What’s Changed For You?

How much has THE world🌏 changed in the last 2 years?! Have the changes within the field of Integrative Health been equally seismic? I’m sure there are many different aspects to speak to & we all have our own thoughts to share on this. I shared my thoughts on this topic in 2021 with AIMA conference attendees and now I’m pleased to share them with you as well. Of course, your position in the integrative health landscape influences your perspective. I’ve relished the ongoing opportunity to mentor and supervise clinicians of various persuasions (nats, nuts, GPs, pharmacists, psychologists etc) and at various levels of experience – from new grads to some seriously seasoned & stand-out successful practitioners, as well as being a member of several medical & health communities such as ACNEM, AIMA, NHAA , not to mention my inner circle being dominated by health professionals, to boot!

To equip me for these roles, I spend a lot of time reading research & I noticed in the first 18months of the pandemic a substantial jump in published papers on topics dear to my heart, such as…
Who visits a naturopath?
Why do they choose naturopathy/nutrition or integrative medicine?
What’s the early career experience like for our new grads?
&
Where do we sit now and where are we heading in the broader health landscape?

As you might have noted too – oodles of this research has come from Down Under ⚡💪 And btw – we have some serious gratitude owing to our publishing peers here in Australia, who are making huge contributions to making ‘us’ and our work visible in academia: (Amie Steel, Hope Foley, Erica McIntyre, Mathew Leach to name just a few!) So while our visibility is improving in academia – are we also being more ‘seen’ by the population as a whole – you know- the ones that make up our client base, stimulate our brains, engage our empathy and sustain our clinics staying open? The data, both published and from practitioner ‘word on the street’, tell us in unison

When the challenges we as humans face, grow in number and variety, the skills and our contributions Integrative Health professionals offer, in terms of advocacy, time-taking, a person- centred approach & individualisation of treatment is in demand more than ever.  And on that note I want to leave you with one of my favourite quotes about person-centred care from Psychiatric Interviewing by Shea – but it is true no matter was the presenting complaint, nor where you are in the process of helping that patient:

“In person centred interviewing, the patient is not viewed as the problem but as a unique individual filled with solutions to the many problems that life invariably brings to all of us”
Shea 2017 page 9

Oh and P.S. The AIMA FACE-TO-FACE Conference is BACK in November this year!! And given the last time I did this, we were just on the eve of the pandemic and I raced home to just miss curfew…it feels like a  perfect place to gently, gingerly come out the other side(??)!!🌈

The Power & Place of Integrative Medicine (Free Video)

As integrative health practitioners, regardless of the tools of our trade, we empower people and advocate for those that don’t feel powerful with respect to their health and well-being. We are compassionate and empathic, ‘alternative thinkers’ and notoriously dogged diagnostic detectives.  This talk aims to remind us about our true super-powers. These distinguish us from other health professionals and service providers and are in greater demand than ever before, during this time of significant planetary and population change and challenge.

More FODMAP Fails

Last week, yet another patient with refractory diarrhoea, up to 10 stools a day, Bristol type 5-7, for 3 decades following a diagnosis of Crohn’s at 16 years old. A range of specialists have thrown everything at ‘it’ – single & combination immunosuppressants, TNF alpha blockers, buckets of sulfasalazine and bathtubs of antibiotics – she’s been gluten and dairy free for years, trialled strict diets that are FODMAPs free, low histamine etc etc etc. She’s even had 50cm of her terminal ileum removed & the diarrhoea continues unabated – perhaps even worse than before…& therein lies a major clue.

 1/2 patients with Crohn’s exhibit bile acid malabsorption –> diarrhoea but with terminal ileum resection this jumps to > 90%

This is Type I BAD (Bile Acid Diarrhoea) & is the easiest to spot, being the result of anatomical change.  You remove the section of the small intestines responsible for 95% of the reabsorption of bile acids…a LOT of bile acids are going to be present in the colon where they act as potent osmotic laxatives, right? But there are 3 other types which are a little trickier to identify – including one that affects up to 50% of IBS-D patients. 

Being a child of the 80s⚡🎹 (ok a teen of the 80s but who’s counting?!) and a personal fan of fat, I NEVER thought I would EVER be recommending a ‘low fat’ diet to ANYONE🤐

But hey, that’s another ‘absolute’ that needs challenging, right? I mean this is the primary, almost only, dietary change these patients need to make and as a stand-alone intervention, is highly effective for many. We’ve had several patient successes in the last year – a total game-changer for patients in similar situations where all kinds of  ‘restriction’ had brought zero joy and reward for all their ‘good (dietary) behaviour’. While sequestrants (like cholestyramine) are recommended in BAD, and are certainly worth a trial at least, patients have very mixed results – for some, in combination with the low fat diet it’s a winner – for others these meds cause GIT upset all on their own and actually undo the good of the fat restriction. Being able to identify the true reason for their loose stools and stop them going down endless rabbit holes of ..is it? is it? is a great way to re-empower people who’ve been bossed and bullied by their bowel for far too long 🤓💪🧻

 

When is IBS BAD?

This is not a trick question. Up to 50% of all patients diagnosed with IBS-D actually have bile acid diarrhoea (BAD) underpinning their digestive complaints as well as some patients with non-resolving diarrhoea post-cholecystectomy and gastro.  Knowing which ones do and how to manage this, which requires distinctly different approaches from our general management of IBS, is the key.  As always, good lessons come from those we learn in the clinic and this story starts with a patient and how we came to recognise the BAD in her belly.

Meet My Alter Ego

Impact of drugs on mental health

Did I say, ‘Our Brain’? 🙄 Maybe it really should be, ‘Their Brain…on Drugs: what recreational substances reveal’. While infinite self-analysis is an occupational hazard for health professionals, when we use our detective powers for good not evil, our patient work-up benefits.  But of course, it is impossible (and not desirable) to avoid all self-reflection.  Let me introduce myself: I am a high dopamine gal.  How do I know?  Because a valid accurate test of my neurotransmitters told so? Heck no – outside of lumbar puncture there isn’t one! Because my reactions to recreational drugs did.

A self-proclaimed ‘cheap date’, with amplified & protracted intoxication experiences from small amounts of any psychoactive & no, sadly, not always pleasant.  I specialise in visual trails, a known trademark of dopamine surges, when under the influence of even just a few drinks – much to the bewilderment of my loved ones.

Some even famously once questioned whether I was, in fact, safe to ride a push-bike 500m on Lord Howe Island after 2 glasses of prosecco. Stop! I heard that murmur, this has nothing to do with my liver & its handling of such substances. [How rude!😆] I can cite ample other evidence in support of this. This is also not simply due to being a teetotaller and therefore having not (yet) developed tolerance.  This high dopamine diva-stuff is echoed by my non-intoxicated ‘normal’: vivid dreaming, impulsivity, and bankable bad reactions to Vitex: ANGER (capitals intended). TMI? 🙄🤐

When you know the questions to ask, the answers to lean in further to, and then the way it can all come together, to create a neat little trail of breadcrumbs we can follow all the way to our their neurochemistry…you can find the gold.

The thing is – and I remain annoyed and frustrated by this to this day – our ‘schooling’ was not very ‘sex, drugs and rock’n’roll’. New grads tell me nothing has changed. In fact, these kind of topics were absolutely omitted, in spite of the claim we consider the ‘whole patient’, the whole health story! Interesting, hey? Nod to those working on the ‘sex’ bit in holistic health: Moira Bradfield-Strydom, Sage King, Monica Francia, Daniel Robson…love ya work!  Now for the drugs! Do you know what recreational substances can reveal about your patients’ neurochemistry?

Finding out about your patient’s historical or current psychoactive appetites and adventures (and yes that could be as commonplace as alcohol), is not purely for the purpose of collecting yet more data on their ‘health behaviours’. Nor yet another cue for casting judgement! It is an opportunity to take a can-opener to their cranium, open that baby up & take a look inside.  Without making a single incision!

But there’s a bunch of background knowledge you need to polish up on re psychoactive MoA and what each part of your patients’ experience (1st vs subsequent exposures, threshold for intoxication, the nature of the intoxication itself, & the possible aftermath) can reveal – as an inventory of their CNS materials and machinery.  All the while having a process to follow to ensure your evidence is leading you to the right and reasonable conclusion. Come with me and let’s follow the trail of breadcrumbs your patients recreational substance experiences have laid out for you…🐓

 Our Brain On Drugs – What Recreational Substances Reveal Part 1

Ever wondered why not everyone loves MDMA given it’s the ultimate love drug? Or why some of your clients are exquisitely sensitive to the aftermath of psychoactives and routinely, reliably experience ‘rebound’, in the following days while others ‘bounce’ seamlessly from a big night into the boardroom the very next morning?  What do these things tell you about the state of play of their neurotransmitters & their neurochemistry? So much more than you expect and given the only validated accurate assessment of an individual’s neurotransmitters is via lumbar puncture…with far less pain and inconvenience.  This is the first of a 2 part discussion.

&

Our Brain On Drugs – What Recreational Substances Reveal Part 1 Part 2

The 2nd part of this discussion goes into the detail of the MoA of each recreational drug class and what our patients’ encounters with these reveal about their neurochemistry. It also includes a resource we’ve developed to help you follow a process, in your review and rate the quality of evidence you have, to ensure your extrapolation and interpretation are well-founded.  **WARNING OVERSIZE LOAD AHEAD** There is a bonus case discussion that puts into action everything outlined in both parts and the process of qualifying the evidence. 

 

You can purchase individually Our Brain on Drugs – What Recreational Substances Reveal Part 1 here and Part 2 here
or become an Update in Under 30 Subscriber to access both episodes plus the entire library (100+ episodes) of Update in Under 30 audio’s and resources here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.

I’m Against Absolutes

And health, no matter which side you sit on, seems to be particularly plagued by them.  I (incorrectly) recall my 4 year degree as being a series of deep personal losses, some favourite food, then caffeine, then alcohol etc etc.😂 Likewise, I’m aware that naturopathy & integrative health’s ‘voice’ in the ‘conversation’, could arguably be perceived as mostly a negative one – as in, ‘No. Never. Not good. No, not even a little bit?!’  But I love both playing devil’s advocate & reading the research (ALL the research – even the stuff that doesn’t support my views and position GASP!~) so I am less in favour of absolutisms.  This came up recently when I suggested alcohol may improve iron uptake 😬

Practitioners’ responses were 1 of 2 types: humorous dismissal (“steak & beer for breakfast – at last a naturopathic prescription I can support!”) or horror. 
But why are we so attached to the absolutes in spite of contradictory evidence?

Let me ask you this: is coffee bad? Full stop? Period? The end? Or is it the most concentrated source of antioxidants consumed in the average Western diet? Does it improve bile flow, peristalsis and at higher levels actually protect the liver against damage? Clearly, we need to read all the evidence, including, the favourable and make individual decisions about ‘what serves and what sabotages’, for each patient. But do we? Or do we imagine we only get membership to the ‘Ultimate Integrative Health-club’ when we adhere to blanket bans? 

Similarly I, like many of you, see a LOT of iron deficient women –  & a fair chunk of these have been incorrectly labelled, ‘refractory’ because the conventional correction strategies (high doses everyday) don’t actually make sense. But like you guys too, I’m always on the hunt for new ways to improve iron absorption in these women, so I can hit them & their gut with less. That’s why I shared the research regarding alternate day dosing, and taking a supplement within an hour of exercise and now, I dare to ask if a tipple could be helpful?

While we know that both ‘GOOD’ (exercise) & ‘BAD’ (alcohol) health behaviours increase gut permeability, which sounds ‘BAD’, right?
But could this be ‘GOOD’ for some?

This has certainly been demonstrated in relation to exercise & iron but most of the research investigating how alcohol intake effects iron uptake and status is based on alcohol abuse. The study below, however, based on a large sample of non, mild, moderate & heavy drinkers captured in NHANES data – is a very well written and reasoned article, such that it can exclude liver damage, inflammation and HFE mutations as other explanations for the better iron status, in drinkers. And it found:

“Consumption of up to 2 alcoholic drinks/day seems to be associated with reduced risk of iron deficiency and iron deficiency anemia without a concomitant increase in the risk of iron overload” and “Any amount of alcohol consumption was associated with a statistically significant 42% reduction in the risk of iron deficiency anemia (OR, 0.58; 95% CI, 0.4–0.8).”
Ioannu et al 2004

   I challenge you to read it for yourself and challenge your absolutes!🤓

Oh and just in case you’re thinking, “Have we all misdiagnosed iron deficiency and it’s actually a Copper deficiency underneath?”  because last year the fashion was everyone was copper toxic and now this year someone’s making noise saying everyone is copper deficient !!! (Absolute? Anyone?!) Ah, no.  Copper deficiency, as a cause of iron deficiency and anaemia, has been around for about as long as nutritional medicine itself.  It is absolutely a thing.  But in the absolute minority of people.  And if you go back to some basic maths & compare and contrast Fe & Cu at each level: 1) requirements almost 20mg Vs < 2mg 2) average intake (inadequate Vs adequate) 3) bioavailability (Fe < 20% more typically < 10% in a modern low meat diet Vs Cu  is typically >50% ) and do some basic sums I call, ‘Menstrual Maths’ – You’ll likely deduce that inadequate iron intake and uptake, given our losses, is in fact the common culprit and a ‘coldie’ may be more beneficial than copper in most!  Can y’all stop asking me about that now – pretty please?

 

So You Think You Know How To Treat Iron Deficiency?

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!

Did you know you can subscribe to these?  We deliver at the end of each month, just add a 12-month subscription to your cart and Rachel’s latest research is on it’s way to you!

 

That ‘Throat Feeling’

Is my sore throat COVID-19 or not? | OSF HealthCare

“My 7yo daughter was frequently distressed, telling me she had that ‘throat feeling’.”

As you can imagine, mum offered up a smorgasbord of suggestions to help her try and describe it: Can you swallow ok? Does it burn or taste funny? Where is it? Is it hard, soft, moving, give me a rating out of ten….so many, but she just couldn’t. When it was really bad, her daughter said she also felt it in her sternum. The first doctor attributed it to ‘stress’ & mum understood why. Her 7yo is a bit of a worrier and while the ‘throat feeling’ was distressing, stress, itself, seemed to also perhaps bring this on. But by the time they made an appointment with their regular family GP, mum had noticed her daughter’s sx were worse with heavy, fatty, high meat meals & that she was burping excessively especially with the night time meal also. So, when their switched-on doctor heard these very careful observations, he referred her for a urea breath test (UBT) for H.pylori.

‘Miss 7’ blew 1200 on the UBT
the decision limit is 200, to confirm the presence of the bacteria in significant amounts

As I’ve said previously, there are (sadly for ‘Miss 7’ & myself) no prizes for the highest score on this particular test.  In fact, I spoke with a gastroenterologist last week who said, really it remains so debateable about the significance of the overall result (?size or virulence of colony) that results should probably be more considered like a pregnancy test: a simple yes or no!  But this together with her sx was a clear yes. GP recommended triple antibiotic therapy which sadly produced vomiting in Ms 7 within a few days. GP contacted paediatric gastroenterologists to get some advice, which was: don’t treat unless symptomatic. Back to square 1.

“In the meantime, I had done Rachel’s two UU30 episodes on H.pylori, so I told him what ‘we’ would do (polyphenols plus cranberry juice plus Zn carnosine plus deal with the hypochlorhydria). GP  says. “Ok, then let’s do it and then let’s breath test again in 3-6 months.

She has now breath tested at 200 and symptoms are non existent!”

Mum contacts me to relay the success story & give me the credit but mum is completely minimising her extraordinary actions that produced this outcome. Firstly, not resting with the ‘stress’ diagnosis. I have seen several children who present in very similar ways to Miss 7, YES! they are anxious, YES! parents might tell you they are the ‘worrying-type’ but when combined with these upper GIT sx I have found they test positive for H pylori more often than they don’t.  And how clever is this mother’s medicine?

“I recognised it was worst after birthday parties where she has eaten too much and done cartwheels or run around (we now talk about recognising when she has a ‘full bucket’. We talk about the fact that her tummy takes a little bit more time to process food it means her bucket fills and she needs a bit of extra time to let it do it’s job before she adds more food to the bucket otherwise it spills over and she feels rubbish. She finds that analogy useful as she can feel her bucket getting full at birthday parties and when she gets the feeling, she knows why and doesn’t freak out.”

 

H.pylori – Eradicate or Rehabilitate?
For a bacteria identified just a few decades ago as being a cause of chronic gastritis, atrophic gastritis and gastric carcinoma, the escalation in the number of antibiotics used to eradicate it (4 at last count + PPI) has been nothing short of breath-taking.  A management approach more consistent with both integrative medicine and with an improved understanding of the delicate microbiome focuses on changing the gastric environment to ‘remove the welcome mat’. What do we know about how to do this successfully? It turns out…quite a lot.

What Good Can Come From ‘Getting on the Gear’

When was the last time you ‘got on the gear?’. Wait, am I showing my age?🙄  The afore mentioned ‘gear’ could be beers or GnTs, weed or hooch, eccies or pingers, ‘nose candy’ or blow. I could keep going! While, anything beyond alcohol, might be purely a historical tale for many of us – during a [ahem] ‘very different phase of our lives’, Australian research tells us that the patients who come to see naturopaths are just as likely to drink alcohol as those that don’t and are in fact about 40% more likely, to have used marijuana or other illicit drugs in the past 12mo.  And this was the women in their 30s!  You heard me.

Now, this is not a call to action, to dob in a dabbler. 

This is instead a wake-up call for all of us, regarding the best insight into our patient’s neurochemistry, that is right there in the patient’s psychoactive substance encounters.

Because let’s get 1 thing clear, straight up – the ONLY valid, accurate, reliable pathology test for the measurement of neurotransmitters is a lumbar puncture.  Correct. And anyway, if you’ve been following psychiatric research this millennium, you’ll know that the belief that neurotransmitter quantities are the whole story (or even main players) in neurochemistry, is fatally flawed.  So, whether your patient’s ‘alcohol or other’ is purely in the past or in the present, this line of questioning and what it can reveal to you about their neurochemical nuances (high or low dopaminergic tone, shortfall in serotonin, high or low histamine etc) is gold. 

Because no recreational substance BYO

Instead they raid your stocks and supplies, get your brain to develop ‘bigger ears’ for some signals over others.  Their effects are purely a manipulation of the patient’s existing materials and machinery. And accordingly, here is the great reveal. So, a 30 something patient of mine reports dabbling in all sorts during her teens and twenties. She relays pretty ‘expected experiences’ with each substance – remember these psychoactives are known quantities, we know a lot about which buttons they push and I so I concur that her responses were anticipated & typical. Maybe if anything, she is able to recognise that she had a lower threshold for intoxication compared with other first time users.  “But MDMA,” she says, “I don’t get it and boy I tried! Several times!” So, while everyone else felt the love in the room, danced all night to the fantazzmical beats and the orgasmic-optic light show…she felt like she’d taken nothing at all.  Aha! This of course would prompt me to ask more questions to help clarify both her serotonergic tone & other instances where she might have encountered oxytocin.  And the real insights about her neurochemical milieu (strengths, weaknesses, balance and imbalance) start to form, so too the best way to support her. Don’t miss the real reveal in your patient’s story – that offers to lift the lid on their cranium and let you take a look inside.

Our Brain on Drugs – What Recreational Substances Reveal Pt 1

Ever wondered why not everyone loves MDMA given it’s the ultimate love drug? Or why some of your clients are exquisitely sensitive to the aftermath of psychoactives and routinely, reliably experience ‘rebound’, in the following days while others ‘bounce’ seamlessly from a big night into the boardroom the very next morning?  What do these things tell you about the state of play of their neurotransmitters & their neurochemistry? So much more than you expect and given the only validated accurate assessment of an individual’s neurotransmitters is via lumbar puncture…with far less pain and inconvenience.  This is the first of a 2 part discussion.

 

You can purchase Our Brain on Drugs – What Recreational Substances Reveal Pt 1 here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

This

There’s probably some poignant lines from a rap song everyone knows that I could insert here but, alas, Gold FM doesn’t play anything produced after 1999, so I’m none the wiser. What I’m trying to bring to mind, is the potential clash between our reality & our response: we’re not all gonna get instafamous, so the majority of us should probably curb the buy-now-pay-later spending and establish some contingency plans.  And while it might seem like I’m just picking on the young folk, this can happen at any age and stage of life. These, in psycho-speak are called Positive Illusions, and are one of the concerns psychologists have about the potential impact of exclusively focussing on ‘the positives’, aka Positive Psychology (PP). 

Cue: ‘Strengths wheels’, Goal Visualisations, Gratitude journals etc etc

There’s a lot to like about this Gen Z offspring of psychology.  And perhaps, as integrative health professionals, a ready-made romance, given both tribes (them & us) believe in health being something beyond the mere absence of disease. That and the fact they give due recognition to the role diet & exercise play in our mental wellbeing…how truly thrilling! Over the last 20 years PPIs (Positive Psychology Interventions not the other ones!) have become so pervasive: schools, workplaces, we’re in an age of the National Happiness Index, we’re overflowing with positivity, spilling over the lip of your coffee mug, emblazoned with ‘You’re Awesome!’ or ‘You’ve Got This!'(Just in case we forget momentarily) But we need to explore the science for and against, to better discern when these messages and tools are a help in clinic and in our patients, and when potentially a hindrance, worse still, a harm.

😁POSITIVITY😁
is extremely popular right now, but an obsession with it & rejection of all things negative (thoughts, feelings, experiences pasted over by something nicer and brighter!) is not necessarily a balanced recipe for mental wellbeing, according to the science.

PP has made a wonderful contribution to how we think and talk about our mental wellness as opposed to just our mental illness. However, there is a critical context in here that’s important for clinicians to understand, in order to use it well, and some thought-provoking criticisms and counter-balances that will help us all avoid becoming as (in)effective as a slogan on a coffee mug.  Oh and guess what guys?  Assessment first 🤓💪 this takes the guess work out of whether your patient is a good candidate for PPIs and we’ve included two in this latest Update in Under 30 – even a validated mental health screen that only uses positive language for those averse to those nasty negative thoughts and feelings!

 

UU30 Positive Psychology Its likability & limits
The ideas behind Positive Psychology may resonate deeply with integrative health professionals, for good reason.  We have in common a belief that ‘the absence of disease’ does not constitute health & that prevention is better than cure.  And PPIs have become so popularised they have permeated into schools, workplaces and most people’s therapeutic interactions, e.g. gratitude exercises, identifying our strengths via a strengths wheel, self-compassion. But do we know the limits of positive psychology? Do we know who it works for and what it means when it ‘doesn’t deliver’  mental wellness?
You can purchase Positive Psychology Its likability & limits here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

FREE Introduction to Nutritional Psychiatry

I’ve been hatching this passion project for quite some time. In truth, I can probably trace its beginning back 2 decades, when I returned to practice, after working in psych meds for big pharma. I knew then I had something to say.  Because even then I knew that we, as integrative health professionals, could see that food must matter, nutrition must play a part, in the difference between mental illness and wellness and that the solutions were unlikely to be all pharmaceutical, or even that the likelihood of a ‘pharmaceutical fix’  would be improved by adequate attention our nutrition. For those of you too young to know, this was about a decade before the ‘Inflamed brain’, as a model for mental illness, got wings. About 5 years before the psychiatrist, Michael Berk, first took NAC to the world & about 5 years after the first links between methylation & mental health were just being muttered. It was before this extraordinarily expanding field of research even had a name: Nutritional Psychiatry, circa 2015 (thanks in part to Jerome & Felice)

And now it has a name
And the evidence is irrefutable
But we still need to get the message out, further, louder.

Since then, I’ve mostly shared my ‘something to say’ with you.  Entrusting you with passing on the message and the medicine further & it has been an honour and something I work to improve all the time. But every year or so along the way, I had the opportunity to speak to the uninitiated, the non-believers. At medical conferences, to doctors and pharmacists, via in-hospital training of psychiatrists, on large public platforms and each time I did, the same thing happened. The room went quiet, people listened, crossed arms before I began, unfolded by the time I finished, with even the staunch non-believers at the outset, approaching me afterwards, to speak to the impact, the revelations.  I had hit a nerve & built a bridge, simultaneously. 

So I decided it was time, to indeed ‘say something’ , to more people and more loudly than ever before & I created this video: How Could Nutrition Improve Your Mental Health?

This is something so many need to hear right now. I hope you might share it with your patients and save yourself some precious time in your already over-crowded appointments. Use it as an educational offering, a soil tiller, a ready rationale, maybe even, a ‘step 1: watch this’, for those you’re about to help. With the other health professionals you share these patients care with, so they can better understand the place and potency of your contribution. Family and friends – so they too can benefit and better understand. It doesn’t feature me, outside of my voice to carry the message & it refers them back to you – to ‘us’, those of us passionate about wellbeing, skilled-up in nutrition, who take the time and know that not all mental health solutions are outside of ourselves & an individualised approach that takes the best of each modality is ultimately best for the individual.

Introduction to Nutritional Psychiatry can be viewed here.
This 30 min video is an introduction to Nutritional Psychiatry. It is especially beneficial for integrative health practitioners and people working in mental health related industries. We encourage you to use this engaging ‘visual’ presentation to educate your clients by giving them this link. Contact admin@rachelarthur.com.au if you would like to receive a digital copy to add it to your website or other online platforms.

 

Nutritional Neuropathies & Much More

Burning, tingling, crawling, buzzing, humming, zapping, pins & needles, numbness: our patients often tell us about strange sensations they have in various parts of their body. It’s typically not their major concern, but they mention it as an aside, a curiosity, ‘another weird thing I get’. While they may have trivialised this, relative to their ‘real issues’ [insert gut, hormonal, mental health] we should do the opposite and bring this concern to top of the list to correctly identify the cause.

If bilateral sensory nerves are mis-messaging it typically means 1 of 2 things:
1. Nerve damage is occurring – and if allowed to progress this can become irreversible or extend to motor and central deficits
2. Nerves are irritated or impaired – and this tells you something ‘systemic’ is out of whack and these sensations are often the only alarm bell

The top cause of paraesthesia, falls into the first category and is of course diabetes – and yes even now diabetics will walk into your clinic not knowing they have this (a good old HbA1c should be routine to rule this out).  Second on the list is alcohol dependence. The third most likely explanation for the patient with paraesthesia is nutritional.  And in contrast to what many of us might incorrectly think, there is a long list of nutritional imbalances that can be responsible for either, nerve damage or irritation, and B12 deficiency is not in fact the most likely.

That’s right all you nutritional ninjas🐱‍👤  – that makes the correct identification of the cause & the solution our bag, right?
I mean who else is going to do this, accurately?

Asking the right questions about these sensations helps you to quickly confirm when a nutritional cause is likely.  From there we need to know how each single micronutrient excess or deficiency or in the case of some, ‘sort of single’ nutrients (we all know people who sit in this category, right?! So why not nutrients 😂) are likely to present, via ‘easy-to-spot’ key characteristics that cover: pattern of distribution, speed of onset and progression, risk factors, accompanying features etc.  In our final New Graduate mentoring session for 2021, a practitioner presented her patient who rated her concerns as 1) Fatigue 2) PMS 3) GIT issues & 4) Tingling & crawling sensations across limbs, face, lips and tongue…and I was like, whoa stop right there, you might just have given us the answer to all of the above~!~! Seriously. Here’s a clue: it wasn’t oral allergy syndrome and it wasn’t B12. Can you pick it?🤓 

The Patient with Paraesthesia – Part 1
Patients often mention experiencing peculiar sensations: crawling, tingling, burning, as an aside, as a ‘oh and by the way’.  But while it may not be their top priority – it should be ours.  That’s because nutritional imbalances are the 3rd most common cause of these and timely treatment is essential to prevent progression to more serious issues.  The list of potential nutrient deficiencies and excesses behind these, is long, but this recording, the first part of 2, will help you narrow the differentials, nail the diagnosis & the solution.

The Patient with Paraesthesia – Part 2
In this continuation of this topic, we discuss several less talked about nutrients whose deficiencies drive potent pathology for the nervous system & move onto a cluster group of minerals, whose imbalances create functional irritation rather than organic change. This episode includes a range of excellent resources from videos demonstrating in-house tests you can perform to aid diagnosis, as well as our own Ready Reference which assists correctly categorising the different paraesthesia patterns and the nutrient issues behind them

You can purchase The Patient with Paraesthesia Part 1 here and Part 2 here.
BUY PART 1 & PART 2 TOGETHER AND RECEIVE 10% DISCOUNT BY USING CODE BUNDLE12
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

 

Are You And Your Patients Stuck?

There are some things we say so often to patients we could record them and just press <PLAY>  Like this daily dogma: ‘When you’re under stress, your demand for Magnesium rises and then in turn that can make you more susceptible to further stress, so we’re going to give you some to support you’. But is this actually the whole story? You guessed it, no. (I know I am fairly predictable like that 😅) 

Recently, a personal new record – a patient reported ongoing daily use of a very high dose Magnesium ‘practitioner only’ product 8 years after it was prescribed by her then naturopath – and guess what, the patient still hadn’t reached nirvana*  
not the band! – a transcendent state in which there is neither suffering, desire, nor sense of self

Jest as I may – I think this raises some serious questions.  The pervasiveness of our prescriptions when patients are not given an end-date coupled with ongoing access. How (not) effective this intervention was if someone perceives ongoing undiminished dependency on it. And specifically with Magnesium – whether our prescriptions (form, dose, adjuvants, advice) are the problem? If stress is synonymous with a shortfall of this mineral then Magnesium is not a solution to stress itself but the amplified stress response and the stress still requires its own redress, right?  But do our patients hear this as well when we press <PLAY>?

Likewise – the BIG doses per serve being recommended might make sense for the minority (seeking potential NMDA antagonism) but are a real mismatch with the majority, who are just stuck in the stress loop and weathering a perfect storm of Magnesium under-supply and increased demand.

I love my minerals as much as, ok more than, the next practitioner but I’m always keen to refine my repletion approaches and oh yes, by the way, there is good data, a meta-analysis in fact, examining how long it takes to achieve repletion using oral Magnesium – and guess what, it’s not 8 years! The latest Update in Under 30 goes into all this and much MuCh MUCH more…you’re welcome 😂

Magnesium – Stuck In The Stress Loop

Practitioners working with nutrition appreciate that Magnesium is vulnerable to depletion by the stress response and that in turn, can make people more prone to stress & keep patients stuck in a so-called ‘stress loop’. But do we understand the intricacies of this and how we, as practitioners, can get stuck in another kind of loop – one of endless Magnesium prescribing without reaching repletion? We discuss ways to improve your Magnesium prescriptions – in particular, ‘doping Vs drip-feeding’ and other things to assess & address if the long road to repletion risks becoming an endless one!

 

You can purchase Magnesium – Stuck in the Stress Loop here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

When CKD C(omes) K(nocking) at your D(oor)

And it will.  It knocked again on a practitioner’s door last week.  She in turn knocked on mine. It turned out to be a very familiar story:

Firstly: Patient presents distressed – recently a nurse applied the term ‘Chronic Kidney Disease’ to HER (note no one has ever mentioned this diagnosis)
Secondly: She is in stage 3 of 5
Then: This practitioner is left to have ‘the conversation’ but wants to know where to start, ‘What do I say?’
Next up: And what else can I do for her – are we really able to make a difference?

Familiar to you too? So,1st & 2nd: Yes, this is not uncommon we would have to say and even with age-appropriate reference range adjustment, her GFR consistently in the 50s,  flags premature decline.  Then: What DO you say?  Well this clearly is a delicate area, not only because of the level of patient distress and concern but because, at this stage the practitioner knows nothing more than what the patient tells her and her ELFTs over the last 2 years.  This is not enough information, right? Chronic Kidney Disease is a heterogeneous condition, with many different causes, manifestations, comorbid conditions, and factors affecting prognosis (Levey et al., 2009) So while most individuals certainly progress from stage I to II and II to III the rate at which they do this differs dramatically.

Two years of data is not long enough for us to appreciate the trajectory of her CKD & means we are unable to provide the patient with any kind of perspective:
‘With no further decline in GFR or progression in stages over 5 years, you’re doing well, so keep doing what you’re doing!’
Vs
‘Ok, I can see what looks like a little period of accelerated decline – let’s review what’s been happening and how we can turn this around”

“Please sir can I have some more?’ Yes, back to her primary carers to request more information to fill in the gaps, and ideally more labs to calculate & observe the trajectory for yourself.  Next Up: What do we have to offer the patient with CKD stage III? Soooooooooooooooooooooooooooooooooo much!! When is adequate hydration helpful?  Always, except Stage V! (and these patients are not coming to see us) What are our treatment objectives & our evidence backed medicines to meet these? Hcy lowering (note often referred to as ‘folate refractory’ in renal dx), vitamin D adequacy, lowering the acid load, supporting the microbiome & in turn the Renal-GIT axis…hang on, got to go…someone’s knocking 😅 but hopefully we all can see, when they present to us, they are indeed knocking on the right door ✊

Nutritional Interventions in Renal Impairment – Place & Potency

Nutritional or naturopathic support for the kidneys tends to have been over-looked in our training and yet research suggests there is much in our tool kit that can make an enormous difference to this system, in particular, slowing the progression of chronic kidney disease in patients.  Rachel talks about what these key evidence based interventions are and also gives you the tools to identify the early pathology markers of renal impairment – the earlier the recognition, the earlier we can make a start on the remedy.

Water & Our Kidneys – Helping or Harassing?

It seems almost farcical to question the merits of hydration for our renal health but is this actually the truism we have been lead to believe?  Where does the recommendation of ‘8 glasses a day’ come from and what is the level of evidence to support it and in whom?  Or should we in fact be setting our sights on output ie. 24 hr urinary volume, over input. Do all kidneys love water – or does this relationship change with the progressive impairment seen in CKD which affects up to 30% of our middle-aged population?  When does hydration become harassment?

Renal Markers – Explained, Expanded and Exploded 

Most practitioners graduated with not much more than a few ‘kidney’ herbs and an under-appreciation of the contribution renal health makes to wellbeing. It’s not just about waste and water.  In reality, the kidneys are pivotal in just about every major element: blood, bones, pH balance, methylation, control of oxidative stress, the GIT microbiome and more!  And we are seeing the impact of this in our patients in all sorts of subtle and not so subtle presentations.  This new instalment in diagnostics, brings the renal system into the spotlight so we can confidently identify and better manage its critical contribution.  In addition to this, just like with other routine labs such as LFTs, we unpack how these so-called ‘renal markers’ can flag a plethora of other insights into your patients, from reflecting (un)healthy muscle mass, to calculating  individual dietary protein adequacy, from key ‘danger and distress’ signals in response to disturbed metabolism, oxidative stress to certain types of GIT dysbiosis!  We call this Explained, Expanded and Exploded because these routine labs can deliver XXX sized insights into your patients.

 

Were We Wrong – Is B6 Da Bomb?

And not in a good way, right. While we’ve known about the potential for peripheral neuropathy with excess B6 supplementation since the 1980s, currently there’s a seismic shift in our sense of safety even with previously regarded ‘safe’ levels.  You may have heard individual whispers, or the chorus of voices coming together, both here and overseas, belonging to members of the public who report suffering sensory nerve impairment with as little as 2mg/d!  Is this a mess of mis-diagnosis, false attribution & nocebo? Perhaps for some, but certainly not for all.

How could this be the case given the many RCTs employing hundreds of mgs per day over months, with no such events recorded? 
How could this be given, your (?), certainly my, high dose prescriptions, with only 1 case of quickly reversed, peripheral neuropathy in over 20 years, on my books?
The pieces of this complex paradoxical pyridoxine puzzle are coming to light.

Is it the form?, the dose? the duration? individual differences in B6 metabolism & toxicity threshold? amplification of risk secondary to levels of other nutrients, or the use of certain medications?  Yes. And we need to understand each element to better tailor every B6 prescription to the individual & mitigate risk. I have spent the best part of this month reading almost every paper on this from the 1970s to last month and I am now alarmed but more importantly, alert, to what prescription practice changes we can all make to lessen the risk, and control the power of B6.  It’s been the most compelling deep-dive. Because in spite of a clear TGA warning issued last year that likely prompted the quiet removal of high dose products from market, it would seem none of the companies have the courage to have this difficult conversation with us 🙁 I invite you to ‘feel the fear & do it anyway’ & listen in to our latest Update in Under 30.

 

Haven’t we always known that nutritional medicine is a potent prescription?  Now thanks to more sophisticated research we have a much greater understanding of this and of both the intended and unintended effects of micronutrient supplements that have the potential to achieve supra-physiological levels.  B6 metabolism is arguably the most complex of the Bs – involving 6 different forms, at least 2 of which are active – and exhibiting some of the most complicated regulatory control designed to both harness the power & limit the accompanying risks.  Excess B6 supplementation, however, has long been known to present as peripheral neuropathy in some individuals and case reports of this are growing, at lower and lower doses. New information has come to light to help us understand the why, the how and better still how to mitigate risk to our patients.
You can purchase Dynamics and Dangers of B6 – Controlling the Power here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

Female Pattern Hair Loss ≠ A Female With Hair Loss

I’m intrigued by the silence.  Hair loss in women is frighteningly common, following pregnancy, menopause & with extreme stress (wait is that a tautology? 🙄) In fact it can strike at any age and for a multitude of reasons.  When it happened to me a few years back I also initially responded with silence, terrified that if I said it out loud it would make it real, but when my daughter suddenly asked, ‘Mum are you losing your hair?’ with her trademark attention to detail & exquisite empathy, she gave me the words & a good kick into gear, simultaneously.  Now I am fascinated by women’s silence around this generally, how little we share our stories & forewarn others, & as practitioners, the lack of adequate training we’ve had identifying the different types (hint: it involves donning gloves or if restricted to online consulting, knowing how to organise correctly positioned pics) & from there finding the right solutions. 

While Female Pattern Hair Loss (FPHL) is the dominant type in women – it only applies to the following pattern:

But alopecia due to stress, thyroid disorders, autoimmunity, contact dermatitis etc will affect different regions of the scalp and with a different onset & progression.

And remember, by the time YOU, the practitioner, can spot a patient is losing hair when they simply walk into the room, they have ALREADY LOST 50% 😢 This is why I think we need to push back against the silence. The research is unflinching about the serious psychological impact this has on women – especially in cultures which place so much emphasis on looks generally, and hair, specifically as a commodity of very high value in women.  The diagram above comes from a 2019 update on the phenomenon of FHPL and it’s a good articulation of the knowns and unknowns (pssst spoiler alert…it ain’t about androgens!) but let’s never forget the other causes and cures.  So let’s make sure as the trusted practitioners women present to so often, we are sensitive enough to have this tricky conversation & skilled enough to help 💪

Stop Pulling Your Hair Out – The FPHL Answers You Need

Female Pattern Hair Loss (FPHL) is everywhere, perhaps you just haven’t been looking.  As the leading cause of alopecia in women globally and with 1 in 5 women affected at any age, we’ve all got clients who have FPHL to different degrees.   We need to be better able to recognise the early features of this condition which profoundly impairs quality of life and induces depression in its sufferers and that begins with validating patients’ concerns when they report “thinning” or “increased losses”.  But what do we do from there?  This recording talks you through the assessment, diagnosis and management of FPHL based on a combination of the most recent research and Rachel’s clinical experiences.  Once you’ve ‘seen’ FPHL.., you won’t ever ‘unsee’ it and your patients will thank you.

The Breakfast Bench Test

You may have noticed I don’t often have recipe raves, swap serving suggestions or generally dialogue about diet.  That’s because about a decade into my career as a naturopath I hit food fatigue – my enthusiasm for explaining basic food swaps and increasing kitchen competency with clients, back to back, day in day out, took a bit of a nosedive. Admittedly, the significant time I spent on oil and gas sites educating workers about the same things ad nauseum, in the early part of my career, may have hastened the arrival of food fatigue for me a little earlier than others. There’s nothing like feeling the need to ask the few male miners who bothered to turn up to your talk, ‘Does your index finger work?’  to convince them of  their capacity to make smoothies – to wear a gal down 🙄  But today I heard another practitioner comment on a patient’s breakfast choice with a simple but eloquently said: ‘Nah, it tastes too good, that can’t be right!’ 

This took me way back.
I taught my kids (when they still were!) that the breakfast bench test was easy: any cereal you would be happy to eat straight out of the box or bag was a ‘no’.

I also used this with my patients.  Somewhere along the way – let’s say in the seriously over-committed second decade of my career and, as it happens, my mum role, I lost my way, and after rearing my kids on such truisms and a wide selection of hand-cooked ‘wholegrains’ for breakfast – millet, buckwheat, barley – I morphed into a ‘muethie mum’ (muesli or smoothie). To be honest – the transition was seamless and insidious – buried under a seemingly never-ending list of tasks I had to get through – it’s only in hindsight I can see the shift. But I’m here to announce, the buckwheat breakfast is back baby & it’s back for good!

Not puffed not milled to make pancakes, not processed in any way.  Just boiled.
(gotta love the purple in the water that screams polyphenols!!)

A pseudo-grain, of course, that’s high in protein, lower in phytates.  Served with lots of fresh nuts, fruit, a couple of prunes for even more polyphenol punch and some yoghurt. Costs about 30cents a serve for the buckwheat – so my big boy tells me- and it definitely passes the breakfast bench-test.  I don’t have any desire to eat the thing on its own, ‘out of the box’, but boy oh boy with this combo…it’s worth writing about, in case you too have had a bit of food fatigue and are ready to start your recovery 😉

It Could

You know when you learn about a ‘new’ dis-ease driver and then you actually have to stop yourself from diagnosing every patient with it? I’ve done this dance with Gilbert’s Syndrome for over a decade, so too maybe have some of you?  And while there have been many, many occasions when I’ve been certain it’s Gilbert’s (clear robust & reproducible patterns of high bilirubin without other explanation) there are other times when I’ve been left wondering, and with questions.  Like – what about a fluctuating pattern – sometimes ‘within range’ sometimes above or at least high-normal – with no other explanation? What about the patient whose symptom-story is a perfect fit – prone to nausea, early satiety, gut issues, food reactions and anxiety all worse for increased oestrogen…but the total serum bilirubin is 14 micromoles/L? I mean, 14, right? that’s well below the top of that range, but remarkably higher than the majority of women of the same age, eating the same diet. And you ask yourself…could it…be??

It could.

The latest UU30 offering on Gilbert’s Syndrome constitutes a complete overhaul of everything we’ve previously been told about how to recognise and diagnose this polymorphism & it’s going to answer a lot of those ‘could it be’ questions we’ve all had!  Known also as familial non-haemolytic jaundice and episodic hyperbilirubinaemia under stress – is everyone with Gilbert’s prone to jaundice? Uh, no. Total bilirubin levels typically have to get to 45 micromoles/L to evoke this effect – many of our GS patients won’t ever get there, some will with increased illness or other stress and may yellow a tad (like a fading bruise), while other patients of mine routinely have a bilirubin at this level but won’t experience jaundice unless they impair their UGT further via doing what they know they shouldn’t: extreme exercise or excess alcohol. The latest deep dive into GS diagnostics 

But as much as we don’t want to miss this diagnosis we don’t want to mis-diagnose patients with it either!

Can you spot the difference?  Don’t forget total serum bilirubin levels are the net result of haem catabolism – so you need to account for rate of blood production, destruction and of course rule out any biliary dx before you can take a guess at Gilbert’s.  Oh and watch out for expected high bilirubin values in the fasting fan(atic)s!

Living on Gilbert Street

For those people living with Gilbert Syndrome at last the research world & the real one are uniting – with greater detailed documentation of how this very common polymorphism presents and the mark it may make in their health story. However, given only 1/5 with Gilbert’s syndrome actually know they have this condition, who are we missing?  This latest instalment rewrites our diagnostic criteria and corrects our past misunderstandings based on the very latest science, while shedding further light on what it’s like to live in Gilbert St.

 

If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can purchase Living on Gilbert Street here
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The Low Fat Fix?

After our group session I suggested the low fat trial but she was ‘no, no, no….I can’t take anything more out of my diet’. It was at the beginning of lockdown & she had other stressors as well. So I asked her to be mindful of her fat intake & if one meal was higher in fat then go low fat for the rest of the day. I saw her last week & she did this & guess what her diarrhoea has dramatically improved. She is not experiencing watery diarrhoea nor the sense of urgency nor leakage.  Mostly 4, sometimes 5 on Bristol Stool. She’s now happy to trial low fat (<40g/d)”

This is the story of a 50-something female who has battled IBS-D for over 30 years. Along the way she has diligently sought the help of so many health professionals and tried numerous ‘tried and true’ IBS approaches, like FODMAPS minimisation, gluten minimisation, dairy minimisation & joy minimisation with hardly any minimisation of her symptoms!  Why? Because her loose stools and urgency were BAD. A very particular form of bile acid dysregulation that is present in almost half of IBS-D patients and responds best to low fat intake, together with a few other tricks.

And with the corresponding slowed transit time, we now can more clearly see if there are additional actual food reactions at play – without all the background BAD confounding and now  that her gut has time at last to actually correctly absorb things that she couldn’t before due to inadequate time in contact with digestive enzymes and absorptive surfaces.

Ahhhhh we love a great ending – especially one that reminds us the most powerful prescription is getting to the root cause such that we can empower patients 💪🧐 This patient and her practitioner inspired the recent Update in Under 30 on how we can all learn to recognise….

When is I.B.S. B.A.D?

This is not a trick question. Up to 50% of all patients diagnosed with IBS-D actually have bile acid diarrhoea (BAD) underpinning their digestive complaints as well as some patients with unresolving diarrhoea post-cholecystectomy and gastro.  Knowing which ones do and how to manage this, which requires distinctly different approaches from our general management of IBS, is the key.  As always, good lessons come from those we learn in the clinic and this story starts with a patient and how we came to recognise the BAD in her belly. Get this as a single download here

 

When Is IBS BAD?

No, this is not a trick question & it’s certainly not a silly one. IBS, as many of us know, has a very loose diagnostic criteria: visceral hypersensitivity coupled with altered motility in the absence of organic disease. Hence it tends to ‘loosely’ fit a vast number of patients struggling with GIT issues. The differential diagnostic algorithm all health professionals are encouraged to use for patients presenting with GIT issues leads us to this IBS label, just as soon as we’ve excluded the red flags. But this ‘early opt out’ according to many experts, including Schiller et al in the American Journal of Gastroenterology, tends to propagate the illusion we’ve reached our diagnostic destination: practitioners stop thinking about the ‘why’ & stop looking for the real drivers & causes, which is the key to shifting the refractory patient into remission.

For those presenting with chronic diarrhoea, Bile Acid Diarrhoea (BAD) is in the diagnostic algorithm & there is strong evidence it’s at play in almost half of these patients!
It’s just that BAD, is the next station along the line after IBS-D, which means most clinicians have sadly disembarked already 🙁

Bile acids, as key biological agents, in both the behaviour & health of the gut & metabolic dx, are getting a lot of attention right now.  While Bile acid malabsorption (BAM) in disorders of the small intestine such as Crohn’s & undiagnosed or refractory Coeliac dx, as well as other miscellaneous GIT disorders that clearly disrupt the bile acid balancing act of the gut-liver axis, have been known for a long time, there’s a new kid on the gut block, previously only known as the idiot, I mean, idiopathic BAD. But us idiots have finally worked it out!  This is not about malabsorption but about excess production of bile acids and this pathophysiology is drastically over-represented in IBS-D patients.

And knowing if your IBS-D patient has a ‘BAD-thing’ going on, every researcher wants you to know, is game-changing. Explaining the strong heritability of this particular IBS subtype and the reason so many patients are refractory to standard IBS approaches.

We need to use distinctly different dietary strategies when IBS is BAD.  Once again patients are our greatest teachers & I’ve relished the excuse one practitioner and her patient gave me to deep dive into the enormous body of BAD research, that is ‘so hot right now’!  The way I look at, ask questions about and assess patients with chronic diarrhoea, especially IBS-D, is forever changed 💪🙏

When is I.B.S.  B.A.D?
This is not a trick question. Up to 50% of all patients diagnosed with IBS-D actually have bile acid diarrhoea (BAD) underpinning their digestive complaints as well as some patients with unresolving diarrhoea post-cholecystectomy and gastro.  Knowing which ones do and how to manage this, which requires distinctly different approaches from our general management of IBS, is the key.  As always, good lessons come from those we learn in the clinic and this story starts with a patient and how we came to recognise the BAD in her belly.
You can purchase When is I.B.S. B.A.D? here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

Naturopathic Nanna’s Club

I’m 100% confident that, as a professional group, among our highest values about healthy, preferable, food choices, would be characteristics like: ‘as close to nature as possible’, ‘unrefined’, ‘unprocessed’, ‘unadulterated’.  Tell me I’m wrong.

So, when I keep hearing about NEW! “Never seen before” (read: never in nature) modified (read: more processed, adulterated) nutritional supplements: water soluble vitamin D, fat soluble C, bioflavonoids with unprecedented (read unnatural) bioavailability

I’m left wondering what these companies are missing about their customer group (because we are clear about our valuing of nature & what’s natural & have a desire to minimise exposures to things that are not, right?

or what are we missing here, in the clear conflict of our core values these constitute?

I think if we find ourselves forsaking this core value & prescribing highly modified, unnatural supps, it’s the result of both hype & fear.  The hype is self-explanatory and I’ve written recently on how modifications exponentially increase profit margins for companies, all the while possibly reducing ours because patients are spending more on product and therefore there is less left over for the practitioner fees 🙁 [The ones spending hours with them face to face, not to mention years & thousands on our training]  The fear is perhaps less apparent, more insidious.  The fear is that we’re not using the best, being the most effective, and deeper still, inevitably that we will fail to action our patients return to health. This is a big one. I think it’s pervasive, if not omnipresent, and works as a motivator for many positive actions by practitioners – like engaging in further education, reading that latest journal edition on your lonesome laptop when you could be streaming some series on a shared sofa. But this same fear can also undermine us, overwhelm us and shake our tree of trust, that we believe to be so firmly rooted within us, of the healing power of nature.

So while my position sometimes makes me feel very ‘old school’, I’m not suggesting we return to nutritional prescriptions composed exclusively of bee pollen & brewer’s yeast and I absolutely recognise and respond to an individual who has very specific barriers to benefiting from nutrients in their natural normal forms.
But let’s be clear, they are a minority.

Some of you will know naturopath Dawn Whitten & know that she is one of my mentors.  I’ve had the benefit of speaking with her over the years about herbal prescriptions but also about the principles & philosophy behind our practice & in one of many conversations she told me that a key objective she has with her patients is to rebuild their trust in their body, their own biological resilience (I love this concept and that’s a talk for another time!) and ultimately in nature. Well jeepers Dawn – how did you get to be so wise so young?  But isn’t that central to vis medicatrix naturae? Maybe that Naturopathic Nanna’s club isn’t so fuddy-duddy after all.  Want to join us?

Speaking of using nutrients in their most natural state for the best health outcomes – the best B3 is probably not what you think!!….
The Balance of B3

Most of us have been taught to ‘balance the Bs’ when supplementing, which discourages the use of single B vitamins in case this interferes with the regulation and roles of others. In reality, outside of a couple of dynamic duos like B12 and folate, there is little concrete information & evidence of this. In the case specifically of B3, however, we now know, the risk of an excess of the most common B3 forms found in supplements and fortified foods, results not only in disruption of other nutrients but imbalanced B3 biochemistry itself. Given B3, in its coenzyme form NAD+, is regarded as highly valued currency in the prevention of many diseases, as well as the key to our optimal health and longevity, it’s critical to understand the different forms and functions of the various B3 sources.

 

 

Copper Crimes (via Misinformation) 🤯

I haven’t personally seen every medical condition known to occur, nor every micronutrient deficiency  & toxicity picture in the flesh but that doesn’t mean I doubt their very existence.  Sadly, it would seem some practitioners due to a) not knowing ‘where’ to look in terms of best assessment medium and/or b) not knowing ‘what’ they’re looking at, when faced with an actual Copper deficiency, have declared this uncommon, but certainly not unknown, nutritional issue to be a figment of others’ imagination!

I know I’ve been fortunate to see more labs than most would want to in an entire lifetime , a collection of my own, my student’s & my mentee’s patients, so let me share just 3 sets of results from 3 different individuals: an 11Y boy, a male teenage athlete and a female in her early 20s with an eating disorder, all with Copper deficiency.

Don’t worry, I have more – just ask.  What’s so dangerous about people spreading myths and misinformation in relation to copper in kids and teenagers specifically, is it shows complete disregard or ignorance of an understanding of how Copper is critical for development during these life-stages and how regardless of which developed country you live in Copper is expected to dominant over Zinc in blood, especially pre-puberty.

AM I SHOUTING???!!!

I’m sorry it’s just that my blood tends to hit boiling when exposed to the misinformed, misinforming others…
and that can make one call out in pain 🤯

You see, I literally heard a practitioner in an “educational” webinar purport that
‘Copper Toxicity is so prevalent in kids in her clinic’ and I was like,
OH.        EM.      GEEE.

Because if you start with that misunderstanding, and are unclear about what constitutes an accurate Copper assessment and how to recognise the pattern that follows low serum levels (each of these patients above had abnormalities in their FBE consistent with Copper deficiency) you are not only going to miss the thing you need to make a priority to fix, you’re going to make it worse!  Take ‘Volatile Vince’ the gorgeous sensitive 11Y boy I saw, whose increasing mood volatility had been misattributed to pyrroles and given large doses of Zinc!  So, Copper Crimes are a thing.  Guilty until proven innocent but in fact, never found innocent by some practitioners it would seem.  The ramifications of unchecked Copper deficiency include negative effects on mood and cognition, immunity, and the balance of other nutrients and kids are going to feel this impact the most!  What are the causes? Inadequate intake being uncommon outside of eating disorders, and excessive Zinc rarely the cause, we’re likely looking at a marker of malabsorption or a genetic issue.  Don’t buy into the confirmatory bias many use when they choose which research to read (risk of excess) and which to ignore (Copper as an essential mineral, critical to kids)  and let’s not discredit something as not being a thing because we haven’t seen it ourselves, yet, hey, anyway, at least, now we all have, right?!😵🥴😆

Copper In Kids

Copper, as a kingpin in angiogenesis, brain & bone building & iron regulation is a critical mineral during paediatric development. So much so, the kind of blood levels we see in a primary schooler might cause alarm if we saw them in an adult. So too their Zn:Cu.  But higher blood Copper and more Copper than Zinc are not just healthy but perhaps necessary during certain paediatric periods.  This recording redefines normal, low and high with a great clinical desktop tool to help you better interpret these labs, as well as reviewing the top causes and consequences of both types of Copper imbalance in kids.

 

Cracking At The Corners?

Name a B vitamin. Hey, Bingo! It’s on the list!   What list? The complete one from all the review papers & references to possible links between individual nutrient deficiencies & Angular Cheilitis – inflammation & cracking at the corners of the mouth. So does that mean more Bs are the answer for people presenting with this painful, recurring issue?…Ahhhhhh No.  Yes, you heard me correctly, these deficiencies rarely cause the breakdown of the integrity of this very specific area of skin in the patients we see.   So now we have a double ouch, right?

We might send patients away with a B complex and some lip balm and over a week the cheilitis resolves – which one was the most therapeutic?
…I hate to tell you 👀

What is the underpinning cause(s) & the important message we are missing with this presentation?  Well, it could be one or more of a long LONG list of differentials, ranging from anatomical, habitual, immune related to iatrogenic. And while many nutrient deficiency pictures can include this feature and therefore make the ‘possible’ list, only one makes the ‘probable’ list. And that’s iron but only in severe deficiency, aka anaemia and only affecting 1 in 5.

Me???
…Telling anyone to push the nutritional issues further down the list of differentials for any condition?
Well, that’s unexpected
…possibly unprecedented

And no, antifungals aren’t the answer either. Yep, that might be worth a listen….👂

 

Just an annoying, embarrassing, cosmetic condition or could it be the clue that helps you ‘crack the case’?  There is a surprisingly long list of differentials for this condition but most of us only know a few, reflexively reaching for either B vitamins or anti-fungal creams. Does either make sense?  Does either address the cause(s) which we now recognise to be a unique series of risk factors in each individual?  Or are we at risk of shooting the messenger and missing the message of Cracking Corners altogether?
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