8 Jul 2015 | Clinic, FAQ
So…a 40 something female walks into your clinic with depression & anxiety…sounds common enough right? But here’s the twist: she’s already seen another practitioner who ran a range of investigations revealing she has pyrroles, high copper levels & is homozygous for the C677T MTHFR mutation. Her medical history includes significant use of Ecstasy and a partial thyroidectomy due to nodules & she has persistently high TSH. But wait there’s more!…The first practitioner upon discovering all of this put the patient on 12 different products which included zinc, B6, evening primrose oil, vitamin D, thyroid support etc etc. And guess what…the patient feels worse!
Frequently our patients are just as complex as this case & sometimes our attempts to narrow the treatment focus through thorough investigation instead leaves us feeling we now have even more things we need to deal with than before! Feeling overwhelmed?? Often! At risk of completely overwhelming the client as well? Definitely! And a reflex to throw your whole dispensary at a client never ends well. (more…)
1 Jul 2015 | Clinic, FAQ
I’m only human & there are some questions that do make me silently groan & invisibly (I hope!) roll my eyes. One is the old chestnut: “but the Japanese consume on average 7mg of iodine a day!” which is typically offered up as a rationale for the need for mega dosing of iodine in everyone. This is of course only a partial truth & the missing bits make all the difference! The Japanese have some of the highest rates of thyroid disease in the world & this is in part, attributed to their high iodine exposure. Secondly, it’s simplistic & flawed to isolate one characteristic of a whole diet & not appreciate that its effect or impact is mitigated by the context of the entire diet & lifestyle of that population. In the case of the Japanese, for example, this includes relatively intake of isoflavones, key goitrogens which will reduce the bioavailability of the iodine both within the gut & at the thyroid. Harrumph! I love iodine & am frequently suspicious of a deficiency in my clients, however, like many nutrients feel that our ultimate objective is for optimal nutrition…not excessive.
Am I just a conservative scaredy cat perpetuating fear around this topic in the industry? Well…..no. There is accumulating international evidence of big spikes in autoimmune thyroid disease diagnoses following the introduction of iodine fortification programs in previously iodine deficient countries such as Greece, Turkey & Brazil. There is of course evidence as well that iodine supplementation in Grave’s & Hashimoto’s disease can lead to delayed recovery or worsening of the condition. (more…)
22 Jun 2015 | News
Last week I spoke to a group of psychiatrists, doctors and nurses working at a psychiatric hospital about N-acetyl cysteine for a whole hour! Anyone who has worked in pharmaceuticals, (which of course I did in a previous life) or has seen medical CPD up close even, will appreciate that this really was a remarkable opportunity a) because it wasn’t funded by a drug company whose sole intention is to drive more prescriptions for their drug and b) because it was instead facilitated by a nutritional supplement company (many thanks to Bioconcepts) who allowed me to simply bring the current evidence regarding NAC in mental health: strengths, weaknesses, limitations and all, to the attention of these front line health care providers.
This sort of information i.e. non-drug company sponsored, is simply not getting through to our medical colleagues. This is in part, because their CPD is monopolised by pharmaceutical companies who have the budget to dominate the stage. I’ve worked in that industry and I remember it well but not fondly. So, in spite of the fact that the bulk of the NAC trials in mental health are actually due to the work of own Professor Michael Berk, their colleague, the majority of the attendees had never heard of this nutrient and certainly were not aware of any relevance it had to their own medical practice. (more…)
11 Jun 2015 | Clinic
I was chatting with a colleague today about a complicated & interesting case of hers, severe hypothyroidism coupled with overt hypercortisolemia (salivary cortisol up to 230!). This is a distance patient & she’s sharing care with a couple of other health professionals with conflicting ideas…tricky!!
So when my friend received an email last week to the tune of… “things are bad, everything is terrible if not worse”, then naturally she starts worrying: What has she missed? What’s gone wrong? What more could/should she have done? Is this some sort of aggravation to the treatment she’s recommended?
This is the place our minds naturally go when faced with these scenarios however one of the things I have really learned over years in clinic is that patients, like me, like everyone else I know, are labile, in the moment kind of creatures & we’re all vulnerable to having BPDs. (more…)
5 Jun 2015 | Clinic, News
Like all thyroid disease, post-partum thyroid conditions seem to be on the rise – and often they rewrite the rule book when it comes to thyroid pathology & its management. Therefore for many of us it can add an extra element of uncertainty about how to help these clients.
One of our graduate practitioners has a great example of this, a 33yo female who developed late gestational diabetes and is now struggling with a new baby and an autoimmune thyroid disease! What would you do? Does post-partum thyroiditis have unique triggers/drivers that require specific treatment? What can you/should you be doing differently because she is still breastfeeding? What’s the likely progression/prognosis?
This is your invitation to come along and find out the answers to these questions and more. During our live graduate mentoring session on Monday 15th June at 3.30pm AEST we’ll work through all aspects of the case, from history to presentation and from looking for clues in her pathology results to where to start with treatment. (more…)
28 May 2015 | Clinic, FAQ, News
Ever noticed that thing called RDW (red cell distribution width) reported in your patients’ haematology results? Given that this parameter is currently regarded as one of the most important & earliest markers of a wide range of serious diseases, you might start paying some more attention to it from now on!
Dr. Michael Hayter, cleverly refers to RDW as being a reflection of the ‘Quality Control’ of an individual’s red blood cell synthesis.
As it’s a measure of how similar or dissimilar our rbcs are in terms of size, smaller values (suggesting homogeneous rbcs) are regarded as healthy, while higher RDWs suggest that some part of rbc synthesis and/or clearance process is faulty.
This makes perfect sense in the context of nutritional anaemias like iron and B12/folate which all produce elevated RDW results but new research proposes that this rbc size disparity is also a common linking feature in just about every major disease, often predating diagnosis or in cases of established pathology signalling progression and warning of imminent poor outcomes for the individual.
There have been 100s of papers published just in the past 4 years on this topic and the findings are nothing if not dramatic. One of the biggest things I’ve realised is that, while Australian pathology companies suggest that all RDW results < 16% are acceptable, in the light of these new associations, a more accurate cut-off is probably around 13.5%! The big question now to answer is, is the increased RDW a passive marker of pathology or actively involved in the pathogenesis of these major diseases. For now, we should be scrutinising our patients’ RDW results more closely and being alert to what these markers are telling us about our clients threats & risks. I’ve recorded a 30min audio summarising all the information I’ve come across on this topic and how to apply it in your patients which you can access here.
Alternatively, if you’re happy to chomp into some juicy journal articles yourself then check out these ones to start with
https://jaha.ahajournals.org/content/3/4/e001109.full
https://www.researchgate.net/profile/Fabian_Sanchis-Gomar/publication/269930590_Red_blood_cell_distribution_width_A_simple_parameter_with_multiple_clinical_applications/links/5499b0e50cf2d6581ab15143.pdf
24 May 2015 | News
These days it seems like patients can almost be divided into two groups: those that have a tendency to iron overload and those that struggle most of their lives just to keep ferritin in the red…and what a struggle it can be. So many clients have spent years taking every form of iron there is in high doses, trying to improve their intake of dietary sources, working on their digestion etc etc but still those numbers can fail to really pick up. (more…)
10 May 2015 | News
Last weekend I attended the Science of Nutrition in Medicine Conference in Melbourne https://nutritionmedicine.org.au/enews/2015-02-06-Program.html and for those of you that didn’t make it I can tell you, it wasn’t your regular CPE event. I’m not sure if the debate inside the presentations or outside in the breaks was more interesting but I can say that I haven’t seen this much stimulated thought, heated discussion and passion at company run events. Why? (more…)
1 May 2015 | News
One of the most common questions I’m asked is whether I have a ‘set list’ of tests that I request for every patient. Of course there is no ‘one size fits all’ in health & each patient presents with their own novel combination of issues & investigative challenges, however, years of clinical experience have taught me which pathology parameters are the most clinically meaningful.
Asking yourself, ‘Will the results of this test determine my thoughts about treatment & therefore ultimately the clinical outcome for my patient?’, before referring for any investigation is a good habit to get into.
Many of us are increasingly aware of the changing environment around pathology testing, which includes reduced access to some tests in mainstream pathology. Rbc folate has had its subsidy withdrawn which means if we request this we’re now likely to receive a serum value or nothing. But does this matter? (more…)
27 Apr 2015 | Clinic, FAQ
We should all be as skilled in investigating & treating male hormone imbalances as we are female ones, yet this is often not the case. A lack of confidence in this area, which seems to be an issue for many, in particular will compromise our ability to question male clients comprehensively and effectively about their reproductive health and ultimately reduce our capacity for making good clinical decisions and achieving the best outcomes for them. If you’re female, how would you feel seeing a male practitioner who doesn’t ask you about your menstrual cycle in detail?
Many of us are at risk of committing similar crimes but we need not be. (more…)
19 Apr 2015 | Clinic
So often in mentoring I hear about patients practitioners have struggled to treat primarily because of irregular points of contact….you know the type, the client who is an Irregular Regular or Random Regular, booking in to see you just once or twice a year or just in acute situations & never doing the follow-up you so want them to do, in order to address the real underpinning causes. A case I heard the other day would sound familiar to many of us, about a patient who saw the practitioner only when she experienced cramping. Each time she’d have an appointment, buy some magnesium which relieved the issue and then disappear again, only to re-emerge with the same issue at a later time. During one of these subsequent visits, the patient mentioned that she was ‘exhausted’. Following the practitioner’s insistence that the patient bring in any pathology she had had done, the practitioner realises much to her horror, the patient has been suffering from macrocytic anaemia for some years but no one had bothered to tell the patient and accordingly, the practitioner has been none the wiser as well. The practitioner of course felt terrible because she’s thorough and conscientious but is she to blame? Where does the patient’s autonomy end and the practitioner’s duty of care begin?
Sometimes patients themselves can be a big barrier to their own wellness for all sorts of reasons and we can’t always resolve this but perhaps we need to consider introducing clinic protocols to try and better manage the Irregular Regulars. (more…)
13 Apr 2015 | Clinic, News
I regard myself as integrative which means working collaboratively with other health professionals to get the best outcomes for our shared patients, sometimes that means my patients are taking psychiatric medications & there have been instances where I have seen the necessity and benefit of the right drug at the right time. This might be in the form of short term use of atypical antipsychotics, so a recent article linking higher rates (approx. 50%) of diabetes with the use of atypical antipsychotics specifically in teenagers, caught my eye. (more…)
29 Mar 2015 | News
It seems like K2 is the supplement on everybody’s lips right now and for good reason. This is particularly true in Australia where we’re seeing a flurry of new K2 products on the market thanks to a relatively recent TGA approval for this particular form of the vitamin. But what do you need to know to make the therapeutic most of this nutrient?
Vitamin K got about 20 minutes in my undergraduate degree, and shamefully I don’t think I gave it much more as a lecturer! The buzz just wasn’t quite around then like it is now. Reading the latest RCTs & metanalyses on K2, however, you can almost hear (or is that just me??? 😉 ) the excitement researchers are feeling being part of this extraordinary wave of discovery about its therapeutic applications.
Traditionally, we’ve focussed on the K1 form, abundant in all the green leafy vegetables, but turns out we’ve been looking in the wrong direction. While K1 is still important for the clotting actions it can’t get to the bones and arteries to run the other important K dependent enzymes. In order to get these happening we need the K2 form which means we need the specific types of meat, eggs and ferments. (more…)
21 Mar 2015 | Clinic, FAQ, News
“Health issues are rarely one individual textbook condition like they were during my studies. The interaction of the body is complex, and Rachel has given me valuable insight into how to link various pathology markers & physical aspects together. Test interpretation has been a huge focus for me. The letters and numbers now mean something, and I can work with “true” reference ranges, and see how different values affect others. The sessions have been great to get assistance with cases and learn how to break things down & prioritise treatment, and also to connect with other practitioners, and hear their cases as well. I really feel like my career has received an invaluable leg up, and I’m so thankful for Rachel’s knowledge and assistance.”
Rohan Smith, Graduate Group Mentoring Participant, Adelaide.
We began our Graduate/New Practitioner Group Mentoring sessions in March 2014 with just a few keen newbies but the sessions have gone from strength to strength since then, with an ever-growing group of new graduates participating in case presentations every month. Every session I’m reminded that people are now graduating with much more sophisticated knowledge than I did. Not because the education standards have improved (ouch!) but actually because the research-backed knowledge base of our whole industry has progressed & improved so dramatically… & that is really exciting & changing the marketplace for all of us. (more…)
15 Mar 2015 | Clinic, News
I read an interesting news item in Medical Observer this week about the increasing number of patients either overtly or covertly recording medical appointments on their smart phones. Have some of your patients already asked if they could do this? Mine have and I’m also aware of some patients getting into hot water when asking their ‘old-school’ medical specialists if they could do the same thing. For me, I have always understood the patient’s desire to do this, as the information they’re being given might be complex, considered critical and they may need to hear it several times in order to grasp the details, instructions etc. In other situations I’ve experienced it’s because the patient needs someone else, who couldn’t be present at the appointment, to hear the discussion ‘firsthand’ e.g. another parent, a partner. In my mind this all makes good sense. Does it make me speak differently, think more carefully about my words etc…You bet it does! (more…)
6 Mar 2015 | News
You might have heard me talk about using an ‘upstream’ rather than ‘downstream’ approach in nutrition – the concept is very naturopathic… look at the water source and address things there rather than just tweak things downriver! One of the most important upstream influences on patient health & wellbeing I can think of is systemic pH – the body’s constant struggle to neutralise its overwhelmingly acidic input, which comes from both metabolism, inflammation, stress and of course unbalanced diets.
It’s a war out there and most of our patients aren’t winning! (more…)
27 Feb 2015 | News
I’ve booked my flights and packed my bags (at least in my mind!) already. The annual Science of Nutrition in Medicine Conference is on 2-3rd May in Melbourne & there’s one name on the bill that alone I would be attending for – Dr Robert Loblay. He’s the head of the Immunology unit at RPAH which specialises in the management & treatment of every possible type of food & chemical reaction (including all the ones the average medico would suggest are impossible/unreal or psychosomatic). By the way he also a strong interest in bioethics so this makes for a great combination in this field. He helped put together the RPAH diet and book ‘Friendly Foods’, which is such a great clinical resource for patients with food intolerances.
The way I approach food reactions in clinic has been heavily influenced by his work and because the RPAH unit is working everyday with some of the most severe, complex and unusual reactions, when he talks I listen! (more…)
23 Feb 2015 | News
How often do you find yourself writing sleep prescriptions for your patients? I do – frequently. I’ll include in my recommendations something like – ‘nap for 20 minutes every alternate day’ or, ‘commit to getting into bed 1 hour earlier 3 nights this week’ or ‘establish a bedtime routine for yourself – something that loosely follows the winning formula of bath, book, bed’.
You see I reckon we humans have tricked ourselves into thinking we can negotiate our way out of almost everything: good food choices, adequate clean water, perpetual motion etc. I mean often people come to us looking for the shortcut let’s be honest…e.g. “I’m not great with the food side so what should I be taking??”
But when it comes to matters of slumber I explain to my patients that sleep sufficiency (both quantitatively & qualitatively) is non-negotiable in the health equation. To put it another way, sufficient sleep is Wellbeing 101, step 1!
I don’t have anything I can prescribe that can make up for a shortfall…seriously…just a prescription for more sleep!
(more…)
16 Feb 2015 | News
Over 20 years ago (ouch!) while studying at Southern School of Natural Therapies, I heard for the first time that calcium perhaps had a ‘dark side’! At the time, and still to a large extent now, calcium is publicly portrayed as something you simply can’t get enough of and 20yrs ago this idea was almost heresy! Certainly in the eyes of the dairy corporation at least 🙂 Yet there had been a long-standing concept in naturopathic nutrition that the distinction between calcium’s healing and harm all came down to where it resided in the body, e.g. bones Vs blood vessels. Last week Medscape ran an editorial espousing the same concept. (more…)
9 Feb 2015 | News
Howdy everyone, thanks to popular demand (and perhaps something some people have against Tuesdays!! 🙂 ) we’ve opened up a new group on the 2nd Monday on every month at 1.30pm NSW time for mentoring. It’s brand-out-of the bag-kinda-new with a small group of practitioners signed up so far, so there’s room for you if you’re keen to give group mentoring a bash this year. We’ve had an exciting start to the year with all all mentoring groups, with lots of juicy cases, great discussion and important networks building before our eyes. If you’re interested in being a part of this group or any of our others please just email us at [email protected]. The next Monday session will run on the 9th March. Hope to hear from you 🙂
