Forever fascinated by the neurobiology of various mental health presentations, addiction included, two medical news items caught my attention this week.  If you’ve ever heard me speak on addiction, in somewhat simplistic terms, it is very much about the reward centre of the brain and how strongly all recreational drugs hit on this.  Think rats tapping levers with their feet to continually self-administer cocaine…to the exclusion of all else….kind of magnitude of reward hits.  You may have also heard me quote or misquote (!) someone famous who once said something to the effect of….and I am totally paraphrasing poorly here: if we can’t seek pleasure legitimately, we will seek it illegitimately. 

So this story from ABC news about a Newcastle addiction group support program showing some early signs of greater retention and engagement and therefore potential success with addicts…because they incorporate prizes…well that makes so much sense!

The article is important to read in its entirety as it creates the context – especially for many people suffering from addiction who tell tragic stories of lives where the only rewards/prizes and even gifts they’ve ever known, being drug-related – even from a young age.  So to normalise reward to some extent, and give individuals an experience of constructive legitimate versions of this, is actually desperately needed and ground-breaking. 

How can we incorporate some element of this in our interactions with these patients?

The second ABC news item touts ‘a new generation drug that restores balance to the brain’ but is actually just a teaser about…wait for it…cue stage right…a not so old favourite…N-acetyl cysteine!  Although this is effectively a recruitment drive for methamphetamine addicted individuals into a new 12 week trial of NAC, run by the National Drug Research Institute, taking place in Melbourne, Geelong and Wollongong, it gives NAC a great wrap and rationale for being a good adjunct in addiction, of course. Just a reminder folks that naturopaths belong on that multi-modality health care team for people struggling with addiction, and we do have some potent therapies to contribute. 

A couple of years back I was asked to deliver an educational session to a group of hospital based mental health specialists on the merits of NAC.  My favourite question/comment at the end of my detailed presentation from a very experienced psychiatrist was, “Well if N-acetyl cysteine is so good for mental health…why haven’t I heard about it before now?!”

I hope they follow the ABC news 🙂

Want to Get Up Close to N-acetyl Cysteine in Mental Health? Previous ideas regarding the pathophysiology of mental illness have been profoundly challenged in recent times, particularly in light of the limited success of the pharmaceuticals that ‘should have worked better’ had our hypotheses been correct. Novel drivers such as oxidative stress, inflammation and mitochondrial dysfunction are on everyone’s lips and N-acetyl cysteine is in prime position in this new landscape, to be a novel and effective therapy for mental illness. This presentation brings you up to date with the current NAC research in a large number of mental health conditions & translates this into the clinical context.

 

In the not too distant past, were you wearing your Sunday-best when you were ceremoniously handed a special piece of paper to say, ‘You’re officially qualified to see patients!’ And did you, or have you since then thought…’Wow! Really?!’ Does the certificate come with my favourite clinic supervisors to boot??’ So where to from here? You’ve got all this incredible knowledge, ideas and motivation bubbling around and having that first, or maybe the tenth, client sit in front of you, it can suddenly seem like you need a bunch of completely new skills or that the gems, which you know are gems, are harder to apply in practice because patients come in such challenging packages. So many things going on in each individual, such incredibly complexity, the antithesis of a ‘one size fits all’ model – does it feel a bit like you are  performing trapeze without a net? 

Taking the leap into practice can be a Grand Canyon-esque  one for most.

Developing practical systems that support you in the real world as opposed to help you pass exams – is a whole different objective.

Patients not paper cases. Time now = Money

But why should we all be out there doing this in isolation? 

Trying to figure out where to start, where the best information and resources are, what are some tools that are going to rock your practice that have already been created and are available for your use this should be a five year path of rocky self-discovery. Ok there are still going to be some rocks but perhaps going completely barefoot is not the best idea! 😉

The New Graduate Group Mentoring Program will give you an advantage, help you to grow as a professional and take the edge off being a newbie! This way you are able to set yourself and your clients up to succeed! Oh, we can her you exhale just a little already, knowing that you could have people supporting you through this transition, who understand exactly where you’re at! You’ll be creating your own collegiate group by having what feels like your own pit crew, cheer squad, research team, your sounding board, and yes some serious clinic supervision in your corner, as well as access to an extensive library of knowledge, resources and experience. (OMG! Wishing I had this when I stepped out into the big wide world those 20 years ago)

This group is designed specifically for the new (or newish) practitioner, with a combination of tutorials and active participation. You’ll be able to bring your own clinic cases, patient pathology results, referral letters etc into these interactive sessions and take home assignments to work on.  “Oh Yay,’ we hear you say…I was so going to miss the homework! You will also be learning how to:

  • Develop Mind Maps – the best ones will write the prescription for you
  • Develop patient timelines that help establish causality
  • Get yourself started with reading basic Pathology results.
  • Write a referral letter for doctors and other health practitioners
  • Know what patient screening tools and questionnaires to use.
  • Learn supplement sleuthing to easily compare your treatment options.
  • Get friendly with patient driven research using real world tips and being shown the best online resources.

Plus it contributes to your CPE points while building a support system around you.

YOU’VE GOT THIS!
This is an investment in you – building your reputation, skills and your clientele.
Oh and this is just not all talk here….just listen to some of our current mentees – check out Georgie’s video who went from “nervous newbie to confident and capable practitioner in 1 year” or listen to Tess’s video testimonial “I always come away from those sessions with so much more knowledge. Always apply straight away to clinic”.

INTERESTED?
Drop us an email at admin@rachelarthur.com.au to get yourself on the list for this specific group offering in 2019.  Applications open 15th October and close mid-November.
Find out what all the goodies you get with the New Graduate Group Mentoring Program here.

So we already know that thyroid problems can start in utero, right…but a recent Medscape review (the fountain of thyroid information that I frequently drinketh from 😉 ) on Hypothyroidism in childhood taught me a couple of big things I hadn’t known before! 

The diagnostic criteria for subclinical hypothyroidism are raised TSH levels in combination with a normal concentration of free serum thyroxine (FT4) but because there are some differences between accepted ranges in TSH assays, high-risk groups should be screened, especially babies with malformations, whose mum received steroid treatment during pregnancy or in the neonatal period, or who had existing thyroid dysfunction, TFTs (or at the least TSH as part of what’s called the Neonatal Screening test) should be repeated 2 weeks later. But now comes the couple of big light-bulb moments: the incidence of eutopic thyroid in twin births is nearly double compared with singletons! As you know, I’m a mother of twins and I’m guessing at 18yrs old now (and multiple peachy TFTs 😉 ) the horse has well and truly bolted for my two but geez…I had no idea of the dramatic increase in risk. And it keeps going…monozygotic twins very commonly show a delayed TSH rise and those numbers are even more prominent in multiple births. The other not-so-fun-fact is the discovery that subclinical hypothyroidism in IVF babies is approx. 10% which is noteworthy considering none were observed in the control group.

This obviously left me thinking “W.H.Y?” And of course…the first place my head goes with the latter…is iodine.

Could this phenomenon in IVF babies be due ultimately to undiagnosed or poorly managed SCH in mum or even simpler still, just basic iodine deficiency, presenting as infertility?!

The reasons behind our increasing rates of thyroid dysfunction across the life-stages are multifactorial (and don’t get me started on the very real contribution of EDCs!) and how, in spite of iodine adequacy being the first thing on the checklist for thyroid health, so many health professionals ignore this, at their patients’ peril… But now at least we know that patients with IVF babies, twins, and preterm bub, who are currently not included in the prioritised screening groups should be…and of course we should keep asking the questions, “what are the mechanisms behind this, why is it so?”

So if this has made you even more curious about the incredible butterflied-shaped gland and you’d like to go for a stroll on the vast plains of “thyroidisms” you can click on this link Thyroid Assessment in Kids and Teenagers and get completely “thyroided” up. There is always more research to come our way so keep your eyes and ears peeled.

 

You may have already heard whispers about some great things happening in our Group Mentoring program next year but it’s ok we can hear your silent screams!! The ones that say, ‘BUT WE LOVE IT  ALREADY!’…or…’But next year was my year to finally find out what everyone else has been talking about!’  Nobody panic.We’re absolutely continuing to offer our regular groups mentoring in its current format AND adding some amazing extras, increased resource sharing, a system for supplement sleuthing, structured follow up on client case presentations and bonus Update in Under 30 discounts to help you drill deeper into particular topics (just to name a few).

But don’t listen to us!  What would we know??!

Just listen to Tess Doig who’s been in our group program for 5 years!!

She’s one straight-talkin’ sister and she reckons group mentoring is the bomb in terms of saving your clients money, developing discernment so that the latest: product, test, other bright sparkling thing, and increasing your skills in solid, sensible, sophisticated naturopathic practice. So getting plugged into 11 other practitioners and Rachel’s brain can give you theknowledge and confidence no matter who walks through the door. Group Mentoring is fast becoming a popular choice (going by all the expressions of interest coming in for 2019) and could be an integrative part of your practice.  As Tess shares in her video below I would pay a million dollars for her brain but instead I just pay for my mentoring which is just as good.” Whether it is her case or other practitioners throughout the year, she always comes away from the sessions with so much more knowledge that she can always apply straight away to her clinic. 

Watch her full testimonial here.

So next year when you sign up, you will continue to receive live monthly sessions on your cases and facilitated by Rachel, with each session an opportunity to take the leap from theory to application in a safe place, supported by similarly skilled practitioners,  while using the incredible Basecamp platform for communication and support between sessions.  We just couldn’t help but add some further touches for 2019:

  • Zoom – we’re looking at moving to Zoom as the platform for delivering the case presentation sessions – simpler, easier to use.   And we can record the video as well as the audio for you to watch later.
  • Structured follow up on client case presentations – New format to follow up on how the client is going after the session – what’s working, and what’s happening now?  Sharing ideas and discussing the outcomes.
  • 30% discount on Update in Under 30 Subscriptions (UU30) when you join the Group Mentoring Program.  Having access to the additional information from UU30 while participating in the Group Mentoring program is a huge bonus.  When certain topics arise in each of your the case presentations, you can then go and listen to the relevant podcast to drill down deeper and build on your knowledge in that area at your own pace and leisure.
  • Serious Supplement Sleuthing – Introducing some very exciting tools to help you better discern between supplement choices for patients
  • Certificate of Mentoring Hours for your CPE points at the completion of the year

 

We’d love to have you join us. Only two weeks until registrations open, so send us an email on admin@rachelarthur.com.au to let us know your interested and be on the list to receive more information on how to apply on 15 October.

REGISTRATIONS OPEN 15 October!

This mentoring community that I am a part of, I absolutely love and together we make good companions on this road that too often we often find ourselves travelling In isolation. So I wanted to put together this little fun video here to get across that mentoring isn’t about a conversation between just two people. It might feel that way when you are in a mentoring session with me but there is so much more connected to this one conversation and this video shows the bigger picture!

Over the years I’ve received amazing feedback on my mentoring services and the perception that my knowledge is really huge!! Yes I am a journal junkie and I do have 20+ years practice under my belt but…I believe a good mentor has their own mentors. Your mentors may change over the time to strengthen different skills sets and it’s knowing where to look for answers, how to always apply critical thinking and developing your own brains trust.

I am privileged to be able to share what I have learnt, so the mentoring I continue to receive, benefits everyone I mentor. Whenever I mentor someone, whether it’s individually or in a group, I am not just relying on what I’ve been taught or what I have managed to come across firsthand, especially when I get a doozie of a question or a condition that I have never personally encountered in practice! Then the sharing circle continues as the practitioners I mentor are more than likely passing on this with other practitioners – strengthening our collective knowledge and our profession.

So if being part of the community excites you and if the thought of learning and benefiting from a collective knowledge base that is strong and pulls on expertise outside of our own, now’s the time to join the conversation through Group Mentoring. 

In 2019, in addition to our tried, trusted and applauded regular group mentoring format, we are introducing some new specialists groups – one for practitioners working extensively in Mental Health and another online program for New Graduates.

Read all about it here or email admin@rachelarthur.com.au to let us know you are interested.

 

A few months back I seriously ‘blew over’. Not on an RBT but on a UBT (Urea Breath Test).  In spite of it being not the kind of test you want to score top marks for, my result was in the high 2000s, when all I needed was around 800 to confirm, and anything over 50 to be suspicious, that Helicobacter pylori had taken up residence in my stomach lining. I tell you, I knew it when I blew it! 😉  After ingesting the radioactive urea and waiting to blow up my sampling balloon, I felt like I could still fill a room full of balloons with all the gas being produced in my stomach and those balloons, I imagined, would all rise to the ceiling as if full of helium! Yep…I burped all the way home, which was representative of what I’d been experiencing daily for a month beforehand and what lead me to get the test done.

But initially, it wasn’t so clear. 

The very first symptom I experienced was a sudden onset of severe tightness around my throat that lasted for minutes but started to happen multiple times in a day.  Yep..no one panic.  Together with a strange sensation of ‘extreme emptiness’ in my stomach on waking or delayed meals, and then mild nausea both with an empty and full stomach…only some days or weeks later the fabulously-unprecedented-&-socially-adorable-burping started, proper.

So a month or so later, I’ve solved my own mystery.  Happy? Not in the least…where the heck have I picked up H.pylori from? Yes…that’s what I said because it had to come from somewhere people…right?   I think there is much we have misunderstood about this bacteria with an incredibly long and interesting human history.  Animals don’t and can’t carry this bacteria.  The evidence suggests that it can’t survive for very long in the environment either (approx 4 days) but that is long enough to get into our food and water and maybe even onto shared chopsticks…just saying (listen in to hear the lowdown on all these and more!) Essentially hoomans are the traffickers, people!  In fact one of the things that surprises people the most is the very high prevalence in young children and the clusters of positive tests & identical strains within families…but once you learn a little more about this bacteria…it won’t surprise you at all. (more…)

 

We are looking at establishing a Mental Health Focus Group to support practitioners in mastering the maze of mental health. This is such a growing health issue, with a recent survey of Australian doctors identifying psychological issues as the number one presenting complaint in general practice and one in five (20%) Australians aged 16-85 experiencing a mental illness in any year. It is likely all health practitioners are witnessing a similar shift…but not everyone chooses to work in this complex area of health.  Some practitioners might refer these clients, or only deal with this when it’s not the primary issue, and this is understandable, often appropriate and ok. For those integrative health professionals, however, working predominantly with mental health presentations, our need for specialist knowledge, skills, supervision and support jumps exponentially. How could we support one another’s practice and therefore the patients, in this capacity?

Over the last 16 years I’ve had a special interest in Mental Health and have seen a lot of patients who present with this as their primary issue. We have so much to offer mental health in our dispensary that we can use, however, there are inherent complexities and challenges – none more so than really being able to identify the ‘red flags’ and knowing when you are not the ‘right tool for the job’

If it sounds like I am talking your talk and speaking directly to you, then I am. And this is your opportunity to let me know you’re interested so that we can continue to work towards establishing such a group. We are looking for practitioners who already have significant knowledge in this area and are looking to take their mental health skills and experience to a new level. This group will help you get building on what you already know and help you gain more confidence when working with clients who present with myriad mental health issues. Ideally we are hoping to attract practitioners from mixed disciplines: naturopathy, nutrition, IM GPs, psychologists, psychiatrists so that we can draw from our collective knowledge base and experience while familiarising ourselves with a ‘team approach’, so essential to mental health management.  Can you see yourself in this collective?

“I really love the cases and listening and seeing how you interpret complicated presentations and methodically break them down in a way that digs down to the core/genesis of the issues. It helps me to provide more laser focus to my own complicated cases with your guidance. Love the mind maps! Thank you for all your energy, incredible knowledge and enthusiasm in skilfully educating me  in a way that makes difficult cases easier to understand!” – Deborah Miller

There are so many great things about being part of a formal peer group focusing on Mental Health including:

  • Monthly hour- long meet-ups online via Zoom with a group of like-minded practitioners with a special interest in mental health
  • Opportunities to present your own case – and receive guidance on all aspects: from diagnosis to management
  • Structured follow up on client case presentations – in 2019 we’re introducing a new format to follow up on how the client is going after the session – what’s working, and what’s happening now?  Sharing ideas and discussing the outcomes.
  • Sharing of multiple resources via our online locked learning platform
  • This will be a self-selecting group, so once you’ve applied to being part of this group for 2019, you will be committed for the full 12 months.
  • Serious Supplement Sleuthing – Introducing some very exciting tools to help you better discern between supplement choices for patients
  • Certificate of Mentoring Hours for your CPE points at the completion of the year

For more information on Group Mentoring and how to apply click here.
Express your interest now by sending us an email on admin@rachelarthur.com.au!

APPLICATIONS OPEN 15 October!

No, not this.

But in setting up a dedicated new grad group mentoring platform for 2019, designed to help anyone who wants support transitioning from student to Naturopathic SuperPower (!)…here are some more details

  • Monthly live, interactive, online tutorials covering key core skills e.g. naturopathic differential development, pathology orientation and interpretation, referral letter writing, supplement sleuthing and lots more juicy stuff!
  • Supervised formal learning community of like-minded and similarly skilled grads
  • An online curated shared resource centre – yours and mine!
  • Introduction and sharing of key clinical tools to assist with screening, case work up and client management
  • Lots of opportunities for structured Q & A on specific topics, both during our live Zoom sessions and between sessions via our online learning platform
  • A year-long opportunity to immerse in a collegiate network – find your tribe
  • An annual subscription at an accessible  price point for new graduates – paid in quarterly instalments
“This mentoring and access to Rachel is my lifeline!! There’s no one else who comes close to the level of education,
dedication and mentorship with such generosity and humility. Thank you!!”

KATE POWE | Naturopath

Interested?

Drop us an email at admin@rachelarthur.com.au to get yourself on the waitlist for this specific group offering in 2019.  Applications open 15th October and close mid-November.

Want to read more about what practitioners have to say generally about their experience of RAMP (Rachel Arthur Mentorship Program)… well check these out:)

Alright, so I can’t teach you how to leap tall buildings in a single bound but I can show you how you can make big leaps towards uncovering your Naturopathic Super-Powers! I often marvel on what I now know, that I wish I had been privy to as a new graduate and while it’s true some things can’t be rushed and only come with time and firsthand experience – my career path and those of so many others was made harder by the silo-esque way we were all encouraged to transition into the clinic: unsupervised, in solo practice, and without a formal support network. Each one of us trying to reinvent the wheel over and over again. Twenty years later, what I do know now, is that there’s a better way.

There is a bucket load of resources, skills, short-cuts and tips that can be shared with you by a good mentor and good practice supervision,  can radically accelerate your progression to becoming the best clinician you can be.

I believe that one of the true strengths of our profession is our sense of community and connecting with that community. When I see this power leveraged to the benefit of the newest, and in some ways the most vulnerable members of our profession, it is a community of which I am genuinely proud of.

When you first start your clinical practice (suddenly now without a net!) you’re full of enthusiasm, overloaded with theories and have a heavy sprinkling of hopes but at the same time, often a tad overwhelmed by the very realness and responsibility of being, ‘the one they came to see and pay (!) to help them’. Making the transition isn’t always easy. Belief in your knowledge and trust in your own competency doesn’t come with your certificate of completion. Nor should it.  You’ve still got training wheels on.  But how reassuring to know that you can be amongst others in the same position & that together you can build skills and confidence with the help of one another and me.  I’ve been there too and I know how important it is for me to share my 2 decades worth of experience (ouch!), not just for the benefit of you, the clinician but for every individual that sits in front of you.  Because that’s why we took on this role in the first place, right?

“I am so happy my younger graduate Naturopath self had the insight to invest further in my knowledge and skill set and join RAN mentoring. As a baby naturopath of just over 5 year clinical experience, I have been able to grow my confidence in my clinical skills at an exponential rate thanks to mentoring. Rachel, thank you so much for being an amazing mentor and sharing your knowledge with us. I will continue to do group and individual mentoring for the rest of your career! (if you will have me of course!)”
Tess Doig, Group Mentoring 2018

Our profession thrives when we thrive as individuals and central to this is building networks of ‘similar others’ in order to find your tribe and benefit from the ‘collective’. Group Mentoring allows you to connect to a community of like-minded, similarly-skilled practitioners in a structured teaching environment. You’ll be learning core clinical skills that you can apply in realtime to your practice and be able to ask questions along the way. The most valued aspect of the mentoring is the ability to discuss practice experiences with the mentor and to hear and learn from all the group members, sharing experiences, knowledge and learning as we go during the sessions.

Joining Group Mentoring is a great way to develop your confidence, skills and knowledge. The bonus of these sessions is you’ll find your tribe, gain support and radically build your toolkit through…

  • additional resources – Mind Maps, Timelines and Mental Health & other screening tools.
  • quick accessible tools for discerning between supplements.
  • the basics in pathology interpretation including introducing you to our pathology template for recording and analysing your patient’s labs
  • the best places to access specific online resources for reference ranges, research etc. for free

 

If you’d like to hear a little about my own journey from the seeds of my childhood (yes seriously we went waaaaaaay back) that helped me make the decision to pursue this career path, through to teacher and now mentor…but the eternal student as well. Check out the FxMedicine podcast “The Value of Naturopathic Mentoring with Rachel Arthur”.

Have you put your name down on the waiting list for 2018 group mentoring?
Read here for more information on the programme.

Applications open mid October, but you can put your name down first by emailing admin@rachelarthur.com.au today. 

 

As an avid reader of medical news I face a barrage of headlines both domestic & international everyday.  I feel this is important for many reasons – not just so that I know what’s being said about their medicine but what they’re saying about ours as well! Anyone see the jaw-dropping headline last week: Could Probiotics be bad for your gut?  Yep. 

Now how many of you didn’t make it past the headline? It’s hard isn’t it. 

There’s almost a reflexive shutdown for many of us to dismiss such a proposition as simply ‘ridiculous’, surely on par with our response to an article from a climate skeptic…as we shake our heads with ‘you gotta be joking right?’… but unless we read on, we’ll never know.  (more…)

OH YES!!…we are rolling out a ‘new look’ for RAN Group Mentoring in 2019. We’re not losing any of the good stuff!, so don’t panic! We are keeping everything that so many practitioners love from the past 6 years of Rachel’s group mentoring (wow..have I been doing it for that long??!?) and simply improving the formula, with some great new features for 2019. We’ve received some great input from our mentees, who have been immersing themselves in the RAN experience over the past 12 months, and as a result of their generous feedback and insights we are fine-tuning our program to offer some great new features so it will be even bigger & better next year!

Check out these improvements for 2019:

(more…)

 

I was lucky enough to hear Jason Hawrelak’s excellent presentation at the Australian Naturopathic Summit last weekend, titled: A Case of Blastocystis Infection – Or Is It?  Timely, highly valuable, immediately usable, provocative education (just how I like it 😉 ) on how perhaps often Blasto is playing the scapegoat for another condition/cause of patients’ GIT symptoms. During this case study,  Jason detailed the shonky diagnostic work-up of his current patient by a naturopath 12 years prior…that naturopath was him.

There was so much to love about his telling of this case study and the discourse around it but here are my Top 3 Takes:

  1. None of us know everything or practice perfectly but rather we do what we do, until we know to do differently…even Jason 😉
  2. As there are 9 strains of B.hominis found in humans and many of these are in fact benign commensals, even perhaps important ‘apex predators’ for the microbiome, attributing someone’s health problems (digestive or otherwise) to the presence of this parasite should in fact be a diagnosis of exclusion…always asking yourself first, what else could it be?? e.g. coeliac, SIBO, food reactions etc etc
  3. The cost of being a ‘premature evaluator’, to your patients and to yourself, can be very high…

(more…)

If you’ve not seen Kitty Flanagan’s skit on current coffee culture...it’s essential viewing.  In true Kitty-fashion, she wants to simplify coffee ordering down to 2 basic lines – White or Black – says all our pretentious coffee orders; macchiato, skinny, decaf, half strength, latte etc can essentially be reduced down to  a much faster 2 queue system. But she’s forgotten the line for taking your coffee rectally.  Sorry – did I make you just spill your coffee? Knowing How across health trends Kitty is, she’ll add this 3rd queue soon, if the number of patients asking me about this or telling me they’re already doing it. Now, while enemas had a place in naturopathic history, my training never covered them and, consequently, I’ve never included them in my practice. But the more hype I heard around coffee enemas specifically, the more I thought we better find out as much as we can, so at least we can better inform ourselves and our patients. And of course the monkey on your back, called FOMO, jumps up and down, incessantly asking, “Are you (and your patients) missing out on an amazing therapy?”

The first patient who told me they were using coffee enemas daily was a celeb.  A very anxious one. Who also told me she couldn’t possibly drink chai let alone coffee because of the caffeine.  This had me a bit stumped…I knew she wasn’t inserting decaff up there and I thought…well given the colon is SUCH an absorptive surface surely this is why she reported feeling, ‘so energised, more clear headed’ etc. with every enema?

But I wanted to find out for sure (more…)


I love it when new research supports my existing beliefs and bias, don’t we all?! 😉   ‘Sitting is the new smoking,’ emerged as a new war-cry a little while ago…then naturally, soon after came the nay-sayers, flooding the media with counter evidence. But you know I have to say, for most of us living and working in integrative health, some knowledge is truly intuitive…and it’s not often I say that word. Originally, I got into naturopathy I guess because I liked nature (I originally applied and got into Enviro Science…sheesh that was a bullet dodged!) and what resonated so strongly with me was the very simple idea that we should probably live more in harmony with nature and our health would likely benefit.  Ok…I had lived in Byron Bay the year prior to entering my degree…you can see how I got here!

Is sitting for work from 9-5 and then getting home to sit some more, just in a comfier place in front of a box that speaks to us & encourages us not to move a  muscle because we might miss something and come out of our trance (!), the way nature intended us humans to interact with our world?

I’m making a wild assumption here I know…but I don’t think so. (more…)

 

 

A recent Medscape review on the medical benefits of fasting, published in July, got me pressing pause on the food button. Now don’t worry, we’re not taking the “breatharian” path…but  for those of us perpetually well-fed people, going hungry has never seemed perhaps so appealing. This fasting focus has brought forth a handful of small but promising investigations and the positive attributes stretch over a huge span of body systems and pathological conditions.

Fasting is one of the cornerstones of naturopathy and in contrast with much of our therapeutic offerings these days does not discriminate in terms of costs. It’s financially available to absolutely everyone. But it might not necessarily, of course, be right for all. It has a long history of healing and is an effective non-pharmacologic strategy to counteract modern health epidemics such as cardiovascular disease, diabetes, and improving cognition. (more…)

One tree in field

Too many times we see thyroxine treated patients on the ‘set and forget’ setting. Often, they’re taking the same dose they started on a decade or so ago, in spite of weight changes, ageing of course and new comorbidities. They’ve undergone limited monitoring, with just an annual in-range TSH viewed as confirmation of efficacy.  But is it? Many patients’ re-emerging hypothyroid signs and symptoms would suggest not.

A recent Medscape review article of a large study by Gullo et al 2017, identifies another shortcoming in the rudimentary way we ‘replace thyroid hormone’, in all patients but especially in those who’ve had their thyroid removed. (more…)

When I look back over how I’ve raised my kids there are a few serious ‘what tha…’ moments – like the time I thought shopping with a child in rollerskates was doable…I mean she loved those rollerskates and she was amazingly agile and good…just not quite good enough to hold onto that 1L Biodynamic Yoghurt sufficiently…who knew?!  Dietary wise, I can look back and be critical in hindsight about different details, the contents of our fridge and pantry have morphed over the years with my changing knowledge (money & time!) but there are a few things I can confidently say – ‘Nailed it’, accompanied by a fist pump!  We’re all meat eaters, not carnivores by any stretch of the imagination but we do partake, however the kids and I were just reflecting the other day on the absolute constancy of legumes in our life. (I know you want CCTV footage of our dinner time chats now don’t you 😉 )  There would rarely be a day in our house without them…several times!

Now I sound like I’m showing off but trust me it’s not that impressive or exotic – it goes a little something like this:  soup,(split red lentils or cannellini),  bolognaise & lasagne (1:4 brown lentils with the meat), nachos for school lunches (kidney beans 4:1 with mince), falafel & hummus (chick peas) & tofu (my kids love this stuff for snacks often & for mains at least once a week).

Ok now everyone relax,  I don’t make our own almond milk, grow our own vegetables or ferment stuff…see…it’s swings & roundabouts 😉 (more…)

So I had to look all the way back in the UU30 back catalogue to 2013 to find my original Gilbert’s Girls recording talking about this common polymorphism and how it might present in your practice but I haven’t exactly been quiet on this one since then.  In the last 5 years, I’ve continued the theme, predominantly focusing on the mental health links but now it’s time to tackle the myriad, murky and mercurial aspects of their digestive problems.  You see, a survey of patients with this so-called ‘benign hyperbilirubinemia’ found that < 10% were genuinely asymptomatic – and the main two areas of their health complaints could be categorised as psychiatric and digestive.  The problem for doctors, gastroenterologists and us alike is that that’s where the ability to categorise, classify or ideally diagnose comes to an abrupt end.  Here’s a few lines from a few of mine to illustrate what I mean:

“I don’t know how to describe it – I just feel ‘off’, yeah I guess, maybe queasy, it changes in intensity but it’s been there as long as I remember”

“Something’s wrong but no one can tell me what. My stools are always different, sometimes pale, sometimes dark, floating, explosive and there’s no pattern with what I eat.  I can eat the same thing every day but never get 2 stools the same.  I’ve had loads of tests – they can’t find anything”

“It’s weird, I can’t say I get hungry. I just feel full like really quickly and it stays for most of the day. Sometimes I can even burp in the morning and it tastes like last night’s dinner!”

” All they’ve found is ‘biliary sludge’ but they say it can’t explain all my symptoms- makes no sense, right? I’m only 20, I’m male, I’m vego…and no one in my family has ever had gall bladder issues!” (more…)

 

I’ve had my nose in all the research on Gilbert’s Syndrome again..watch this space…in the interim just thought I’d share this image and a couple of important details I may not have been able to convey when you last heard me talk (very fast!) about this important and common polymorphism:

  1. While the incidence is approximately 10% of Caucasian population, rates are heavily influenced by ethnic background and the highest rates (up to 1/4) are seen in Middle Eastern populations
  2. Gone are the days of thinking this condition only effects bilirubin levels and the enzyme responsible for its clearance – more recent research has shown over 3/4 of patients with Gilbert’s Syndrome have multiple SNPs that compromise clusters of enzymes within the glucuronidation pathway – with varying patterns – this goes a good chunk of the way to explaining the variability we see in bilirubin levels and symptom pictures across patients all deemed to have Gilbert’s Syndrome.  This also explains why figures of reduced glucuronidation activity vary anywhere between 10% less to 90% less! It depends on your cluster..but the average reduction is around 50%
  3. UGT enzymes, the ones affected in Gilbert’s, are also expressed all the way down the GIT and constitute important food and drug handling. These UGTs are most active in the small intestines,as you can see above, but may explain why Gilbert’s patients are ‘more sensitive’ to medications than just paracetamol!
  4. And are you still thinking you need to run an $$$ gene test to confirm your Gilbert’s hunch in a client whose bilirubin sits consistently high normal or high? Think again… here’s a great little diagnostic short-cut that even the Royal College of Pathologists Australasia cites as sufficient evidence to confirm the polymorphism:

In the face of elevated total bilirubin levels and in the absence of liver pathology or increased haemolysis to explain this..”If the diagnosis is uncertain the serum bilirubin fasting level can be measured and should exceed the non-fasting level by  >50%.”

Nice.  So that means you only need to demonstrate that the patient’s fasting total bilirubin levels go up by at least 50% compared with their fed levels and BINGO you have your diagnosis. Much easier.  Oh and this image comes from an interesting paper from Tukey & Strassburg 2001 – but is probably not for the faint-hearted 😉

Stay tuned for more 🙂

Just new to this condition and need a soft place to land with understanding Gilbert’s Syndrome?  This previous UU30 is just the thing! Affectionately called Gilbert’s Girls because in particular it details a set of twins with this condition, this short audio explains the basics about this common polymorphism and why we tend to see a lot of patients who have this…even if no one has pointed it out to them yet!  You could be the first to provide them with this important understanding about how genetics is impacting their detox pathways, changing their sex hormone handling and perhaps setting them up for both mental health issues and some serious upset guts! Better still, what to do once we have that diagnosis. 

With many of the mentoring sessions I run, I suspect there’s often a misperception that the learning is one way. Part of what thrills me about being a mentor is all the learning opportunities I am personally presented with.

Recently, I had an exceptional example. You see, I am privileged to have a colleague, Sonya Cacciotti, in one of my groups. She has worked for over a decade in tandem with an extraordinary doctor up here in Ballina, and they have had a particular long-standing interest in sleep quality, assessment and management. Consequently, her knowledge in this area is exceptional, particularly with regard to not just obstructive sleep apnoea (OSA) but the much more and often missed, upper airways resistance syndrome, that is especially common in women.  She’s been in my ear on numerous occasions and during group sessions saying, Watch out for this Rachel, it’s more common than we all realise and could be behind many people’s problems‘.

As luck would have it, I have seen a series of cases now within quick succession that all look suspiciously like undiagnosed apnoea or airways resistance. I was listening all along but now Sonya’s wise words and these conditions have my full attention. (more…)