You Might Want to Write This Number Down

No you’re right, it’s not long enough to be a Hemsworth’s mobile number but actually it’s more sought after ūüėȬ†If you’re up to date with reading & recognising all the different patterns of Iron Studies & the stories they tell, which is a daily business for most of us, then you will know by heart the striking pattern we call, ‘Pseudo Iron Deficiency’. You know the one where your patient’s serum iron & transferrin saturation are mischievously trying to trick you into thinking you need to give this patient iron…when in fact this is absolutely not what they need!¬†

This is of course the result of the redistribution of iron during inflammation – iron is actively removed from the blood and¬† sequestered in the liver instead.¬† It’s designed to protect us from bacterial bogeymen, which is how our stone-age bodies interpret all inflammation of course.¬†

Doesn’t sound familiar? Ok you need to start here or even embrace a full overhaul of all things iron here.

But for those of you nodding so hard you’re at risk of doing yourself an injury, this number is for you.¬†¬† We’ve often talked about the redistributional increase in patients’ ferritin levels in non-specific terms: it goes up..but by how much?¬† Of course we would like to know because no one is fooling us with this transiently inflated value…but can we make an estimation as to what this person’s ferritin will drop to once this inflammation is resolved?¬†Yes.

X 0.67

Write it down. Consider a tattoo, perhaps?

This glorious magic number comes from Thurnham et al paper in 2010¬†who did the number crunching on over 30 studies involving almost 9,000 individuals to determine the mathematical relationship between inflammatory states & markers and the reciprocal increases in ferritin.¬† Their work is exceptional in that it also differentiates between incubation (pre-symptoms), early and late coalescence periods (if you want to differentiate your patients in this way and get even more specific then you need to read the paper), however, overall when we see a patient who has a CRP ‚Č•5 mg /dL , we can multiply their ferritin by 0.67 and get a lot closer to the¬†truth of their iron stores. Oh and another important detail they revealed, this magnitude of ferritin increase is more likely seen in women or those with baseline (non-inflamed) values < 100 ug/L..so generally more applicable to women than men.¬†Thanks Thurnham and colleagues and the lovely Cheryl, my previous intern who brought this paper to my attention…you just took the guessing out of this extremely common clinical scenario ūüôā¬†

We’re not deaf…we heard that stampede of Iron-Inundated Practitioners! The Iron Package is for you!

Our recordings and clinical resources for improving your skill-set in¬†all things iron¬†including,¬†your accuracy of diagnosing deficiencies, pseudo-deficiencies & excesses, plus radically rethinking the best treatment approaches for each scenario‚Ķhave been some of our most popular.¬†Because nailing iron (pardon the pun) is harder than we were all lead to believe and at least 1 ‚Äėiron maiden‚Äô or ‚Äėiron man‚Äô walks into our practice every day, right?¬†So we‚Äôve brought together 5 extremely popular UU30‚Äôs on Iron into one bundle for the price of 4! So if you‚Äôre more than ready to graduate from ‚Äėiron school‚Äô, now‚Äôs your best chance!

 

 

 

Time for Some Tipi Talks?

I’ve had a bit of ‘a bee in my bonnet’ this year. I heard that! Ok, arguably it extends a little further back…like my whole career!¬†But if you’ve seen the topics I’ve been speaking on at conferences in recent months, you’ll know exactly the soapbox I’ve climbed up onto.¬†¬†Inter-professional communication & collaboration.¬†My particular focus (naturally ūüėČ ) has been current issues regarding the sharing of, and access to, pathology results for our shared-care patients. However, in the face of several distinct threats to the practise of both naturopathy and medicine in Australia of late, especially in the form of anti-collaborative rhetoric/push affecting both professions right now (read PHI reforms, promptly followed by proposed MBA review..if you haven’t read this regressive and repressive set of recommendations you seriously¬†must), the question of how to improve collaboration in order to ultimately serve our patients better, has never been more urgent.

Last week, at the ICCMR conference, I outlined the current barriers for naturopaths to accessing patients’ pathology results (current and historical) and the heightened risks that this results in, either because of incomplete information or because of the subsequent direct pathology referring by naturopaths.¬†Yes, bypassing the GP and another set of trained eyes on your patients labs comes with risks.¬†I also spoke to the opportunities that await us if we can overcome this: in terms of improved patient outcomes, reduced risk, more economically responsible public health budget spending etc. etc.¬†need I go on?!¬† In the Q & A following my presentation,¬† a doctor in the audience made two very important contributions, which deserve some additional air…she said:

“Shouldn’t the patient ultimately own their own pathology results?¬† Then it would be a case of them electing who has access to these: their GP, their naturopath, their osteopath. Rather than the other way around – after all, we are all supposed to be members of their¬†health care team, right?”

She said it.¬† Not me. But I applaud her. She’s right of course. Right now, under the current proposed changes, we and integrative health care delivery¬†and¬†patients’ right to choose and self-direct their healthcare¬†and¬†public health budgetary burden…are all under threat of de-evolving. Right at the time when, with the current chronic disease burden and predicted public health budget blowouts,¬† it should be all hands to the pump!¬† Who has ever conducted a cost-benefit analysis of what integrative health care (successful patient sharing between naturopaths and GPs /specialists) saves the government?¬† No one is my guess and when I proposed I do exactly this for my PhD on a particular parameter some years back, I was not so subtly told, that in spite of a great application, given the primary funding of the research group was from government, and a clear conflict of interest with the head researcher who was also a government advisor, ” my proposal was not in line with the current directives”.¬† Yep.

Last week, a dear mentee of mine mentioned that a GP one of her patients sees responded to her respectful correspondence regarding their shared patient with absolute terror, citing possible de-registration if they are seen to be collaborating or interacting with her in any way…assuming the MBA changes go through.¬†¬†This doctor then decided the lesser risk, was to cease communication with this other key member of the patient’s health care team, not refer the patient for any follow up investigations (including those representative of basic duty of care) and certainly not enable access to any pathology results for this patient from the past or in the future.¬† My mentee’s exemplary response to this doctor:

“My apologies for placing you in an uncomfortable position. I do understand the restrictions and guidelines GPs must work within for Medicare and AHPRA and understand that as you are the requesting practitioner you are liable for any pathology referred for.¬†¬†I make this clear to all my patients and that my referrals are on a request base only and it is up to yourself or the requesting GP for the final decision. I only try and request pathology through a GP or other medical practitioner to try and minimise both risks (of only myself viewing these labs) and unnecessary costs to the patient.

…’X’¬† has currently been seeking medical and alternative treatment for over 2 years and yet has had no change, if not a worsening of his condition and when I saw them 2 weeks ago, it was my understanding that not even basic assessment of full blood count, liver function and other general health markers had been completed. I had advised X that not all pathology may be covered under Medicare, and to come back to me so I could send him privately for those tests not able to be completed under Medicare. My apologies this was not made clear to you at the time of his appointment.

I take pride in my evidence-based approach to nutritional health in my practice, and work frequently with other patients‚Äô medical practitioners in supporting their health. Thank you for your time and I appreciate your thoughts on this matter”

If the patients’ best interests are no longer the primary goal, as decided by bureaucrats, both government and organisational, is it time to ask the actual health professionals to please stand up?! Is it tipi-talk time for practitioners from all disciplines?¬† Growl over.

Want to ensure you are writing professionally to other health care practitioners?  Then our recording and resource Dear Doctor, is for you!

In this 45min podcast Rachel succinctly covers the serious Do’s and Don’ts for your professional letter writing. Rachel gives step-by-step instructions and examples for key phrasing and clear medical justifications, what terms to use when in order to come across respectfully, and how to present urgent red flags without sensationalising. This podcast is will  help your professional letters improve collaboration for you and your patients need.

 

Wondering Who Shouldn’t Fast?

 

 

Remember biochemical individuality folks? That great core underpinning principle of naturopathic & integrative nutrition. We should always keep this in front of mind, when something utterly fabulous for absolutely everyone pops its head up.  Like every month or so, in the area of health, correct?

Fasting, in all its forms, is having a lot of time centre-stage right now. What a novel & truly prehistoric notion in this era of food 24/7! I get it and I agree, most of us would do much better by regularly moving out of the top paddock.

BUT…and there has to be a but…or we are no longer treating the individual…

Some of whom, due to specific conditions or biochemical tendencies, do utterly horribly with any sort of prolonged periods between feeds.¬†¬†I already have a hit-list of conditions where fasting and food restriction is a no-no…then I saw a set of labs the other day from a patient who self-initiates regular, 4-6 day fasts during one of said fasts,whose alarming results jumped out in¬†bold, italicized¬†CAPITALS, illuminated¬†itself in neon pink and reminded me to remind you!¬† This patient’s (extended) fasting labs went a little like this… total bilirubin 48 (normally 15 umol/L),¬† bicarbonate 18 (normally 26 mmol/L), corresponding anion gap 20 (normally 12), uric acid 0.62 (normally 0.4 mmol/L).¬†Are you thinking what I am thinking B1?

So here’s my hit-list of ‘fasting = foe’ for – still subject to case by case assessment (of course!! because we treat the individual, right?!)…but

  • Any individual with a history of, or currently risk factors for, disordered eating, e.g. orthorexia, bulimia, binge eating disorder, anorexia
  • Gilbert’s Syndrome
  • Low T3 – thyroid ‘hibernation’
  • Hypocortisolemia
  • Anxiety and PTSD
  • Drug addiction
  • Children, pregnant women, the elderly…of course!

In short: any patient whose condition or biochemistry may be too negatively impacted even in the short term by any of the following: higher cortisol release, significant slowing of phase II detoxification, or radically elevated acidosis, should step away from the fast and towards the fridge!¬† ūüôā ūüôā

Got any you want to add to this list?

What’s this you say about a hibernating thyroid?

Thyroid hibernation produces a low T3 value coupled with a ‚Äėlowish‚Äô TSH¬† and typically a clinical picture of hypothyroidism.¬† As the practitioner we are faced with the conundrum of how to effectively ‚Äėwake up‚Äô the pituitary which appears to be sleeping on the job.¬† This audio connects up the dots between this type of thyroid dysfunction, dietary patterns, restrictive eating (including a history of eating disorders), carbohydrate intake and disturbed iodine nutrition of the thyroid gland.¬† This pattern is increasingly seen in practice and this audio is a must for anyone working in the area.

 

Mind Your P’s and P’s

 

Do you know that saying, ‘mind your Ps and Qs?’¬† It basically means mind your manners and I heard that a lot as a kid ūüėČ But what we really need to hear now, as practitioners and promoters of healthy eating and wellness is really,¬†Mind your P’s and P’s because a lot of biggest health consequences of any diet are determined by the balance or imbalance of two major players; protein and potassium. We’re always looking for simpler ways to enable patients and ourselves to¬† be able to both recognise the strengths and weaknesses of their diets and, better still, apply a simple method to making better choices moving forward.¬†¬†Eyeballing the protein and potassium rich sources in any diet speaks volumes about other essential dietary characteristics and the likely impact of diet on health – and getting the relationship between these two right should be a goal for us all.

“World Health Organization (WHO) Dietary Targets for Sodium and Potassium are Unrealistic”, reads the recent headline from yet another study finding that humans would rather challenge the solid science of¬† human potassium requirements than acknowledge the urgent need to turn this ship of fools around!

This large study, conducted over 18 countries, involving over 100 thousand individuals, reported that 0.002% met these targets.¬† That’s 1 person in 50,000.¬† Now, the researchers’ response to this is that we should lower our dietary potassium expectations….such that the targets are more achievable and so that (frankly) we are less perpetually disappointed in ourselves and our terrible food choices. Wha???? Back up there. The WHO guidelines, just like any other nutrition authority, derived these minimum amounts from a thorough review of the science that speaks to our physiological requirements and the level of nutrients that have been shown to be associated with health. Australia’s own fairly conservative NHMRC suggests even higher amounts for good health!¬† Perhaps rather than revise the established dietary targets we should revise what we’re putting in our mouth!

So where does protein come into this?¬† Well one of the most important and central nutrient dynamics is the balance or imbalance of our intake of both.¬†¬† And in this regard, yet again, we have a surprising lot in common with plants!¬† Whether you’re trying to understand optimal nutrition conditions for growth (nitrogen alone won’t get a plant there, nor protein alone in a human) or the intricacies and nuances of finely tuning our physiological processes such as cardiovascular function, renal health, blood glucose management etc. the answer lies in a happy marriage between these two.

In this area of nutrition, we should be listening most closely in fact to renal specialists/researchers.¬† These ‘undercover’ protein and potassium experts have been talking about this for a long time and in particular, in my humble opinion, Lynda Frassetto has lead that charge for decades.¬† If you haven’t read much on this issue and want somewhere to start at least, jump into her pivotal paper from 2001 which eloquently explains why the human design can not shoulder a potassium shortfall…well not without causing real health problems…like the ones we’re seeing in record numbers currently and why the protein potassium balance of any diet is a major health determinant. That’s why giving ourselves and our patients the knowledge and the tools (yes lovely shiny meaningful¬†infographics included!!), to quickly determine their protein potassium balance, are so necessary and important.

Thanks to Frassetto and many other researchers’ work, looking at food through this protein potassium lens has sharpened my focus and I think it’s about time we all took a good look ūüôā

Check out the latest UU30 to hear the latest information…

The health consequences of any diet are largely determined by the balance or imbalance of two major players & proxy markers; protein and potassium. When it comes to this area of nutrition, we should be listening more closely to renal specialists whose research shows why the human design cannot support a potassium shortfall and the health consequences of this.¬†Whether you’re trying to understand optimal nutrition conditions for growth (nitrogen alone won’t get a plant there, nor protein alone in a human) or the intricacies and nuances of finely tuning our physiological processes such as cardiovascular function, renal health, blood glucose management etc. the answer lies in a truly happy marriage between our intake of these two.¬† These recording comes with a clinical resource tool to help you quickly identify the dietary protein:potassium balance for your clients.
Hear all about it by listening to my latest¬†Update in Under 30: Mind Your P’s and P’s
For all Update in Under 30 Subscribers, it’s now available in your online account and if you are not a subscriber you can purchase this individually here.

 

 

 

Naturopaths Need to Reclaim Wellness

When I was studying my under-graduate I imagined my clinic was going to be full of them: well patients wanting to maintain or even improve upon their wellness.¬†Turns out…not so much…all the really really sick people have taken their spots and the former has¬†been listed as an endangered species.¬† But I do catch glimpses of them, as I am sure we all do, in their natural habitat, with over-flowing baskets at the organic grocery store or farmer’s market, routinely up the front of the pilates class and also sometimes in our clinics. So now that naturopathy, by consumer demand, not practitioner intent, has transitioned so much into the ‘unwellness space’, do we know anymore what to do with the well ones??

I heard some great talks at the NHAA conference recently. One, in particular, was by my stellar colleague, Liza Oates, who observed that contemporary naturopaths tend to respond to these clients in 1 of 2 ways:

a) Unaccustomed to a patient who eats, exercises, sleeps and balances their work & non-work worlds better than themselves…PANIC…¬†

b) Dig deep back through the dusty archives of their personal & family medical history until they FIND A PROBLEM THEY CAN TREAT!!! such as, ‘Once I was constipated for a couple of days’ or, ‘Once I took a course of antibiotics’.

I know…we’re hilarious…we have to laugh at ourselves ūüėȬ† Liza offered up some great ideas about how to approach our consults with these patients. Many of her tips, however, could be applied to the rest of our patients as well to gather some really valuable insights. And it’s always great to hear from someone who has been seeing patients over decades…there’s so much to be gained from those who’ve gone before us (or alongside us…in my case!) and can speak to these firsthand lessons.¬† Here are just a few of her pearls

The ‘not stressed’ patient

We encounter a lot of people who can misreport their stress levels, not because they are trying to lead us astray but that’s that slippery slope of self-reporting & the possibility that someone has normalised their ‘load’.¬† Liza says she likes to step away from that potential trigger word, ‘stress’ and instead ask, ” What are your tell-tale signs when the demands exceed your capacity?”

This is not so that we can fulfil option¬†b) mentioned at the beginning…digging desperately to find some unwellness to treat – but rather as an aid for both practitioner and patient alike to understand better that individual’s response to their psychosocial environment.

Ask them to design their own health retreat

If they reply, “I would start every day with a little meditation and yoga, a chai and then a healthy hot meal”, then these can be translated into¬†little goals we can set to bring some of their ‘best self ‘ into their every day. It also helps to better understand their values, individualised self-soothing and self-care & great prescriptions to begin with, given they’re telling you they are already at contemplation in terms of their readiness for behavioural change. They’re not going to require too much convincing – they’re already converts they just need permission and support to implement.

And if you’re sitting there reading this and thinking, ‘Hey! These are exactly the patients I want my clinic full of”…then to hear more of Liza & Greg Connolly’s commentary and insights about how the wellness space has been hijacked by others and how naturopathy needs to move centre-stage in this increasingly popular trend, take a listen to this interview they recorded at the conference.

Want to¬†Improve Your Patients’ Compliance?

This UU30 recording from our back catalogue on the behavioural change model and how it impacts patients’ response to our advice is a key element in developing a professional approach that actually works. Unless practitioners are aware of the way that patients approach changing their dietary behaviour or exercise regimes, they the¬†mystery of non-compliance will never be solved!

 

 

 

 

 

 

 

 

Have you heard? It All Comes Back to the Gut

How often were we told this in our training?¬† And how often have we found this to be true in practice?¬† And now suddenly, it seems, the medical researchers (at last!) are rapidly coming around to this core concept?? Our microbiome is suddenly the hottest property on the body block, and it seems every interested party is shouting, ‘Buy!Buy!Buy!’ As integrative health practitioners, of course, we had a major head-start, not just by appreciating the gut’s central positioning in the whole health story (iridology beliefs, maps & teasers aside!!) but also a heads-up about the damage the western diet, our medication exposures and lifestyle tend to wreak upon it. A favourite quote of Jason Hawrelak’s by Justin Sonnenburg, “The western diet starves your microbial self”, underscores the significance of just one element of this impact.¬†And…are we all clear that the increasing number of patients reporting adverse food reactions, once again, overwhelmingly are a response to aberrant processes in the GIT?

Sounds silly it’s so obvious right, but it’s easy to get distracted & misattribute blame…for example, it’s the food that’s the problem. Well yes in a minority of situations interactions between someone’s genes, immune system and a particular food turns something otherwise healthy into something pathological, but for the majority, the food itself & in others is healthy, & could¬† be beneficial to this individual, if only we could resolve their GIT issues…like FODMAPs for example.

Not the problem, just the messenger.

So if the ‘problem food’ is just the messenger, what’s the actual message we need to understand?¬†¬†Is it that this patient has medication, disease or otherwise induced hypochlorhydria, impairing ‘chopping up’ of potential antigens implicated in immune mediated food reactions? Or is that this person’s got fat maldigestion &/or malabsorption so that in addition to not tolerating fats, they may experience dietary oxalate intolerance to boot? Or are the food reactions the result of altered microflora changing what we can and can’t digest (via their critical contribution) & absorb?

So what message does the presence of IgG antibodies to consumed foods send us about the state of someone’s gut? It’s telling us 2 things: this individual exhibits abnormal intestinal permeability¬† & currently in the context of this leaky gut, these foods may constitute a barrier to resolving this & other symptoms as well.

We’ve recently released the mp4 (that’s audio plus the movie version of the slideshow so grab your popcorn…that’s if you don’t have a corn issue!)¬† of¬†A Guide to Investigating Adverse Food Reactions – What’s IgG got to do with it? which details the science behind IgG, including debunking, the incorrect debunking of IgG food antibody testing!! But more than this, it overviews the whole maze of adverse food reactions, articulates a logical investigative path for practitioners through this maze, and helps us to really understand that finding the food(s) responsible for a patient’s symptoms is not the final destination..and can be in fact a distraction, if we don’t cut to the chase and find out the why…and funnily enough…my dear old iridology teachers and colleagues...it almost always comes back to the gut ūüėČ

Confronted with the possibility of adverse food reactions in an increasing number of our patients can be an overwhelming prospect, in terms of accurately identifying and understanding the faulty mechanism underpinning these aberrant responses to healthy foods.¬† Elimination of culprits in most situations is only a short term reliever, not an appropriate long term solution, so to optimise results we need to know the real mechanism of action.¬† The majority of these, of course, stem from the gut, but being able to elucidate exactly which of the many things that can go wrong there,¬†is¬†going wrong and therefore what foods are problematic until we address this, is the key. This 2hr mp4 is all about the bigger picture and helping you find method in the madness that can be the AFR landscape. Along the way, we detail the science of where IgG reactions fit into this and it’s a fascinating story that just might be the missing puzzle in your leaky gut patients.
and watch this presentation now in your online account.

Q: If a patient says they can only tolerate 7 foods…

Q: If a patient says they can only tolerate 7 foods…how many did they start with?

A: Typically about 20

No, this answer doesn’t come from some complex mathematical formula…it comes from appreciating the low dietary diversity of those eating a Western diet.¬† When we boil down these diets to the number of foods from different biological origins (families) it can be a frighteningly small number.

You see, like most practitioners, I feel utter dread when I encounter the patient who prefaces their diet story with a statement similar to the one above. It speaks to the severity of their symptoms, their attribution of these with food, that by the way is essential for their sustenance and nutritional salvation, and implies an exhaustive pursuit they’ve undertaken probably over years to find ‘safe foods’.¬† And yes, as discussed in my recent talk A Guide to Investigating Adverse Food Reactions – What’s IgG got to do with it? – food reactions, as in more than one mechanism of food reaction, often do move in packs and that comes typically back to a poorly functioning gut…BUT…that latter assumption…’they’ve explored and exhausted all foods’ is the one we need to keep in check.

Have they tried daikon? Prickly pear or jambu? Okra?  Snake beans? Quail or duck eggs? Kangaroo? Crickets?  Etc Etc. Etc.

Are you catching my drift?¬† Because someone has DIY diagnosed a wheat, dairy, soy and, and, and, reaction (correctly or incorrectly) and perceive themselves to react also to most of the limited fruit and veg they can identify in Woolies…doesn’t mean they’ve remotely exhausted the global food supply! Where am I going with this?¬† When patients tell us they’re down to 7 foods they can tolerate – some sensible follow up actions on our behalf may include:

  1. Check the strength and validity of their level & strength of evidence for their DIY diagnosis
  2. Think about the linking ‘process’ (more than likely gut) that is the real potential issue (aka don’t eliminate the messenger and do nothing more!)
  3. Encourage and advise them to shop anywhere other than where they normally do – somewhere that sells fresh produce they don’t recognise at all…like Asian, Indian or Middle Eastern supermarkets and grocers

My tour of A Guide to Investigating Adverse Food Reactions – What’s IgG got to do with it? (and the weeks of lit review leading up to this) provided me with¬†enormous food for thought…and this is just one! If you want to hear more about how to find method in the madness of food reactions…you should probably listen in to the whole shebang…goodness knows with the increasing number of patients who present with self-determined food reactions and an increasingly narrow menu of safe foods…practitioners and patients alike need all the help we can get!

Confronted with the possibility of adverse food reactions in an increasing number of our patients can be an overwhelming prospect, in terms of accurately identifying and understanding the faulty mechanism underpinning these aberrant responses to healthy foods.¬† Elimination of culprits in most situations is only a short term reliever, not an appropriate long term solution, so to optimise results we need to know the real mechanism of action.¬† The majority of these, of course stem from the gut, but being able to elucidate exactly which of the many things that can go wrong there, is going wrong and therefore what foods are problematic until we address this, is the key. This 2hr mp4 is all about the bigger picture and helping you find method in the madness that can be the AFR landscape. Along the way we detail the science of where IgG reactions fit into this and it’s a fascinating story that just might be the missing puzzle in your leaky gut patients.
Click here to purchase¬†A Guide to Investigating Adverse Food Reactions – What’s IgG got to do with it?

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A Package Packed With Iron, Iron & Even More Help With Iron

 

 

We’re not deaf…we heard that stampede of Iron-Inundated Practitioners!

Our recordings and clinical resources for improving your skill-set in all things iron including,¬†your accuracy of diagnosing deficiencies, pseudo-deficiencies & excesses, plus radically rethinking the best treatment approaches for each scenario…have been some of our most popular. Because nailing iron (pardon the pun) is harder than we were all lead to believe and at least 1 ‘iron maiden’ or ‘iron man’ walks into our practice every day, right?¬†So we’ve brought together 5 extremely popular UU30’s on Iron into one bundle for the price of 4! So if you’re more than ready to graduate from ‘iron school’, now’s your best chance!

1. So You Think You Know How to Read Iron Studies? (‚ȧ30 min audio + Cheat Sheet)

Overt Iron Deficiency Anaemia or Haemochromatosis aside…do you understand the critical insights markers like transferrin and its saturation reveal about your patients iron status?¬† Most practitioners don’t and as a result give iron when they shouldn’t and fail to sometimes when they should.¬† This audio complete with an amazing cheat sheet for interpreting your patients Iron Study results will sharpen your skills around iron assessment, enabling you to recognise the real story of your patients’ relationship with iron.

2. Pseudo Iron Deficiency (‚ȧ30 minute audio)

The most common mistake made in the interpretation of Iron Studies is this one: confusing inflammation driven iron ‚Äėhiding‚Äô with a genuine iron deficiency.¬† Worse still, following through and giving such a patient oral iron ‚Äď when in fact it is at its most ‚Äėtoxic‚Äô to them.
This audio together with some key patient pathology examples will prevent you ever falling for this one! Learn how to recognise a ‚ÄėPseudo Iron Deficiency‚Äô in a heartbeat!

3. Iron Overload… But not as you know it (‚ȧ30 minute audio)

We’re increasingly seeing high ferritin levels in our patients and getting more comfortable referring those patients for gene testing of the haemochromatosis mutations; but, do you know how to distinguish between high ferritin levels that are likely to be genetic and those that are not?  This can save you and your patient time and money and there are some strong road signs you need to know.  In addition to this, what could cause ferritin results in the hundreds if it’s not genetic nor inflammation?  This Update in Under 30 summary will help you streamline your investigations and add a whole new dimension to understanding iron overload…but not as you know it!

4. So You Think You Know How To Treat Iron Deficiency? (‚ȧ30 min audio)

And then you don’t.¬† The reality is we all struggle at times with correcting low ferritin or iron deficiency anaemia¬† – so what have we got wrong?¬† In spite of being the most common nutritional deficiency worldwide, the traditional treatment approaches to supplementation have been rudimentary, falling under the hit hard and heavy model e.g. 70mg TIDS, and are relatively unconvincing in terms of success. New research into iron homeostasis¬† has revealed why these prescriptions are all wrong and what even us low-dosers need to do to get it more right, more often!

5. So You Think You Know the Best Iron Supplement, Right?!¬† (‚ȧ30 min audio + Iron Supplement Guide)

Iron supplementation, regardless of brand, presents us with some major challenges: low efficacy, poor tolerability & high toxicity – in terms of oxidative stress, inflammation (local and systemic) and detrimental effects on patients’ microbiome.¬†¬†What should we look for to minimise these issues & enhance our patients’ chance of success.¬† Which nutritional adjuvants are likely to turn a non-responder into a success story and how do we tailor the approach for each patient? It’s not what you’ve been taught nor is it what you think! This comes with a bonus clinical tool, a fabulous easy reference guide – to help you individualise your approach to iron deficiency and increase your likelihood of success.

You’ll never look at iron studies or your iron-challenged patients the same way.

Listen to these audios straight away in your online account.
To purchase the Iron Package click here.

A Dash of Milk Madness?

So this is not news to most people who know me but I don’t like taking things out of people’s diet.¬†As a result, in a room full of naturopaths & integrative medicos, I might be voted the least likely to use the phrase, “No Gluten or Dairy for you!” [said with the Soup Nazi’s accent from Seinfeld]. I must have slept through that class when we were taught to do this for absolutely every patient.¬† But seriously, I try not to remove or exclude foods without a very strong rationale and evidence-base that relates directly to the person sitting in front of me, for several reasons: 1) those seeds are powerful ones to plant in your patient’s mind…how do they carry that with them as they move through life, navigating food and social settings etc etc…all well and good if this is a proven life-long pathological provocation for them but otherwise… 2) dietary exclusion is stressful for families & in kids especially, can create disordered eating and a range of other psychological impacts and 3) GFDF diets are not necessarily healthier in the basic nutrition stakes…if you haven’t read Sue Shephard’s work on the deterioration of diet quality in GF patients…you should. It can be¬†much healthier of course…but often the real-world application of the principle doesn’t always match the lovely ‘serving suggestion image’ on all the GFDF highly processed, packaged foods!!

So listen up people, because now I’m talking about when I¬†would¬†seriously consider joining in on the GFDF chant.¬†¬†

The one patient group I’ve never quibbled over the benefits of GFDF, has been the autistic one.¬† I was taught the merits of this approach early on by a few fabulous courageous integrative doctors and paediatricians who came back from the front-line of their clinics, reporting good effects.¬† I then had the important firsthand experience of unprecedented verabilisation in a non-verbal ASD child’ after excluding these foods. But what I’ve been thinking a lot (and reading a lot!) about lately is the possibility that these ‘dietary exorphins’ may have negative mood effects in other subsets of mental health patients. My thought process is like slow TV! That aside, there’s a lot to be said for taking the time to really getting across an issue – even if that involves reading papers from as far back as the 1960s when the idea of a negative role for dietary exorphins in schizophrenics was first floated by Dohan & colleagues.

Let me say, when you go back to the beginning it’s undeniably a shaky start for the exorphin evidence base, but as you read the studies that emerge from decade to decade until the noughties…it reveals a nagging research topic that won’t go away and a fascinating process of discovery.

So is the devil really in the (regular commercial cow’s) milk? Well I think¬† for some patients it may well be a contributor – most notably those with features consistent with the pattern of excess opiate effects including a higher dopamine picture, regardless of the mental health label they’ve been given, although, more commonly seen in ASD, psychotic presentations etc.¬† But how do we work out which ones, because none of the evidence points to it affecting 100% of these groups…well that’s where we need to go back and truly understand the structure of these dietary exorphins and just how they potentially wreak havoc in some.

The latest UU30 takes your through the story of BCM-7 with a summary of research compile over half a century in Under 30 minutes!

There is a well-rehearsed chant in the integrative management for ASD individuals, “Gluten free- casein free diets” is based on the dietary exorphin theory which suggests these foods generate bioactive peptides that act unfavourably in the brain.¬† Where did this theory emerge from and how strong or weak is the evidence upon which this therapeutic intervention stands? Even more interesting, is there support of this theory in a wider range of mental health presentations such as schizophrenia, post-partum psychosis and depression. Is there such a thing as milk madness for a subset of our patients?
Hear all about it by listening to my latest Update in Under 30: Milk Madness РIs it a thing?
For all Update in Under 30 Subscribers, it’s now available in your online account and if you are not a subscriber you can purchase this individually here.

 

Let There Be No Bad Blood(s) Between Us

So you’ve gone to all the effort.¬† Be that writing referral letters suggesting some pathology investigations might be warranted or you’ve coached your patients endlessly to get copies of ones done elsewhere so that you may be privy to their findings. Worse still, you’ve directly requested the pathology, with your patient paying out of pocket for the tests. Then the results come in and they look…well wrong.¬† You, as the conscientious clinician, typically do 3 things:

Step 1 Spend hours pouring over & over the labs and back over the case notes

Step 2 Worry about the new differential diagnoses that are now suddenly seemingly a possibility in your patient. It doesn’t look good.

Step 3 Doubt your own pathology reading ability, ‘Hey maybe I just don’t understand these bloods like I thought I did’

But (often)…it’s not you, it’s them.

And that’s what I often explain to practitioners who contact me (step 4). You see sometimes what they’re losing sleep over are what I call, Bad Bloods.¬† Occasionally, the fault of the pathology company…but way way way more often the fault of the patient and the referring practitioner, who has not educated the patient correctly about what to do¬†and¬†not do prior to blood collection for certain tests. I am excited to see¬†how many practitioners are competent with pathology reading these days and building their skills and confidence all the time, that’s why it is so so disheartening for the practitioners (and for me as a mother hen mentor) when they lose time (& sleep) getting to Step 3 when they should be able to spot ‘Bad Bloods’ fast.¬†¬†There are 7 classic give-away patterns.

Will are unlikely to know every quirk of every blood test our patients will ever have done, but knowing what constitutes the ideal time and conditions for the most commonly performed ones, can go a long way to minimising any future Bad Bloods between you and patient as well.¬† This includes things like exercise, alcohol intake, duration fasting and even sexual intimacy…yup!¬†

This month’s Update in Under 30 installment¬†¬†Beware of Bad Bloods¬†teaches you the 7 patterns to watch for and provides you with a great resource stipulating the best collection conditions for the most common blood tests.¬† Don’t let Bad Blood come between you and your patient, the right diagnosis & management or just some well-deserved sleep!¬†

Good practitioners are being led to bad conclusions by some patients’ pathology results. Not because they can’t interpret them or the testing has no merit but because they just don’t know when to discard a set because they are ‘bad’.¬† Occasionally, the fault of the pathology company but much more often the fault of the patient and the referring practitioner, who has not educated the patient correctly about what to do¬†and¬†not do¬†prior to blood collection for certain tests. This recording clearly describes the¬†7 classic give-away patterns of ‘Bad Bloods’ which will enable you to spot them fast in the future.¬† In addition to this.¬† while we are unlikely to know the idiosyncrasies of very lab our patients will ever have done, knowing the ideal collection times and conditions for the most common ones assists you and your patients to avoid any in the future – handy clinic resource included.

Hear all about it by listening to my latest Update in Under 30: Beware of Bad Bloods.
For all Update in Under 30 Subscribers, it’s now available in your online account and if you are not a subscriber you can purchase this individually here.

Someone’s Lost Might Be Your Found!

 

As Britney so famously put it, ‘Oops, I did it again!’ I remember the actions on my to do list but not the intended recipients!¬†D.O.H.¬†I was talking with a practitioner the other day who lamented that she had never really learnt about stats nor how to assess the quality of research in her undergraduate and could I point her in the right direction towards a resource that simply explains this increasingly important basic skill-set…well I would if I could remember who you were!!¬†Anyhoo, I followed through in my usually dogged way to the bottom of my actions list and with the help of a lovely past-intern, got directed to these free BMJ resources¬†on how to read research…G.O.L.D.¬†

Papers that go beyond numbers (qualitative research) Trisha Greenhalgh, Rod Taylor

Papers that summarise other papers (systematic reviews and meta-analyses) Trisha Greenhalgh

Papers that tell you what things cost (economic analyses) Trisha Greenhalgh

Papers that report diagnostic or screening tests Trisha Greenhalgh

Papers that report drug trials Trisha Greenhalgh

Statistics for the non-statistician. II: “Significant” relations and their pitfalls¬†Trisha Greenhalgh

Statistics for the non-statistician Trisha Greenhalgh

Assessing the methodological quality of published papers Trisha Greenhalgh

Getting your bearings (deciding what the paper is about) Trisha Greenhalgh

Anyway…while I continue to ponder who this was actually intended for… it dawned on me how many people would just LOVE these & benefit from them immensely in the meantime. Couldn’t most of us do with a little more research literacy?¬†So I thought I’d share.¬†Don’t you love it when we work as a team.¬† Now…who can help me find my keys?! ūüėČ

It’s starting to feel a lot like…that Update in Under 30 time of the month!

Update in Under 30 are dynamic power-packed¬†podcasts that 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‚Äôt have to trawl through all the primary evidence yourself. All¬†topics are aimed at clinicians¬†and cover a range of areas from¬†patient assessment to management, from condition based issues to the latest nutritional research.¬†Most importantly, each podcast¬†represents unbiased education that can contribute to your CPE points,¬†so if you haven’t subscribed yet…what are you waiting for??!! ūüôā

Two Pointers for Addiction Management

Forever fascinated by the neurobiology of various mental health presentations, addiction included, two medical news items caught my attention this week.¬† If you’ve ever heard me speak on addiction, in somewhat simplistic terms, it is very much about the reward centre of the brain and how strongly all recreational drugs hit on this.¬† Think rats tapping levers with their feet to continually self-administer cocaine…to the exclusion of all else….kind of magnitude of reward hits.¬† You may have also heard me quote or misquote (!) someone famous who once said something to the effect of….and I am totally paraphrasing poorly here: if we can’t seek pleasure legitimately, we will seek it illegitimately.¬†

So this story from ABC news about a Newcastle addiction group support program showing some early signs of greater retention and engagement and therefore potential success with addicts…because they incorporate prizes…well that makes so much sense!

The article is important to read in its entirety as it creates the context – especially for many people suffering from addiction who tell tragic stories of lives where the only rewards/prizes and even gifts they’ve ever known, being drug-related – even from a young age.¬† So to normalise reward to some extent, and give individuals an experience of constructive legitimate versions of this, is actually desperately needed and ground-breaking.¬†

How can we incorporate some element of this in our interactions with these patients?

The second ABC news item touts ‘a new generation drug that restores balance to the brain’ but is actually just a teaser about…wait for it…cue stage right…a not so old favourite…N-acetyl cysteine!¬†¬†Although this is effectively a recruitment drive for methamphetamine addicted individuals into a new 12 week trial of NAC, run by the¬†National Drug Research Institute, taking place in Melbourne, Geelong and Wollongong, it gives NAC a great wrap and rationale for being a good adjunct in addiction, of course. Just a reminder folks that¬†naturopaths belong on that multi-modality health care team for people struggling with addiction, and we do have some potent therapies to contribute.¬†

A couple of years back I was asked to deliver an educational session to a group of hospital based mental health specialists on the merits of NAC.¬† My favourite question/comment at the end of my detailed presentation from a very experienced psychiatrist was, “Well if N-acetyl cysteine is so good for mental health…why haven’t I heard about it before now?!”

I hope they follow the ABC news ūüôā

Want to Get Up Close to N-acetyl Cysteine 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 ‚Äėshould have worked better‚Äô had our hypotheses been correct.¬†Novel drivers such as oxidative stress, inflammation and mitochondrial dysfunction are on everyone‚Äôs lips and N-acetyl cysteine is in prime position in this new landscape, to be a novel and effective therapy for mental illness.¬†This presentation brings you up to date with the current NAC research in a large number of mental health conditions & translates this into the clinical context.

The Best Form of Charcoal

This weekend I re-experienced an incredibly potent therapeutic intervention firsthand.¬†¬†We drove 40 minutes inland to vamp under the stars (that’s between camping and glamping and has nothing to do with vaping!) That was a good start. Breaking from the ‘norm’, looking at different scenery, digital detoxing, these are all important aspects of what helps us to distinguish time off from ‘time-on’… but the real therapy started when we lit a fire.

So we sat, just the 2 of us, in front of our little fire.

Talking for hours, being silent as well.  Warm and cosy against the brisk night air, both totally mesmerized by the flames and glowing embers.

And surprisingly quickly – I could feel all its goodness – letting me down, filling me up, expanding me out. The antidote to our ridiculously busy lives.

And it made me think of all the times my patients need to sit in front of the fire.¬† When the therapy, the remedy doesn’t come in a bottle or a powder but actually an act of reconnecting, of intentional slowing down, whatever you want to call that. I’ve prescribed some pretty funny and unusual things for my patients over 20 years and a lot of them, I guess, not dissimilar to this powerful charcoal remedy. Daily naps. A completely spontaneous trip away. Podcast Diets (aka health info abstinence periods). Long baths. Cups of tea with friends. Walks with a loved one after dinner. Candle-lit nights for one. (more…)

How Do YOU Take Your Coffee??

If you’ve not seen Kitty Flanagan’s skit on current coffee culture...it’s essential viewing.¬† In true Kitty-fashion, she wants to simplify coffee ordering down to 2 basic lines – White or Black – says all our pretentious coffee orders; macchiato, skinny, decaf, half strength, latte etc can essentially be reduced down to¬† a much faster 2 queue system. But she’s forgotten the line for taking your coffee rectally.¬† Sorry – did I make you just spill your coffee? Knowing How across health trends Kitty is, she’ll add this 3rd queue soon, if the number of patients asking me about this or telling me they’re already doing it. Now, while enemas had a place in naturopathic history, my training never covered them and, consequently, I’ve never included them in my practice. But the more hype I heard around coffee enemas specifically, the more I thought we better find out as much as we can, so at least we can better inform ourselves and our patients. And of course the monkey on your back, called FOMO, jumps up and down, incessantly asking, “Are you (and your patients) missing out on an amazing therapy?”

The first patient who told me they were using coffee enemas daily was a celeb.¬† A very anxious one. Who also told me she couldn’t possibly drink chai let alone coffee because of the caffeine.¬† This had me a bit stumped…I knew she wasn’t inserting decaff up there and I thought…well given the colon is SUCH an absorptive surface surely this is why she reported feeling, ‘so energised, more clear headed’ etc. with every enema?

But I wanted to find out for sure (more…)

The Blame Game

Quite the month for it, I hear. My inbox has run hot with practitioners deeply concerned about some serious finger pointing that’s been going on.

The fingers in these instances have belonged to medical practitioners and the direction they’re all pointing, is seemingly at any complementary medicine their shared patient is taking.

Here’s a couple of good examples: “Your high blood pressure is the result of the combined mineral formula you’re taking!”¬†¬† These were the words of a GP to a 50 something female patient when he discovered she was taking a calcium, magnesium, potassium containing formula.¬† The patient was hypertensive at the initial appointment, at which time the naturopath encouraged her to actually seek review, assessment and prescription of an anti-hypertensive, however the patient declined.¬† The nutritional prescription was recommended in response to high acidity (raised anion gap) and prematurely low GFR (impaired renal function). Patient’s HBP continued to be problematic so the next doctor she sees, points the finger and says, it must be this product!

Would anyone like to explain that to me? In fact, that was my advice back to this very concerned and understandably rattled practitioner…just to cordially request the GP to outline the mechanism by which this might occur.¬†¬† (more…)

Are You Chasing the Wrong End of Dientamoeba fragilis?

Ever feel like you’re chasing your own tail trying to treat & find the source¬† of GIT parasites in some patients?!¬† Well guess what, you just might be!

We’re seeing more & more patients test positive for¬†Dientamoeba fragilis¬†and increasingly patients struggling to eradicate it and prevent relapse.¬†And then there’s Blastocystis hominis affected patients… and then those lucky enough to have both.¬†

Well, while we might have been grouping D.frag together with B.hominis, being the two most common GIT parasites in humans, looking for what they share in common,¬† they are worlds apart (we think!) in terms of how they are transmitted to humans. (more…)

Have I Got Your Attention Now?

You know I’m not one to raise my voice and make scene.

Ok, I always raise my voice and make a scene, but only when I think something really warrants our attention and the issue of under-recognised, under-estimated and mismanaged chronic worms, demands our attention.¬† I’ve been talking about this ever since the first patient stepped into my clinic, a young girl with severe mood issues who just happened to also have treatment-resistant chronic threadworm, and since then, as the volume of patients I see affected by this has grown, so too has the volume of my message. And there’s actually so much to say.

Chronic worm problems don’t always come with an itchy bottom calling card. In fact, many individuals don’t have any of the telltale signs you might be used to screening for.¬† Recent research suggests adult men, in particular, are commonly asymptomatic when infected with them (Boga et al 2016)

So what alerts us as practitioners to the possibility of chronic worms – so many things…but here’s just some thought bubbles to get you started.

Are you treating patients with recurrent or treatment-resistant Dientamoeba fragilis?

Are you seeing women who have thrush-like symptoms, in spite of negative swabs and no benefit from antifungals?

Are you faced with families coming undone because of one child’s behaviour whether that’s aggression, defiance, emotional lability or just serious sleep problems? (more…)

One Size Doesn’t Fit All – Not Even for Besties

I have a good friend…who happens to be a naturopath…who happens to also be a patient of mine.¬† Have you got a few of these as well? A month ago,¬† looking over her recent bloods which included fasting lipids that had been steadily climbing for the last couple of years, post-menopause, she said, ‘do you think I should take something for that?’ Ahhhhhh no. My reasoning went like this:

“You love saturated fat right? You eat butter and cheese and and and…and the type of elevated lipid pattern you have LOOKS like it is at least partially the result of this, your triglycerides are low, your HDLs are good it’s just this LDL component that is too high.¬† You could add in another supplement…and take it…forever…or you could do a little n=1 experiment and just lower your butter, cheese & coconut oil intake for a month and repeat the test.”

The horror on her face! You see I didn’t know exactly how¬†much she loved butter but it all became clear with the first text a few hours after I had thrown down the gauntlet…which included a sobbing emoji and the comment that her afternoon snack will never be the same…turns out it was a shortbread biscuit with butter on it!!! But as a practitioner who does pride herself on walking the talk…off she went determined to give it a good go for a month.¬†¬†But boy did it hurt! (more…)

That’s Not A Methylation Issue…

This is. 

¬†I think we’re all going to scream when the next patient says, ‘I’ve got an MTHFR’, right?!

Congratulations, I want to say, because you would be in much more serious trouble if you didn’t have a copy…

‘Oh, sorry, you mean you have a mutation on at least one allele encoding for the MTHFR enzyme…Oh, I hate to tell you but contrary to popular (online) belief, you’re not special.’

<Ouch> (more…)

No Holiday For The Thyroid

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 ‚Č• 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 (‚Č• 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…)

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