It’s no secret I am in the midst of some serious deep-diving through the micronutrient evidence base & at a depth of about 30 metres I struck Boron! Don’t yawn! I saw that. Thinking, ‘boring’, when we hear, ‘Boron’, is almost as bankable as watching everyone reach for their water bottles when you mention anything hydration-related 🤣 But I am here to restore your positive regard for this mineral and remediate its bad (& boring) rep! In preparation for the Nutrient Prescriber’s Program we started each nutrient review with the seminal contemporary nutritional texts and then launched ourselves headlong into the latest & greatest research. By the end of all the Boron bits in all my trusty texts the yawn was not gorn! But the moment I started reading the research I was like, ‘Are we even talking about the same thing?!’Turns out we’re not 😵🤦♀️
You see Boron has been a longstanding victim of identity theft. What we’ve been lead to believe is Boron is weed-killer and ant-poison and look it does give us some of the benefits of Boron but not all. And it possess a pharmacokinetic & toxicity profile that naturally occurring Boron simply does not.
Who decided that the Boron that is ubiquitous in our environment but almost exclusively consumed by us only after biotransformation by plants – could just skip that last bit and still be safe and optimally beneficial?! Probably the same guy that came up with folic acid, may I suggest? Anyway, enough is enough. We all need to relearn Boron – naturally occurring Boron – in the form of Sugar Borate Esters (SBE)- the evidence of benefits for which will blow all of our little minds! Well it certainly blew mine! Looks like this natural form of Boron is going to hit the Australian market in the not-too-distant-future 🐦 can’t wait to see which supplier is sufficiently progressive and research-aware that they bring this to market, having been available as a high grade supplement, employed in numerous RCTS OS for some time. But this little Update in Under 30 is not waiting around for that release date – there is much to be gained from SBEs right now – so make some noise as the real Boron at last takes the stage!🎤
Boron has been the victim of longstanding identity theft and we unknowingly have been interacting with its imposter. Contrary to everything you’ve ever been told about this mineral, naturally occurring Boron is full to overflowing with benefits for our gut, our bones, our brain, our management of other minerals and is safe in large quantities. That ‘bad guy Boron’ you were introduced to and is still present in many of your supplements is a form we never consume in food…and therein lies a world of difference! Come meet the real Boron so you and your patients can get the real benefits!
You can purchase The Boron Deception: How We’ve Been Fooledhere. 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.
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.
Wow, menopause is really having a moment, isn’t it? Or is that just me (and my mates who are all somewhere on that perimenopausal path)?! But seriously, medical perception of this reproductive transition is undergoing a revolution right now—widening the lens to take in more diverse potential presentations and lengthening the period of impact recognised both ‘before, during, and after’ that last, last…no hang on…last period. But I fear we are at a crucial crossroads. Anything could be related to (peri)menopause, but not everything is or should be.
There are several other conditions whose onset tends to rise or peak at the same age and stage for women, and due to their shared features, they get missed & misdiagnosed, misattributed to that!(more…)
Any steps towards inclusivity in societal & cultural terms are cause for celebration but in medicine, that can come in the form of a ‘diagnosis of inclusion’, the opposite, of course, of a ‘diagnosis of exclusion’ and potentially as slippery and loose as it sounds. That’s the somewhat precarious position we find ourselves presently in with perimenopause and menopause. With greater recognition of just how long health effects can kick in before there are any cycle changes [2-12 years for those of you playing along at home] and the widening lens now taking in the diversity of such health effects, women’s health has had a win. But, I would argue, this is not without a double edge. After all, aren’t we, as a result, more at risk, as women, of having everything attributed to “just ‘the change’, love”, and, in turn, going to be offered sex hormones more often as the solution?
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.
Let’s play a word association game of minerals & their major roles
I say, ‘Potassium’. Maybe you say, ‘Sodium Potassium Pump’ I say, ‘Magnesium’. You say, ‘Muscles?’ I say, ‘Calcium’. You say, “Bones’….
But I say, Second Messenger. And arguably the most pervasive & potent one, at that. Remind you about second messengers? Well, sure. They are the ones who get sh*t done. Not like a boss (i.e. hormone or neurotransmitter) who shout directives from above but never step foot inside the dirty guts of the engine room itself. It’s the second messengers who run these messages from the outside of the cell to the inside and the engine room, to ensure that the directive is actually actioned! Amazing huh! And free calcium in the blood is, as I said, really a superhero even among the second messengers – with its regular responsibilities including: Insulin, TSH, Adrenaline, Oxytocin, Serotonin receptor activation etc etc
Does, it have a dark side? Well, sure. Don’t most superheroes?
If the available Calcium in blood and the extracellular environment is too high then basically bad sh*t gets done. Including vasoconstriction, clotting, deposition of calcium in the wrong place like arteries and joints and etc etc. That’s why the amount of Calcium in our blood is the MOST tightly regulated of all electrolytes and, in turn, has the NARROWEST of reference ranges. But will a Serum Calcium level always tell you when there is a problem with Calcium regulation? No. You’d need to have measured the major regulator itself, Parathyroid Hormone (PTH). Wait, am I seriously trying to tell you, that Serum Calcium alone can look completely normal in spite of really damaging Calcium dysregulation underway – leading to accelerated BMD loss, increased cardiovascular and renal risks etc.? I most certainly am.
So do you know which of your patients’ really need PTH assessment and why 1 dominant group amongst those, is any woman leading up to and following menopause?
No? Well you better pull up a pew and have a listen and a watch then! Yes this latest Update in Under 30 episode even comes with a little video tutorial!🤓🤯
Parathyroid hormone is a career criminal. In addition to buoying dropping blood calcium levels via legitimate means, it illegitimately achieves this by stealing it from our bones. But you wouldn’t know it – because like all career criminals this occurs completely under the radar. Elevated PTH, however, constitutes the most modifiable risk factor for bone mineral density loss & fracture risk and offers the biggest BMD gains secondary to its normalisation. In addition to this, even within range but ‘high-normal’ PTH correlates with a range of other cardiovascular and urinary presentations & if combined with elevated serum calcium can become a multi-systemic presentation (GIT, Mental health etc) frequently mistaken for other aetiologies. So how can we be alert to this ‘bone thief’? Which of our patients will benefit the most from PTH measurement and monitoring? This recording, resource & video tutorial on how to use a Ca PTH Nomogram answers all!
You can purchase Unmasking Hyperparathyroidism – Menopause & Morehere. 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.
Current New Graduate Mentee: Kelly Allan giving her elevator introduction in a recent New Grad mentoring session
The fabulous Nina, one of our behind-the-scenes-dream-team & early career nat, said, ‘During our training and early in our career it’s like we don’t “see” the Generalists. We’re only aware of the ‘rockstars’ in our profession and they are all specialists in IVF, vaginal microbiomes or gut ones. So we end up thinking, to be any good you’re going to have to specialise’ ‘Yes,’ I said, ‘but imagine if we only ever had the option of seeing a specialist?’
You’ve been experiencing a bit of gut stuff – and rather than being able to bounce this off a generalist you have to go ‘straight to the top of gastroenterology’ – wait in line for your time, pay the big bucks etc to get their thoughts. But really it was only ‘a bit of gut stuff’ and perhaps all this was over-kill?(more…)
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…)
Especially given I am now a relic, my original training not quite pre-industrial revolution but pre-specialisation obsession. So that once I started seeing paying patients I just saw, and have seen…everyone. And because our patients always drive our desire for new knowledge and skills, I have therefore taken particular interests in & accordingly read the extra research pertaining to a whole variety of different systems, conditions and presentations etc. that I have then been able to share with others as part of my contribution to education. (more…)
After running a deeply rewarding Group Mentoring program for over a decade it is indeed time for change. I’ve witnessed first-hand the exceptional growth of thousands of practitioners, and in turn they have guaranteed and forged my own. It’s provided me, & my small team of naturopaths working behind the scenes, with an extraordinary opportunity to further develop, refine & sharpen many of the clinical tools I had originally created just for my own practice, to ensure they are user-friendly and outcome-oriented for everyone who choses to adopt them. Over this period, I’ve even seen some of my mentees become mentors themselves (!) carving out their own paths, creating their own clinical toolkits etc. I am eternally grateful for having occupied this space and role for so long.
But my contribution to ongoing practitioner development is not done – just done differently – moving forward.
Inspired by, & truth be told a little envious of, the content, culture and collegiate experiences my university attending big kids are having – we’ve decided to adopt some of the same elements including semesters! So our 2024 is now divided in half, with Sem 1 starting in Feb and finished by June. This means we can offer intensives, accelerated learning formats which will especially appeal to and benefit our intake of newly graduated nats/nuts/herbies into our New Grads program. This is the result of more frequent touch points and does not come at the cost of the comprhenesive content or outcomes. Likewise, all those returning (via a stampede!!) to our much anticipated Nutrition Prescriber’s Program
This is a Case Series delivered live via monthly meet-ups whereby a real case work-up, covering all key aspects of diagnostics, prescriptives, the therapeutic relationship, behavioural change & patient management etc is detailed and discussed. The cases have been hand-picked for their ability to offer maximal learning for us all – both in general terms of case work-up skills and tools, as well as an opportunity to upskill in the primary affected systems and the associated presentations – be that endocrine, skin, metabolic etc . We are so excited to announce this one’s arrival!
So if you want to head back to uni with us for Sem 1 at RAN Uni 😂 get in contact [email protected]
Ever feel like the universe has been preparing you just for this moment? Me neither really…but in this one weird way – yes!
So hear me out.
Thyroid disease as a result of a viral infection was first described in 1902 by Dr Fritz De Quervain and of course he and his ego called it De Quervain’s subacute thyroiditis. For some historical context, this predates the recognised role of iodine deficiency in thyroid disease! Skip ahead almost a century to deep in the 1990s and mini-me was sitting in a uni lecture room [front row & wearing fluro of course🤣] and over hundreds of hours (no scrap that zillions*^# of hours) of lecture content I was exposed to, the description of De Quervain’s Subacute Thyroiditis stood out and stayed stuck to me. I’ve brought it out for a twirl from time to time in the interim with some of my patients & in particular in correspondence with their docs.Skip ahead to the 2020s when we had this thing called. ‘a global pandemic’, and now everyone wants to talk viruses and their broader health implications & as a result, good ol’ Fritz, me and our buddy, De Quervain’s subacute thyroiditis, are all having a moment.
But just to recap – this is (clearly) not new.
What is new is the way this ‘virus of the moment’ has brought this Thyroid V Virus battle to the forefront. We are living an important chapter in history where all the textbook entries on De Quervain’s Subacute Thyroiditis are madly being rewritten to reflect the veracity of this viral attack on the gland and the wide-scale & varied damage that ensues over the months and years that follow. And so many of our patients are the walking embodiment of it – whether that be in the form of low or high thyroid hormones, nefarious changes to gland anatomy only evidenced on US. So what do we need to know? in short, that pathogens as goitrogens have never been more of an issue than right now for ourselves and our patients. And that compared with just our usual desire for comprehensive investigation of the HPT, taking a complete look ‘under the hood’, not only by way of a full TFT and Ab titres but also, wherever there is an additional suspicion – by way of a thyroid US – has become non-negotiable. But regardless of what you find there, once you look, do you know what to do next?
Biopsies and autopsies of diseased thyroid glands alike reveal the prevalence of many common viruses within, setting the scene perfectly for the Thyroid V Virus battle. So, what happens when a virus takes a specific liking to this gland? While there are several different possibilities, one brought to the forefront in recent years is viral thyroiditis wherein stage 1 is ‘spill’, stage 2 constitutes a gland that is now ’empty’ and while stage 3 is reported to be ‘recovery’, this is increasingly scarce – replaced with chronic or recurrent thyroiditis, relapses of previously remitted GD and a doubling of new AITD diagnoses – not to mention the wide variety of unfavourable anatomical changes being found on ultrasound. Comes with a great desktop reference with prescription examples.
You can purchase ThyVIRoidhere. 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 shared this recently on socials but for those of us that don’t hang around that ‘hood I am sharing again here because it is just too important. While we’re busy updating our knowledge regarding reproductive health for women (soooo many huge headlines of late!)…ahhhhh…this might be something we all want to read!🤓
This thought-provoking reviewchallenges the long held assumption that oestrogen is at the root of much breast cancer causation. Instead it creates the case for PROGESTERONE as the actual source of oncogenesisand relegates oestrogen to merely (but monstrously) fanning the flames.
Now before anyone panics (?too late ) you need to read the article in its entirety – esp this not being about demonstrable differences in measurable P4 levels – and keep in mind that this hypothesis, though well argued and supported by evidence also from trans-gender individuals, is not currently a consensus. BUT what I think it does really well is SHAKE THE TREE🌴🥥 and prompt us to challenge our own biases and blind-spots. For far too long in IM Oestrogen has been made out to be the baddy. I too am guilty of having done that. And Progesterone everyone’s saviour! Of course there are a lot of PMDD sufferers who have good grounds to punch us for even suggesting this.
But of late – many of my peers have helped remediate oestrogen’s reputation and put us back on a more balanced path – I am thinking of @Sandra Villella especially here.
Who straight away responded to my post regarding this on socials, “I just got back from the Australasian menopause Congress in Queenstown, and the different types of exogenous progestogens are certainly implicated in breast cancer.” And then generously shared some of the hot off the press slides and stats from the Australasian Menopause Society.
In a nutshell she says, “Breast cancer increases with age and with increased time of use and those increases are greater when Progesterone is included in the MHT prescription”
And whoah…maybe we all need to rethink all the pro-progesterone prescribing…dare I say?!
Btw – the article implies that having anovulatory cycles might actually be protective too!!
Not my normal space and speciality area but I keep finding these gems in women’s hormonal & repro health and I feel a duty of care to share!
Update and Under 30 Podcast episodes are streamed monthly audios and resources to keep you up to date with the latest ‘must-knows’ in integrative medicine, covering a wide variety of topics from diagnostics to diet, all through the lens of an integrative health model. Every month each new episode will provide you with a quick scientific review with ‘clinic-ready’ practice tips, in under 30 minutes. In addition, the subscription gives you access to the ENTIRE back catalogue of UU30 audios that have been released…that’s over 120 episodes! You can become an Update in Under 30 Subscriber to access the entire library of Update in Under 30 audios and resources here.
The debasing of BMI as a stand-alone assessment of weight is long overdue given its significant limitations and lack of meaningfulness with respect to overall health. This coincides with a bigger societal and cultural shift towards inclusivity which involves redressing bias against people with diverse body sizes and compositions.
And how do we, as integrative health professionals, continue to uphold our principles of prevention and treating the cause when excess adiposity may be a very real contributor? While ensuring we ‘see’ and treat each individual in front of us, not our assumptions about adiposity, not our body size bias nor blind spots?
One part of the answer: read and be led by their lab results – because pathology is nothing if not personalised.(more…)
The builder responsible for my reno arrived one day with a frown. When I asked him what was wrong – he said he’d just had his second high PSA result and now the doctor wants him to see a specialist. It was apparent that he felt this was a real cause for concern. Talk about raising a red flag to a bull 🚩🐂 Yes, of course you know what followed. I insisted on reviewing the results myself only to find the reference range provided on his report was not specific to his age – and if we adjusted up for this (as the science supports) his result is just 0.5 ng/mL above the expected value!
Now, remember he is a builder so, ‘0.5’ in his mind might well be on par with 5mm which apparently is a big deal…or so he keeps telling me every time I try asking for some weird unconventional thing for my roof, windows, walls, whatever!! So I still had to provide a little bit more detail for him to get perspective and to understand the true meaning (and lack of scary meaning) of his results.
This however is just a micro-illustration of a big problem in pathology – we all risk a lack of perspective but if we can get it back, aids us to see that seemingly ‘normal’ results are sometimes a concern, and so-called ‘concerning’ ones, non-significant. The incredible patient insights that can be gained from being able to measure & monitor actual quantities of things in our patients; nutrients to novel disease markers, precursors to end-products, all comes down to understanding how their values compare with…with what? With someone of a different sex and age? With ‘all adults 18-108!’? With any other pre-menopausal woman regardless of reproductive or cycle stage? With ‘the average’ adult given that this current definition is overweight & unwell? Who are we comparing ourselves and our patients to?
When I undertook my undergraduate training many moons ago – there was no education in blood test interpretation. But as soon as I got out into practice I found my patients had all these bits of paper filled with magic numbers that I felt certain might offer me insights and a deeper understanding of their whole health – and how to best help them.
I desperately wanted to decipher this foreign language and made it my mission to do so. I was lucky enough to meet and be paired with a kindred spirit, Dr Tini Gruner, who happened to be my supervisor when I returned to undertake my honours thesis. Together we pooled our knowledge, sought out & shared with each other yet more and found that, together with comprehensive case taking, it provided excellent scaffolding to our work-up of patient cases. Better than that, it created this baseline for patients, identified clear treatment objectives and we could measure the success of our interventions based on how their results did (or didn’t) respond to our interventions. It was (and still is) a totally thrilling way to practice.
We talk about there being both an art & science to medicine generally and certainly an integrative approach. Without the benefit of pathology interpretation, I felt too at sea at times, without quite enough of the science to check the accuracy of the ‘art’ and my speculation.
Being able to understand what each individual result represents and reflects, to know how to form meaningful comparisons – with external reference ranges that speak to healthy individuals of the same sex & life stage, derived from rigorous research – and also form a comparison with the patient themselves, to pick up on the most subtle and significant early alerts to an emerging pathophysiological or healing process – is the skill, I believe, we all need in health to complete the toolkit. That’s why I made it my mission to learn the language of labs, from a conventional & integrative interpretative perspective, and then to share this learning with everyone wanting and willing to take this baton from me (& Tini) and run with it 🏃♀️🏃
MasterCourse I: Comprehensive Diagnostics. Click here to read more and here to purchase it.
*Please note that this is the place to start for everyone wanting to add preventive diagnostics to their tool kit. It is also the pre-requisite for MasterCourse II, so make sure you have completed this before continuing with MasterCourse II: Thyroid and Adrenal Diagnostics.
MasterCourse II: Thyroid & Adrenal Diagnostics. Clickhereto read more and here to purchase it and sign up for the Free Watch Party commencing tomorrow, 3rd August 2023 with is included with each purchase of the MasterCourse II.
Heck yeah. It’s going to take a lot more than 1 push-back post to turn this ship around! Likewise, I was only getting started with my recent Update in Under 30 episode, ‘What’s Hiding Behind Histamine’ 🤓😂 & part 2 has just been released where we unpack the case of a 41yo female with chronic diarrhoea, multiple food reactions, very high stress and very high oestrogen. Sounds like she’s a walking Histamine Headline – except she isn’t.
Right now we really do need to keep this conversation going such that a healthy discourse can help us deconstruct the histamine dogma.
I know I’m showing my age here, but anyone remember when Candida was having a ‘moment in the 90s? Ok, so that ‘moment’ stretched to over a decade of a ‘Candida-contagion’. No one could eat melons or mushrooms, eat ferments or feel joy. It was a bleak time that did our profession some reputational damage. Not only because seeing an ‘alternative practitioner’ became synonymous with being put on an unbearable, unattainable restrictive diet and positioned practitioners as peddlers of punishment but also because it took some time for science, in the form of accessible (& always improving) assessment methods, to come along and save us from the folly of the 1-diagnosis-for-all mentality.
Let me ask you, how many times do you actually see Candida overgrowth on reports from stool testing performed using best practice modern methods?
In my experience – never – not as a stand-alone issue. Occasionally, as part of the overgrowth of a suite of opportunistic organisms where the real-take home is the need to ‘remove the opportunity’ via the promotion of more good guys. So not only was the diagnosis incorrect, the proposed treatment for it was a complete misdirection as well.
Can’t help thinking in the current climate of Histamine Hysteria that history is repeating itself.
How will we all individually, and as a profession, respond this time?
In this follow-up episode we observe how the 3 key elements often hiding behind a histamine intolerance diagnosis: Misunderstandings, Missed Messages & the potential for Mistaken Identity, have played out in the case of a 41yo female who presents with chronic diarrhoea, a long list of problem foods including now a suspicion of ‘histamine foods’. Rachel offers up new ways to approach the patient work-up that cut through the ‘noise’ and enable us to better identify what is hiding behind histamine in similar cases of marked gut dysfunction.
You can purchase What’s Hiding Behind Histamine? – Part 2here. 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.
You’re invited to attend acnem’s 2023 Annual Conference ‘Long COVID, Navigating the Complexity, A Clinician’s Roadmap’.
Saturday 29th & Sunday 30th July 2023, Melbourne. Both face-to-face and online.
To get 25% off acnem Annual Conference USE CODE: acnem25
Never done a MasterCourse in Diagnostics with me? Is that because you’re scared of…
a) investing that much time Aren’t we all – but we can hold each others’ hands & hold each other accountable each Thursday for just 7 weeks🤝 b) investing that much money We hear over & over again from our alumni that this was the best investment they made in their practice & it paid them back in spades! 💰💰 c) your own future fully fluent – all seeing all knowing (almost!) – diagnostic diva/divo self?! Don’t be: Dare to be remarkable. This will set you up & apart.🤓 d) of Rachel Well that’s a point – hard to argue! But feel the fear and then be pleasantly surprised by the fun! 🤸♂️🤸♀️ e) all of the above you best keep reading then…
Is now the time to face your fears, save a substantial amount of $$ and get on board with this train(ing) destined for your new empowered practice model, before it leaves the station?? Yep.
The MasterCourse I: Comprehensive Diagnostics has been called the single greatest change-maker to people’s clinical practice and likened to a total brain reboot. Not only with respect to the interpretation of patients’ results but to your complete understanding of integrative physiology. Liver function tests become markers of mitochondrial function, muscle mass and much more. Patterns in routine labs make patent the otherwise ‘invisible’: central and peripheral sleep-disordered breathing, the earliest signs of bone demineralisation etc And now it has a new sibling MasterCourse II: Thyroid & Adrenal Diagnostics. (more…)
Have you had a book that is so compelling & transporting you can’t put it down?
In the last year or so I’ve rewritten my own little book of sorts, on thyroid physiology and results interpretation and during that process I came across a paper that referred to ‘the thyroid biography of each individual’. I was so struck by this concept, how it brings into life my new appreciation of how a patient’s thyroid function speaks to the totality of their exposures – from their diet to their dopamine, from their exercise regime to their environmental pollutants, from their sex hormones to their stressors.
Being immersed in the research was deeply rewarding but the obsession proper began when I started applying everything new I’d learned to patient labs. Reading the ‘thyroid biography’ of every individual is the book I just can’t put down.
Not just because it enables us to see that our clinics are full of responsive thyroids more so than rogue and that the ultimate tailored ‘treatment’ is spelt out, right there, in the nuances of each patient’s TFT & other pathology patterns but also because these results themselves are a portal into the patient’s bigger story. During a recent interview on this topic, where I had the good fortune to be interviewed by someone who really understands health, we got deep into a discussion about how differing macrophage dominance (M1 or M2) in our adipose tissue disturbs thyroid function differently. The interviewer then asked – well how do you know if your patient is M1 or M2 dominant – is it just based on different measures like waist-circumference etc? and I said something to the effect of, ‘Well these can be indicators but actually more and more in someone with excess adiposity I look to their TFTs to tell me the answer to that!’
And that was actually a Tada! moment right there!
I realised the truth and gravity of what I’d just said – increasingly I’m looking to patients’ thyroid function to tell me the rest of their story – to reveal not only their totality of exposures but to shine a light into some darker corners that are otherwise hard to see or measure or know…like macrophage dominance patterns in fat tissue, or HPA setpoint recalibrations following trauma, or subinflammation that remains under the inflammatory marker radar.
We’re understandably critical of the over-stretch a name like ‘Thyroid Function Tests’ conjures up – how can 1 panel of 3 (ideally!) markers deliver on such a promise?! But I am here to tell you it can and in fact, it can deliver on far more than that once we learn to read TFTs as Thyroid First-Responder Tests, instead. And of course, we generally don’t see TFTs in isolation – so we can couple these with patient results for routine labs that add to our understanding, support our suppositions or challenge them based on their FBE, their renal or metabolic markers etc. This is integrative endocrinology within the broader framework of integrative medicine after all. This necessitates de-compartmentalisation while being able to disentangle one source of HPT directive or disruption from another. This is real-world results interpretation that optimises our insights and understanding & patient outcomes.
The back cover of my copy of this well-thumbed thyroid biography so far reads:
⇒Rather than rogue thyroids our clinics are full of responsive ones – responding to the totality of each individual’s exposures. ⇒If you don’t read patient TFTs through the lens of the HPT as a first responder – you’ll misinterpret what’s happening within their HPT. ⇒If you don’t read these results through this lens you will miss out on a much bigger understanding of their whole health story.
Of late, I’ve been woken at night to find I have been page-turning through a patient’s thyroid biography and a lightbulb moment of discovery is coming into land! I wish for everyone else the same…not the sleep disruption bit of course but those glorious Aha! moments. Oh and don’t get me started on HPA Assessments – that’s another page-turner!
MasterCourse II: Thyroid & Adrenal Diagnostics is NOW available. Clickhereto read more and here to purchase it and sign up for the Free Watch Party commencing 3rd August 2023 with is included with each purchase of the MasterCourse II.
I can barely bring myself to write the word given how overused it has been of late 🤐🙄😯😕🙃 But I gotta say something! If we have found ourselves currently in a place where every second (or indeed single!) patient has a ‘histamine issue’ then I am afraid that it is we, that have an issue. (more…)
The case of a slim 41YOF under very high stress due to marriage separation & the care of 2 young kids was presented in mentoring this month. Her a.m. Cortisol was 710 nmol/L – Rachel asked the group to identify 3 results in her routine labs that are consistent with & likely to be caused by this hypercortisolism…
Mentee & MasterCourse I & II Alumnus: In this case… – High-normal sodium – High neutrophil:lymphocyte ratio (on a few occasions) – Mildly elevated CRP
Rachel: The 3 markers you mention can indeed be consistent with and purely caused by high Cortisol: HN Na, HN Neutrophils and LN Lymphocytes producing an elevated Neutrophil Lymphocyte Ratio (NLR) and some low-level CRP elevation
Wow, menopause is really having a moment, isn’t it? Or is that just me (and my mates who are all somewhere on that perimenopausal path)?! But seriously, medical perception of this reproductive transition is undergoing a revolution right now—widening the lens to take in more diverse potential presentations and lengthening the period of impact recognised both ‘before, during, and after’ that last, last…no hang on…last period. But I fear we are at a crucial crossroads. Anything could be related to (peri)menopause, but not everything is or should be.
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The debasing of BMI as a stand-alone assessment of weight is long overdue given its significant limitations and lack of meaningfulness with respect to overall health. This coincides with a bigger societal and cultural shift towards inclusivity which involves redressing bias against people with diverse body sizes and compositions. 
MasterCourse I: Comprehensive Diagnostics. 
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