One Direction Is So Last Decade…

With many of the mentoring sessions I run, I suspect there’s often a misperception that the learning is one way. Part of what thrills me about being a mentor is all the learning opportunities I am personally presented with.

Recently, I had an exceptional example. You see, I am privileged to have a colleague, Sonya Cacciotti, in one of my groups. She has worked for over a decade in tandem with an extraordinary doctor up here in Ballina, and they have had a particular long-standing interest in sleep quality, assessment and management. Consequently, her knowledge in this area is exceptional, particularly with regard to not just obstructive sleep apnoea (OSA) but the much more and often missed, upper airways resistance syndrome, that is especially common in women.  She’s been in my ear on numerous occasions and during group sessions saying, Watch out for this Rachel, it’s more common than we all realise and could be behind many people’s problems‘.

As luck would have it, I have seen a series of cases now within quick succession that all look suspiciously like undiagnosed apnoea or airways resistance. I was listening all along but now Sonya’s wise words and these conditions have my full attention. (more…)

The wait is nearly over…

It is with great excitement & enthusiasm that I’ll be speaking at the second independent Australian Naturopathic Summit being held in Lennox Head, NSW on the 24-26th August 2018. You’ll have to wait until Sunday though…and I’ll be sharing the stage with Dr Nirala Jacobi & Dr Jason Hawrelak. Our group plenary session is titled ‘Your CPE – What Ethics Got to Do with It. During this session we will be exploring how the practitioner may be influenced by subtle and not-so-subtle marketing, disguised as education and ask the question: “Can companies with a commercial interest,  provide ethical and fair education that’s worthy of our CPE” ?

For Australian naturopaths, continuing professional education is most often provided by companies who either supply supplements or services to us. Not dissimilar to our medical colleagues, this presents an inherent conundrum with the risk of bias – from its most simple form: cherry picking research to favourably showcase a product or ingredient without providing a balanced account of the evidence, to its most sinister: manipulation or concealment of less favourable data. How can the astute practitioner glean valuable information and education from a biased presentation?


Real vs Research


A discussion in the Australian Medical Observer this week has got me thinking about the huge push for evidence-based Medicine to form the foundation of our naturopathic practice.  Now as you well know, I am a lover of science, and I enjoy immensely when scientific investigations are done well but is 100% of what I do scientifically supported? Heck, no.

I’m a naturopath and by virtue of this, at times I have to work on the edges, frequently push new frontiers and sail some completely unchartered waters – in my management of every unique ‘n=1’ client who comes through my door.

The over-emphasis or incorrect reflexive association between EBM and Random Controlled Trials and Meta-analyses, such as the Cochrane reviews can lead to a potentially dismissive attitude towards other forms of evidence – traditional, anecdotal and empirical and clinic-based results.  Our best teachers taught and reminded us that EBM should include ALL forms of evidence, right?  

Turns out this is not remotely unique to naturopathic or complementary medicine however. Increasingly, universally-accepted interventions from mainstream medicine is being found to be unfounded!

A recent Cochrane review has created a divide in the medical industry due to its evidence-based slant on a review of direct-acting antiviral drugs (DAAs) in the treatment of Chronic Hepatitis C. To give you some background on DAAs… these antiviral drugs have been seen as a kind of “wonder drug” by researchers and doctors trialling them, with clinical results showing a 90% cure rate in patients with Hep C!!! That’s not a bad success rate, right?! Well, the Cochrane review had a different opinion….It made these actual accepted clinical results appear questionable according to science, claiming that “the therapies were not proven to save lives or prevent harm [and that] the trials were generally weak.”

The clinical trials that the Cochrane review was based on, were focused on the effects of the DAAs on sustained virological response i.e. the long-term absence of the Hep C virus RNA in patients’ blood. However, the review declared that it was “questionable if sustained virological response has any clinical relevance to the person with chronic hepatitis C.” 

Hmmmmm…?!? Surely the absence of the virus in the blood of a person diagnosed with hepatitis C has great relevance to that person??!!

This opens up a lot of questions regarding the relevance or the appropriateness of over-reliance on evidence from meta-analyses and computer-generated statistics, in the absence of tradition, real -world and clinical findings. With more and more pressure to base our practice on EBM, are we forgetting that the foundations of our art and our science, lie in the traditional knowledge passed down through generations of healers? The knowledge of using Nature as medicine? Are traditional, anecdotal and empirical forms of evidence being pushed aside too readily, in the name of science? Of course, I could be seen to be as guilty as anybody for perpetuating this…so I’m just setting the record straight…it’s the marriage of the best of all the evidence sources that is the true potency and success of naturopathic approaches, I believe.

ABB…Which Ages are Affected and What Effects at Each Age?

Just back from Slovakia and I am a little EXCITED & a giant bit KEEN TO SHARE!!!! Thank goodness we have a tour planned for Aug/Sept so I don’t have to sit on this incredible info for too long!! I had already been delving into the impact of mild acidosis across the life-stages before I left but post-conference…all my thoughts on this have been fed with industrial Slovakian-strength (totally organic) fertiliser!  With the bulk of the research on acid-base balance (ABB) in the elderly, we need to clarify what we know about this across other equally important life-stages. We then know what to look for, and can make any necessary adjustments to the expectations and optimal management of all clients.

  • Could acid-base balance be affecting children? If so, how do we identify it?
  • Pregnancy – does this profound change in physiology also bring challenges for ABB?
  • What are the potential problems of not addressing acidity in pregnancy and early life stages?

I will be presenting a seminar series for bWellness on The life Spectrum of Acid Base Balance in August and September. What ages and life stages are affected by acid-base balance issues?  Is Chronic Mild Metabolic Acidosis (CMMA) a phenomenon across the life-stage spectrum that simply takes different shapes and forms and are you able to recognise each? Evidence suggests there are many chronic diseases associated with high acid diets, especially as we age.  Health practitioners are aware that the ability to excrete acids diminishes in older populations and they are familiar with the associated signs and symptoms.  However, it is now clear, from the research, that we must be mindful of acid-base balance throughout all stages of life and ignoring it can have some incredibly profound impacts in individuals of vastly different ages and stages.

And especially…post my Slovakian castle experience at the International Acid Base Symposium..I am FULL TO OVERFLOWING WITH NEW INFORMATION ON THE IMPACT ON CHILDREN (!!! that has literally blown my mind AND YES!  that warrants caps lock screaming…trust me) as well as the latest research in other age groups. (more…)

It Had to Happen

Right? I’ve been banging on about our kidneys for years now – only to be met with a deafening chorus of practitioners of all sorts chanting, “Yes! What about renal health & the best way for us to support it?!  We haven’t been trained in this!!”

 I hear you and I’m onto it.

You’ve no doubt heard me talk before about the incredible rise in Chronic Kidney Disease (CKD) and how often patients aren’t being alerted in the early stages because even though their renal deterioration is there for all to see in their basic bloods, it may be dismissed as a ‘normal part of ageing’…but for a population living longer and longer…holding onto our kidneys for life has never been more important! And yes, I’ve talked about what an incredibly powerful agent nutrition is for renal health – whether we’re talking dietary change (note: diet changing = game-changing), addressing even mild acidosis (that’s my talk in Slovakia), improving the microbiome for better urea handling – we should all be literate in this area of health because our contribution is potentially significant in both prevention and, within our scope, treatment.

But have we gone way way way back and checked in at Renal Health HQ (that’s like the Pond’s Institute but better) and asked ourselves…how much water do our kidneys need?  Does anyone actually know the answer?  Is there a role for therapeutic fluids? Are there situations when the relationship flips and H2O shifts from helping to harassing, an already burdened system?


NAC can knock negative symptoms down!

WOW!! Did we hear that right??!

Medical doctors are branching out in their search for effective treatments for schizophrenic patients.  You see while most of the drugs available currently for this condition are aimed at reducing ‘positive symptoms’, however they can often make patients’ ‘negative symptoms’ worse or simply fail to improve these in the same way

Need a quick lesson in positive and negative symptoms? Sure thing! In schizophrenia positive symptoms are the ones most typically associated with schizophrenia or psychosis, such as  hallucinations, delusions, disorganised thoughts and sensory processing deficits. While experiences such as apathy, anhedonia, lack of energy and impaired cognition and all the way through to catatonia, are referred to as negative.  Different patients will have their own mix of these as part of the condition but generally, as you can imagine, both are severely debilitating and impair an individual’s ability to function well.

Enter N-acetylcysteine (or NAC to friends!)…..

The neuroprotective, antioxidant, anti-inflammatory and glutamatergic properties of NAC have been shown to significantly improve the ‘negative symptoms’ of schizophrenia in recent trials, when given in conjunction with an antipsychotic drug, over a one year period. There is also hope that NAC may prevent the progression of brain mass loss that is consistently observed in schizophrenic patients.  Dopamine-receptor agonists (antipsychotics), which are the go-to treatment for schizophrenia, potentiate the negative symptoms of the disease and contribute to brain mass loss.

AND!! That’s not all folks! For the Herbalists out there…

Trials using Withania have also resulted in “significantly greater reductions in negative, general and total symptoms…in comparison with placebo.”

One doctor from the Semel Institute at the University of California went as far as to say he “used to be skeptical about the utility of herbals and nutraceuticals” but he “now believe(s) this is an up and coming field”!!  Good news all round!! Serious kudos and credit must be piled enthusiastically on Professor Michael Berk, the prominent Australian psychiatrist, whose pioneering work in the field of NAC in mental health has paved the way for truly attitude-changing studies like these.

For Medscape subscribers – read the full article online: Nutraceuticals May Treat Negative Symptoms of Schizophrenia – Medscape – Jun 13, 2018.

For those of you who’d like to know more about NAC in Mental Health, we have just what you need…a presentation brings you up to date with the latest in NAC research in a large number of mental health conditions & translates this into the clinical context.

NAC in Mental Health
Previous ideas regarding the pathophysiology of mental illness have been profoundly challenged in recent times, particularly in light of the limited success of the pharmaceuticals that ‘should have worked better’ had our hypotheses been correct.


Tools to Master Mental Health

I’ve just completed the Mastering Mental Health tour in May with Nutrition Care. The last 16 years I’ve been focusing on Mental Health and have seen a lot of patients who present with this as their primary issue. We have so much to offer mental health in our dispensary that we can use. From my experience of working in the pharmaceutical industry, the use of anti-depressants is enormous but in Germany it was almost none. Why??… because in Germany nutrition and herbal medicine is elevated and a doctor will choose to use this option over pharmaceuticals.

As a practitioner you need to know what the red flags are and when you are not the right tool for the job. This presentation hands over a roadmap that helps you to recognise where you start from, and the road to take when accessing and treating your client.

In this presentation, I introduced new clinical tools that I’ve been developed 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.

Here’s some of the feedback from people who saw this presentation live…

  • “This will help me so much with a number of clients that will really benefit from this education.”
  • “It was fabulous. I love the tool and the way Rachel broke the process down into achievable goals”.
  • “Theory to practical example. Such an EASY way to explain the difference between over and under methylation + high and low histamine.”
  • “I am a recent graduate and this makes me more confident in patients with mental health.”
  • “As a practicing credentialed mental health nurse of 24 years, I found the information quite accurate and informative.”

Mastering Mental Health: New Assessments and Management Resources in Your Clinic
This is a 2 hour video presentation with pdf’s of slides, assessment tools and case study notes.
Add this presentation to your Mental Health toolkit!

Are worms sending kids mental?

A recently published case study takes out the ‘WOW! Factor Medal’ for its extraordinary illustration of just how impacting simple silly old lil’ (I’m being tongue in cheek of course) threadworm (aka Enterobius vermicularis) can be on a child’s mental health.
“The patient was a 10-year old Syrian female, who presented with unusual and vague symptoms like insomnia and irritability, nightmares and weight loss. Given the violent background of the Syrian warzone that the patient had escaped, she was firstly diagnosed with post traumatic stress disorder (PTSD) before eventually getting correctly diagnosed with enterobiasis.”
They understandably thought she had a mental disorder
The medical officers understandably had it flagged as PSTD.
She had worms – threadworms
Two rounds of systemic (not OTC) worming drugs – with each dose two weeks apart, in order to avoid reinfection, the symptoms all resolved and after a 3 month follow-up period, the patient remained asymptomatic without any signs of recurrence.
Just makes you think are there others out there with the wrong diagnosis when it could be these creepy critters – doesn’t it
Want to learn more in the whole area of the potent overlap between GIT and neurobehavioural presentations in kids? Paediatric Digestive Issues & Neurocognitive Abnormalities was one of Rachel’s most popular presentations captured last year which talks you through the links and the practical work-up in each of paediatric patient. Rachel’s presentation reviews the key neurobehavioural manifestations of a variety of common paediatric digestive issues and introduce you to a few of her favourite paediatric patients that taught her all this (!), along the way. Available as Audiovisual streaming and PDF notes.

Special offer for RAN subscribers…

Not long ago, Kathryn Simpson and I were sharing a hotel room on yet another work trip to somewhere. The lights were out, it was way past our bedtime and we were just gasbagging incessantly like a couple of teens, when a thought pops into my head:

“Hey Kathryn, back when you were my student, did you ever imagine this scenario in the future – you know us being colleagues and friends and having slumber parties full of laughing?”, she replied, “Well no, but you know what I REALLY never could have imagined in my wildest dreams…the Australian Naturopathic Summit and you inviting me to be a co-founder of something that’s had such a big impact! That one I just didn’t see coming!”

Well to be honest, neither did I but sometimes I just have an idea that won’t leave me alone and is too important and too promising to ignore. Three years ago when I shared one of these, the vision of a national naturopathic conference by naturopaths for naturopaths, that would lift us all professionally, offer collaboration over competition and provide us the highest level of non-biased education, with Nirala Jacobi, turned out she’d been visited by the same thought bubble.  Then I approached Kathryn, who was working for me at the time and pretty fresh out of uni but full of passion and drive about building a better ‘new’ naturopathic career path, one that supported rather than splintered those emerging out of great courses into a harsh, challenging professional space.

Time-travel forward to now, we are just 10 weeks(ish) out from erecting the chai tent, marquees and lanterns, for the second inception of this extraordinary thing called the Australian Naturopathic Summit 24-26th August at Lennox Head.

This is the culmination of 3 years of work from us, one paid project manager and the exceptional generosity of over 25 of our naturopathic idols, thought leaders and torch bearers who are donating their time to present plenaries, workshops, case studies, panel discussions… because they believe so strongly in the cause and the need for such an event. 

If you think I am running out of breath between all these words..I am. This thing…has taken on a shape and life much greater than even we had envisioned.

If you follow the work I do – you’ll know that I am passionate about collaboration over competition.  I could never have come to this place in my career without the input of many (some who remain on speed dial even now!) and through my mentoring programs, the infamous RAN internship and hopefully times we’ve come across each other…I’ve encouraged you to do the same and by doing so, grow bigger together.  So just imagine the value of collaborating face-to-face…over 3 days…at a festival in Lennox Heads… ? And not just for 1 hour, but for 3 full days with 100’s of other practitioners from all areas, specialities and locations. Oh and if you’re thinking you’ll just have to wait ’til the next one’…SPOILER…there is no guarantee of a next one! Being a passion project that we 3 donate our time to, for you, it requires your support to keep it going.

So with saying all that…..(cajon roll…that’s a drum for you non-hippies)….It is with great excitement and enthusiasm that today I can announce a special deal for RAN subscribers. Yes….that’s you! Just like myself you all see a need to grow and build skills, knowledge, competence and confidence in the practice of naturopathic medicine. Come join the very best of your profession and take up this special offer to attend the second independent Australian Naturopathic Summit held in Lennox Head on 24-26 August.

To get 15% off a full 3 day pass enter Festival at the checkout

Book your tickets before they run out at
For information or questions about this special email

This summit is unprecedented in Australia for the following reasons:

  • It is free from commercial bias
  • It is about professional development, improving our practices and career paths, not products
  • The primary objective is to support the Australian Naturopathic community, celebrating our diversity and creating a platform for our own Naturopathic torch-bearers in various areas (Practice, Research, Herbal Manufacture, Corporate Health, Entrepreneurship etc.) to help light the way for the broader professional community

This year our theme for ANS 2018 is ‘Coming Together On Common Ground’
Naturopathy has many different practices and paths,
but we all work for the same purpose, guided by the same principles.

The ANS 2018 program has three distinct themes across the 3 days…

  • Friday 24 August: Custodians of the Vital Force
  • Saturday 25 August: Upskilling Your Clinical Practice
  • Sunday 26 August: The Business of Business Development

The morning of each day consists of plenary sessions followed by a lengthy lunch break that allows for networking, beach walking, guided outdoor meditation, perusing the vendor village, or simply enjoying the festival atmosphere in the beautiful outdoor location that our summit is surrounded by OR for those die-hards some amazing case studies presented by the likes of Jason Hawrelak, Dawn Whitten and Sandra Villella.  Afternoon sessions are workshop-style, designed to be more interactive. There are plenty of workshops to choose from to keep you riveted and inspired.

We have created a jam-packed program to do just that.
Download your copy of the full program here!

ANS 2018 – come join the very best of your profession.

Book your tickets before they run out at
To get 15% off a full 3 day pass enter Festival at the checkout.
For information or questions about this special email

Enough said.

Getting Down & Dirty on Worms…

These little blighters are getting a lot of airplay this month and rightly so…..! Oh Em Geeeeeeeee….so much misinformation out there!! It’s time to set the record straight

Worm infestations never conjure up a pretty picture in our minds although a video of humans trying to bum slide across the floor like some dogs we know would get a fair few laughs (…will share that vid later) 

Despite much talk of the potential therapeutic activity of helminths for things like autoimmune diseases and allergies due to their immuosuppressive effects, there’s nothing nice, friendly or ‘good for us’ about a chronic Enterobius vermicularis (threadworm) infestation in a child or adult (YES! You heard me). Oh and don’t forget the possible link with your D.fragilis patients…you just might need to treat these guys instead.

It was great to get down and dirty on worms with Andrew at FX Medicine. This podcast has us uncovering and debunking myths on these creepy critters that have more to answer for than you probably realise…

The outcry from the public is enormous, in terms of their need for help and the gaps that are there at the moment in terms of getting it. There is an online resource called, which is primarily there for the public to meet this need and practitioners can learn a lot by going on there as well.

Sheesh….I Need New Material!

Help!!! I’m about to share the stage at the 3rd International Acid-Base Symposium on the 25th-27th Jun, with the best acid-base researchers in the world, all of whom I actively stalk (well read and recite everything they’ve ever published but close enough!) I’m terrified and excited in equal doses…but urgently need to change my presentation approach because until now I’ve had the privileged position of simply fulfilling the town-crier role, announcing far and wide the findings of their incredible research into acid base physiology and their findings about impact of chronic mild metabolic acidosis.  But I can’t quote Arnett to Arnett! I can’t tell Dawson-Hughes about the incredible insights of Dawson-Hughes’ large body of work in this area! Oh my Goodness (cue, shaking knees), I’m going to meet Thomas Remer…of Potential Renal Acid Load Formula Fame!!

Yes, my partner is a musician and through him I have brushed shoulders with all kinds of famous…but nothing that has made my heart beat quite this fast! 

Must buy an autograph book for them to all sign. 

Joking (kind of). (more…)

Good Morning San Francisco!


Good morning San Fran!!! 🙂 You know me…I’m notorious for challenging outdated ideas in our fabulous integrative health landscape and along the way, trying to introduce new ones that are backed by better scientific evidence. I regularly get asked to speak in spite of this (!) and now I get to be heard by over 20,000 people who subscribe to the Fertility Hour which is based in San Francisco. It’s great to be spreading the (real) word on Iodine!

Iodine deficiency can constitute a major barrier to fertility and in some individuals increases risk of miscarriage 4 fold. Not to mention decreasing IQ,possibly increasing rates of ADHD and contributing strongly to poor pregnancy and delivery outcomes, generally for mum and bub. We can agree that iodine is essential to health but what has become hotly debated is how does one assess if they are iodine deficient and what dosage is appropriate?

And given a long period of basic neglect, does our current increased attention and use of this essential mineral, constitute the pendulum swinging too far the other way?

Here are some points covered in this freely accessible podcast, for those of you who haven’t quite had your iodine fill yet 😉 (more…)

Are You Chasing the Wrong End of Dientamoeba fragilis?

Ever feel like you’re chasing your own tail trying to treat & find the source  of GIT parasites in some patients?!  Well guess what, you just might be!

We’re seeing more & more patients test positive for Dientamoeba fragilis and increasingly patients struggling to eradicate it and prevent relapse. And then there’s Blastocystis hominis affected patients… and then those lucky enough to have both. 

Well, while we might have been grouping D.frag together with B.hominis, being the two most common GIT parasites in humans, looking for what they share in common,  they are worlds apart (we think!) in terms of how they are transmitted to humans. (more…)

When Going Vegan is Best…


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…)

Have I Got Your Attention Now?

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…)

What in the GFR is going on with this reference range?!^#@

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 conditionwhich 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…)

Less Iron Proves More in Some BUT Not All Patients

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…)

A Guide (at last!) to Picking Up On Pyrroles

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.


Wondering About The One That Got Away?

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…)

A Hat Trick Week for Gilbert’s Syndrome… Guys and Gals

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…)