Isn’t it always the case that when something takes on personal significance – ‘we’ give it more attention? Whether that ‘we’ is a country, a group of researchers, a practitioner or a patient. Let me explain…
🌍Denmark, among many other European countries, I love your hyperfocus!
Having regulated Nickel content of certain consumer goods since the 1990s they continue to monitor compliance, exposures, calculating not only food content but other sources and correlate changes in these with the impact on Danes & their Nickel related dermatitis!! Recent research, for example, picking up that many common kitchen kettles were leaching Nickel – which lead to their subsequent removal from sale! Sadly, ‘down south’ there’s no such regulation or interest and so our ongoing Nickel exposure continues to go unchecked.
😎😎 Two retired scientists personally affected by severe Nickel Allergy, motivated to make more information available for everyone – I can’t thank you enough!
These two researchers have together created the most up to date, evidence based, full referenced Nickel food tables in addition to a bunch of other invaluable resources for practitioners and patients alike…helping us take huge steps forward in understanding how to undertake the Low Nickel diet with the scientific rigour it requires. And as part of this, identifying previous invisible sources of oral Nickel exposure by way of our SUPPLEMENTS!😲 Yes you heard me 😥
👩⚕️The practitioners who keep bringing me their Nickel Allergy cases & sharing the success stories of our approach!
You know who you are! Since learning about Nickel allergy you’ve become dogged in diagnosing in your patients with skin/gut presentations and determined to do better all the time! I salute you and I celebrate your successes with you! 🤓
🤕The affected patients who continue to teach us about Nickel Allergy by way of sharing all their experiences
So thanks to everyone above 👆 I keep learning & expanding my understanding, my tool kit and can keep sharing these with you – check out the latest Update in Under 30 to reap these rewards 👇🤓
New Tools For Lowering Nickel
As many of us move into a new area of practice, the recognition, management and treatment of Nickel allergy, we find ourselves in search of more scientific support. Given most of our patients will not have access to the proper investigations required to confirm Nickel as the culprit, there’s almost total reliance and emphasis on the diagnostic dietary intervention: The Low Nickel Diet. Questions about how to undertake this correctly and in a way that ensures sound conclusions are reached, in addition to, the equally important question, ‘What happens next?’, are answered in this episode which is accompanied by the very latest referenced Low Nickel diet resources
You can purchase New Tools for Lowering Nickel here. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Back when I used to go to parties, I remember the kind of things that got passed around 🤐 but these days the nature of the shared-substance has changed… Activated charcoal, anyone?!😶
Sure this says a lot about me and even more about the kind of people I hang out with…others also full of gas?!!😁 But seriously…would we all benefit from a bit of ‘burnt organic matter’?
To know the answer to that we would first need to answer these:
1.What exactly was burnt to produce this?
2.What type of ‘activation’ was applied?
3.Does the end-product now meet the definition of medical-grade AC? (radically different in composition, structure, function & therapeutic benefit)
4.What are you presenting with, or in what way are you hoping to benefit from taking this orally?
Because if you or someone you know is still using this to ‘relieve gas, flatulence, bloating etc’ or as a heavy metal chelator, or a general detoxifier, or a hangover cure, or a teeth whitening agent, you might want to point them towards a better prescription. But let’s not throw the baby out with the bath water! Let’s learn also about its strengths and applications as much as its myths and limitations!! So that at the next party you know whether to partake or not!!
Activated Charcoal Anyone?
Activated charcoal has had the most incredible and long-lasting medical career! From the good old days of 1550 BC in Egyptian medical writings to modern day medicine, where it remains part of the essential emergency room arsenal for treating overdose of many common drugs. And right this very minute it’s hitting the headlines (and the hype) again. But between these timepoints we’ve come to learn a lot about its structure, function, application & limitations.
You can purchase Activated Charcoal Anyone? here. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
These days it’s all about who you know right? So if we applied that same mindset to rating and ranking our organs then the kidneys would’ve amassed the largest number of followers, ‘top fan badges’, likes, watches, you name it. The kidneys are nothing if not ‘connected’ – with reciprocal relationships with our vascular, neurological & respiratory systems, liver, haematopoietic tissue and…🥁
We’re forever in debt to the 1960s ✌ The decade that brought us all peace love and mung beans but more importantly (!) an awareness about the connection between our gut and our kidneys.
Their union becoming more ‘official’ when someone first applied the term, ‘Gut-Kidney Axis’, in research around 2010 and ever since attracting the attention of researchers, nephrologists and now naturopaths alike! These two organs are involved in significant ‘job-sharing’ which typically works well for us, ensuring our survival (generally a feature of a good day at the office in my opinion!) through their combined efforts of noxious waste removal. This is especially when they both ‘bring their A game’. Many of us know that in severe renal impairment the negative ripple effects on gut function are substantial but how often are we thinking about it the other way around. How does the gut dysfunction or disease in a patient actually drive renal impairment? Let me count the ways!!
There’s a rapidly growing body of evidence attesting to the causative, or at least contributory role, things such as coeliac & inflammatory bowel diseases, abnormally increased intestinal permeability, dysbiosis and even periodontal disease can play in causing kidney conditions, and more generally, chronic kidney disease (CKD).
This places our food preferences, our bugs, their biome, by-products and our barrier integrity all at the forefront of the gut’s ‘good guy’ status when it comes to kidney care. This is important to know, not only for the purpose of understanding why someone with ‘no traditional CKD risks’ presents with CKD but also to arm us with solutions and opportunities for course correction when they do. I started this conversation in last month’s Update in Under 30 episode: CKD- Causes Catalyst & Contributors, talking about our urgent need to ‘broaden the lens’ when working up cases of CKD but in the latest episode I’ve taken a very targeted look just at the role of gut dysfunction and disease – including a very intentional discussion of IgA nephropathy (a strong link between the two) that is grossly over-represented in Australia and NZ and therefore a ‘must know’ for us all 🤓
When GIT Dysfunction Drives Kidney Dx
The gut is a ‘good guy’ when it comes to supporting renal function for the majority of us via a balance of bugs, their beneficial by-products and an intact barrier. Additionally, there is direct job-sharing with respect to elimination of wastes. However, if the gut ‘goes down’ due to disease or even, on occasion, just dysfunction, this can then add substantially to the vulnerability, burden and risk of renal decline. The gut-kidney axis offers many advantages including a key point of indirect access for treatment of renal impairment when this bidirectionality goes ‘bad’. In particular we take note of IgA nephropathy – a prevalent and under-recognised cause of intrinsic renal disease that is a potent illustration of this.
You can purchase When GIT Dysfunction Drives Kidney Diseasehere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
I know you haven’t heard a lot from me of late. 📢 I repeat I been BUSY📢 . Anyone currently undertaking our Nutrient Prescriber’s Program this year or Cracking the Case Series will vouch for that and fill you in on the insanely dynamic details!! But something has come to my attention that I can’t keep quiet about..
🤸♀️⭐Man we’re awesome!⭐🤸♀️ Seriously.
I am just back from the NHAA Summit so I am understandably all inspired all over again but this is not limited to those on the stage. In fact, as impressive as the ‘big names’ are – there are some other names you may not have heard of, or that shall not be mentioned because they would simply wither with embarrassment but impress the pants off me, that make me burst with pride to be a part of this profession. Here’s just a taster (with names and details slightly changed to avoid unwanted attention!! 😉)
The 50 odd (in number not in nature!) naturopathic students that were in attendance at the summit 👩🎓 with their bright sparkly eyes, sharp minds & effervescent enthusiasm 🧠🌟
‘Barbara the Brave’ also there who had to take her employer to the fair work commission after she raised concerns about unsafe prescribing protocols and in turn lost her job (and won by the way)!! 🙌
Every single praccie young or wise who came up & said, ‘You don’t know me but I know you and thank you!’🙏 each shining a light on a way in which their practice had been impacted by something I’ve written or said via 1-2 or 10 degrees of separation
An awesome experienced naturopath who works in the intersection between farming, food production, remote health care & naturopathy
who let me know about her new lil’ passion project, a soon to be launched podcast to bring us big bites of this amazing nutritional enviro nexus, via chats with regenerative farmers👨🌾
My New Grads in my New Grads 2024 Group showing up and showing themselves to have some kick-arse clinical skills I’ve had a sneak peak inside their cranial kits by way of case notes & clever questions that demonstrate their critical thinking is firmly ‘ON’ 💡
Nina Lange, Cathy Bisset, Katie Ayscough & Peter Christinson No anonymity allowed for these 4! This crew support me and enable me to get out there and deliver something of real value every single time…they really are the dream team 🎯
I could go on and on and on. Let’s all take a moment to reflect on this and celebrate our pride-inspiring peeps…oh except for that Vicki she’s such a 🐮
No one panic, Vicki will laugh herself silly and I just got even! 😂
Anyone noticed I have ants in my pants? Can’t sit still. Can’t keep things the same. Always have new questions that I suddenly realise we all desperately need to know the answers to?!
I’m always changing my education offerings, formats, time-frames etc. For example you might have noticed this year mentoring is only running in the first half. Next year will be different again. So if you want to be across all your options at the earliest opportunity so you can plan ahead for your PD and be sure to not miss out…make sure you’re on our mailing list! We’re not so keen on (and also just too busy for!) socials these days but if you’re on that list you can be confident you’re in the loop and hearing things first and first hand!
It’s so wonderful to know kidney health is moving address. From the darkest bits at the back, now to the front of our clever clinical minds. We’re easy to impress when it comes to any ‘axis’ – gut-brain, brain-immune etc. so we all need to take a moment and take note of arguably the most well ‘connected’ organ of all… 🥁 our kidneys, with their individual axis with the CNS, CVS, Respiratory, Liver, Bone Marrow, Bone, GIT etc etc etc No wonder we should be taking active steps to protect their structure and function as part of our ‘whole health approach’, rather than accepting the short-sighted ‘short-list’! of so called causes of kidney harm…that’d be: HBP, Diabetes, Obesity, Smoking…oh and Age!
I’ve been on a kidney health crusade for many years now and I’m thrilled to see an increasing number of praccies beside me at the frontline! But I think where our conversations & clinical skills have still been coming up short is with regard to ‘true cause’ and therefore also ‘course-correction’
Now that renal markers have our attention (!!) we’re noticing premature decline in GFRs in patients who actually do not fit with anything on this list…oh except ageing…the good ol’ explain-all for everything 🙄 I’ve seen patients in their 90s with better renal function than their children 30 yrs younger. Age does not cause CKD, something…a culmination typically of many things in fact – primary (causes) secondary (catalysts) and tertiary (contributors) – unique to each individual, crushes our kidneys! And is the real place of understanding we need to reach – such that we can actually personalise the prescription required for course correction.
Both of these come with our, can I just say…⭐kick-arse clinical tool⭐ that guides you through the work-up of every case of lower GFR than expected, including a comprehensive compendium of medications implicated and they are some of our most common! So if you’re a clinician with not much more than ‘corn silk’ filed in your cranium under ‘kidney’…ummmmmmmmmmmmmmmmmmmmmmmm the time is now!⏰
CKD: Causes Catalysts & Contributors
Increasingly integrative health is taking a keen interest in renal health and engaging in important conversations about chronic kidney disease, but where all modalities and messages tend to pull up short is with respect to: Why us? Why this? Why now? There has been a dramatic rise in CKD in the space of one generation which means this is not simply explained by the ‘wear & tear’ of ageing. There are very likely environmental factors at play that may have escaped the attention of the medical community but not the researchers. This recording and accompanying clinical tool helps you to identify all the ingredients in an individual’s unique recipe for renal decline and, in turn, helps you to identify how to course-correct for their kidney health.
You can purchaseCKD – Causes, Catalysts & Contributorshere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Do you realise we’re often giving our patients Crabs? Stay with me 🙄 We’re all BIG fans of polyphenols right, but did you know that one of the key ways they qualify as antioxidants is that they chelate metals?
Chemically speaking that means that polyphenols (flavonoids, isoflavones, tannins, stilbenes etc) have a structure that looks and works like two ‘crab claws’ 🦀 the ends of each claw attracting and binding metal ions, following which, the claws kind of ‘close’ around the metals and trap them within. 🦀
Now sometimes the closing of those claws results in a clear ‘stop & block’ effect – the metal will remain trapped and be lost from the gut or other parts of the body along with the polyphenol but not always…other polyphenols can be favourable chelators just temporarily binding a metal but ultimately making it bioacccessible to us and increasing its bioavailability & bioefficacy. So polyphenol prescriptions, aka ‘crab medicine’, need to be precise. Every different class of chelator or ‘binder’ e.g. MCP, zeolites etc will have different metal affinities. Our beloved polyphenols have a predilection for one metal above all…and that happens to be iron!
As clinicians, we can harness their polyphenol power to either enhance iron uptake or block it.
🦀 Both actions, of course, well indicated in different patients & presentations 🦀
In the latest Update in Under 30 we write a polyphenol program for those individuals ‘on the road to iron overload’, who simply ‘can’t close the door to more’! Knowing how to perfect this prescription and still allow for personalisation & preferences etc is the key to sustainable essential everyday iron mitigation between blood removals and to minimise the need for these. And if your bigger challenge is the issue of iron deficient patients who are refractory to your well-reasoned remedies then take a listen and a look at the accompanying resource and ensure they are doing the exact opposite! I am being completely serious. I don’t think many people realise the power of the polyphenols & how pervasive they are in our herbal & dietary recommendations 🤓😲🤯
For those individuals with HFE mutations on the road to iron overload, whether they ultimately reach that destination of absolute hyperferritinaemia or not, excess iron mitigation ‘every day & in every way’ is key to better outcomes. While avoidance of dietary haem iron and, where indicated, therapeutic phlebotomy, are cornerstone treatments, patients are increasingly being offered add-ons such as PPIs and pharmaceutical chelators. However our polyphenol prescriptions (both food form and nutritional & herbal supplements) offer additional novel actions to address excess iron mitigation, while also providing patients with improved cardiovascular protection, immune system support etc. This recording comes with an incredible resource for both you and your patients. Packed with evidence-based options they can choose from at each meal & across the day, it offers them their own tailored treatment plan by identifying options as (un) favourable, & therapeutic in each category of food, beverage, even cooking methods.
You can purchaseThe Power of Polyphenols In Iron Excesshere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
It’s no secret I am in the midst of some serious deep-diving through the micronutrient evidence base & at a depth of about 30 metres I struck Boron! Don’t yawn! I saw that. Thinking, ‘boring’, when we hear, ‘Boron’, is almost as bankable as watching everyone reach for their water bottles when you mention anything hydration-related 🤣 But I am here to restore your positive regard for this mineral and remediate its bad (& boring) rep! In preparation for the Nutrient Prescriber’s Program we started each nutrient review with the seminal contemporary nutritional texts and then launched ourselves headlong into the latest & greatest research. By the end of all the Boron bits in all my trusty texts the yawn was not gorn! But the moment I started reading the research I was like, ‘Are we even talking about the same thing?!’Turns out we’re not 😵🤦♀️
You see Boron has been a longstanding victim of identity theft. What we’ve been lead to believe is Boron is weed-killer and ant-poison and look it does give us some of the benefits of Boron but not all. And it possess a pharmacokinetic & toxicity profile that naturally occurring Boron simply does not.
Who decided that the Boron that is ubiquitous in our environment but almost exclusively consumed by us only after biotransformation by plants – could just skip that last bit and still be safe and optimally beneficial?! Probably the same guy that came up with folic acid, may I suggest? Anyway, enough is enough. We all need to relearn Boron – naturally occurring Boron – in the form of Sugar Borate Esters (SBE)- the evidence of benefits for which will blow all of our little minds! Well it certainly blew mine! Looks like this natural form of Boron is going to hit the Australian market in the not-too-distant-future 🐦 can’t wait to see which supplier is sufficiently progressive and research-aware that they bring this to market, having been available as a high grade supplement, employed in numerous RCTS OS for some time. But this little Update in Under 30 is not waiting around for that release date – there is much to be gained from SBEs right now – so make some noise as the real Boron at last takes the stage!🎤
Boron has been the victim of longstanding identity theft and we unknowingly have been interacting with its imposter. Contrary to everything you’ve ever been told about this mineral, naturally occurring Boron is full to overflowing with benefits for our gut, our bones, our brain, our management of other minerals and is safe in large quantities. That ‘bad guy Boron’ you were introduced to and is still present in many of your supplements is a form we never consume in food…and therein lies a world of difference! Come meet the real Boron so you and your patients can get the real benefits!
You can purchase The Boron Deception: How We’ve Been Fooledhere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Still. And yes – like you – I don’t see any slowing down any time soon in this extraordinary paradigm shift occurring in medicine and health. Which for us humans involves one humbling discovery after another.
Here we were thinking we made our dietary choices from a place of free will & individual preferences 🤣🦠
Thinking those microscopic mates, were making those B vitamins, and SCFAs and and and…for us & our benefit 🤣🤣🦠🦠
And while there’s a lotta love going on between our microbes and our micronutrients – in both directions – Pat Benatar said it best, “Love is a battlefield”
(sorry but I feel compelled to insert a link here for the youngsters – you’re welcome 😉)
The tussle over who gets to access those nutrients that are actually essential to both of us (the hostage and the microbiota) is an absolute turf war, peeps, and this battleground has seen some bloodshed! The new new question being raised is how the prescribing of nutrients, especially at the higher doses we tend to use, trickles down to influence and impact those microorganisms who reside in the bowel. Directly – as a selection pressure we have, likely unintentionally unknowingly, introduced. Which species do well when exposed to levels of a vitamin or a macro or trace mineral that are simply unobtainable in the diet? Yes – research answering these questions has begun in earnest revealing some positive ‘prebiotic-like actions’ of some but not of course for all nor in all scenarios. Want to learn more about this latest aspect we need to consider when formulating our nutrition prescriptions? You can either jump in and join us in the Nutrient Prescribers Program which kicks off next week to get across absolutely everything new in nutritional medicine or just dip your toe in here with our latest Update In Under 30: The Micronutrient Microbiota Universe
The world of health science went microbiota-mad a few turns back and there’s no sign of an end. Research continues to reveal the breadth of the GIT microbiota’s positive & negative reach, in particular, & with discovery upon discovery we’ve come to understand how often the microbiota are ‘managing us’. Both in terms of being integral to the success of our digestive, immunological, metabolic etc processes but also in a self-serving way, for example, directing our dietary preferences to satisfy their own needs. This has understandably prompted the question about the impact micronutrient supplementation is unintentionally having as a selection pressure on our gut microbes. Which bugs like which B vitamins when taken in excess of the amounts achievable in the diet? And which microbes flourish and which falter when we radically change their mineral exposure?
You can purchase The Micronutrient Microbiota Universehere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
I’m such a sucker for marketing!…ZoomZoom is from an old Australian car ad – an earworm clearly conveying ‘ the speed of something’, and let me tell you, totally fitting for this little Zinc tale I’m about to tell! Many years ago, I wrote a thesis on Zinc that necessitated me reading every research paper ever written (that’s how it felt anyway!🤪) on this trace mineral. Like everything in nutritional medicine, especially in the area of our burgeoning understanding of micronutrients, this is a highly dynamic space, so regular reviews of what’s new is essential and, since my thesis, part of my regular practice. Well, I just did my latest deep dive, and HELLOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO radical paradigm shift(s)…yep plural!
Zinc supplements should ideally be: Organic amino acid chelates Taken daily – due to the lack of Zinc stores in the body Taken fasting Taken in doses in excess of the RDI to compensate for the smaller % absorbed
Yep – nope. Or in true-blue Aussie: Yeah, nah. Can’t believe what you’re reading right now? Neither could I when I undertook this recent review but the studies are increasingly sophisticated and the resultant paradigm shifts are being echoed, reiterated & reinforced. And these have, in turn, challenged all those old ‘norms’ about how best to administer zinc for those patients with a shortfall. If you’d like to take this little journey for yourself…I suggest you start here! I immediately changed how I take it myself and now my mission is to both spread the word and get us all reflecting and reviewing our prescribing principles around Zinc…and tbh, around all micronutrients! After spending my ‘summer’ doing sufficient reading for a second thesis on everything new in micronutrients…I am armed and dangerously prepared for our upcoming *NEW* program: The Nutrient Prescriber’s Program which kicks off in late Feb for 5 months.
I truly believe that based on all this new information, we can now get so much more out of our medicines.
Nutrition represents such an extraordinary set of tools for us to work with, but it’s time to sharpen those tools in terms of how we apply them!
The Changing Zeitgeist Of Zinc Prescribing
Zinc research is a highly dynamic field and given its relative recency of discovery as being essential to humans, we’re still in the early days of truly getting to know this mineral. In just the last few years, enormous gaps have been filled-in regarding its regulation and roles that look to radically change our prescribing practices. Tune in to this essential update for some serious food for thought about doses and dosing frequency.
You can purchase The Changing Zeitgeist Of Zinc Prescribinghere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Wow, menopause is really having a moment, isn’t it? Or is that just me (and my mates who are all somewhere on that perimenopausal path)?! But seriously, medical perception of this reproductive transition is undergoing a revolution right now—widening the lens to take in more diverse potential presentations and lengthening the period of impact recognised both ‘before, during, and after’ that last, last…no hang on…last period. But I fear we are at a crucial crossroads. Anything could be related to (peri)menopause, but not everything is or should be.
There are several other conditions whose onset tends to rise or peak at the same age and stage for women, and due to their shared features, they get missed & misdiagnosed, misattributed to that!(more…)
Any steps towards inclusivity in societal & cultural terms are cause for celebration but in medicine, that can come in the form of a ‘diagnosis of inclusion’, the opposite, of course, of a ‘diagnosis of exclusion’ and potentially as slippery and loose as it sounds. That’s the somewhat precarious position we find ourselves presently in with perimenopause and menopause. With greater recognition of just how long health effects can kick in before there are any cycle changes [2-12 years for those of you playing along at home] and the widening lens now taking in the diversity of such health effects, women’s health has had a win. But, I would argue, this is not without a double edge. After all, aren’t we, as a result, more at risk, as women, of having everything attributed to “just ‘the change’, love”, and, in turn, going to be offered sex hormones more often as the solution?
Recently I asked practitioners to tell me where the ‘therapeutic reference range’ many of us were taught for nutrients comes from & no one has been able to answer that.🙄 If you’ve heard me refer to my original naturopathic education before you’ll know I generally hold it in high regard. And I’m forever mindful that there are always things that can be made better. What’s been playing on my mind lately is the recognition that I originally learned nutrition from one (exceptional) individual, and then went on to become the lecturer years later at that same and other institutions. Additionally, I am aware of some of my past students also going on to become the next generation of nutrition lecturers at those same places – and often in fact inheriting their lecturer’s notes, slides, overheads [showing my age!!] with the job. Can anyone else see a problem here? What’s brought this into sharp focus lately are many of the questions I’m endeavouring to answer as part of our much-anticipated Nutrient Prescriber’s Program. How much? How often? When? Which form when? & For how long? Which are the key questions we have to answer with every single nutritional prescription.
To not only source the most rigorous scientific answers to these core critical questions but to also develop a framework that we can all use to answer them for ourselves at the point of any future prescription creation, I have had to go to great lengths.
But as I research & write, I also keep asking myself, ‘How would ‘old-me’ have answered this?’ How did I up until now either consciously or unconsciously answer these sufficiently to make such decisions?
So it’s an ongoing little (& sometimes BIG🧠) internal debate that is raging as I write. And when I ask current praccies these questions they reflect back similar ‘old-me answers’, the vast majority of which were handed to us by our lecturers with plenty of top-up ideas from industry. These answers include things like:
How much? Somewhere within the therapeutic dose range? How often? Depends on lots of things but generally aiming for daily of course!
When? Minerals before food, fat soluble vitamins with or after, magnesium at night etc
Which form when? Now it gets tricky – because there are all these new forms that we weren’t even taught – but maybe ‘active’ – active is always better, right? Or is that natural? The most bioavailable?
& For how long?Ummmmm how long is a piece of string?! Until the signs and symptoms resolve?
Now all of these as general statements are partly correct. And with respect to the level of understanding we need to have when crafting a nutritional prescription for a specific patient, with a specific presentation and for a specific purpose (correction of deficiency Vs supranutritional Vs therapeutic antagonism etc)…well they are plain wrong in the majority of instances. Don’t freak-out in freefall!🪂 The prescribing of nutrients is a wonderful and typically, a wonderfully safe, modality that offers us the potential for extraordinary patient outcomes. When used well. We could all benefit, I believe, from just sharpening our tools so we bring out the very best in our medicines & in ourselves, as prescribers & clinicians. I am neck-deep in writing the 10 modules that can start us all on that journey. Want to join me?
And to be clear, about the educational echo chamber,
In the past I was part of the problem and ever since I have tried to be part of the solution.
With over a decade of mentoring practitioners, Rachel has recognised a need for an educational program that provides practitioners with more structure, more science, and therefore more certainty in navigating each individual prescription. This monthly meet-up is delivered in 5 live sessions and runs from February to June (10 modules). All sessions, encompassing both theoretical and applied learning will run for approximately 2 hrs each.
Let’s play a word association game of minerals & their major roles
I say, ‘Potassium’. Maybe you say, ‘Sodium Potassium Pump’ I say, ‘Magnesium’. You say, ‘Muscles?’ I say, ‘Calcium’. You say, “Bones’….
But I say, Second Messenger. And arguably the most pervasive & potent one, at that. Remind you about second messengers? Well, sure. They are the ones who get sh*t done. Not like a boss (i.e. hormone or neurotransmitter) who shout directives from above but never step foot inside the dirty guts of the engine room itself. It’s the second messengers who run these messages from the outside of the cell to the inside and the engine room, to ensure that the directive is actually actioned! Amazing huh! And free calcium in the blood is, as I said, really a superhero even among the second messengers – with its regular responsibilities including: Insulin, TSH, Adrenaline, Oxytocin, Serotonin receptor activation etc etc
Does, it have a dark side? Well, sure. Don’t most superheroes?
If the available Calcium in blood and the extracellular environment is too high then basically bad sh*t gets done. Including vasoconstriction, clotting, deposition of calcium in the wrong place like arteries and joints and etc etc. That’s why the amount of Calcium in our blood is the MOST tightly regulated of all electrolytes and, in turn, has the NARROWEST of reference ranges. But will a Serum Calcium level always tell you when there is a problem with Calcium regulation? No. You’d need to have measured the major regulator itself, Parathyroid Hormone (PTH). Wait, am I seriously trying to tell you, that Serum Calcium alone can look completely normal in spite of really damaging Calcium dysregulation underway – leading to accelerated BMD loss, increased cardiovascular and renal risks etc.? I most certainly am.
So do you know which of your patients’ really need PTH assessment and why 1 dominant group amongst those, is any woman leading up to and following menopause?
No? Well you better pull up a pew and have a listen and a watch then! Yes this latest Update in Under 30 episode even comes with a little video tutorial!🤓🤯
Parathyroid hormone is a career criminal. In addition to buoying dropping blood calcium levels via legitimate means, it illegitimately achieves this by stealing it from our bones. But you wouldn’t know it – because like all career criminals this occurs completely under the radar. Elevated PTH, however, constitutes the most modifiable risk factor for bone mineral density loss & fracture risk and offers the biggest BMD gains secondary to its normalisation. In addition to this, even within range but ‘high-normal’ PTH correlates with a range of other cardiovascular and urinary presentations & if combined with elevated serum calcium can become a multi-systemic presentation (GIT, Mental health etc) frequently mistaken for other aetiologies. So how can we be alert to this ‘bone thief’? Which of our patients will benefit the most from PTH measurement and monitoring? This recording, resource & video tutorial on how to use a Ca PTH Nomogram answers all!
You can purchase Unmasking Hyperparathyroidism – Menopause & Morehere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Current New Graduate Mentee: Kelly Allan giving her elevator introduction in a recent New Grad mentoring session
The fabulous Nina, one of our behind-the-scenes-dream-team & early career nat, said, ‘During our training and early in our career it’s like we don’t “see” the Generalists. We’re only aware of the ‘rockstars’ in our profession and they are all specialists in IVF, vaginal microbiomes or gut ones. So we end up thinking, to be any good you’re going to have to specialise’ ‘Yes,’ I said, ‘but imagine if we only ever had the option of seeing a specialist?’
You’ve been experiencing a bit of gut stuff – and rather than being able to bounce this off a generalist you have to go ‘straight to the top of gastroenterology’ – wait in line for your time, pay the big bucks etc to get their thoughts. But really it was only ‘a bit of gut stuff’ and perhaps all this was over-kill?(more…)
Practitioners have been bringing their most challenging cases to me for mentoring & supervision for over a decade, that’s hundreds, in fact, probably thousands, of cases, tempting me to say, therefore I’ve seen ‘everything’.Except of course I haven’t. And each new case helps reinforce that and the utter uniqueness of everyone’s experience of health & disease.
From each & every case, no matter how unusual, remarkable, uncommon, exotic some or all of their experience and story, once we’ve asked the key clarifying questions that often prove to be ‘diamond diagnostics’, constructed a comprehensive timeline, suddenly bringing to the forefront: their disease chronology, causation & contributors, analysed their pathology for insights far beyond what a patient or their diagnoses can ever speak to, and then completed the work-up by incorporating all of this information into the step by step construction of a MindMap…
🤓We all leave each session with truckloads of new info & skills to apply to our own patients🤓(more…)
Especially given I am now a relic, my original training not quite pre-industrial revolution but pre-specialisation obsession. So that once I started seeing paying patients I just saw, and have seen…everyone. And because our patients always drive our desire for new knowledge and skills, I have therefore taken particular interests in & accordingly read the extra research pertaining to a whole variety of different systems, conditions and presentations etc. that I have then been able to share with others as part of my contribution to education. (more…)
After running a deeply rewarding Group Mentoring program for over a decade it is indeed time for change. I’ve witnessed first-hand the exceptional growth of thousands of practitioners, and in turn they have guaranteed and forged my own. It’s provided me, & my small team of naturopaths working behind the scenes, with an extraordinary opportunity to further develop, refine & sharpen many of the clinical tools I had originally created just for my own practice, to ensure they are user-friendly and outcome-oriented for everyone who choses to adopt them. Over this period, I’ve even seen some of my mentees become mentors themselves (!) carving out their own paths, creating their own clinical toolkits etc. I am eternally grateful for having occupied this space and role for so long.
But my contribution to ongoing practitioner development is not done – just done differently – moving forward.
Inspired by, & truth be told a little envious of, the content, culture and collegiate experiences my university attending big kids are having – we’ve decided to adopt some of the same elements including semesters! So our 2024 is now divided in half, with Sem 1 starting in Feb and finished by June. This means we can offer intensives, accelerated learning formats which will especially appeal to and benefit our intake of newly graduated nats/nuts/herbies into our New Grads program. This is the result of more frequent touch points and does not come at the cost of the comprhenesive content or outcomes. Likewise, all those returning (via a stampede!!) to our much anticipated Nutrition Prescriber’s Program
This is a Case Series delivered live via monthly meet-ups whereby a real case work-up, covering all key aspects of diagnostics, prescriptives, the therapeutic relationship, behavioural change & patient management etc is detailed and discussed. The cases have been hand-picked for their ability to offer maximal learning for us all – both in general terms of case work-up skills and tools, as well as an opportunity to upskill in the primary affected systems and the associated presentations – be that endocrine, skin, metabolic etc . We are so excited to announce this one’s arrival!
So if you want to head back to uni with us for Sem 1 at RAN Uni 😂 get in contact [email protected]
Ever feel like the universe has been preparing you just for this moment? Me neither really…but in this one weird way – yes!
So hear me out.
Thyroid disease as a result of a viral infection was first described in 1902 by Dr Fritz De Quervain and of course he and his ego called it De Quervain’s subacute thyroiditis. For some historical context, this predates the recognised role of iodine deficiency in thyroid disease! Skip ahead almost a century to deep in the 1990s and mini-me was sitting in a uni lecture room [front row & wearing fluro of course🤣] and over hundreds of hours (no scrap that zillions*^# of hours) of lecture content I was exposed to, the description of De Quervain’s Subacute Thyroiditis stood out and stayed stuck to me. I’ve brought it out for a twirl from time to time in the interim with some of my patients & in particular in correspondence with their docs.Skip ahead to the 2020s when we had this thing called. ‘a global pandemic’, and now everyone wants to talk viruses and their broader health implications & as a result, good ol’ Fritz, me and our buddy, De Quervain’s subacute thyroiditis, are all having a moment.
But just to recap – this is (clearly) not new.
What is new is the way this ‘virus of the moment’ has brought this Thyroid V Virus battle to the forefront. We are living an important chapter in history where all the textbook entries on De Quervain’s Subacute Thyroiditis are madly being rewritten to reflect the veracity of this viral attack on the gland and the wide-scale & varied damage that ensues over the months and years that follow. And so many of our patients are the walking embodiment of it – whether that be in the form of low or high thyroid hormones, nefarious changes to gland anatomy only evidenced on US. So what do we need to know? in short, that pathogens as goitrogens have never been more of an issue than right now for ourselves and our patients. And that compared with just our usual desire for comprehensive investigation of the HPT, taking a complete look ‘under the hood’, not only by way of a full TFT and Ab titres but also, wherever there is an additional suspicion – by way of a thyroid US – has become non-negotiable. But regardless of what you find there, once you look, do you know what to do next?
Biopsies and autopsies of diseased thyroid glands alike reveal the prevalence of many common viruses within, setting the scene perfectly for the Thyroid V Virus battle. So, what happens when a virus takes a specific liking to this gland? While there are several different possibilities, one brought to the forefront in recent years is viral thyroiditis wherein stage 1 is ‘spill’, stage 2 constitutes a gland that is now ’empty’ and while stage 3 is reported to be ‘recovery’, this is increasingly scarce – replaced with chronic or recurrent thyroiditis, relapses of previously remitted GD and a doubling of new AITD diagnoses – not to mention the wide variety of unfavourable anatomical changes being found on ultrasound. Comes with a great desktop reference with prescription examples.
You can purchase ThyVIRoidhere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
I shared this recently on socials but for those of us that don’t hang around that ‘hood I am sharing again here because it is just too important. While we’re busy updating our knowledge regarding reproductive health for women (soooo many huge headlines of late!)…ahhhhh…this might be something we all want to read!🤓
This thought-provoking reviewchallenges the long held assumption that oestrogen is at the root of much breast cancer causation. Instead it creates the case for PROGESTERONE as the actual source of oncogenesisand relegates oestrogen to merely (but monstrously) fanning the flames.
Now before anyone panics (?too late ) you need to read the article in its entirety – esp this not being about demonstrable differences in measurable P4 levels – and keep in mind that this hypothesis, though well argued and supported by evidence also from trans-gender individuals, is not currently a consensus. BUT what I think it does really well is SHAKE THE TREE🌴🥥 and prompt us to challenge our own biases and blind-spots. For far too long in IM Oestrogen has been made out to be the baddy. I too am guilty of having done that. And Progesterone everyone’s saviour! Of course there are a lot of PMDD sufferers who have good grounds to punch us for even suggesting this.
But of late – many of my peers have helped remediate oestrogen’s reputation and put us back on a more balanced path – I am thinking of @Sandra Villella especially here.
Who straight away responded to my post regarding this on socials, “I just got back from the Australasian menopause Congress in Queenstown, and the different types of exogenous progestogens are certainly implicated in breast cancer.” And then generously shared some of the hot off the press slides and stats from the Australasian Menopause Society.
In a nutshell she says, “Breast cancer increases with age and with increased time of use and those increases are greater when Progesterone is included in the MHT prescription”
And whoah…maybe we all need to rethink all the pro-progesterone prescribing…dare I say?!
Btw – the article implies that having anovulatory cycles might actually be protective too!!
Not my normal space and speciality area but I keep finding these gems in women’s hormonal & repro health and I feel a duty of care to share!
Update and Under 30 Podcast episodes are streamed monthly audios and resources to keep you up to date with the latest ‘must-knows’ in integrative medicine, covering a wide variety of topics from diagnostics to diet, all through the lens of an integrative health model. Every month each new episode will provide you with a quick scientific review with ‘clinic-ready’ practice tips, in under 30 minutes. In addition, the subscription gives you access to the ENTIRE back catalogue of UU30 audios that have been released…that’s over 120 episodes! You can become an Update in Under 30 Subscriber to access the entire library of Update in Under 30 audios and resources here.
The debasing of BMI as a stand-alone assessment of weight is long overdue given its significant limitations and lack of meaningfulness with respect to overall health. This coincides with a bigger societal and cultural shift towards inclusivity which involves redressing bias against people with diverse body sizes and compositions.
And how do we, as integrative health professionals, continue to uphold our principles of prevention and treating the cause when excess adiposity may be a very real contributor? While ensuring we ‘see’ and treat each individual in front of us, not our assumptions about adiposity, not our body size bias nor blind spots?
One part of the answer: read and be led by their lab results – because pathology is nothing if not personalised.(more…)