I promised I would keep all you fellow desk workers posted. Over 6 months has passed since I started standing for work….and I LOVE IT!
Here are the pros I can wax lyrically about so far:
Back ache from long days at the computer, gone…seriously
I am more energised about coming to work, starting work, staying at work…because I am not sitting! YAY! I move around…everyone I meet with on Skype will vouch for that!
I am fitter & stronger as a result of standing for approx. 35hrs a week ( I know this because it took a while to develop this…after the first 2 slightly grueling weeks!)
At the end of a long day/week, my mental fatigue and physical fatigue finally match – which means I am no longer brain-dead but in desperate need of a run around the block! The previous mismatch used to make winding down etc hard
I get to actually walk my constant talk to patients about being active, avoiding sitting etc. Soooooo much better than sitting there for client after client and saying…’you know you really should move more!’
And at the end of a big day…sitting never felt so good…it’s been restored as the luxury item it should be 😉
No, I haven’t gone crazy for the ‘caped crusader’… but I thought that would get your attention…. oh look it did! 😉
I’m off to Melbourne for the ACNEM Conference May 5-6th and Batmania was one of the interim names of this very cool and happenin’ town before it became known as Melbourne in 1837! Things have certainly changed in nutrition and the environment since then and as practitioners we now need to address sometimes very complex dynamics between genes, gut, nutrition and environmental health. Which, luckily enough this conference is all about!
This year’s theme for ACNEM is Health for Life – Mastering the Integrated Approach.
I am fortunate to be included in the exceptional speaker line-up (thanks for lovely sentiments many of you have expressed so far about that 🙂 ) I am presenting on ageing..which many of you know that I am suddenly now very interested in…getting old and all.
Ok now you’re getting mad at me, right? Because how many ‘absolute givens’ can I debunk?! Last Update in Under 30 certainly got people talking…giving iron less often rather than more often to our most iron deficient patients seems counter-intuitive, right?! Wrong. And as part of the influx of emails I’ve received from practitioners who listened and loved the podcast, came a flurry of great questions – like this one from Michelle Toocaram:
“The Moretti et al study was done on ferrous sulphate which I would never use as it has poor bioavailability. Are there any studies on better forms such as ferrous glycinate etc”
It’s a perfect question – because of course the success of most mineral supplements is largely determined by the form the mineral is presented in – so comparing the same dose of, for example, Calcium carbonate with Calcium citrate is a bit like comparing chalk and yoghurt! The substances that minerals are bound to, generally play a huge role in determining the amount you will absorb from that product and therefore the degree and speed with which your nutritional status will improve. But is that the case with iron? Not quite.(more…)
“Researchers followed more than 500 women trying to conceive over about five years and found that, overall, those with moderate to severe iodine deficiency had 46% lower odds, per cycle, of becoming pregnant.”
All researchers dream of generating the kind of results that are ground-breaking but sometimes you read about the latest study’s findings and you think, ‘Really, you spent all your time & cleverness for years on this and that’s all you have to show for it!’ Like the study that finally confirmed dog’s can feel empathy (at last thank goodness …phew…cos I had my doubts until they crunched the numbers!)
So too a study published this month on the possibility that iodine deficiency is common in women trying to conceive in developed countries and may be connected to increasing fertility issues.
Stop press! I know…that made you spill your coffee!(more…)
Is this the way of the future for health practitioners interested in patients’ digestion…?
“The team developed an ingestible electronic capsule to monitor gas levels in the human gut. When it’s paired with a pocket-sized receiver and a mobile phone app, the pill reports tail-wind conditions in real time as it passes from the stomach to the colon…The authors are optimistic that the capsule’s gas readings can help clear the air over the inner workings of our intricate innards and the multitudes of microbes they contain. Such fume data could clarify the conditions of each section of the gut, what microbes are up to, and which foods may cause problems in the system. “(more…)
If you receive the free Medical Observer newsfeeds you’ll know what I’m talking about. Here are some recent headlines:
I stand accused of rorting Medicare. This is what it’s like
A GP is sued after doing everything right — except her notes
After-hours funding shakeup
‘We’re becoming unviable,’ says GP hit with $22K e-PIP repayment
This Christmas I wish for doctors to feel valued again
So the answer is, probably. Tales direct from the trenches that I hear from GPs, suggest it is increasingly difficult to make a living without adhering to a crazy volume of <10min appts, without being sued (too often) or dragged in front of AMA or APRHA. I hear them and know that the increased pressure is coming from multiple angles and I think it is very sad that previously such a respected and valued role in society appears to be ‘losing its value’. Don’t get me wrong, I don’t agree with the old ‘Doctor as God’ model and think it ‘s very unhealthy actually for patients, but I feel like GPs with all their extensive training, knowledge and expertise are in urgent need of an Oprahesque ‘new dawn’! (more…)
Just because most of us have been on holidays doesn’t mean the thyroid knowledge wagon has stopped or even slowed! Always amazed at what we continue to discover about the complex working of this amazing gland and how its health impacts so much of the rest of the body and of course our babies’ bodies! So I thought I’d give you a quick recap of an important study published while you were at the beach/in the bush/in bed ;)…
A Finnish prospective cohort study of over 3000 pregnancies by Heikkinnen et al has revealed that at 16yo, offspring from these pregnancies, had a 1.56 increased rate of unhealthy weight and a 2.5 greater likelihood of meeting criteria for metabolic syndrome, if their mothers were thyroperoxidase antibody (TPO) positive during their first trimester
TPO antibodies affect up to 20% of pregnancies but in this study they defined ‘TPO positive’ as those women with levels ≥ 167.7 IU/mL (the 95th centile in this sample)
What adds to the noteworthiness of this news is that:
More than half (55%) of the TPO positive mothers were classified as euthyroid during their pregnancy, suggesting that the effect was not driven by maternal hormone concentrations
The offspring of mothers with actual thyroid dysfunction did not show any statistically significantly greater risk of cardiometabolic issues
The offspring of hyperthyroid mothers in fact demonstrated significantly better insulin sensitivity at 16yo than children of euthyroid mothers
Thyroglobulin Abs over the 95th centile (≥ 47.7 IU/mL) did not correlate with any increase in cardiometabolic risks for their children
When we consider the substantial evidence of poorer maternal cardiometabolic outcomes for women who are hypothyroid during pregnancy – it would seem that the abnormal thyroid hormones are most impacting for mum but in fact the TPO Abs the most detrimental for bub!(more…)
I’m getting a sore neck from this, but looking back at 2017 and looking ahead to how I want 2018 to be, is of course perfectly appropriate for this time of year.
And if we don’t take this opportunity for a little bit of reflection and review then we risk our growth: both personal & professional.
Looking back, as always there were both highlights and some lowlights – highlights for me included receiving the BIMA lecturer of the year award, being asked to speak in Europe and getting out from behind the computer and coming face to face with more and more practitioners as I toured around – sorry webinar junkies…but long live LIVE REAL PRESENTERS & PRACTITIONERS! Lowlights? Well they included of course the private health insurance reform in Australia…enough said.(more…)
Recognise your own name or someone else’s on this list?
Dear 2017 Group Minties aka Mentees. I have always struggled with the term, ‘mentees’…seems too American or something and this morning when I was out walking, I had a light-bulb moment – I am proposing a re-branding to something much closer to home (!)… I propose we rename you Minties!! Because you are always fresh and you give me & your fellow Minties always something; cases, questions, clinical conundrums, ethical dilemmas, every month to seriously get our teeth stuck into! Cheesy but true 😉
Congratulations on completing your full year of group mentoring – and if this is your 2nd, your 3rd even your 4th year then I bow to you even more deeply.
Thank you for including me on your support team and entrusting me with helping you grow & develop as exceptional practitioners.
You should be celebrated for your commitment to your own learning & your endeavour to always improve your knowledge and skills.(more…)
And then you don’t, right? Because if my experience is anything to go by, there are some patients that just don’t respond to the usual iron repletion strategies. Depending on how low their ferritin is, this can then precipitate ‘practitioner panic’ (we’ve all had it right?!) where we’re inclined to go higher & higher with the dose and number of doses per day. Typically, this also fails. I hear about this from other practitioners all the time and I see the ‘normal’ doses of iron sneaking up and up. Remember the days when we couldn’t get a non-pharmacy supplement with over 5mg elemental iron in it and now we have > 20mg? But still, I hear you say, this fades into insignificance when you think about the standard medical model for iron correction which provides 100-200mg/day and you’re right.
Gee… after hundreds of years of knowing about this deficiency and being the most common deficiency word-wide, you’d think we had our supplemental regime nailed.
**Note this 1st group is only offered to those individuals who have previously undertaken mentoring, either group or individual sessions with Rachel(more…)
No this is not a joke. The room they enter happens to be the clinic space of a practitioner I mentor. The older women are friends, both originally from the UK and they sit in on one another’s consultations sharing many of the same experiences: grief over loved ones lost, memories, laughter and both describe waking in the morning with a sense of dread, because they’re tired, feel they’ve lost their oomph, their motivation, their chutzpah…that’s mostly why they’ve come today.
But know what else these two have in common? (more…)
Standing at the podium, I looked down at my notes & slowly read out the title of my presentation to the hundreds of people attending, ‘Paediatric Digestive Issues & Neurocognitive Abnormalities’ and briefly froze thinking, Holy Heck (!) this is someone else’s presentation! Seriously. No, this is not one of my work stress dreams. This happened. I thought…oh my how am I going to deliver this, it sounds very complex and lofty and scary!!
Then I saw my scribbled hand notes on the page, the unofficial name I had affectionately given this presentation as I researched, compiled my case studies and brought it into being, months prior and I instantly relaxed…oh…Kids’ Guts Are Mental…now that I have some serious experience with and something to say about!(more…)
Have you been a bit vitamin D trigger happy? Does a patient’s low blood 25(OH)D test result have you reaching for a vitamin D supplement like the rest of us? Yes…you might need to listen up then. Sunshine doesn’t come in a bottle. That’s right, if your patient’s problem stems from inadequate sun exposure, have a guess what the best remedy is. I’m not meaning to sound flippant but I think in all my ‘complex highbrow nutritional understanding’, occasionally (ahem), I have lost sight of the simple truths.(more…)
Chronic coughs, rhinitis, postnasal drip or even asthma? Have you ruled out silent reflux?Aka laryngopharyngeal reflux. Patients experiencing silent reflux don’t present with heartburn or any typical GORD features but ultimately suffer from a similar failure of the lower oesophageal sphincter (LOS) – with their complications manifesting higher up, into the upper digestive and respiratory systems. An overlooked and under-recognised condition, medical opinion has fluctuated about its name, prevalence, significance, management…you name it…however there is now a strong body of evidence that says this condition should be diagnosed and investigated as a cause of many of these otherwise unexplained chronic symptom pictures.
Take this case from group mentoring last month:(more…)
Can you help me out here? My memory has failed me. Someone, somewhere (Mel? Syd? Auckland? Online during a mentoring session? In a Mullumbimby supermarket?!), in the past month asked me for this paper documenting the increased pain perception reported by subjects given IV saline with a slightly acidic pH compared to a neutral preparation. Quite an extraordinary illustration of the potency of small pH changes in the ECF and the impact this can have on our pain perception.This study is one Professor Vormann has previously talked about and as I’m touring with the fabulous German Professor right now I said, ‘Sure!’…then seemingly instantly erased from my mind who made this request! Is it you?
This month is a fabulous blur of travelling & speaking, getting back face to face with everyone at a bunch of seminars & conferences, which I love but I do forget some days where I am, who I am and exactly what I have promised and to whom!(more…)
I’ve been known to give calcium more attention than most and now I feel vindicated. Serum calcium, of course is not a reflection of your calcium intake, calcium losses nor overall calcium status. In this regard it is totally useless. But my fixation is about what even slight variations away from healthy levels of this mineral can reveal.
You’ve probably heard me openly scorn the parathyroid glands
“How hard can it be? These glands have just 1 job: keep the blood calcium in range! Snort!”
And that is exactly why it is so meaningful when this appears to be a ‘big ask’ and the serum calcium slips under 2.2 mmol/L or over 2.45 mmol/L & so potent given the huge chain of physiological reactions that follow from such a small shift – producing profoundly negative effects on vascular dynamics, neurological function etc.(more…)
…Chronic Kidney Disease (CKD) that is! That’s the ad we really need broadcast on prime time tv. On par with osteoporosis and other conditions that ‘seemingly appear out of nowhere’ in people’s 60s and beyond, there’s a potent combination of ignorance (patients) and denial (health professionals) at play it seems, when it comes to discussing the earliest signs of CKD that typically start decades before you’ll ever get a ‘diagnosis’. Being specialists in preventative health care – this is something we need to have firmly on our radar in terms of early identification and also in our repertoire when it comes to risk reduction. Most of us know about water intake and all the medical risks for renal impairment but are we equally onto the critical role that mild acidosis plays in driving this condition?
Another young female presents in my clinic with a newly diagnosed thyroid cancer and has been recommended urgent thyroidectomy. Her story is increasingly common. If you’re not seeing it in your clinic, you will, because thyroid cancer, and almost exclusively papillary thyroid carcinoma (the form my patient and most young patients have), is dramatically increasing. Since the 1970s the early 2000s there was a 67% increase in the incidence in women and a 48% increase in men, documented in 5 continents (Peterson et al 2012). Our Australian data is equally shocking with the number of new cases of thyroid cancer diagnosed increased from 361 (104 males and 257 females) in 1982 to 3,154 in 2017. The question begging to be answered is why…?!
Increased screening and more effective detection of smaller tumours was the going theory for years. New research rejects this absolutely and concludes instead this is a ‘true increase in occurrence’. Increased radiation exposure? Mutation studies say no. Many researchers are pointing to is a ‘new environmental chemical and/or dietary factor’ and EDCs (Endocrine Disrupting Chemicals) that target the thyroid such as perchlorates, phthalates, parabens and phenols are the likely suspects. And, more than likely, with iodine deficiency in an individual, conveying even greater susceptibility to these EDCs.
But wait there’s more.These ‘new goitrogens’ aren’t only implicated in thyroid cancer, a large number of human studies confirm the higher your urinary metabolites of these, the lower your thyroid function. More worryingly is that they might be doing this ‘without a trace’. With myriad impacts at the receptor level, altered hormone excretion rates, impaired peripheral conversion etc. the data to date suggest these patients TFT results might only look ‘slightly low’ or even ‘normal’ but the reality is they are suffering hypothyroidism. Sound familiar?
There is a HUGE body of scientific evidence we can pull from to understand the role of EDCs in thyroid problems in our patients, how to maximise prevention and minimise impact – even when your patient, like mine, is perhaps already in the full grip of the consequences. I’ve read all the papers and summarised them in this 30min recording…
Hypothyroid without a trace – the role of EDCs.
Have you got patients with hypothyroid symptoms but normal results? Or results that suggest the HPT axis just seems to be broken? Could it be the result of a combination of Endocrine Disrupting Chemicals (EDCs)? How do you assess for these ‘new goitrogens’, which act more potently and more insidiously, inducing hypothyroidism ‘without a trace’. How do you maximise prevention for all of your clients and the most at risk sub-populations or minimise impact for those already in the full grip of their consequences.
This Update in Under 30 audio comes with 3 key related scientific articles and a bonus larger powerpoint presentation
Last week I threw down a challenge. Following on from the ruffling of many feathers regarding Jason Hawrelak’s report that dietary saturated fat increases uptake of endotoxins from the gut, I provided his reference list in support of this claim, effectively saying, “if you don’t like his findings, then make your own informed conclusions but make sure you read all the evidence first”. I offered a prize to everyone who made an attempt and a year’s free subscription to Update in Under 30, to the person who produced arguably the best summary.
I’ve said it before and I will say it again, and again, and again: Our professional community abounds with extraordinary individuals.
People’s response to this challenge proved that once again.(more…)
