I arrived home from the Farmer’s Market this week ready to cook a little number I like to call ‘egg dinner’ (fancy I know 😉 ) and found my organic bunch of kale, covered in dirt. Ok, admittedly, there was a small reflexive, barely-audible-beyond-immediate-neighbours, ‘tsk’ that may have escaped my pursed lips…quickly followed by my own auto-correct that went something like this, “thank goodness we have a Farmer’s market with real farmers and they grow real food, that actually grew in real dirt and you know what else I love about it…it goes off real fast.” Seriously, that should be a selling point and proof of the kind of substances I want to put in my mouth…readily biodegradable! Not long after these thoughts popped into my head…this article popped into my inbox…
A new year, a newly issued list of the famous ‘Dirty Dozen’. And look who just made it in at number 12!!
Kale
Not my kale from the certified organic farmers at my local market, but regular Kale. The Kale that is in your green smoothie at a cafe & stuffed into every other recipe plausible on many menus. The kale that many patients will go and buy from the supermarket shelf, spurred on by sound advice from us and fabulous intentions.
A recent Medscape Review talks all about what the Environmental Working Group (EWG), a nonprofit organisation focused on human health and the environment, have found in their annual report about the agricultural contamination of fruits and vegetables in the USA. Even though the report is always good food for thought and a routine reminder that some of ‘best foods turn bad’ as a result of unhealthy modern agricultural practices, we should not assume complete translatability. The Australian dirty dozen is not likely to be identical to the one from the US, given farming practices and laws around food safety vary significantly between countries. If you want to drill down more into this then make sure you read One Bite at A Time co-authored by one of very our Own Clean Fifteen 😉 Tabitha McIntosh.
Far from wanting to place any further barriers or discouragement in path of regular patients keen to increase their vegetable intake, which the report states are the (currently accused) growers concerns (hey, how about you spend more time focusing on cleaning up your farming practices guys!), It is just a gentle reminder that a bit of (certified organic) dirt is far preferable & the kind of dirt want to be eating.
PS You might also like to know that the clean list of fruit and veg for 2019 in the US includes: Avocados, sweet corn, pineapples, frozen sweet peas, onions, papayas, eggplants, asparagus, kiwis, cabbages, cauliflower, cantaloupes, broccoli, mushrooms and honeydew melons
Love getting back to grassroots with a bit of dirt therapy?
Our famous Dynamic Balance recording is the foundational teaching resource in mineral nutrition. Minerals represent a critical tool in naturopathic nutrition and there has been an explosion of research in this area over the last 10 years. In order to optimise patient care, practitioners need to keep up with the constant stream of information, updating their previous beliefs and understanding in the process. This seminar is designed to facilitate and accelerate this process of review and re-evaluation via a fresh look at the key minerals iodine, selenium, iron, copper, zinc, calcium and magnesium.
So we already know that thyroid problems can start in utero, right…but a recentMedscape review(the fountain of thyroid information that I frequently drinketh from 😉 ) on Hypothyroidism in childhood taught me a couple of big things I hadn’t known before!
The diagnostic criteria for subclinical hypothyroidism are raised TSH levels in combination with a normal concentration of free serum thyroxine (FT4) but because there are some differences between accepted ranges in TSH assays, high-risk groups should be screened, especially babies with malformations, whose mum received steroid treatment during pregnancy or in the neonatal period, or who had existing thyroid dysfunction, TFTs (or at the least TSH as part of what’s called the Neonatal Screening test) should be repeated 2 weeks later. But now comes the couple of big light-bulb moments: the incidence of eutopic thyroid in twin births is nearly double compared with singletons! As you know, I’m a mother of twins and I’m guessing at 18yrs old now (and multiple peachy TFTs 😉 ) the horse has well and truly bolted for my two but geez…I had no idea of the dramatic increase in risk. And it keeps going…monozygotic twins very commonly show a delayed TSH rise and those numbers are even more prominent in multiple births. The other not-so-fun-fact is the discovery that subclinical hypothyroidism in IVF babies is approx. 10% which is noteworthy considering none were observed in the control group.
This obviously left me thinking “W.H.Y?” And of course…the first place my head goes with the latter…is iodine.
The reasons behind our increasing rates of thyroid dysfunction across the life-stages are multifactorial (and don’t get me started on the very real contribution of EDCs!) and how, in spite of iodine adequacy being the first thing on the checklist for thyroid health, so many health professionals ignore this, at their patients’ peril… But now at least we know that patients with IVF babies, twins, and preterm bub, who are currently not included in the prioritised screening groups should be…and of course we should keep asking the questions, “what are the mechanisms behind this, why is it so?”
So if this has made you even more curious about the incredible butterflied-shaped gland and you’d like to go for a stroll on the vast plains of “thyroidisms” you can click on this link Thyroid Assessment in Kids and Teenagers and get completely “thyroided” up. There is always more research to come our way so keep your eyes and ears peeled.
Too many times we see thyroxine treated patients on the ‘set and forget’ setting. Often, they’re taking the same dose they started on a decade or so ago, in spite of weight changes, ageing of course and new comorbidities. They’ve undergone limited monitoring, with just an annual in-range TSH viewed as confirmation of efficacy. But is it? Many patients’ re-emerging hypothyroid signs and symptoms would suggest not.
A recent Medscape review article of a large study by Gullo et al 2017, identifies another shortcoming in the rudimentary way we ‘replace thyroid hormone’, in all patients but especially in those who’ve had their thyroid removed.(more…)
Medical doctors are branching out in their search for effective treatments for schizophrenic patients. You see while most of the drugs available currently for this condition are aimed at reducing ‘positive symptoms’, however they can often make patients’ ‘negative symptoms’ worse or simply fail to improve these in the same way
Need a quick lesson in positive and negative symptoms? Sure thing! In schizophrenia positive symptoms are the ones most typically associated with schizophrenia or psychosis, such as hallucinations, delusions, disorganised thoughts and sensory processing deficits. While experiences such as apathy, anhedonia, lack of energy and impaired cognition and all the way through to catatonia, are referred to as negative. Different patients will have their own mix of these as part of the condition but generally, as you can imagine, both are severely debilitating and impair an individual’s ability to function well.
Enter N-acetylcysteine (or NAC to friends!)…..
The neuroprotective, antioxidant, anti-inflammatory and glutamatergic properties of NAC have been shown to significantly improve the ‘negative symptoms’ of schizophrenia in recent trials, when given in conjunction with an antipsychotic drug, over a one year period. There is also hope that NAC may prevent the progression of brain mass loss that is consistently observed in schizophrenic patients. Dopamine-receptor agonists (antipsychotics), which are the go-to treatment for schizophrenia, potentiate the negative symptoms of the disease and contribute to brain mass loss.
AND!! That’s not all folks! For the Herbalists out there…
Trials using Withania have also resulted in “significantly greater reductions in negative, general and total symptoms…in comparison with placebo.”
One doctor from the Semel Institute at the University of California went as far as to say he “used to be skeptical about the utility of herbals and nutraceuticals” but he “now believe(s) this is an up and coming field”!! Good news all round!! Serious kudos and credit must be piled enthusiastically on Professor Michael Berk, the prominent Australian psychiatrist, whose pioneering work in the field of NAC in mental health has paved the way for truly attitude-changing studies like these.
For those of you who’d like to know more about NAC in Mental Health, we have just what you need…a presentation brings you up to date with the latest in NAC research in a large number of mental health conditions & translates this into the clinical context.
NAC in Mental Health Previous ideas regarding the pathophysiology of mental illness have been profoundly challenged in recent times, particularly in light of the limited success of the pharmaceuticals that ‘should have worked better’ had our hypotheses been correct.
I’m packing the bag and getting my ‘roadies’ ready……well, not really but it would be great to have one or three!
I’m super excited to be going on tour in May with Nutrition Care and introducing new clinical tools I’ve been developing to help you master the maze of mental health, and what a maze it is! With so many possible biological drivers: from methylation to inflammation and from gonads to gut, these tools can help you quickly identify those most relevant to each patient and also outline the strategies necessary for redressing these.
This year’s theme for Nutrition Care is
Mastering Mental Health: New Assessments and Management Resources in Your Clinic.
I’ll be visiting all the major cities again and I’m especially excited about coming to Newcastle and the Gold Coast! Can’t wait to see you all and pow-wow about what I’ve learned about mental health management.
Better than online.
When we’re all in the same room is when the magic happens with a true sharing of our experiences and knowledge.
Upgrade’s always give you so much more and here at RAN, we wanted to give our UU30 subscribers more….more podcasts…actually, access to the ENTIRE LIBRARY OF UU30 PODCASTS!
Get yourself plugged into Rachel’s knowledge from over the last four years with 55+ podcasts worth a total of $1300+ for only $299! You can audio stream Rachel’s pearls of wisdom in one online location, anytime.
“It has become the most useful, productive and effective way for me to learn new information. I can listen to it when it suits me, and stop and start the recording as I am noting the key points into the format I need ready for easy access when I have clients in front of me! “ – Maria Harpas, Naturopath
Another reason to go premium…
You can look through the back catalogue and with no need to purchase them individually. These include ones that provide you with actual clinic handouts and other downloadable tools such as: Ten Top Tips for Accurate Blood Tests (includes a Pathology Testing – Patient Support Questionnaire) , ‘Dear Doctor – tips on letter writing’ (includes a referral letter template), ‘Taking Care Down There’, and the famous ‘Gilbert’s Girls’,‘Histamine Excess’ and the very popular ‘Chronic Threadworm’. Listen to these incredible clinical updates anytime and make the most of the time-saving clinical tools that are shared with you.
PREMIUM SUBSCRIPTION
Access the ENTIRE back catalogue of podcasts over the last 4 years, in addition to all podcasts released over the next 12 months. Best value of just over $4.50 per UU30 edition.
Let’s get in you plugged in to the UU30 library by becoming a Premium Subscriberor upgrading your Standard Subscription by logging into your account, selecting your subscription and clicking on ‘upgrade’.
Are you hearing me? Yup, it’s been a BIG year..and to think I don’t even have the ANS technically to blame this year!! How about you?
But listening to myself say this to people, in my wrap-up of the year-that-just-was, I am thinking….Has anyone EVER got to the end of year and exclaimed, “Wow! That was a small one?!”
Not me, not ever, well not in my living memory! But somehow I forget. I get to December and I think, ‘Geez, I’ve never felt this spent before! I need to go on holidays and never come back, retire from work and retreat from the world’, until someone who loves me, and who has a longer memory than a goldfish says, ‘Love, you always feel just like this.’ The upside to this annual amnesia is, it pushes me to make very conscious choices for my holidays.(more…)
We’ve got a Brand New Specialist Mentoring Group starting up in 2018! Due to a growing number of medical doctors participating in individual mentoring and our group program we have decided to offer a group entirely dedicated to integrative doctors or any medical doctor interested in incorporating wellness models and nutritional interventions into their practice. Across all of the mentoring groups I always try and ensure a ‘good fit’ for participants, with shared levels of experience, areas of interest wherever possible and over the years of mentoring doctors, I have come to appreciate there are unique educational needs and a clinical context that is clearly distinct from the naturopathic practice model and reality. So, this new 1hr our monthly online meet up with like minded doctors across the globe to go over cases, offers us an opportunity to meet your mentoring needs in the best way possible and truly accelerate your knowledge and skills in integrative medicine.(more…)
PPIs are one of the prescribed medications in Australia but the concerns are escalating. Not just from a naturopathic or nutritional perspective regarding the extraordinary concept of lowering gastric HCl by approx. 80% but much much more worrying concerns. I talked about some of these back in 2014, I remember making an executive decision at the time not to mention concerns that their long term use produced higher rates of gastric cancer, that even conservative medical news-feeds were starting to mention… I didn’t want to be alarmist. But the mechanism for this correlation is highly plausible – PPIs only inhibit acid production but they do not control the gastrin release by these cells and in fact the gastrin release rises with their use…and guess what gastrin is a trophic agent, it stimulates growth in the stomach and in other tissues. (more…)
I had the privilege of presenting at the Integria GIT Symposium last weekend. For those of you who attended, you’ve gone back to your clinic with a bunch of new ideas and inspiration I hope…oh and a new respect, terror and watchfulness for threadworm thanks to me! In my presentation I outlined the many presentations of this infestation, what to watch for and the risk of chronic recurrence due,in particular, to a reduced ability for some individuals to produce chondroitin sulfate which renders the GIT environment hostile to worms.
Chronic threadworm is a huge & grossly under-recognised issue in paediatrics, often presenting as behavioural & cognitive disorders (and these can be severe), bruxism, enuresis etc. of course, but another presentation typically missed is vulvovaginitis, vulval pain or UTI like sx in young girls.(more…)
Ever wondered where on earth (or Mars?!) I came from? As much as I can’t keep quiet on some topics, my personal journey to here has been a bit of closed book to many. Recently during an interview with Andrew Whitfield-Cook from FxMedicine, which was supposed to be strictly about postgraduate education paths and the desperate need for mentoring, internships etc for naturopaths, the sneaky devil got me to spill the beans on a whole lot more!
Having been involved in so many aspects of naturopathic and integrative health care education over the past 15 years, of course I do have a lot of ideas about how practitioners can best accelerate their learning and development, the need for more independent education and the importance of fostering critical thinking.
I think you already know that I feel passionately about this but do you know the whole story? Who I have been mentored by and how I continue to tread the path of the ‘student’?(more…)
Kia ora tātou!
Yes, that’s right! I’m heading off again to the land of the long white cloud. I’m very excited to be part of the Inaugural Conference that the New Zealand Society of Naturopaths and the Naturopaths of New Zealand are hosting 9-10th September in Auckland.
I’m coming to talk about the wealth of clues hidden in the most common blood tests results your patients already have and as per usual this information will be illustrated by lots of examples from my own patients and (I hope!) a few good chuckles 🙂 I will be doing a couple of presentations over the weekend and here are the times… (more…)
Make the most of this special offer! If you become a12 month subscriberbefore the end of January (that’s tomorrow!) you receive 10% off ALL individual mentoring sessions in 2017!
And just so you know what we have in store for you as an Update in Under 30 Subscriber this month: Rachel’s kicking off the year with ‘Melatonin – Misunderstandings and Mistakes’ – an amazing clinical update about what we are getting right and wrong with Melatonin. This podcast answers in particular, one of the most common sources of fascination & frustration for clinicians, the reasons behind the Melatonin non-responder. We’ve all encountered patients who have taken Melatonin for sleep problems and reported no benefit, or initially responded and then lost efficacy quickly, or even patients who experienced insomnia after taking. What does this tell you about your patient and what should you do to resolve this and better still, prevent it? Now we know.(more…)
Have you heard what everyone is saying about the “Update in Under 30 Podcasts”? But more importantly, have you heard about “Update in Under 30 Podcasts”… fullstop?! If you’ve somehow missed out on being a subscriber & receiving these monthly gems over the last few years, you MUST read on … These dynamic podcasts will help you keep abreast of the latest must-knows in integrative medicine. Focused on one key issue at a time, Rachel details all the salient points so that you don’t have to trawl through all the primary evidence yourself. In Under 30! Each podcast represents unbiased education that can contribute to your CPE points and is delivered to your inbox every month for under $13 a month… how easy is that!(more…)
I think most of us visualise the clearly malnourished young woman, when we think of eating disorders however, while anorexia nervosa is something to be on the watch for, our patients are presenting increasingly with more unusual, atypical patterns of disordered eating, that are easier to miss. Some of you for example, will be familiar with the term ‘orthorexia’ which is an emerging diagnosis characterised by an obsessional approach to only eating those foods deemed by the individual as healthy, ‘pure’, ‘good’. Gluten-, Dairy-, Soy-, Grain-, FODMAP-, Sugar free organic cookie anyone?
Are we likely to see people afflicted with this…absolutely! As practitioners who deal extensively in food and health related behaviours we are really sitting in the hot seat when it comes to eating disorders – likely to see more of these clients than many other practitioners and also walking a fine line when giving restrictive dietary advice to patients, so as not to trigger this sort of unhealthy thinking.(more…)
Due to popular demand and increasing interest, I am so pleased to announce that I will be starting a secondRachel Arthur Mentorship Program (RAMP) from May until November 2016!
RAMP is a program that focuses on providing practitioners with the most accelerated form of post-graduate education and clinically relevant skill development. RAMP will be commencing in May, on the last Monday of every month at 10:30am until the final call in November (a total of 7 skype call mentoring sessions).
RAMP group mentoring is a great way to build a supportive networkamongst likeminded practitioners, whilst refining your skills in areas of pathology interpretation, differential diagnosis, shared care navigation, research skills, and nutritional & naturopathic interventions.
We’re super excited to announce Rachel’s upcoming tour Sensational SAMe – Mental Health and Beyond with Nutrition Care & based on the incredible feedback about Rachel’s last tour…you should be too! 🙂
“I love having the opportunity to share what I know about one of my absolute favourite products with everyone. I prescribe this every day and it’s one my clients always come back for. When it works it really works!” Rachel
Whether you’re a practitioner that regularly uses SAMe or you have just started dabbling with it, this seminar is must attend. Overflowing with case studies, the latest cutting edge research and Rachel’s expertise, this half day seminar will tell you everything you need to know about how to best use SAMe in you practice as well as deepening you knowledge of how it works in application to conditions from addiction all the way through to arthritis.
“Don’t be frightened off by all the Methylation Madness out there! Come along and find out just how powerful, easy to use and diverse SAMe really is”(more…)
I am frequently asked by practitioners about where I find research and whether I subscribe to journals. I always tell people to look for information that is available for free first. Google has recently released a new web browser plug-in making accessing free, independent, full text research articles even easier! Pretty groovy huh?
As my last post suggested not relying on information provided just by company reps (if you missed it check it out here) is essential to being an informed practitioner. So here’s an introduction to Google Scholar button for your web browser to help you do just that!
What is it?
The Google Scholar button is a plug-in that you can install on your web browser (currently available for Chrome, Firefox and Safari) so that you can find the source article of referenced information via the title or take your web searches straight to Scholar. Google Scholar will show free and fee-based article in its results.
How does it work?
Simply install the plug-in on your browser (‘How-to’ install and use Google Scholar Button is detailed California Digital Library here) and use the button in the tool bar to search Google Scholar or copy and paste the title of the article you wish to find.
How will it help you?
This tool enables users to find the full text article from just the article title, or to search for full text scholarly articles and books. These may be free or fee based, but the point being it enables you to find free ones.
Get it here!
Download the plug-in right now for Chrome here and Firefox here.
I’ve just completed a seminar series educating practitioners across Australia about how to recognise & correct sex hormone dysregulation in men & the response has been overwhelming. Everyone seems to be in agreement that this subject was seriously under-cooked in their undergraduate training, which is such a shame given that low testosterone, male subfertility and infertility have escalated in recent years and so too has the number of male patients we’re now seeing Here’s some highlights that might give you something to think about:
There is general agreement that men’s sexual health is an independent marker of their current whole health & strong predictor of future health – not just in terms of cardiovascular but also mental health, premature ageing, bone integrity…the list goes on!
While the rate of erectile dysfunction in a cohort of health middle-aged American men was 52%, a recent Italian study revealed that 25% of men with a recent onset of erectile dysfunction were less than 40 years old!
International men’s health specialists go even further & suggest that results of a semen analysis provides us with all we need to know about a man’s health
So if you’re not asking your male patients about their sexual health (and yes that includes the young ones) how much of their whole health story are you missing??
Many of you would now be aware of the shift from culture (stool MCS) to gene-based stool testing (stool PCR) which has now become available under Medicare subsidy. While this has been an exciting development that promised greater accuracy for the detection of parasites in our patients, there remains limitations. One of the biggest is the fact that the PCR test is based on just one stool sample compared to the 3 day samples used in the culture test.
While this is rationalised, both by the pathology companies and some doctors, by higher test sensitivity and specificity, it flies in the face of our understanding about the irregular shedding of parasites i.e. the presence of the parasite in an infected individual’s stool can vary from nothing to severe, just day to day, therefore diagnosis must be based on several days of stool collection to account for this.
A practitioner I mentor, faced with several patients with negative PCR results but a clinical picture and other pathology results (raised eosinophils, impaired iron levels etc.) that strongly suggested the presence of parasites has been debating this with her shared care providers trying to encourage them to still refer patients for the stool PCR but performed over several samples.
She came across this article as a nice piece of supportive evidence Irregular shedding of Blastocystis hominis (Venilla et al 1999): ncbi.nlm.nih.gov/pubmed/9934969
While there are numerous other studies confirming the irregular shedding of most parasites this is a handy paper perhaps to use to strengthen the case for PCR stool tests performed over 3 days rather than 1. Let’s face it – it’s a big enough ask to get our patients to collect stool – we should really ensure we have optimised their chances of getting an accurate result!
