Most of us know that measuring a fasting blood glucose to assess how well someone is managing their glucose levels is about as crude and insensitive as waiting for the smoke detector alarm to tell you your dinner is cooked! If we wait to see an abnormal result here we’ve missed a prime opportunity for patient education and prevention long ago. Much the same story if you’re looking at HbA1c results.
To explain this I always use the analogy of a duck. A duck will always be able to swim but the question is how much effort does it have to exert to swim the same distance? If your blood glucose is within range after an overnight fast that’s as good as saying, ‘this duck can swim the length of the pond’. What it doesn’t tell you is how fast its little legs are paddling in order to achieve that. Measuring a fasting insulin at the same time, however, tells us some additional important information. It tells you how fast the duck’s legs are paddling just to keep its head above water! The more insulin you’re having to secrete to just maintain normal blood glucose levels, the more alarmed we should be! (more…)
Howdy hard working praccies 🙂 well I received a very interesting email this week from someone asking me if I thought her urinary iodine result was accurate or if, as I have written about previously (https://rachelarthur.com.au/concentrating-concentration-getting-urinary-iodine-right/), it needed to be corrected for the creatinine content of her urine. Her raw iodine result was 24ug/L which suggests severe iodine deficiency. Her referring doctor however had also asked for creatinine and applied the creatinine correction formula I have previously described:
Iodine (mcg) ÷ Creatinine (mmol) X 8.85 = Corrected Iodine – which changed her result to 265 mcg/gCR which suggests she is NOT iodine deficient at all
She then asked another doctor to review the result who had told her 24ug/L was correct in the first place as ‘pathology companies automatically correct for the concentration of the urine’. Naturally the individual found the difference in opinions and results absolutely striking and ultimately disconcerting so she thought she’d ask me.
It was good to get this email because it made me go and check my facts, get in touch with all the major mainstream pathology companies we deal with and ask their labs ‘Do you or do you not automatically correct for creatinine when you report urinary iodine results?’ I was worried I had given you guys some bad advice 🙁 …here’s what I found out: (more…)
No matter how long I am in practise there is always a group of patients for whom ‘vaginal thrush’ is a major problem. Most of us have some fabulous tricks up our sleeves to help resolve these issues & reduce their susceptibility – intravaginal lactulose is one of mine thanks to Jason Hawrelak. And then you come across those clients who vigilantly do every thing you ask them to and yet you fail to completely resolve the issue. Doh!
One of the most important things to do with all clients presenting with ‘thrush’ sooner rather than later is send them STAT (!) for a vaginal swab.
Not only does this clarify if it is in fact actually thrush (2/3 of self-diagnosed women get it wrong according to research!) but better again it names the actual culprit. It may come as a surprise but not all vulvovaginitis is due to Candida albicans – increasingly they are the result of other Candida species and this is something you absolutely need to know.
During a recent mentoring session, a practitioner wanted to better understand why she had a group of patients whose thrush seemed so resistant to her usually successful treatment. Here’s my initial response in a nutshell… (more…)
I am frequently asked by practitioners about where I find research and whether I subscribe to journals. I always tell people to look for information that is available for free first. Google has recently released a new web browser plug-in making accessing free, independent, full text research articles even easier! Pretty groovy huh?
As my last post suggested not relying on information provided just by company reps (if you missed it check it out here) is essential to being an informed practitioner. So here’s an introduction to Google Scholar button for your web browser to help you do just that!
What is it?
The Google Scholar button is a plug-in that you can install on your web browser (currently available for Chrome, Firefox and Safari) so that you can find the source article of referenced information via the title or take your web searches straight to Scholar. Google Scholar will show free and fee-based article in its results.
How does it work?
Simply install the plug-in on your browser (‘How-to’ install and use Google Scholar Button is detailed California Digital Library here) and use the button in the tool bar to search Google Scholar or copy and paste the title of the article you wish to find.
How will it help you?
This tool enables users to find the full text article from just the article title, or to search for full text scholarly articles and books. These may be free or fee based, but the point being it enables you to find free ones.
Get it here!
Download the plug-in right now for Chrome here and Firefox here.
Recently a practitioner lamented that because of her clinic location she didn’t see company reps very often & felt this was a barrier to her staying current with her clinical knowledge. Of course, I had to beg to differ.
We’re quick to judge the medical profession for their reliance on commercial sources of CPD, overwhelmingly provided of course by the ‘drug reps’ but it seems we’re less fazed or concerned about ourselves being equally reliant, unduly influenced and misguided (might I add) by the people employed by the CAM manufacturers expressly to encourage us to sell more of their products! How does that make sense?
I go back to my very repetitive mantra: always be mindful of who delivers you the message/information etc. and what their agenda is.
By promoting their company’s products to us, focusing on the products’ strengths, ignoring or simply not making it a priority to know the limitations or weaknesses of the products or the evidence, ignoring or again simply not making it their business to know when superior products are being produced by competitors or when new evidence comes to light that puts into question their products, reps are only doing what they’re employed to do. But is it helpful and is it ok? (more…)
About a decade ago there was a lot of excitement about using fish oils in the management of mental health, so much so even the American Psychiatric Association developed recommendations suggesting that people with mood, impulse control & psychotic disorders should all consume 1g EPA + DHA per day… but then what happened?
Ask most health professionals (GPs, psychiatrists, naturopaths & nutritionists alike) today whether fish oils are their first choice in mental health nutritional interventions and you’ll frequently get a, ‘No’ and I include myself in that.
Let’s retrace our steps to find out how we got here. The epidemiological evidence linking low omega 3 intake to myriad mental health problems in terms of susceptibility, incidence and severity is almost overwhelming. For example, depression rates are 10 times higher in countries with limited seafood intake and post-partum depression 10-50 times higher (Kendall-Tackett, 2010).
Noaghiul & Hibbeln postulated that countries where individuals consumed less than ≈ 450-680g of seafood per person per week demonstrated the highest rates of affective disorders (2003). One study of 33 000 women with low omega-3 intake were found to have an increased risk of psychotic symptoms (Goren & Tewksbury 2011) and it goes on. Then, we have other evidence also pointing in the direction of fish oils, such as the general consensus that excess unchecked inflammation is evident in many mental health conditions (Maes et al 2013). Numerous intervention studies using fish oils as stand-alone or adjunctive treatments have been published. Interventions have included high dose omega 3 (no specific EPA/DHA breakdown), EPA alone, ethyl-EPA, high DHA, blends with high DHA:EPA ratio, flaxseed oil etc. etc. (more…)
We had a great case in one of our graduate mentoring sessions the other day (thanks Kate 😉 ) , about a 40 something mum of 3 who reported to have cyclical mood and depression. Further investigation of the case, however, revealed that some of the key characteristics of the mood disorder were actually anger, aggression, irritability, hyperactivity, vivid nightmares etc. This particularly came to light with her responses to a mood survey that the practitioner had asked her to complete. I think validated tools like this (esp. DASS), when used appropriately, can give us enormous insight – often revealing things we might not have thought to ask about or that the client might not have voluntarily offered up, particularly if they are not socially accepted or attractive qualities.
If you practice anything like me, then Vitex is an absolute reflex response (think the very funny reflex paper ad – that’s me in my clinic!) & godsend for most cyclical mood issues. However, apart from the fact that this woman’s key period of mood aggravation, although clearly related to her menstrual cycle, was day 5-14 rather than during the late luteal phase, there was another stand out reason for me why I definitely wouldn’t use Vitex. (more…)
So…a 40 something female walks into your clinic with depression & anxiety…sounds common enough right? But here’s the twist: she’s already seen another practitioner who ran a range of investigations revealing she has pyrroles, high copper levels & is homozygous for the C677T MTHFR mutation. Her medical history includes significant use of Ecstasy and a partial thyroidectomy due to nodules & she has persistently high TSH. But wait there’s more!…The first practitioner upon discovering all of this put the patient on 12 different products which included zinc, B6, evening primrose oil, vitamin D, thyroid support etc etc. And guess what…the patient feels worse!
Frequently our patients are just as complex as this case & sometimes our attempts to narrow the treatment focus through thorough investigation instead leaves us feeling we now have even more things we need to deal with than before! Feeling overwhelmed?? Often! At risk of completely overwhelming the client as well? Definitely! And a reflex to throw your whole dispensary at a client never ends well. (more…)
I’m only human & there are some questions that do make me silently groan & invisibly (I hope!) roll my eyes. One is the old chestnut: “but the Japanese consume on average 7mg of iodine a day!” which is typically offered up as a rationale for the need for mega dosing of iodine in everyone. This is of course only a partial truth & the missing bits make all the difference! The Japanese have some of the highest rates of thyroid disease in the world & this is in part, attributed to their high iodine exposure. Secondly, it’s simplistic & flawed to isolate one characteristic of a whole diet & not appreciate that its effect or impact is mitigated by the context of the entire diet & lifestyle of that population. In the case of the Japanese, for example, this includes relatively intake of isoflavones, key goitrogens which will reduce the bioavailability of the iodine both within the gut & at the thyroid. Harrumph! I love iodine & am frequently suspicious of a deficiency in my clients, however, like many nutrients feel that our ultimate objective is for optimal nutrition…not excessive.
Am I just a conservative scaredy cat perpetuating fear around this topic in the industry? Well…..no. There is accumulating international evidence of big spikes in autoimmune thyroid disease diagnoses following the introduction of iodine fortification programs in previously iodine deficient countries such as Greece, Turkey & Brazil. There is of course evidence as well that iodine supplementation in Grave’s & Hashimoto’s disease can lead to delayed recovery or worsening of the condition. (more…)
Ever noticed that thing called RDW (red cell distribution width) reported in your patients’ haematology results? Given that this parameter is currently regarded as one of the most important & earliest markers of a wide range of serious diseases, you might start paying some more attention to it from now on!
Dr. Michael Hayter, cleverly refers to RDW as being a reflection of the ‘Quality Control’ of an individual’s red blood cell synthesis.
As it’s a measure of how similar or dissimilar our rbcs are in terms of size, smaller values (suggesting homogeneous rbcs) are regarded as healthy, while higher RDWs suggest that some part of rbc synthesis and/or clearance process is faulty.
This makes perfect sense in the context of nutritional anaemias like iron and B12/folate which all produce elevated RDW results but new research proposes that this rbc size disparity is also a common linking feature in just about every major disease, often predating diagnosis or in cases of established pathology signalling progression and warning of imminent poor outcomes for the individual.
There have been 100s of papers published just in the past 4 years on this topic and the findings are nothing if not dramatic. One of the biggest things I’ve realised is that, while Australian pathology companies suggest that all RDW results < 16% are acceptable, in the light of these new associations, a more accurate cut-off is probably around 13.5%! The big question now to answer is, is the increased RDW a passive marker of pathology or actively involved in the pathogenesis of these major diseases. For now, we should be scrutinising our patients’ RDW results more closely and being alert to what these markers are telling us about our clients threats & risks. I’ve recorded a 30min audio summarising all the information I’ve come across on this topic and how to apply it in your patients which you can access here.
Alternatively, if you’re happy to chomp into some juicy journal articles yourself then check out these ones to start with
We should all be as skilled in investigating & treating male hormone imbalances as we are female ones, yet this is often not the case. A lack of confidence in this area, which seems to be an issue for many, in particular will compromise our ability to question male clients comprehensively and effectively about their reproductive health and ultimately reduce our capacity for making good clinical decisions and achieving the best outcomes for them. If you’re female, how would you feel seeing a male practitioner who doesn’t ask you about your menstrual cycle in detail?
Many of us are at risk of committing similar crimes but we need not be. (more…)
“Health issues are rarely one individual textbook condition like they were during my studies. The interaction of the body is complex, and Rachel has given me valuable insight into how to link various pathology markers & physical aspects together. Test interpretation has been a huge focus for me. The letters and numbers now mean something, and I can work with “true” reference ranges, and see how different values affect others. The sessions have been great to get assistance with cases and learn how to break things down & prioritise treatment, and also to connect with other practitioners, and hear their cases as well. I really feel like my career has received an invaluable leg up, and I’m so thankful for Rachel’s knowledge and assistance.”
Rohan Smith, Graduate Group Mentoring Participant, Adelaide.
We began our Graduate/New Practitioner Group Mentoring sessions in March 2014 with just a few keen newbies but the sessions have gone from strength to strength since then, with an ever-growing group of new graduates participating in case presentations every month. Every session I’m reminded that people are now graduating with much more sophisticated knowledge than I did. Not because the education standards have improved (ouch!) but actually because the research-backed knowledge base of our whole industry has progressed & improved so dramatically… & that is really exciting & changing the marketplace for all of us. (more…)
As we head rapidly towards the change over of our calendars we would like to offer you a special on the very best educational recordings from 2014 – buy 2 CDs before Jan 31st and receive one complimentary Premium Audio Recording of your choice OR purchase 4 CDs and receive a 3 month Premium Audio subscription for free.
It’s been a busy year during which Rachel has delivered 7 very successful new seminars in the area of mental health and beyond, most notably fortifying her role as a leader in the field of diagnostics and pathology interpretation. This has included collaborations with ACNEM, Biomedica, Health Masters Live, MINDD and Nutrition Care, however, each recording is classic Rachel – full of fresh perspectives on diagnosis & treatment, colourful analogies & humour. In case you missed some of these this year or want a copy for keeps – here’s a quick summary of the 2014 recordings included in this end of year offer: (more…)
We’ve just had another mentoring case in which a 40 something female with deficiencies of almost all other minerals but ‘pretty normal ferritin levels’ presented with a range of endocrine problems and arthralgia. Sounds as if iron’s not the problem right? Except that in this case her iron studies also tell us that her transferrin saturation % on last check was 48%. The diagnostic criteria for hereditary haemachromatosis (HH) necessitates elevated ferritin – to indicate that the iron stores are reaching saturation, however, while this becomes evident at relatively young ages in men (20s-40s), who have no specific excretory pathway for iron, is this still appropriate in menstruating female, whose monthly periods may mask the HH tendency with regard to ferritin? I’m guessing you know what my answer is already! 😉
Some would argue that HH, in spite of being an inherited disorder, is only clinically meaningful once the ferritin is elevated ( earlier and more potent elevations are seen in people possessing the C282Y genotype) but again this is very much up for debate in the current scientific literature, with a lot of research concluding that the transferrin saturation (also referred to as the transferrin ratio) being an important prognostic indicator for various chronic diseases including CVD.
When we go back to basics and remember the higher the transferrin percentage the more iron is being delivered to tissues around the body (whether they like/want it or not! so we refer to this as being ‘iron dumping’) and the higher the serum iron, the more unbound iron is in the system – a key source of oxidative stress..it becomes patently clear that these two parameters are important early warning signs of a tendency to iron overload, increased risk of heavy metal toxicity and already active mineral imbalance. So in future keep your eyes open for women with fasting transferrin saturation values that consistently sit above 35% and men, > 40% and if you do see a series of suspicious values – consider the genotype test through mainstream labs.
“Two great speakers – inspirational in the first half and bang on in the second – I now know how much I don’t know”
Just out now in time for Christmas…no seriously though… this year I had the good fortune to team up with Biomedica and in particular Rachel McDonald and we delivered a 3 hour seminar called Mental Health in Holistic Practice. The intention behind this collaboration was to shift the education focus for practitioners from a prescription based approach, to one really about the clinical reality of managing mental health clients. Probably most of you will agree that the ‘treatment’ counts for only a portion of the positive outcomes in your patients and this is particularly true in clients challenged with mental health issues. After more than 20 years in practice working in this area, I’m keen to share what I’ve learned so other practitioners can get there much much faster! (more…)
I’ve learned a lot (!) and as always that learning has principally driven by my clients – their pathology, the diagnostic investigations we’ve employed to better understand the drivers behind their conditions, their response to various treatment approaches & of course a million other subtle thing we’re learning along the way. The other teachers are the many practitioners I interact with on a daily basis as part of our individual or group mentoring sessions – whether it’s some curly question or problem they bring that throws me into the scientific literature searching for answers or a fabulous bit of wisdom they bring to the table themselves, it’s a great reciprocal learning environment. You know, the most common thing I hear from naturopaths is the frustration they feel at the limitations of their under-graduate education and how it is only since graduating that they’re ‘learning all this stuff” but in reality, as with most health professions, the bulk of the learning has to happen on the ground.
I’ve been in practice for about 20yrs (ouch!) and I don’t think my rate of learning has slowed at all. It’s great if we can view this as the eternal fountain of inspiration that keeps us motivated and engaged in our profession…no not every minute of every day…let’s be realistic now…but overall it’s a strength not a weakness 🙂
Over the next month I’m being let loose on the major capital cities thanks to Nutrition Care to for a series of evenings of case study discussions – bringing together quick teaching points from all the things my clients have taught me this calendar year. Whether it’s from a diagnostic or treatment & management perspective I’ve got some juicy morsels to share! I hope you can come along and we can learn from each other yet again as a nice way to reflect on the year and our ever –growing profession…. If you’re interested in attending contact your local Nutrition Care representative for more information or call them on (03) 9769 0811
- Brisbane – 12th November
- Melbourne – 20th November
- Sydney – 26th November
- Adelaide – 27th November
When I grow up I’d like to be a few different things, forget any ballerina or astronaut aspirations, my list includes a clinical psychologist, an integrative psychiatrist and last but by no means least, an endocrinologist. I’m fascinated by hormones, their regulation & incredible interconnectedness and the longer I’m in practice and the more patients I see with hormonal issues, the deeper I dive into the endocrinology texts (Endocrinology by Greenspan & Baxter is an absolute favourite of mine and you can now purchase this as a download to your computer which is super handy). I think (more…)