Looks like an allergy, sounds like an allergy but it’s not! Are you missing Histamine Excess?

histamine-intolerance-flow-chart

In walks a patient with recurrent episodes of swelling (lips, fingers), hayfever and hive like eruptions all over – it’s got to be an allergy right?  Not necessarily. Of course we should follow the classic allergy investigation path but what happens when you discover that your patient doesn’t have raised total IgE nor raised basophils/ eosinophils.  This means it absolutely is not allergy.  I’ve seen quite a few clients like this, some have even gone to the trouble of extensive skin-prick testing only to discover absolutely no allergens and no sign of allergy yet again…what is going on??

So with the classic features of swelling, itching, rash, +/- wheeze the presentation looks like an allergy, sounds like an allergy but you know…it simply can’t be a classic (IgE) allergy without these markers.  What now? This is often the point at which practitioners might reach for IgA/IgG food allergy tests…but you know what…even though patients might produce some positive reactions in these, this is not the answer either! Because IgA and IgG allergies do not tend to produce these symptoms. (more…)

Imagine No Days Off…

A few weeks ago I was camping with my kids in rural northern NSW. We’d gone there for a long weekend to sail on the glorious Clarence river… yes that is literally what floats our boat! Anyway, thanks to a public holiday we all planned to stay on for the Monday, still sailing, lolling about on grass under gorgeous trees etc.  Not observing the sacred public holiday thing completely though I started my Monday with a run.  I noticed how quiet everything was, the siren for the boatyard had sounded but of course none of the workers were there to respond to the call… this small town had become a bit ghost-like.  Further on I ran past several huge farms and I noticed that of course they were ‘business as usual’, full of workers going about their usual work and a very simple realisation hit me… (more…)

The Case Is In – The Jury is Out

We have a case being presented on Monday at 3.30pm EDST on a 32yo Female presenting with hives, swollen lips and eyelids but minus the classic biochemical markers of allergy (IgE and eosinophil elevation)..what’s going on?  To boot she has very high stress levels, difficulty settling, being still and has a tendency to anxiety. Is it possible she is an under-methylator and that correction of this might go some of the way to settling her immune system?  Or could there be food intolerances rather than allergies at play? With a history of an unusually high number of broken bones – what else is going on that requires our attention? (more…)

Sensational SAMe – National Tour in November

We’re super excited to announce Rachel’s upcoming tour Sensational SAMe – Mental Health and Beyond with Nutrition Care & based on the incredible feedback about Rachel’s last tour…you should be too! 🙂

“I love having the opportunity to share what I know about one of my absolute favourite products with everyone.  I prescribe this every day and it’s one my clients always come back for.  When it works it really works!” Rachel

Whether you’re a practitioner that regularly uses SAMe or you have just started dabbling with it, this seminar is must attend. Overflowing with case studies, the latest cutting edge research and Rachel’s expertise, this half day seminar will tell you everything you need to know about how to best use SAMe in you practice as well as deepening you knowledge of how it works in application to conditions from addiction all the way through to arthritis.

“Don’t be frightened off by all the Methylation Madness out there!  Come along and find out just how powerful, easy to use and diverse SAMe really is” (more…)

New Insights into Vulvovaginitis: Getting Species Specific & Sex Hormone Savvy

 

No matter how long I am in practise there is always a group of patients for whom ‘vaginal thrush’ is a major problem.  Most of us have some fabulous tricks up our sleeves to help resolve these issues & reduce their susceptibility – intravaginal lactulose is one of mine thanks to Jason Hawrelak.  And then you come across those clients who vigilantly do every thing you ask them to and yet you fail to completely resolve the issue. Doh!

One of the most important things to do with all clients presenting with ‘thrush’ sooner rather than later is send them STAT (!) for a vaginal swab.

Not only does this clarify if it is in fact actually thrush (2/3 of self-diagnosed women get it wrong according to research!)  but better again it names the actual culprit.  It may come as a surprise but not all vulvovaginitis is due to Candida albicans – increasingly they are the result of other Candida species and this is something you absolutely need to know.

During a recent mentoring session, a practitioner wanted to better understand why she had a group of patients whose thrush seemed so resistant to her usually successful treatment.   Here’s my initial response in a nutshell… (more…)

Is there a role for you here?

A 33yo Female presents with severe long-standing diarrhoea, weight loss, fatigue and generalised musculoskeletal pain.  Initially without a medical diagnosis, however she’s been told by an ‘integrative practitioner’ that unusual African parasites were the cause of her sickness and then subsequently independently diagnosed with Giardia which was treated with Flagyl.  By the time she returns some 6 months later for her next appointment,  she’s now got an official medical diagnosis of Myositis, which is producing crippling pain requiring hospitalisation at times and  is not relieved by standard pain meds.  While the acute diarrhoea is less of an issue now there are still significant GIT problems in spite of a restricted diet and when we zoom out to take in the whole case there is still a significant dysbiotic, immune story of repeat UTIs, thrush and her white cells counts bounce from high to low.  Doctors have now switched her from steroids to methotrexate to try and address her myositis at least.

Now before you all run screaming from the room…let’s just stop for a minute and ask ourselves a couple of ALWAYS IMPORTANT QUESTIONS:

  1. Is there a beneficial role that I can play for this client? i.e. is there anyone else taking a whole systems approach to her health
  2. While I may not KNOW what is going on exactly and precisely WHY – are there enough clues to point to the systems that need support, processes that seem aberrant that I could put back on track etc.

(more…)

Hold the DHA in Mental Health?

About a decade ago there was a lot of excitement about using fish oils in the management of mental health, so much so even the American Psychiatric Association developed recommendations suggesting that people with mood, impulse control & psychotic disorders should all consume 1g EPA + DHA per day… but then what happened?

Ask most health professionals (GPs, psychiatrists, naturopaths & nutritionists alike) today whether fish oils are their first choice in mental health nutritional interventions and you’ll frequently get a, ‘No’ and I include myself in that.

Let’s retrace our steps to find out how we got here.  The epidemiological evidence linking low omega 3 intake to myriad mental health problems in terms of susceptibility, incidence and severity is almost overwhelming. For example, depression rates are 10 times higher in countries with limited seafood intake and post-partum depression 10-50 times higher (Kendall-Tackett, 2010).

Noaghiul & Hibbeln postulated that countries where individuals consumed less than ≈ 450-680g of seafood per person per week demonstrated the highest rates of affective disorders (2003). One study of 33 000 women with low omega-3 intake were found to have an increased risk of psychotic symptoms (Goren & Tewksbury 2011) and it goes on.  Then, we have other evidence also pointing in the direction of fish oils, such as the general consensus that excess unchecked inflammation is evident in many mental health conditions (Maes et al 2013).  Numerous intervention studies using fish oils as stand-alone or adjunctive treatments have been published. Interventions have included high dose omega 3 (no specific EPA/DHA breakdown), EPA alone, ethyl-EPA, high DHA, blends with high DHA:EPA ratio, flaxseed oil etc. etc. (more…)

Speak of the (Synthetic Folic Acid) Devil!

It’s just been reported on Medical Observer today that because of a ‘worldwide shortage of food fortification folic acid’ all Australian commercial breads covered by the mandatory fortification laws, will potentially be without this additional synthetic folic acid for up to 12-18 months.

This is unlikely to take effect for another few months, however, is important for people (& their practitioners!) to know that their food will be changing.  In light of this women aged 16-44 are being encouraged to increase their consumption of other folate rich foods such as dark green vegetables, citrus fruit, legumes & other whole grains.

This wordwide shortage (fortunately/unfortunately..?!) will not effect the supply of synthetic folic acid supplements or the inclusion of SFA in infant formulas.

“According to the Health Department, the shortage came about as the result of Chinese folic acid supplement manufacturers slowing down production in response to the introduction of new pollution emissions regulations there this year.” (more…)

Unmetabolised Folic Acid – Should We Be Worried?

 

 

Using products that contain synthetic folic acid (SFA)?  Worried about this?  There’s so much misinformation, fearmongering and hysteria out there I’m not surprised!  I’ve been bombarded this year by really experienced & cluey practitioners who have been losing their confidence around using folate, treating methylation issues etc. and it is incredibly frustrating and disheartening to see.

My big message is be mindful whose messages you’re listening to!! 

Seriously though…if you’re being told by someone that SFA is toxic for everyone and they just happen to sell a range of products specialising in other forms of folate and methylation education galore…ask yourself is this unbiased reliable information?  Equally, when you have companies telling you not to worry about SFA at all, that it’s perfectly safe in all doses for all clients and they happen to have a lot of products on the market that contain SFA, ask yourself the very same question! 

 Let’s face it the truth is probably somewhere in between. 🙂 (more…)

Ever Wanted to Pick Rachel’s Brain For An Hour?

Well now’s your chance!  Due to some of our regulars being away, suddenly a group mentoring session has opened up for tomorrow that offers you this fabulous opportunity!

Running at 11.30am tomorrow at EST via Skype for 1 ¼ hours, Rachel will be holding a Q & A session on your key questions and topics.  Big or little, case based or theory… you can pose the questions you’ve been meaning to or needing to & get the answers you’re really after.  Your questions should be submitted via email in advance of the session to ensure they get adequately addressed and if you have any accompanying information (e.g. test results) you want Rachel to look over then send these to us as well prior to the session at admin@rachelarthur.com.au

For the standard price of a group mentoring session you will also receive one free ‘Update in Under 30’ download of your choice  from Rachel’s extensive library!

These include popular topics such as Gilbert’s Girls  & the Acid Base Balance  – check out all the ‘Update in Under 30’ topics  here (more…)

Is General Practice the toughest gig?

I will never forget a conversation I had with a GP colleague many years ago now, he looked tired and we were chatting about workloads etc. and he said to me, “If I had have known in uni what I know now about general practice I would have specialised!”  He then went on to describe the stress associated with fulfilling the role of the ‘one stop shop’, “I never know what’s about to come in my door and whatever it is: cardiology, obstetrics, oncology…I have to know what to do and how to best treat the patient”.  His overwhelm was palpable and he in fact was one of the most conscientious & competent doctors I knew.

I think, I’ve replayed & retold this conversation so many times because it translates readily into naturopathic practice.

When I qualified a squillion years ago, we all assumed general practice was the only option and the training with all its modalities left many of us fearing we would be ‘jack of all trades & master of none’ but nowadays, specialising, thankfully has become more common.  If you’re not yet doing this then it’s possibly time to have a serious think about it. Perhaps it’s a demographic (paediatrics, men, geriatrics) rather than a system and your specialisation does not have to be absolute…you get to make the rules 🙂

It’s my belief that with the ever increasing popularity of integrative medicine there is enough business out there for everyone and if we can each narrow our focus and become better at our given area, then the whole profession and industry will ultimately benefit. (more…)

Do You Know Men Like I Know Men?

I’ve just completed a seminar series educating practitioners across Australia about how to recognise & correct sex hormone dysregulation in men & the response has been overwhelming.  Everyone seems to be in agreement that this subject was seriously under-cooked in their undergraduate training, which is such a shame given that low testosterone, male subfertility and infertility have escalated in recent years and so too has the number of male patients we’re now seeing   Here’s some highlights that might give you something to think about:

  • There is general agreement that men’s sexual health is an independent marker of their current whole health & strong predictor of future health – not just in terms of cardiovascular but also mental health, premature ageing, bone integrity…the list goes on!
  • While the rate of erectile dysfunction in a cohort of health middle-aged American men was 52%, a recent Italian study revealed that 25% of men with a recent onset of erectile dysfunction were less than 40 years old!
  • International men’s health specialists go even further & suggest that results of a semen analysis provides us with all we need to know about a man’s health
  • So if you’re not asking your male patients about their sexual health (and yes that includes the young ones) how much of their whole health story are you missing??

(more…)

Why Haven’t I Heard About This Before?!

Last week I spoke to a group of psychiatrists, doctors and nurses working at a psychiatric hospital about N-acetyl cysteine for a whole hour! Anyone who has worked in pharmaceuticals, (which of course I did in a previous life) or has seen medical CPD up close even, will appreciate that this really was a remarkable opportunity a) because it wasn’t funded by a drug company whose sole intention is to drive more prescriptions for their drug and b) because it was instead facilitated by a nutritional supplement company (many thanks to Bioconcepts) who allowed me to simply bring the current evidence regarding NAC in mental health: strengths, weaknesses, limitations and all, to the attention of these front line health care providers.

This sort of information i.e. non-drug company sponsored, is simply not getting through to our medical colleagues. This is in part, because their CPD is monopolised by pharmaceutical companies who have the budget to dominate the stage. I’ve worked in that industry and I remember it well but not fondly. So, in spite of the fact that the bulk of the NAC trials in mental health are actually due to the work of own Professor Michael Berk, their colleague, the majority of the attendees had never heard of this nutrient and certainly were not aware of any relevance it had to their own medical practice. (more…)

What Do You Do For Post-Partum Hashimoto’s Thyroiditis?

 

Like all thyroid disease, post-partum thyroid conditions seem to be on the rise – and often they rewrite the rule book when it comes to thyroid pathology & its management. Therefore for many of us it can add an extra element of uncertainty about how to help these clients.

One of our graduate practitioners has a great example of this, a 33yo female who developed late gestational diabetes and is now struggling with a new baby and an autoimmune thyroid disease!  What would you do?  Does post-partum thyroiditis have unique triggers/drivers that require specific treatment? What can you/should you be doing differently because she is still breastfeeding?  What’s the likely progression/prognosis?

This is your invitation to come along and find out the answers to these questions and more.  During our live graduate mentoring session on Monday 15th June at 3.30pm AEST we’ll work through all aspects of the case, from history to presentation and from looking for clues in her pathology results to where to start with treatment. (more…)

Who gives an RDW about RDW?

Ever noticed that thing called RDW (red cell distribution width) reported in your patients’ haematology results? Given that this parameter is currently regarded as one of the most important & earliest markers of a wide range of serious diseases, you might start paying some more attention to it from now on!

Dr. Michael Hayter, cleverly refers to RDW as being a reflection of the ‘Quality Control’ of an individual’s red blood cell synthesis.

As it’s a measure of how similar or dissimilar our rbcs are in terms of size, smaller values (suggesting homogeneous rbcs) are regarded as healthy, while higher RDWs suggest that some part of  rbc synthesis and/or clearance process is faulty.

This makes perfect sense in the context of nutritional anaemias like iron and B12/folate which all produce elevated RDW results but new research proposes that this rbc size disparity is also a common linking feature in just about every major disease, often predating diagnosis or in cases of established pathology signalling progression and warning of imminent poor outcomes for the individual.

There have been 100s of papers published just in the past 4 years on this topic and the findings are nothing if not dramatic. One of the biggest things I’ve realised is that, while Australian pathology companies suggest that all RDW results < 16% are acceptable, in the light of these new associations, a more accurate cut-off is probably around 13.5%! The big question now to answer is, is the increased RDW a passive marker of pathology or actively involved in the pathogenesis of these major diseases. For now, we should be scrutinising our patients’ RDW results more closely and being alert to what these markers are telling us about our clients threats & risks. I’ve recorded a 30min audio summarising all the information I’ve come across on this topic and how to apply it in your patients which you can access here.

Alternatively, if you’re happy to chomp into some juicy journal articles yourself then check out these ones to start with

https://jaha.ahajournals.org/content/3/4/e001109.full

https://www.researchgate.net/profile/Fabian_Sanchis-Gomar/publication/269930590_Red_blood_cell_distribution_width_A_simple_parameter_with_multiple_clinical_applications/links/5499b0e50cf2d6581ab15143.pdf

Do We Need to Relearn Something Old about Addressing Iron Deficiency?

 

These days it seems like patients can almost be divided into two groups: those that have a tendency to iron overload and those that struggle most of their lives just to keep ferritin in the red…and what a struggle it can be. So many clients have spent years taking every form of iron there is in high doses, trying to improve their intake of dietary sources, working on their digestion etc etc but still those numbers can fail to really pick up. (more…)

Nutritional Science & Debate in Action

 

Last weekend I attended the Science of Nutrition in Medicine Conference in Melbourne https://nutritionmedicine.org.au/enews/2015-02-06-Program.html and for those of you that didn’t make it I can tell you, it wasn’t your regular CPE event.  I’m not sure if the debate inside the presentations or outside in the breaks was more interesting but I can say that I haven’t seen this much stimulated thought, heated discussion and passion at company run events.  Why? (more…)

Top 10 Investigations in Mental Health Patients

One of the most common questions I’m asked is whether I have a ‘set list’ of tests that I request for every patient.  Of course there is no ‘one size fits all’ in health & each patient presents with their own novel combination of issues & investigative challenges, however, years of clinical experience have taught me which pathology parameters are the most clinically meaningful.

Asking yourself, ‘Will the results of this test determine my thoughts about treatment & therefore ultimately the clinical outcome for my patient?’, before referring for any investigation is a good habit to get into.

Many of us are increasingly aware of the changing environment around pathology testing, which includes reduced access to some tests in mainstream pathology.  Rbc folate has had its subsidy withdrawn which means if we request this we’re now likely to receive a serum value or nothing.  But does this matter? (more…)

Increasing Off-label use of Anti-psychotics – Should we be worried?

I regard myself as integrative which means working collaboratively with other health professionals to get the best outcomes for our shared patients, sometimes that means my patients are taking psychiatric medications & there have been instances where I have seen the necessity and benefit of the right drug at the right time.  This might be in the form of short term use of atypical antipsychotics, so a recent article linking higher rates (approx. 50%) of diabetes with the use of atypical antipsychotics specifically in teenagers, caught my eye.  (more…)

What’s New in K2?

It seems like K2 is the supplement on everybody’s lips right now and for good reason.  This is particularly true in Australia where we’re seeing a flurry of new K2 products on the market thanks to a relatively recent TGA approval for this particular form of the vitamin.    But what do you need to know to make the therapeutic most of this nutrient?

Vitamin K got about 20 minutes in my undergraduate degree, and shamefully I don’t think I gave it much more as a lecturer!  The buzz just wasn’t quite around then like it is now.  Reading the latest RCTs & metanalyses on K2, however, you can almost hear (or is that just me??? 😉 ) the excitement researchers are feeling being part of this extraordinary wave of discovery about its therapeutic applications.

Traditionally, we’ve focussed on the K1 form, abundant in all the green leafy vegetables, but turns out we’ve been looking in the wrong direction.  While K1 is still important for the clotting actions it can’t get to the bones and arteries to run the other important K dependent enzymes.  In order to get these happening we need the K2 form which means we need the specific types of meat, eggs and ferments. (more…)