Luckily I still had the file. After seeing patients for a couple of decades, I have to get periodically ruthless with the shredder for those I haven’t seen in a long time and 7 years qualifies as a long gap between appointments but when I saw her name in my calendar, I knew exactly who she was and had clear a sense of where we had left off…somewhere I regarded as the early stages of treatment, in the sometimes vast space of no man’s land, a long long way before done. Where had she been? Why was she coming back? Hadn’t my attempts to treat failed?
I’m sure we’ve all thought about the patients that don’t return and effectively disappear, after the first, the third or the sixteenth appointment. Chances are, there is often some sense of failure…’I failed in keeping them engaged in the process’ or ‘I failed to get them the results they were after’…and certainly sometimes, ‘they failed to undertake a perfectly good management approach because they weren’t ready.’ But this is really just left up to our imagination & we tend to fill in a lot of gaps with our particular bias.
We’re both full of smiles when she enters. It actually feels like reuniting with an old friend, because the rapport building it turns out has a long shelf-life (for both of us). She’d moved interstate, then back again and today she has traveled over 2 hours to come and see me. She likes me, she’s in fact fond of me and therefore she proceeds to share deeply what’s happening for her and I feel so honoured that I am trusted in this way with such personal information, but I am also a little surprised. Didn’t my treatment approach fail? And then she drops the biggest surprise bomb of all… (more…)
Sometimes we wonder who put the invisible sign up out the front of our practice, right? The one that says…absolutely everyone with Condition ‘Z’ come and see me, now! I’m sure you know what I’m describing. Well this week I have hit the trifecta, performed a neat little hat-trick and diagnosed 3 patients with Gilbert’s Syndrome who all present in their own individual way but actually each one also with quite a textbook Gilbert’s picture, it almost beggars belief. Have a little look
70yo Female says: Since childhood she has felt like she has had a rock in her stomach after she eats. This ‘rock’ is there for hours. Her stools are never the same in spite of a regular diet and she has always been uptight and anxious. All her bilirubin results are in the 20s & she reports she’s ‘always’ had high values
55yo Male with severe ‘constitutional anxiety’ and surprisingly high oestrogen and a worrisome profile of oestrogen metabolites. His bilirubin is in the 20s
30yo something Female presents with unexplained severe unwellness for 20yrs that mostly involves nausea, bloating, a functional gut disorder without a real diagnosis, anxiety, depression and poor stress tolerance. Her bilirubin fluctuates between 30 to high 40s. (more…)
When Dr. Christabelle Yeoh says, ‘Hey, we all need to up-skill in Mitochondrial & Metabolic Medicine, Gut and Immunity & Healthy Ageing,’ and then invites a dozen or so absolute experts in each of these fields to speak at the 8th Science in Nutritional Medicine Conference…I listen. Ok to be fair I listen to everything Christabelle says because she is one of the clueiest & most effective integrative GPs I know, however, I do think if you like being on the front-foot of medicine and research and you’re dealing in these complex areas, then this is really a stellar line-up. Check this out
Dr. Rob Roundtree – of IFM fame
Dr Sebastian Brandhorst – heard of the Fasting Mimicking Diet? This is the man.
Associate Prof. Ross Grant – haven’t heard him talk on specific nutrients & the brain? It’s a must
Prof. David Cameron-Smith – connects ALL the dots in ageing..from individual nutrition to the global environmental impact and back
Check out the full list of speakers and program here
So I’m also excited to say, because I am on the playlist (minor B side role)… YOU GUYS GET A DISCOUNT!! (more…)
I’m packing the bag and getting my ‘roadies’ ready……well, not really but it would be great to have one or three!
I’m super excited to be going on tour in May with Nutrition Care and introducing new clinical tools I’ve been developing to help you master the maze of mental health, and what a maze it is! With so many possible biological drivers: from methylation to inflammation and from gonads to gut, these tools can help you quickly identify those most relevant to each patient and also outline the strategies necessary for redressing these.
This year’s theme for Nutrition Care is
Mastering Mental Health: New Assessments and Management Resources in Your Clinic.
I’ll be visiting all the major cities again and I’m especially excited about coming to Newcastle and the Gold Coast! Can’t wait to see you all and pow-wow about what I’ve learned about mental health management.
Better than online.
When we’re all in the same room is when the magic happens with a true sharing of our experiences and knowledge.
The words together with the horror on her face made me feel instantly nauseous. I’d been internally debating for months now if I was simply imagining things and intellectualising about how this just might be the case… observing myself looking in the mirror more often, getting closer to the mirror, brushing my hair more often, cleaning the brush more frequently…in psychology it’s called something like confirmatory bias…ah yes just enough psych knowledge to be a danger to myself!
But louder than the chronic self-analysis and attempts at reassurance was the voice that said, ‘You’re losing your hair like an old woman. You’re not even menopausal. You eat fabulous food and have too much energy for your own good but you’re starting to look like you’re ill’. The horror. I felt instantly like a fraud. (more…)
I was just reading the results of a spot Facebook poll of GPs asking what the most wonderful medications ever invented are. Once everyone got the customary “caffeine” gag out of the way, the rest of the nominations and auspicious award winners unfolded like a who’s who of the modern medicine prescription pad. Naturally, Penicillin took out first prize (no surprises there unless you’ve been living under a rock…a very clean sterilised one at that that!), one vaccine made the top 10 but I thought there were a few unexpecteds in here:
1. Penicillin “Because of it, entire nations can now afford to worry more about diseases of old age rather than infection. Penicillin’s success ushered in the era of modern pharmacology. To be fair, alongside antibiotics were profound improvements in housing and sanitation.”
2. Smallpox vaccine according to the author of this poll Dr. Justin Coleman,”was a triumph of research, pharmaceuticals, human cooperation and public health planning.”
3. Contraceptive pill for changing the lives of women all around the world. True but BOY does it change it for the worse in some!! (more…)
I think we’re all going to scream when the next patient says, ‘I’ve got an MTHFR’, right?!
Congratulations, I want to say, because you would be in much more serious trouble if you didn’t have a copy…
‘Oh, sorry, you mean you have a mutation on at least one allele encoding for the MTHFR enzyme…Oh, I hate to tell you but contrary to popular (online) belief, you’re not special.’
“I always give some Glutamine to heal their leaky gut”
Cue pained expression on my face. No, I’m not a fan. I take that back, I have no problem with the amino acid itself and I’m still in awe of its incredible multifaceted role in the gut. What I do have a giant issue with is the mismatch between everything we are being told Glutamine is going to help our patients with, and the dosages that apparently will do that, and the reality. I know, I’m attacking the Holy Grail of Gut Health 101….right? But it’s time to set the record straight. Firstly, where’s the evidence at in terms of Glutamine interventions in GIT pathology, particularly in relation to reducing excessive intestinal permeability and improving lining integrity Well if you’re a rat – Good news! Rats’ GITs have a greater dependence on Glutamine than ours, a deficiency of this amino produces clear reproducible negative effects and supplementation fixes these brilliantly!
But if you’re treating humans not rats – well – the evidence & the case for Glutamine for the Gut is not so straight forward or impressive. (more…)
They’ve just come from the immunologist, having presented with extensive vitiligo in dad and early stage vitiligo now in their primary school aged son. The immunologist, without running a single blood test, told them, ‘Bad news, you both have autoimmune issues and watch this space because the vitiligo is just the first presentation, there will be more to come’. Slightly unsatisfied with this dead-end conclusion and non-existent management plan, the family then presents at a long established naturopathic clinic to see Anna Sangster, a fabulously sleuth-like detective, who takes her patients’ health very seriously and has the knowledge and skills that make her one of the best at what she does. I can say that because I’ve been mentoring Anna for a long time & she is one of the clueiest practitioners I know.
For example, she knows about the substantial research demonstrating the overlap between thyroid autoimmunity and vitiligo and, in addition to comprehensive case taking, decides some blood tests may provide valuable insight that would help to understand the degree of self-attack from their immune systems, identify if there are in fact already concurrent autoimmune targets and perhaps even provide a clue as to underpinning drivers. Well, look what she found! (more…)
Just finished talking with the fearless fertility naturopathic specialist, Rhiannon Hardingham, who wanted to let me know that after listening to my Update in Under 30: Silent Reflux she’s had a lot of success treating both GORD and insomnia in her pregnant patients. That calls for double the celebration …YAY! YAY!
‘What’s the magic answer?’, I hear you ask… (more…)
That’s me…always questioning the ‘status quo’ and Iodine is the perfect example! The interview I did on this important subject with Andrew Whitfield-Cook from FxMedicine, covers a lot of key areas of confusion & underscores why it’s so critical all health practitioners get clarity on this topic. ‘It’s just a matter of geography’.
You know, I say to people, we can make vitamins ourselves, we can get all sorts of other organisms including animals, bacteria and plants to make vitamins for us, and then eat those…but minerals…our source of minerals…well it all comes down to the rocks and the soil our food itself is grown or fed on. And iodine is profoundly influenced by these factors. (more…)
I promised I would keep all you fellow desk workers posted. Over 6 months has passed since I started standing for work….and I LOVE IT!
Here are the pros I can wax lyrically about so far:
- Back ache from long days at the computer, gone…seriously
- I am more energised about coming to work, starting work, staying at work…because I am not sitting! YAY! I move around…everyone I meet with on Skype will vouch for that!
- I am fitter & stronger as a result of standing for approx. 35hrs a week ( I know this because it took a while to develop this…after the first 2 slightly grueling weeks!)
- At the end of a long day/week, my mental fatigue and physical fatigue finally match – which means I am no longer brain-dead but in desperate need of a run around the block! The previous mismatch used to make winding down etc hard
- I get to actually walk my constant talk to patients about being active, avoiding sitting etc. Soooooo much better than sitting there for client after client and saying…’you know you really should move more!’
- And at the end of a big day…sitting never felt so good…it’s been restored as the luxury item it should be 😉
Here are the cons I can also attest to: (more…)
No, I haven’t gone crazy for the ‘caped crusader’… but I thought that would get your attention…. oh look it did! 😉
I’m off to Melbourne for the ACNEM Conference May 5-6th and Batmania was one of the interim names of this very cool and happenin’ town before it became known as Melbourne in 1837! Things have certainly changed in nutrition and the environment since then and as practitioners we now need to address sometimes very complex dynamics between genes, gut, nutrition and environmental health. Which, luckily enough this conference is all about!
This year’s theme for ACNEM is Health for Life – Mastering the Integrated Approach.
I am fortunate to be included in the exceptional speaker line-up (thanks for lovely sentiments many of you have expressed so far about that 🙂 ) I am presenting on ageing..which many of you know that I am suddenly now very interested in…getting old and all.
Ok now you’re getting mad at me, right? Because how many ‘absolute givens’ can I debunk?! Last Update in Under 30 certainly got people talking…giving iron less often rather than more often to our most iron deficient patients seems counter-intuitive, right?! Wrong. And as part of the influx of emails I’ve received from practitioners who listened and loved the podcast, came a flurry of great questions – like this one from Michelle Toocaram:
“The Moretti et al study was done on ferrous sulphate which I would never use as it has poor bioavailability. Are there any studies on better forms such as ferrous glycinate etc”
It’s a perfect question – because of course the success of most mineral supplements is largely determined by the form the mineral is presented in – so comparing the same dose of, for example, Calcium carbonate with Calcium citrate is a bit like comparing chalk and yoghurt! The substances that minerals are bound to, generally play a huge role in determining the amount you will absorb from that product and therefore the degree and speed with which your nutritional status will improve. But is that the case with iron? Not quite. (more…)
“Researchers followed more than 500 women trying to conceive over about five years and found that, overall, those with moderate to severe iodine deficiency had 46% lower odds, per cycle, of becoming pregnant.”
All researchers dream of generating the kind of results that are ground-breaking but sometimes you read about the latest study’s findings and you think, ‘Really, you spent all your time & cleverness for years on this and that’s all you have to show for it!’ Like the study that finally confirmed dog’s can feel empathy (at last thank goodness …phew…cos I had my doubts until they crunched the numbers!)
So too a study published this month on the possibility that iodine deficiency is common in women trying to conceive in developed countries and may be connected to increasing fertility issues.
Stop press! I know…that made you spill your coffee! (more…)
Is this the way of the future for health practitioners interested in patients’ digestion…?
“The team developed an ingestible electronic capsule to monitor gas levels in the human gut. When it’s paired with a pocket-sized receiver and a mobile phone app, the pill reports tail-wind conditions in real time as it passes from the stomach to the colon…The authors are optimistic that the capsule’s gas readings can help clear the air over the inner workings of our intricate innards and the multitudes of microbes they contain. Such fume data could clarify the conditions of each section of the gut, what microbes are up to, and which foods may cause problems in the system. “ (more…)
If you receive the free Medical Observer newsfeeds you’ll know what I’m talking about. Here are some recent headlines:
I stand accused of rorting Medicare. This is what it’s like
A GP is sued after doing everything right — except her notes
After-hours funding shakeup
‘We’re becoming unviable,’ says GP hit with $22K e-PIP repayment
This Christmas I wish for doctors to feel valued again
So the answer is, probably. Tales direct from the trenches that I hear from GPs, suggest it is increasingly difficult to make a living without adhering to a crazy volume of <10min appts, without being sued (too often) or dragged in front of AMA or APRHA. I hear them and know that the increased pressure is coming from multiple angles and I think it is very sad that previously such a respected and valued role in society appears to be ‘losing its value’. Don’t get me wrong, I don’t agree with the old ‘Doctor as God’ model and think it ‘s very unhealthy actually for patients, but I feel like GPs with all their extensive training, knowledge and expertise are in urgent need of an Oprahesque ‘new dawn’! (more…)
Just because most of us have been on holidays doesn’t mean the thyroid knowledge wagon has stopped or even slowed! Always amazed at what we continue to discover about the complex working of this amazing gland and how its health impacts so much of the rest of the body and of course our babies’ bodies! So I thought I’d give you a quick recap of an important study published while you were at the beach/in the bush/in bed ;)…
- A Finnish prospective cohort study of over 3000 pregnancies by Heikkinnen et al has revealed that at 16yo, offspring from these pregnancies, had a 1.56 increased rate of unhealthy weight and a 2.5 greater likelihood of meeting criteria for metabolic syndrome, if their mothers were thyroperoxidase antibody (TPO) positive during their first trimester
- TPO antibodies affect up to 20% of pregnancies but in this study they defined ‘TPO positive’ as those women with levels ≥ 167.7 IU/mL (the 95th centile in this sample)
- What adds to the noteworthiness of this news is that:
- More than half (55%) of the TPO positive mothers were classified as euthyroid during their pregnancy, suggesting that the effect was not driven by maternal hormone concentrations
- The offspring of mothers with actual thyroid dysfunction did not show any statistically significantly greater risk of cardiometabolic issues
- The offspring of hyperthyroid mothers in fact demonstrated significantly better insulin sensitivity at 16yo than children of euthyroid mothers
- Thyroglobulin Abs over the 95th centile (≥ 47.7 IU/mL) did not correlate with any increase in cardiometabolic risks for their children
When we consider the substantial evidence of poorer maternal cardiometabolic outcomes for women who are hypothyroid during pregnancy – it would seem that the abnormal thyroid hormones are most impacting for mum but in fact the TPO Abs the most detrimental for bub! (more…)
I’m getting a sore neck from this, but looking back at 2017 and looking ahead to how I want 2018 to be, is of course perfectly appropriate for this time of year.
And if we don’t take this opportunity for a little bit of reflection and review then we risk our growth: both personal & professional.
Looking back, as always there were both highlights and some lowlights – highlights for me included receiving the BIMA lecturer of the year award, being asked to speak in Europe and getting out from behind the computer and coming face to face with more and more practitioners as I toured around – sorry webinar junkies…but long live LIVE REAL PRESENTERS & PRACTITIONERS! Lowlights? Well they included of course the private health insurance reform in Australia…enough said. (more…)