“Health issues are rarely one individual textbook condition like they were during my studies. The interaction of the body is complex, and Rachel has given me valuable insight into how to link various pathology markers & physical aspects together. Test interpretation has been a huge focus for me. The letters and numbers now mean something, and I can work with “true” reference ranges, and see how different values affect others. The sessions have been great to get assistance with cases and learn how to break things down & prioritise treatment, and also to connect with other practitioners, and hear their cases as well. I really feel like my career has received an invaluable leg up, and I’m so thankful for Rachel’s knowledge and assistance.”
Rohan Smith, Graduate Group Mentoring Participant, Adelaide.
We began our Graduate/New Practitioner Group Mentoring sessions in March 2014 with just a few keen newbies but the sessions have gone from strength to strength since then, with an ever-growing group of new graduates participating in case presentations every month. Every session I’m reminded that people are now graduating with much more sophisticated knowledge than I did. Not because the education standards have improved (ouch!) but actually because the research-backed knowledge base of our whole industry has progressed & improved so dramatically… & that is really exciting & changing the marketplace for all of us. (more…)
I read an interesting news item in Medical Observer this week about the increasing number of patients either overtly or covertly recording medical appointments on their smart phones. Have some of your patients already asked if they could do this? Mine have and I’m also aware of some patients getting into hot water when asking their ‘old-school’ medical specialists if they could do the same thing. For me, I have always understood the patient’s desire to do this, as the information they’re being given might be complex, considered critical and they may need to hear it several times in order to grasp the details, instructions etc. In other situations I’ve experienced it’s because the patient needs someone else, who couldn’t be present at the appointment, to hear the discussion ‘firsthand’ e.g. another parent, a partner. In my mind this all makes good sense. Does it make me speak differently, think more carefully about my words etc…You bet it does! (more…)
You might have heard me talk about using an ‘upstream’ rather than ‘downstream’ approach in nutrition – the concept is very naturopathic… look at the water source and address things there rather than just tweak things downriver! One of the most important upstream influences on patient health & wellbeing I can think of is systemic pH – the body’s constant struggle to neutralise its overwhelmingly acidic input, which comes from both metabolism, inflammation, stress and of course unbalanced diets.
It’s a war out there and most of our patients aren’t winning! (more…)
I’ve booked my flights and packed my bags (at least in my mind!) already. The annual Science of Nutrition in Medicine Conference is on 2-3rd May in Melbourne & there’s one name on the bill that alone I would be attending for – Dr Robert Loblay. He’s the head of the Immunology unit at RPAH which specialises in the management & treatment of every possible type of food & chemical reaction (including all the ones the average medico would suggest are impossible/unreal or psychosomatic). By the way he also a strong interest in bioethics so this makes for a great combination in this field. He helped put together the RPAH diet and book ‘Friendly Foods’, which is such a great clinical resource for patients with food intolerances.
The way I approach food reactions in clinic has been heavily influenced by his work and because the RPAH unit is working everyday with some of the most severe, complex and unusual reactions, when he talks I listen! (more…)
How often do you find yourself writing sleep prescriptions for your patients? I do – frequently. I’ll include in my recommendations something like – ‘nap for 20 minutes every alternate day’ or, ‘commit to getting into bed 1 hour earlier 3 nights this week’ or ‘establish a bedtime routine for yourself – something that loosely follows the winning formula of bath, book, bed’.
You see I reckon we humans have tricked ourselves into thinking we can negotiate our way out of almost everything: good food choices, adequate clean water, perpetual motion etc. I mean often people come to us looking for the shortcut let’s be honest…e.g. “I’m not great with the food side so what should I be taking??”
But when it comes to matters of slumber I explain to my patients that sleep sufficiency (both quantitatively & qualitatively) is non-negotiable in the health equation. To put it another way, sufficient sleep is Wellbeing 101, step 1!
I don’t have anything I can prescribe that can make up for a shortfall…seriously…just a prescription for more sleep!
Over 20 years ago (ouch!) while studying at Southern School of Natural Therapies, I heard for the first time that calcium perhaps had a ‘dark side’! At the time, and still to a large extent now, calcium is publicly portrayed as something you simply can’t get enough of and 20yrs ago this idea was almost heresy! Certainly in the eyes of the dairy corporation at least 🙂 Yet there had been a long-standing concept in naturopathic nutrition that the distinction between calcium’s healing and harm all came down to where it resided in the body, e.g. bones Vs blood vessels. Last week Medscape ran an editorial espousing the same concept. (more…)
Howdy everyone, thanks to popular demand (and perhaps something some people have against Tuesdays!! 🙂 ) we’ve opened up a new group on the 2nd Monday on every month at 1.30pm NSW time for mentoring. It’s brand-out-of the bag-kinda-new with a small group of practitioners signed up so far, so there’s room for you if you’re keen to give group mentoring a bash this year. We’ve had an exciting start to the year with all all mentoring groups, with lots of juicy cases, great discussion and important networks building before our eyes. If you’re interested in being a part of this group or any of our others please just email us at firstname.lastname@example.org. The next Monday session will run on the 9th March. Hope to hear from you 🙂
Thyroid function is critical to successful conception, healthy pregnancies, babies and mum’s post-partum wellbeing, so we need to take the time to ensure we’re monitoring it properly.
First of all you need the right tool for the right job & that means we need trimester specific reference ranges – which unfortunately many pathology companies don’t use in Australia. Due to the thyrotropic action of HCG (acting a bit like TSH), TSH should actually decrease in the 1st trimester and while TSH is less affected in 2nd and 3rd trimesters it should still actually sit lower than in non-pregnant females. (more…)
Ever had those patients… young, slim, fit…I won’t go so far as to say ‘well’ or otherwise they probably wouldn’t be seeing us right? But not overtly inflamed and yet when you measure their CRP, it registers. The average CRP of ‘healthy’ adult populations is reported to be between 1 and 3 mg/L but we know that even values within this range positively correlate with long-term CVD risk and most of us believe that unless there’s a good reason for immune activation at the time of the test, we’d like to see values < 1mg/L.
I saw one of my patients who fits this bill just the other day – an updated CRP and there it was again bubbling away at 1mg/L. This guy is young (20s), slim (BMI of 19 kg/m2), non-smoker (another classic driver of this sort of brewing CRP), doesn’t report any acute illness e.g. URTI, at the time of each test (we would expect a much higher value with this anyway)…so why is there any CRP? (more…)
We now suspect that many of the drivers behind PCOS are heritable components – a genetic vulnerability passed from parents, possibly one but often both. This growing understanding has identified a phenomenon referred to as ‘PCOS families’ i.e. a family in which at least one female has confirmed PCOS.
Being a primary biological relative of someone with PCOS, it would seem, suggests a shared risk, even if you are a son, or brother or father.
So beyond the very high rates of undiagnosed PCOS in sisters of someone already diagnosed, there is much talk now about a male PCOS phenotype equivalent. (more…)
We’ve had a lot of inquiries regarding our end of year CD special. So just to clarify – here’s the deal and below that how to make it happen! 🙂
Purchase any 2 CDs before Jan 31st and receive one complimentary Premium Audio Recording of your choice OR purchase 4 CDs and receive a 3 month Premium Audio subscription for free.
If you’d like to take advantage of either offer – please go to our RAN store https://rachelarthur.com.au/product-category/audio/?orderby=date & simply select the CDs you would like & complete the online payment as per usual. On receipt of your order we will then email to let you know you’ve automatically been subscribed to the Premium Audio for 3 months OR ask you which single premium audio download you would like to receive as your bonus gift.
Apologies for having a one-track mind currently but yes I’m still banging on about the thyroid this week. You see, this year in my own clinic I connected up some dots I hadn’t connected before via a series of young female patients. Each of these women presented with some hypothyroid features, most notably, low basal body temperatures, fatigue and weight gain and while their thyroid hormones (TSH, T4 and T3) were all technically ‘within range’, their T3 levels were very low (low 3s) and the TSH seemed to sit low as well (<1.5). Normally of course, when T3 levels drop we expect TSH secretion from the pituitary to rise in response, as a means to correcting this dip, however, this part of regulation appeared ‘blunted’ or even ‘broken’ in these women.
So why would their pituitary be sleeping on the job, allowing them effectively to experience long term suboptimal thyroid function? (more…)
I learned to drive more than 20 years ago in a mustard yellow VW beetle with my ageing father beside me playing the dual role of instructor and slightly hysterical passenger. The one catch-cry that he screamed over and over again was, “Where’s the fire? Where’s the fire?” In case you require translation, this was his way of indicating that I was almost travelling at 60kmph & essentially meant, ‘unless you are part of the emergency services & on your way to a crisis there is no reason to be travelling this fast!’ I know, it’s a wonder I ever learned to drive! But I’ve actually come to love that catch-cry, “Where’s the fire?” because for me it has become a pressing question in clinic every day. (more…)
I’ve been re-reading lots of studies for a talk I’m delivering at ACNEM in Melbourne, investigating the relationship between selenium and a myriad of thyroid pathologies: from hypo- to hyperthyroidism and from subclinical thyroiditis to cancer. The sheer number of trials is overwhelming & increasing, in fact I think there’s more every time I go back and look (!) and the bulk of the findings keep telling us yes! yes! yes!…selenium plays a pivotal protective & corrective role unmatched by any other nutrient. Whether it’s buffering the oxidative stress that comes with high TPO antibodies or lowering antibody titres, preventing or minimising the orbitopathy associated with Grave’s or simply maintaining a better level of T3 in euthyroid individuals, there are numerous potential positive effects from selenium supplementation …in the right patient… and therefore this is the bit we need to be clear about: while the majority of both epidemiological and interventional studies all concur that low selenium levels equate with a greater risk of thyroid issues in all our patients & poorer outcomes in patients with already established thyroid disease, the big question is how low are we talking?? (more…)
When was the last time you drank or ate something that contained an artificial sweetener (AS)? I remember it well and my most striking recollection was the way it ‘hit the spot’ just like I would have expected sugar to, making me immediately suspicious of the effects it would have on my body. It seemed implausible that it could mimic the taste/the sensation/the mood effects of a major sugar hit but not evoke any of the physiological responses of sugar…whether that be in my brain, my pancreas, my whatever! We’ve been sold the concept that AS offer the western world an exit point from our collective march towards metabolic syndrome for decades but sweet relief (pardon the pun ;)), new scientific studies are piecing together the real impact of AS consumption.
“‘We found that artificial sweeteners may drive…an exaggerated elevation in blood glucose levels, the very same condition that we often aim to prevent by consuming them,’ Eran Elinav, MD, PhD, from the Department of Immunology at the Weizmann Institute of Science, Rehovot, Israel, said at a press briefing.” Medscape (more…)
We’re all aware of the reported link between Isotretinoin (aka Roaccutane, Accure, Oratane), originally listed by the FDA in 1982 for the treatment of severe treatment refractory cystic acne, and depression & suicidality in some individuals. Any suggestion of causality however remains hotly debated by the manufacturer of course & there is a recent small RCT not only refuting a relationship but claiming that via effectively resolving acne, patients’ depressive features decrease on this drug (Marron, Tomas-Aragones, Boira. Anxiety, depression, quality of life and patient satisfaction in acne patients treated with oral isotretinoin. Acta Derm Venereol. 2013 Nov;93(6):701-6.). However most of us have read the media reports regarding tragic case studies, are aware of the warnings listed on the package insert and have met patients whose mental health problems appear to have been precipitated by use of the drug. (more…)
When I started studying naturopathy I quickly became full to over-flowing with inspiration that everyone could achieve wellness simply by making better choices with their diet, their lifestyle, activity levels and perhaps some slippery elm thrown in. As a senior student and then later again as lecturer, I played ‘spot the first year student’ – they were always the ones biting into a whole capsicum like an apple at lunch time or drinking copious amounts of green pond scum, obviously infected with the same fervor that I’d experienced. During my studies, I certainly didn’t foresee myself prescribing the amount of supplements I do in my practice today. So what happened to my grass root ideals? Did I go wrong somewhere to end up being so prescription heavy now? (more…)
Just this week Medscape featured an article arguing there’s a need for all doctors (GPs & specialists) to undergo nutritional training. It follows on from a commentary in the September issue of the American Journal of Medicine which criticised the deficiency of nutrition education in medical training, particularly in the context of the 2013 report on US health that “identified dietary factors as the single most significant risk factor for disability and premature death”. An interview with one of the lead authors of this paper, Stephen Devries, a cardiologist with 25 years’ experience, forms the basis of the article. (more…)
Recently in our group & individual mentoring sessions we’ve been looking at lots of patients’ urinary iodine results. Many of you will know that I’m a bit of a fan of doing spot urinary iodine testing to gain some understanding about patients’ iodine, in spite of several well-documented limitations of the test. The first thing to remember is that urinary iodine has a diurnal rhythm, parallel to the rhythm seen with the thyroid hormones, so urinary values will fluctuate throughout the day. We can get around this by always asking patients to collect the sample at the same time – preferably a fasting early morning urination, which represents the lowest iodine concentration in a day. That way we know we’re always comparing apples with apples. The second limitation and frequent cause for misinterpretation of results is not allowing for the concentration/dilution factor of the urine sample. (more…)
So far this year I’ve been doing most of my presenting online which has been fantastic because we can all be in our PJs and no one’s the wiser (except now!!) but I do miss the face to face seminars where sometimes the real magic happens thanks to the two-way dynamic between you and me!
So guess what? I’m coming to Sydney on the 31st August (and then Brisbane 6th September and then Melbourne 13th September) to touch base with many of you again. I’m joining forces with Rachel McDonald from Biomedica to talk about the real world application of naturopathy in mental health conditions. (more…)