How often were we told this in our training? And how often have we found this to be true in practice? And now suddenly, it seems, the medical researchers (at last!) are rapidly coming around to this core concept?? Our microbiome is suddenly the hottest property on the body block, and it seems every interested party is shouting, ‘Buy!Buy!Buy!’ As integrative health practitioners, of course, we had a major head-start, not just by appreciating the gut’s central positioning in the whole health story (iridology beliefs, maps & teasers aside!!) but also a heads-up about the damage the western diet, our medication exposures and lifestyle tend to wreak upon it. A favourite quote of Jason Hawrelak’s by Justin Sonnenburg, “The western diet starves your microbial self”, underscores the significance of just one element of this impact. And…are we all clear that the increasing number of patients reporting adverse food reactions, once again, overwhelmingly are a response to aberrant processes in the GIT?
Sounds silly it’s so obvious right, but it’s easy to get distracted & misattribute blame…for example, it’s the food that’s the problem. Well yes in a minority of situations interactions between someone’s genes, immune system and a particular food turns something otherwise healthy into something pathological, but for the majority, the food itself & in others is healthy, & could be beneficial to this individual, if only we could resolve their GIT issues…like FODMAPs for example.
Not the problem, just the messenger.
So if the ‘problem food’ is just the messenger, what’s the actual message we need to understand? Is it that this patient has medication, disease or otherwise induced hypochlorhydria, impairing ‘chopping up’ of potential antigens implicated in immune mediated food reactions? Or is that this person’s got fat maldigestion &/or malabsorption so that in addition to not tolerating fats, they may experience dietary oxalate intolerance to boot? Or are the food reactions the result of altered microflora changing what we can and can’t digest (via their critical contribution) & absorb?
So what message does the presence of IgG antibodies to consumed foods send us about the state of someone’s gut? It’s telling us 2 things: this individual exhibits abnormal intestinal permeability & currently in the context of this leaky gut, these foods may constitute a barrier to resolving this & other symptoms as well.
We’ve recently released the mp4 (that’s audio plus the movie version of the slideshow so grab your popcorn…that’s if you don’t have a corn issue!) of A Guide to Investigating Adverse Food Reactions – What’s IgG got to do with it? which details the science behind IgG, including debunking, the incorrect debunking of IgG food antibody testing!! But more than this, it overviews the whole maze of adverse food reactions, articulates a logical investigative path for practitioners through this maze, and helps us to really understand that finding the food(s) responsible for a patient’s symptoms is not the final destination..and can be in fact a distraction, if we don’t cut to the chase and find out the why…and funnily enough…my dear old iridology teachers and colleagues...it almost always comes back to the gut 😉
Confronted with the possibility of adverse food reactions in an increasing number of our patients can be an overwhelming prospect, in terms of accurately identifying and understanding the faulty mechanism underpinning these aberrant responses to healthy foods. Elimination of culprits in most situations is only a short term reliever, not an appropriate long term solution, so to optimise results we need to know the real mechanism of action. The majority of these, of course, stem from the gut, but being able to elucidate exactly which of the many things that can go wrong there, is going wrong and therefore what foods are problematic until we address this, is the key. This 2hr mp4 is all about the bigger picture and helping you find method in the madness that can be the AFR landscape. Along the way, we detail the science of where IgG reactions fit into this and it’s a fascinating story that just might be the missing puzzle in your leaky gut patients.
b. Every herbalist’s jaw at my table at the NHAA conference gala dinner, when I got almost all my Latin binomials right during the trivia quiz?…and after some champagne, that’s a particular achievement
c. My jaw, when I saw firsthand how much those herbalists could drink of ye-not-so-olde herbal extracts!!
d. The latest Update and Under 30 – Milk Madness Part 2
e. All of the above
If you answered, ‘e’…. you must have been one of those herbalists at my table, otherwise you have way too much insider information! But yes you are correct on all accounts. So this latest UU30 is an extension of our discussion last month about the potential contribution from to mental health from dairy intake in a subset of patients. This whole topic, the research for which dates all the way back to the 70s, was too big to fit into one – given the current evidence base that now depicts at least 2 different mechanisms that might be at play, and the different types of mental health problems, each has been linked with. Last month was all about retracing the ‘dietary exorphin’ path, this month it’s about the propensity for some individuals to make antibodies to casein and the significant growing data that suggest this happens to a larger extent in patients with certain psychiatric diagnoses. More importantly, we talk about the ‘why’.
What compelled me to make time to look through all the literature on this was that there is some. No seriously. When I initially learned of the GFCF dietary approach to ASD patients I was told that in spite of a lack of supportive research, the empirical clinical evidence was irrefutable, which I later saw with my own eyes. In the couple of decades since, I only really heard about negative findings, short trials of the elimination diet specifically in ASD kids, that failed to produce significant change. Funny how the bad stories rise to the top, right? But when I spent the time doing a thorough literature review, I found these negative findings were far from the whole story. In fact, I was really surprised by the high level of evidence employed by researchers of late, who have repeatedly found associations between either exorphin or antibody levels and patients with particular diagnoses, in addition to really progressing our understanding of why these measurable differences (urinary exorphins, plasma IgG and to a lesser extent IgA casein antibodies) are meaningful. Do we know everything? What do you think? The answer, of course, is always no. But we know enough to consider this aspect in our comprehensive workup of mental health patients and all their biological drivers and we know dramatically more than anyone in mainstream medicine, or the dairy industry for that matter, is ever going to let on!
If you want to hear a synthesis of the casein antibody link with mental health then download the latest UU30 – Milk Madness – part 2. If you can’t go that far, then “do yourself a favour” and read a couple of seriously important articles on this topic – and why not start at the deep end with this study by Severance in 2015.
Could dairy intake in susceptible individuals be a risk promoter for mental health problems? In addition to evidence of the exorphin derivatives from certain caseins interacting with our endogenous opiate system discussed in part 1, we now look at the evidence in support of other milk madness mechanisms. Specifically, the IgG and, to a much lesser extent, IgA antibodies about what this tells us about the patient sitting in front of us about their gut generally and about their mental health risks, specifically. The literature in this area dates back to the 1970s but the findings of more recent and more rigorous research are compelling.
I arrived home from the Farmer’s Market this week ready to cook a little number I like to call ‘egg dinner’ (fancy I know 😉 ) and found my organic bunch of kale, covered in dirt. Ok, admittedly, there was a small reflexive, barely-audible-beyond-immediate-neighbours, ‘tsk’ that may have escaped my pursed lips…quickly followed by my own auto-correct that went something like this, “thank goodness we have a Farmer’s market with real farmers and they grow real food, that actually grew in real dirt and you know what else I love about it…it goes off real fast.” Seriously, that should be a selling point and proof of the kind of substances I want to put in my mouth…readily biodegradable! Not long after these thoughts popped into my head…this article popped into my inbox…
A new year, a newly issued list of the famous ‘Dirty Dozen’. And look who just made it in at number 12!!
Not my kale from the certified organic farmers at my local market, but regular Kale. The Kale that is in your green smoothie at a cafe & stuffed into every other recipe plausible on many menus. The kale that many patients will go and buy from the supermarket shelf, spurred on by sound advice from us and fabulous intentions.
A recent Medscape Review talks all about what the Environmental Working Group (EWG), a nonprofit organisation focused on human health and the environment, have found in their annual report about the agricultural contamination of fruits and vegetables in the USA. Even though the report is always good food for thought and a routine reminder that some of ‘best foods turn bad’ as a result of unhealthy modern agricultural practices, we should not assume complete translatability. The Australian dirty dozen is not likely to be identical to the one from the US, given farming practices and laws around food safety vary significantly between countries. If you want to drill down more into this then make sure you read One Bite at A Time co-authored by one of very our Own Clean Fifteen 😉 Tabitha McIntosh.
Far from wanting to place any further barriers or discouragement in path of regular patients keen to increase their vegetable intake, which the report states are the (currently accused) growers concerns (hey, how about you spend more time focusing on cleaning up your farming practices guys!), It is just a gentle reminder that a bit of (certified organic) dirt is far preferable & the kind of dirt want to be eating.
PS You might also like to know that the clean list of fruit and veg for 2019 in the US includes: Avocados, sweet corn, pineapples, frozen sweet peas, onions, papayas, eggplants, asparagus, kiwis, cabbages, cauliflower, cantaloupes, broccoli, mushrooms and honeydew melons
Love getting back to grassroots with a bit of dirt therapy?
Our famous Dynamic Balance recording is the foundational teaching resource in mineral nutrition. Minerals represent a critical tool in naturopathic nutrition and there has been an explosion of research in this area over the last 10 years. In order to optimise patient care, practitioners need to keep up with the constant stream of information, updating their previous beliefs and understanding in the process. This seminar is designed to facilitate and accelerate this process of review and re-evaluation via a fresh look at the key minerals iodine, selenium, iron, copper, zinc, calcium and magnesium.
Q: If a patient says they can only tolerate 7 foods…how many did they start with?
A: Typically about 20
No, this answer doesn’t come from some complex mathematical formula…it comes from appreciating the low dietary diversity of those eating a Western diet. When we boil down these diets to the number of foods from different biological origins (families) it can be a frighteningly small number.
You see, like most practitioners, I feel utter dread when I encounter the patient who prefaces their diet story with a statement similar to the one above. It speaks to the severity of their symptoms, their attribution of these with food, that by the way is essential for their sustenance and nutritional salvation, and implies an exhaustive pursuit they’ve undertaken probably over years to find ‘safe foods’. And yes, as discussed in my recent talk A Guide to Investigating Adverse Food Reactions – What’s IgG got to do with it? – food reactions, as in more than one mechanism of food reaction, often do move in packs and that comes typically back to a poorly functioning gut…BUT…that latter assumption…’they’ve explored and exhausted all foods’ is the one we need to keep in check.
Have they tried daikon? Prickly pear or jambu? Okra? Snake beans? Quail or duck eggs? Kangaroo? Crickets? Etc Etc. Etc.
Are you catching my drift? Because someone has DIY diagnosed a wheat, dairy, soy and, and, and, reaction (correctly or incorrectly) and perceive themselves to react also to most of the limited fruit and veg they can identify in Woolies…doesn’t mean they’ve remotely exhausted the global food supply! Where am I going with this? When patients tell us they’re down to 7 foods they can tolerate – some sensible follow up actions on our behalf may include:
Check the strength and validity of their level & strength of evidence for their DIY diagnosis
Think about the linking ‘process’ (more than likely gut) that is the real potential issue (aka don’t eliminate the messenger and do nothing more!)
Encourage and advise them to shop anywhere other than where they normally do – somewhere that sells fresh produce they don’t recognise at all…like Asian, Indian or Middle Eastern supermarkets and grocers
My tour of A Guide to Investigating Adverse Food Reactions – What’s IgG got to do with it? (and the weeks of lit review leading up to this) provided me with enormous food for thought…and this is just one! If you want to hear more about how to find method in the madness of food reactions…you should probably listen in to the whole shebang…goodness knows with the increasing number of patients who present with self-determined food reactions and an increasingly narrow menu of safe foods…practitioners and patients alike need all the help we can get!
Confronted with the possibility of adverse food reactions in an increasing number of our patients can be an overwhelming prospect, in terms of accurately identifying and understanding the faulty mechanism underpinning these aberrant responses to healthy foods. Elimination of culprits in most situations is only a short term reliever, not an appropriate long term solution, so to optimise results we need to know the real mechanism of action. The majority of these, of course stem from the gut, but being able to elucidate exactly which of the many things that can go wrong there, is going wrong and therefore what foods are problematic until we address this, is the key. This 2hr mp4 is all about the bigger picture and helping you find method in the madness that can be the AFR landscape. Along the way we detail the science of where IgG reactions fit into this and it’s a fascinating story that just might be the missing puzzle in your leaky gut patients.
Click here to purchase A Guide to Investigating Adverse Food Reactions – What’s IgG got to do with it?
We’re not deaf…we heard that stampede of Iron-Inundated Practitioners!
Our recordings and clinical resources for improving your skill-set in all things iron including, your accuracy of diagnosing deficiencies, pseudo-deficiencies & excesses, plus radically rethinking the best treatment approaches for each scenario…have been some of our most popular. Because nailing iron (pardon the pun) is harder than we were all lead to believe and at least 1 ‘iron maiden’ or ‘iron man’ walks into our practice every day, right? So we’ve brought together 5 extremely popular UU30’s on Iron into one bundle for the price of 4! So if you’re more than ready to graduate from ‘iron school’, now’s your best chance!
1. So You Think You Know How to Read Iron Studies? (≤30 min audio + Cheat Sheet)
Overt Iron Deficiency Anaemia or Haemochromatosis aside…do you understand the critical insights markers like transferrin and its saturation reveal about your patients iron status? Most practitioners don’t and as a result give iron when they shouldn’t and fail to sometimes when they should. This audio complete with an amazing cheat sheet for interpreting your patients Iron Study results will sharpen your skills around iron assessment, enabling you to recognise the real story of your patients’ relationship with iron.
2. Pseudo Iron Deficiency (≤30 minute audio)
The most common mistake made in the interpretation of Iron Studies is this one: confusing inflammation driven iron ‘hiding’ with a genuine iron deficiency. Worse still, following through and giving such a patient oral iron – when in fact it is at its most ‘toxic’ to them.
This audio together with some key patient pathology examples will prevent you ever falling for this one! Learn how to recognise a ‘Pseudo Iron Deficiency’ in a heartbeat!
3. Iron Overload… But not as you know it (≤30 minute audio)
We’re increasingly seeing high ferritin levels in our patients and getting more comfortable referring those patients for gene testing of the haemochromatosis mutations; but, do you know how to distinguish between high ferritin levels that are likely to be genetic and those that are not? This can save you and your patient time and money and there are some strong road signs you need to know. In addition to this, what could cause ferritin results in the hundreds if it’s not genetic nor inflammation? This Update in Under 30 summary will help you streamline your investigations and add a whole new dimension to understanding iron overload…but not as you know it!
4. So You Think You Know How To Treat Iron Deficiency? (≤30 min audio)
And then you don’t. The reality is we all struggle at times with correcting low ferritin or iron deficiency anaemia – so what have we got wrong? In spite of being the most common nutritional deficiency worldwide, the traditional treatment approaches to supplementation have been rudimentary, falling under the hit hard and heavy model e.g. 70mg TIDS, and are relatively unconvincing in terms of success. New research into iron homeostasis has revealed why these prescriptions are all wrong and what even us low-dosers need to do to get it more right, more often!
5. So You Think You Know the Best Iron Supplement, Right?! (≤30 min audio + Iron Supplement Guide)
Iron supplementation, regardless of brand, presents us with some major challenges: low efficacy, poor tolerability & high toxicity – in terms of oxidative stress, inflammation (local and systemic) and detrimental effects on patients’ microbiome. What should we look for to minimise these issues & enhance our patients’ chance of success. Which nutritional adjuvants are likely to turn a non-responder into a success story and how do we tailor the approach for each patient? It’s not what you’ve been taught nor is it what you think! This comes with a bonus clinical tool, a fabulous easy reference guide – to help you individualise your approach to iron deficiency and increase your likelihood of success.
You’ll never look at iron studies or your iron-challenged patients the same way.
Listen to these audios straight away in your online account.
In 1 of about 3 storage facilities for tinctures…yes they go through that much!
My career path has taken me a long way and in a very different direction from the one I started on. During my uni days I wildcrafted herbs, enthusiastically made potions and, yes as the semi-famous story goes, even misidentified one wild-crafted species and accordingly almost poisoned my mother and me. Ahhh the good old days. But seriously, I did initially aspire to become a great herbalist. Then I almost poisoned myself again with some over-enthusiastic dosing in fourth year – and perhaps like people who’ve ever made themselves truly hideously sick on a particular alcohol, have struggled consuming tinctures myself ever since. I know…right…it was as much that the nutrition path chose me as it was that herbal medicine said, no thanks!
Last week, after speaking at an event, I went walkabout around Hobart & had the great fortune to visit both the Gould’s Apothecary & their herb farm, Bronzewing and I was potently reminded of why this core naturopathic modality is so incredibly appealing & powerful – for practitioners and patients alike – when it is executed with such a high level of integrity.
You’ve heard it all before, right?Perhaps even done the taste test comparison between a ‘regular’ ginger or echinacea or…whatever herbal prep and one born from Gould’s and had that ‘Aha!’ moment? Yes, me too, but seeing it with my own eyes from paddock to…product…was even more impacting. Herbs are not my strong suit in naturopathy & never will be, that’s why I have monthly mentoring specifically in herbal medicine with a colleague who lives and breathes herbs, however, I love that it is hers and others and via collaboration, we can give our patients it all. Especially, if we are discerning regarding herbal product quality. Oops did I just say that out loud? [trouble maker!]
Drying calendula and some other green herb! LOL
Apparently, this 3 storey heritage apothecary is already firmly on the selfie-taking map among tourists (who happen to also be naturopaths) – but if you haven’t already done so, don’t miss it if you go to Hobart…that and Mona 😉
Harvesting Echinacea flowers, I know, how instagrammable right?!
The incredible Greg Whitten who runs the herb farm
So this is not news to most people who know me but I don’t like taking things out of people’s diet. As a result, in a room full of naturopaths & integrative medicos, I might be voted the least likely to use the phrase, “No Gluten or Dairy for you!” [said with the Soup Nazi’s accent from Seinfeld]. I must have slept through that class when we were taught to do this for absolutely every patient. But seriously, I try not to remove or exclude foods without a very strong rationale and evidence-base that relates directly to the person sitting in front of me, for several reasons: 1) those seeds are powerful ones to plant in your patient’s mind…how do they carry that with them as they move through life, navigating food and social settings etc etc…all well and good if this is a proven life-long pathological provocation for them but otherwise… 2) dietary exclusion is stressful for families & in kids especially, can create disordered eating and a range of other psychological impacts and 3) GFDF diets are not necessarily healthier in the basic nutrition stakes…if you haven’t read Sue Shephard’s work on the deterioration of diet quality in GF patients…you should. It can be much healthier of course…but often the real-world application of the principle doesn’t always match the lovely ‘serving suggestion image’ on all the GFDF highly processed, packaged foods!!
So listen up people, because now I’m talking about when I would seriously consider joining in on the GFDF chant.
The one patient group I’ve never quibbled over the benefits of GFDF, has been the autistic one. I was taught the merits of this approach early on by a few fabulous courageous integrative doctors and paediatricians who came back from the front-line of their clinics, reporting good effects. I then had the important firsthand experience of unprecedented verabilisation in a non-verbal ASD child’ after excluding these foods. But what I’ve been thinking a lot (and reading a lot!) about lately is the possibility that these ‘dietary exorphins’ may have negative mood effects in other subsets of mental health patients. My thought process is like slow TV! That aside, there’s a lot to be said for taking the time to really getting across an issue – even if that involves reading papers from as far back as the 1960s when the idea of a negative role for dietary exorphins in schizophrenics was first floated by Dohan & colleagues.
Let me say, when you go back to the beginning it’s undeniably a shaky start for the exorphin evidence base, but as you read the studies that emerge from decade to decade until the noughties…it reveals a nagging research topic that won’t go away and a fascinating process of discovery.
So is the devil really in the (regular commercial cow’s) milk? Well I think for some patients it may well be a contributor – most notably those with features consistent with the pattern of excess opiate effects including a higher dopamine picture, regardless of the mental health label they’ve been given, although, more commonly seen in ASD, psychotic presentations etc. But how do we work out which ones, because none of the evidence points to it affecting 100% of these groups…well that’s where we need to go back and truly understand the structure of these dietary exorphins and just how they potentially wreak havoc in some.
The latest UU30 takes your through the story of BCM-7 with a summary of research compile over half a century in Under 30 minutes!
There is a well-rehearsed chant in the integrative management for ASD individuals, “Gluten free- casein free diets” is based on the dietary exorphin theory which suggests these foods generate bioactive peptides that act unfavourably in the brain. Where did this theory emerge from and how strong or weak is the evidence upon which this therapeutic intervention stands? Even more interesting, is there support of this theory in a wider range of mental health presentations such as schizophrenia, post-partum psychosis and depression. Is there such a thing as milk madness for a subset of our patients?
Let’s talk turkey about our pharmaceutical Pet Hates, mine are Proton Pump Inhibitors (PPIs). They irk me more than any other drug class. It’s not entirely rational. Let’s face it, they have some stiff competition but for some reason, in my mind, they almost always win: helping so little & at such a high cost to patients. What fuels my fire of course is their over-prescription, followed closely by the complete disregard for the prescribing guidelines which state:
“When clinically indicated, PPIs should be used for the shortest duration necessary and chronic use is not recommended except for treatment of pathological hypersecretory conditions including Zollinger-Ellison syndrome and maintenance healing of erosive oesophagitis.”
Sorry…did I hear you correctly?Chronic use is not recommended – yet this is one of the drugs most commonly on ‘set and forget mode’ in general practice. To boot, their chronic use has been associated with a number of serious concerns, which I’ve touched on before, from osteoporosis to increased rates of GIT infections. not to mention just the little ol’ detail of malabsorption of multiple nutrients! But this week, yet another health concern has popped up and into my inbox…and well..I found myself shouting at the medical newsfeed on my screen…[again] 🙁
“In their analysis, more than 42,500 adverse events reported to the US Food and Drug Administration by patients on PPI monotherapy were compared with more than 8300 reports from patients on histamine-2 receptor antagonists (H2RAs)….Patients on PPIs alone were 28 times more likely to report chronic kidney disease than those taking H2RAs, while the frequency of acute kidney injury reports was around four times higher…Reports of end-stage renal disease were 35-fold higher among PPI users, while reports of renal nephrolithiasis were three times higher”
To be clear, while these increased rates are TERRIBLE and unacceptable in the context of the ‘set and forget’ prescribing that seems it be rife in most countries, they still only effect a small % of patients e.g. approx 5% of patients had adverse renal effects on PPIs Vs 1% on the older generation H2 blockers for reflux but it’s yet another reason (like we needed more?!) to think twice before our patients are initiated on these meds, which are presented to patients as being benign. Typically with drug development, the older drugs in a class are superseded by newer ones that are ‘cleaner’, and therefore more effective with less adverse effects but this is one situation where if one of my patients really did need a med, I would say out with the new and in with the old!
One scenario where PPIs in combo with multiple antibiotics get routinely rolled out is of course H.pylori infections. But does this make sense??
For a bacteria identified just a few decades ago as being a cause of chronic gastritis, atrophic gastritis and gastric carcinoma, the escalation of number of antibiotics used to eradicate it (4 at last count + PPI) has been nothing short of breathtaking. A management approach more consistent with both integrative medicine and with an improved understanding of the delicate microbiome focuses on changing the gastric environment to ‘remove the welcome mat’. What do we know about how to do this successfully? It turns out…quite a lot. You can find out here with our previous UU30: H.pylori- Eradicate or Rehabilitate?
Hear Hear…on all levels, right. But this is actually the first recommendation of an easy to read patient resource for families dealing with adolescent depression, that you and your patients can access here. As lovely as the picture above makes parenting look, the one to one (or even 2 to 1) ratio isn’t realistic or necessarily optimal for anyone. I think we can all make a great addition to any parent’s team, especially given the emphasis these recommendations place on nutrition, sleep and exercise as being central to improving mental health…full-stop..and in this age group.
But while some things are the same between depressed adolescent and adults, there are important differences we need to be aware of: like the best assessment tools and the barriers for teenagers (and parents) in admitting there is an issue. Think, parent guilt and over-attribution, standing defiantly on the top rung of that ladder!
They also mention different types of therapy for this age-group and I have to say the old CBT…oh yes it gets wheeled out yet again…really does offer something, given the kind of kids I’ve seen this work a treat on. This is a developmental staged characterised by curiosity and a desire to understand more about the real stuff of life…rather than the soft focus lens we got them to look through in primary school. I’ve seen teenagers benefit enormously from sitting with a good psychologist or GP who can explain the ‘brain mechanics’ of depression, or anxiety (amygdala activation that sends the frontal lobe executive control offline etc). They love the demystification and, in the best cases, feel re-empowered by this knowledge. Not perfect for every teenage but it does work for many. And then there’s the parental advice to discuss suicidal ideation.
Yes parents, even more than practitioners, fear the ‘planting of seeds’ when contemplating this topic with their teens but the opposite is true. This paper is hot on the heels of an editorial, revealing that 50% of parents were unaware of their teenager’s suicidal thoughts.
There is much to be gained from the ‘knowing’ and so much to lose from avoiding this one. It’s the beginning of another school year (at any level) and with this can bring significant stressors and provocation for mental health challenges. Let’s encourage every parent, to get themselves a team and take our own place in that invaluable roadside assist crew.
This is a succinct recap of the many investigative paths we need to follow when presented with kids or teenagers with behavioural disorders. From grass roots dietary assessment through to the key pathology testing that is most helpful in clarifying the role & treatment approach of integrative nutrition for each individual child.
My second speaking gig for 2019 is approaching at a vertigo-inducing speed (hey…wait..someone stole January??), heading to Hobart as part of theNEW primary training course that ACNEM have created and will be rolling out this year around the country. I am really pleased to be one of the new presenter/practitioners to help ACNEM deliver their renovated course, with a renewed focus on delivering independent, unbiased and high quality training. My specific mission, the Micronutrients…I am like a pig in mud!
Here’s a snapshot of what the Primary Program covers:
Primary Modules in Nutritional and Environmental Medicine (NEM)
The Primary Modules in NEM, designed for GPs, registrars and other graduate healthcare professional, are ACNEM’s foundational training in post graduate Nutritional and Environmental Medicine. The modules will be delivered over 2 days face-to-face, plus equivalent of 2 days online (4 months online access) to view the lectures and to complete the required learning activities.
These modules provide an introduction and overview of NEM within primary care. Each major biological system is explored covering the key nutritional, environmental and biochemical factors affecting health and disease. Through case studies delegates will gain practical tools to aid integration into daily practice. The Primary Modules enable practitioners to begin practising NEM confidently and safely.
More information on the Primary Modules can be found here.
On the same weekend, ACNEM are also presenting a GIT Health module – so I’ll be front and centre to get the latest Jason Hawrelak goodies along with those from doctors, James Read, Robyn Cosford and Nadine Perlen, which will go a little something like this:
This module will address a number of the most common functional and inflammatory gastrointestinal complaints that present to clinic. Conditions to be covered include gastritis and reflux, constipation, Inflammatory Bowel Disease and Irritable Bowel Syndrome, from pathogenesis to treatment.
Our highly regarded presenters will bring their clinical experience and knowledge on the application of nutritional and environmental medicine in collaboration with conventional medical practice. Current scientific evidence for the effectiveness of treatment modalities will be presented including nutraceutical prescription, dietary manipulation, lifestyle modification and environmental factors, alongside the range of available testing and investigation options. More information on Gastrointestinal Health can be found here.
When you get clinicians with extensive real-world experience talking about the things they know best, not just academically but also clinically…then you’re in for a very practical & clinically impacting learning opportunity.
So you’ve gone to all the effort. Be that writing referral letters suggesting some pathology investigations might be warranted or you’ve coached your patients endlessly to get copies of ones done elsewhere so that you may be privy to their findings. Worse still, you’ve directly requested the pathology, with your patient paying out of pocket for the tests. Then the results come in and they look…well wrong. You, as the conscientious clinician, typically do 3 things:
Step 1 Spend hours pouring over & over the labs and back over the case notes
Step 2 Worry about the new differential diagnoses that are now suddenly seemingly a possibility in your patient. It doesn’t look good.
Step 3 Doubt your own pathology reading ability, ‘Hey maybe I just don’t understand these bloods like I thought I did’
But (often)…it’s not you, it’s them.
And that’s what I often explain to practitioners who contact me (step 4). You see sometimes what they’re losing sleep over are what I call, Bad Bloods. Occasionally, the fault of the pathology company…but way way way more often the fault of the patient and the referring practitioner, who has not educated the patient correctly about what to do and not do prior to blood collection for certain tests. I am excited to see how many practitioners are competent with pathology reading these days and building their skills and confidence all the time, that’s why it is so so disheartening for the practitioners (and for me as a mother hen mentor) when they lose time (& sleep) getting to Step 3 when they should be able to spot ‘Bad Bloods’ fast. There are 7 classic give-away patterns.
Will are unlikely to know every quirk of every blood test our patients will ever have done, but knowing what constitutes the ideal time and conditions for the most commonly performed ones, can go a long way to minimising any future Bad Bloods between you and patient as well. This includes things like exercise, alcohol intake, duration fasting and even sexual intimacy…yup!
This month’s Update in Under 30 installment Beware of Bad Bloodsteaches you the 7 patterns to watch for and provides you with a great resource stipulating the best collection conditions for the most common blood tests. Don’t let Bad Blood come between you and your patient, the right diagnosis & management or just some well-deserved sleep!
Good practitioners are being led to bad conclusions by some patients’ pathology results. Not because they can’t interpret them or the testing has no merit but because they just don’t know when to discard a set because they are ‘bad’. Occasionally, the fault of the pathology company but much more often the fault of the patient and the referring practitioner, who has not educated the patient correctly about what to do and not do prior to blood collection for certain tests. This recording clearly describes the 7 classic give-away patterns of ‘Bad Bloods’ which will enable you to spot them fast in the future. In addition to this. while we are unlikely to know the idiosyncrasies of very lab our patients will ever have done, knowing the ideal collection times and conditions for the most common ones assists you and your patients to avoid any in the future – handy clinic resource included.
While we’re on the topic…I tend to think, that as good as we are at asking a lot about a patient’s health, we can always do better. One of the classic pitfalls for practitioners is having to rely so much on patient self-reporting: Is your period heavy,moderate or light?; How would you rate your appetite?; Do you suffer from excess flatulence? When our patients answer these questions, who are they able to compare their own experiences with? Or do they only compare them with themselves at another time in their life, e.g. my periods are heavier/lighter than they were before? Either way, this may lead to unintentionally misleading information from our patients, producing erroneous conclusions for us as clinicians. Do you suffer from excess flatulence? Well do they?? How exactly would most of us know?! Unless we can define what ‘normal’ looks like…?
(But as many as 22 times a day – that’s almost one on the hour)
That’s the average number of ‘pop offs’, ‘air biscuits’, ‘bench-warmers’, ‘fluffs’, or whatever you want to call them, healthy humans do per day as cited in this great evidence based & entertaining article. Funnily enough I had exactly the same lecturing experience as the author: performing a snap poll on my students, asking for averages…and can I just say almost everyone was clearly under-reporting!! But the point is clear. How can our patients accurately rate the magnitude, severity or normality V abnormality of their bowels, menses, appetite, pain threshold etc – unless we provide some goalposts? And are we, in fact being lead to believe there is a problem when perhaps there isn’t? That certainly has been the conclusion of several studies into the matter of self-reported excessive flatulence. Hippocrates himself put in a good word for bottom trumpeting, saying “passing gas is necessary to well-being” and as a recent article in the Harvard Health Letter reads, “A little bit of extra flatulence, could be an indication that you’re eating the way you should!” Here here!
But my favourite quote from this article has to be about the high tech solutions on offer – for those who do accurately fall into the excessive category:
“Such as carbon fiber odor-eating underwear (cost: $65), which were put to the test in an American Journal of Gastroenterology study that included such gems as “Utilising gas-tight Mylar pantaloons, the ability of a charcoal lined cushion to adsorb sulphur-containing gases instilled at the anus of eight subjects was assessed.” Assessed, that is, by a panel of fart-sniffing judges. And the name of the charcoal lined cushion? The “Toot Trapper.”
How different that scene in Bridge Jones’ Diary would have been had these been her undergarment of choice instead of the control briefs!
Of course, if there is associated pain or an odour (which the article discusses as well) that makes the family dog leave the room…well, that’s another matter…;)
Is Glutamine your go-to prescription for patients with gut problems? Do you look for good levels of it when you’re choosing your gut repair formulas? Most of us do this because we’ve heard that a deficiency negatively impacts the gut tight junctions , villi structure and immunity etc. but how long has it been since you’ve reviewed the latest human studies on the digestive effects of Glutamine supplementation? The time is now. This previous UU30 installment cuts to the chase on the big research findings that warrant our urgent attention and necessitate big adjustments in how we use glutamine for guts.
How long? How long must we sing this song? I’m feeling a bit 80s anthemic and righteous. It turns out that patients’ bowel movements could be improved by using a foot stool?!! Who said that??
Only every naturopath, ever. Right?
But now medical researchers are singing the praises of the Stool Stool too…sorry, I mean the ‘defaecation postural modification device’…because lo and behold a new study of over 1000 bowel movements revealed using a stool to elevate your feet while on the toilet improved the speed and ease, improved full emptying, reduced the strain etc of laxation, >70% of the time, even in ‘healthy, non-constipated patients’. There’s a quick video you can watch to get across this groundbreaking research, or you can read the full article here. I’ve been educating patients about this for about 20 years and it never fails to revolutionise their world!
It would seem that elevating your feet results in straightening “the unnatural bend in the rectum that occurs when sitting on the toilet by placing the body in the squatting position nature intended”…hang on a second…who’s calling what unnatural???…I think the highfalutin anti-anatomical bathroom contraption, we westerners call a toilet, wins the ‘unnatural’ crown!
Next thing you know there’ll be a study that tells us squatting to have babies makes more sense that lying on your back…right?! 🙂
Love talking all-things Stool?
Fabulous Farty Fibre is a previous UU30 recording. Rachel at her warmest and funniest reminds us that fibre is a critical component to good nutrition and is often overlooked, partly due to the popularity of paleolithic and no grain diets. This UU30 details the important functions of different types of fibre and therefore the importance and therapeutic applications for fibre diversity.
Remember the good old days when we understood everything about food allergies and life was simple? IgE was the culprit – short and sweet – which made patient assessment (SPT) & management (never eat this again, never feed it to your infants if you don’t won’t them to develop the same health issues and never doubt that it will never be an option for you to consume it) real tidy. What’s that thing about never say never?
It hasn’t escaped our attention that the so-called rule-book on food allergies appears to have been shredded, set on fire and then eaten by someone not suffering from an ash allergy, in the last few years. Now, we’re told that many of these truisms…weren’t just a little, but a lot, wrong and in some instances have lead to the further escalation of adverse food reactions that we’re now facing.
So what else did we get wrong? Well in the good ol’ days we were also informed that there was no role for IgG antibodies in immune mediated food reactions and that of course there was no interplay between the IgG system and say mast cells…right???!!!! Want to get up to speed on the real story on how IgG is involved in well book yourself a ticket and strap yourself in because there is loads to learn in addition to a whole new way of thinking about food allergies and intolerances!
As clinicians there is perhaps no more complex a labyrinth than the correct diagnosis of adverse food reactions. In part, this is because of the multitude of potential mechanisms driving them. However, the long lag time between radical-re-writes in immunology and reciprocal changes to mainstream medicine’s approach & understanding, has marginalised our views, planted seeds of disbelief & stymied our progress in diagnosis and management.
This upcoming seminar presents a scientific summary regarding IgG mediated food reactions, their validity, their correct assessment & their meaningfulness and along the way…it will introduce you to the ‘even better’ new days, where the lid has been lifted on what we kind of suspected was going on all along!
Immune Mediated Food Reactions – What’s IgG got to do with it?
It all starts in Sydney onFebruary 16, Melbourne on February 23 and Brisbane on March 2. Email [email protected] to confirm your place.
I hope you’ll join me at the IgG Food Intolerance Workshop.
For more details download the flyer here for more details.
Virginal skin, as my sister calls it, is on the endangered list. She also predicts that as a result, it will be a highly sort after commodity in the future and I agree but our reasons are a little different. Hers are aesthetic and mine are well, health-based.
I dislike spreading fear in the wellness world, especially around the area of autoimmunity, which is already plagued with podcasting puritans, espousing the notion that people with autoimmune conditions need to give up every single source of joy in their lives and then, and only then, they will be healed
[Silent Scream !!!!!!]
The essential formula for autoimmunity is generally thought to be: genetic susceptibility + environmental trigger = Bingo! i.e. Hashimoto’s or Grave’s or AS or or or…There are already so many candidates, both confirmed and speculated, on the environmental triggers list, from individual nutrient deficiencies, to food groups, from infectious organisms to of course, the big monster under the bed and everywhere else (!), environmental toxins. But wait there’s one more.
Recently I was prompted to ask one of my mentors whether tattoo inks contained heavy metals. His reply, “I seriously doubt that heavy metal-free tattoo inks even exist.” Then someone on my team forwarded me this well referenced article that contains the above quote titled, Toxic Chemicals Found in Tattoos: Links to Autoimmune & Inflammatory Diseases. I haven’t had a chance to read their citations and understand the real implications of this very plausible biological threat and I can’t do anything about the skull & crossbones on my back but I can warn my kids, my patients and anyone else with virginal skin to rethink the ink.
It’s summer time for all of us in the southern hemisphere & that means….Slip Slop Slap?!
Vitamin D deficiency has been associated with a long list of major health conditions: from autoimmunity to mental health & almost everything in between. This has lead to many of us recommending high dose vitamin D supplementation for a large proportion of our patients but do we understand everything we need to to be certain of the merits and safety of this? In this provocative podcast, Should We Rethink High Dose Vitamin D, Rachel outlines the key unresolved vitamin D dilemmas that should encourage us to exercise caution with supplementation and outlines how adequate sun exposure is associated with improved health outcomes independent of the production and action of vitamin D.
Did you read something fabulously non-work related over the break? I did. Basically opening any book by Isabelle Allende evokes a Pavlovian relaxation reflex in me – ok admittedly some salivation as well! Then I decided to seamlessly segue into some work-related reading that I intended to catch up from the previous year. Good idea, right. Just slip it into the beach-bag among the sunscreen (sorry Pete) and the sunnies (double sorry Pete), as if I would not even notice I was actually working, while not working. Only then…I started reading and thinking and thinking and thinking…which was not the intention of these authors.
You see I’d gathered a collection of hard-copy newsletters and new product information from some practitioner only companies – these lovely multi-page shiny things were full of clever graphics, so colourful, so eye-catching I was tempted to wallpaper the clinic with them. There’s one on methylation and mental health, there’s another on approaches to immune modulation in allergy management and so forth.
Then I read the accompanying text…not so impressive…references often only provided on application & when provided often quite out-dated, one even referenced the 3rd edition of Braun & Cohen…heck I’m not sure why we bothered to put out another edition since then that’s twice the size and content! Or, in those materials where primary studies were cited in support (of the product…let’s face it) were of very poor quality, with sample sizes of 20 for example, or other major methodological issues and only ever had positive findings. Then, a lightbulb moment.
I looked back at these lovely eye-catching graphics that make effective gut protocols appear a cinch or complex mental health management a bit of a dawdle & 2 thoughts landed
No.1: ‘Holy guacamole…beyond the engaging colours, lovely fonts and stylised imagery, most don’t really say anything other than…we have the perfect thing for this,’
Shortly followed by thought No.2: ‘Gosh these remind me of the landfill the pharmaceutical companies wanted to fill GP in-trays with’
I’m not surprised by this parallel with the pharmaceutical world of course, just disappointed. Others do better…but therein lies the key. We, the practitioners, have to be discerning. Now I know I am a boring old nag about these things and at the ANS last year together with Jason Hawrelak and Nirala Jacobi, really did dance on our soapbox about 1) the need for independent and unbiased education and 2) the need for us all be vigilant about being discerning when the information comes from a vested interest. And boy did we cop some flack about this! But we also received enormous support from practitioners, ex-company employees & even some current company employees who echoed our concerns and agreed it is up to us, the practitioners to force the bar higher for all providers of goods and services to our patients.
So how can we do this when our schedules are already full? Form a collective of colleagues – pose the same set of questions and comments to each company representative you encounter and then share your findings. Basically…use the force. What kind of questions, I hear you ask? Well maybe ones along these lines:
Can you please provide me with full text copies of your key supporting papers – for this product or test?
Can you also provide me with full text copies or links to studies which produced negative findings – for this product or test?
Could you please explain to me why the form/dose/combination used in the study your company is citing is different from the form provided in your product – and can you provide evidence of equity?
Could you please explain to me why the testing method, sample, collection etc used in the study your company is citing is different from those employed in your test- and can you provide evidence of equity?
Can you please provide me with the method used to derive your reference ranges for this functional test – including sample size, gender and age distribution, location (think about it….minerals, heavy metals), reported health issues and outline how frequently you review and update this reference range?
[if relevant] Why don’t you include all your references in your materials rather than demanding more of my time having to call and request them? It is essential to me, in order to make an informed choice to have immediate access to these
I undertook a holiday..not a lobotomy or a personality transplant 😉
Let’s make 2019 a great one professionally and raise the bar!
Speaking of a reliable source of non-biased independent education. I know that was a conflict of interest, right?! Well spotted.
If you’re not an Update in Under 30 subscriber yet…you might want to get on board. Open to all ages (LOL) a monthly podcast of less than 30 mins that delivers something dynamic and immediately clinically relevant to help you keep informed, growing and improving as a clinician. With our next installment ready for release at the end of January – now’s a good time to put your best foot forward education-wise in 2019. Find out more about the subscriptions here.
Relax, no one is leaving RAN central – they’ve deadlocked all the doors (!) but I’ve left another online abode I built and time-shared in last year….The Worm Whisperer…which is exclusively focused on educating the public about worms. Not the compost ones, but the ones that like to inhabit us humans and cause so many health conditions that most people, & sadly many practitioners alike, are not aware of. So back to my wormy tale… In 2018 I started up a Facebook page: The Worm Whisperer. I recognised from the many talks I’d given that there was a need to educate people more about threadworms because the information just wasn’t getting through and affected individuals were basically being grossly medically mismanaged. There are just so many cases where children have been diagnosed with an alphabet soup of physical or behavioural disorders only to discover that chronic treatment refractory threadworms were in fact the culprit. And no…mebendazole is not going to fix that.
Then there are the women, who have had years of sleepless nights and complex disturbing health issues. They visit many different medical & allied practitioners who can’t seem to pinpoint the issue. Or even if the practitioner accurately does diagnose Enterobius they mistakenly use inappropriate anti-parasitic strategies and therefore struggle to get any long-term resolution and reflief. I can’t tell you how many women have discovered The Worm Whisperer Facebook page and told me how they cried with relief when they read the information in our eBook and understood for the first time that this was not in fact ‘all in their head’ and help was on its way.
I’m so glad I started this up. It’s been an amazing privilege to support women, children and whole families from around with world with their worm journey and see such positive results. And it’s only the tip of the iceberg because there are so many more out there being told their pre-pubescent daughter just has ‘thrush’ (impossible by the way in this age group) or referring women to psychologists and telling them they’re ‘hysterical’ (that’s an old chestnut that has made a strong & unwelcome comeback in this area) when they present with myriad symptoms that just don’t fit neatly into other diagnostic boxes. Anyway, together with the joy of being able to help so many came..who would’ve thought (!)…more and more followers…and more and more work…and well..The Worm Whisperer is continuing to grow at a rapid pace and now it’s time to hand over the baton to a team of people who have the time to focus just on this issue and who are just as passionate about worms as me. So I wanted to let you all know, there is a new team at the helm and I have officially left the (WW) building…but you know…they’re cheeky little blighters…so I’m sure they haven’t left me 😉
Check out The Worm Whisperer Facebook page, support this great Australian initiative and let others know. There is a great eBook, resources and products to treat all worm conditions.
Sheesh…who turned down the music and turned on all the lights…are the holidays seriously over??! That’s right, pack away the Christmas tree (somehow), drag yourself away from your (endless tennis/cricket watching) meditation practice and start looking at your calendar because my first tour is kicking off in February! That’s right, you heard me, F.E.B.R.U.A.R.Y So given my computer (the mothership) also didn’t want the holidays to end…staging a pathetic ‘sorry, no power, protest’ for the last week…I too have now got my skates on, getting ready for this juicy and thought-provoking seminar to jump-start all our brains for 2019:
Immune Mediated Food Reactions – What’s IgG got to do with it?
Because let’s face it, identifying, testing and understanding food based reactions, is typically plagued by myths and misunderstandings among the public & can be a source of confusion & frustration for many practitioners. The testing technology has advanced so far, however, that if we combine these improved methods with astute case taking and sound clinical reasoning, well while, food based reactions are always going to be a complex area, now we at last can be systematic in our approach of investigating these and better understand the clinical significance of our findings.
I kick off in Sydney on February 16, Melbourne on February 23 and Brisbane on March 2. Early Bird price of $50 ends 11 January, so don’t miss the early bird discount and email [email protected] to confirm your place.
I hope you’ll join me at the IgG Food Intolerance Workshop. For more details download the flyer here for more details.
Oh no, it’s her again 🙁 I mean the chick in the photostock image not the other ‘her’, me. I know. It’s the end of another mammoth year, you’re tired, worn out, used-up all your brain-power quota (a little projection?) and I can hear you begging for mercy when I start a sentence with…”So you think you know….” followed by, “blah blah blahIron,” but hear me out.
Correctly identifying & managing iron issues is a bread & butter part of our business, right?
With Iron deficiency affecting an estimated 1 in 5 women and Iron excess almost another 1 in 5 – patients with one form of iron imbalance or another tend to be over-represented in waiting rooms.
Anyone can spot overt iron deficiency anaemia or full-blown haemochromatosis but many health professionals find the ‘in-betweens’ confusing and fail to recognise some key patterns we see over and over again, that spell out clearly your patient’s current relationship-status with this essential mineral. This often results in giving iron when it wasn’t needed and missing it when it was. If you’re imagining someone else, i.e. the person who ordered the Iron Studies for your patient, will step in and accurately interpret the more curly results can I just say D-O-N’-T...they’re often as perplexed or even more so than you. After starting this conversation a year ago with So you think you know how to Treat Iron Deficiency, & its baby sister, So you think know the best Iron Supplements, our (imaginary) switchboard went crazy. While practitioners got the message loud and clear about how to improve the likelihood of treatment success in iron deficient patients, hot on the heels of this came email, after fax, after carrier pigeon, with examples of patients’ Iron Studies, the ‘somewhere in between ones’, accompanied by the equivalent of a dog head tilt…aka ‘I don’t get it’.
And this is to be expected.
What were you taught about reading Iron Studies? Was it made out to be all about ferritin? And TSH is a solid stand-alone marker of thyroid health, right? 😉
Were you introduced to the other essential parameters included in Iron Studies, explained how they contribute to your diagnosis and reveal important details about the patient’s ability to regulate this mineral or not? About when to dose and when to hold your fire?
Nah…I didn’t think so. But it’s up to us, people, to hone our skills in Iron Study interpretation…because individualised nutrition is our ‘thang’ and more than any other nutritional assessment, this collection of markers, actually allows us to go beyond the ‘one size fits all’ model…everyone must have X of this and Z of that in their blood tests…and see each patient’s actual individualised need and relationship with this mineral. In the latest Update in Under 30, I introduce you to 3 key players in iron assessment and the insights each offers become so clear, you’ll be able to read any combination or permutation of iron results that walk through your door. To boot, I’ve included a wizz-bang cheat-sheet of those iron patterns that are frequently seen and rarely recognised, including one totally novel one that I’ve never talked about before…to make your job even easier and put you well and truly ahead of the pack in understanding iron nutrition. It’s Christmas…and as the mantra goes…we can always fit just a little more in at Christmas time, right? 😉
Overt Iron Deficiency Anaemia or Haemochromatosis aside…do you understand the critical insights markers like transferrin and its saturation reveal about your patients iron status? Most practitioners don’t and as a result give iron when they shouldn’t and fail to sometimes when they should. This audio complete with an amazing cheat sheet for interpreting your patients Iron Study results will sharpen your skills around iron assessment, enabling you to recognise the real story of your patients’ relationship with iron.
Yes them’s fightin’ words. It’s 6 days til Christmas and we’ve all got way too many things to do before Santa visits, right? But this will take you 1 minute and takes precedence over finding excuses not to attend Christmas parties, half-crazed-mad present buying, watching Love Actually….again and building tension with loved ones in preparation for the big day/fight. I joke but I am serious. I don’t know how you feel about the proposed PHI reforms which are due to come into effect from the 1st April, removing Naturopathy & Herbal Medicine as modalities that can be covered by Private Health Insurance, but in the least amount of words, here are mine:
For me, the financial impact on patients and secondarily on me, is not my primary concern. Our profession represents a significant proportion of the health workforce in Australia and according to 2005 data, a form of healthcare that 69% of Australians engaged with, and according to Wardle & Adams research, often as primary healthcare providers. We provide such an important service, the public knows this better than any political party, and they will continue to come through our clinic door, seeking the kind of quality care we can offer.
No, what really concerns me about this (among other things) is the marginalisation of my profession, my colleagues and by virtue of this, the implied message to both patients and other healthcare professionals alike, that we are not active contributors to the improved health and wellbeing of a substantial proportion of the population…and as a further extension of this – we should not be part of ‘the conversation’. It is yet another step backwards away from any shared care or integrative model that truly puts patient outcomes first or that recognises the importance of an individual’s right to choose in regard to their healthcare.
Now the NHAA have created a petition that is going straight to the health minister, Greg Hunt. Their focus is a little different from mine – about the potential for more ‘fake naturopaths’ to hang up a shingle post PHI reform and therefore increase public risk. This is not my major beef and it may not be yours IT DOESN’T MATTER. We need to all sign this petition – naturopaths, herbalists, nutritionists, integrative doctors and healthcare providers of every persuasion.
Just my thoughts…what are yours?
PS It doesn’t matter if this is your association or not…let’s allsign it...& get some groundswell going