SAMe Strikes Again!

If my dispensary was on an island and could only stock 3 items, S-adenosyl-methionine would make the cut.  That’s how important this nutraceutical is to my practice and has proved itself to be to so many of my patients.  Regularly, I cross paths with practitioners who declare similar favouritism and then there are many others who remain apprehensive and uninitiated in its use.  Often this results from 7 myths and misunderstandings, such as…

No.1 Giving someone SAMe will impair their own synthesis of it

No.2 If it’s not ‘right’ for your patient it could go horribly wrong – the risks are big!

No. 3 SAMe will increase homocysteine in your patients & shouldn’t be used if the homocysteine is high, or high-normal, to begin with

Wrong.  Wrong &, you guessed it, wrong.  But many of us don’t believe anything till we see it with our own eyes.  Like a mentee of mine who is a seasoned SAMe savant but, like us all, continues learning more all the time through her own prescribing experience.  Case in point:

“Remember when we discussed my patient with stubborn high homocysteine, who has not responded to high dose methyl factors?  You suggested a trial of SAMe because other things pointed to her being an under-methylator. You were right (standard!)- it came down from 9 to 5 with 2 months of 400mg/day SAMe. She’s also been able to stop other supplements she was using for her mood and overall is much more stable emotionally, so turned out to be the perfect solution. Thanks as always :)”
So exciting to bring SAMe, together with other important CAM options in mental health management, to the attention of an increasing number of psychiatrists and other health professionals of late. It easily makes my top 3, and the other 2 supplements in my island dispensary?…well if we’re still talking mental health, Zinc and N-acetyl-cysteine, due to their versatility, potency and accessibility regardless of income.  But I think you could have guessed those & likely have shared confidence, right?
This 3hr recording & resource is overflowing with case studies and the latest research relating not only to psychiatric presentations but also as a key nutraceutical to consider in liver pathology, Gilbert’s syndrome and some pain presentations. Together with this ‘literature lowdown’ we clear up a lot of misunderstandings practitioners tend to have about its prescription –    busting the 7 SAMe myths along the way and giving you the confidence to know when SAMe is likely to be the solution and exactly how to prescribe and what to expect.
I’d love to continue this conversation with you… 
so join me and be part of my ongoing dialogue on this and my other blogs by following my Facebook page.

A Case of Stoned Sperm?

Tonic. Homeostatic modulator.  These terms and concepts, which have a long tradition in herbal medicine (and let’s be clear, were considered yet another example of the wishy-washiness of the modality) are being appropriated by some areas of mainstream medicine right now. Cheer up ‘leaky gut’, you’re no longer alone! And arguably misappropriated by the public’s very ‘lay’ interpretation of the science on medicinal cannabis and its subsequent elevation to panacea, of late.

“So many of my patients are telling me they’re taking Cannabis now, just as a tonic”, says yet another practitioner to me recently, “No, not for pain, they’re young and fit but they take it because it’s a homeostatic regulator!!”

Oh lordy…

The capacity to maintain homeostasis, and particularly in the face of adversity or imbalance, is a sign of the vitality of the individual, according to what I remember  from naturopathic philosophy (and have truly taken on and observed firsthand)…so just back up there a tad and explain to me how this one herb proposes to do this for everyone on a one-size-fits-all-fashion?  As confessed in an earlier communication, I am a cannabis convert. But only in the sense of appreciating the niche areas where it is likely to offer true therapeutic benefits. I still have the words of warning from the brilliant  Professor Michael Lintzeris, the Director of the Drug & Alcohol Services, South East Sydney Local Health District; Conjoint Professor, Division of Addiction Medicine etc., ringing in my ears, pleading with health practitioners to not ‘fall’ for cannabis in the way we have previously ‘fallen’ (so far and landed so badly) for the panaceas of the past: opiates and benzodiazepines.  Most notable major omission for me, in an otherwise rigorous scientific debate of late, is any discussion about its potential for impacting fertility.

I’ve been aware of the potential negative effect on male fertility, in particular, for over a decade and while we undoubtedly need more targeted research on this topic to reach a consensus, the evidence base to date points to lower LH +/- testosterone and impaired sperm quality and motility.  Certainly not perhaps what tonic-seeking patients know they’re signing up for.

There is in fact evidence to suggest ‘sperm under the influence’…’lose their way’ and are less effective at finding and fertilising the egg.  Sorry but the image always makes me chuckle…stoned sperm.  ‘Hey, dude where’s my egg?!’ style.  But it’s not funny when impaired fertility is a problem affecting so many these days, and we still are guilty of over-focusing on ‘her’ and under-assessing ‘him’…and lo and behold it could be his chronic cannabis use to blame.  We had a case recently, years of unprotected sex, daily cannabis, no baby, no dots connected.  We may think this is a handy incidental contraceptive for young men sitting on couches with cones (one mum recently said as much to me) but for the rest…?

Getting Men’s Hormones Right

As practitioners we should know as much about investigating and treating male hormone imbalances as we do female ones, yet this is often not the case.  While we are increasingly aware of everyone’s exposure to lifestyle & environmental endocrine disruptors and the fragility of the HPO axis, we sometimes fail to recognise that the reproductive health of our male patients is equally under threat.  This is clearly demonstrated by generally diminishing levels of testosterone amongst men and increasingly early onset of andropause. These issues then become barriers to achieving success in other health areas with your clients, mood, metabolism, fertility and beyond.  Learn more here

 

I’d love to continue this conversation with you… 
so join me and be part of my ongoing dialog on this and my other blogs by following my Facebook page.

 

 

Are You Being Foxed By An Ox…alate Result?

Ok here’s some tough Tuesday talk..not all tests are valid.  Tougher still…not all of the mainstream nor the functional pathology ones.  I am talking across the board here. Each and every pathology parameter requires good knowledge about its strengths. limitations and, one of my absolute favourite nemeses, confounders.  “How on earth am I supposed to learn all that and everything else I have to know too?!!” I hear you scream at your screen. Btw keep yourself nice if you’re in public while you’re reading this 😉 

But rather than imagining you need to have this level of knowledge for all tests, I would suggest you set yourself a hit list of the ones you rely on most, either in terms of frequency or in terms of the degree to which they direct your decisions about patient care…can I mention (ahem) Iron studies here perhaps for us all…but maybe you have a specialist area so you use a particular investigation routinely or at least frequently…

CDSAs? Breath tests for SIBO?  Oxalates?  

May I please then politely suggest that you get to know these inside and out? Not based purely on the information and assistance that the test provider provides you..but you scrutinise them independently.  Top to bottom.   Because that’s your business, right? And your diagnoses and treatment decisions are pivoting on these results. Jason Hawrelak gave us all some great examples, including his informal experiment of sending the same stool sample to multiple labs.  Don’t know about this and his findings?? If you’re in the business of ordering stool tests, you need to.  I am doing this all the time with numerous pathology markers because diagnostics is my passion (alright, obsession)…and recently I put Oxalate Assessment to the test and oh boy! 

Here’s something for free:

If you are measuring urinary oxalates to diagnose oxalate overload in your patients and you, 1) are using a lab that does not preserve the urine as you collect it, using acidified containers or providing additional preservatives for take home testing kits….you are wasting your patients money and you are likely getting a lot of false positives, i.e. the result infers the patient has a problem when they don’t!!

And 2) if you are simply  following the labs reference ranges for what ‘healthy’ urinary oxalates look like – you’re wasting your patients money again and likely getting false negatives – a failure to show a problem that is actually there! If you’re hunting oxalates…please ensure you have a current effective hunter’s licence…by getting up to speed fast  regarding accurate investigation of this.  Oh yes…it’s tough-talkin’-Tuesday and I’ve come out firing…watch out this may become a regular feature 🤷‍♀️

Update in Under 30: Oxalate Overload – Assessment and Management

Oxalates are present in many healthy foods and in all healthy people, but when ‘normal’ levels are exceeded they can spell trouble in a whole raft of different ways due to their extensive distribution across the body. Some tissues, however, have more problems than others, especially the urinary system and soft tissue and joints but now there are also questions about oxalates’ relationship with thyroid and breast issues.  We review the latest evidence about the health consequences, blow the lid on accurate assessment for oxalate excess and talk management in this jam-packed update.

How Many Hats Have You Worn Already This Week?

 

My current count is about 13. Lucky for some? Patient advocate, referral point, primary prescribing practitioner, behavioural change motivator, wise business counsel, good empathetic listener, fearless myth buster, researcher, head chef to a group of nats…that’s the toughest hat right there, right?! 🤣 

While there is a concern in naturopathy and integrative health that we increase our own load due to our eclecticism – I see this as a strength & part of the appeal.

But it does warrant regular review.

I semi-regularly cry-out, “I just want a normal job, you know 9-5, clock on, clock off.”  To which anyone who knows me tends to drop to the floor in a fit of uncontrollable laughter.  They’re right of course, I do not have the temperament or the ability to be sufficiently single-minded to work at Coles. And the reality is I do feel privileged and satiated by wearing all my different hats bar just a couple…but this is par for the course and part of the important reflective process we should all continually undertake in our careers: Which hat no longer fits me?  Which gives me a bit of headache?  We can then re-orient our work and our businesses in a way that tries to reduce, or remove altogether, our time spent in these roles.

“I am completely over giving 101 dietary advice!”  I wish I had a holiday for every time I’ve heard a nat with more than 10 yrs experience say that!

“Oh the never ending story of answering my inbox!!!!!!!!!!!!!!!!!!!!!!!” is another one on high rotation in our ranks.

These ‘lost loves’ and potential disproportionate time wasters should never be ignored & simply endured but should instead be met…head on.  The more I hear about different practice models & observe my own business over 20+years, the more I can see that when a practitioner is losing too much time or job satisfaction, wearing some of these hats that no longer fit, the less financial growth and sustainability their practice model holds. I know…them’s fighting words!  Anyway, I’ll be talking about this and the delicate balance of our mild super-powers V our soft underbelly at Vicherbs monthly meet-up Sept 26th if you live in Melbourne and want to come along the join in the conversation.  I think it’s a good one that we need to keep having. 

2020 Group Mentoring Program Applications Open in October!

The Group Mentoring program provides integrative nutrition practitioners with monthly sessions of the most accelerated form of post-graduate education and clinically relevant skill development. Join this online 12 month program of like minded professionals and work with Rachel through real clinical cases and questions presented by each member in a collegiate setting.  If you know you want in for next year already, get ahead of the queue and email us: admin@rachelarthur.com.au

“Rachel’s mentor program is something I look forward to each month and I feel very privileged to be one of her mentees (or mintees as she likes to call us). Each session is action packed with so much information shared that my brain gets a lot of dopamine hits! Rachel has a rare talent of teaching in a way that makes the most complicated information easy to understand, and even fun! The learning doesn’t stop after each mentor session. The group, including Rachel, will share research and continue to follow the cases shared. Amazing value for money. I know this is something I will want to do my whole career…there is always something more to be learned.”

VINKA WONG | Clinical Nutritionist, New Zealand

 

Lots to be Said for Boring Basics

Horses not Zebras.  You’ve no doubt heard me repeat that quote which is famous in medical schools, something to the effect of, “When you hear a heard of animals outside your door, think horses not zebras”…unless of course you are practising in Africa might I suggest 😉 This of course reminds us all in short to think of the most likely explanations not the most exotic first. Likewise with our case taking. The number of times I ask practitioners for the ‘boring basics’ and am met with an embarrassed silence.  Think:

Body Mass Index

There I said it…and yet these are like dirty words in integrative health.  Why? Because we’re starting to ignore the ‘boring basics’ in favour of getting ‘fancy first up’, as I like to call it.   Look I love a good bit of bioelectrical impedence assessment as much as the next clinician and I am not about to use this crude measure as replacement for that but I absolutely need to have these key landmark pieces of information to understand a very long list of things such as contribution to future health risks,  current burdens from literally the weight on those joints leading to knee pain, to the weight/mass not pulling on their bones and therefore contributing to lower BMD their whole life. Even their likelihood of a leaky gut today, right, Brad Leech, our colleague and impressive IP researcher?  BMI drives also the appropriateness and their capacity for any exercise interventions I might recommend, not to mention the frequently mentioned, accurate interpretation of their labs. 

For many many labs that we routinely see for our clients…the reference range should actually be a sliding scale that moves with BMI…what do we really ‘expect’ and what is actually ‘healthy’ is different at different weights. 

Like TFTs – this may be a big newsflash for most but I never want to see a patient with a BMI > 30 have a TSH anywhere < 2, unless they’re on replacement.

 Say wha? You heard me. I promise I’ll tell you more about that soon.

But again…let’s not get fancy first up especially not in any of our paediatric patients and in spite of what their words or ‘tude may be telling you, that includes all the way up to 18 in our books! Brace yourself, I’m going to speak that dirty word again…BMI..boring basics before all else. We need to review their height, weight and BMI against paediatric growth charts.  These oldies are goldies and can reveal so much about growth trajectories, puberty milestones when any other discussion is off the table,  type 2 nutritional imbalances (protein, zinc, potassium, magnesium, sulfur) and flag all other sorts of concerns or reassurance…and you haven’t had to steal a drop of blood or any much hard earned money off mum and dad to work a lot out. Anyway,  that’s my ‘boring basic beef’ for now…there’s a lot to be said for ensuring such ‘dirty words’ come before everything else.

Need help with wrestling all the most important patient information into a clear management plan?

As integrative health practitioners, we pride ourselves on taking in the ‘whole health story’ as a means to accurately identifying all the contributors & connections to each patient’s presenting unwellness.  In the process, we gather a wealth of information from each client  – pathology, medical history, screening tests, diet diaries etc. that borders on information overload and often creates so much ‘noise’, we struggle to ‘hear’ what’s most important. The management of complex patient information and the application of a truly integrative approach, requires due diligence and the right tools. Mindmapping and Timelines are two key tools to help you go from vast quantities of information to a true integrated understanding of what is going on in the case and the more time we spend learning and applying these tools, the more they will write the prescription for you. Not just for today but for the next 6-12mo for that patient.

 

A Low Oxalate Diet Is Not A Healthy Prescription

Until it is. Following on from my frolicking in frocks made of my favourite oxalate-rich foods around the Alps, let’s be clear these are great, healthy and health-promoting inclusions in ours and our patients’ diets. Until they’re not. Just like FODMAP avoidance is not, and should not, be generic dietary directive, nor a long term ‘solution’ to a digestive issue, oxalates are in fact, just like FODMAPS, great for our guts!  Your consumption of these oxalate-rich foods drives greater abundance of the key bacteria in your gut that subsists on oxalates alone, the very same bacteria that has recently been recognised as a very desirable diversity marker.  Unless you’re starting with zero.

Or your oxalate threshold is dramatically reduced for other reasons like leaky gut, fat malabsorption, renal impairment and so on.

Over and over again we speak to practising ‘individualised’ medicine – but do we know when our favourite healthy inclusions are another’s downfall? Can we spot the individual who oxalate susceptible, sensitive or actively challenged?  And more to the point do we know how to navigate around this in the short term (food choices, preparation and combinations) and most importantly, start to actually increase tolerance in the longer term? Because oxalates are not the baddies, they are the messengers. As are FODMAPs and amines and and and…remember not to shoot the messenger!

This is a big topic that is important to be across and much more complex than a quick google search or some wellness blogger’s misleading ‘Low Oxalate List’…but given most of us hold the position of loving all things food and have a strong grasp of science this is one we can master, given the right reading, resources and up-skilling.  Cue…a succinct entertaining audio summary of the true science and sense on this topic, clocking about 29 mins of your time, plus a couple of key full text and very readable articles for those with a desire for deepening and a PT ride to fill.. and you have our latest Update in Under 30 Oxalate Overload 😉

Oxalates are found in high concentrations in many of the ‘healthy food choices’ we promote and are even higher again when these are organically farmed!  Given the importance of individualising therapeutic diets are we able to quickly recognise those who need to lower their low of these naturally occurring plant products? Who shouldn’t be drinking green juices?  And which of our patients might benefit from being educated about different food combinations and preparation to lower the oxalate load from these otherwise fabulous foods?

Get the latest Update in Under 30: Oxalate Overload here

 

It’s Not Rocket (Dental) Science!

With the increasing weight of evidence pointing to a potent pathogenic portal between our mouths and every other part of the body, whether that be in terms of cardiovascular disease, rheumatoid arthritis, appendicitis, even a growing case for Alzheimer’s disease, we need to ensure we’re not overlooking the condition of each patient’s oral cavity.  I got very excited about the recent Medscape article: A rapid non-invasive tool for periodontitis screening in a medical care setting. It’s true, I live a quiet life 😉 But seriously, a validated tool for all non-dentists to accurately pick up on the likelihood of this condition would be a nifty little thing indeed, so we can narrow down just who we quick-march off the dentist as well as understand their whole health story. But then I read the 8 actual questions which included gems such as: Do you think you have gum disease? and Have you ever had treatment for gum disease such as scaling and root planing, sometimes called “deep cleaning”? I thought, ok, this is not rocket (dental) science.

But that’s the point, I guess, right?

So while I encourage you to check out & employ this screening tool by all means, we can also be reassured that just by ensuring that when we ask about someone’s digestion (and when don’t we?!) we start at the very top of the tube, we’re doing a good job!! As my new grad mentees learnt this year…following the patient’s GIT from mouth to south anatomically, is my rather simplistic way of guaranteeing I cover everything digestive..without using formal consultation script. So in the case of the mouth, my questions include things like: last trip to the dentist; any prior dental diagnoses, number of amalgams, implants, root canals etc & their routine dental care techniques, any signs of bleeding on brushing & all foods they avoid for dental or oral reasons? Look, it hasn’t undergone the rigorous validation that the Self-Reported Oral Health Questionnaire has..but I think it’s a good start.

Whether we’re being picky about pathogens and exactly how they got access to the rest of the body (and gums make a great entry point!!) or just concerned about chronic low level inflammation, a ‘gurgling’ CRP between 1-5 in an otherwise ‘healthy adult’, picking up on periodontitis is a pivotal.

Oh and if you’ve ever wondered about possible health implications from mouth metals other than amalgams…don’t worry, soon I’ll be getting to that with a forthcoming UU30.  

Want to hear more about how certain microbiota (from the mouth to the south) are being implicated in joint diseases such as rheumatoid arthritis and ankylosing spondylitis and how we can investigate these individuals? Getting to the Guts of Women with Joint Pain is a recent UU30 instalment that gets down & dirty on the detail. 

You Say Tomatoes I Say…

Histamine, Oxalates & Nickel…any of which may be at fault when your patient reports they experience adverse reactions from eating them.  The same can be said for legumes, with a few extra contenders thrown in like oligosaccharides for those farty on FODMAPs.  Additionally, in either case, there could be a bona fide allergy (IgE) or an intolerance (IgG) at play.  Tricky, right? 

I hear from practitioners often, though, that their interpretation of food reactions like these are at risk of being 1 dimensional, like a food word association game: tomato = histamine; legumes = FODMAPS; gluten = NCGS.   

The labyrinth of possible pathways for food reactions is just that, a labyrinth!!  So, we have to always be on our toes and try and approach each case methodologically. 

I outlined how to approach this in clinic in A Guide to Investigating Food Reactions, released earlier this year.  We cover a lot in this 2hr recording, but let’s face it, it’s an area that needs yet more time and a field that we never stop learning in. Next week, as part of our UU30 series on Getting to the Guts of Joint Pain, we need to take a little scenic detour along Oxalate Boulevard!  Keep your eyes open peeps, because our very own food prescriptions tend to be full of them!! Not naming any names….berries, green smoothies, sweet potato &…

Need to catch up on investigating adverse food reactions??

Elimination of suspected food 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 adverse food reactions landscape. 

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 😉 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 ≥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 🙂 

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…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!

 

 

 

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 😉 ) 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’ 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!  🙂 🙂

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 ‘lowish’ TSH  and typically a clinical picture of hypothyroidism.  As the practitioner we are faced with the conundrum of how to effectively ‘wake up’ 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 😉 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 🙂

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 😉  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 😉

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? (≤30 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 (≤30 minute audio)

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

3. Iron Overload… But not as you know it (≤30 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? (≤30 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?!  (≤30 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.

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 – Is 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?! 😉

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’t 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??!! 🙂

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 🙂

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 ‘should have worked better’ had our hypotheses been correct. Novel drivers such as oxidative stress, inflammation and mitochondrial dysfunction are on everyone’s 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.