Still. And yes – like you – I don’t see any slowing down any time soon in this extraordinary paradigm shift occurring in medicine and health. Which for us humans involves one humbling discovery after another.
Here we were thinking we made our dietary choices from a place of free will & individual preferences 🤣🦠
Thinking those microscopic mates, were making those B vitamins, and SCFAs and and and…for us & our benefit 🤣🤣🦠🦠
And while there’s a lotta love going on between our microbes and our micronutrients – in both directions – Pat Benatar said it best, “Love is a battlefield”
(sorry but I feel compelled to insert a link here for the youngsters – you’re welcome 😉)
The tussle over who gets to access those nutrients that are actually essential to both of us (the hostage and the microbiota) is an absolute turf war, peeps, and this battleground has seen some bloodshed! The new new question being raised is how the prescribing of nutrients, especially at the higher doses we tend to use, trickles down to influence and impact those microorganisms who reside in the bowel. Directly – as a selection pressure we have, likely unintentionally unknowingly, introduced. Which species do well when exposed to levels of a vitamin or a macro or trace mineral that are simply unobtainable in the diet? Yes – research answering these questions has begun in earnest revealing some positive ‘prebiotic-like actions’ of some but not of course for all nor in all scenarios. Want to learn more about this latest aspect we need to consider when formulating our nutrition prescriptions? You can either jump in and join us in the Nutrient Prescribers Program which kicks off next week to get across absolutely everything new in nutritional medicine or just dip your toe in here with our latest Update In Under 30: The Micronutrient Microbiota Universe
The world of health science went microbiota-mad a few turns back and there’s no sign of an end. Research continues to reveal the breadth of the GIT microbiota’s positive & negative reach, in particular, & with discovery upon discovery we’ve come to understand how often the microbiota are ‘managing us’. Both in terms of being integral to the success of our digestive, immunological, metabolic etc processes but also in a self-serving way, for example, directing our dietary preferences to satisfy their own needs. This has understandably prompted the question about the impact micronutrient supplementation is unintentionally having as a selection pressure on our gut microbes. Which bugs like which B vitamins when taken in excess of the amounts achievable in the diet? And which microbes flourish and which falter when we radically change their mineral exposure?
You can purchase The Micronutrient Microbiota Universehere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
I’m such a sucker for marketing!…ZoomZoom is from an old Australian car ad – an earworm clearly conveying ‘ the speed of something’, and let me tell you, totally fitting for this little Zinc tale I’m about to tell! Many years ago, I wrote a thesis on Zinc that necessitated me reading every research paper ever written (that’s how it felt anyway!🤪) on this trace mineral. Like everything in nutritional medicine, especially in the area of our burgeoning understanding of micronutrients, this is a highly dynamic space, so regular reviews of what’s new is essential and, since my thesis, part of my regular practice. Well, I just did my latest deep dive, and HELLOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO radical paradigm shift(s)…yep plural!
Zinc supplements should ideally be: Organic amino acid chelates Taken daily – due to the lack of Zinc stores in the body Taken fasting Taken in doses in excess of the RDI to compensate for the smaller % absorbed
Yep – nope. Or in true-blue Aussie: Yeah, nah. Can’t believe what you’re reading right now? Neither could I when I undertook this recent review but the studies are increasingly sophisticated and the resultant paradigm shifts are being echoed, reiterated & reinforced. And these have, in turn, challenged all those old ‘norms’ about how best to administer zinc for those patients with a shortfall. If you’d like to take this little journey for yourself…I suggest you start here! I immediately changed how I take it myself and now my mission is to both spread the word and get us all reflecting and reviewing our prescribing principles around Zinc…and tbh, around all micronutrients! After spending my ‘summer’ doing sufficient reading for a second thesis on everything new in micronutrients…I am armed and dangerously prepared for our upcoming *NEW* program: The Nutrient Prescriber’s Program which kicks off in late Feb for 5 months.
I truly believe that based on all this new information, we can now get so much more out of our medicines.
Nutrition represents such an extraordinary set of tools for us to work with, but it’s time to sharpen those tools in terms of how we apply them!
The Changing Zeitgeist Of Zinc Prescribing
Zinc research is a highly dynamic field and given its relative recency of discovery as being essential to humans, we’re still in the early days of truly getting to know this mineral. In just the last few years, enormous gaps have been filled-in regarding its regulation and roles that look to radically change our prescribing practices. Tune in to this essential update for some serious food for thought about doses and dosing frequency.
You can purchase The Changing Zeitgeist Of Zinc Prescribinghere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Recently I asked practitioners to tell me where the ‘therapeutic reference range’ many of us were taught for nutrients comes from & no one has been able to answer that.🙄 If you’ve heard me refer to my original naturopathic education before you’ll know I generally hold it in high regard. And I’m forever mindful that there are always things that can be made better. What’s been playing on my mind lately is the recognition that I originally learned nutrition from one (exceptional) individual, and then went on to become the lecturer years later at that same and other institutions. Additionally, I am aware of some of my past students also going on to become the next generation of nutrition lecturers at those same places – and often in fact inheriting their lecturer’s notes, slides, overheads [showing my age!!] with the job. Can anyone else see a problem here? What’s brought this into sharp focus lately are many of the questions I’m endeavouring to answer as part of our much-anticipated Nutrient Prescriber’s Program. How much? How often? When? Which form when? & For how long? Which are the key questions we have to answer with every single nutritional prescription.
To not only source the most rigorous scientific answers to these core critical questions but to also develop a framework that we can all use to answer them for ourselves at the point of any future prescription creation, I have had to go to great lengths.
But as I research & write, I also keep asking myself, ‘How would ‘old-me’ have answered this?’ How did I up until now either consciously or unconsciously answer these sufficiently to make such decisions?
So it’s an ongoing little (& sometimes BIG🧠) internal debate that is raging as I write. And when I ask current praccies these questions they reflect back similar ‘old-me answers’, the vast majority of which were handed to us by our lecturers with plenty of top-up ideas from industry. These answers include things like:
How much? Somewhere within the therapeutic dose range? How often? Depends on lots of things but generally aiming for daily of course!
When? Minerals before food, fat soluble vitamins with or after, magnesium at night etc
Which form when? Now it gets tricky – because there are all these new forms that we weren’t even taught – but maybe ‘active’ – active is always better, right? Or is that natural? The most bioavailable?
& For how long?Ummmmm how long is a piece of string?! Until the signs and symptoms resolve?
Now all of these as general statements are partly correct. And with respect to the level of understanding we need to have when crafting a nutritional prescription for a specific patient, with a specific presentation and for a specific purpose (correction of deficiency Vs supranutritional Vs therapeutic antagonism etc)…well they are plain wrong in the majority of instances. Don’t freak-out in freefall!🪂 The prescribing of nutrients is a wonderful and typically, a wonderfully safe, modality that offers us the potential for extraordinary patient outcomes. When used well. We could all benefit, I believe, from just sharpening our tools so we bring out the very best in our medicines & in ourselves, as prescribers & clinicians. I am neck-deep in writing the 10 modules that can start us all on that journey. Want to join me?
And to be clear, about the educational echo chamber,
In the past I was part of the problem and ever since I have tried to be part of the solution.
With over a decade of mentoring practitioners, Rachel has recognised a need for an educational program that provides practitioners with more structure, more science, and therefore more certainty in navigating each individual prescription. This monthly meet-up is delivered in 5 live sessions and runs from February to June (10 modules). All sessions, encompassing both theoretical and applied learning will run for approximately 2 hrs each.
Practitioners have been bringing their most challenging cases to me for mentoring & supervision for over a decade, that’s hundreds, in fact, probably thousands, of cases, tempting me to say, therefore I’ve seen ‘everything’.Except of course I haven’t. And each new case helps reinforce that and the utter uniqueness of everyone’s experience of health & disease.
From each & every case, no matter how unusual, remarkable, uncommon, exotic some or all of their experience and story, once we’ve asked the key clarifying questions that often prove to be ‘diamond diagnostics’, constructed a comprehensive timeline, suddenly bringing to the forefront: their disease chronology, causation & contributors, analysed their pathology for insights far beyond what a patient or their diagnoses can ever speak to, and then completed the work-up by incorporating all of this information into the step by step construction of a MindMap…
🤓We all leave each session with truckloads of new info & skills to apply to our own patients🤓(more…)
When it comes to the recognition of Nickel as the number one metal allergen worldwide, affecting up to 30% of adults and with a particular predilection for women, it seems like Australian health professionals really do come from the ‘land down under’, with many of us still somehow yet to read that memo.
How much? How often? When is the best time & timing? do you know about friends, foes and frenemies? Which form, when? e.g. building blocks or bioactives? And for how long? aka are we there yet…?
These are the kind of questions that one would imagine nutritional prescribers can always answer – but can you? Yet this is the goal, right? So that with each and every unique individual who needs supplements – we have a clear, consistent go-to framework to guide & direct these prescriptions. One that makes scientific sense, offers optimal outcomes and removes the uncertainty.
From my interactions with thousands of practitioners, however, I know many of these key questions plague practitioners & they feel, at times, as if they’re flying without a net, or without a strong systematic approach, or at the very least without all the answers to these questions.
I’ve had so much good fortune & so many others to thank for providing me with this foundation. Fay Paxton – my nutrition lecturer in my under-grad who indoctrinated me with a systematic approach. Dr. Tini Gruner – my principal supervisor at SCU, who shared & further fuelled my passion for biochemistry and reading labs to extract insights into each individual. And thanks also to all the pharmacists I’ve delivered education to over the years, who, as a result of their grounding in the principles of pharmacokinetics, always ask the best questions – questions that if I don’t know the answer I know I need to know the answer! So I made it my mission to find out!
While we dip into these aspects of nutritional prescribing in our regular mentoring groups on an ‘as needs’ basis, I’ve decided the time has come to create a year-long program dedicated to sharing this information and building this skill-set in practitioners.
This monthly meet-up is delivered live (max 1.5hr) and runs from Feb to November with the following currently proposed format *subject to change dependent upon the needs of the group
Feb Factors Affecting: digestion, absorption (host, form, dose)
March What happens to what gets left behind? e.g. enhanced enterocyte micronutrient concentrations & their effects plus unabsorbed nutrients & their interactions with the colonic environment
April What happens to what’s absorbed e.g. distribution, hierarchy of needs, activation and deactivation
May The pharmacokinetics of prescribing
June Where do our ideas on dosing come from? e.g. Physiological Vs Pharmacological dosing & actions. The basis & believability of maximal intake boundaries?
July Bioefficacy V Bioequivalence. Beyond building block nutrients: Is ‘Bio’ (-active, -peptides, -materials) always better? e.g. GABA Vs Glycine, NAC Vs GSH, PLP Vs Pyridoxine, Niacin Vs Niacinamide riboside ——————————————————————Aug month off—————————————————————————
Sept How often & for how long? Are we there yet? And how would we know? Plus Fast Vs Slow Nutritional therapeutics
Oct Strategies for Supplement Success e.g. friends, foes and frenemies in nutrition underpinning principles with examples; compliance changers for clients
Nov Live attendance & opportunity to participate in a case-based mentoring session
This monthly ‘live’ meet up will be delivered as part of 2023 Group Mentoring as The Nutritional Prescribing Program Group Mentoring applications open 17 October 2022.
To join the waiting list and be notified when applications are open, email the team at [email protected]
Find out more about what groups are available for Group Mentoring in 2023 here.
It’s quite the meme of the moment and while I completely get the sentiment behind its original meaning, my take is a little different:
Results in Practice 2021!
How were yours?
Here were some of ours from the cases presented in group mentoring:
💪 We correctly identified hyperparathyroidism in several presentations of GIT, mood & musculoskeletal concerns (remember bones, stones, groans & moans?) with good response to targeted doses of D & Ca
🎯 We correctly identified BAD in a patient with ‘refractory IBS-D’ for decades – who responded well to lowering her fat intake & other support
🧐 We determined HFE mutations were present & a pathophysiological player all over the place – with presentations from psych to fatigue
🤯 We stumbled across several cases of concurrent Gilbert Syndrome & PCOS – ‘mixed messages’ in both labs & presentations – which research now suggests may be related! & should change the way we treat these PCOS patients e.g. not with CHO restriction!
But the best result of all – arguably was the growth we got to witness in all our mentees – from those in our New Graduate Program:
“I truly appreciate your compassionate way of lifting everyone up whilst stretching our brain gently to build up on knowledge, and confidence. You have such beautiful skills in navigating us – how you treat us all helped to restore my trust in this industry/naturopaths and myself 😅 so huge thank you 🙏❤️🔥” Reiko Fujike-Stirling | New Graduate Group Mentoring 2021
…to those dedicated practitioners working to build their competency & confidence in mental health:
“There’s so much to learn and stay on top of in terms of new information, I realise it is important for developing integrity and how I practice. Having a mentor, like Rachel, who I can rely on who is super on top of what’s going on in research in Mental Health. Someone I can rely on for very accurate and practical information that keeps me on my toes and challenges me and is practical for my clients. Doing mentoring and learning how to refine my understanding of case taking, mental health screening / testing, treatments and just really deepening my understanding has ignited a passion in me as a practitioner. Rachel presents everything so brilliantly and practically. Thanks so much Rachel, the content and everything is just brilliant.” Steven Judge, Naturopath, Nutrition & Herbalist | Mental Health Group Mentoring 2021
We’re sharing some of our ‘Conversations with our Community’ via our social platforms at the moment – it’s such a joy to listen to each individual practitioner’s journey…and we might end on just such a note here courtesy of Amanda Astrop – another ‘survivor and thriver’ from our 2021 New Graduate Program:
Want to join me next year so we can make RIP 2022 mean something far more positive?? Email us at [email protected], before the 22nd November, to tell us your needs, wants and desires (educational only of course 😅) & we’ll find the right group for you 🙂
New Graduate – great opportunity for New Grads to build confidence as they leap from student to practitioner, or for practitioners wanting to refresh their core clinical skills such as MindMaps, Pathology, Case Taking etc
General – our regular case presentation groups, with one practitioner presenting a case each month, or just listen in.
Mental Health Primer– topic based to build on your knowledge in the role of naturopathic medicine in Mental Health – from screening tools to key management issues, specialist diagnostics and beyond.
Mental Health Applied – this group will help you fortify and buildupon what you already know and increase your confidence when working with clients who present with myriad mental health issues & shared care arrangements. This is a case presentation group, with one practitioner presenting a case each month, or just listen in.
We are getting ready to launch our new look Group Mentoring for 2021! We are now counting down the weeks days (gULp!!) until we open up applications for Group Mentoring next year. We’re keeping everything our practitioners have told us they love, over the past 8 years, and simply improving the formula, with some great new bonuses for 2021!
So with 2 weeks to go, we’d thought we’d introduce what’s on offer.
Live sessions are starting in February for 2021. January is often a period when we’re recovering from ‘recovering’ e.g. Christmas holidays, so we thought it would be good to start a month later this time around, in February when everyone’s recharged and ready to get back in the swing. There will be 10 live sessions in 2021 starting Feb and ending November.
Fly on the wall options on offer! Want to present a case? Great! Not ready or have enough time to present one? Great! Having successfully launched the ‘fly on the wall’ (non-presenting participants) experience this year we’ve been left in no doubt that practitioners loved this & continued to learn just as much as those in the ‘hot-seat’. Hence, it’s back again!
BONUS: Update in Under 30 Subscription is now included for those in General Group Mentoring (GM1 or GM2), either of our Mental Health Groups (Primer & MH Applied) or to those in our MasterCourse Alumni (not included for New Graduates)You gain access to the ENTIRE back catalogue of Rachel’s UU30 recordings (30 min podcasts), with atotal value of over $1800, and receive a new podcast each month for 12 months. For those mentees who are already current subscribers, when your subscription expires in 2021, you’ll get to renew for free! This provides you with even more of an opportunity to drill down and dig deeper into certain areas that we routinely come across in our session cases and content. This gives you a much greater opportunity to seriously expand your learning in those areas most relevant to you.
We’ve broadened your 30% discount to ALL Rachel Arthur Nutrition products on our website for 2021.
Certificate for CPE Hour
Here’s what one of our mentees had to say this year…
“I’ve listened to the recording of the live mentoring sessions multiple times and sooo sooo much goodness in each session. I love how your mind works Rachel. This is also my second year in mentoring and I am so grateful for this safe space to continue to enlarge our thinking. I learn something new every single time. I am also loving the update in under 30 – that is also changing my practice with every single listen. Eg the ones regarding interpreting iron studies and prescribing. TOTAL GAME CHANGER. I was a novice in iron prescription kind of going with whatever my patients Dr’s were prescribing but then understood why they were getting such crappy results – both in actual improvements in their iron test results but also negative symptoms. Honestly, the combination of mentoring with the little individual nuggets in the updates is totally transforming my practice so I’m so grateful. Rachel please keep mentoring forever. I love it.” – Bek DiMauro, Functional Nutritionist, Adelaide
We have a great range of groups to choose from. Whether your a nervous newbie or have 15+ years experience…
General Group Mentoring – our regular case presentation groups, with one practitioner presenting a case each month, or just listen in.
New Graduate Groups – great opportunity for New Grads to build confidence as they leap from student to practitioner, or for practitioners wanting to refresh their core clinical skills such as MindMaps, Pathology, Case Taking etc
New Grad Next Level group – for graduates of the New Graduate 2021 group to continue to build on your skills and apply all the great learning from this year to real client cases.
Mental Health Primer – topic based tutes & interactive sessions to build on your knowledge in the role of naturopathic medicine in Mental Health – from screening tools to key management issues, specialist diagnostics and beyond.
Mental Health Applied – practitioners presenting their client cases with a focus on primarily Mental Health presentations.
MasterCourse Alumni Monthly – NEW for 2021 – Participants from this year’s MasterCourse In Comprehensive Diagnostics can continue to build on their knowledge and application of Pathology interpretation with this Live monthly session and online community.
For all those Mentoring Virgins 😇out there wanting a clearer understanding of what it’s really like to be part of my group mentoring, this video is a little snippet from a session with one of my groups. This year has flown by and I have thoroughly enjoyed working with each fabulous group of dedicated ‘life-long learners’.
And don’t forget some of the offerings our Group Mentoring already reliably provides – the high level of applied knowledge, our incredible Basecamp platform for communication and support between sessions and our ongoing sharing of pearls of knowledge from my 22+ years of experience and research together with the collective wisdom and know-how of each group.
Can you see yourself in this collective?
REGISTRATIONS OPEN 9 November!
Information on how to apply will be released soon, to find out more click here. Join the waiting list now so you won’t miss out by sending us an email on [email protected].
Shhhhhhhh(eesh)! I am confessing my sins. As part of our mentoring discussions we try to keep one another honest & in-check with, what seems to be, integrative health professionals’ innate flair for over-delivering. Name someone right now from another health modality that spends as much time on researching & working up your patients as you do. Name another kind of health professional who makes themselves as accessible as you do to their patients. See, I know your type. And feeling like a donkey (in many regards) but especially as in the context of this evocative picture, is not something that happens just once in your career, which you learn from, adjust your load, and never repeat. I should know, I’ve had a bit of a donkey year, myself 🙄
Our old mate, Albert (Einstein), said, “Wisdom is not a product of schooling but of the lifelong attempt to acquire it.”
I think, for health professionals (at-times) over-endowed with care mixed with an infinite curiosity (for answers), we can find ourselves with quite the ‘heady mix’, an excessively heavy load and on a slippery slope of over-delivering. This manifests in different forms at different stages of our career. I’ve talked about some ‘so-common-I-wish-I-had-a-dollar-for-every’… ways practitioners over-deliver in the clinic before. But for those of us that are seasoned practitioners, we master the basics…no sharing of personal mobile phones or even email addresses, clear communication with clients about appropriate times and means of contact, we even commit to taking some time out for ourselves and our own wellbeing (Wowee watch us go!! Physician Heal Thyself!) but often we just find new ways to over-deliver. They sneak in and up on us. It takes us a while to realise we’re back in a familiar place of dangling donkey feet in the air, over-burdened by our load.
But perhaps we should think of this as Process (a lifetime one of becoming wise, like the other guy said) rather than a pathological problem.
And as we near the end of another year, a very taxing year for many of us, take this opportunity to pause, process the strengths and limitations of our practice model over the last 12months and adjust the load so we can proceed towards an ever more sustainable practice.
Because people need practitioners like us; full of care and curiosity, not overloaded donkeys who can’t go anywhere or carry their own load, let alone anyone else’s.
Got some tips you can share about healthy boundary setting for health professionals? We’d love to hear them 🙂
As a health practitioner, you are always actively building: your reputation, your practice and your knowledge.There’s theoretical …and then there’s applied. Some of the biggest leaps we take forward as practitioners come with being shown how (rather than told) & then being forced to ‘do the work’ ourselves, rather than being exposed to simply more information, be that about pathology, patient prescriptions or practice structure! The slogan ‘Just Do It!’, might have already been nabbed and TMed by a huge corporate beast, but this doesn’t undo the universal truth of it! Prefer your mantras to come from mystical philosophers rather than monster multinationals? How about this then?
I hear and I forget. I see and I remember. I do and I understand. Confucius
This mentoring community that I am a part of, we are about applied learning. We learn by doing. We learn, not just through each individual’s patient encounters but through the collective clinical experience. We make what can otherwise be an isolating experience of constantly, seemingly, reinventing the wheel, if not many wheels (!), into one of collegiality and ‘using the force’. If you haven’t experienced Group Mentoring with me previously and are thinking about next year being your year (see below to find out more about our 2021 offerings), we put together this fun little video here to get across that mentoring isn’t about a conversation between just two people.
With Group Mentoring you’ll be learning, through the application of core clinical skills, improved patient questioning, methodical information gathering, evidence based answer finding & getting access to resources that you can apply in real-time in your own practice.
“Having the group session each month, as well as having Basecamp to bounce ideas around in, is a reassuring connection to know is there if I need it. Having just started practice this year and working in an environment without other Nats around, I have noticed the occasional feeling of isolation. So having the monthly catch up keeps me feeling connected to other clinicians and gives me exposure to other cases and perspectives that I wouldn’t have otherwise had.” – Georgie
We have a range of groups on offer to suit all levels and most types of integrative health modalities. Go to our Group Mentoring page to discover the groups and bonus extras on offer for 2021.
Going by the landslide registrations for 2020, our ongoing excellent retention rate of practitioners from year to year & our already overflowing waitlist for 2021, the reputation of RAN Group Mentoring is highly regarded and a popular choice.
So, if being part of our community excites you and if the thought of learning and applying collective knowledge from expertise outside of our own, now’s the time to put your hat 🎩 in the ring, put your hand up ✋🏼 & join the conversation 📣 through Group Mentoring.
We’re midway through mentoring 2020 and we’ve temporarily shifted gear out of case presentations and into dedicated time for answering praccies toughest questions…and oh man, I love these opportunities! This year in our Mental Health Primer Group, there are clinicians whose questioning…nEVeR sTOps. [insert: excited squeal] and that means I have an excuse to dig deeper, go further, read more research and ensure I can provide answers confident of their comprehensiveness and that they reflect all the contemporary information to date. So amongst stiff competition – here’s my favourite from the gIAnT piLE on my desk right now…
“We often hear that the bulk of our body’s serotonin is in our platelets – so do platelets (counts, activity etc) have a role in mental health?”
Well, I’m so glad you asked! Yes, 99% of your body’s serotonin is found inside your platelets. Where did this come from? From the plasma. How did it get there? Using the identical transporter mechanisms that your neurons do. Sounds like all the pieces fit right…oooooh so low platelets might drive low serotonin and poor mood and and and…
No. You may get excited when you get a box of jigsaw pieces but you must first complete the puzzle and ensure everything is in its rightful place.
Platelets are linked to depression but not as a cause but as a consequence. Because their transporter systems & receptors for serotonin are virtually identical to those in the CNS, they suffer from the same serotonin deficit…in spite of a relative abundance in the plasma they’re floating in. So really platelets are of interest in mental health as a more accessible way of studying and understanding neurochemical regulation in the brains of those affected. Did she just say neurochemicalS…as in, plural. I sure did. Because healthy platelets contain a whole plethora of substances, even a relatively large quantity BDNF, the concentration of which also becomes severely compromised in the platelets of depressed individuals. So it seems like its tough-talkin’ Tuesday and just to bust a few more moves myths while we’re here…
Your platelets get their 5HT from the plasma
Your neurons make it themselves
Platelet numbers are not indicative of your 5HT producing capacity…anywhere
Therefore treatment objectives that speak to platelet numbers or platelet activity are clearly non-sensical A bit like measuring serotonin derivatives in your urine…and imagining that reflects the <1% from your CNS….hey?
Don’t be fooled by the false promises of functional tests. Make sure all the pieces of the puzzle fit to actually make something sensible, accurate, reproducible and meaningful. Mainstream pathology results actually offer a goldmine of information and insight about your patients However to realise their full value and make the most accurate interpretations we need to first learn more about ‘lab language’, upskill in finding our way around reports which are packed with a surprising amount of hidden extras, demystify reference ranges and then develop a logical critical process we can apply to every result of any patient to get the real take-home. Packaged with numerous specifically developed resources to aid in your application of these skills this is a foundational offering that changes practices.
I take my job to heart. When someone asked me recently to choose the single value that spoke most to me personally I couldn’t seem to go past, ‘Purpose’. I feel very honoured to have contributed to the learning of so many health professionals in their undergraduate and so many more in their professional careers following graduation and I know that with this comes huge responsibility. Second on my values list (again, possibly unsurprising) is Empowerment & coming in with a photo finish at 3rd:Integrity. Discernment and critical thinking (about information, about research, about reflective practice) are perhaps the eggs in this souffle, helping us all to rise up.
As part of our critical thinking we need to accept a few truisms:
Research changes Experience changes Knowledge changes
Information is not static. So we need to ask ourselves, how long ago did I learn this? How long since I’ve checked it is still correct? And just because perhaps this information came out of the mouth of our mentors or teachers, makes it no less up for regular review. I’m trying to undertake these internal audits on a regular basis. Typically they’re prompted by bloody good questions my mentees have asked me. A question I can’t answer or, more to the point, I can’t answer with full confidence I’ve double-checked my old beliefs and understandings against new evidence recently…these almost always provoke a lost night of sleep for me. Not from sleeplessness per se but due to immersing myself in the latest research and performing a mini informal lit review, bringing out all my old beliefs/evidence etc. Marie Kondo style and asking do they still spark joy✨ (in light of the latest evidence)?! And yes sometimes there’s a little bit of heartache when you have to let your old tightly held beliefs and understandings go 😢
The 1st update is about N-acetyl cysteine. Some of you may have heard me previously question the efficacy of the vegan form. Now that all but 1 Australian product is vegan, produced from bacterial fermentation or purely synthetic, I was wayyyyyyyy overdue to check the validity of my old ideas. Let the record show, I was wrong. Unlike some other nutraceuticals like chondroitin sulphate, wherein the source radically changes the overall structure of the molecule and therefore its uptake and actions – the same is simply not true for NAC.
So those ducks, & their NAC rich feathers, can all sleep a little easier at last…phew! Now the 2nd internal audit well that did cause some tears for me…
We often identify patients who could do with a little glucuronidation first aid: marked dysbiosis, Gilbert’s syndrome, oestrogen excess, cancer risk (especially bowel, breast & prostate) and one of our nutritional go-to’s has typically been Calcium D Glucurate. While there is ample evidence that one of CDG’s metabolites: 1,4 GL – inhibits beta-glucuronidase, is an antioxidant, platelet activation inhibitor and generally all-round good guy to have onboard, new research strongly challenges that oral CDG will convert to this at levels sufficient to support this detoxification pathway. Sounds like we’re overdue for an update on this supplement and when and where it might be useful in addition to how to find the real deal in real food!
Forehead USB not required. Phew. All that is required, is a real thirst for new knowledge, rapid development of your diagnostic skills and a willingness to commit an hour every month to tap into your new Brain’s Trust: Rachel and a collection of colleagues with a shared desire (general practice or mental health-focused) and similar level of experience to you – new graduate, medical, naturopathic or dual qualification. And take one great leap forward closer to being the practitioner you want to be.
The Rachel Arthur Group Mentoring Program has the longest (7 years and counting!!) and most impressive track record of practitioner satisfaction for value for money and meeting clinician’s key learning outcomes.
And the long-awaited good news is…we will offer our New Graduate Program, which debuted this year to much critical acclaim, again in 2020!
Being part of the 12-month group program allows you to connect to a community of like-minded, similarly-skilled practitioners in a structured teaching environment either via case-based presentations (regular groups) or via an interactive curriculum (New Graduates, Mental Health Introduction). You’ll be plugged into 11 other practitioners and together with Rachel’s brain, you’ll receive the knowledge and confidence to assess, investigate and manage no matter who and what walks through the door. Our profession thrives when we thrive as individuals and central to this is building networks of ‘similar others’ in order to find your tribe and benefit from the ‘collective’.
“Rachel is a wealth of information, she has such a knack for breaking down cases. All case presentations no matter how complex are nicely deconstructed into bite sized bits of information that’s easy to digest and take away and put into practice. This mentorship program is worth its weight in gold, it shows you how to deconstruct cases, develop knowledge, gain greater clinical insights and you’ve got a fabulous base of other knowledge practitioners you can ask questions. Can’t wait for the rest of the cases! And you can count me in as a second year mentee next year.” – Megan
In Group Mentoring you’ll be learning core clinical skills that you can apply in realtime to your practice and be able to ask questions along the way. The most valued aspect of the mentoring is the ability to discuss practice experiences with the mentor and to hear and learn from all the group members, sharing experiences, knowledge and learning as we go during the sessions.The bonus of these sessions is you’ll find your tribe, gain support and radically build your toolkit.
I love witnessing every practitioner’s growth, I want everyone to find mentors to support them in their career in integrative health. – Rachel
“Having the group session each month, as well as having Basecamp to bounce ideas around in, is a reassuring connection to know is there if I need it. Having just started practice this year and working in an environment without other Nat’s around, I have noticed the occasional feeling of isolation. So having the monthly catch up keeps me feeling connected to other clinicians and gives me exposure to other cases and perspectives that I wouldn’t have otherwise had.” – Georgie
Going by the landslide of registrations for 2019, Group Mentoring is fast becoming a popular choice and could be an integrative part of your practice & your career progression.
So if being part of the community excites you and if the thought of learning and benefiting from a collective knowledge base that is strong and pulls on expertise outside of our own, now’s the time to join the conversation through Group Mentoring.
If you know me, you may wonder if I’ve recently undergone a personality bypass. I am passionate about diagnostics, pride myself on ‘making the invisible visible’ through better understanding of pathology markers and confirming the true nature of the underpinning problem in order to be most effective in our management of every client. And I absolutely see that for the majority of patients ‘ knowledge is power’, so what on earth is this all about? Well, while I stand by my stubborn commitment to diagnostic sleuthing for ‘most patients most of the time’, there are occasions when I’m left wondering about the value and the likely outcome should we finally catch that elusive diagnosis by its tail…case in point:
Recently I’ve been aware of a bit of spike in ‘diagnosing’ Ehlers Danlos Syndrome for patients who present with myriad problems – from the text-book connective tissue issues (loose joints, hypermobility etc) to the seemingly more far flung like mast-cell activation syndrome and overactive pelvic floors.
Just so happens this ended up being a thought-provoking 3 way conversation. Got to love having so many wise women’s email ear..and especially such generous ones. First, I ran this case and the differential past the wisest dual qual physio/naturopath I know Alyssa Tait who specialises in pelvic conditions and any and every other bizarre – no-one-else-could-name-it, kind of conditions. And her response, breathtakingly comprehensive and punctuated by copious journal articles throughout as always, proceeded to flesh out the evidence for and against the more unusual patient features and the possibility of EDS from bladder irritability (maybe) to functional GIT disorders (definite maybe) to the dysautonomia link (patchy). But it was what she said next that struck a deep cord for me:
“This happened recently to me when I referred a very difficult Painful Bladder Syndrome (PBS) patient to a GP – suddenly she had EDS as the answer to all her problems. But we can’t change genetics. All we can change is the function, and I have seen a worrying pattern of blaming the unchangeable (EDS) at the expense of looking for the changeable (e.g. an EDS patient of mine who actually had low thyroid function which had been over-looked.)
My feeling is it’s better to evaluate and treat what we see. As soon as we start giving our patients a litany of all the possible horrible ways their health is/will be pervasively affected by a completely unchangeable genetic reality (EDS), it’s a major “thought virus” that can both reinforce the “sick person” self-image and negatively impact their health-seeking behaviour – either by making them give up, ‘cause it’s all too overwhelming, or to follow an infinite journey through rabbit holes that make health their hobby rather than experiencing their life and relationships to the full.”
So back I went to the original practitioner who was contemplating chasing this EDS diagnosis in her patient and she was not short on some of her own wisdom. Like many people who end up working in health Gabby battled her way out of her own ‘no-one-cold name-it’ health crisis before training to be a naturopath. So understandably she sees both sides:
“As a terrified 20 something who kept ending up in the emergency ward with flares – I desperately wanted to know what was wrong with me, why it was happening, why I was in so much pain and why at the time no-one could tell me. I remember being about 28 asking my Prof (of immunology) whether what I had was going to kill me. He said ‘If you want me to be honest I’m really not sure at the moment darling but I’ll do my absolute best to take care of you’. That answer changed my life. Now as a Nat with a history of chronic conditions – I can see managing the symptoms is probably really all you need plus regular monitoring. Which is what I do for myself and many of my clients. The hurdle is getting over the lack of trust these clients feel after years and YEARS of being misdiagnosed and fearing for their lives.”
So..I’m asking us all again..is a diagnosis always helpful? Perhaps with each patient we need to think this through afresh? Thanks wise women 😉
There’s a significant increase in the number of women in their 20s to 50s presenting with ‘atypical’ joint pain, that seems hard for specialists to diagnose and therefore, hard for any of us to know how best to treat. If we listen closely to these patients, however, they are often telling us that their, ‘gut isn’t right’. It doesn’t tend to grab so much attention but maybe it should! We examine 3 ‘atypical’ arthropathies that can have GIT symptoms and arguably may represent a key driver of their joint pain. The different clinical pictures & targeted investigations for these big 3 together with some key papers are covered in this audio.
If my dispensary was on an island and could only stock 3 items, S-adenosyl-methionine would make the cut. That’s how important this nutraceutical is to my practice and has proved itself to be to so many of my patients. Regularly, I cross paths with practitioners who declare similar favouritism and then there are many others who remain apprehensive and uninitiated in its use. Often this results from 7 myths and misunderstandings, such as…
No.1 Giving someone SAMe will impair their own synthesis of it
No.2 If it’s not ‘right’ for your patient it could go horribly wrong – the risks are big!
No. 3 SAMe will increase homocysteine in your patients & shouldn’t be used if the homocysteine is high, or high-normal, to begin with
Wrong. Wrong &, you guessed it, wrong. But many of us don’t believe anything till we see it with our own eyes. Like a mentee of mine who is a seasoned SAMe savant but, like us all, continues learning more all the time through her own prescribing experience. Case in point:
“Remember when we discussed my patient with stubborn high homocysteine, who has not responded to high dose methyl factors? You suggested a trial of SAMe because other things pointed to her being an under-methylator. You were right (standard!)- it came down from 9 to 5 with 2 months of 400mg/day SAMe. She’s also been able to stop other supplements she was using for her mood and overall is much more stable emotionally, so turned out to be the perfect solution. Thanks as always :)”
So exciting to bring SAMe, together with other important CAM options in mental health management, to the attention of an increasing number of psychiatrists and other health professionals of late. It easily makes my top 3, and the other 2 supplements in my island dispensary?…well if we’re still talking mental health, Zinc and N-acetyl-cysteine, due to their versatility, potency and accessibility regardless of income. But I think you could have guessed those & likely have shared confidence, right?
This 3hr recording & resource is overflowing with case studies and the latest research relating not only to psychiatric presentations but also as a key nutraceutical to consider in liver pathology, Gilbert’s syndrome and some pain presentations. Together with this ‘literature lowdown’ we clear up a lot of misunderstandings practitioners tend to have about its prescription – busting the 7 SAMe myths along the way and giving you the confidence to know when SAMe is likely to be the solution and exactly how to prescribe and what to expect.
I’d love to continue this conversation with you… so join me and be part of my ongoing dialogue on this and my other blogs by following my Facebook page.
Recognise your own name or someone else’s on this list?
Dear 2017 Group Minties aka Mentees. I have always struggled with the term, ‘mentees’…seems too American or something and this morning when I was out walking, I had a light-bulb moment – I am proposing a re-branding to something much closer to home (!)… I propose we rename you Minties!! Because you are always fresh and you give me & your fellow Minties always something; cases, questions, clinical conundrums, ethical dilemmas, every month to seriously get our teeth stuck into! Cheesy but true 😉
Congratulations on completing your full year of group mentoring – and if this is your 2nd, your 3rd even your 4th year then I bow to you even more deeply.
Thank you for including me on your support team and entrusting me with helping you grow & develop as exceptional practitioners.
You should be celebrated for your commitment to your own learning & your endeavour to always improve your knowledge and skills.(more…)
**Note this 1st group is only offered to those individuals who have previously undertaken mentoring, either group or individual sessions with Rachel(more…)
