty of having a ‘man’s look’ for something? I have. Particularly when it comes to the online omniverse! I can be a bit flaky at finding things right there on the page…allegedly! So for those of you who have a similar experience with my website & endless educational offerings, I FEEL YOU! We do have a tonne of training options and a whole lot of (love 😉 couldn’t resist the Led Zepplin reference)… lab & diagnostics resources! This has come up in conversation a lot recently, following the release of our RAN Student Pathology Hub, for example: “I’ve done your MasterCourse in Diagnostics, does this cover something different?” or “LOVED😍 this new hub its *$@# incredible resources & extra training vids but I also wished it included your take on… [insert your pick from infinite list: thyroid, cortisol, zinc etc etc etc]
So here’s a Dummies Guide:
How to Find the Help you Need in Diagnostics
If you are just starting out on your path to pathology & true lab literacy & want an accelerated way to ensure you are starting this journey on solid ground and you have the most called-upon skills you’ll need in clinic today, then the RAN Student Pathology Hub is your perfect match. NOTE: this is not limited to actual students but anyone who considers themselves, like us, a life-long learner! This 12 part module includes some small core components of our MasterCourse, a few expanded episodes from our Update in Under 30, plus unique short training videos, covering tests and topics including: Iron studies, B12 assessment methods, Coeliac screening & much more
If you’re seeking the immersive experience – you want to maximise your competence and confidence & forge your path as a true Diagnostic Diva or Divo then look no further than our ‘mothership’, the MasterCourse in Comprehensive Diagnostics which now has a part payment option. This really is the most seminal training we offer, taking the time to dig deep into the science behind all the ‘signposts’ our patients’ results are pointing to. A big commitment for a big reward. It comprehensively covers all the routine labs you will see everyday: LFTs, Renal markers, Glucose and Lipids, FBE & WCCs & is loaded up with case illustrations for each key pathology pattern – that many practitioners say was an absolute highlight
Just have a specific question or need for upskilling in Cortisol assessment? Zinc or Zonulin? It’s probably in our vast Update in Under 30 library! Yes, with more than 100 episodes in there and my penchant for pathology…you’ll find something, if not in the UU30 episodes, then somewhere else on my website. You know how in pdfs ‘Control + F’ is a god! Ok on my site it is this fella 🔎 You can use this to search my whole site to find free information on the topic (blogs) or manifest the same magnifier🔎 magic once you have clicked ‘Catalogue’ on the top right of the tool bar on any page, to locate any specific educational offerings. Remember with the UU30, you can purchase single episodes or subscribe and get access to the whole shebang.
And for those of you primed praccies, patiently waiting for our MasterCourse II to land? Well about that…did we mention we got hit with a flood? Twice? And then got covid? Two of us? And have our beloved Nina about to depart to become a mumma!!! Yeah, so our plans to have this up and ready for May changed to Mayhem, real fast 🙄🤪 We will definitely keep you posted on any developments and new timeframes but for now we can only apologise for the delay and will do our best to get back on track with this, at the earliest opportunity. In the meantime maybe a little review of some of MasterCourse I is in order? I refer back and re-listen all the time, myself!!😂
Being a practitioner who is able to read labs will set you apart in practice. For your patients this flows from your ability to form a more sophisticated understanding of what’s happening for them, enabling you to better individualise treatment and deliver superior outcomes. Amongst other health professionals, it will attract positive regard and an increased willingness and enthusiasm for sharing the care of patients with you. Learning to be lab literate could take a lifetime…or you can enter the expressway from the very outset! We have curated the content to reflect the most essential elements, to help you hit the ground running in the shortest period of time. Spread across 12 modules which can be consumed as monthly instalments or, as an all-in-one experience for those wishing to waste no time. The teaching points, tips and tools make the complex simple, engaging, even fun!
Developed, designed and delivered with students of any health discipline in mind.
Burning, tingling, crawling, buzzing, humming, zapping, pins & needles, numbness: our patients often tell us about strange sensations they have in various parts of their body. It’s typically not their major concern, but they mention it as an aside, a curiosity, ‘another weird thing I get’. While they may have trivialised this, relative to their ‘real issues’ [insert gut, hormonal, mental health] we should do the opposite and bring this concern to top of the list to correctly identify the cause.
If bilateral sensory nerves are mis-messaging it typically means 1 of 2 things: 1. Nerve damage is occurring – and if allowed to progress this can become irreversible or extend to motor and central deficits 2. Nerves are irritated or impaired – and this tells you something ‘systemic’ is out of whack and these sensations are often the only alarm bell
The top cause of paraesthesia, falls into the first category and is of course diabetes – and yes even now diabetics will walk into your clinic not knowing they have this (a good old HbA1c should be routine to rule this out). Second on the list is alcohol dependence. The third most likely explanation for the patient with paraesthesia is nutritional. And in contrast to what many of us might incorrectly think, there is a long list of nutritional imbalances that can be responsible for either, nerve damage or irritation, and B12 deficiency is not in fact the most likely.
That’s right all you nutritional ninjas🐱👤 – that makes the correct identification of the cause & the solution our bag, right? I mean who else is going to do this, accurately?
Asking the right questions about these sensations helps you to quickly confirm when a nutritional cause is likely. From there we need to know how each single micronutrient excess or deficiency or in the case of some, ‘sort of single’ nutrients (we all know people who sit in this category, right?! So why not nutrients 😂) are likely to present, via ‘easy-to-spot’ key characteristics that cover: pattern of distribution, speed of onset and progression, risk factors, accompanying features etc. In our final New Graduate mentoring session for 2021, a practitioner presented her patient who rated her concerns as 1) Fatigue 2) PMS 3) GIT issues & 4) Tingling & crawling sensations across limbs, face, lips and tongue…and I was like, whoa stop right there, you might just have given us the answer to all of the above~!~! Seriously. Here’s a clue: it wasn’t oral allergy syndrome and it wasn’t B12. Can you pick it?🤓
The Patient with Paraesthesia – Part 1 Patients often mention experiencing peculiar sensations: crawling, tingling, burning, as an aside, as a ‘oh and by the way’. But while it may not be their top priority – it should be ours. That’s because nutritional imbalances are the 3rd most common cause of these and timely treatment is essential to prevent progression to more serious issues. The list of potential nutrient deficiencies and excesses behind these, is long, but this recording, the first part of 2, will help you narrow the differentials, nail the diagnosis & the solution.
The Patient with Paraesthesia – Part 2 In this continuation of this topic, we discuss several less talked about nutrients whose deficiencies drive potent pathology for the nervous system & move onto a cluster group of minerals, whose imbalances create functional irritation rather than organic change. This episode includes a range of excellent resources from videos demonstrating in-house tests you can perform to aid diagnosis, as well as our own Ready Reference which assists correctly categorising the different paraesthesia patterns and the nutrient issues behind them
You can purchase The Patient with Paraesthesia Part 1here and Part 2here.
BUY PART 1 & PART 2 TOGETHER AND RECEIVE 10% DISCOUNT BY USING CODE BUNDLE12
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.
There are some things we say so often to patients we could record them and just press <PLAY> Like this daily dogma: ‘When you’re under stress, your demand for Magnesium rises and then in turn that can make you more susceptible to further stress, so we’re going to give you some to support you’. But is this actually the whole story? You guessed it, no. (I know I am fairly predictable like that 😅)
Recently, a personal new record – a patient reported ongoing daily use of a very high dose Magnesium ‘practitioner only’ product 8 years after it was prescribed by her then naturopath – and guess what, the patient still hadn’t reached nirvana* not the band! – a transcendent state in which there is neither suffering, desire, nor sense of self
Jest as I may – I think this raises some serious questions. The pervasiveness of our prescriptions when patients are not given an end-date coupled with ongoing access. How (not) effective this intervention was if someone perceives ongoing undiminished dependency on it. And specifically with Magnesium – whether our prescriptions (form, dose, adjuvants, advice) are the problem? If stress is synonymous with a shortfall of this mineral then Magnesium is not a solution to stress itself but the amplified stress response and the stress still requires its own redress, right? But do our patients hear this as well when we press <PLAY>?
Likewise – the BIG doses per serve being recommended might make sense for the minority (seeking potential NMDA antagonism) but are a real mismatch with the majority, who are just stuck in the stress loop and weathering a perfect storm of Magnesium under-supply and increased demand.
I love my minerals as much as, ok more than, the next practitioner but I’m always keen to refine my repletion approaches and oh yes, by the way, there is good data, a meta-analysis in fact, examining how long it takes to achieve repletion using oral Magnesium – and guess what, it’s not 8 years! The latest Update in Under 30 goes into all this and much MuCh MUCH more…you’re welcome 😂
Practitioners working with nutrition appreciate that Magnesium is vulnerable to depletion by the stress response and that in turn, can make people more prone to stress & keep patients stuck in a so-called ‘stress loop’. But do we understand the intricacies of this and how we, as practitioners, can get stuck in another kind of loop – one of endless Magnesium prescribing without reaching repletion? We discuss ways to improve your Magnesium prescriptions – in particular, ‘doping Vs drip-feeding’ and other things to assess & address if the long road to repletion risks becoming an endless one!
You can purchase Magnesium – Stuck in the Stress Loophere.
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.
I’m intrigued by the silence. Hair loss in women is frighteningly common, following pregnancy, menopause & with extreme stress (wait is that a tautology? 🙄) In fact it can strike at any age and for a multitude of reasons. When it happened to me a few years back I also initially responded with silence, terrified that if I said it out loud it would make it real, but when my daughter suddenly asked, ‘Mum are you losing your hair?’ with her trademark attention to detail & exquisite empathy, she gave me the words & a good kick into gear, simultaneously. Now I am fascinated by women’s silence around this generally, how little we share our stories & forewarn others, & as practitioners, the lack of adequate training we’ve had identifying the different types (hint: it involves donning gloves or if restricted to online consulting, knowing how to organise correctly positioned pics) & from there finding the right solutions.
While Female Pattern Hair Loss (FPHL) is the dominant type in women – it only applies to the following pattern:
But alopecia due to stress, thyroid disorders, autoimmunity, contact dermatitis etc will affect different regions of the scalp and with a different onset & progression.
And remember, by the time YOU, the practitioner, can spot a patient is losing hair when they simply walk into the room, they have ALREADY LOST 50%😢 This is why I think we need to push back against the silence. The research is unflinching about the serious psychological impact this has on women – especially in cultures which place so much emphasis on looks generally, and hair, specifically as a commodity of very high value in women. The diagram above comes from a 2019 update on the phenomenon of FHPL and it’s a good articulation of the knowns and unknowns (pssst spoiler alert…it ain’t about androgens!) but let’s never forget the other causes and cures. So let’s make sure as the trusted practitioners women present to so often, we are sensitive enough to have this tricky conversation & skilled enough to help 💪
Stop Pulling Your Hair Out – The FPHL Answers You Need
Female Pattern Hair Loss (FPHL) is everywhere, perhaps you just haven’t been looking. As the leading cause of alopecia in women globally and with 1 in 5 women affected at any age, we’ve all got clients who have FPHL to different degrees. We need to be better able to recognise the early features of this condition which profoundly impairs quality of life and induces depression in its sufferers and that begins with validating patients’ concerns when they report “thinning” or “increased losses”. But what do we do from there? This recording talks you through the assessment, diagnosis and management of FPHL based on a combination of the most recent research and Rachel’s clinical experiences. Once you’ve ‘seen’ FPHL.., you won’t ever ‘unsee’ it and your patients will thank you.
I confess I was a chemistry nerd ‘way back when’, but my skill for stoichiometric calculations had sadly slipped by the time my kids needed help with high-school science & now my son, who’s about to graduate from chemical engineering, is my ‘chem-friend’ 🙄🧐 I suspect he feels FB messenger wasn’t intended for such use – or at least there should be some veneer of, ‘Hi darling how are you?’ before…’Need to talk through these pharmacokinetic datasets’ However, the one equation that was like turning a light on in my brain & therefore never forgotten was the Fenton reaction – basically metals’ MO for messing with our biology, especially iron. Turns out – it’s the most essential and helpful in understanding health & disease:
Endometriosis IBD Neurogenerative disorders: MS, PD, Alzheimer’s Higher than healthy GGT Impaired COMT or catechol excess for other reasons Cardiovascular disease & Diabetes Vitiligo Both the Big Cs Heavy metal burden Iron dysregulation (Obesity, HFE mutations, Thalassaemia) & Excess (IV or oral over-treatment etc)
(almost) All roads lead to radicals & reactive species…if you follow the Fenton pathway & iron leads us down this path more often than any other metal. Certainly sometimes for good: like protecting us against pathogens and destroying dodgy cells, but when it gets out of hand, a key pathophysiological process in a long list of disease. So understanding how to recognise patients prone to dysregulation of this mineral, avoiding iron over-treatment at all costs (I am seeing incorrect and excessive use of IV iron in many patients make it stop!) and identifying means to contain and control its movement, are important. Oh and in case the Fenton has faded in memory, it goes a little something like this:
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? Click here for this episode.
Wow, menopause is really having a moment, isn’t it? Or is that just me (and my mates who are all somewhere on that perimenopausal path)?! But seriously, medical perception of this reproductive transition is undergoing a revolution right now—widening the lens to take in more diverse potential presentations and lengthening the period of impact recognised both ‘before, during, and after’ that last, last…no hang on…last period. But I fear we are at a crucial crossroads. Anything could be related to (peri)menopause, but not everything is or should be.
You can purchase 
MasterCourse I: Comprehensive Diagnostics. 
Burning, tingling, crawling, buzzing, humming, zapping, pins & needles, numbness:
