Sounds were emanating not just from me, but from everyone around me, at my table. Admittedly, I was sitting with some very seasoned practitioners, no doubt skewing how representative the sample was of our entire profession, however, at least one thing was clear. Allowing each sponsor the mic for 90 seconds to hard-pitch at us prior to each session of the conference – and sometimes that meant 4 sponsors back to back in a row! – didn’t feel, to experienced practitioners, ‘right’, ‘good’, ‘appropriate’ nor, conference organisers & sponsors please take note, therefore, ultimately effective. Now, of course, I don’t have data to base this on – I’m just going off the low-level groans – along with under-the-breath comments such as, ‘Let’s be sure to put this at the top of our feedback forms!’ Done.
Now recently, I wrote about not wanting to blog from atop a mountain 🌄 Because of course it’s an incredibly privileged position & one that offers potentially, a lot of protection from the realities of life actually on the ground.
Also, that’s a particularly risky take for someone with matching fingerprints! Having run a national naturopathic conference (& precisely 2.7 times -the 3rd all systems go until a nasty virus took us out), that received sponsorship $ from industry, I am all too familiar with the harsh financial realities of running these events. Actual ticket sales cover very little of the actual bill. Especially when we all enjoy the spoils of beautiful venues, edible offerings from caterers, along with all the bells & whistles, e.g. yoga at sunrise & networking drinks at sundown. Transforming what could feel like, yet more work, into something occupying the space between research & a reset. I mean, I’ve pitched pitching our own tents in some bush for a conference where we each cook our own meals over a campfire & entertainment ends with a bit of Kumbaya at 8 but only the most hardcore hippies among us seemed keen. Thanks Jason & Dawn for your boundless enthusiasm 😂
But whenever industry is involved it immediately takes a range of topics off the table.
I knowthis all too well. Great abstracts addressing some of the most important issues will never see the light of day. Certain people will never get a speaking spot. And even in the instance someone manages to get something onto a program that promises to explore issues on the edge of, or even out-of-reach, of what sponsors are prepared to financially support – perhaps that’s questions about the quality of their products & services, or the health & integrity of the relationship we, as a profession, have with our associated industry – the politics that then plays out is deeply disheartening. Either beforehand, via excessive editorial oversight, e.g. remove slides 4,5 & 6, or after the fact. This was the jarring & scarring experience we had first hand with the industry-sponsored, yet entirely independent, Australian Naturopathic Summit. After getting our audience in the mood, via some on-stage bad dancing to ‘Money’ by Pink Floyd, Jason, Nirala and me dared to present concrete de-identified evidence of some unethical behaviour by practitioner-only supplement companies. The first aftershock we all felt was right there in the room. As it became clear that many practitioners had swallowed the story whole sold to them: that these commercial interests were there to merely ‘support’ us, not ‘sell’ us anything (laughable considering practitioner-only brands supposedly only have one customer : practitioners) & certainly not ‘swindle’ us…ever! The second after-shock came later.
The backlash from some sponsors was fast & furious. For others it was a long slow burn & grudge that meant that all future sponsorship of the ANS was in severe jeopardy. And the 3 of us, as the presenters of this evidence, were independently targeted.
We all have thick skin (plumped by good nutrition😉) so that’s not the point but rather where do these conversations happen now? Not so long ago I had an off-the-record 4 way conversation with 2 leading naturopathic educators and 1 integrative GP who also offers training. It was prompted by a mentoring session a practitioner, who had only recently undertaken training with several of them, had with me. I was stunned because this well meaning and clearly well-educated praccie presented a case with a whole swathe of testing performed by a particular very dubious pathology provider. I went back to each educator and asked, ‘Are you recommending these guys?” and ‘Heck no!’ was the answer all round. With each adding something to the effect of, ‘Their results are entirely unreliable. I can’t openly say that for fear of litigation or at the very least backlash but we all know this, right?! [wrong 😥] …I share images of results from other providers in my training – trusting practitioners pick up on the fact that I never use them – that’s the best I can do!’ 😶
So now, a word from my Sponsors. 🦗🦗🦗
Yep crickets. I ain’t got none which is a good thing because I believe we desperately need a place to speak openly about the issues that matter. I am not anti-industry. And the conversations I want all of us to share in are much bigger and go way beyond this. But if we find ourselves in this place, where all the big names in naturopathic education know something that none of them can say out loud, such that practitioners continue to incorrectly place their trust, & spend their patients’ money, with companies underserving of that trust – well we need to find a better way 🙄
I am leaving the blogosphere.
Well not entirely but almost. At the EOFY all my weekly blogs will be accessible only to those signed-up to The Curious Minds Club. Every event, practitioners tell me how they love these blogs. I’ve heard ‘learning while laughing (lmao)’ more than once and it never fails to delight! And I love this small kind of community that we’ve created here between you and me. I so appreciate being able to talk to you. To have the ‘other conversations’, the ones others can’t or won’t. The bigger ones, the tougher ones, the more involved, complicated ones, than most mediums and messaging allows. But I also have had a rapidly growing sense that I want to say more and I really want to hear from you.
So we’re switching on comments.
Because I want this to be an actual conversation between us – not me monologing from atop the mountain! too removed from the realities of our very real clinical lives. I want it to be a co-creation. So we get to address the questions that might remain for you about an issue, the weeds we need to walk through together, in order to come out the other side with real clarity. Whether that’s in relation to ethics, practice models, education, prescribing, diagnostics, industry, politics etc
I’m genuinely excited about this next chapter. More depth. More honesty. More conversation.
We’ll be in touch with the details soon. Because you’re on our mailing list you’ll be first to know.
But chances are you know very little. This is especially true of the parasocial relationships we experience with lots of different people – not just those we’ve never met. You might have been in the same room as them, talked to them, and on more than one occasion. Might have even been taught by them, read their blogs, followed their feed. And because of all those interactions, that for us, have been very impacting, we autofill all the other information about these individuals, using our imagination, lead by our own cognitive biases, to create our own version of ‘them’. Often making them increasingly one-dimensional, ‘They’re Perfect! Lives it – breathes it’, or alternatively, ‘Here’s a naturopath that still knows how to party!” Our assumptions & autofill could be about any aspect of that individual, their privilege, up-bringing, background, previous life & career, pivot points, their diet, their lifestyle, their own health journey.
Kirabecame profoundly unwell each time she attempted to complete her Masters in Research which, taken together with her Californian upbringing & the legacy of summer camps full of tie-dying anything not tied down, told her to return to her ‘woo woo’.
Phil had an established international career in anti-nuclear activism& is ultimately motivated by the need for improved social equity.
Lesley, the daughter of an energetic healer, studied naturopathy alongside pharmacy but found the emotional load of 1:1 practice the most difficult to navigateso chose a better suited application of everything she knew.
Sescame to Australia at the time of our AIDS crisis in the 80swhich motivated her to reach out & build a bridge with ACON prior to her Hep C research & work.
Sueworked in youth justice in her mid 20s, which she was passionate about but burdened with excessive responsibility by, so she fled to London & found herself working in a health food store – because they loved employed articulate ‘girls from the colonies’!
Liza was exposed to a childhood of nothing more than a dehydrated apricot for dessert, once her mother discovered naturopathy as a necessary course-correction for their ‘toxic farming’ lifestyle.
Hearing myselfacross the weekend’s program referred to as, ‘The Queen of Mentoring’, along with, ‘Needs no introduction’, was the other side of this same phenomenon. It’s a surreal experience. I imagine that if I wasn’t me, I too would think things about ‘me’. Make some assumptions, autofill the rest. I wondered who ‘she’ is – in the minds of all of these people – and what fraction of my whole that represents. I am sure I am both much less and also much more. I’m aware of a particular role I’ve played in parasocial relationships practitioners have formed with me. I intensely compartmentalised my life, segregated & split-off work from anything personal, for the most part of my career. I don’t post pictures of my kids, speak about my family in any firm terms, I’ve probably sounded sketchy on the details about lots of aspects of my life. It was driven by both my desire to present as the professional I am (& back in the day when that was absolutely mutually exclusive from the current ‘authenticity’ piece) and a desire to protect both mine & my little flock’s privacy.But when I hear some versions of ‘Rachel Arthur’ I think it maybe was a little to my detriment. Perhaps it’s fostered an impression of me more robot than real flesh and blood human, who has all the struggles, the uncertainties, the challenges, the love & the load that you would expect of any middle aged, divorced, single mother of two, solo practitioner, who had their first paid work at 12 (oh yes the work ethic was alive and kicking in my neck of the woods) but transitioned to working for myself from the time my twins turned 2!
I still find myself asking, what’s the value in you knowing this & more of the personal stuff about me?
I guess just so that you don’t ‘other’ me. Such that you can see yourself in me, both in my strengths, but equally my follies. But also so I don’t feel so alone. The summit program this weekend was all about our community & how we each individually need our community to be well – ’tis so true – and Kira, in her closing speech, gave us the evocative analogy of the mother tree of a sequoia grove. To have had the honour of influencing how we educate ourselves in this community but to simultaneously have often felt on the ‘outer’ (because I am not part of an institution, I decline to absolutely align with any aspect of industry, I am not even part of a praccie chic-click – more of a chic-flitter between several 😅) has been a confusing combination over my career. The Australian Naturopathic Summit circa 2016 & 2018 (& 2020 which was put to a stop only by a pandemic!), co-created with Nirala Jacobi, Kathryn Simpson and via all the input of our incredible speakers, vollies and attendees was, I guess, an attempt at creating the community that I until then, I hadn’t experienced myself. And I know to this day, it holds that place in many hearts forever for that reason. But in the absence of the ANS, I ‘gotta’ say NHAA, You did a good job – offering us a big warm hug, an opportunity for reconnection & to see all of ourselves as real people with so much more to each of our stories…
I am leaving the blogosphere.
Well not entirely but almost. At the EOFY all my weekly blogs will be accessible only to our Curious Minds Club subscribers. Every event, practitioners tell me how they love these blogs. I’ve heard ‘learning while laughing (lmao)’ more than once and it never fails to delight! And I love this small kind of community that we’ve created here between you and me. I so appreciate being able to talk to you. To have the ‘other conversations’, the ones others can’t or won’t. The bigger ones, the tougher ones, the more involved, complicated ones, than most mediums and messaging allows. But I also have had a rapidly growing sense that I want to say more and I really want to hear from you.
So we’re switching on comments.
Because I want this to be an actual conversation between us – not me monologing from atop the mountain! too removed from the realities of our very real clinical lives. I want it to be a co-creation. So we get to address the questions that might remain for you about an issue, the weeds we need to walk through together, in order to come out the other side with real clarity. Whether that’s in relation to ethics, practice models, education, prescribing, diagnostics, industry, politics etc
I’m genuinely excited about this next chapter. More depth. More honesty. More conversation.
We’ll be in touch with the details soon. If you’re on our mailing list you’ll be first to know.
Overly responsible for everyone else from a young age. Parentified even. Dependable to the point of invisibility. If you’re a Swifty, you know where this is headed, but for the rest of us: welcome to Eldest-daughter Syndrome and, strangely enough, to the story of Thiamine. It’s the number 1 in B1, right, that unambiguously announces the arrival of nutrition’s firstborn to the world. Isolated & identified as essential to humans in 1926, she’s undeniably our eldest and yes, she’s turning 100! But before we get her to blow out the candles, just like Tay Tay, she has a few spicy words she’d like to share on what being the often-ignored eldest has entailed, especially in the context of our long-standing carb culture wars!
But, first she’d like to set the record straight regarding her siblings.
“We’re not related – you know– me & all those that came afterwards, like B2, 3, 5, 6 etc.?! Our names make it sound like each new ‘B’ baby was just a small shift in chemical structure from the last! But nothing could be further from the truth! Have you seen any snaps of us all side by side?! We look nothing alike! [ignore the artist’s impression above!] Other than occasionally crossing paths on a job, there’s nothing more meaty or meaningful that connects us!”
And it’s true of course, the numbers merely reflect the chronology of their discovery. And what about all the missing ones like B4 & B8? These were micronutrient miscarriages, of a kind. For example, we thought they were essential, but then we identified endogenous production, only much later to acknowledge not enough, as was the case with choline (B4). But by this time, Nutritional Science had conceded the complete folly of such a simplified naming system, acknowledging that the ‘B vitamin family’ was in reality more of a biochemical ‘junk drawer’ rather than a coherent collective but misunderstandings about this persist! ‘Why is she so keen to separate herself from her siblings?‘, you might be wondering, well listen in…
“Because I mostly work alone. Well except for my one true metabolic mate: Magnesium. Whom without, I can’t get a thing done! And what’s most crazy about us two is twofold! We’re both central to energy supply – especially in the form of carbohydrates – yet diets at either end of the carbohydrate intake spectrum (LCDs, grain-free, Keto, Carnivore OR SAD) are equally at risk of our inadequate intake! So if you know who’s behind these carb culture wars – I’d like to have a word!”
But if this was the case, wouldn’t you be seeing B1 deficiencies in your patients? Look again. Our whole understanding of its deficiency picture has undergone a complete rethink. One of my favourite articles on this, that has stayed with since I first read it in 2021, calls this out from the kick-off: Hiding in Plain Sight – Modern Thiamine Deficiency. But there’s SO much more that has emerged even since then! Have you met the new baby of the Beri Beri family? Remember the wet (CVS) and the dry (Neuro) presentations & forms? Well now there’s a third, plus a whole subclinical syndrome that we’re absolutely seeing! And sometimes in our so-called ‘healthiest’. Should we just dose everyone with the ‘biochemical junk drawer’…ummm, no. Yeah…our ideas on how to support B1 status are also in need of an entire overhaul! While I’m sure you’d love to hear about this from our eldest herself, it’s been another big day in a big birthday year, and never one to say no to carbs and especially cake when it’s full of B1 fortified flour(!) she’s a bit sleepy now…so you might just need to listen to my 30 min summary of all the absolute must-knows instead!
B1 Caught in the Crosshairs of Our Carb Culture Wars
For a vitamin discovered through catastrophic deficiency disease, thiamine (Vitamin B1) has become strangely invisible in modern health conversations. And yet, quietly and relentlessly, it sits at the gateway of carbohydrate metabolism itself. In this episode, Rachel revisits one of nutrition science’s oldest discoveries through an unmistakably contemporary lens – exploring how modern eating patterns may simultaneously increase our dependency on B1 while reducing the likelihood of obtaining enough of it.
From ultra-processed diets and alcohol intake to grain-free eating patterns, obesity, bariatric surgery, and the rise of GLP-1 medications, this episode examines why thiamine may be uniquely vulnerable in the modern metabolic landscape.
This is not an episode about demonising carbohydrates, glorifying low-carb diets, or promoting simplistic supplement narratives. It’s an exploration of metabolic context, nutritional trade-offs, and the hidden micronutrient costs embedded within contemporary food culture. Or, put more simply: the story of a tiny vitamin carrying a disproportionately heavy load.
You can purchase B1 Caught in the Crosshairs of Our Carb Culture Warshere. If you are an Update in Under 30 Subscriber, you will this episode 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.
Tenacity (adj.) the quality of being very determined, persistent, and unwilling to give up, even when facing difficult challenges, setbacks, or opposition.
Sounds admirable right? You might think unworthy of a ‘toxic’ title. Might even think, here we go, here’s her ‘humblebrag’ bit. But it’s both. I mean, my super-power & my kryptonite. I have an almost pathological inability to stop pulling at loose threads once something doesn’t make sense. And SO many things in nutrition, naturopathy, mainstream medicine et al don’t make sense!
I can’t leave inconsistencies alone. Can’t ignore the gap between what’s confidently repeated and what’s actually evidenced. Can’t keep quiet when our profession starts mistaking certainty for understanding, trends for progress, or louder voices for truths.
It’s exhausting! Potentially annoying. Definitely not always ‘brand-friendly’. Think for a moment about all the ramifications – the full fallout- of never being able to let the things that matter (in medicine, in nutrition, in health) slide. And while you’re humouring me with that I’ll just scattergun some headline-highlights that may help to illustrate my point. Speaking out about questionable business ethics, mis & disinformation about products & services has had me blacklisted by numerous companies across my career. Side note, I had to laugh when one ran a whole conference in my area of expertise but didn’t invite me to speak, however, according to several accounts, many of their speakers openly referenced me! 😆 And recently I heard about a particular governance role related to supplements sold in Australia and when I mentioned I might be interested, the individual sharing this with me replied, ‘That’ll never happen! Your reputation proceeds you! They think you’re anti-them!’Um…. ouch & wow! 😶
But of course, outside of my early career when I worked for a couple of companies, I’m not doing this for them. I am doing it for me.
Because I am passionate about naturopathy, nutrition, integrative health & all the potential these hold when practiced well and untruths, partial truths, myths & misunderstandings lie across our path, obstructing us from attaining that. Oh and I am a total science-nerd!!! These are the real reasons I’ve spent decades asking questions others didn’t/couldn’t/wouldn’t/’shouldn’t’ – about whether ‘new’ always means ‘improved’ (forms, delivery technology, protocols etc), about whether the doses recommended deliver results or just more sales, about what amounts to truly integrative pathology interpretation, and especially the incredibly tricky task of trying to assess nutrient status of individuals, via any medium (blood, urine, hair, skin – take your pick!) I have unpicked assumptions about aetiology (Gilbert’s Syndrome being not-so-benign after all, up to 50% IBS being B.A.D. & the high histamine hysteria that feels like it could be here to stay etc) And I have made plenty of mistakes and missteps when I thought I understood something – only later to know better! But I have always tried to be open about those and own that – I’m thinking pyrroles & Zn dosing for a start! Always asking myself, as much as anyone else, about all the quiet little leaps of logic hiding inside the increasingly unwell ‘wellness culture’.
But, however, and (one of my favourite little sayings) I get push-back from practitioners who just want it all to be easier. Who desperately want to subscribe instead to someone selling certainty over the inherent complexity that is all things holistic health! And to those who don’t & won’t make us all feel uncomfortable in the unknowns of it all.
I get it. Really I do. I’d leave (and leave it alone) if I could! And you know, the irony is, something that’s only literally just occurred to me in this moment (!!), my dad had a series of sayings that he repeated over and over again to me & it totally gave me the S H 1 T s’s (that’s one of his 😂) and probably his top pick was this: “Persistency – do you hear that Rachel Jane? Persist and see!” Oh boy I miss his maddening catchcries…turns out, he got me good – and yes I mean that both ways 😥
Anyway, what I’m trying to say is, I’m not trying to be difficult – it just is difficult. And my goal isn’t to make things more complicated – it’s simply to make us all, and our medicines, more successful, more often.
Just in case you were worried I’d forgotten our April episode…never!!! I’ve been busy, and for some time now, mulling over the medicine we offer our patients that is beyond the bottle…in the form of our capacity to communicate their Mattering, increase their Expectancy for better health & encourage and cultivate Active Hope – three psychological constructs that every practitioner needs to know more about, in order to vastly improve patient outcomes. I’ve talked about Mattering before…and as per usual it started with a story…
After not seeing her for some time I messaged my longstanding (or should that be long suffering? 😂) psychologist chasing up a contact. Much to my astonishment she rang & left a voice message along the lines of, “Great to hear from you, I often think of you and would love an update if you want to call me back.” So I did.
I mean this was an unmistakable demonstration of care.
More than that, it potently evoked a sense in me of mattering. And in this instance, mattering in the mind & crazy-busy world of this exquisite professional with decades of experience & oodles of clients. And well it made my day, my week, my month… & reminded me all over again why I choose her.
Cut to today’s story… given the gift of time and space for more reflection, including a long sustained stare into the rear-view at the road I’ve travelled with patients across all these years, I’ve come to see that sometimes the most technically correct naturopathic medicine I’ve practiced hasn’t always been the most therapeutic, or even effective at all. And that’s where this month’s Update in Under 30 begins: both an acknowledgement of, and an attempt to rebalance, the uneven attention currently afforded to our so-called “unifying” naturopathic principles.
Because while the bell of Tolle causam — treat the cause — tolls loudest, we risk forgetting that naturopathic medicine was never intended to be a perfectionistic exercise in pathologising, but a system equally anchored in Vis medicatrix naturae: the cultivation of the conditions through which healing becomes possible.
The Medicine Beyond the Bottle
What if the most powerful part of your treatment plan isn’t what you prescribe—but what the patient leaves believing? In this episode, we challenge the idea that better outcomes come solely from more precise diagnoses, more detailed testing, or more targeted interventions. Instead, we explore how the therapeutic interaction itself shapes patient physiology, behaviour, and engagement through three core drivers: mattering, expectancy, and active hope. Grounded in behavioural science and clinical insight, this episode unpacks how these forces influence outcomes—and how clinicians can intentionally design for them in practice. If you’ve ever wondered why technically “perfect” care doesn’t always translate into results, this conversation will change how you think about what actually makes treatment work.
You can purchase The Medicine Beyond the Bottle here. If you are an Update in Under 30 Subscriber, you will this episode 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 resourceshere.
We’re in the grip of a podcast plague. I’m serious – everyone has one. Have you checked the children?! Not to ensure they’re safe in bed but to be certain they’re not broadcasting from there 🙃😆 And podcasts have now gone AV! We’re able to watch people speak!! It’s almost like IRL but better because they’re wearing massive headphones. Being able to watch, what was previously, an audio-only offering, caters to our microattention span issues & is also the only assurance (though not for long of course!) that this is an actual conversation between two or more real humans, rather than an AI bot exchange 😥 But when they’re good they’re great!
Recently I’ve been interviewed by athletes & performance coaches, a nutritionist who’s an expert in weight management, along with some great GPNs (general practice nats).
And what a delight it’s been to dine out on these kind of conversations! When two minds meet in the middle- our shared curiosity for critical thinking in nutrition – & the hosts, themselves, bring so much to the table, by way of their own expertise.
Given my slowed pace & ipso facto increased sense of space I’m now able to accept these invites & I am eager to unflinchingly unpack the evidence with other experts and spread the word! Not of the New Testament or any other holy text but rather of the extraordinary lessons I’ve learned, particularly in the last few years. Because, generally speaking, the longer anyone works in nutrition, the less interested they become in simplistic answers. Not because simplicity is bad but because the innumerable exchanges between our bodies & the nutrients that fuel them, rarely behave as neatly as entry-level education suggests. After 20+ years in practice, I spent an entire year revisiting the latest research (the actual research not the premasticated and often adulterated AI abridged version of it).
I expected updates. What I found instead fundamentally changed how I interpret assessment, prescribing and almost every aspect of clinical decision-making regarding nutrition.
I’ve spoken many times about my foundational undergrad nutrition as being phenomenal and also incomplete & incorrect. Two issues are at play here – firstly science doesn’t stand still (thankfully) so what may have been correct at the time the content was created (no matter how many years ago that was for each of us…) is often no longer and secondly, because, entry-level education has to be simplified. That’s normal. simplification is a pedagogical necessity but dangerous when mistaken for the full picture. An organisation contacted me recently asking if I would deliver nutrition training to their new intake of heath professionals, as I’ve done many times before but it became clear they wanted to stay with the ‘old songbook’ & an overly simplified and outdated script.
I can do simple. But I can’t & won’t make the mistake of making out that Nutrition is simple. There’s a difference.
So I had to say no but how many of us already out there working with nutrition, still sing from the old songbook? Plagued by questions about why our nutritional prescriptions don’t always work? Or work in some and not in others? Or left feeling a little lost because the markers we’re using to measure individual nutrients aren’t responding to repletion the way we’d anticipated. Or even, ask ourselves, ‘Is this the best way to address my patients needs using these sources and supplements?’ Entry-level education enables us to name the nutrients needed. A significantly more advanced understanding, however, is essential to answering all the other questions embodied in any prescription: What form? How much? How often & when? &, for how long for? Being across critical details, that have only emerged in the evidence more recently, changes all of these decisions and ultimately our patient outcomes.
Maybe you’re ready to join our Nutrient Prescriber’s Program Alumni? A group of practitioners who tell us repeatedly, they have undergone an extraordinary (& uncomfortable!) transformation. If that’s you, why wait? Because optimal outcomes begin where entry-level education ends.
The Nutrient Prescriber’s Program is a structured process for creating prescriptions that’s systematic, scientific and more likely to produce successful outcomes. You’ll gain a reliable and robust framework to answer key questions such as: Which form? How much? How often? And, for how long? Dive into the pharmacokinetics of micronutrients, their various uptake pathways in different scenarios, how they work in networks & how co-prescribing in the right ratios is essential for efficacy and safety, rather than as ‘single nutrient solutions’. Are you ready to reexamine the science when it comes to nutritional prescribing?
What unites you as a family? For me, my kids & their partners, it’s humour & the more absurd & unexpected the better. Know the type? You spend most of the show asking yourself, ‘Is this the show?!’ Confused as to whether you should laugh because you’re also a little scared you’ve stumbled into something so loose it could fall apart at any moment! Making our annual pilgrimage to Melbourne Comedy Festival, you’ll find us front row for the fringe-dwellers. The ones too fringe to make money, so they settle for exposure. No budget for polish. No safety net. Just raw, slightly unhinged creativity. So there’s no money for extras & the comedy kicks off early as they stand, often in sight, but just off to the side, appropriating the role of the ‘announcer’ & hilarious self-hype-person.
Which is ironic, because as a professional speaker, sitting somewhere in a room full of delegates, dissociating, while someone reads out the bio I wrote but I hate, has to be my least favourite thing.
Penning your own bio is a bit bent right? Referring to yourself in the 3rd person while letting your ‘id’ introduce you, is not a natural social phenomenon &, in fact, it’s the very opposite of what balanced folk aspire to. So what exactly are you meant to do? Tell the truth the whole truth and nothing but the truth? Most would fall asleep a few hours in and for those still with us, they’re thinking, ‘Sheesh, that was a lot of main character energy with some unexpected plot twists that someone shoulda taken a chainsaw to!’ But if you’ve got to the point of presenting education en masse, your story is always going to be long because you didn’t become an authority overnight. Or do the opposite & downplay it (which I have absolutely done) and then, as you listen to the other ‘id’ intros of the speakers before you, you think, ‘Ok, well Ms Humble how’s that feeling in the midst of all that Hype?!’
We have a lot of newbies, here & on socials & I notice you’re supposed to re-introduce yourself ala – ‘on previous episodes’...but tbh this is triggering my bio trauma big time!
So, instead, I thought, maybe I’ve found the perfect job at last, to give AI? Given it never tires of telling us ALL how UNIQUELY EXTRAORDINARY we are…as INDIVIDUALS (of course) 😆 Telling me how especially AWESOME I am, any chance it gets: “You’ve articulated something important there” “That’s a powerful observation!” “You’re thinking about this in a very nuanced way”“The fact you’re questioning this shows real awareness” “Most people don’t think about this, but you are” You too?! Maybe AI is how I distance myself from getting bogged down in the significant details of my expansive CV, get some perspective about what really should be shared, outsource my ‘id’, avoid downplaying my achievements and feel better about my bio?
Hilariously, it offered me options – straight or subversive (Even suggesting the latter fits better with my style😲 Settle down Romeo!) I’ll let you guess which one I am going with 😂
Rachel Arthur has spent over two decades in clinic, long enough to know that more information doesn’t make better practitioners—better thinking does.
A nutritionist, naturopath and educator, she now works primarily with healthcare professionals, teaching them how to interpret what others miss and question what’s routinely accepted. Through her CPD programs and longstanding role in ACNEM’s GP training, she’s known for pulling apart the gaps between research, pathology and real-world practice—and making clinicians far more precise in how they work.
Her background spans academia (including teaching electives in medicine at Monash University), authorship and editorial roles in leading Elsevier texts, and large-scale industry work analysing health data across corporate populations.
Rachel is an Advisory Board Member and Founding Fellow of the Association of Accredited Clinical Nutritionists, and a Fellow of the NHAA.
She is not known for being a hype person. She is known for changing how practitioners think.
It then promised, as it always does, to do better 😅 To ‘push it further—making it almost uncomfortable, in its simplicity.’ Well, when have I ever said no to making people uncomfortable?!! Go! I could play this game all day but it’s never going to cure me of my bio-baggage! If you really want to know where I’ve been & what I’ve done that might, in any way shape or form, justify why you find yourself here – dare I say – look at my Linked In LOL
It’s 2004 & I’m practicing from South Melbournewhen one of my patients comes in with a few pages of test results she wonders if I want to take a look at. I’d love to of course but the ‘language of labs’ was not taught in naturopathy back then, so it all just looks like scribble to me. But I need all the help I can get. She’s got a complex medical history, including a serious condition I don’t think I’d ever encountered even in our pathology lectures. That’s not necessarily a deal-breaker for naturopaths of course. And as I had been taught to do, I put that aside in an effort to see her health as a ‘whole’. Identify & then follow all the individual threads, so that I can see how her key vulnerabilities or imbalances intersect & therefore know how and what to actually treat, rather than any diagnoses & labels she’s been given. But I look at these pieces of paper full of impenetrable information in my hand &instinctively think, ‘Ineed to follow this thread too & see where it takes me.’
The universe was clearly in a conspiratorial frame of mind in that moment, because I went to the books (see above reference to the year) to learn about some of her out of range results – one was Cu, I remember that clearly!- and it provided me with immediate insight that I hadn’t arrived at by any other method.
And so I began building.
Within 12 months with my preschool twins & partner in tow, I had relocated to Northern NSW to undertake research on this at SCU. Yep this sense of something building was quite the force! I wanted to add to my emerging understanding of the role of pathology interpretation but also create a conversation with my whole profession about how this could be of enormous additional value to all of us. And my bilingualism was building & I had come to believe this was the only option for us as a profession: to understand mainstream markers enough to be completely competent medically with our interpretation of them and by adding our deeper and more detailed knowledge of biochemistry & nutrition, radically optimise those insights & understanding about each individual we could glean from these.
The universe conspired again, this time in the human-form of Dr. Tini Gruner, who became my SCU thesis supervisor.
A woman equally passionate about this being part of naturopathic practice and already doing it. A biochemist by trade (then a naturopath) she was renowned for her sleuthing skills & her superpower was including pathology results in the work up of her own patients. She taught her undergrads not just how to incorporate but also integrate these into their practices. While she constantly sought out further CPD in this space for herself. Pushing us all forward on this front as a result – until she wasn’t. However, Tini had already well & truly passed me a baton before she tragically passed away & was emphatic that I should Keep. On. Building.
So I did.
In addition, seeing its enormous potential to improve the way we practice, my thesis had given me a glimpse into how problematic pathology testing could be. We make assumptions that if a test is available commercially (& esp mainstream) it must have good evidence behind it. Uh…no. And then the very idea that reference ranges represent what’s healthy. Also a no. I was now insatiable in my appetite for anything that could help me better understand & extract the full value from the biggest dataset we have on every patient – routine screen results. I undertook any vaguely related CPD including courses with the association of pathologists, that were so dry they bordered on crumbly! And I applied every new bit of information. In my own private practice, through my role as a clinic supervisor and lecturer, via all the cases I was exposed to across over a decade of mentoring huge numbers of practitioners. I kept reading research & applying it in real time. Not only in the initial work up but all the way through individuals’ treatment – to see what was still standing at the end, as solid, sensible, reliable, reproducible, interpretation of these mainstream markers. At every stage I learned & adjusted my lens. And my instructions about how to improve their accuracy also because I’d seen first-hand results go rogue in response to every type of collection condition confounder us crazy humans can conjure up!
Over time isolated ideas I’d had about individual results & what they reflected became intricate patterns, such that I was able to formalise frameworks, shaped in practice.
When the plague came in 2020 I turned to my team and said, this is our opportunity. It was the culmination of something that started that day in South Melbourne. We built the MasterCourse in Comprehensive Diagnostics & ‘comprehensive’ was not an adjective used lightly. From reading enormous amounts of primary research we were able to actually redefine the ‘reference ranges’ for all routine screens . Transforming these from what we see on our patients’ reports, which are simply statistical ‘norms’ of the population (or even worse, an inconceivably small sample of users from one pathology provider!) – into ranges that actually reflect ‘healthy’, even in some instances ‘optimal’. And not satisfied with simply applying this to every adult, we went further, stratifying by sex, by age, by reproductive stage wherever possible. Then we added another layer, emerging mathematical ratios reflecting meaningful relationships between markers. It was of course no longer 2004 and we were no longer beholden to borrowing books and making photocopies, but it was an enormous undertaking and one I will always be proud of.
But it was never about creating just a new set of numbers and a narrower threshold for triggering ‘Hs & Ls’ but about fostering a paradigm shift in pathology interpretation & equipping clinicians with an entirely new skillset.
It’s 2026 and pathology interpretation has never been more important & relied upon in our practices. I’m thrilled and Tini would be too. Accordingly, references range cheat sheets, software apps etc are popping up everywhere. I love a shortcut as much as the next person if it takes me to the same destination, but these are not designed to do that. The ranges and models I teach, as hopefully you might now have an inkling of, are part of a comprehensive system developed over many years and are not reproducible without that training and context. Oh and if you’re assuming the praccies behind these products (who often reference me but off the record) have undertaken my MasterCourse…uh, again. no. But one individual did reach out. Refreshingly retro and professional & perhaps even, sensible. Has the universe once again acted conspiratorially to write this next part of the story? We’ll see🤔
Sorry for such a long rave but we have a lot of new people here & the practice landscape including all the options for pathology interpretation are seemingly changing on a daily basis and I just thought sharing the story of how it all started might be timely.
“You absolutely delivered! I knew that there would be some clinical pearls at least, but I did not expect to get such a comprehensive exploration of the theory behind basic pathology tests. I am so impressed with not only your analytical mind and ability to explain how things connect and where they fit into a vast pathology mural, and your ability to convey the concepts clearly and create presentations that facilitate absorption of the information.”
ALYSSA TAIT | Naturopath & Physiotherapist
“I thought my pathology skills were pretty up there until I did Rachel’s 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.”
Take a moment to reflect honestly on your (ouch!), or alternatively ‘our’ collective (if that’s more comfortable) opinions over time regarding each of these: Butter. Coffee. Spinach. Red meat. I could go on and on…and tragically, on some more.The total number of ‘opinions’ each of us have had will be largely determined by simply how long we’ve been in nutrition. And yes this tracks even pre-social media 😞 There’s an understandable, in fact, entirely acceptable element to this. Discoveries that fuel truly new thinking in nutrition are rarely linear or even predictable. These discoveries are disjointed with often big delays in between, many a contradictory finding, a juxtaposition to juggle & U-turns are not uncommon. The science can be so complicated & confusing it’s hard to sell it to ourselves, let alone others – so we turn them into stories. Problems arise when that’s all they become – stories – especially those that follow a familiar narrative arc:
Narrative Simplification – Complex biology becomes a clean story.
Nutrition science is inherently messy because nutrients & non-nutrient elements of food all interact, context matters, dose, timing, and physiology all alter outcomes and individuals have individual responses! But complexity doesn’t travel well, so we compress it. This food is ‘flammable’ avoid in inflammation. Eating this is good for your gut. Don’t include this ‘disruptor’ in your diet if your value your hormonal health. A nuanced, conditional & complex body of evidence becomes a one liner that’s easier to sell.
Suspect simplification when any food ceases to be healthy inclusions for some individuals some of the time – instead its now either for everyone or no-one!
Splitting – Foods become heroes or villains.
Once our stories get so simplified that they lose lost sight of the (ever evolving) science, it’s an easy 1,2,3 into binary, black & white thinking. Foods (or nutrients or forms of nutrients) get elevated to the giddy heights of hero-status – from which they’ll inevitably fall in the future – but until that time they are objectified as: right, helpful, health-full, optimal for all. While others are demonised to death! Attributed anti-health super-villain powers – good for no one. And to be eaten never.The phenomenon of splitting is cognitively efficient, so it appeals to our overloaded brains, yes. And in a crowded information landscape, clarity – even false clarity -is the winner of people’s attention. But biology doesn’t operate in binaries. And hey, aren’t we supposed to favour holism over reductionism and personalised prescribing over population based dietary advice?
Moralisation – Food becomes a proxy for virtue.
Once foods are sorted into good and bad, it’s just another step (to the left ala Rocky Horror Picture Show!) into extrapolating about the moral virtues of the individual eating them! Clearly, the people eating these foods can be subsequently seen to also be either good or bad. Vigilant or careless, Disciplined or lazy. Informed or ignorant. Now we’re no longer just discussing food—we’re making moral judgements about its consumer. If you cared about X you wouldn’t be eating that. If you understand anything aboutnutrition you’d know not to eat Z. This is where Food Cancel Culture emerges. And a new cycle kicks off: a food we previously loved, or at the very least liked, becomes loathed. But spoiler alert! – if you do continue to seek out the (ever-evolving) science & accordingly critically review your ‘stories’…this opinion is not your end destination.
Once you see the cycle, you can choose not to perpetuate it. No more heroes. No more villains. Just a quieter commitment to letting the science -not the story- lead.
Anyone else? Or should that be…’Everyone else?‘ 🙄Because if I had a dollar for every cracking encounter I’ve had with people that included this line, I wouldn’t be writing this line – so too, if I’d been persuaded by the push-back against this lovely little legume. It just happened again the other night, out to dinner with relatives. But my all-time favourite Soy Scream Scene was when I was invited to meet a ‘wellness celebrity’. We caught up in a cafe & when I ordered my beverage of choice, she just about leapt across the table (entirely unnecessary given her elevated volume) to shout, “I can’t believe you drink soy?!” I think she felt it was her civic duty that the entire balcony benefitted from her wisdom – or at least just a way to ensure more individuals had clocked her presence 😎
And these encounters, of course,are not limited to those without qualifications.
That’s not to say that I expect, or ever desire, those of us that do to be unified on all issues. That sounds far from ideal. We’re free thinkers after all and each of us has been privy to different information & our own experiences. Me siding with soy (& not in all individuals or instances ofc!) is both personal and professional. On the n=1 front, I was 18, living my best life in Byron Bay (which often did not include shoes) when I was introduced to soy milk in lieu of cow’s. I loved it. Never having been a big fan of the old moo juice and less & less as a teenager, I preferred the taste, the texture, the principle. I was a vego. (Side-note: ‘plant-based’ was not invented until long after the 80s!) So, I also got right into plant proteins – namely tofu & tempeh. Miso was our main go-to as a way to add flavour to our cooking, even lacquering toast with it as a tasty spread! Ahhhh my glory days & mine were swimming in soy!
Go forward a few years &, having readjusted to the rigors of footwear, I am sitting in a lecture room listening to my herbal medicine teacher talking us through the chemical structure, physiological functions & potential applications of isoflavones.
I have a vivid visual memory of the whiteboard and her words. These were none of the reasons I loved this legume but I was enthralled by the revelation about its potential role as a health intervention. I still am. Because despite the sequential Soy Scream Scenes that have punctuated my life – I think the body of evidence demonstrating its beneficial effects is too large to ignore and why would we? Either it’s because of evidence that is well out of date (feeding babies infant formula made from soy flour!), a hypothetical that has since been disproven (clinically meaningful goitrogen) or mis and dis information. But look I get it! Check out soy’s wrap sheet – it’s not for the faint (food) hearted !
Potentially allergenic, as well as interacting with our immune cells in other myriad ways!
Agriculturally it’s one of the biggest mono-crops & a major contributor to deforestation, heavy on the pesticides, and often GMO
So, if we were cops profiling for potential culprits in a case of: farting, digestive discomfort, unexplained nutritional deficiencies, hypothyroidism, immune issues, food allergy, reproductive disorders or gout – certainly bring the guy in for questioning! (among a LONG list of other food and also non-food items included in the line-up!) And ensure you’ve read the research & understood all of the evidence enough to know what is plausible (theoretical but without in vivo real world confirmation), possible (it has been shown to happen but not commonly) & probable (it’s deserving of its place on your list of differentials but is still just a suspect, not a certainty). If all this sounds sizeable (and it is) then get the cheat notes. We just recorded an Update in Under 30 episode on the very latest evidence for SIFs in perimenopause including an update on adverse effects 🤓
Oh & if you’re qualified in nutrition I don’t need to tell you to choose: locally grown, organic, non GMO, whole forms, which you ferment frequently & include as part of a balanced diet, right? But is that any different from your advice generally about good eating principles? 🙄
This episode explores how one of nutrition’s most debated foods has moved from early promise, through backlash, into a far more nuanced clinical role. This episode unpacks receptor selectivity, equol, bone preservation, vasomotor symptoms, and why SERMS such as isoflavones may matter most during a phase defined by instability. This is a fresh look at where soy genuinely earns its place in modern peri/menopause care.
You can purchase Soy’s Second Act in Perimenopause here. If you are an Update in Under 30 Subscriber, you will this episode 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.
I’ve been talking lately about my own perimenopause experience & I’ve been listening to others do the same when suddenly it occurred to me that when these conversations happen – women all around lean in. Physically, mentally, emotionally, biologically. While for many of us, this kind of deep communing doesn’t happen often (enough), I feel the other occasion it reliably shows up is when we the share our birth stories. You know what I am saying? Like the second a woman opens that file & finds those words, all other noise in the room stops. And almost trance-like, we’re all drawn toward the teller. An impromptu circle of women appears around her that could not have been better coordinated had it been choreographed & rehearsed! Powerful stuff.
Women’s circles we know, have a long history & tradition.
And though I decidedly spend less time in the woods with womenfolk these days, as both a naturopath & resident of the Northern Rivers for most of my adult life – you can trust I gave it a good nudge in my younger years.
But here we are. Come full circle…if you’ll pardon the pun. Others have spoken to this phenomenon far more eloquently than I’m able to but in simple terms, when women begin sharing stories, whether it’s birth, bleeding, breastfeeding, miscarriage, perimenopause, or any other deeply embodied experience, what often looks like simple conversation is actually something perhaps much more primal, it’s pattern recognition in real time. We’re listening for ourselves inside someone else’s story – asking ourselves along the way things like
What happened next?
Has that happened to me?
Could that explain what I’ve been feeling…Why I am feeling..?
Is this normal?
…Am I normal?
I don’t have to tell you guys why these have had to be the places women seek answers rather than medicine & medical authorities 😠🤬🤯🤐 And even now, when it feels perimenopause is finally now ‘a thing’ in primary care be warned sisters 🧙♀️that’s mostly because when symptoms get loud enough, sales soar and the ‘peri/menopause market’ is one of the biggest money makers right now for many 🥺 …so go cautiously & let’s keep these more honest conversations between us going.
Soy’s Second Act in Perimenopause
Explores how one of nutrition’s most debated foods has moved from early promise, through backlash, into a far more nuanced clinical role. This episode unpacks receptor selectivity, equol, bone preservation, vasomotor symptoms, and why SERMS such as isoflavones may matter most during a phase defined by instability. This is a fresh look at where soy genuinely earns its place in modern peri/menopause care.
You can purchase Soy’s Second Act in Perimenopausehere. If you are an Update in Under 30 Subscriber, you will this episode 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.
I often feel on the outer even among my peers. I recall a period during which I was a regular invited speaker at an event, where I was increasingly the odd one out from the others & their escalating unified chant of the same single solution: the GAPS diet. I could say this was simply because being passionate about personalised prescribing, I am protocol-proof💪 🏋️♀️ but that’s not the whole story. When you imagine you’re on the outer even from ‘your own’, it leads to self-doubt: 🤔Maybe I’m the dinosaur here because I’m not an early adopter of this! Behind the 🎱 because I feel the need to wait until there’s more evidence. I took a bet each way & excused myself from future programs.
And while it’s both alarming & personally affirming to note that the spruiking of this ‘universal solution’ has slowed if not stopped since the GAPS gold rush around 2010, there’s a new one, in fact several new ones since – that repeat the pattern.
I think the inclination for early-adoption, or the self-doubt if you don’t, both make sense for us as a profession, in particular. We’re innovative by nature, rebels at heart and we’ve been gaslit that many times by conventional ‘consensus’ science & the dominant ‘only-pharmaceuticals-fix’ thinking, that we’ve lost count. We were told that leaky gut was a lie, a period of instability prior to menopause was nothing more than attention-seeking & non IgE adverse food effects a figment of our imaginations! So, naturally we’ve lost a bit of faith 😔
But equally, when we look back over the salves we’ve been sequentially sold as the latest & greatest protocol & panacea:
Anti-candida
Blood type diet
Lectin-free
Paleo (where is butter coffee – haven’t seen him around these days?)
Auto-immune protocol
Carnivore (I could go on but feel free to add any I’ve missed)
it should provide us with some perspective.
This is not the same as saying these don’t work for anyone or that there’s no merit to any element of these approaches in some patients. In fact, it’s often the case that these have stemmed from a scientific understanding of an aspect of health that was/is often overlooked by medicine. To boot it attracted some good google reviews from early adopters. Jane Does gives this diet: ⭐⭐⭐⭐⭐ But then that original insight or innovative idea becomes distorted & damaging through over-generalisation, misapplication, ignoring any evidence of the diet’s negatives and ignoring all other aspects – including the very individual nature of us individuals!
I saw this video of Jason Hawrelak & his patient, Alma-Jade, on socials the other day and I just appreciated it so much, So, I asked Jason if I could share it.
So, if you sometimes feel on the outer because you’re not always an early adopter, you might be amongst some good company 🤗🤓
Completely breaking up would have been easier for everyone. But cutting the cord isn’t an option because she’s everywhere. She remains essential, beneficial & yes, indicated in some patients as part of their prescription. But her ‘toxic nature’, exposed via excess supplemental intake, is something we shouldn’t turn away from either. So, a ‘situationship’ has emerged involving intense emotions, a lack of clarity & consistency about how we feel, the nature of this new relationship between B6 & us & accordingly, ‘how we should act’. I mean, are we even still friends?? Practitioners seem to be responding to this relationship shift in very different ways…
Ghosting – suddenly ceasing all communication, without warning or goodbye -removed from our shelves & thought processes seemingly overnight.
Slow Fade – gradually pull away, including B6 less & less in your thoughts about the nutrition of patients, either as a potential deficiency or as part of their remedy… then not at all
Benching – storing B6 in a mental “maybe” file or “just in case” folder, remembering the benefits she can bring to some patients but not willing to play her on the pitch right now.
Orbiting – No longer speaking directly… but obsessively watching from afar. Reading every article, every social media post, every case report, every opinion piece. Quietly consumed by everything being said about our ex
Either way B6 is orbiting us! Because even if we did want to ‘forget we ever met’, our patients bring her into almost every consult: they’re ‘seeing’ her, did see her, have experienced awful adverse effects as a result, or are filled with worry that they will. And we’re (rightly) rethinking every product on the shelf, including those we’ve used successfully for years with seemingly ‘no problems’ and reassessing them in this new light. This is tough terrain. Especially when it starts to erode our very own identity as the experts in nutrition.
The bar for attributing blame to B6 is currently incredibly low – and everyone is doing it. Any altered sensation? Are you taking anything with B6? You are? Well, bingo! This is where things are getting messy and very misleading
Even those ‘diagnosed’ by way of B6 blood levels, reveal to me, those doing the diagnosing have not read the research – because there is no concentration of any B6 biomarker that consistently in any way correlates with its neurological toxicity, for a start! I’ve heard B6 being blamed for paraesthesia that are not bilateral or do not fit the characteristic distribution pattern of small sensory fibre neuropathy (stocking glove +/- facial). Heck! I’ve heard of some that aren’t even sensory or peripheral, instead it’s about dizziness and altered hearing etc. Hellooooooo 📣 There is no convincing evidence that B6 toxicity produces central nervous system involvement — not in mechanistic work, not in clinical descriptions, not in animal studies nor the broader literature. I’ve been talking with many practitioners recently about this issue and how we should respond – to the valid concerns of their patients, to the very real threat posed by B6 containing supplements as well as the need to keep using these in some, to the enormous concern & confusion causedby these misdiagnoses.
One of the things I’ve been saying repeatedly is, ‘Remember you’re the expert in the room.‘
But, of course that’s only if you are. Being the expert is never permanent. It isn’t something you achieve once and then keep forever without effort. And of course it’s relative to who else is in the room. Nutrition as a science is wonderfully dynamic, & accordingly our understanding of something, can go ‘out of date’, seemingly overnight. So if you’re sitting with someone who’s seen a neurologist — especially one with a clear diagnostic pathway & ideally biopsy findings — and you haven’t kept up with this aspect of B6, your role will be to listen and learn. But if you have read the literature… If you understand what B6 toxicity is — and what it is not — and a patient’s GP is confidently pointing at B6 containing supplements while the clinical picture simply doesn’t fit… Then back yourself. Respectfully. Calmly. And get busy finding the real cause. 🔎
Because good clinical nutrition isn’t about choosing sides – It’s about staying evidence-literate enough to know when B6 deserves the blame and when it’s just an easy-out to accuse your ex of everything!
The mechanism behind B6 toxicity – the evidence from across the board Risk reducers – dose, duration, timing & how to co-prescribe to minimise risk Risk amplifiers including patients on certain medications The role of genetic susceptibility What ‘recovery’ looks like after reducing intake
The best questions to clarify the cause of any altered sensation The most common causes & their unmissable clues Other nutrients implicated in organic nerve damage including B1 B9 B12 & Zn The role of testing
The iron options available to us have undergone a ‘Grand-Designs-Scale’ reno. And whether your taste is for supplements that offer more food-like forms (I’m thinking an off-grid rammed earth, built into a hill) or you welcome nutrition borrowing from the best that drug development has to offer us (Neofuturistic architecture?) – there’s something for everyone! These novel forms parallel newly identified means of iron uptake in our gut which completely rewrite our ideas on iron digestion, absorption & regulation. So if you’re still choosing iron products based on:’ organic, soluble and in its ferrous state’ – baby your ideas are out of date!
Because lo and behold that’s not in fact how iron occurs in our food & Surprise surprise – our digestive system is designed for the forms that do
Those forms include iron di & tripeptides, members of the large family of ferritins from either animals or plants, in addition to dear old haem. That’s right, while there might be a sprinkle of (Fe) citrate in your kim chi, there’s no bisglycinate in your borlotti beans, no iron fumurate in your fennel & no (Fe) sulphate anywhere to be seen (unless of course someone snuck in some as fortification)! So all these, organic (except SO4), soluble and ferrous forms (except citrate) are reliant on DMT1 transporters and are actually at a disadvantage compared with our newly discovered funky food forms& the curious ways they find to get across the intestines.
Including a range of phytoferritins present in most legumes – especially soy and the common pea. Pea-Ferritin products anyone?
But this is just a small part of their story that you need to understand to know in which scenarios a supplement like this makes most sense. And equally the progeny of elite engineering: Iron Polymaltose (aka Maltofer) and Ferric Pyrophosphate nanoparticles (aka Sunactive, Lipofer) have their advantages in some patients and presentations and therefore also their place. As we wrap up the Supplement Boom Series putting all that we’ve learned into these final two episodes on iron has been nothing short of thrilling! 🤓
If Iron is important in your practice then you’re going to get enormous value out of these two recent episodes
One of our most popular past episodes explored the relative efficacy of the many iron supplements on the market. Since then, the landscape has changed dramatically. New and novel forms have emerged — including haem iron products, phytoferritins, nanoparticles, dermal patches, and more — each claiming to solve long-standing issues with iron interventions. In this episode, we begin by retracing the evolution of iron as one of nutritional medicine’s most commonly prescribed interventions. From there, we examine the renewed interest in food as medicine and food-like forms: molasses and grape syrup, offal, iron-rich herbal tonics, and naturally iron-containing mineral waters.
In this second part of our iron investigation, we take the following forms to task: haem, plant ferritins, iron polymaltose & nanoparticles of ferric pyrophosphate. Discussing in detail each of their unique dynamics regarding digestion, absorption and regulation of iron. Ultimately it answers the questions when to use each form and why.
Listen in as we revisit some of our long-held assumptions about what makes a “good” iron form and hold them up against emerging evidence that is reshaping our understanding of digestion, absorption, regulation etc. It’s time to rethink iron — and update old ideas in light of new science.
It always does! Turns out I rely heavily on those last few days of every month to get my homework done in time 😦 as many of my 11th hour Update and Under 30 timestamps will attest to! And this month (as is the case every other month tbh) I felt the topic was so important that I just couldn’t cut any corners. Yes folks we’re wrapping up our whole Supplement Boom Series applying all that we’ve learned to Iron – and this episode is overflowing with aha moments 🧐
🎤Brand spanking newly discovered uptake mechanisms for more diverse dietary forms
⚡How even endocytosis uptake of the entirely engineered forms – don’t escape regulation
💥The precise pocket that each of the new forms (Pea ferritin, Iron polymaltose, FPP nanoparticles) would be the perfect fit for in terms of your patients and their presentations!
💡The option for daily dosing back, and even combining with iron’s key competitors could be back on the table with certain forms!
Ok that’s the extent of the words I have left right now…February ate all them too!!
One of our most popular past episodes explored the relative efficacy of the many iron supplements on the market. Since then, the landscape has changed dramatically. New and novel forms have emerged each claiming to solve long-standing issues with iron interventions. In this second part of our iron investigation, we take the following forms to task: haem, plant ferritins, iron polymaltose & nanoparticles of ferric pyrophosphate. Discussing in detail each of their unique dynamics regarding digestion, absorption and regulation of iron. Ultimately it answers the questions when to use each form and why.
Listen in as we revisit some of our long-held assumptions about what makes a “good” iron form and hold them up against emerging evidence that is reshaping our understanding of digestion, absorption, regulation etc. It’s time to rethink iron — and update old ideas in light of new science.
You can purchase New Iron Offerings – Novel or Nonsense? here. If you are an Update in Under 30 Subscriber, you will this episode 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 resourceshere.
While we’re on the topic of perimenopause –and will we ever get off it btw because quite frankly there’s so much that needs to be said?!– I need to bang the drum some more about bone health & our role in that. During our recent all-things-peri-education-event I said, this is the time when our bones adopt the ‘brace position’. You know the one before the plane crashes?🛬 Unless. Unless we use it instead as the ultimate window of opportunity to preserve the existing BMD – better yet, even build on this, which, of course, only resistance training can claim.
So let me guess what comes to mind supplement wise for preservation of BMD?
Vitamin D? K2? and Calcium?
Most of us are well past the point of believing that it’s just about taking enough of these 3. Neither the evidence nor our own clinical experience supports that. Bone metabolism & its heath is far more multifaceted and, in particular, nutritionally complex than this. So while I left the crude Calcium concept (you know, it’s the major mineral component so load ’em up) for dead a long time ago, I use Calcium almost always during perimenopause for two reasons. Firstly, most women’s intake is grossly inadequate – and I am talking here with respect to the most well-supported recommendation for daily intake and optimal bones of 800mg, not the ridiculous RDI (this is something we discuss – all RDIs and how to rationalise these in light of levels of evidence in the Nutrient Prescribers’ Program – so if you want refs just ask). The second reason to prescribe Calcium is to put pause on any increase in PTH & therefore STOP! its pilfering in its tracks. Like right here right now in this moment.
PTH is an acute responder to any dip in Calcium …Within seconds it surges Within minutes the GIT becomes ‘leaky’ to increase Calcium’s paracellular uptake Within 1-3hrs the bones have been tapped
PTH peaks first thing in the morning partly in response to an endogenous circadian rhythm but also because, quite simply, we’ve been fasting and no new Calcium has come into the system. So what if we extend our overnight fasting? The PTH gets higher and stays up for longer, resulting in more negative impact on the bones. And SO many women have embraced TRE or at least extended overnight fasting – for good reasons, right? But are you assessing the impact this is having on one of the most modifiable risk factors for osteoporosis? I am and I’ve just had this conversation again with yet another woman. We had sequential PTH measures one at 7.20am (PTH 4.7 pmol/L), one at 8.30am (PTH 5.3 pmol/L) – both are too high for optimal BMD preservation. But the real issue is she doesn’t actually eat her breakfast usually until about 10! This translates to a very long period of exposure not only to high PTH but peak cortisol concentrations to boot. She was taking enough Calcium (and doing everything else right) but I had to tweak the timing of her first dose… and then we had to try and reconcile this with her TRE.
For a patient like this with that tendency for the PTH to push up too high – the 1st dose of Calcium must be within 2hrs of waking
Compared with other supplements it’s an easy one to take (not a gastric irritant like some) & with just 50-100ml of whatever milk or substitute you prefer is an easy ask before hitting the gym or the pavement or the desk! Alternatively, of course, if someone is not adhering extended overnight fasting, you just bring breakfast forward & ensure it’s a calcium rich choice. This is what I mean when I say science drives the most successful prescribing…not the bad most basic of nutritional science that SCREAMS, ”Deliver Ca to those bones like a concrete-mixer. Just pour it in!”
Nope.
The exceptional science that reveals the real nuance of how nutrients work and how then to employ them to achieve the very best results.
And if now you’re rushing to reach for Calcium but have questions about best form and dose, duration and combinations…and are hungry to experience the same level of confidence prescribing all the other nutrients to boot…well might I suggest 🤓
The Nutrient Prescribers’ Program offers you a complete revolution in the way you practice Dynamically delivered across 11 modules which will answer just about every question you’ve ever had (What form? When? How much? How often? For how long? What with?) And all the others you haven’t thought about yet!
Or want to understand the parathyroid better as well as be across some other common things missed or ‘mistaken’ as menopause? Yes? Then check out this episode
It’s 2022 and I am celebrating my 50th with friends. Within just a few months of this I have left a 14 year long relationship & relocated to a new town where I know no one. Next up, I’m undertaking an 11 day solo hike across the island of Kythira in Greece and at its completion I call a meeting with my team back in Aus to say, ‘It’s over. The thing I have loved doing for so long, group mentoring, it’s a wrap.” With each and every seemingly sudden decision I made across this period, the spectrum of responses included surprise, disbelief and shock. And numerous times, I genuinely asked myself, ‘Is this a breakthrough or a breakdown?’
I’ve never experienced vasomotor symptoms, even cycle changes of any great significance, nothing that might act as some kind of signpost. So like so many other women, I wasn’t able to know it and name it, for the most part.
But this is perimenopause.
All I had was what I was experiencing: a dramatically reduced bandwidth. Not the classic irritable woman trope. Just that I couldn’t do as much without some kind of inflated cost to myself which came in a variety of forms. And when I overrode ‘new me capacity’ with ‘old me expectations’, the wheels started to wobble, especially cognitively. Scary sh*t, right? When Rhiannon and I spoke this week on perimenopause to many of you, I mentioned I dislike the term ‘brain fog’ as a description of what happens for women during this stage. It’s diminutive. Minimising. Yet the evidence of its impact is breathtakingly BIG. Almost a third of women during perimenopause cut their work hours and more than 1 in 10 consider quitting work altogether. In addition to this, suicide rates jump up by 48% in women between the ages of 45 and 54 – where for men it increases only by 1.4%. This is not just some kind of bad mood of middle age – it’s a FEMALE physiological rollercoaster.
Amongst the attendees at our event there were a few tears being shed, as several shared with me afterwards that literally it was our conversation, right here, right now, that had enabled them to see at last, their own perimenopausal picture.
Me too
It wasn’t until we were prepping for this perimenopause conversation that I literally learned my increased susceptibility to injury with exercise over the last year comes courtesy of the same bloody carnival-house-of-horrors-big-dipper mash-up. Again, thanks Rhi! And what about my cognitive concerns and what, early on, seemed like a pathological drop off in drive?? I was lucky. Without knowing what I was doing , all those big decisions I made from 50, turned out to be the right ones, in the sense that I deloaded. Which just happens to be my top rec for all women during perimenopause. Wherever and in whatever way they can – accept and better yet embrace the ‘new you capacity’. Because once I did this my cognitive concerns etc disappeared and I realised there’s nothing wrong with me just what I was asking of me… and what the world asks of women too, by the way.
Anyway, I normally wouldn’t have posted such a personal P.S but some of you shared so honestly with me, I felt anything else wouldn’t be right. A big thank you to Give Back Health for such an innovative format than enabled something more valuable to be shared. Let’s keep the conversation going.
Just back from my 6th…🤔 or 7th… trip to Vietnam. But this one was different – made all the more special, as I was visiting family🤗 Which meant I got to eat and enjoy things, I myself, despite being there so often, was never previously game to try mostly due to the ‘what exactly is that’ factor! Apart from being simply DELISH real-deal Vietnamese cuisine reminds me of some core health eating principles that I like to aspire to at home.
There’s always room for more Greens
We could — and should — always add more. Into the hot pot or the pho. Wrapped inside or around that crackling savoury pancake. Or simply piled high on the table for everyone to help themselves. I mean, my usual ratio of Added Greens : Actual Dish is already pretty ambitious. At home, whatever I’m eating is typically buried under rocket, baby spinach, and whatever fresh herbs I can get my hands on. The “main meal” often functions more like structural support. But the ratio in Vietnamese cuisine defies both maths and physics. A platter of greens arrives that dwarfs the original dish. Mountains of mint, Thai basil, perilla, lettuce, water spinach. You add a handful. Then another. Then another. And somehow… it all fits. Greens as far as the eye can see! Not as a garnish or an afterthought but a ‘do not pass go do not collect $200’ directive!
And growing your own is essential to feed this level of ingestion addiction
Whether it’s a small plot on an abandoned lot, a couple of polystyrene boxes on the footpath, a window box in an apartment up high – everyone tries to grow their own Greens.
Dine out on Diversity
That’s right – that’s Greens –plural. It’s a tumbling twirling ever-changing and inclusive mix! So inclusive that even non-greens, like beansprouts and long curls of finely cut banana blossom are welcomed into the fray. The mushrooms incorporated into dishes are multiple varieties rarely ‘mono’ and noodles ain’t noodles, though they may look similar, made from regular or red rice, tapioca, wheat etc. And while pork is a firm favourite amongst many, there’s all kinds including snake, eels and snails.
And if we’re going to eat the Animal – Eat every bit of it
No muscle-meat madness like most of us silly whities in the West! Prawn heads are a delicacy and of course, offal is everyday fodder, with cubes of blood common, entrails as well. Nutritionally superior, environmentally sensible. While I do a bit better each time I visit I still have a long way to go on this one!
Plant proteins accompany the animal ones
Other dishes feature tofu, peanuts, mung beans and other legumes – not as an alternative but for everyone as an add-on to any meal.
Small bowls allow endless sampling from these smorgasbords!
Yet another aspect that seems to defy physics. You eat and eat and eat your fill…but you don’t overeat! Thanks, in part, to the tiny bowls and chopsticks no doubt!
There’s a lot to love and learn from other cultures and their cuisines ❤️
Image c/o Stephy Nguyen❤️ – thanks for making me eat eel!🪱
Not just differently in terms of how we view other peoples’ success but also how we recognise it within ourselves, orwhere we perceive ourselves to be in relationship to that ‘goal’. Our ‘identifiers’ will be as unique as we are. What we’ve had modelled within our family, first & foremost, then maybe our peers and our profession. We renovate and remodel our ideas as we go, through our own experiences & evolution.
I asked AI to list the most successful naturopaths in Australia & a ‘curious’ conversation ensued...
The first list it generated crowned Amie Steel our 👑 thanks to her incredible contribution to research & academia. Next up an extremely high-profile naturopath that, no doubt, came to AI’s attention as a result of the enormous number of ads they run. Last on the list, a dragnet of names pulled from association newsletters and other media. However, not ALL associations, just ANPA and NHAA?! And nobody tell him, but Kerry didn’t make the cut 🤐
When I pointed out this omission (and several others!) the LLM always of course had an answer…
It went along the lines of, “Oh, I see the problem, you’re defining success differently” Naturally, followed by, “I can generate a new list based on your definition” (just you watch😂)
But throughout this exchange I was force-fed clues about how ‘it’ would define success, including some brutal-truths apparently I needed to hear, such as, “Clinics alone rarely compete financially with product, IP, or corporate power.” Am I being overly-woke & it’s actually just all about the cold hard Ca$h?…I’ve seen behind the veil too many times to be fooled by that one. Attributions of success based on visible bling can blind us to the rest of the story.
I’ve sat with a LOT of naturopaths I would regard as successful.
I’ve seen their success take different shapes & forms – independent of their income
For example, 20+ years of consulting that has seen them through all the stages & phases of their family life, with the flexibility they needed. Or establishing a practice that was able to employ others, better yet, ‘bring them up’ with loads of support, informal mentoring and great modelling that can otherwise be hard to find in our profession. There are those whose love of learning & growth ensured they found all kinds of pivot points along the path – resulting in time spent in corporate, in academia, in aspects of associated industry etc. Then there’s those that started out in stella-supporting roles for others, running those desks, those dispensaries, those website dashboards like divas! – only to at last be ready to take flight and do the thing they wanted all along – be in practice. And, of course, there are amongst us some awesome entrepreneurs who might make it look like they’re living it large on 🚩Easy St, but in fact, they are themselves absolutely extraordinary powerhouses fuelled by their own sense of purpose. And these are just the conversations I had last week!
Tell me what shape and form has your success taken?
Seriously, hold my beer. A pattern has come to my attention that warrants calling out. A social media manosphere of sorts. You see I have these ‘Facebook fellas’, let’s just say, who appear out of nowhere, as in, they are not people I know, not in truth even my peers, & certainly not people with academic or experiential acumen I might look up to. And they only materialise on my posts in the comments section to execute what they seem to think is their big mic drop moment. Their comments go,‘HEY! HEY YOU! YOU’VE GOT THIS ALL WRONG. I UNDERSTAND IT BETTER. LISTEN UP!’ Yes, bold & CAPSLOCK-all-intended because, while plain text doesn’t possess tone, it apparently can deliver at different decibels and comment such as these are always dialled up to DISTORTION.Well Chuck, or Chad or Hank or whatever your name is. I tell you what you clearly don’t understand…
Evidence
Science
Nutrition
Academic Discourse & Debate
let alone Basic Manners or Online Etiquette
And sorry but it has to be said….
Women’s Health Better Than Women
Because to have whatever-his-name-is tell me, and all women, for example. that if we need to use iron supplements we don’t actually understand iron and we’re doing it wrong…well…. For those of us that have spent years studying nutrition as part of our qualifications, then yet more years, if not decades, applying it in the real world, while always updating our understanding based on the very latest evidence…while perhaps even in countries affected by food insecurity and most of our lives menstruating…well we may beg to differ. But the real rockstar ‘tude is when I actually take the time to engage, offering some alternative things for them to reflect on and respond to, about physiology or pathology or the intricacies of a micronutrient’s LADME+R and their response. Well there isn’t one. So I’ve stopped taking the bait.
Because they’re not here to engage in an intelligent exchange – they are here to dominate They don’t want to discuss – they actually want to shout you down – shut you down And they’re certainly not here to learn…
So let me say this, if this is your MO my mansplaining FB Fellas get out of my comments and off my page….because as one of your better brothers, Bruce Lee, put it “A wise man can learn more from a foolish question than a fool can learn from a wise answer”.
By the way…these ‘FB FELLAs’ don’t actually look like this according to their profile pics…but ‘it’s the vibe of the thing’…right?!😉
