How many times have you heard me suggest a vegan diet as the most effective and sensible dietary intervention for a condition….yup…not often but here I am saying it now. I had a great one-on-one session with a long-term mentee yesterday to discuss a case of advanced Chronic Kidney Disease (CKD). Her patient, a 60 something male, has had a GFR < 30 for over 5 years, (I know don’t get me started again, right…Goodness Friends Really!), but was only alerted to this being indicative of severe renal impairment (stage 4 of 5 stages, in fact) in the last 6 months. Pause. Everybody who cares about kidneys, take a deep breath.
So…what’s been his dietary advice and management to date in response to the NEW (!) recognition that his kidneys are not functionally normally, can not clear wastes – whether that’s nitrogenous wastes from protein, or fluid, hence the diminished urinary output & susceptibility to oedema, or even excess potassium and other nutrients, as well as he should?
Cut down on red meat.
That’s the advice from his renal specialist & there’s not even a referral to a specialist dietitian. (more…)
You know I’m not one to raise my voice and make scene.
Ok, I always raise my voice and make a scene, but only when I think something really warrants our attention and the issue of under-recognised, under-estimated and mismanaged chronic worms, demands our attention. I’ve been talking about this ever since the first patient stepped into my clinic, a young girl with severe mood issues who just happened to also have treatment-resistant chronic threadworm, and since then, as the volume of patients I see affected by this has grown, so too has the volume of my message. And there’s actually so much to say.
Chronic worm problems don’t always come with an itchy bottom calling card. In fact, many individuals don’t have any of the telltale signs you might be used to screening for. Recent research suggests adult men, in particular, are commonly asymptomatic when infected with them (Boga et al 2016)
So what alerts us as practitioners to the possibility of chronic worms – so many things…but here’s just some thought bubbles to get you started.
Are you treating patients with recurrent or treatment-resistant Dientamoeba fragilis?
Are you seeing women who have thrush-like symptoms, in spite of negative swabs and no benefit from antifungals?
Are you faced with families coming undone because of one child’s behaviour whether that’s aggression, defiance, emotional lability or just serious sleep problems? (more…)
Goodness Friends Really (GFR) – where do we start talking about the GFR (Glomerular Filtration Rate)!
This is the standard way to estimate the competency of your kidneys, in particular their ability to filter waste from the blood. There is SO much to say and not quite enough attention span for most of us because renal stuff is silent, it’s not typically what patients write down on their forms as requiring your utmost urgent attention &, let’s be real, it only happens to old people, right? So wrong. Commonly reported as part of ELFTs or General Chemistry, of course it is only an estimation & it’s not infallible – the GFR can both under and over-estimate renal health depending on a number of confounders, however, putting that aside for another time, can we all just agree that renal risks are REAL, they are RIGHT NOW, (CKD won’t happen over night but for 1/3 it WILL happen) and they are REALLY REALLY not talked about enough, by most health practitioners?
“Less than 10% of people with chronic kidney disease are aware they have the condition, which means more than 1.5 million are unaware they have indicators of the disease. One in three Australians is at an increased risk of developing chronic kidney disease (CKD).”
Hmmmmmmmmmm… knowing how effective our kidneys are at removing waste is a pretty important insight to have about our whole health story and if we are truly aiming to practice preventatively then, this system has to come somewhere close to the top of the to do list! Essentially we are all aiming for a GFR >90 and the lower the actual result, the greater the renal impairment. CKD arguably begins with any value <90, although this is only regarded as ‘mild impairment’, that may well still be highly significant, if for example, your patient is only in their 30s! But conversations about this typically start when results drop under 60, at which point you are in CKD stage 3 = moderate impairment. Not yet time to put the patient’s name on the dialysis wait-list ….yet, however, the reduced ability to remove nitrogenous waste will not only hasten the progression to needing this but also potentially contribute to heavy metal accumulation and cognitive decline but increase cardiovascular mortality risk by up to 57% ! So today I have a bewildered mintie pose a very sensible question – check it out: (more…)
I need to clear the air, to clarify. If you’ve listened to my So you think you know how to treat Iron deficiency podcast and implemented a less frequent dosing regime and it’s worked like a treat for your patients, like Tina….HOORAY! And if you tried out this protocol and instead your patient’s ferritin plummeted…listen up.
Something I said during the podcast but likely needs re-emphasising is that this strategy of separating each dose by at least 48 hours is for those patients who are non-responders. This means their iron stores have failed to really budge in spite of big (>50mg elemental iron) daily iron supplements OR for those individuals, of which there are many, who simply can’t tolerate large iron doses but their ferritin is bottoming out as a result 🙁
So just to balance out the feedback…it’s true my days are not exclusively punctuated with good vibes & pats on the back ;)… I also heard from another practitioner whose vegan client’s ferritin had increased by about 30mcg/L on 50mg iron daily and after hearing my podcast, she decided to try pulling the dosing back to alternate days. So, unsurprisingly (to me), her next lot of bloods showed a drop in the iron stores. Why? Because she is a vegan, so there is little iron outside the daily supplement dose itself coming in, she is ‘hungry’ for the iron, and in response to this her body is appropriately increasing her iron transporters on enterocytes to improve uptake in the gut and increasing the number of taxis for iron in the blood (transferrin) and there are no other issues at play like inflammation, to mess up this lovely example of nutritional physiological compensation. She is not the right target for this approach.
But Tina’s patient was… cue email subject header; ‘Iron dosing in pregnancy awesome!!!’ (more…)
Got fair skin and white spots on your nails and go a bit off-grid in stressful situations? Thinking it’s pyrroles? Well, you’re probably wrong! Man. I’ve been waiting a long time, since being introduced to the pyrroluria biochemistry and diagnosis over a decade ago in fact, to get something that looks anything like validated scientific clarification about this condition: what exactly we’re measuring in the urine test, where the line is between healthy & unhealthy with these results and a clear set of physical and psychological traits that actually correlate with this disorder and therefore can help to screen your patients in order to determine in whom testing for urinary pyrroles is really warranted and most likely to bear fruit. And finally we’re getting somewhere! Cue Crowded House ditty 😉
With mental health patients, understanding their unique biological & psychological contributions and drivers is the key to individualised treatment and optimal outcomes but in terms of biological assessment, we can’t just order ‘one of everything’, using a dragnet approach & drain their bank account along way.
Previously, what I had learned, 1st and 2nd hand about patients with pyrroles left me with uncertainty about the specificity of the clinical picture. Then when I caught glimpses of the incredibly, (ridiculously) long list of symptom attributions being made with pyrroluria online via public and some practitioner forums, I felt even more uneasy. It was becoming more likely a Dolly quiz – that’s a mag from the 80s young folk 😉 – than a credible way to pick up pyrroles in patients. And like every health fad, it seems to have been reaching scapegoat and panacea heights. Consequently, it really lead me to question my own convictions about how this condition presents and the significance of that. I started ordering the test left often.
Luckily I still had the file. After seeing patients for a couple of decades, I have to get periodically ruthless with the shredder for those I haven’t seen in a long time and 7 years qualifies as a long gap between appointments but when I saw her name in my calendar, I knew exactly who she was and had clear a sense of where we had left off…somewhere I regarded as the early stages of treatment, in the sometimes vast space of no man’s land, a long long way before done. Where had she been? Why was she coming back? Hadn’t my attempts to treat failed?
I’m sure we’ve all thought about the patients that don’t return and effectively disappear, after the first, the third or the sixteenth appointment. Chances are, there is often some sense of failure…’I failed in keeping them engaged in the process’ or ‘I failed to get them the results they were after’…and certainly sometimes, ‘they failed to undertake a perfectly good management approach because they weren’t ready.’ But this is really just left up to our imagination & we tend to fill in a lot of gaps with our particular bias.
We’re both full of smiles when she enters. It actually feels like reuniting with an old friend, because the rapport building it turns out has a long shelf-life (for both of us). She’d moved interstate, then back again and today she has traveled over 2 hours to come and see me. She likes me, she’s in fact fond of me and therefore she proceeds to share deeply what’s happening for her and I feel so honoured that I am trusted in this way with such personal information, but I am also a little surprised. Didn’t my treatment approach fail? And then she drops the biggest surprise bomb of all… (more…)
Sometimes we wonder who put the invisible sign up out the front of our practice, right? The one that says…absolutely everyone with Condition ‘Z’ come and see me, now! I’m sure you know what I’m describing. Well this week I have hit the trifecta, performed a neat little hat-trick and diagnosed 3 patients with Gilbert’s Syndrome who all present in their own individual way but actually each one also with quite a textbook Gilbert’s picture, it almost beggars belief. Have a little look
70yo Female says: Since childhood she has felt like she has had a rock in her stomach after she eats. This ‘rock’ is there for hours. Her stools are never the same in spite of a regular diet and she has always been uptight and anxious. All her bilirubin results are in the 20s & she reports she’s ‘always’ had high values
55yo Male with severe ‘constitutional anxiety’ and surprisingly high oestrogen and a worrisome profile of oestrogen metabolites. His bilirubin is in the 20s
30yo something Female presents with unexplained severe unwellness for 20yrs that mostly involves nausea, bloating, a functional gut disorder without a real diagnosis, anxiety, depression and poor stress tolerance. Her bilirubin fluctuates between 30 to high 40s. (more…)
When Dr. Christabelle Yeoh says, ‘Hey, we all need to up-skill in Mitochondrial & Metabolic Medicine, Gut and Immunity & Healthy Ageing,’ and then invites a dozen or so absolute experts in each of these fields to speak at the 8th Science in Nutritional Medicine Conference…I listen. Ok to be fair I listen to everything Christabelle says because she is one of the clueiest & most effective integrative GPs I know, however, I do think if you like being on the front-foot of medicine and research and you’re dealing in these complex areas, then this is really a stellar line-up. Check this out
Dr. Rob Roundtree – of IFM fame
Dr Sebastian Brandhorst – heard of the Fasting Mimicking Diet? This is the man.
Associate Prof. Ross Grant – haven’t heard him talk on specific nutrients & the brain? It’s a must
Prof. David Cameron-Smith – connects ALL the dots in ageing..from individual nutrition to the global environmental impact and back
Check out the full list of speakers and program here
So I’m also excited to say, because I am on the playlist (minor B side role)… YOU GUYS GET A DISCOUNT!! (more…)
I’m packing the bag and getting my ‘roadies’ ready……well, not really but it would be great to have one or three!
I’m super excited to be going on tour in May with Nutrition Care and introducing new clinical tools I’ve been developing to help you master the maze of mental health, and what a maze it is! With so many possible biological drivers: from methylation to inflammation and from gonads to gut, these tools can help you quickly identify those most relevant to each patient and also outline the strategies necessary for redressing these.
This year’s theme for Nutrition Care is
Mastering Mental Health: New Assessments and Management Resources in Your Clinic.
I’ll be visiting all the major cities again and I’m especially excited about coming to Newcastle and the Gold Coast! Can’t wait to see you all and pow-wow about what I’ve learned about mental health management.
Better than online.
When we’re all in the same room is when the magic happens with a true sharing of our experiences and knowledge.
The words together with the horror on her face made me feel instantly nauseous. I’d been internally debating for months now if I was simply imagining things and intellectualising about how this just might be the case… observing myself looking in the mirror more often, getting closer to the mirror, brushing my hair more often, cleaning the brush more frequently…in psychology it’s called something like confirmatory bias…ah yes just enough psych knowledge to be a danger to myself!
But louder than the chronic self-analysis and attempts at reassurance was the voice that said, ‘You’re losing your hair like an old woman. You’re not even menopausal. You eat fabulous food and have too much energy for your own good but you’re starting to look like you’re ill’. The horror. I felt instantly like a fraud. (more…)
Upgrade’s always give you so much more and here at RAN, we wanted to give our UU30 subscribers more….more podcasts…actually, access to the ENTIRE LIBRARY OF UU30 PODCASTS!
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– Maria Harpas, Naturopath
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I was just reading the results of a spot Facebook poll of GPs asking what the most wonderful medications ever invented are. Once everyone got the customary “caffeine” gag out of the way, the rest of the nominations and auspicious award winners unfolded like a who’s who of the modern medicine prescription pad. Naturally, Penicillin took out first prize (no surprises there unless you’ve been living under a rock…a very clean sterilised one at that that!), one vaccine made the top 10 but I thought there were a few unexpecteds in here:
1. Penicillin “Because of it, entire nations can now afford to worry more about diseases of old age rather than infection. Penicillin’s success ushered in the era of modern pharmacology. To be fair, alongside antibiotics were profound improvements in housing and sanitation.”
2. Smallpox vaccine according to the author of this poll Dr. Justin Coleman,”was a triumph of research, pharmaceuticals, human cooperation and public health planning.”
3. Contraceptive pill for changing the lives of women all around the world. True but BOY does it change it for the worse in some!! (more…)
I think we’re all going to scream when the next patient says, ‘I’ve got an MTHFR’, right?!
Congratulations, I want to say, because you would be in much more serious trouble if you didn’t have a copy…
‘Oh, sorry, you mean you have a mutation on at least one allele encoding for the MTHFR enzyme…Oh, I hate to tell you but contrary to popular (online) belief, you’re not special.’
“I always give some Glutamine to heal their leaky gut”
Cue pained expression on my face. No, I’m not a fan. I take that back, I have no problem with the amino acid itself and I’m still in awe of its incredible multifaceted role in the gut. What I do have a giant issue with is the mismatch between everything we are being told Glutamine is going to help our patients with, and the dosages that apparently will do that, and the reality. I know, I’m attacking the Holy Grail of Gut Health 101….right? But it’s time to set the record straight. Firstly, where’s the evidence at in terms of Glutamine interventions in GIT pathology, particularly in relation to reducing excessive intestinal permeability and improving lining integrity Well if you’re a rat – Good news! Rats’ GITs have a greater dependence on Glutamine than ours, a deficiency of this amino produces clear reproducible negative effects and supplementation fixes these brilliantly!
But if you’re treating humans not rats – well – the evidence & the case for Glutamine for the Gut is not so straight forward or impressive. (more…)
They’ve just come from the immunologist, having presented with extensive vitiligo in dad and early stage vitiligo now in their primary school aged son. The immunologist, without running a single blood test, told them, ‘Bad news, you both have autoimmune issues and watch this space because the vitiligo is just the first presentation, there will be more to come’. Slightly unsatisfied with this dead-end conclusion and non-existent management plan, the family then presents at a long established naturopathic clinic to see Anna Sangster, a fabulously sleuth-like detective, who takes her patients’ health very seriously and has the knowledge and skills that make her one of the best at what she does. I can say that because I’ve been mentoring Anna for a long time & she is one of the clueiest practitioners I know.
For example, she knows about the substantial research demonstrating the overlap between thyroid autoimmunity and vitiligo and, in addition to comprehensive case taking, decides some blood tests may provide valuable insight that would help to understand the degree of self-attack from their immune systems, identify if there are in fact already concurrent autoimmune targets and perhaps even provide a clue as to underpinning drivers. Well, look what she found! (more…)
Just finished talking with the fearless fertility naturopathic specialist, Rhiannon Hardingham, who wanted to let me know that after listening to my Update in Under 30: Silent Reflux she’s had a lot of success treating both GORD and insomnia in her pregnant patients. That calls for double the celebration …YAY! YAY!
‘What’s the magic answer?’, I hear you ask… (more…)
That’s me…always questioning the ‘status quo’ and Iodine is the perfect example! The interview I did on this important subject with Andrew Whitfield-Cook from FxMedicine, covers a lot of key areas of confusion & underscores why it’s so critical all health practitioners get clarity on this topic. ‘It’s just a matter of geography’.
You know, I say to people, we can make vitamins ourselves, we can get all sorts of other organisms including animals, bacteria and plants to make vitamins for us, and then eat those…but minerals…our source of minerals…well it all comes down to the rocks and the soil our food itself is grown or fed on. And iodine is profoundly influenced by these factors. (more…)
I promised I would keep all you fellow desk workers posted. Over 6 months has passed since I started standing for work….and I LOVE IT!
Here are the pros I can wax lyrically about so far:
- Back ache from long days at the computer, gone…seriously
- I am more energised about coming to work, starting work, staying at work…because I am not sitting! YAY! I move around…everyone I meet with on Skype will vouch for that!
- I am fitter & stronger as a result of standing for approx. 35hrs a week ( I know this because it took a while to develop this…after the first 2 slightly grueling weeks!)
- At the end of a long day/week, my mental fatigue and physical fatigue finally match – which means I am no longer brain-dead but in desperate need of a run around the block! The previous mismatch used to make winding down etc hard
- I get to actually walk my constant talk to patients about being active, avoiding sitting etc. Soooooo much better than sitting there for client after client and saying…’you know you really should move more!’
- And at the end of a big day…sitting never felt so good…it’s been restored as the luxury item it should be 😉
Here are the cons I can also attest to: (more…)
No, I haven’t gone crazy for the ‘caped crusader’… but I thought that would get your attention…. oh look it did! 😉
I’m off to Melbourne for the ACNEM Conference May 5-6th and Batmania was one of the interim names of this very cool and happenin’ town before it became known as Melbourne in 1837! Things have certainly changed in nutrition and the environment since then and as practitioners we now need to address sometimes very complex dynamics between genes, gut, nutrition and environmental health. Which, luckily enough this conference is all about!
This year’s theme for ACNEM is Health for Life – Mastering the Integrated Approach.
I am fortunate to be included in the exceptional speaker line-up (thanks for lovely sentiments many of you have expressed so far about that 🙂 ) I am presenting on ageing..which many of you know that I am suddenly now very interested in…getting old and all.
Ok now you’re getting mad at me, right? Because how many ‘absolute givens’ can I debunk?! Last Update in Under 30 certainly got people talking…giving iron less often rather than more often to our most iron deficient patients seems counter-intuitive, right?! Wrong. And as part of the influx of emails I’ve received from practitioners who listened and loved the podcast, came a flurry of great questions – like this one from Michelle Toocaram:
“The Moretti et al study was done on ferrous sulphate which I would never use as it has poor bioavailability. Are there any studies on better forms such as ferrous glycinate etc”
It’s a perfect question – because of course the success of most mineral supplements is largely determined by the form the mineral is presented in – so comparing the same dose of, for example, Calcium carbonate with Calcium citrate is a bit like comparing chalk and yoghurt! The substances that minerals are bound to, generally play a huge role in determining the amount you will absorb from that product and therefore the degree and speed with which your nutritional status will improve. But is that the case with iron? Not quite. (more…)