While many of us have made it our business to ensure we are competent IN the business of understanding patients’ iron studies, it sadly seems, many even in teaching and training positions, still have not ūüôĀ¬† I was sent 2 messages this week that had me lost for words (other than expletives).¬† The first, an email from a final year nat in student clinic with the subject: Please tell me I’m not crazy!!

“Fasted male with high ferritin & high-normal transferrin saturation at two time points, with constantly raised Liver enzymes & neurological Sx. He is currently being treated for blasto in student clinic because they think the high ferritin comes from “blasto infection!!!
He needs to be checked for an HFE mutation, right??”

Ok so high ferritin because of ‘blasto’ is NOT A THING! And on the HFE front…Correct! I ask, “Have you mentioned this to the supervisor?¬† What do they say?” Student’s reply, “They say HFE mutations are uncommon so, in¬† a word, it’s not it. But THANK YOU!!!!!!!!!!!!!!!!!!!!! I feel sane again”¬†So, what do I do?¬†The student is studying at a leading institution, one that has sought advice and input from me in the past regarding their diagnostics curriculum, but it would seem, the clinicians they allow to supervise our precious next gen of nats are not expected to be even as competent as the students themselves. Danger Will Robinson! Danger! [old tv show reference…apologies, young folk!]¬†I’ve [not] recovered from this when I get hit with the old 1-2!¬†A naturopath messages me with a screenshot of a FB group exchange over a set of iron results: Ferritin over 400 but low serum iron and transferrin saturation values…which another health professional, who offers training to naturopaths, says is ‘Iron Deficiency’

Email says, “Please help me, I’ve worked so hard to understand iron studies and this has just CONFUSED THE #@*^ out of me!”¬†

Again someone who would typically defer to the voice of authority here, fortunately knows enough to know to question this (mis)interpretation.

I tell you…you may have thought that when I previously¬†wished for all health professionals to be competent in reading studies…but it’s actually a big ask, it would seem 🤔¬† Could we just, as a start, get anyone who professes to teach, train or mentor health professionals, to actually get up to speed on this themselves or…keep their mouths 🤐

No wonder our “So You Think You Know How To Read Iron Studies” is in our top 3 downloaded resources!!!

Overt Iron Deficiency Anaemia or Haemochromatosis aside…do you understand the critical insights markers like transferrin and its saturation reveal about your patients iron status?  Most practitioners don’t and as a result give iron when they shouldn’t and fail to sometimes when they should.  This audio complete with an amazing cheat sheet for interpreting your patients Iron Study results will sharpen your skills around iron assessment, enabling you to recognise the real story of your patients’ relationship with iron.

Or better yet, go the whole hog, with our Iron Package

 

Last week I had my say about acknowledging our elders & mentors, this week I want to speak to the power of the young peeps.¬† Just like a younger sibling, nipping at your heels can act as a great motivator to move faster, or having children can inspire us to do more to improve the ‘world’ we’re welcoming them into, my interactions with naturopaths, nutritionists & herbalists of the younger generations generally effect both responses in me! The best of these come from cluey ‘youngsters’ (mature-age-second-career-new-nats included!!) who ask the most difficult questions & show dogged determination in getting answers to these either via me or in spite of!¬†

This is exactly what’s been in play over the last few years (yes, you heard me…years) while I’ve been under the watchful gaze of Jostling Josh Weymouth! He’s a youngun’ – it’s all relative right – who has kept us both on the straight and narrow writing: The accuracy and interpretation of plasma selenium in our patients: a literature review, which has just been published in the the Australian Journal of Herbal & Naturopathic Medicine.

At the outset I was able to hand over a substantial selenium research hoard I had obsessively compiled, Josh was able to build on this, refine some fledgling theories I had and then completely redefine my appreciation & understanding of how chronic over-treatment (not toxicity…) is so deleterious to human health.¬† Check this out:

When Selenium (Se) saturation point occurs in plasma, there is a potential reduction in health protection… Se will progressively pool within plasma non-specifically as SeMet in lieu of regular, sulphur containing methionine, in albumin and other proteins…inducing oxidative stress via a complex disruption of cell reactions/signalling
This is likely to be how Selenium over-treatment increases the risk of both CVD and T2DM

Many of you may ‘Know Your Numbers’ when it comes to Serum Se targets in thyroid health or just generally know how to Stay Safe with Selenium Supplementation because I’ve spoken extensively about these in the past and you will be relieved to know neither my ‘numbers nor my message’ have changed BUT I encourage everyone to read this new article because Josh has added so much more, including the interplay between our microbiota and our individual selenium needs, handling and tolerance and and and….I could go on but…what I really want to say is, thanks Josh for your academic rigor, your firm determination & diligence and for nipping at my heels all this time. This important piece of work just wouldn’t have happened without it 🐶

 

I stand on the shoulders of my elders.¬† [I hope it’s not too painful for them, it’s been going on a long time now!!]¬† And I regularly lean on my mentors – who are often my peers, practitioners specialising in areas different from mine.¬† I recite their names often like a little mantra in our mentoring sessions: Kate Worsfold, Dawn Whitten, Tini Gruner, Michael Hayter, Jason Hawrelak and a few others that are on high rotation like ‘Rhiannon-repro’ Hardingham and I feel this is important to reaffirm that learning is lifelong for us all and to make clear the passing on and around of knowledge in our profession.¬† There’s been a long history of honouring our history, so to speak, in naturopathy.

My training definitely acknowledged, paid homage to & revered elders past and present & while I’ve never been one to participate in the making of herbal preps by a full moon, at solstice, in a field somewhere, in the company of said herbal elders (you know who you are!!)…

I do try to continue & foster this important collegiate quality of our professional community by reciting the names of the saints source of clinical pearls I have been given so generously by others.  

Lately, I’ve been wondering if we’re losing this tradition. I’m hearing practitioners present concepts as ‘theirs’, ‘develop’ & distribute teaching tools ‘adapted’ from others work, parrot identical ‘catch-cries’ even, with no mention of the origin, the source – even the inspiration.¬† Now perhaps I am showing my age, reflecting a very different time in naturopathic training when we were so fortunate to be taught by some of these amazing (solstice honouring, field dwelling, herbal making) elders, but even by today’s standards and the dominant EBM model, surely every emerging clinician understands the need to cite their sources?

The green tea & lactulose intravaginal wash recipe I use and frequently share with mentees always comes with the prelude – “I got this from Gould’s”
The tips on testing tools in mental health, I propagate like mad, has the epilogue – “All that I know, is because Kate taught me so!”¬†

Of course I say more than I cite (otherwise the sessions would be impenetrable!) but I like the way it helps us all to see we are a part of something bigger.

 

Cortisol – Have You Been Caught Out?

I have!¬† And just recently a stark contrast between the results from 2 different methods of cortisol capture in the same patient illustrated just how likely this is. How do we ‚Äėcapture‚Äô something so ‚Äėdynamic‚Äô and¬† interpret anything of substance from a ‚Äėstatic‚Äô assessment technique?¬† ¬†But rather than throw up our hands and throw out the whole attempt to measure cortisol, we can improve the rigor, reliability and real-world meaningfulness of our patients‚Äô results by refining our timing of tests, choosing the medium wisely & manipulating test conditions to answer specific questions about their HPA function.¬† Great ready reference resource included!¬†

If you’re already an Update in Under 30 Subscriber – go directly to your Active Content…it’s already there!
If you’re not and want to improve the accuracy of your Cortisol Capture in patients go
here!

What’s your knee-jerk response to 52Y Lipids Lucy & Liver, whose ALT & AST suddenly jumped above range when she was put on statins?¬† They’re damaging her liver?¬† You’d be wrong.¬† One of the practitioners who undertook the MasterCourse in Comprehensive Diagnostics just graduated with flying colours when she was able to correctly identify the true cause of this patient’s LFT abnormalities, can you?¬†

[Cheeky hint: there is more than one explanation/process at play]

This naturopath now knows her pathology patterns.¬† She knows the interpretation of any liver enzyme must also take into account the movement in other markers, to make meaning of the whole.¬† Because so-called ‘liver enzymes’ are never exclusive to the liver.¬† They are expressed in multiple other tissues and organs – sometimes at equal concentrations to their liver-level (e.g. ALP and bone). For some, even referring to them as a ‘liver enzyme’ is a mislabelling of sorts, with minimal expression in the liver itself compared with ubiquitous distribution all over the body (e.g. GGT & LDH).¬† Of course this is both a blessing and a curse.¬† A curse if you make the mistake of only interpreting their levels through a ‘liver lens’…a blessing if you know when they are flagging problems elsewhere through the specific pattern recognition.¬† So back to Lucy – the statins had induced a rhabdomyolysis not hepatocellular damage.¬†The clues?¬† Significant AST dominance over ALT, above range CK and LDH.

So if the statins weren’t causing increased hepatocellular damage what is that increasingly high-normal ALP pattern all about?

Bones. And again, this practitioner picked it.  And then got to win herself some pretty BIG credit and credibility points with all the other health professionals sharing care of this patient by suggesting that they clarify and confirm this by referring her for an ALP bone isoenzyme assay, which answers the question: is the elevated ALP originating from the liver, the intestines or from the bone? Bingo, bones it is!  Or was, because this practitioner was able to alert not only the patient but all the other practitioners treating her to the increased bone remodelling taking place, independent of the statin reaction, but part of her perimenopause. Left unchecked this would escalate further of course at menopause and leave her bones in bad shape. This is just one illustration of how we can show ourselves the be the incredible one we are on the shared-care team. 

Being lab literate and pathology proficient, sets you apart from the rest and enables you to practice truly preventative medicine.
How else would we have known she was experiencing increased BMD loss that may be the start of something truly tragic?

 

Realise the true value you can extract from the most commonly performed labs.
Join Rachel Arthur LIVE on the MasterCourse I: Comprehensive Diagnostics WATCH PARTY
This skill is the biggest ‘game-changer’ in Integrative Medicine!
Want to know more? Head over to my website here and check out more of the great benefits and bonuses of joining this program
This course is a fantastic learning opportunity to identify the many intricacies in cases that have previously been missed.

The average woman & her dog (& likely every other member of her household, be they furred or otherwise), can tell you that sudden changes in sex hormones can undermine, derange, psychopathise, impact her mind and mood.¬† Hey, for me most days reverse parking is my mild super power, the envy of all, but on day 26 of my menstrual cycle, I can struggle with a ‘nose-to-kerb’! But if we are quick to attribute this to the fluctuating sex hormones produced by our ovaries, alone, we’d be making a mistake.¬† A portion of these peripheral steroids do cross the BBB and act in our brain, so changes to these levels during any kind of transition: follicular to luteal, pregnant to post-partum, menstruating to menopausal, early adulthood to andropause, will be ‘felt’ but the sex (hormones) we have on our brains at any given time, are far more abundant, potent and complex than this, thanks to the brain’s ability to make its own.

So in fact, the amount of sex hormones active in the brain represent an intersection between peripheral and central steroidogenesis. 
These Neurosteroids, made ‘on site’, are as much produced in response to our mood, our neurobiology, our psychological and environmental stress, to help us navigate these, as they are the creators of mood itself.

Yes, these particular sex hormones, due to their actions in our brain, belong to that growing list of CNS celebrities: the Non-Classical Neuromodulators. ¬†Which, for the otherwise neurotransmitter-centric & obsessed among us (that’s everyone), makes mental health and illness much more complex than ‘serotonin deficiency’ or ‘glutamate excess’ and a whole lot more real.¬† We now need to consider other entities like: ‘suboptimal LDLs’, 5 alpha reductase over or under-expression & ‘xs inhibitory tone via progesterone’.

The ‘sex on the brain’ of any patient therefore is impacted by both their Endocrine (ovaries, testes, adrenals) and Synaptocrine (neural) contributions – and these demonstrate some shared dependence (for cholesterol & healthy mitochondria etc) and independence.

We all know the depressing stats in support of the ‘ovarian withdrawal hypothesis’ and the risk to women’s mental health with each reproductive transition, and also in andropause in men, but the time has come to now deepen our understanding and to recognise¬† we can have an imbalance of ‘sex’ on the brain – regardless of the ‘balance’ we might see in the periphery and put our thinking caps on about the options we have to address steroidogenesis either side of the blood brain barrier.

When it comes to a modern take on how sex hormones impact both the structure & function of our CNS, we need to blend the ‘old’ with the ‘new’.¬† The ‘old’ tells us, production of sex hormones is in the gonads and action at a distant target anywhere else in the body, including our brain. And the ‘new’ is in the form of the ‘Synaptocrine’ – where production of these sex steroids is actually within neural tissue itself and their immediate actions occur close-by, in the synpase and at the post-synaptic neuronal membrane. These two contributive pathways show some shared dependence but also independence from one another and the balance of both has now been recognised to be integral to the overall health of the nervous system.
You can purchase Sex (Hormones) On The Brain here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

 

Well, this is different, now I’m watching you! 😆 In early 2021 we released our very popular MasterCourse I: Comprehensive Diagnostics, as a ‚Äėself-paced‚Äô online offering for the many who missed out on attending live in 2020.¬† Many have grabbed this opportunity with both hands (& a headset and some hardcore Do Not Disturb! signs) but we know that for some, doing the entire course on your own, >24hrs of video presentations, can be a tad onerous & overwhelming. We want to remove these barriers and empower & upskill as many practitioners in pathology interpretation as are keen, and as a means to achieve this, we‚Äôre offering the MasterCourse I Watch Party.¬† So bring your bhujia and a beverage and let’s do this!!

Practitioners who sign up for this will be able to watch each session’s video replay live with other practitioners and have the opportunity to ask Rachel questions & participate in case discussions at the end. Another key detail is that we will run the sessions weekly, so that the full course is covered in just 6wks, from July 8th to August 12th.

MasterCourse I: Comprehensive Diagnostics LIVE WATCH PARTY
24 hours of live Zoom sessions + Bonus sessions!
8, 15, 22, 29 July & 5, 12 August on Thursday at 3.30pm to 7.30pm AEST.
Each Thursday, the video presentation for that week will be played so we can watch it together. Then Rachel will open up her webcam and mic, inviting you to do the same, to participate in a Q&A  as well as set case discussions. When you register, you get immediate access to watch our preliminary/preparatory sessions, prior to 8 July: Accurate Pathology Interpretation Starts Here and the RAN Patient Pathology Manager Tutorial.

Below is an overview of the Watch Party schedule.

Week 1 – 8 July | SESSION 1: Acid Base Balance & Electrolytes
Week 2 – 15 July | SESSION 2: Renal Markers
Week 3 – 22 July | SESSION 3: Liver Enzymes
Week 4 – 29 July | SESSION 4: Lipids & Glucose
Week 5 – 5 August | SESSION 5: Immune Markers
Week 6 – 12 August | SESSION 6: Haematology

“I thought my pathology skills were pretty up there until I did Rachel‚Äôs Diagnostic Masterclass course!¬† Nothing like being knocked off my perch by a literal avalanche of new information, especially when it comes from the most commonly tests that we all use so often.¬† The course has been a fantastic learning opportunity for me, and has since helped me pick out many intricacies in cases that have previously been missed.¬†¬†

The course structure was great, the level of detail was right up my alley, and the case studies were entertaining (in true RA fashion).¬† Once again Rachel has increased my knowledge base, and help me provide way better service to my patients.” –¬†Rohan Smith, Naturopath


Join Rachel on MasterCourse I: Comprehensive Diagnostics Watch Party and register here.
MasterCourse I is a pre-requisite to join MasterCourse II which will be delivered live in 2022.

Just like Kevin, ‘Niacin’ is profoundly misunderstood and consequently runs the risk of doing us harm. Unlike ‘Kevin’, we can’t watch the movie to see how this (our arguably excessive use of the wrong forms of B3 in supplements and fortified foods) is all going to play out, so that we can be suitably alarmed and start making some different choices. The risks that follow from our B3 ignorance are twofold:

One comes essentially from our gross under-estimation of this B vitamin – we’re stuck in the Pellagra Paradigm, believing that prevention of the 4 D’s is confirmation of adequacy.

The second, is our lack of discernment when it comes to the different forms or precursors of B3 & our unfamiliarity with their very specific physiological roles – good and bad.

In this regard we’re all likely to say, ‘Well back up there 1 second, we do know that Niacin (aka nicotinic acid) is different from the other forms!’¬† Producing flushing, yes.¬† Used as a lipid lowering agent in pharmacological doses, yes. But can you tell me, which serious concerns and biochemical disruption is shared between both gram doses of niacin and everyday ‘routine’ mg doses of niacinamide? Yep, that one, the so-called ‘safe’ one. Better still, can we all list the various B3 forms in order from most to least potent, in regard to their capacity for NAD+ promotion in the human body?¬†

Because this is now the definition of B3 ‘adequacy’ or ‘optimisation’ according to modern scientific understanding & it is a long long way from the absence of¬† Diarrhoea, Dermatitis, Dementia and Death!

In fact, the boosting and optimisation of NAD+ pools in the human body is key to life – a long and healthy one according to the current research consensus – and its depletion is akin to ‘death’, or a faster one, anyway.¬† From increased metabolic disorders, mitochondrial dysfunction, impaired gene stability (cancer, infertility etc) and higher rates of neurodegenerative disorders, just to start, these take up the lion’s share of our chronic health burden and battle that currently dominates the dis-ease landscape.¬†And more niacinamide might just make that worse.¬†

I didn’t mean to to alarm you. I am alarmed.¬† Want to deep dive into this yourself?¬† Start with this older but still brilliant review article by Bogan & Brenner.¬† Want me to hold your hand while we jump off the high platform diving board together into this vastly different and powerful new understanding of B3?¬† Let’s do it!

The Balance of B3

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

 

You can purchase The Balance of B3 here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

‘Hey Alexa, What’s that formula for correcting urinary iodine for hydration status?’
Oh yes, if only she could answer these kind of questions!

There’s no one here by that name but we get these kind of emails all the time [Oh and also for Freya who hasn’t worked here in like 5 years!!😂]¬† But we love them because it means our blogs provide useful, sought after and (we like to think!) really really hard to get anywhere else answers . But hey try it, Ask Siri!¬† We’re always forthcoming with references – not just citations but the full low down and dirty full texts (as long as we’ve managed to get our hands on it!!) and we know which topics particularly hit a spot across our professional group by not just the number of enquiries but how far the actual blog they’re referring to, dates back.¬† So we’ve just received more comms regarding one that’s often on high rotation…a post I wrote on urinary Iodine Assessment & how and why we should adjust for hydration!¬† That was 2014…what a vintage 🤩 Show’s though how topical and tricky this little test is.¬†

So I dove back into the musty archives (no seriously we don’t use parchment) and thought it might be good to create a central source for all things Iodine…because…well there’s a LOT!
If you haven’t read the original post on the iodine creatinine correction – the fun starts HERE!
We named names (the companies that did correct for creatine and those that didn’t) – way back in 2015
We told you companies may change their reporting style but there’s one easy way to tell if the correction for hydration has been done for your patient’s results
I clarified, the Pitfalls of (so-called) Patch Testing for Iodine Status
And we linked you to my Free-for-all-FxMed talk on the Intricacies of Iodine – which discussed assessment & so much more!

Then there’s iodine and breast pain, iodine and sub-fertility & & &…& [ahem] turns out I perhaps have been a little Iodine Infatuated.¬† But you know, it’s still 100% warranted, right?¬† I mean here’s that latest Newsflash post Australia’s ‘genius’ bread fortification: Women Remain at Risk of Iodine Deficiency during Pregnancy: The Importance of Iodine Supplementation before Conception and Throughout Gestation. Oops, Britney style, I think I just did it again! Oh and don’t forget our website does have a search function – top right ūüėČ

Iodine Deficiency, Toxicity & Treatment ‚Äď Where are we now?

The iodine landscape has undergone radical change recently.  We’ve moved from recognising the resurfacing of a widespread deficiency, to large-scale food fortification that has failed to correct deficiency in most and produced excesses in a few. Parallel to this, we have the ever growing incidence of thyroid disorders and some radically contrasting ideas regarding iodine’s role in both aetiology and treatment.  Micrograms V milligrams?  Random urinary iodine or iodine loading test? Important new evidence and clinical experience helps us understand more about how to accurately assess patients’ need for iodine and know when & how to use it therapeutically & when not to!

When I was 12 tartan was in.¬† Like, really in.¬† And I rode that tartan wave as far as it could go, arguably beyond where it should go…I had a tartan bowtie I wore. 🙄¬†I knew it was on trend because I saw it flashed across magazine covers (we never bought them so I couldn’t tell you what was inside!), my pop icons wore it and many of my fellow grad sixers had various tartan clothing items and accessories. It was a real overload for the eyes when we congregated together as a group of girls, on the town in our tartan, I am sure. All I can say is, thank goodness, we didn’t have the internet and socials. Why? Because it would have been far worse. Because now we have constant comparison to others, an acute awareness of daily dizzying escalation of things ‘trending’ and ultimately, in spite of these aesthetics perhaps originating from something original- ultimately perpetuating a loss of originality and distinction across those that ‘follow’ and ‘watch’ and ‘aspire’. I would have been a true follower and done worse than even my bowtie.

I feel so privileged to be a mentor to the next gen of naturopaths, nutritionists and herbalists and I worry about how this aspect is impacting them, their sense of themselves, the sense of who clients ‘want’ or ‘expect’ them to be and present.

Are you seeing what I’m seeing?¬† When I look at websites of many early-career practitioners I’m struck by their ‘sameness’.¬† Lots of white space background offsetting particular on-trend fonts, extraordinary high quality ‘visual food porn’ (there I said it!)¬† and of course lots of smiling, beautiful, young women often wearing linen (hardly a man in sight btw… hmmmmmm).¬† It’s me and the tartan all over again.¬† But at least I wasn’t trying to run a business that is based on communicating that I and the service I offer is accessible, relatable and inclusive, to any potential patients that happen to have found their way to my website! Older women, men, LGBTQIA+ individuals, people of different cultural backgrounds, or those with a disability.¬† Let alone, just people with minimal or zero interest, confidence or competency in cooking!¬† That includes me. When I look at some of these pages I instantly go, ‘No, not interested’, because it appears the path to health with this practitioner necessitates making vegan miso brownies decorated with rose petals and, you know what, I choose to spend my time doing other things! Brutal, but honest. We also need to remember that if we are reducing ourselves to pretty pictures and creators of healthy food we may distance ourselves further from other modalities and we may also limit people‚Äôs (patients and practitioners) understanding of how we work and what we offer. Now, of course, there will be plenty of patients to whom these same aesthetics appeal greatly.

But I have 3 questions we should all ask ourselves semi-regularly about our online presence:
1. Does this appeal to a large enough group of individuals to sustain a business?
2. Are the same individuals who ‘like’ & ‘follow’ your Insta stories also likely to pay to engage in a therapeutic relationship? Or are they there for the free *Insta Inspa* (aka inspiration)?
3. What are we communicating to potential and existing patients about what it takes to be healthy? An abundance of time, good genes, looks & money for all those ingredients & gorgeous clothes?

With Erica Mcintyre and colleagues survey mapping patterns of engagement with nats & herbalists, from the largest to date nationally representative sample of the Australian population, revealing that men and women were equally likely to have seen a naturopath or herbalist in the past 12mo and that,¬† approx only 1/4 of our patients come for ‘wellness’, without any chronic health condition, while a striking 16% present with 5 or more chronic health diagnoses, I wonder if we all need to rethink who we want & need to appeal and ‘speak’ to. Having had a wonderful conversation with Gill Stannard Naturopath & Mentor in preparation for my mentoring of New Grads this year, bouncing this and many more topics between us, I feel there is a need for us all to regularly reflect on our ‘messaging’, no matter what the medium,¬† not just as individual practitioners and business owners but as a bigger professional group.¬† I’m going to start campaigning to ‘bring back the tartan’, who’s with me?¬†

The MasterCourse in Comprehensive Diagnostics I is finally here as a self-paced learning program you can undertake yourself.  We know you’ll get as much out of it as those who attended live:

‚ÄúI thought my pathology skills were pretty up there until I did Rachel‚Äôs Diagnostic MasterCourse! Nothing like being knocked off my perch by¬†a literal avalanche of new information, especially when it comes from the most commonly tests that we all use so often.¬†The course has been¬†a fantastic learning opportunity¬†for me, and has since helped me pick out many intricacies in cases that have previously been missed.‚ÄĚ
‚Äď Rohan Smith | Clinical Nutritionist

MasterCourse 1: Comprehensive Diagnostics is a self-paced online program
Gives you access to 24+ hours of streamed video presentations, 2 x Bonus Update in Under 30 episodes (The Calcium Conspiracy & Using Urea to Creatinine Values for Protein Adequacy) PLUS resources, a template and pdfs of all presentations. This package includes $200 worth of bonus material and remains forever in your online account. You will also receive access to any future updates of resources and our template. More information can be found here.

Please note completion of MC I is a pre-requisite for MasterCourse II that will be delivered live in the second half of 2021.

 

 

Don’t know why on earth I would be discussing ‘Glassing’? I have a hunch.¬† I was supposed to be doing a deep dive into Taurine & Glycine & their CNS effects for the latest Update in Under 30 and due to a technical glitch we produced a software generated transcript from my first attempt at the audio recording. We’ve never done this before and it seems to suggest, I have an accent and I’m a little mortified.¬† I wasn’t under some delusion that my utterance was universal…my speech narrows my origins to certainly the ‘bottom of the globe’, but, ‘Strewth Sheila, how does any of yous guys understand me??!’

So we’re giving away 3 free copies of this recording to the first 3 individuals who can correctly translate the following from that transcript!:

“In fact, if we go back to their chemistry, you might recall that Glassing, well I refer to it as the naked amino acid. It refers to the fact that Glassing is the amino acid in its most stripped back form. It actually doesn’t have a side chain, which of course all other aminos do.¬† So therefore it doesn’t have eyes and ears. It doesn’t have an Alan O’Day form.”
🥴😵😬

What?!¬† Yes it took me a while to work it out…and I WAS THE PERSON IT WAS QUOTING!!¬†So while I am currently using a medium released from my regional rhino-challenged speech, let me tell you why I am right into ‘Glassing’ as CNS support and as a sleep aid for many patients. Ever listen to the long list of enviable actions Melatonin has on the brain and think…’gee I wish we had something that wasn’t a hormone that could do that?’…hello Glassing, I mean Glycine. SCN sensitising, circadian entrainment, sleep architecture improvement without being a sedative or hypnotic…just to name a few.¬† And guess what?¬† The overlap between these two even extends to their behaviour within the upper GIT!¬† Both of course being shown to be helpful in aiding the healing and recovery of function and integrity in the stomach.¬† What else dose it do and how can we use it to its fullest benefit? The answers are in our latest instalment,¬† A Fresh Look: Taurine & Glycine In The CNS.

And you’ll be pleased to know, the transcript experience has certainly got me paying more attention to my enunciation than ever before. So you’ll understand every word!

Maybe my parents really were just being kind when they said, ‘Everyone sent their kids to elocution lessons back then, it wasn’t because we thought you specifically needed help” 🤣😂

Both¬†taurine¬†& glycine have a claim-to-fame as amino acids that effectively calm an over-revving brain, via their net inhibitory actions within the CNS.¬† They achieve this via different means and while in some circumstances, one, either or both will is the result of differences in the regulation of their BBB transfer, pharmacokinetics, as well as add-on benefits or detractors, unique to each.¬† Learn how to use both of these powerful and affordable mood-modulators, to their fullest, and be more able to know ‚Äėwhich one when‚Äô, by listening to this latest narrative review.

The latest Update in Under 30 has landed!!!

You can purchase Take A Fresh Look: Taurine & Glycine in the CNS here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.

There’s enormous potency in nutritional medicine for mental health but it ain’t in the form of a ‘dash of precursor here and a sprinkle of co-factor there’, like some may have you believe.¬† Many nutritional prescriptions can look good on paper but that’s the extent of it, take the suggested use of glutamine for GABA production, for example.¬† Sure it can be said to be a precursor (so is glucose!) – so will higher intake of this equate to higher production of this neurotransmitter? Ah, no. The reasons relate to distribution and hierarchy of use for this amino acid, as well as determinants of glutamatergic neuron activity.

Why would we limit our prescriptions to precursors, anyway, when we have 2 amino acids at our disposal, whose oral supplementation is known to translate to higher CNS levels and their actions and efficacy as major inhibitors of neuronal firing (akin to GABA), involves no modification nor maybes?!

Hello, Taurine & Glycine, where have you been all this time?

While, many of us may have been using taurine in combination formulas for mood, chances are you’re not entirely clear why sometimes those work and sometimes they don’t.¬† The answer may be in the regulation of CNS taurine transfer & balance- sometimes the people who need it most, have the least capacity for its uptake across the BBB.¬† This is well-established in neurobiology, but news to many nutritional and integrative health professionals, who have been using it in patients where Glycine, in fact, makes more sense. So while taurine has myriad impressive strings to its bow in relation to mood-modulation and powerful protection of brain structure & function, Glycine, has an extensive network of receptors throughout the brain and spinal chord, enabling it to exert inhibitory effects, second only to GABA itself. And, most importantly, BBB transfer of this amino is not subject to the same impediments that we see with taurine.¬† These are two of my most frequent and favourite mood-modulators, affordable and accessible when used as single ingredients, for patients, with anxiety, addiction & sleep disorders etc but understanding how they work (and when they won’t) is essential in choosing which one to use, when.¬†

For example, do you know the Tmax for either of these oral supplements?¬† How long it takes, to create a spike in patients’ plasma, better still their CSF, and therefore speed of onset of action?¬† What about their elimination half-lives to guide your understanding their duration of action and therefore the timing of follow-up doses?

When we’re trying to realise the full potency of our medicines – these are important details to know that convert our ‘prescription potential’ into something powerful.¬†Just like die-hard herbalists will tell you, its an art and a science and this is true in nutritional medicine as well.¬† Don’t skimp on the science!🤓

 

Both¬†taurine¬†& glycine have a claim-to-fame as amino acids that effectively calm an over-revving brain, via their net inhibitory actions within the CNS.¬† They achieve this via different means and while in some circumstances, one, either or both will is the result of differences in the regulation of their BBB transfer, pharmacokinetics, as well as add-on benefits or detractors, unique to each.¬† Learn how to use both of these powerful and affordable mood-modulators, to their fullest, and be more able to know ‘which one when’, by listening to this latest narrative review.

The latest Update in Under 30 has landed!!!

You can purchase Take A Fresh Look: Taurine & Glycine in the CNS here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

Don’t know this thrash anthem for all nutritional medicine practitioners written by Supernova about 20 years ago?¬† Do yourself a favour and check it out!! It makes me laugh to the point of tears every time.¬† What also got me giggling recently was a coffee catch-up with a fellow nat (relax, it was decaf people!) Both being active women approaching the half century we found common ground discussing our ‘war wounds’. She, an ankle injury, me, lax ligaments in my knee thanks to touch football minus any pre-season prep whatsoever. I was waxing lyrical about the wonders of swimming, which I’ve taken up to heal said gammy knee, at which point she asked, “What are you taking for it?”¬†

My mouth dropped open & nothing came out…because the answer was *!NOTHING!*😂
At which point, she mentions a couple of supplements I have *!ON MY SHELF!* that really helped her ankle 😂😂

I text her 3 days later with, “Man, our medicines really work!!”¬† You see, like the song says,¬† I do ‘take my vitamins’ and ‘they’re good for you! Good for you!’ – just this physician health yourself thing can be a blinking full time occupation sometimes! Anyway, it got me thinking about how we choose the products we do.¬† So turmeric caps are part of my new regime and they seem to be working a treat. I stock one brand only.¬† Now how did I come to that decision amongst an ocean of options?!¬† Well in this instance, I had asked a colleague who works OTC and dispenses a variety of turmeric products en masse – better still she sees those people come back either for more…or not.¬† I’ve found asking my well-placed peers about these kind of products invaluable!! But there are so many different ways each and everyone of us may have made product choices – ethical concerns, personal experience, research, a teacher, mentor or rep’s influence.¬† Anyone who has done the UTAS post-grad, of course, has exhaustively analysed the options, complete with comprehensive spreadsheets of all comparative products…god love these guys!! But for the rest of us mere mortals, how do we make such choices?

Let’s just talk turmeric for now, I’d love to know…

My gorgeous sister first brought this ditty to my attention & we’ve had a wonderful trip down memory lane today (with our elderly mother as our hostage as we both belt out the lyrics in laughter down the speaker phone)…she’d be cross if she didn’t get the credit here, rightly so 🤣

I’m gonna take my vitamins!
(Vitamins! Vitamins!)
You better take your vitamins!
(They’re good for you! They’re good for you!)

You better take your vitamins,
Two by two!
Two by two!

I’ve seen two 20-year-old young men in my practice this last month who’ve already made a lasting impression on me. The first, is buff, full of cheek and humour while deeply engaged with his health, earnest in his desire to understand his 7 years of daily upper gastric pain, for which he has read much, changed his diet & given up what most 20 year olds would consider their rite of passage and right (late nights and alcohol).¬† The second is pale, gaunt, neuro-atypical, full of tics and avoiding eye contact at the beginning of each consult, only to look me solidly in the eyes as he reveals incredible insight about ‘being different’ & his desire to be able to engage with something/anything so that he can live a more normal life, by the end. What do they have in common?

They’re 20 & trying to make their way in the world.¬†¬†
Undertaking all these newly autonomous actions, previously taken care of by parents, including fronting up to a health professional with concerns, seeking understanding and support.

The first, in spite of 7 years of gastric pain and irritation (I can see mum took him to a GP with similar concerns at 13 years & again at 15!!), self-reported extreme worsening with gluten exposure and a family history of similar GIT issues, was not offered a single investigation by the GP they visited but was given a month long trial of a PPI.¬† I caught him 3 days in.¬† Was he feeling less pain? Yes?¬† What does this mean? He has gastritis at best, something more sinister at worst? Does it reveal the cause? Not one iota. But tests for H.pylori, coeliac disease and a few other basic labs, might.¬† Does it offer a long-term solution?¬† Nope – even the GP said , ‘Now this will probably help but you won’t be able to stay on this too long!” While up to 80% reductions in gastric acid, will definitely lessen gastric irritation and pain for most, will a month ‘fix’ anything?¬† Unlikely. Especially when the well-documented withdrawal rebound effect kicks in, once he stops!¬†¬†After a month of actual stomach repair work, he’s feeling dramatically better and yes, we’re still pushing for those test results.

The second 20yo, was seeking a mental health care plan from a GP he’d never seen before.¬† He walked out after 15minutes instead with an SSRI.

With a diagnosis of Asperger’s at 12, ADD at 13 and a series of high level neurocognitive assessments and stimulant trials – how could anyone make an informed decision about appropriate medication for this neurobiologically complex individual in 15mins, while simultaneously ignoring his request for hands-on psychological support?¬† I was a bit stunned. He was too. How long, and how much effort and courage, will it take for him to make another appointment, get himself back to a medical clinic and ask again? He struggles to remember to eat.¬† I’m glad he came. I can’t offer all of the services and support he needs, far from it, but I can listen long enough to ‘see him’, acknowledge that his personal priorities and values are valid and in turn, direct mine in terms of how best to support him.¬† I can also try to encourage him not to give up on getting the support from others he desires and desperately needs. This is not gender specific of course – I’ve heard similar stories from young women.¬† I remember being 20 – perhaps all health professionals need to take a moment to remember what that was like too? 🤔🤗

 

That’s not a word you hear often spoken by people practising nutritional medicine. Which is odd. I mean outside of the whole, ‘I’m not good with sulphites so I just have to add these magic drops into my glass of red so I can knock back my share,” often overheard at our conferences… it’s like this essential macromineral, pivotal to human health for things like barrier function, antioxidant defence and our basic ability to create the white cells for immune defence (for that matter), detoxification, musculoskeletal tissue integrity etc has just not received its due attention from us. Not entirely surprising given 1) there’s no RDI and 2) there’s no lab test to assess an individual’s status and how about 3) because we were never taught about it!¬†

But the biggest ‘call to action’ here is that, in spite of items 1, 2 & 3, we’re ‘prescribing’ Sulphur Strategies all the time!

Take one of my favourite examples;¬†GAGs.¬†Glycosaminoglycans like Glucosamine sulphate (not the crappy, found to be not as effective, other forms that we now see more commonly) hit the headlines back in the noughties as an effective arthritis remedy. This is one of the 100s of our body’s ‘end products’ of its endogenous Sulphur Stream.¬† We naturally make this in adequate amounts to ensure the integrity of our joints (and many other tissues of course!) when we have enough Sulphur in the ‘top pool’ (organic Sulphur) to trickle down to the 2nd pool (Inorganic Sulphur), therefore creating a constant essential supply of something known as ‘the universal Sulphur donor’ – ‘PAPs’, to its friends ūüėČ Like a waterfall, it helps to have a good flow from the top to increase the likelihood we’ll have anything to ‘show’ at the bottom.¬†

So when we give a patient Glucosamine Sulphate it may well help. Or not. But did we ‘treat the cause’ of their Sulphur problem? Should we have treated higher up, increasing the size of either the organic or inorganic pool to have improved and widened the benefits for their health? Or, as is equally common, actually identified why someone might need more Sulphur than most – due to increased demand and losses?

Herein lies my reason for liking this particular Sulphur story so much. The common medication that places the highest ‘demand’ on Sulphur (due to its need for detoxification) is paracetamol. There’s no debate regarding this – just absolute scientific consensus. NSAIDs and steroids also negatively affect the Sulphur status of individuals, as does Vitamin D deficiency and chronic mild metabolic acidosis. Now how commonly are these phenomena co-occurring in our patients afflicted with arthritis?¬† And traditionally of course, what was the remedy for arthritis? Sulphur springs.

Unseen Sulphur РTime To Take A  Look
If you don‚Äôt have a clear picture of the gross daily requirements, determinants of altered individual needs, sources, regulation & associated deficiency picture of Sulphur, you‚Äôre not alone.¬† Turns out this essential macromineral remains ‚Äėunseen‚Äô by most, even though you‚Äôre probably writing prescriptions every day that have Sulphur as their key component.¬† From the simple: Taurine, N-acetyl cysteine, Protein powders, to the sublime: Brassica extracts & concentrates, N-acetyl Glucosamine, Alpha Lipoic acid etc. In order to use these Sulphur strategies successfully and safely, however, we need to fill in the missing detail on its metabolism, the difference between the ‚Äėorganic‚Äô and ‚Äėinorganic pools‚Äô, how regulation regularly goes wrong even in those seemingly consuming enough and how to balance the risks of this reactive medicine with its substantial therapeutic value.¬† This recording comes with a great clinical tool to help you, at last, see the Sulphur strategy most indicated for your patient.

 

You can purchase Unseen Sulphur РTime to Take a Look here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

I say: Biotin, Broccoli Sprouts & Bone Broth
You say….?

If you said: ‘Sulphur’, go directly to the top of the class, passing ‘Go’ & collecting $200 on your way!🤓¬† If you nervously said…”I don’t know, they all start with ‘B’ ?”, you are not alone.¬† In fact, most integrative health professionals aren’t aware of the Sulphur Strategies they’re using, probably, everyday.¬† But it’s time we all were.

How about this list?
Glycosaminoglycans (GAGs for joint, gut etc tissue integrity),  Cerebroside Sulphate (Myelin),
Metallothionein, Glutathione, Hydrogen Sulphide (H2S), Co-Enzyme A, Lipoic acid, SAMe, are just some things Sulphur is essential for.

I could go on…and on and on.¬† You see Sulphur, in spite of being an essential macromineral (adult dietary requirements > 1g per day) and critical to health, remains largely unseen.¬† Often we don’t know when we’re writing patient prescriptions that actually we’re using a particular vehicle for Sulphur and therefore we’re also not able to discern which, of the very long list of options (dietary and supplements), makes the most sense in this patient at this time. We’re not to blame, not many ‘possess the power’ to see it, it seems. Por old essential, irreplaceable Sulphur doesn’t even have an RDI. But the time has come to take a good look.¬† We need to know how patients are able to meet their needs, who needs more and how, very commonly, someone who is seemingly ‘consuming enough’ may still exhibit a functional Sulphur deficiency with poor musculoskeletal tissue integrity, low white cell replication capacity or higher oxidative stress load etc and in those who do have a shortfall, how to treat successfully & safely.¬† Who needs a top down approach (more protein, methionine, cysteine, bone broth) and in whom would that be a risky path and using ‘downstream’ Sulphur products instead would be a better balance of pros and cons?

Because all Sulphur needs to be handled with care.

That’s right.¬† Like other highly chemically reactive minerals, with reactivity comes risk – a great potency that requires careful consideration of both form and dose, so that we can harness this power for good not…well evil’s a bit strong…but how about, for not-good.¬† I’m a bit of fan of Sulphur and using Sulphur strategies in my patients. I think it has interesting echoes with our past: the ‘healing’ waters of a Sulphur Spring and of course even further back the old ‘brimstone and treacle’ medicine of eons ago.¬† This paper by Nimni in 2007: Are we getting enough sulfur in our diet? got me thinking about Sulphur again in a contemporary context, over a decade ago, I’ve done a lot more thinking, researching and prescribing since then but it seems that Sulphur still remains ‘unseen’ by most. But with the rise and rise and rise of popular Sulphur-based supplements (alpha lipoic acid, GSH, N-acetyl glucosamine, Brassica & Allium extracts and concentrates, N-acetyl-cysteine etc) I think it’s time to talk.

Unseen Sulphur – Time to take a look

If you don’t have a clear picture of the gross daily requirements, determinants of altered individual needs, sources, regulation & associated deficiency picture of Sulphur, you’re not alone.¬† Turns out this essential macromineral remains ‘unseen’ by most, even though you’re probably writing prescriptions everyday that have Sulphur as their key component.¬† From the simple: Taurine, N-acetyl cysteine, Protein powders, to the sublime: Brassica extracts & concentrates, N-acetyl Glucosamine, Alpha Lipoic acid etc. In order to use these Sulphur strategies successfully and safely, however, we need to fill in the missing detail on its metabolism, the difference between the ‘organic’ and ‘inorganic pools’, how regulation regularly goes wrong, even in those seemingly consuming enough, and how to balance the risks of this reactive medicine with its substantial therapeutic value.¬† This recording comes with a great clinical tool to help you at last see the Sulphur strategy most indicated for your patient.

 

The latest Update in Under 30 has landed!!!

You can purchase Unseen Sulphur РTime to Take a Look here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

The first time I saw a set of lab results was when a patient brought them in to her appointment.¬† True.¬† In spite of the comprehensive training I’d received in nutrition and biochemistry and pathophysiology my undergraduate did not include one single lesson on lab interpretation & now here I was faced with some badly formatted inkjet printed document full of numbers I was supposed to make sense of.¬† Was the patient right to expect me to be lab literate?

We profess to be proficient in identifying and correcting nutritional deficiencies, as much as, cardiovascular risk, chronic inflammation, methylation imbalance etc etc so surely these ‘numbers’¬† are essential to informing our baseline understanding of & decision making regarding the management of our patients, as well as tools for monitoring their progress & safety.

Let alone the knowledge we need to work collaboratively with other health care professionals and show ourselves to be the asset that we are. 

And herein lies the golden opportunity, I believe.  Most of us do possess excellent foundational knowledge in nutritional biochemistry etc, much more so than other health professionals, who are ordering and seeing these results routinely, they will often tell you this themselves. And while more recent naturopathic, nutritional & herbal medicine graduates have had some basic orientation and education in pathology, are we really making the most of this powerful marriage of knowledge areas? What would we see, if we made it our business to view the same labs? So much more.

We can see warning signs well before the diagnosis, we can see the process behind the emerging or established pathology rather than simply a disease label, and accordingly, the individualisation of our patients’ presentations and their prescriptions.¬†

But first we need to learn our labs.

That very first patient who turned up with results in her hot little hand started me on this path to lab literacy. Later, I was lucky enough to find a kindred spirit¬† & mentor during my time at SCU, with Dr. Tini Gruner and then Dr. Michael Hayter, whom I co-presented my first diagnostics course with many years ago, and every day my patients and my mentees’ deepen my understanding.¬† This path to lab literacy goes on forever I suspect, but with every new corner I turn, I am reminded of and rewarded by all that it has gifted me and my patients.¬†

I’d like to share that gift with you through stories filled with new favourite characters, like ‘Mr More More More Monocyte’ above, engaging animations, loads of real cases, heaps of humour and plenty of practice in pattern-recognition, that make remembering, what can be very detailed content, doable.

In other words: The MasterCourse in Comprehensive Diagnostics I is finally here as a self-paced learning program you can undertake yourself.¬† We know you’ll get as much out of it as those who attended live:

 

“I thought my pathology skills were pretty up there until I did Rachel‚Äôs Diagnostic MasterCourse! Nothing like being knocked off my perch by a literal avalanche of new information, especially when it comes from the most commonly tests that we all use so often.¬†The course has been a fantastic learning opportunity for me, and has since helped me pick out many intricacies in cases that have previously been missed.”
– Rohan Smith | Clinical Nutritionist

 

MasterCourse 1: Comprehensive Diagnostics is a self-paced online program
Gives you access to 24+ hours of streamed video presentations, 2 x Bonus Update in Under 30 episodes (The Calcium Conspiracy & Using Urea to Creatinine Values for Protein Adequacy) PLUS resources, a template and pdfs of all presentations. This package includes $200 worth of bonus material and remains forever in your online account. You will also receive access to any future updates of resources and our template. More information can be found here.

This is a pre-requisite for MasterCourse II that will be delivered live in 2021.

 

 

Cone Of Silence GIFs - Find & Share on GIPHY

We have been madly working towards our anticipated December 2020 release. We’ve been in our own little cone of silence, busy editing over 20 hours of videos, putting together resources and extra bonus audios.

We’re really excited because we’re in the process of building, for the first time, quite an amazing comprehensive training package in diagnostics, that we know will not just serve, but surpass, integrative practitioners of all persuasions’, educational needs in this area.¬† We wanted to let you know flooding, storms and resultant internet failure will not deter us from getting it done, but these forces of nature have slowed us down a little 🙄

So we now have a new release date of January 2021.

We’ve set the bar high and want this to be as fabulous as possible and ensure that the content translates cohesively from what were very dynamic live interactive sessions to an excellent ‘off the shelf” DIY learning experience so…. take the rest of the year off people!” Step away from the computer and enjoy time with your family during the festive season. You deserve it.

We wanted to thank you for your patience and know it will be worth the wait…

“Absolutely loved this course, I’ve listened to each of the recordings at least 3 times now taking furious notes and am still picking up new gems. Love that it’s helping me build up my knowledge and confidence in such a fundamental area of practice. The case studies are super valuable as they bring the labs to life, I’d be keen for more of these!¬† Really appreciate all the extra PDFs / audios that have been added also. Eagerly awaiting MasterCourse II” – Naturopath | Australia

‚ÄúWhy wasn‚Äôt this content covered in medical school? As a psychiatrist,¬† I have greatly benefited from attending this course which comprehensively covers the ins and outs of interpretation of pathology labs and how this applies to clinical cases ‚Äď many of which have both physical and mental health considerations.¬† I believe all doctors from general practitioners to specialists will gain from attending! ” – Psychiatrist | Australia

“Thank you so much for this course, it has been brilliant. It has ‚Äėfuelled my practice‚Äô and many people have benefited already ‚Äď from such insights. It‚Äôs quite thrilling!!!¬†I‚Äôll definitely be signing up for the second course later next year” – Naturopath, Medical Herbalist | New Zealand

 

 

MasterCourse 1: Comprehensive Diagnostics is a self-paced online program due for release in January 2021.
The course has over 20+ hours of video presentations plus 2 free bonus sessions 1) Accurate Pathology Interpretation Starts Here and 2) Patient Pathology Manager and access to resources and tools within, for your own use.
This is a pre-requisite for MasterCourse II that will be delivered live in 2021.

This skillset has been found by many to be biggest ‚Äėgame-changer‚Äô in Integrative Health
You can view the full course outline here.

Key texts tell us, 2nd trimester Serum Ferritin may be between: 2……………………………………………………………………………………….and……………………………………………………………………………………….230 mcg/L
But a 2nd trimester Ferritin even > 40 mcg/L is remarkable – and not in a good way🙄
So, ummmm what should it be and why?

Given all the attention iron gets from me alone, you would think we would be a lot clearer and a little ‘clueier’ regarding the answers to core questions like this. But we’re not. Correction, they’re not.¬† Who is this ‘they’ of which I speak, um well, just the dudes in the top level office who write the practice guidelines for GPs, Obs, Midwives etc.¬† Big call I know, but answer these to get my drift:

What is the average Serum Ferritin in healthy women with healthy pregnancies in the 2nd trimester?
After all the routine Iron treatment given across numerous countries, in line with the WHO recommendations, is there any evidence that values higher than this have irrefutable benefits for mother or baby?
Is there evidence to the contrary, that it can be harmful? 

And while we’re busy asking questions that shake the flimsy foundations of the practice guidelines regarding monitoring and managing iron levels in mid-pregnancy – how about we get up to speed with the evidence that shows 1st trimester Serum Ferritin is in fact the most meaningful as an iron marker both in the short and long-run for any woman’s pregnancy. I know, right…this is all sounding very different from the, inappropriately named, ‘normal’, which is to test women at wk28, in the midst of peak haemodilution, and therefore physiological anaemia, and to then send that patient home often with a new diagnosis of iron deficiency and a sense of urgency to ‘fix this fast for you and baby’.¬† In some instances this is appropriate and important, especially women who weren’t comprehensively cared for & whose iron status wasn’t monitored & well-managed in the first trimester. But for so many women, who are just riding the Ferritin-Fun-Bus…they are right on track with looking their very worst!

Couldn’t resist finishing this year of Update and Under 30s with a serious BANG! 🧨🧨🧨

 

Pregnancy Iron Balance – Part 2 Aiming For ‘Normal’

In this continuation of our discussion about better iron balance for mum and baby we now map what is happening in each trimester with regard to requirements and regulation, and accordingly, what ‘healthy looks like’ in terms of both serum ferritin and transferrin, at every time point.¬† This also gives us a clear¬†practice protocol around when and how exactly to treat iron deficiency in pregnant women.¬† Additionally, we review the risks of both under and over-treatment.

The latest Update in Under 30 has landed!!!

You can purchase Pregnancy Iron Balance Part 2 here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

I love a little temporal lobe tap. Especially the kind patients provide.¬† This week mine came from a mentee’s patient who, while presenting with concerns about possible perimenopause, was found to have radical shifts in her thyroid hormones, largely thanks to a dramatic increase in TPO Abs (>1000).¬† The patient’s other presenting complaint was ongoing gastritis (confirmed via scope) and reflux…and that’s when I started to deep-dive into the archaeological archives of my brain…with the…’didn’t I have somewhere in here, in some dark dusty deep recess…a connection between the two?!’

Aha!  With the help of a torch [read Google Scholar] the temporal tap bore fruit.
1 in 4 patients with AITD (Hashimoto’s or Graves, you choose!) test positive to Parietal Cell Antibodies

I’ve created (clearly, not-so)SmartArt graphics on powerpoint slides on this exact topic, waxed lyrical about it in my thyroid training packages…but in fact needed a temporal tap to be reminded!¬† And in turn thought, well gosh if this has slipped from my mind, it might just have slipped from yours too! ‘Thyrogastric autoimmunity’ as it’s called, refers to a patient group that exhibit antibodies to both and remember, the antibodies precede the condition in both disorders, so you can have a patient with established AITD, who has zero gastric symptoms but tests positive for the antibody…an important heads-up, as it speaks to significant risk of the subsequent development of gastritis in the following years.¬† This excellent prospective study of AITD patients by Tozzoli and colleagues mapped exactly that!¬†Jump forward just another day or so and…

I’m preparing for our final FiNAl FINAL Q & A on Haematology for our MasterCourse in Comprehensive Diagnostics and I’m wrestling with all the conflicting ‘facts’ about the anaemia that may present alongside hypothyroidism – it has been documented and described as being macrocytic, normocytic and even microcytic… how can it possibly be so diverse I wonder and then 💡
I’m guessing the presence or absence of these parietal cell Abs likely has something to do with it!!

Anyway, it’s getting towards the end of a VeRy loooooooooooooooooooooooooooooong year…thought we could all do with a temporal tap ūüėČ

 

MasterCourse 1: Comprehensive Diagnostics is a self-paced online program due for release in December.
The course has over 18 hours of video presentations plus 2 free bonus sessions 1) Accurate Pathology Interpretation Starts Here and 2) Patient Pathology Manager and access to resources and tools within, for your own use.
This is a pre-requisite for MasterCourse II that will be delivered live in 2021.

This skillset has been found by many to be biggest ‚Äėgame-changer‚Äô in Integrative Health
You can view the full course outline here.

A few things really took up a disproportionate amount of our time & attention in 2020: Zoom, Mask Fashion & Gin based hand sanitiser.¬†On a personal note I need to confess another: Iron. So while my one true (mineral) love remains zinc, iron answer hunting has infiltrated a lot of my days and some nights! There’s no hiding it…3 out of my 12 UU30 episodes this year have iron in the title 🙄 a sure sign its been on my and my mentees’ minds and sitting across the desk from a lot of health professionals in human form. And this affair I’ve been having, like most, started innocently… it started with a just a ‘quickie’, you know a quick question from a well meaning practitioner: “So, what’s expected in terms of ferritin levels across pregnancy?”

There are 2 answers to this.
The first reflects the practice guidelines for GPs and obstetricians in most western countries: > 30 mcg/L regardless of trimester
And then there’s another that is [ahem] evidence based, accounts for the essentiality of physiological anaemia in pregnancy &,¬†naturally, trimester specific

There’s a big Fe-ar factor at play when it comes to answering the question, ‘Does this woman have enough iron for her and bub?’ Public health and practice guidelines appear to assume we are ‘guilty’ until proven innocent, patients are worried and health professionals are plagued with their own doubts about whether they’re ‘reading this right?!’¬† I’m sure we’ve all been in the situation where we feel our pregnant patient is doing well iron wise early in pregnancy, only for them to have that routine antenatal 28wk GP/Ob visit and discover a total panic has descended upon the patient and the rest of the health care team, with calls for ‘IV Iron STAT!’ But 28wks is the height of haemodilution right?¬† You know, that time when ferritin, Hb and Hct should look at their lowest, right?¬†¬† There certainly is a limit to how low we want any pregnant woman to go – for her and her baby’s health but that limit is not the one routinely used and the truly evidenced based one is going to shock you. So what? What’s the issues if we are a little Fe-ar based about Fe, resulting in hypervigilance (calling a deficiency when there isn’t actually one) and giving them a ‘boost’ of more iron, surely this is good news ultimately for baby’s iron levels and for lactation and for…sorry what? No?

There’s a U shaped Curve for Iron supplementation & serum Ferritin levels in pregnant women?!!

Say it isn’t so!!¬† But I can’t.🤐

Pregnancy Iron Balance – Sorting the ‘Normal’ from the ‘Noise’

It starts with a simple enough question: What should women’s ferritin levels be in pregnancy? But the answer will surprise many. There are in fact two. The first¬†reflects the practice guidelines for GPs and obstetricians in most western countries regardless of trimester and then there’s another that is arguably more evidence based, accounts for the essentiality of physiological anaemia in pregnancy & is also, sensibly, trimester specific. To challenge the ‘noise’ and have the confidence that ‘normal’ is ‘enough’,¬† we need to better understand the mother’s protective physiological adaptation of iron regulation and the intricate systems the foetus has to ensure its needs are met.¬† This of course is not without limit, so we need to also be clear about the maternal serum ferritin threshold for negative impact on the foetus and newborn. Getting the balance or iron right in pregnancy for both mother and baby, is perhaps easier than we have been led to believe.¬†

 

The latest Update in Under 30 has landed!!!

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