I take my job to heart. When someone asked me recently to choose the single value that spoke most to me personally I couldn’t seem to go past, ‘Purpose’. I feel very honoured to have contributed to the learning of so many health professionals in their undergraduate and so many more in their professional careers following graduation and I know that with this comes huge responsibility. Second on my values list (again, possibly unsurprising) is Empowerment & coming in with a photo finish at 3rd:Integrity. Discernment and critical thinking (about information, about research, about reflective practice) are perhaps the eggs in this souffle, helping us all to rise up.
As part of our critical thinking we need to accept a few truisms:
Research changes Experience changes Knowledge changes
Information is not static. So we need to ask ourselves, how long ago did I learn this? How long since I’ve checked it is still correct? And just because perhaps this information came out of the mouth of our mentors or teachers, makes it no less up for regular review. I’m trying to undertake these internal audits on a regular basis. Typically they’re prompted by bloody good questions my mentees have asked me. A question I can’t answer or, more to the point, I can’t answer with full confidence I’ve double-checked my old beliefs and understandings against new evidence recently…these almost always provoke a lost night of sleep for me. Not from sleeplessness per se but due to immersing myself in the latest research and performing a mini informal lit review, bringing out all my old beliefs/evidence etc. Marie Kondo style and asking do they still spark joy✨ (in light of the latest evidence)?! And yes sometimes there’s a little bit of heartache when you have to let your old tightly held beliefs and understandings go 😢
The 1st update is about N-acetyl cysteine. Some of you may have heard me previously question the efficacy of the vegan form. Now that all but 1 Australian product is vegan, produced from bacterial fermentation or purely synthetic, I was wayyyyyyyy overdue to check the validity of my old ideas. Let the record show, I was wrong. Unlike some other nutraceuticals like chondroitin sulphate, wherein the source radically changes the overall structure of the molecule and therefore its uptake and actions – the same is simply not true for NAC.
So those ducks, & their NAC rich feathers, can all sleep a little easier at last…phew! Now the 2nd internal audit well that did cause some tears for me…
We often identify patients who could do with a little glucuronidation first aid: marked dysbiosis, Gilbert’s syndrome, oestrogen excess, cancer risk (especially bowel, breast & prostate) and one of our nutritional go-to’s has typically been Calcium D Glucurate. While there is ample evidence that one of CDG’s metabolites: 1,4 GL – inhibits beta-glucuronidase, is an antioxidant, platelet activation inhibitor and generally all-round good guy to have onboard, new research strongly challenges that oral CDG will convert to this at levels sufficient to support this detoxification pathway. Sounds like we’re overdue for an update on this supplement and when and where it might be useful in addition to how to find the real deal in real food!
When a teenage girl presents seeking her first oral contraceptive pill (OCP) script, what information is she privy to that enables her to make an informed decision? Read the insert inside the box? Please. Which 50 year old, let alone 15 year old does that? Forget it! What might her doctor tell her? Perhaps about clotting risk, as part of their determination of the suitability of this form of contraception for her but is there any discussion about the potential for adverse mood effects? A recent study of over 1,000 teenage girls followed over more than a decade adds to other evidence that suggests this should be flagged as a consideration prior to the prescription being written.
Most integrative health practitioners not only know about the potential negative impact on mood from OCP use in women but we’ve observed firsthand the havoc it has wreaked in some teenage girls’ and women’s lives.
A very experienced practitioner I know says, ‘if I am hearing mood instability and then I see a significantly elevated serum copper and or cortisol in these girls that’s when I just say to have to say to them, you know I don’t think this is the best contraception for you!’
This latest study did not find higher rates of depression across all OCP users in this group of 16-25 year olds but when they looked at this at different ages they found its use increased depression scores and was associated specifically with more crying, eating problems and hypersomnia. The discussion around the enhanced vulnerability at this younger age compared with older girls centres on the relative immaturity of their CNS. But wait, I hear you critical thinking clinicians ask, perhaps those teenage girls had more depressive features prior to starting the OCP. Good thinking 99! And the answer is…maybe…but the relationship goes both ways: from the related Medscape Continuing Medical Educational Activity
“For 16-year-old girls, the association was weakened after adjusting for depressive symptoms before use of OCPs, but the findings remained significant. This suggests that the relationship between OCP use and depressive symptoms could be bidirectional…For instance, 16-year-old OCP users were more sexually active and had more stressful events, as well as more menstruation-related pain and acne, than their counterparts in the nonuser group. Analyses showed that all these factors weakened the association, although none diminished it.”
The commentary surrounding this latest study is essentially 1) this is not the first study to find an association and others have been more able to demonstrate that COCP use predated the mood disorder in those affected and 2) those exhibiting higher depressive scores did not actually score strongly for anhedonia or sadness which are the most typical features in adult depression – so perhaps we are missing some of these negatively impacted young women. Awareness regarding reproductive psychology is rapidly growing and in Australia we are fortunate to have emerging hubs to seek help and specialist advice in this area, such as the important work of Professor Jayashri Kulkarni and colleagues out of the Women’s Mental Health Clinic. I’ve referred patients, both when a patient’s mental health appears to be caused or aggravated by use of hormonal agents but which they can’t not use for various reasons and for those small number of women in whom I feel hormonal management may in fact offer a psychiatric solution. So again I am asking, while we know & mainstream medicine increasingly knows about this association…who’s telling these young women?
How many of your clients are on a combination OCP? Do you know the full extent of the physiological impact as a result and are you able to identify to key pathology indicators of the size of that impact?
We’re all aware that in theory OCP use correlates with a range of elevated risks but in reality many females will make the decision that the pros, in terms of contraception or control of acne etc., outweigh the cons. What if we could provide more individualised advice by looking to their pathology results and identifying and quantifying specific danger signs for each individual? This approach enables us to better support patients who chose this form of contraception and to accurately identify those that should be be encouraged to find other safer options more biochemically suited to them. Learn more here.
This year I heard a great quote that hit the spot for me: anyone who offers you a simple solution to a complex problem is lying or misguided, the solution to a complex problem will inherently be complex. Dang! I’m frequently reminded of this in relation to many different aspects of working in integrative health. Or even just answering work-related questions socially. Random-friend-I-haven’t-met- yet, upon finding out I work in nutrition, asks: Is [insert any given food, beverage, macronutrient, micronutrient] good for you? In spite of over 20 years of this happening, I confess, the poker face still requires concentration.
The poker face is necessary of course to
a) conceal my amusement at how predictable humans are and
b) to cushion the blow for them as I tear down the delusion that real nutritional science is simple and can be served up in a soundbyte or
c) lie and infer that it is, just to get out of there faster!
But recently, I’ve had another reminder of that ‘in here’ rather than ‘out there’, about how even as practitioners we long for things to be simpler than they are. This month in mentoring I’ve been talking about the dark side of both zinc and Akkermansia muciniphila (I know wash my mouth out right?!) in neurological issues. What, but we had them on the good guys list?! Remember the answer to a complex problem (and human health surely owns this territory) will inherently be complex, right? Similarly, I’ve been digging deep in research about beta-glucuronidase, that enzyme that undoes our phase 2 detoxification of oestrogen, bilirubin and a long list of nasty xenobiotics, earning it the informal title of ‘bad ass biomarker’…scoundrel! And well, I’ve found some really nice things to say about it…like actually it extends the half life of most of our flavonoids such as quercetin, isoflavones etc etc and that’s a great thing for increasing their positive punch given that their rapid detoxification limits how much we can benefit from them. Turns out, like everything else, even dear old beta-glucuronidase exhibits light and shade.
How I ended up losing a weekend to such papers was because I was trying to resolve some burning questions about Ca-D-glucurate (CDG) that I’ve had for as long as I’ve been recommending it to people who arguably could benefit from a little less beta-glucuronidase activity.
My two most pressing ones were: How much is required to be effective & Where’s the evidence?
And that’s when the fight broke out [just in my head] You see every review I’ve read, every piece of product information too, repeats the mantra CDG 500mg TID but turns out this is based on…not much. More uncomfortable still, is that even our assumption that we can convert CDG into its active form has been strongly challenged. The new research, which is not the work from the 1990s that everyone cites, is a must read…or if you actually have a life, and other ways to spend a weekend then maybe just spend 30 mins with me in my Update in Under 30 this month 😂 I wanted to keep it simple and neat and tidy. I tried I promise. But in the end…wouldn’t you know it…it’s complex.
So to bring everyone up to speed, including myself!, I recorded an UU30 on…
The ABC of CDG We often identify patients who could do with a little glucuronidation first aid: marked dysbiosis, Gilbert’s syndrome, oestrogen excess, cancer risk (especially bowel, breast & prostate) and one of our nutritional go-to’s has typically been Calcium D Glucurate. While there is ample evidence that one of CDG’s metabolites : 1,4 GL – inhibits beta-glucuronidase, is an antioxidant, platelet activation inhibitor and generally all round good guy to have on board, new research strongly challenges that oral CDG will convert to this at levels sufficient to support our detoxification pathways. Sounds like we’re overdue for an update on this supplement and when and where it might be useful in addition to how to find the real deal in real food!
Remember the days when we had the brain all back-to-front & upside down? Anatomy & physiology told us it was an island, completely protected by the blood-brain-barrier from pathology in the rest of the body, that it was incapable of regeneration after damage and that it didn’t have its own lymphatic system. All wrong. Which presents a problem, the CNS is absolutely in trouble if other parts of our body are (!), but also some solutions: plasticity and the brain’s own capacity for cleaning up after itself. New research has revealed more about this critical CNS cleansing and what is likely to get in the way of this
The latest Medscape update on this is quite poetic, speaking to the movement of body fluids like tides within the human body.
“They found that the blood flow to the brain diminishes, allowing for an influx of cerebrospinal fluid (CSF), washing away the day’s detritus of proteins and other waste substances that might harm the brain if they aren’t cleared out.”
But these particular tide times are restricted to sleep – having never been identified during awake states & even more specifically only during our Deep Sleep, the period of slowest brainwave activity. The speculation is, of course, given sleep issues predate or are a feature of neurological and mental health conditions, that perhaps this comes back to the impeded process of waste removal that accompanies this and how this may contribute to accelerated negative neurological change. For example, beta-amyloid proteins are well known to be removed most rapidly during our sleep and this week I’ve been faced with a small mob of patients who have substantial cognitive impairment risk from a genetic standpoint (e.g. Apo E 4 carriers in families riddled with dementia) but their unmanaged long-standing insomnia plus or minus OSA is likely just AS risky. So here we are again back at one of the key non-negotiables for health: Sleep.
I often say to my patients, ‘There is nothing I can give you in a bottle or a blend than can do one 100th of what healthy (quantity & quality) sleep can do for your wellbeing today or for preventing health issues for you in the future’
And then I say it out loud again when no one else is around just to ensure we’re all aware of that 😉
The brain is no longer considered an immunoprivileged organ separated from immune cells by the blood-brain barrier, with research revealing numerous interactions between the neurological and immune systems. A large body of evidence now shows that these interactions, in particular an imbalance in pro-oxidant & antioxidant systems, play a clinically relevant role in the mental health issues of our patients and may go some way to explain why patients with chronic inflammation frequently present with mood and cognitive issues. Identifying and addressing the source of the inflammation (musculoskeletal, gastrointestinal etc.) therefore potentially addresses the underpinning cause and creates a ‘win-win’ scenario for patients. This updated recording aptly named: The Inflamed Brain, covers all this and more!
When I returned to seeing clients after my stint working in the pharmaceutical world of antidepressants & antipsychotics I was truly excited by the potential in our dispensary. 18 years later I remain just as excited. But what I hadn’t yet understood was just how much new knowledge I had gained from working in that other world. For example, did you know that SSRIs have secondary binding properties that all have a different pattern of boosting or blocking other neurotransmitters…and knowing these can help us choose the right treatment for any patient who has responded (un)favourably?
And I also hadn’t yet come to recognise all the other skills and knowledge needed to really help patients with their mental health…that are as a) important as anything in a bottle b) help the ‘bottles’ work better and c) direct you to the best ‘bottle’ in the first place .
Like understanding the trajectory of certain diagnoses, recognising red flags, the need to rewrite your regular consult for patients with primary mental health presentations to get the most important information and adjust your expectations: never setting them up to fail etc. Over the same time it has taken for my toddlers to almost stop being teenagers, I’ve continued to passionately research, upskill and work in this area and discover more and more tools that matured my ‘dispensary excitement’ into a more well-rounded practitioner who is a real part of the mental health care team and most importantly a genuine resource for my clients. But my under-graduate didn’t get me here.
Do you know your DASS (Depression, Anxiety & Stress Scale) from your MDQ (Mood Disorder Questionnaire)? And how to assess kids and teenagers who are too young for these? Do you know which methylation SNPs actually have the strongest links with mental health risk & what your patient’s uric acid levels tell you about their excitatory/inhibitory (im)balance? Do you have go-tos for the amotivational depressed patient to improve engagement with their own health changes? Do you know how to write a referral letter for a mental health client?
I’m very pleased to say the ‘mintees’ who are just wrapping up their year of the Mental Health Primer Mentoring with me do and much more. Recently, the fabulous Dr Erica McIntyre [who is of course in reality one of us…a naturopath…just a turbo charged one;)] has been conducting a seriously important survey asking naturopaths about our work in mental health. This is so timely (and yes your time is NOW if you haven’t done it already!!) because Erica has told me that some other new data she’s getting ready to publish has revealed that 70% of CAM users have had a mental health diagnosis in the past 3 years.70%👀 Erica is as passionate as I am about the enormous contribution we can make here but we also agree that a) we are flying under the radar as significant contributors in mental health care with the rest of the providers unaware and b) our training might be falling short in preparing us for this kind of client base and important role. I’m passionate about us all stepping up to that plate en masse as soon as we can.
If you’re interested in joining our Mental Health Primer Group for 2020 then email us at [email protected] for more information today.
Assessing Adrenals can be hit and miss, especially given that even more so than other labs, timing is everything. That’s why endocrinologists typically won’t look at anything less than a 24hr urine collection. If the total output is deemed to be high = Cushing’s and if it’s low = Addison’s. Sounds simple right? But to say only values outside of this reference range flag a problem might just be a case of throwing the baby out with the bathwater (or urine in this case!). Especially given it has been established that humans frequently fail at correct & complete 24hr urine collection! Alternatively we can use saliva or blood assays and capture the cortisol at any given time point, comparing that to expectations based on diurnal rhythm – but again, how are the reference ranges for these ascertained and is there such as thing as low normal. high normal results for cortisol, that actually warrant follow up investigation? I’m so glad you asked.
I see a number of patients who present with possible indications of flagging adrenals: from some distinguishing, but far from definitive features, in the clinical picture, to secondary lab markers. However, when they ‘limp’ over the line with their morning blood cortisol result I am often left talking to myself in an echo chamber about the need for more follow up.
But with the RCPA a.m. reference range of 200-650 nmol/L (Some seriously wide goalposts!) and some labs even going down to 150 with their minimum acceptable level for morning cortisol…are we right to still flag hypocortisolism (for any reason) as a differential in patients with low normal results?
Well Medscape yet again delivered Christmas 🤶 early last week with the largest study to date of blood cortisol, that has narrowed what’s ‘normal’ significantly…at least in terms of how low you can go before warranting further investigation. In this study they tested blood cortisol in the morning and afternoon, in over 1200 individuals presenting at an endocrinology clinic to determine in real world terms how low is too low (and associated with an increased likelihood of genuine adrenal insufficiency). They then gave this new ‘minimum cortisol’ a bit of test-run in 2 other large cohorts of patients to check it really did work as an effective cut off and wham bang…we now have a fully validated bare minimum… and guess what…it’s 275 nmol/L in the morning and 250 nmol/L in the afternoon!
Let’s be clear, their cut-off has what’s called a low ‘positive predictive value’ – which means most people (approx 2/3) with cortisol under this cut-off, upon further investigation (typically the ACTH stimulation test) will be found to be fine. BUT the point of this study was to ensure we don’t miss patients with adrenal problems just because they have ‘within range’ cortisol…and this new cut-off delivers on that.
This is big helpful news actually. Previously with patients who had am cortisol between 150- 275 we tended to find ourselves in ‘no man’s land’ – unable to provide enough of an argument about why adrenal insufficiency should still be on the differential list but unable to abandon that suspicion entirely. Thanks Medscape! Now if all the labs, RCPA and the referring physicians can just read this study and shift their goal posts…🙄
Our Group Mentoring 2020 Doors are just…about…to…close!
TODAY!
So if you love labs (or want to learn to love them more), desire to be a better diagnostic detective than you already are and want truly independent mentoring in a collegiate and structured environment for next year and you haven’t applied yet…best shove your foot to hold that door open right now! We offer a range of different levels & types of special interest groups: from New Graduates & the Mental Health Primer group (for those wanting to upskill and focus on this area), from rotating case presentations in our regular groups which are a mix of funky similarly skilled clinicians, to our pure GP group…take our pick! But get in quick by emailing us right this very second: [email protected]
Did someone explain the kidneys are like a really important, not to be forgotten, under-estimated, ignored or under-valued kind of organ in your training as a naturopath?No, me neither. I mean I know Buchu and Uva and Zea (on a first name basis only, clearly!) and …no actually, I’m done. But seriously, it didn’t take too long in practice to stumble across a whole lot of bad when kidneys aren’t getting the attention they warrant and equally to develop a slight obsession with renal markers in all of my patients not just because of their incredible impact on whole health but also because of what ‘lay beneath’.
As you might suspect, I get sent labs all the time from practitioners. Stop no! That is not an invitation!
Often it’s client’s renal markers which I do appreciate because it tells me there is an increasing number of praccies that absolutely have done some post-grad DIY knowledge building about these bean-shaped babies and their critical contribution to health. The results might come with a question like, “What’s going on with their kidneys?!” [insert worried face emoji of choosing]
To which my reply is often… “not much but boy do we need to talk about your patient’s GIT microbiome! [or] mental health! [or] sarcopenia!”
Say what? Yes abnormalities within the renal markers: urea, creatinine and uric acid may be a reflection of renal issues. But if you know where each of these molecules enters the blood,exits the body and all the interesting good & bad they can get up to in between…then the patterns speak less (if at all in some instances) to what’s going down in the kidneys but instead give you an incredible insight into key issues all over the body: from the gut to the brain. But wait there’s more! Want to know what’s the latest and greatest in management of advanced renal disease? Treat the gut to lower the urea. What about managing mania? Add in a gout treatment to lower uric acid. Dang! This is holistic health at its best with those poor kidneys no longer being left out in the cold!
“Who knew urea, creatinine, GFR and uric acid could be such a Goldmine….Mind…officially…blown!” New Graduate Mentee 2019
Most practitioners graduated with not much more than a few ‘kidney’ herbs and an under-appreciation of the contribution renal health makes to wellbeing. It’s not just about waste and water. In reality, the kidneys are pivotal in just about every major element: blood, bones, pH balance, methylation, control of oxidative stress, the GIT microbiome and more! And we are seeing the impact of this in our patients in all sorts of subtle and not so subtle presentations. This new instalment in diagnostics, brings the renal system into the spotlight so we can confidently identify and better manage its critical contribution. In addition to this, just like with other routine labs such as LFTs, we unpack how these so-called ‘renal markers’ can flag a plethora of other insights into your patients, from reflecting (un)healthy muscle mass to calculating individual dietary protein adequacy, from key ‘danger and distress’ signals in response to disturbed metabolism, oxidative stress to certain types of GIT dysbiosis! We call this Renal Markers: Explained, Expanded and Exploded because these routine labs can deliver XXX sized insights into your patients.
Yet another super-helpful part of Iron-Land has been mapped!! Ever struggled to correct chronic iron deficiency in athletes or even just weekend warriors? Yep, me too. One of the key barriers being the 2-3 fold rise in hepcidin in response to exercise. Hepcidin whose day job is an inflammatory signal that two-times as an iron uptake blocking agent at the small intestine. In addition to other exercise-induced factors that either reduce Fe uptake or increase losses, it really is no surprise that these cases can be hard to treat. However, a recently published small Australian study has brought to light some constructive new information. Similar to the often talked about ‘anabolic window of opportunity’ whereby we encourage people to consume protein +/- CHOs within a short time-frame post-exercise to optimise exercise outcomes and negate negatives, these new findings imply the same might be true for optimal Iron uptake. But only in relation to exercise done in the morning!
The key finding was when individuals consumed iron after 90mins of exercise in the morning they exhibited higher uptake than both when they took the iron at the same time but didn’t exercise beforehand or took it after exercising at night.
This is a game-changer for potentially ALL our patients who struggle with iron absorption. With the key take-home being…not just take your iron preferably in the morning which we already know (when hepcidin is naturally lower as part of its diurnal rhythm) but before you pop that pill, pop on your sneakers and get busy sweating! How on earth might this be working? Well this study demonstrated that while hepcidin rises after exercise typically for up to 6hrs…it is not yet ‘up’ and blocking within the first hour – gotcha! But why would this mean an even greater uptake compared with the same iron at the same time in the same individual…but a resting version of themselves? Because exercise may in fact cause a transient leaky gut post exercise & enhanced nutrient uptake may be its silver lining! A small study that actually punches above its weight, this one is worth the read – via a great comprehensive summary on Medscape if you have it or you can check out the abstract.
Our ever-expanding Iron knowledge gives us great hope for the improved understanding we are likely to reach with all nutrients in the future. Let’s not forget Iron has about a 70 year head-start on other microminerals such as Zinc and almost a century on Selenium, which was identified to be essential in just 1979!
And the contrast is apparent anywhere you care to compare and contrast the ‘older’ with the ‘younger’ nutrients. Just look at iron studies. A personalised detailed account of each individual’s iron story: how much you’re consuming, how effective you are at absorbing what you’ve been offered, how hungry that makes you for more and what good stores mean to you (not some fictitious average male or female)! All told through 4 distinct but inter-related markers: serum iron, transferrin, transferrin saturation and ferritin. What can we glean from our current routine assessment of Selenium in contrast? Their short-term Se intake…yep. Looking forward to the multi-parameter markers of each individual nutrient we just might have at our fingertips in the future, thanks to iron nutrition which continues to teach us how sophisticated nutritional physiology really is 🙂
We know the most about iron and yet we know there is always more to learn. And who better to teach us this than our clients with iron deficiency or iron excess? Need some help getting across the most important aspects of recognising and correcting each iron issue in clinic? We released an Iron Package earlier this year for this very reason. It covers how to really read iron studies (with a great cheat sheet), how not to fall for a fake (deficiency) and what the best supplements and dosing regimes look like and how that differs in pregnancy, athletes, those with marked gut issues and other key groups. It’s your 1 stop iron shop.
What’s the most common thyroid disease you’re seeing in practice? Nope, try again. I’m serious. There would be very few of us who’d get this right without cheating. It’s nodules. Current figures suggest 1/2 of all us middle-agers have them and by the time we’re 80 that’s risen to 90%! There’s a school of thought that says these figures have jumped purely because of increased rates of thyroid imaging and we should stop sticking our nose in places it doesn’t belong. Just because they are there doesn’t mean we need to know about them or that they are causing trouble. All this is true and yet there is a percentage of patients for whom these nodules are a whole lot of trouble, in fact, that’s why they’re coming to see you…they (& possibly you!) just don’t know it yet.
Nodules, outside of radiation exposure, have always been primarily viewed as a nutritional deficiency disease: Iodine. While this was always a bit one-dimensional (poor selenium…when will you ever get your due?) it’s an explanation that no longer fits as well as it once did because even in populations who have addressed iodine deficiency, the incidence of nodules continues to rise.
So, what now?
New nutritional drivers have been identified but rather than being about our deficiencies they speak to our nutritional excesses. And while iodine is not totally out of a job here, some people of course are still experiencing long-term suboptimal iodine which can trigger nodule development, we now need to question if there is any therapeutic role for iodine once the nodules are established. Well the answer is both ‘yes, maybe’ and ‘absolutely not’. The determinant being whether we’re dealing with Hot or Cold. Unfortunately most patients and therefore their practitioners can’t tell the difference. But it is the presence or absence of a hot nodule that radically changes what complementary medicines you can and can’t use and what an effective treatment plan looks like.
I’ve seen a lot of thyroid nodule cases pop up in mentoring this year and it’s been a great learning opportunity for everyone to get comfortable with clues in both patients’ presentation & their pathology. While iodine deficiency no longer ‘fits’ like it did, nutritional medicine should arguably remain the primary approach to their management and the new research gives even more credence to this and identifies a far greater range of dietary and supplemental tools.
Thyroid nodules are going to explain a surprising number of our subclinical (hypo and hyper) thyroid patients and we already have a dispensary full of powerful interventions but we need to start by familiarising ourselves with their story: their why (they happen), their what (this means for patients) and their how (on earth are we going to address these effectively) Knowing your Hot from your Cold…is step one.
An increasing number of our patients have thyroid concerns but unbeknown to many of us the most likely explanation of all is thyroid nodules, whose incidence is on the rise globally.The development of nodules has always been primarily viewed as a nutritional disease. Traditionally attributed to chronic iodine deficiency but recently novel nutritional causes have emerged . Benign nodules come in 2 flavours: hot and cold and while patients can present with a mixture, it is the presence or absence of a hot nodule that radically changes what complementary medicines you can and can’t use and what an effective treatment plan looks like. The pointers, as is often the case, are there for us in the patient’s presentation and pathology, so knowing the difference is no longer a guessing game. This UU30 comes with a great visual clinical resource and includes key papers on the nutritional management of nodules.
You can purchase Are You Running Hot and Cold on Thyroid Nodules here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
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Having just spent the last four days in Sydney delivering education at ACNEM to doctors, dentists, pharmacists and other medical professionals, I am reminded afresh about what we all share: a passion for problem solving and a diagnostic detective determination! What’s truly wonderful is when teaching shifts from didactic to dialogue-based, with sharing of our different training and expertise, as happened during this weekend. That’s when I find the gains are greatest. Since the first time I was invited to speak at ACNEM in 2009 (that makes me feel very old!) I observed this collegiate and collaborative learning environment and, I realise in hindsight, worked on developing this a little more within my own naturopathic ranks via my group mentoring.
Over this decade my interactions with integrative doctors have grown in frequency and familiarity. Coming to see and appreciate ever more about important differences in the clinical context from mine and learning increasingly how I can help build a bigger stronger bridge for us to walk between the two approaches – in order to practice true integrative medicine. With the best of both worlds.
For several years now I have been privileged to mentor doctors & specialists, both individually and as part of group mentoring. This year we have had a combined group of GPs and naturopaths with advanced standing, which has worked well & has attracted excellent feedbackthat speaks to consistently meeting the needs & learning objectives of practitioners, regardless of background.
“[At first] I found the sheer complexity of this very well presented case initially overwhelming. What would I have done first that hadn’t already been done? [Then] the most satisfying was seeing that maybe there was a way of tackling this problem in a clear and systematic way.” Melbourne Integrative GP
“I always thought alopecia was impossible to treat, and it was a challenging process to unravel in this case but reassuring that a path emerged… Trying to figure out who may be affected the nickel hypersensitivity (SNAS) will be interesting” Integrative GP in NSW
“Highly professional, thoroughly researched, relevant to clinical practice – her insights have certainly been a help already to many patients in my practice.” Auckland GP
In 2020 we would like to run agroup entirely dedicated to integrative doctors or doctors interested in incorporating wellness models and nutritional interventions into their practice.This group, like our others, will meet online for 1hr every month for case discussions, offering us an opportunity to meet your mentoring needs in the best way possible and truly accelerate your knowledge and skills in integrative medicine. If this is on your to do list then the time is now. We’re currently taking expressions of interest.
What’s Presented in Each Session?
Each session is 1 hour & occurs monthly from January to November. Practitioners present their cases in a rotating fashion across the year. The work-up of each case will include pathology interpretation, identification of other key clinical questions to be asked and specific additional assessments, drug-nutrient interaction review, discussion of differentials & a proposed integrative management model. Ideally (dependent on final group numbers) these case based sessions will be interspersed with several open Q&A sessions, during which Rachel can answer key questions you have in any given area & follow up on previously presented cases.
Other Benefits
New 15min Follow up with Rachel via Zoom for those cases that have been presented in our group mentoring sessions. This is a brand-new format to follow up on how your client is going after the session – what’s working, and discuss what next. Rachel will spend 15 mins with you on Zoom 1-2 months after you’ve presented your client case. The recording will then be uploaded to Basecamp so the whole group can catch up on the progress and extend our learning opportunities again.
Now there’s an option to join Group Mentoring and not present Yes, this ‘fly on the wall option’, to join in but not present a case, which we’ve come to learn is preferred by some practitioners (due to a lack of time, good cases or confidence with presenting) is finally getting formalised for 2020
30% discount on ALL Rachel Arthur Nutrition products on our website. When you join the Group Mentoring Program, you receive a discount code that you can use for any and all purchases on Rachel’s website in 2020 – the Update in Under 30 subscriptions, New Master Diagnostics Package, Thyroid Package and all other recordings.
Where Can You Get More Information?
If you’re a medical doctor and you’re interested in being a part of this dynamic specialist group for next year you can…
Fill out the registration form to secure your place before applications closed mid November. If you have further questions email us at [email protected] or read more information about the program click here.
I had to say to a mentee just yesterday, “You’re going to see the topic for the Update in Under 30 this month and think it’s inspired by your patient but it was actually about the 3 other cases I’d seen this month, before yours!” Yep…I’m talking about thyroid nodules, which happen to be hot (pardon the pun) right now. But they’re not always hot, right? I mean, they are always a good topic for discussion because so many of our clients thyroid issues are due to these but nodules come in 2 flavours: hot and cold. And knowing the difference is about as important as knowing your left from your right 🤲
“Oh Iodine the panacea of all things thyroid (tongue firmly in cheek) – can you fix nodules as well?” chorus the masses
Honest (salt of the earth!) Iodine Replies, “No & in fact I may make some nodules worse!”
Sorry for the re-enactment of this little local theatre piece in my head…it’s been a big week. Hence the marionette…ah yes it’s all becoming clear now 🙄 But it seems this isn’t common knowledge because a mentee presented a case this week of a 39 year old female who has confirmed multiple thyroid nodules that had prior to seeing her, seen another practitioner who put her on high dose iodine with the reassurance “there’s nothing wrong with your gland that iodine can’t fix”..or something to that effect. Oh boy 🤨
“Tell us! Tell us what happened next!” the chorus chants
Well it looks like as a result of the iodine, her cold nodules just might have switched to hot…that’s bad news all round I am afraid 🙁 But if we all knew our nodule nutrition better, this wouldn’t happen.
Next week our October UU30 release becomes available: Can you tell you tell your Hot from your Cold in Thyroid Nodules?
Our Update in Under 30 Subscription allows access to the ENTIRE back catalogue of podcasts in addition to all podcasts released over the next 12 months. We are currently offering the Premium at a reduced SALE price of $239 (excluding GST) for 12 months. This Premium Subscription is worth its weight in gold! With a total value of over $1800, you receive each month a new podcast and access to the ENTIRE back catalogue to the value of $20/month (ex GST).
This week’s wonder-full paper and light-bulb discovery was prompted by a 34 year old woman with a history of Depo Provera injections over several years to control unruly menstrual bleeding and pain. She was subsequently diagnosed at 28 with osteoporosis. That’s not a mispelling…not -penia, -porosis. Now I may be a bit slower than some on the ol’ synthetic hormone fallout front but when it was pointed out that this is a known possible side effect of this synthetic progestin (even features in the consumer brochure), which is used for a range of indications in both pre and post-menopausal women, I did a double-take. What kind of progesterone replacement impacts your bone health negatively and how? And therein the real trouble started.
So fixated are we (myself included) on the evils of oestrogen, I think we’ve failed to notice the wolf in sheep’s clothing that can be synthetic progestins for some patients. Not just in general terms of concern regarding all synthetic hormones but as a result specifically of their interaction with glucocorticoid receptors (GR). This excellent paper reviews this aspect of the 2 most commonly used ones: medroxyprogesterone acetate (MPA) and norethisterone enanthate.
The bottom-line? MPA (which is Depo provera) is a significant GR agonist. That means it’s behaving like cortisol producing a degree of immune suppression and constituting yet another mechanism, in addition to the low oestrogen state it induces, by which negative bone effects may be mediated. This is not a mild or minor action according to this and other research. This is likely to have significant implications for some women, including this 34 year old female. Some women see reversal of this demineralisation following cessation, but not all and the younger your first exposure, the higher the likelihood it won’t correct. This woman had other osteoporotic risk factors, sure, but never enough on their own to produce such severity so young. Mind. Blown.🎆 Or is that just me?
While none of us are likely to be advocating for replacement sex hormones without very careful consideration, this has really helped me to change channels off my oestrogen obsession and become alert to the potential for broader effects from synthetic progestins. MPA…you’re firmly on my radar now in a whole new way.
As always, our patients teach us the most and thanks to Amanda Mullemeister for bringing hers to our recent mentoring session. The learning is never one-directional and I am so privileged to share in these discoveries with all of my mentees, every week. I just wanted to share some light from this particular light-bulb 💡
If you’ve heard Rachel speak ever (!) you probably know she’s on a mission to stop the late diagnosis of osteoporosis in patients and as part of this reminds us that this is a condition that develops over a lifetime not overnight – so waiting until women are 65yrs and men are 70yrs (which is the standard recommended age for BMD screening) seems a little remiss in terms of identifying our opportunity for preventative medicine. Are there earlier warning signs that we are ignoring or specific tests more sensitive and accessible than DXA scans that we could be ordering to better monitor patients who are at higher risk of bone demineralisation? The answers are of course, yes and yes! This Update in Under 30 outlines the clinical tools we should be using to uncover unhealthy bones earlier in our patients, how to implement them, their limitations and their strengths.
Stop press. No, seriously. This new research warrants the attention of every practitioner working with children & teenagers. In the largest paediatric study of its kind to date, which included 2,480 children aged 10-18yrs diagnosed with hyperthyroidism (Grave’s or otherwise), Zader & colleagues found
Double the rate of ADHD diagnoses
5 times the rate of Bipolar diagnoses (almost 7 times in males)
5 times the rate of suicidality
That’s what I said: in 10-18 year olds
What is most alarming of course is that these mental health diagnoses were made in half of these children >3 months prior to the diagnosis of hyperthyroidism. What does this mean? It means we are missing this critical biological driver in this patient group. We all recognise the potential for some psychological presentations people affected with thyroid conditions, however, perhaps we are more alert to this in adults and letting it slip off our radar in kids? There’s been renewed talk about the over- and mis-diagnosing of ADHD lately and given that research has found up to 80% of hyperthyroid children meet ADHD diagnostic criteria this is one of the 1st place arguably to look! It also means, as these researchers discuss in detail, these kids are being medicated with psychiatric meds that in fact may, at the least mask their abnormal thyroid, lead to the incorrect diagnosis of hypothyroidism (lithium & even stimulants for example) or exacerbate their hyperthyroidism (quetiapine). But wait there’s more and it’s essential to understand.
Zadar & colleagues note that while we can not be 100% clear about the direction of the relationship…e.g. were these children already at risk psychologically and the hyperthyroidism just exacerbated that, they note that correction of the TFTs does not always equate to ‘cure’ of the mental health issues. This is not entirely surprising of course. What the problem emerges via a combination of biology and psychology & we resolve or remedy the biology…guess what you have left? PLUS the learned behaviours etc from suffering from anxiety, impaired cognition, suicidality they’ve been battling at the hands of excess T3 and a subsequent tsunami of reactive oxygen species.
This is one of those papers we should all have to read top to toe and therefore ideally be able to access for free but alas 🙁 What you can read is the Medscape review of this, which is a reasonable summary but the full paper is worth it if you can. You know the other key take home here…the diagnosis of hyperthyroidism was only made with overt out of range TFTs… which begs the question what about all those subclinical hyperthyroid cases we know exist? Yes, no wonder this paper has RACHEL’ S FAVOURITE written all over it…paediatric thyroid assessment and missed biological drivers of mental health and the opportunity to get better at both…can my research reading get any better this week?!🤓
Currently in Australia there is limited use of age specific reference ranges for thyroid parameters in children & teenagers yet they are essential for correct interpretation and diagnosis. Even doctors & specialists seem to be at a loss with diagnosing thyroid problems in kids unless they are extreme presentations. Subclinical thyroid presentations, however, are increasing in both children and adults. Many practitioners competent in adult thyroid identification & management are less familiar and confident with knowing when why and how to test in this population. Make sure you’re not missing thyroid imbalance in your paediatric patients…early detection makes treatment easy.
For all those Mentoring Virgins 😇out there wanting a clearer understanding of what it’s really like to be part of my group mentoring, this video is a little snippet from a session with one of my groups. This year has flown by and I have thoroughly enjoyed working with each fabulous group of dedicated ‘life-long learners’.
OH YES!!…and the real announcement is…..(drum roll)… It’s that time of the year….Applications open next week for GROUP MENTORING in 2020!
As a result of the generous feedback and insights from our current Mentees, we are always fine tuning our program & level of service. Yep…it just keeps getting better and better every year!! We are keeping everything that so many practitioners have told us they love from the past 7 years (wow….have I been doing it for that long?!) and simplyimproving the already incredibly popular formula, with some great new features for 2020.
New 15min Follow up with one on one with me! via Zoom for those cases that have been presented in our group mentoring sessions. This is a brand new format to follow up on how your client is going after the session – what’s working, and what’s happening now, what should you do next? Rachel will spend 15 mins with you on Zoom 1-2 months after you presented your client case. The recording will then be uploaded to Basecamp so the whole group can catch up on the progress and extend our learning opportunities again.
We’ve expanded our mentees 30% discount to ALL Rachel Arthur Nutrition products on our website for 2020.When you join the Group Mentoring Program, you will receive a discount code that you can use for any and all purchases on Rachel’s website throughout 2020– the Update in Under 30 subscriptions, Audio and Video recordings, Packages on Pathology, Thyroid, Iron.
Certificate for CPE Hours– we’ve done this for the last 2 years and will continue to do so to make your CPE easier at your end
General and Specialist Groups – we’ve had a great response to our specialist groups this year, and we are offering these again in 2020, so you can choose from:
General Group Mentoring–our regular case presentation groups, with practitioners taking turns to present a case, or just listen in. Yes, this ‘fly on the wall option’ which we’ve come to learn is preferred by some praccies (due to a lack of time, good cases or confidence) is finally getting formalised for 2020!
GP dedicated Group – this depends on our final numbers of applicants for 2020. This year we had a combined group of GPs and naturopaths with advanced standing, which has worked well. Either way, we have a good track record in catering to the needs of doctors, medical specialists and dual qualified naturopaths (osteo, psychology etc).
New Graduate Groups – great opportunity for New Grads to build confidence as they leap from student to practitioner, or for practitioners wanting to refresh their core clinical skills such as MindMaps, Pathology, Improved Case Taking etc.
Mental Health Primer Group – topic based to build on your knowledge in the role of naturopathic medicine in Mental Health – from screening tools to key management issues, specialist diagnostics and beyond.
Mental Health General Group Mentoring – practitioners presenting their client cases with a focus on primarily Mental Health presentations.
“I believe the mentoring you are offering is allowing me to develop myself into the type of practitioner that I want to be.
I really aim to provide evidence based treatments, and wish to utilise pathology testing results as one of the major diagnostics in my practice. I can see that every mentoring session with you brings me closer to that, filling my knowledge gaps every time. You and your knowledge base is so inspiring, and I only hope that one day I will know close to some of what you know!” – Andrea Robertson
And don’t forget some of the offerings our Group Mentoring consistently delivers as part of your program – the opportunity to learn every month via high level applied knowledge not theoretical and to see it in action with tracking and updates on patient progress, our incredible online resource sharing platform for communication and support between sessions and the opportunity for sharing of pearls of knowledge from my 20+ years of experience and research together with the collective wisdom and know-how of each unique group.
“I am one of Rachel’s New Grad mentees. My first year out has been pretty overwhelming and I wanted to let Rachel know that I have been watching the zoom sessions and have learned so much to take my clinical confidence and practice to the next level. She has an amazing gift of nailing the important aspects of practice and giving useful usable information that brings together the fuzz of everything you have learned and ties it all up with a neat bow with her pearls of wisdom every month. I plan to be a mentee again next year (and for many years I suspect)” – Bek Di Mauro
REGISTRATIONS OPEN 14 October!
To read more about the program click here. Information on how to apply will be released on 14 October. Join the waiting list now so you won’t miss out by sending us an email on [email protected].
Behind their deceptively-dated inkjet printing and boring black and white font (punctuated occasionally by a comparatively thrilling red H or L)mainstream pathology results actually offer a goldmine of information and insight about your patients….if you know where to look. And even the most seemingly status quo reference ranges for routine labs reveal so much, if you understand how to identify when results are ‘expected’ or even ‘optimal’, as opposed to ‘unexpected’ or ‘the new (ab)normal’, reflective of an increasingly unhealthy population. Because unlike measurements of beauty, wealth or intelligence…more B12, TSH, GGT etc. etc. is not necessarily better and in fact being ‘average’ may sometimes be the aspirational goal 😉
Many holistic practitioners feel unnecessarily ‘locked out of labs’ due to inadequate training or, even worse, the false belief they are not relevant to their naturopathic work-up but they are abundant in holistic insights about our patients.
You can change that today and start developing your mild naturopathic super-power in diagnostics.
“Rachel – I have to say thank you, thank you, thank you!! That session on pathology was epic. It has really made me look at each set of path results I have seen in a different context. In terms of relevance – a definite 10/10. Everything from the reference range info to looking for any clinical and collection notes – definitely gives more scope in mining for those answers. Can’t wait for the next session 🙂 “
Chris Hibbert (Group Mentoring Program 2019)
To boot, upskilling just a little in accurate pathology interpretation will help you write better referral letters, practice true individualised medicine and sort the real from the rubbish in terms of all the **whizzbang-bright-sparkly-functional tests** you and your patients are being offered in spades.
“I’m totally enjoying the pathology sessions. I use pathology in my clinic all the time but have learnt so much from these last couple of sessions and I know I can squeeze out a lot more. I’m a convert (within reason) to the idea of many of the OS functional medicine practitioners who prescribe to the ‘test don’t guess’ motto and that pathology highlights the body’s ‘debris’ which can lead us to a certain pathway, system and help us go back up stream to the point of origin. I feel that’s the unique value we add to our clients’ health. Thanks Rachel.”
Elke Jesdinsky (New Graduate Mentee 2019)
We need to start with a good grasp of ‘lab language’ and have the veils of mystery around reference ranges removed so we can make the most out of all these results our patients already have, if not in their hot little hand then in their equally hot not so little (!) medical records.
Mainstream pathology results actually offer a goldmine of information and insight about your patients. However to realise their full value and make the most accurate interpretations we need to first learn more about ‘lab language’, upskill in finding our way around reports which are packed with a surprising amount of hidden extras, demystify reference ranges and then develop a logical critical process we can apply to every result of any patient to get the real take-home. Packaged with numerous specifically developed resources to aid in your application of these skills this is a foundational offering that changes practices.
Sometimes timing is everything. I recently FINALLY had my (almost) lifelong dream come true, installing a self-care-haven-outdoor-bath and guess what, a few days later I stumbled across an exciting study talking about the benefits of baths! But it’s not in the traditional hydrotherapy way you might be thinking. It requires at least one co-bather…or more 😉
About now you (and my recently relocated kids) may be wondering exactly how big I’ve gone with the bath. Relax it’s smaller than the one in this image. Promise. But based on this recent study you definitely want room for at least one more…but make it someone you’ve already seen a CDSA for 👀
We’ve all been taught ad nauseum that the establishment of intestinal gut microbiota starts at birth if the child is born through the birth canal and for those that took a different emergency exit route, via contact with surrounds in the days following. But what do we say about doing what we do, til we know better? This particular study by Odamaki et al. (2019), puts a very different spin on things regarding how we end up with the ‘gut’ we have today. Using the old tradition of Japanese families sharing bathwater to answer a very modern question: is it a possible medium for the exchange of strains of Bifidobacterium longum?
It turns out that the number of gut microbes shared by family members of the group who bathed together was higher than that in the ‘solo-submergers’ group, reinforcing the likelihood that shared bathwater is an effective vehicle for microbial exchange of bifidobacterial strains.
So maybe in the future, our probiotic treatments might look a lot more holistic… a new addition to our oft-repeated list of favourites: whole food diets, fibre diversity, all the polyphenols of the rainbow etc. They might just include sharing baths with some healthy family and friends rather than swallowing yet another little pill – I am certainly open to that. Come on over but just fax me your CDSA well in advance;)
“Man’s mind, once stretched by a new idea, never regains its original dimensions.” — Oliver Wendell Holmes
In our profession, we are confronted with new knowledge on a daily basis and the challenge is to keep an open mind. But let’s be real, the theory isn’t always easy to implement in practice…If you want to stay up to date but you don’t have the time to look for the newsUpdate in Under 30 are dynamic power-packed podcasts that will help you keep abreast of the latest must-knows in integrative medicine. Focused on one key issue at a time, Rachel details all the salient points so that you don’t have to trawl through all the primary evidence yourself. All topics are aimed at clinicians and cover a range of areas from patient assessment to management, from condition-based issues to the latest nutritional research. Most importantly, each podcast represents unbiased education that can contribute to your CPE points.
Our Premium Subscription is ON SALE and offers you a fast efficient and inexpensive way to stay up to date in under 30 mins a month plus access to the entire UU30 Library (over 75+ epidsodes)!
Our knowledge is subject to constant change, and it is oh so necessary to stay up to date in our field for a bazillion reasons, give or take a few 😉 So sometimes we can feel like we need eight arms (for the visual amongst us) to manage and keep up with it all. However, if we ‘use the force’ together we are stronger, learn faster and can stop with the whole ‘recreating the wheel thingo’ that so many practitioners find themselves doing out there in solo practice. Like, like…well, how confident do you feel about putting pen to paper? How good are you at your inter-professional communicating?
Referrals and inter-professional communication are just lightly touched on in the current undergraduate degrees (if at all!). But it’s actually such an important way to grow your own professional reputation while simultaneously the credibility of our whole profession. One might even argue, a pillar that stabilises the castle of shared patient-centred care & the future of true integrative health. I hear from my “New Graduates” as well as seasoned mentees about the unease that starts to creep in at the thought of writing the dreaded referral letter. I’ve been writing referral letters for 20+ years and it’s given me a lot of time to think!And refine. And refine again! To make inter-professional care a positive experience for everyone, we need to correct some misperceptions and ensure that our patients are everyone’s priority. And to fulfil our duty of care, communicating with the other practitioners on your patient’s healthcare team is fundamental. Sometimes, as you’ll learn, it’s about modelling the best kind of shared care to boot and being the bigger person 😉
Better still, positive experiences of inter-professional communication will bring collaborators out of the woodwork. Medicos and other allied health professionals you may never have been aware of otherwise, with a desire and openness to shared care tend to rise to the surface.
To get you even more excited about referral letters (you didn’t think that was going to be possible, right?!) and unlearn that Pavlovian procrastination you may have developed, Rachel has completely redesigned an older presentation to ensure it’s truly reflective of the contemporary healthcare landscape (oh yes, RACGP position statement included!). Expect to roll up your sleeves and get seriously practical advice with loads of examples about how to medico-speak naturopathic concepts, explain your role in the patient’s care, provide rationale for consideration of investigations and present ‘red flags’ with punch but minus the sensationalism. And above all else, reveal yourself as the asset you really are to the rest of the healthcare team.
“Thank you so much for a wonderful presentation yesterday, Rachel. It gave me a new perspective on how it must feel as a GP to receive incessant demands from Naturopaths/Nutritionists to order pathology for their clients. I am in awe of your integrity, desire for patient empowerment, humility and respect for other professionals in the mainstream health arena. I felt that every single naturopath and nutritionist out in the big wide world ought to have listened to your insightful words of wisdom when it comes to shared care of our clients. We are blessed to have you as our teacher.” – Michelle Blum (Mentee 2019)
Remember when I said you say tomatoes… equal histamine but I say, well maybe oxalates, maybe Nickel? So in the UU30 released just last week How Noxious is Nickel we get down and dirtily detailed with just why Nickel, which is almost ubiquitous in soils and therefore the food and water we consume, may prove to be a catalyst for change in the digestive systems of our patients and beyond. While we humans don’t have any actual use for this metal, many bacteria do and this means in a Nickel rich diet or environment, some will thrive and others struggle, potentially creating unrest in our very own microbiotic megacity.
It’s bigger & broader than this though, with Ni triggered contact allergies not just possible on the skin like we commonly see for some individuals with cheap jewellery. The gastrointestinal lining may also manifest a similar reaction. Yes, you heard me right.
What would this look like? Well, a patient who ‘reacts to’ tomatoes, legumes, nuts maybe and given the chance (!) chocolate cake with icing especially, which happens to be highest containing Ni food documented 👀 Someone who has been given an IBS label, or has even been diagnosed with gastritis. Still a non-believer? Check out these papers to get you started. The labyrinth of potential food reactions makes us dizzy yet again! We seriously need a map and compass to find our way through this with patients!
While nickel sits rather benignly among its mineral mates in the transition metals of the periodic table, it is a metal that humans are constantly exposed to yet have no need for. What could possibly go wrong? Well, a lot it seems. Nickel is the most prevalent metal allergen worldwide and beyond this, there is strong evidence of its potential to trigger autoimmunity, major endocrine pathology and a raft of GIT problems that masquerade as other conditions like IBS & NCGS. This episode captures the dance we all do with the ‘Devil’s Copper’ and why some of our patients are likely to end up with a bigger dose and a much bigger disease picture as a result of noxious nickel.
For all Update in Under 30 Subscribers, it’s now available in your online account and if you are not a subscriber you can purchase this individually here.
Forehead USB not required. Phew. All that is required, is a real thirst for new knowledge, rapid development of your diagnostic skills and a willingness to commit an hour every month to tap into your new Brain’s Trust: Rachel and a collection of colleagues with a shared desire (general practice or mental health-focused) and similar level of experience to you – new graduate, medical, naturopathic or dual qualification. And take one great leap forward closer to being the practitioner you want to be.
The Rachel Arthur Group Mentoring Program has the longest (7 years and counting!!) and most impressive track record of practitioner satisfaction for value for money and meeting clinician’s key learning outcomes.
And the long-awaited good news is…we will offer our New Graduate Program, which debuted this year to much critical acclaim, again in 2020!
Being part of the 12-month group program allows you to connect to a community of like-minded, similarly-skilled practitioners in a structured teaching environment either via case-based presentations (regular groups) or via an interactive curriculum (New Graduates, Mental Health Introduction). You’ll be plugged into 11 other practitioners and together with Rachel’s brain, you’ll receive the knowledge and confidence to assess, investigate and manage no matter who and what walks through the door. Our profession thrives when we thrive as individuals and central to this is building networks of ‘similar others’ in order to find your tribe and benefit from the ‘collective’.
“Rachel is a wealth of information, she has such a knack for breaking down cases. All case presentations no matter how complex are nicely deconstructed into bite sized bits of information that’s easy to digest and take away and put into practice. This mentorship program is worth its weight in gold, it shows you how to deconstruct cases, develop knowledge, gain greater clinical insights and you’ve got a fabulous base of other knowledge practitioners you can ask questions. Can’t wait for the rest of the cases! And you can count me in as a second year mentee next year.” – Megan
In Group Mentoring you’ll be learning core clinical skills that you can apply in realtime to your practice and be able to ask questions along the way. The most valued aspect of the mentoring is the ability to discuss practice experiences with the mentor and to hear and learn from all the group members, sharing experiences, knowledge and learning as we go during the sessions.The bonus of these sessions is you’ll find your tribe, gain support and radically build your toolkit.
I love witnessing every practitioner’s growth, I want everyone to find mentors to support them in their career in integrative health. – Rachel
“Having the group session each month, as well as having Basecamp to bounce ideas around in, is a reassuring connection to know is there if I need it. Having just started practice this year and working in an environment without other Nat’s around, I have noticed the occasional feeling of isolation. So having the monthly catch up keeps me feeling connected to other clinicians and gives me exposure to other cases and perspectives that I wouldn’t have otherwise had.” – Georgie
Going by the landslide of registrations for 2019, Group Mentoring is fast becoming a popular choice and could be an integrative part of your practice & your career progression.
So if being part of the community excites you and if the thought of learning and benefiting from a collective knowledge base that is strong and pulls on expertise outside of our own, now’s the time to join the conversation through Group Mentoring.
Kupfernickel. It’s the original German name for Nickel and it literally translates to ‘Copper Nickel’ which inferred it to be the ‘Copper Nickel’ aka ‘Devil’s Copper’…because each metal can masquerade and be mistaken for the other! There’s an interesting story behind this of course and lo and behold the explanation (as is often the case with minerals and metals) is revealed by looking at where Nickel sits in the periodic table. Haven’t heard me rave on before about how all the key nutritional relationships are illustrated in that cornerstone of chemistry?? Where have you been?! Nickel is a transition metal and that tells us many things – including that its key relationships and interactions are likely to be with Iron, Cobalt, Zinc and Copper. And guess what? It’s all true. Still, I’ve had another Nickel-centric chemistry lesson of late because I actually had not the slightest appreciation of how noxious this can make it for us humans.
It started with one patient then, as is always the way, I’ve had about 3 in the past few months: predominantly women, some with ‘known’ nickel allergies, in the form of jewellery-related dermatitis and sometimes not, many with significant gut disturbance (IBS like, non-infectious gastritis) and most with early or advanced autoimmunity.
And the vast amount of scientific literature on the prevalence of Ni allergy (conservative figures suggest 15% population with a very high female:male) and its capacity to go beyond the ‘cosmetic’ and trigger gross immunological aberrations in Th1 cells, well, the case for Noxious Nickel is one of those things that once you see it, you can’t ‘unsee’, ever. Think if you or your patients have never had an issue with wearing cheap jewellery we can rule this one out? Think again. While the jewellery reaction might be the helpful clue in some patients, there are also 3 other ways that the old Kupfernickel may be undermining your health. And yes! The fact that contact dermatitis to nickel-containing silver jewellery is such a common issue tells us straight up, that its absorbed via our skin, think: watches, mobile phones, e-cigarettes, hair clips, and…yes I am having another crack at these again…tattoos! We also inhale and consume it via a wide variety of food and drink we consume. Oh and did I mention dental interventions, yet? 👀 Sheesh….
So while we all accept humans have zero requirement for Nickel, it’s in us all the time and the question is (always) how each individual inner chemistry lab (!) is interacting with it and to what extent this may explain some pretty potent health problems, from GIT disturbance to Hashimotos and from skin conditions and alopecia to CFS & Fibromyalgia-like conditions.
My latest Update in Under 30: How Noxious is Nickel – highlights the fundamentals of Nickel in terms of our sources of exposure and who is most susceptible and just how this can play out as a driver of disease. Next month we move onto our testing options, drilling down into the myriad signs & symptoms and how to effectively manage the patient dancing with the Devil’s Copper. This one has been a real ‘sleeper’ for me, but it’s time to wake the beast for us all 👀
While nickel sits benignly among its mineral mates in the transition metals of the periodic table, it is a metal that humans are constantly exposed to yet have no need for. What could possibly go wrong? Well, a lot it seems. Nickel is the most prevalent metal allergen worldwide and beyond this there is strong evidence of its potential to trigger autoimmunity, major endocrine pathology and a raft of GIT problems that masquerade as other conditions like IBS & NCGS. This episode captures the dance we all do with the ‘Devil’s Copper’ and why some of our patients are likely to end up with a bigger dose and a much bigger disease picture as a result of noxious nickel.
Hear all about it by listening to my latest Update in Under 30:
For all Update in Under 30 Subscribers, it’s now available in your online account and if you are not a subscriber you can purchase this individually here.
