A few years ago I heard Felice Jacka, Associate Professor (Deakin University), speak about her research linking mental health to certain Western dietary patterns and possibly many of you have already heard me rave about her work. This year I had the pleasure of hearing her again at the recent Science of Nutrition in Medicine Conference and guess what I learned this time? Felice is actually Alf Jacka’s daughter…I know I’m a bit slow sometimes. For those of you still going, “Huh?” – I am guessing you’re not from Victoria and certainly didn’t study at Southern School of Natural Therapies. Alf Jacka is considered by many, a pioneer of naturopathy in Australia and he established SSNT. So I was thoroughly delighted when Felice, who is a very highly regarded researcher, made reference to her late father, & naturopaths generally, as being trail blazers: articulating many of the physiological drivers behind mental health decades before they turn up in the mainstream zeitgeist e.g. digestive health & the central importance of microbiota, excess glutamate activity in addiction. Felice’s key interest lies in how we can prevent depression and mental illness at a population level via diet and she seems keen to essentially bring a more holistic perspective to the often reductionist world of health research.
I also recently attended the annual Biobalance Conference one (yes I truly have nothing else to do with my weekends!) which had Jerome Sarris on the bill. Many of you will be aware of Jerome who is a Senior Research Fellow at The University of Melbourne, following completion of his doctorate at The University of Queensland in the field of psychiatry. Again, some of you would have heard me mention his work in previous posts – he’s attracted more than $4 million in grants and has published some very high impact papers on the use of CAM in psychiatry. Personally, I find his review papers demonstrate a deeper understanding of CAM so clearly lacking in those written by non-naturopaths i.e. the others miss the point and he generally gets it and can find a way of putting voice to naturopathic nutrition in the forum of a scientific dialogue.
Anyway, at Biobalance, another speaker on the bill essentially suggested (possibly unintentionally) that naturopaths had less of a grasp of complex nutrition than integrative GPs and much to my delight, Jerome, a keynote speaker, responded by identifying himself first and foremost as a naturopath and then saying on the matter , “Ahem…I don’t agree at all”…or something to that effect. It was a great moment.
So fellow naturopaths and integrative practitioners, be assured that we are being beautifully represented by these trailblazers & if you’re interested in getting into research yourself – I suspect there’s never been a better time.
Also presenting at the Science of Nutrition in Medicine Conference this year was Professor Eastman who is a world-renowned Australian endocrinologist with a primary interest in global iodine deficiency. He is also Deputy Chairman elect of the International Council for the Control of Iodine Deficiency Disorders (ICCIDD) and is frequently consulted by Australian health authorities and medical groups on the issue of iodine deficiency in Australia. Boy did he have some things to say…and it kind of went like this:
Substantial epidemiological research has shown that 95% of euthyroid patients have a TSH between 0.04-2.5 mIU/L (note the current reference range suggests results < 4 mIU/L are okay, Eastman strongly refutes this)
The mean TSH in adisease free population is actually 1.5 mIU/L
In fact Professor Eastman was emphatic that the meanTSH in iodine replete individuals is actually 1 mIU/L
While acknowledging the limitations of spot urinary iodine testing for the assessment of individual iodine status, he genuinely seemed at a loss to understand GPs reluctance to refer for this test when patients exhibit risk factors for hypothyroidism and in his article (Screening for thyroid disease and iodine deficiency. Eastman CJ. Pathology. 2012 Feb;44(2):153-9.) he argues strongly for screening of all mature age women, pregnant women (1st trimester) and school children, using the urinary iodine and TSH together
And while we’re stirring the pot how about this: Professor Eastman says that hyperthyroid individuals who have a low urinary iodine result should still be given judicious iodine! Such sacrilege!!
But wait…before you get too excited and join the ‘too much iodine is never enough… just look how much the Japanese eat’ camp…I was very relieved to hear Professor Eastman remind the audience that while the Japanese diet does provide substantially more iodine than the Western one, it is not without problems, with very high rates of thyroid disease especially thyroid cancer and in fact, Japanese health authorities are concerned about excessive intake and are currently investigating ways to cut back. And lastly, if you’re not convinced by this, he says perhaps you should talk to one of the many litigants in the current class action against Bonsoy, who developed severe thyroid diseases thanks to excessive iodine exposure from the milk (7.5mg/cup)!
So keep arguing for urinary iodine assessment and for addressing individuals with ‘within range reference results’ for TSH that are clearly not healthy ones. Check out Professor Eastman’s article, there’s a goldmine of information in there and while we’re talking about incredible resources in nutritional medicine – take a moment out to thank Dr. Tini Gruner (previously from Southern Cross University) for her significant contribution to naturopathic nutrition education in Australia. She was a mentor and inspiration to me and many others. She sadly passed away this week and we will miss her dearly.
A key speaker every year at the Science of Nutrition in Medicine Conference is Professor Michael Fenech, who is a research group leader at the CSIRO. He’s internationally regarded as an expert in understanding the relationship between DNA damage and nutrition. If you’ve ever heard him speak before you would know that while folate is a topic often at the centre of his research he is not a fan of folic acid food fortification nor the recommendation for all women to use supplements prior to and during pregnancy. I’ve heard him approach this issue from several angles, not the least of which is the danger of exposing everyone to high levels of folic acid. As Professor Fenech says, while this level of intake may be appropriate and helpful for some, it will be problematic for others. This year he mentioned the elderly as a specific at risk-group. There have been several papers published both here and in the UK (which has a similar fortification program), which suggest a link between higher folic acid intake and worse cognitive function in those elderly with low B12. A recent Victorian study (Moore et al. 2014 Among vitamin B12 deficient older people, high folate levels are associated with worse cognitive function: combined data from three cohorts. J Alzheimers Dis. 2014;39(3):661-8) found that elderly subjects with a serum B12 <250 pmol/L & red cell folate >1,594 nmol/L were more likely to have impaired cognitive performance (adjusted odds ratio (AOR) 3.45, 95% confidence interval (CI): 1.60-7.43, p = 0.002) when compared to participants with biochemical measurements within the normal range. That means almost 3.5 times the risk!
This study, alarmingly, also found that participants with high folate levels, but normal serum B12, were also more likely to have impaired cognitive performance than individuals with within-range results, but not to the same extent as the B12 deficient (about 1.7 times the risk) & other research has not consistently shown a negative impact from high folic acid alone. Professor Fenech cautions that excessively high rbc folate results are increasingly being seen in Australians and warns we won’t know the full fall-out from this for some time to come.
Of course B12 deficiency is rife in the aged community, with a UK paper recently citing that the reported B12 deficiency incidence rises to 24% and 46% among free-living & institutionalised elderly respectively when a more accurate marker of B12 status, blood methylmalonic acid, is used (Cuskelly, Mooney & Young 2007. Folate and vitamin B12: friendly or enemy nutrients for the elderly. Proc Nutr Soc.Nov;66(4):548-58.) but it also begs the question who else is at risk of excessive folic acid exposure? Anyone with possible low B12, malabsorption issues, individuals homozygous for the C677T mutation…and…..and…?
What an absolute pleasure to attend this conference this weekend just gone, where the presenters were researchers, most of them internationally acclaimed in their respective area and to find what they had to say SO clinically relevant and to find the presenters SO unafraid of bucking the norm (be that the NHMRC dietary guidelines, folate fortification, the use of broad TSH reference ranges, the refusal by many medicos to use urinary iodine testing of individual patients etc. etc.).
Then to boot – to be able to ask them questions! Want to know about N-acetyl cysteine? – How about asking Dr. Michael Berk the Australian researcher who ran the first human studies in psychiatry and is the most prolific research of NAC yourself?!
I’d attended the inaugural conference some years ago in Sydney and, while there were less attendees this time around on the Gold Coast (must be our horrible weather! ), I thought the format and quality was just as good. While I certainly saw some familiar faces – I would have loved to see more – I think we’ve got to make the most of these independent sources of information, because, while we can get some great ideas and tips from company seminars – there will always ultimately be a barrow to push and some bias. I found this to be true, most disappointingly even at last year’s NHAA conference where so many of the main speakers ultimately had a vested interest and a product to sell the audience. Given that’s supposed to be independent that was even more appalling I thought. The Science of Nutrition in Medicine Conference is of course not free of all sponsorship but I didn’t see any bias permeate into the presentations from this. So major congrats to the organisers of this one (ACNEM, CSIRO & NSA), mark it on your calendar for next year as a probable must-see and over the next few weeks I’m going to bring you some of the key highlights from what I heard – that might just change the way you practice! Very inspiring 🙂
As most of you know, I’m a big fan of establishing good communication with the other practitioners (GPs, psychologists, osteopaths, specialists etc.) also caring for my patients and what began as occasional letters that I found exasperatingly difficult & time consuming to write has become second nature. That’s not to say every letter I write now hits the spot & evokes the desired response but I think I’ve got a pretty good run rate. So I put together some tips that I thought might help you either get started or get SMARRRTer at it!
S – Service
M – Medical language & conventions
A – Accuracy
R – Reasonable
R – Rationale
R – Respectful
T – Time-conscious
Service
A summary of the most important medical aspects of the case is a great time saver for other health professionals & assists them in making better informed clinical decisions
Summarise key points of reference
e.g. Betty Smith (BMI 36kg/m2, Waist 92cm)
e.g. Depression (diagnosed 2010, Zoloft 100mg/d)
Pick out the salient features of the case
What are the absolute must-knows in the case?
Medical language & conventions
Only use medically accepted terms & diagnoses
e.g. avoid naturopathic speak such as dysbiosis, adrenal fatigue etc.
Quantify EVERYTHING relevant
e.g. weight loss/gain (7kg in 3mo), DASS scores, stool Bristol type & frequency
Include all units of measurement
e.g. 4.6 mmol/L, 129/84 mmHg
Summarise medical hx in table form for easy reference
Accuracy
Clarify which details you have first-hand Vs second hand – be careful not to be part of Chinese whispers
e.g. patient reports being diagnosed with lactose intolerance
When including patients’ own words – use quotation marks
e.g. patient reports feeling “dizzy & vague with brain fog most days”
Clarify if some things have been self-prescribed – otherwise the assumption will be that you gave/recommended it to them
Reasonable
Don’t use a scatter gun approach when suggesting investigations
Try not to ask for subsidised testing that the GP is simply unable to do under subsidy
e.g. Full thyroid function test can’t be subsidised without a prior diagnosis of thyroid disease or TSH outside of reference range…WEIRD BUT TRUE
Rationale
Present a brief, clear justification for any requests
e.g. Iron studies (vegetarian diet)
Include appropriate references when the justification is likely to be beyond expected knowledge
e.g. as a deficiency of this vitamin has Vitamin D – both 25 (OH)D & 1,25(OH)2 D, been implicated in a large number of autoimmune conditions assessment of both forms is recommended (Smieth et al. Vitamin D in Autoimmunity. Am J Clin Nutr. 2013)
Respectful
Ask for their assistance/insight/review/guidance
Don’t forget – you want & need it!
Keep in mind also how the relationship your patient shares with this practitioner may be positively or negatively impacted by the respect & tone of your letter
Time-conscious
How far in advance should the GP receive your letter in order to give him/her adequate time to read & digest the content?
e.g. too close to consult – GP might understandably feel ambushed/rushed/unprepared
How much time does a GP or other professional have to spend with each patient?
In summary the less words the better – look for ways to reduce your word count, cut to the chase and ideally get most letters down to 1 page
In the Byron shire we have a fabulous local comedian called Mandy Nolan who makes a lot of fun of the health and food fads that regularly sweep this area and one of her favourite catch-cries is “I’m gluten intolerant-intolerant, if I meet another person who tells me they’re gluten intolerant I’m going to scream!” Although I take genuine gluten reactions very seriously I do get where she’s coming from and it stems primarily from pervasive misunderstandings & misuse of terms in the community. The problems with this are multiple: firstly those people who are walking around with an exaggerated sense of their problem will unnecessarily limit their diet (and perhaps the diets of their loved ones) at significant financial, nutritional & even psychological cost and then we have people who have the most extreme gluten reactions not receiving the serious attention that they absolutely need in all sorts of settings like restaurants, childcare centres and schools…because seemingly everyone has some sort of ‘gluten issue’ & therefore it has become dangerously ‘normalised’.
So let’s just recap the possibilities and try to clear the confusion. When people walk through our door and tell us they ‘can’t eat bread’ or ‘pasta makes them bloat’ or ‘I don’t think wheat agrees with me’, that’s where our work just begins in terms of needing to clarify what the nature of their reaction is. Putting them immediately on a gluten free diet is a mistake because it doesn’t tell us which one of the below issues is at play and therefore fails to give us clear guidance about what is an appropriate course of treatment & dietary intervention.
Coeliac disease – while there are a multitude of testing options for CD the first place to start is the genotype. If you don’t have the gene it is extremely unlikely that you have CD. If you have the gene then there’s about a 1/3 chance you might & specific tailored antibody testing or jejunal investigations are necessary.
A genuine wheat allergy (not CD) is rare but is more common in infants & toddlers. It can be diagnosed by blood antibody tests (IgE RAST) or skin prick testing (SPT) for wheat
Non-coeliac disease gluten sensitivity – may not involve the immune system at all, however, raised anti-gliadin antibodies are frequently seen in these patients
FODMAPS – is not an allergy but a type of intolerance due to impaired digestion of the fructans found in wheat. We must rule this out as a possible explanation for someone’s reaction and I would start with a good checklist of other FODMAP foods to check tolerance e.g. soy, dairy, increased fruit intake and check for other conditions that can lead to this via disruption or destruction of the small intestinal brush border
Carbohydrate digestion issues other than (or in addition to) FODMAPs i.e. underfunctioning of the pancreas
Red herring! And don’t forget this old pearl… it could of course be a total red herring. Perhaps the reaction is due to another component in bread (yeasts, preservatives etc.), or the other foods they always eat with the pasta (tomato etc.) or their general poor diet quality and speed of eating, lack of relaxation around meals etc. etc.
My one exception would be in children diagnosed on the spectrum for autism. I think going gluten free where possible is appropriate from the get-go in ASD. For everyone else, a correct diagnosis is the essential first step to effective & proportionate treatment so keep your wits about you my fabulous fellow diet detectives!
We’ve all heard about the higher incidence of mood disorders (depression, anxiety etc.) in women and chances are we’ve all seen this reflected in the dominance of female clients who present seeking help but what’s this really telling us? Many of us are aware that men are more likely to ‘self-medicate’ with alcohol and other substances, as a maladaptive way of dealing with the psychological stressors, however, the lesser talked about fact is that substance induced (i.e. cannabis etc.) psychotic disorders are significantly more prevalent in men and occur at younger ages than women (Bogren et al 2010) and substance use & abuse is commonly not sufficiently explored or adequately diagnosed in general practice amongst male patients. Oh dear…what else do we need to know?
The results of a large English survey on mental health and help-seeking behaviour published in 2005 found that men were less likely than women to say that they would seek help (OR=0.78, 95% CI 0.72–0.88,P<0.001). The preferred reported source of help was friends or relatives with 63.1% saying they would seek help from this source. In addition to this and somewhat, more alarmingly, the WHO reports that “doctors are more likely to diagnose depression in women compared with men, even when they have similar scores on standardised measures of depression or present with identical symptoms.” https://www.who.int/mental_health/prevention/genderwomen/en/ So even when males do finally present for help, often, the mental health problem is being overlooked or missed.
One theme that keeps coming up in research is the ongoing associated stigma for men with mental health issues. A study published in 2008, conducted by two National Institute of Mental Health postdoctoral fellows in mental health care policy at Harvard Medical School, investigated the effect of gender, race and socioeconomic status on psychosocial barriers to mental health care and found that white males were most likely to mistrust the mental health care system and were also likely to perceive mental illness as a stigma and therefore avoid formal mental health care https://www.sciencedaily.com/releases/2008/09/080908125123.htm
In my practice we actually have a high proportion of males presenting with mental health concerns, admittedly, our practice specialises in this area so that may be a key reason for this and in many instances the appointment has been instigated or driven by a concerned mother, a wife etc. Regardless, I’ve found that many men really struggle & it’s made somewhat more complicated by the role they are expected to play in society. I think the key message is not to reinforce gender based stereotypes on our patients, have the confidence to explore mental health with male patients, their vulnerabilities, concerns etc. as much as you would your female patients. Make sure you thoroughly assess their substance use and take heart there is a lot we can do for these individuals, the first step is recognising there’s a problem.
Rachel will be speaking on Young White Men & the Mental Health Challenges They Face at the MINDD International Forum in Sydney June 14-15th. For more information and bookings check out: https://mindd.org/forum/mind2014.html
2014 is well and truly zipping along & we wanted to let you know Rachel is lined up for some great seminars and webinars this year. Here are the next few off the rank so you can join us in anticipation and set aside the dates:
Biomedica N-Acetyl-Cysteine Webinar
N-Acetyl-Cysteine the ‘King of Anti-oxidants’ but what is all the fuss about and is it clinically relevant? Rachel will step you through the current literature punctuated by her own cases to let you know how powerful this ‘King’ can be as part of your dispensary.
“It’s not often that a nutritional product becomes available and changes the way you practice but NAC has done exactly that!” R. Arthur
Date: 19th June 7-8.30pm
Nutrition Care monthly webinars
‘Current Controversies in Nutritional Medicine – What Do We Need to Know?’
In this series of webinars, Rachel will take a close look at the medical research – and how recent studies have sparked controversy and cast doubts about the use of nutritional supplements in complementary healthcare.
The first installment will be ‘Calcium supplementation and cardiovascular disease, what are the risks and how relevant are they?’
Dates: May 29th, June 12th, July 24th, August 21st, September 18th and October 23rd
MINDD Forum
Young White Men & Mental Health
Rachel is delighted to have been invited to present at MINDD again this year and her contribution will include a presentation of 2 case studies of young white men struggling with mental health issues. Many say this demographic doesn’t often present for help but come and find out what an important part of Rachel’s client base they are and the promising results we can achieve. In addition to this, Rachel will be coordinating a practitioner Q & A forum as part of the event.
Dates: 14th-15th June Sydney
Don’t despair there are more events to come but we’ll update you later in the year. We look forward to seeing you at some of these and hearing your feedback & suggestions, so we can continue to bring you more of the tailored education you want from Rachel Arthur Nutrition.
About a decade ago there was a lot of excitement about using fish oils in the management of mental health, so much so even the American Psychiatric Association developed recommendations suggesting that people with mood, impulse control & psychotic disorders should all consume 1g EPA + DHA per day… but then what happened? Ask most health professionals (GPs, psychiatrists, naturopaths & nutritionists alike) today whether fish oils are their first choice in mental health nutritional interventions and you’ll frequently get a, ‘No’ and I include myself in that.
Let’s retrace our steps to find out how we got here. The epidemiological evidence linking low omega 3 intake to myriad mental health problems in terms of susceptibility, incidence and severity is almost overwhelming. For example, depression rates are 10 times higher in countries with limited seafood intake and post-partum depression 10-50 times higher (Kendall-Tackett, 2010).
Noaghiul & Hibbeln postulated that countries where individuals consumed less than ≈ 450-680g of seafood per person per week demonstrated the highest rates of affective disorders (2003). One study of 33 000 women with low omega-3 intake were found to have an increased risk of psychotic symptoms (Goren & Tewksbury 2011) and it goes on. Then, we have other evidence also pointing in the direction of fish oils, such as the general consensus that excess unchecked inflammation is evident in many mental health conditions (Maes et al 2013). Numerous intervention studies using fish oils as stand-alone or adjunctive treatments have been published. Interventions have included high dose omega 3 (no specific EPA/DHA breakdown), EPA alone, ethyl-EPA, high DHA, blends with high DHA:EPA ratio, flaxseed oil etc. etc.
These studies are quickly followed by the systematic reviews, meta-analyses etc. which almost invariably conclude that supplementation with fish oils isn’t effective – or more correctly, based on this terrible mish–mosh of evidence no firm conclusions can be reached.
Take the Cochrane Review on the use of fish oils in Bipolar Disorder for example, which based their negative conclusion on the results of one study (Frangou et al 2006), while > 23 others failed to meet their inclusion criteria (Montgomery & Richardson 2008).
The big take home message should actually be: Fish oils ain’t fish oils!
If you understand some of the key structural & biochemical differences between EPA (precursor to eicosanoids, able to generate DHA, little structural contribution to the brain) and DHA (major structural brain fat, precursor to the docosanoids including resolvins, mild reuptake inhibitor of 5HT and DOP), the superior bioavailability of triglyceride forms over ethyl esters and the seriously limited ability of humans to convert plant omega 3 precursors to the LCPUFAs, then you can start to see your way through the research mess and step away from the broad brush stroke conclusions of the Cochrane review and similar.
Check out some of the better written and more insightful reviews – especially this one by Sublette (2011) which found that in successful treatment of depression fish oil supplements must have >60% EPA compared with DHA and read her theories on this. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534764/ So we need to get reading and get clearer about which specific omega 3 fatty acid or blend (and in what ratios) works for which mental health problem – its definitely not a case of one-size-fits-all – do your homework and pick your products well and most importantly let’s not throw the fish out with all that fishy research!
Do you still eat & recommend fish as part of a healthy diet? I do. Of course these recommendations have now become species-specific and include other key criteria such as ‘wild not farmed’ and ‘local not imported’ in response to increasing concerns about contaminants especially organic methyl-mercury (MeHg) and the organohalogen pollutants (OHPs or POPs). Most of us understand about biomagnification of MeHg in the food chain which results in the highest levels in the largest fish but did you also know that as the MeHg content rises, the relative Selenium content drops? What are we worried about? Lots actually. A key mechanism behind MeHg toxicity that has come to light is due to its negative interaction with selenium. Now, as many of you know, I just love a good nutritional interaction and this is a great example of one!
It is now understood that MeHg is a highly specific, irreversible inhibitor of Se-dependent enzymes required to prevent and reverse oxidative damage throughout the body (i.e. glutathione peroxidase & thioredoxin reductase), particularly in the brain and neuroendocrine tissues. In fact inhibition of selenoenzyme activities in these vulnerable tissues appears to be the proximal cause of the pathological effects known to accompany MeHg toxicity.
MeHg binds tightly to Se rendering it unavailable for selenoenzyme activities and their synthesis. This makes sense in terms of the cardiovascular, thyroid and oxidative consequences associated with MeHg toxicity. So essentially what MeHg is doing in one sense is inducing a profound selenium deficiency which funnily enough shares a lot of the features of MeHg toxicity: thyroid dysregulation, immune system dysfunctions, & infertility! But wait there’s more…several pieces of research highlight the potency of this relationship showing that we can predict who will manifest Hg toxicity features following exposure by the individual’s Se status e.g. those that maintained reasonable Se levels in spite of the Hg exposure didn’t manifest the toxicity picture. One study on this topic looked specifically at Hg amalgams. Another study fed juvenile rats a diet of fish with a known content of MeHg, and a variable amount of natural or supplemental Se. They found that Se in blood, brain, & spinal cord was positively correlated (r between 0.69 and 0.90) with protection from neurological damage attributable to MeHg.
In response to these findings, there is some discussion about grading the health and safety of fish for human consumption according to their Se:Hg ratio (ideally >1), however, further research in this area suggests this is complicated with evidence that this is not simply species-specific but strongly influenced also by locality (Jones, Butler & Macleod 2013). While an American study found for both saltwater and freshwater fish, some species with ratios >1 had a significant proportion of individual fish with ratios < 1 (Burger & Gochfeld 2013). So what’s the upshot of all this and where do fish oil supplements fit in? Well MeHg levels in TGA approved supplements are extremely low so this is really a non-issue as long as your patients are not shopping for their fish oils overseas and with all our fish eating friends – keep an eye on their mercury levels (blood or hair) – we’ve picked up a few with extremely high levels from seafood intake alone and consider Se the logical first step in addressing high levels.
Head on over to the down loadable audio page, now.
Many of you have been asking if we could make my presentations available for download instead of on CD. You can now do both!
The Rachel Arthur Nutrition (RAN) store on the website now has downloadable audio and CD-audio sections where you can buy my presentations. You can also get the regular case-study premium audio product from its own page.
If you have been waiting for presentations in this form, or you just want to have a look around, please go to the downloadable audio page now.
The first step is to reflect the posts that we add to this site and our newsletter. We will let you guide us as to what you would like to see us do with it in the future.
In the meantime please “like” us so that we can start to get traction in that corner of the online world.
I love Rachel! She is an extraordinary clinician and researcher and still manages to maintain a sense of humour despite the volumes of work she does and the number of other practitioners and students she supports in addition to her own research and teaching.
Rachel is superb at honing in on critical issues that are not always immediately apparent. One of her greatest strengths is her ability to examine a case in-depth and break it down piece by piece to determine what tests might be most valuable, and then to interpret the lab findings in an overall context, e.g. what a patient’s copper balance is in relation to zinc, rather than just looking at independent values, in order to build a comprehensive picture of a patient’s health or otherwise.
Rachel invariably pulls a rabbit out of the hat … ! Not only is she supremely generous with her knowledge and clinical expertise, she is always glad to share her research and has been known to go to extraordinary lengths to set aside time for supervision / mentoring – even if this means 9pm on a Saturday night!
“Sessions with Rachel have given me the insight and knowledge I need when I don’t have time to research myself. An hour with Rachel is similar to three months of filtering through books and data. Valuable evidence based knowledge and support for any practitioner”.
“I have found the mentoring sessions with Rachel invaluable in terms of professional development and support. Typically the clients that come through the door present with quite complex health issues. This can be overwhelming as a new practitioner, and having Rachel to discuss cases with has been a huge boost to my confidence and my effectiveness.”
Cate Creemers, Naturopath & Medical Herbalist
Ibod, Clevedon, Auckland
), I thought the format and quality was just as good. While I certainly saw some familiar faces – I would have loved to see more – I think we’ve got to make the most of these independent sources of information, because, while we can get some great ideas and tips from company seminars – there will always ultimately be a barrow to push and some bias. I found this to be true, most disappointingly even at last year’s NHAA conference where so many of the main speakers ultimately had a vested interest and a product to sell the audience. Given that’s supposed to be independent that was even more appalling I thought. The Science of Nutrition in Medicine Conference is of course not free of all sponsorship but I didn’t see any bias permeate into the presentations from this. So major congrats to the organisers of this one (ACNEM, CSIRO & NSA), mark it on your calendar for next year as a probable must-see and over the next few weeks I’m going to bring you some of the key highlights from what I heard – that might just change the way you practice! Very inspiring 🙂
