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 ≥ 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 (≥ 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…)

Two Women Over 70 Walk Into A Room…

No this is not a joke. The room they enter happens to be the clinic space of a practitioner I mentor.  The older women are friends, both originally from the UK and they sit in on one another’s consultations sharing many of the same experiences: grief over loved ones lost, memories, laughter and both describe waking in the morning with a sense of dread, because they’re tired, feel they’ve lost their oomph, their motivation, their chutzpah…that’s mostly why they’ve come today.

But know what else these two have in common?  (more…)

Sunshine Doesn’t Come In A Capsule..Last Time I Checked

Have you been a bit vitamin D trigger happy?  Does a patient’s low blood 25(OH)D test result have you reaching for a vitamin D supplement like the rest of us?  Yes…you might need to listen up then. Sunshine doesn’t come in a bottle.  That’s right, if your patient’s problem stems from inadequate sun exposure, have a guess what the best remedy is.  I’m not meaning to sound flippant but I think in all my ‘complex highbrow nutritional understanding’, occasionally (ahem), I have lost sight of the simple truths. (more…)

This is the Threadworm Answer You’ve Been Asking About..I repeat

this is an announcement

I had the privilege of presenting at the Integria GIT Symposium last weekend.  For those of you who attended, you’ve gone back to your clinic with a bunch of new ideas and inspiration I hope…oh and a new respect, terror and watchfulness for threadworm thanks to me!  In my presentation I outlined the many presentations of this infestation, what to watch for and the risk of chronic recurrence due,in particular, to a reduced ability for some individuals to produce chondroitin sulfate which renders the GIT environment hostile to worms. 

Chronic threadworm is a huge & grossly under-recognised issue in paediatrics, often presenting as behavioural & cognitive disorders (and these can be severe), bruxism, enuresis etc. of course, but another presentation typically missed is vulvovaginitis, vulval pain or UTI like sx in young girls. (more…)

Are you feeling your AGE?

Saggy skin

Ever got to the end of a day or a week and felt like this?  Or woken up to find your skin looking like this?! Just quietly, me too.  When my son was about 3 he was sitting in the back of my car with my mum (she would have been in her early 70s) and he asked how people get wrinkles.  We told him it was from having a fun life with lots of laughter, to which he replied out loud while still staring intently at my mother’s face, ‘Wow Grandma! You must have had the best life ever!’ I digress.

I personally am not a crusader of anti-ageing (seen my pics recently?!!) but my recent research into effectively reducing Advanced Glycation End-products (AGE) via the diet, to in turn potentially lower both my risk of tuckshop arms AND just about every other disease you can name (cardiometabolic, neurodegenerative, psychiatric, malignant, you name it), got me sitting up and paying attention! (more…)

Let’s Stop Normalising Abnormal Breasts

Breast boxer

Let’s play a little word association game:

I say ‘Fibroids’ – you say, ‘Oestrogen’.  

I say ‘Cyclic Breast Pain’ and you say, ‘Ouch!’ [because it just slipped out] but then you say, ‘Prolactin’, right?  Me too. 

Prolactin driven breast pain’s most characteristic form is the premenstrual ‘oh my goodness get these off me!!’ kind, with patients experiencing anything from burning, aching, bruised feelings and acute hypersensitivity to touch, which builds in intensity for days leading up to their bleed. Of course cyclic mastalgia can progress to being full-time mastalgia in women whose breasts start to exhibit structural tissue change in the form of cysts, fibrosis and ultimately fibrocystic breast disease.  If you’ve ever experienced even a day of mastalgia it is truly hard to conceive there are so many women (about 50% of premenopausal women!!) living with it daily.

Adding to our concerns about this so-called ‘benign breast disease’ (BBD) is that researchers are now certain it’s a significant risk factor for breast cancer, with women with any form of BBD experiencing at least a doubling of risk of a subsequent breast cancer diagnosis, while those women with proliferative BBD exhibiting a risk of 3.5X that of women without BBD.  Castells et al 2015  (more…)

Seriously..this $%*# is still happening

Milk the word

Setting: Local cafe

Scenario: Run into friends of friends who join us in the sunshine for a cuppa & we’re discussing the finer details of chai (western version V the real streets of Delhi stuff), tumeric lattes etc etc. as you do.  I comment on how unpleasantly strong I found the cow’s milk in those downtown Delhi chais we had when we were there.

50 something man: Oh I LOVE that – I just LOVE cow’s milk. I drink loads of the stuff.  I used to drink 2L a day but now it’s more like 1L a day.

Me: Seriously?

50 something man:  Absolutely.  Then there’s the cheese as well – I would eat at least 1kg of that a week.  But it’s good for my bones, right?  I have that thing, you know, before osteoporosis…brittle bones. (more…)

‘Take Me To Your Master!’

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I am frequently asked what scientific journals I subscribe to and often by the same practitioners over and over, because they can’t reconcile my answer: “None”.  Yet I constantly have my head in the scientific literature, right?  The two are not mutually exclusive, it’s just about knowing which free scientific and medical news-feeds are worth their weight in gold!  If you really are digging into the itty-bitty detail of things these won’t answer all your questions on all your topics but they do a great job of 1) keeping you up to date with the big headlines in general medicine, or, with the use of alert systems and filters, just the areas of health you’re particularly interested in and 2) offering you a huge highly credible resource database that is easily searchable. 

Point 1, Exhibit A 😉 :

Here’s just a few examples from the last month that popped into my inbox from Medscape that got my pulse racing:

(more…)

‘Sup with Zonulin?

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Watch the gap!  You know I love a good diagnostic test probably (way!) more than the next person but I am slow to come around when there’s suddenly a ‘new-kid-on-the-block’ that every functional testing company wants to offer you. This is how I felt about serum zonulin testing as marker of intestinal permeability too. In spite of Fasano’s important work, identifying this molecule and its role in the reversible opening of tight junctions in the small intestine – I didn’t embrace the test.   Why not?  Didn’t I love Fasano’s ability to add this piece to the jigsaw that had been missing til now?  Well I did.  Does that make it an accurate and reliable marker of intestinal permeability in every client with any kind of digestive issue…?  Well heck no!  That’s not how science works friends and I suspect we may have really jumped the gun a little on this one. (more…)

Chew

chew

Ask me to name a lymphatic herb other than Cleavers and Poke Root and I might struggle (sorry Sue!) but some other things stay with us forever. One of my stayers pops into my head every time I eat a carrot.  Every time I make my partner or my kids eat a carrot.  Every time I see those kids in shopping trolleys slurping on those awful yoghurt squeeze pouch thingamabobs and I want to ask their parents…does your child have teeth?  Well when was the last time they ate a carrot?!.  A whole carrot. Yup.

Remember to Chew. (more…)

Taking Care Down There

picture1Often we assume our patients know at least the basics about health – especially about things soooo seemingly basic…that we fear mentioning them would offend and make us look like someone trying to teach grandma anything!  But there are some instances where I’ve found I have simply assumed too much.

I think the issue of what I affectionately call ‘Vag Care’, is right up there as an example.

Soapy water?  Female deodorisers, daily panty liners, re-enacting bad movie scenes with soapy suds sex…what the???  It’s been my astonishing discovery that women of all ages, but especially a frightening majority of younger females (<30 yo), in this time of increasingly unreal ideas about sex and sexuality, feel inclined or pressured to adopt these practices in order to erase all trace of natural odour and healthy discharge. The abnormal has become normalised.  (more…)

Prolactin – But Wait There’s More!

bp

As an add on to my recent blog, I thought you might find this other detail about prolactin levels (PRL) interesting.  Several studies including a one published in 2009, have demonstrated a positive correlation between PRL and increased CVD risk in both men and menopausal women.  This correlation, which is believed to be the result of PRL’s vasoconstrictive effects, was evident while PRL levels remained well within range!

Women in early menopause with a PRL level just > 170 mIU/L (or 12.6 ng/mL) had 100% sensitivity in predicting a high peripheral blood pressure.

These researchers concluded that “Prolactin may play a role in accelerated arteriosclerosis in early menopause by affecting central/peripheral blood pressure and arterial stiffness.”  Similarly an earlier study in men, again found PRL in the slightly upper end of a ‘normal’ range correlated with increased blood pressure and hypertension rates.

So keeping an eye on PRL levels may also be a good inclusion in CVD risk monitoring and again, lowering even slight elevations, could prove highly beneficial according to the study by Sowers et al 1981.  Good food for thought perhaps.

It’s Friday…I thought you might need some reading matter for the weekend 🙂

Your Burning Zinc Questions Answered

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Most practitioners are pretty knowledgeable about Zinc and are quick to recognise a deficiency and the opportunities for zinc supplementation as an effective therapy and those same practitioners are often plagued by nagging questions that come up, in spite of loads of clinical experience, like:

  • Are plasma and serum zinc levels interchangeable?
  • What does zinc adequacy look like?  Is it just a single number on a page or do we always have to factor in copper levels and get the ratio right as well?
  • What can I expect from zinc supplementation in terms of changes to the patient’s plasma zinc?
  • What should I do when a patient’s zinc marker is refractory to the intervention?
  • Is there really a significant difference between the different supplemental forms available?

(more…)

Mental Health Assessment for the Integrative Practitioner

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I became interested in working in mental health not entirely of my own free will.  I guess you could say, it had made it’s way into my world via family members and friends as well as my own problems when I was younger. So when I was at uni and I came across any information about mental illness, whether it was pathology or prescription, it was when I undoubtedly resonated most strongly with what I was learning. I’ve had some great opportunities throughout my career to feed my interest, met some wonderful mentors and some other powerful teachers who were often my patients. It’s now become a running joke among my teenage children that all my friends are either psychologists or have some sort of mental health diagnosis, ‘…and what does that say about you?’ they love to add teasingly.  Well it says a lot probably: that I enjoy people who are comfortable talking about the psychology of our lives and ourselves, that I deeply appreciate that to be human is to suffer and we all suffer it’s just a question of degrees and the bravest of us share that with others.  Lastly, I think it tells you that I live in the real world with real people 🙂 (more…)

Uncovering Unhealthy Bones Earlier

bonesRecently, while I was touring around the country talking all things Acid Base (!), I spent a bit of time talking to practitioners about the limitations of our current protocols and assessment tools for detecting ‘Bad Bones’.  I was surrounded by a sea of nodding heads and when I offered a solution in the form of additional bone health markers, I could see light bulbs going on all over the room 🙂

 We all appreciate that osteoporosis develops over a lifetime not overnight, yet the current screening recommendation in most countries suggests that women at the ripe old age of > 65yrs and men >70yrs undergo their FIRST (!) BMD scan!  The only exception to this rule is that they recommend an earlier scan in those individuals at high risk…ahem….does anyone here not have their hand up??   (more…)

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