Keeping Things Real & Representative

 

Any pathology test is only of value if the result produced is ‘real’, or, representative of that individual, right? So the timing of the test is a major pivot point then: do I tell my patient to present for the test, or collect the sample themselves, on their ‘best’, their ‘worst’ or their ‘average’ day? 🤷‍♀️  Well, that all depends on the question you are trying to answer.

Whenever we reach or refer for a test, we have a question in mind we’re seeking an answer to. But the question always comes in two parts, at least.

Part 1: How much progesterone is she making?
Part 2: …When she’s ovulated & her corpus luteum should be most productive?

A third might refine the question you’re answering further by adding another contextual clarification

Part 3,4,5: …When she’s eating her regular diet, not exercising excessively or under extreme stress

Without these other parts – the answer to the first one: How much progesterone is she making (full stop), is hard to correctly interpret, right? By refining and expanding on the full extent of our question, we can be clear about which elements of this patient’s life the result likely reflects. We might say that for her, this time-point, or set of collection conditions, is a ‘real reflection’ of her generally and therefore, representative.  But what if she does occasionally undertake a 5 day fast, or train for & compete in marathons? If we were to specifically test during these times, we answer a different question, right?  Likewise every time we instruct a patient to present for their blood tests (routine or fancy schmancy): Fasted, Rested, Hydrated and off their supplements – is this sound advice or a misdirection?  Well it depends on the individual in front of you and the real question you want answered about them 🤓

Ahhhhh I love rules: both the making of them and the subsequent breaking of them 🦜🏴‍☠️

Fasted, Rested, Hydrated & Unsupplemented? Exceptions to the rule

The collection conditions for any pathology test – can refine or ruin the question you were hoping to have answered about your patient but is it always appropriate to ask everyone to ensure their preparation for the test was ‘ideal’? What if their real life is far from ‘ideal’ and contrasts dramatically with these ‘conditions’ e.g. they forget to drink water but never alcohol! Or do they run 20km every weekday and 40 on weekends?  And why would we tell some patients to stop their supplements prior to a blood-test and not others? If our goal is to ensure any pathology test answers the question we need answered we need to know how to respond to these and other scenarios.  This new update is all about keeping results ‘real’ & representative.

 

You can purchase Fasted, Rested, Hydrated & Unsupplemented? Exceptions to the Rule here.
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You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

Are You A Finger-Pointing-Prescriber Or A Change-Maker?

Are we doing ourselves out of a job?  I’ve been talking treatment plans with my New Grads recently. Given, only recently these were major assessment items in their clinic units, they have been trained to create ALL-ENCOMPASSING (biopsychosocial) prescriptions and recommendations of utterly EPIC PROPORTIONS – to simply prove they know it all. Problem is this doesn’t work in the real world. 

Emailing your client multiple pages of advice that covers: a whole sizeable supplement schedule that only a military-training could nail (2 tablets 1 XTID 1 X BID, a liquid, a powder, some with food, some definitely not with food) plus dietary advice, plus hyperlinks to exercise advice, mindfulness exercises and a request for follow up investigations before the next appointment…is…a L*O*T!!

It is also ineffectual – because it completely disregards the human on the other end. Let me ask you this, how much change are you capable of between a first and second appointment, roughly a period of 2-3 weeks?  Personally, I gotta say not that much. It took my dentist years to get me just embrace flossing & I don’t think I am an exception! With all the knowledge we possess its hard not to see people as (a long list of) problems (& problematic behaviours) that we translate into, and solve via, a prescription.

Effectively we are saying to patients with this practice model, ‘Go change & come back when you’re done & then I’ll probably ask you to change some more!’
That’s both a big ask and a huge missed opportunity.

I hear from reliable sources over the ditch, that GPs are increasingly referring their patients to, or teaming up with health coaches, rather than naturopaths. Given what I’m observing, I get it.  Doctors on the whole only have time (and barely then) for a finger-pointing prescription – certainly not the time and touch-points required to actually support patients with the very difficult thing that is, behaviour change. Nor the skills to truly facilitate patients making the necessary and desired changes – so they outsource this role.  But we shouldn’t.

After all – I want to be on my patients’ support bench & health care team always – not a flash in the pan, that blinded them with science or my ‘smarts’ and proved to them in one over-stretching prescription – that naturopathy is not for them, or at least, they’re not fit for the task.

Compliance Changers – Strategies for Success

At the end of an information & insight heavy appointment, formulating a list of products and doses for our patients to take can feel like a bit of a ‘tada moment’, like a magician pulling a rabbit out of the hat.  “Here is the solution – now off you go!”  Research tells us, however, that treatment-plans that are a co-creation between you and your patient – evolving from a discussion that not only allows them a voice, but a major role in the decision making – are far more likely to succeed. While we are the authority on our medicines, our patients are the authority on what makes them tick & what’s likely to succeed, in terms of taste, texture, temperature & timing!  This is called Patient Centred Prescribing and together with some other tips tricks and hacks I share with you in this episode, can really increase patient buy-in, compliance and therefore bring your treatment plan to fruition and fulfilment!

Increasing Patient Buy-in: Compliance Changers

Patient Centred Prescriptions

Have you ever noticed that our products don’t work if our patients don’t take them?!🙄 

The reasons for non-compliance, dis- or non-engagement, poor patient buy-in & follow through are many:

*My dog ate the instructions
* My inbox swallowed the instructions
*As soon as I left your clinic, your instructions left my brain

Reasons also include far more credible things such as non-patient centred prescribing.  This is what most of us do when we’re full of good intentions but short on time at the end of a consult, so we just throw a bunch of products and a script with them out the door.  Arguably many of us make this mistake also because our training perpetuated this relic of conventional medicine and paid insufficient attention to the therapeutic relationship. In contrast, patient centred prescribing recognises the patient as best-placed to find personalised solutions to their very individual challenges, including, decision making around dosing regimes.  So while we continue to ensure & oversee that therapeutic doses are used and that best conditions for taking certain things are adhered to – your patient remains the expert in the room about how to actually achieve this – both in terms of when & where in their very real lives – with a little help from us – and what ‘works for them’, in terms of taste, texture & temperature. 

That’s right, I said temperature…are you telling patients to take everything at room temperature??
You need to think again – this is something we can safely manipulate with many powdered & liquid remedies (some exceptions of course!) to match patient preferences & radically increase palatability, pleasure and ultimately patient compliance.

Are you like me? I have supplements scattered all over my house – in places that correlate with an action or moment in the day when I am most likely to take them. This is another important element of Patient Centred prescribing, so I work with my patients to identify these easy solutions too.  After the gym? In the gym bag. After breakfast as you leave for work? In the key bowl. At work? On the desk beside the computer screen.  Keeping taurine in the drinks cupboard in front of the alcohol is another nifty reminder and trick for those looking to ‘pre-load’ and cut down! Tips and tricks like these save our over-loaded memory. They remove or minimise barriers. They make compliance less effortful. And as a result, you know what? They might just get the results we would have expected!

Compliance Changers – Strategies for Success
At the end of an information & insight heavy appointment, formulating a list of products and doses for our patients to take can feel like a bit of a ‘tada moment’, like a magician pulling a rabbit out of the hat.  “Here is the solution – now off you go!”  Research tells us, however, that treatment-plans that are a co-creation between you and your patient – evolving from a discussion that not only allows them a voice, but a major role in the decision making – are far more likely to succeed. While we are the authority on our medicines, our patients are the authority on what makes them tick & what’s likely to succeed, in terms of taste, texture, temperature & timing!  This is called Patient Centred Prescribing and together with some other tips tricks and hacks I share with you in this episode, can really increase patient buy-in, compliance and therefore bring your treatment plan to fruition and fulfilment!

 

You can purchase Compliance Changers – Strategies for Success here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

More FODMAP Fails

Last week, yet another patient with refractory diarrhoea, up to 10 stools a day, Bristol type 5-7, for 3 decades following a diagnosis of Crohn’s at 16 years old. A range of specialists have thrown everything at ‘it’ – single & combination immunosuppressants, TNF alpha blockers, buckets of sulfasalazine and bathtubs of antibiotics – she’s been gluten and dairy free for years, trialled strict diets that are FODMAPs free, low histamine etc etc etc. She’s even had 50cm of her terminal ileum removed & the diarrhoea continues unabated – perhaps even worse than before…& therein lies a major clue.

 1/2 patients with Crohn’s exhibit bile acid malabsorption –> diarrhoea but with terminal ileum resection this jumps to > 90%

This is Type I BAD (Bile Acid Diarrhoea) & is the easiest to spot, being the result of anatomical change.  You remove the section of the small intestines responsible for 95% of the reabsorption of bile acids…a LOT of bile acids are going to be present in the colon where they act as potent osmotic laxatives, right? But there are 3 other types which are a little trickier to identify – including one that affects up to 50% of IBS-D patients. 

Being a child of the 80s⚡🎹 (ok a teen of the 80s but who’s counting?!) and a personal fan of fat, I NEVER thought I would EVER be recommending a ‘low fat’ diet to ANYONE🤐

But hey, that’s another ‘absolute’ that needs challenging, right? I mean this is the primary, almost only, dietary change these patients need to make and as a stand-alone intervention, is highly effective for many. We’ve had several patient successes in the last year – a total game-changer for patients in similar situations where all kinds of  ‘restriction’ had brought zero joy and reward for all their ‘good (dietary) behaviour’. While sequestrants (like cholestyramine) are recommended in BAD, and are certainly worth a trial at least, patients have very mixed results – for some, in combination with the low fat diet it’s a winner – for others these meds cause GIT upset all on their own and actually undo the good of the fat restriction. Being able to identify the true reason for their loose stools and stop them going down endless rabbit holes of ..is it? is it? is a great way to re-empower people who’ve been bossed and bullied by their bowel for far too long 🤓💪🧻

 

When is IBS BAD?

This is not a trick question. Up to 50% of all patients diagnosed with IBS-D actually have bile acid diarrhoea (BAD) underpinning their digestive complaints as well as some patients with non-resolving diarrhoea post-cholecystectomy and gastro.  Knowing which ones do and how to manage this, which requires distinctly different approaches from our general management of IBS, is the key.  As always, good lessons come from those we learn in the clinic and this story starts with a patient and how we came to recognise the BAD in her belly.

Meet My Alter Ego

Impact of drugs on mental health

Did I say, ‘Our Brain’? 🙄 Maybe it really should be, ‘Their Brain…on Drugs: what recreational substances reveal’. While infinite self-analysis is an occupational hazard for health professionals, when we use our detective powers for good not evil, our patient work-up benefits.  But of course, it is impossible (and not desirable) to avoid all self-reflection.  Let me introduce myself: I am a high dopamine gal.  How do I know?  Because a valid accurate test of my neurotransmitters told so? Heck no – outside of lumbar puncture there isn’t one! Because my reactions to recreational drugs did.

A self-proclaimed ‘cheap date’, with amplified & protracted intoxication experiences from small amounts of any psychoactive & no, sadly, not always pleasant.  I specialise in visual trails, a known trademark of dopamine surges, when under the influence of even just a few drinks – much to the bewilderment of my loved ones.

Some even famously once questioned whether I was, in fact, safe to ride a push-bike 500m on Lord Howe Island after 2 glasses of prosecco. Stop! I heard that murmur, this has nothing to do with my liver & its handling of such substances. [How rude!😆] I can cite ample other evidence in support of this. This is also not simply due to being a teetotaller and therefore having not (yet) developed tolerance.  This high dopamine diva-stuff is echoed by my non-intoxicated ‘normal’: vivid dreaming, impulsivity, and bankable bad reactions to Vitex: ANGER (capitals intended). TMI? 🙄🤐

When you know the questions to ask, the answers to lean in further to, and then the way it can all come together, to create a neat little trail of breadcrumbs we can follow all the way to our their neurochemistry…you can find the gold.

The thing is – and I remain annoyed and frustrated by this to this day – our ‘schooling’ was not very ‘sex, drugs and rock’n’roll’. New grads tell me nothing has changed. In fact, these kind of topics were absolutely omitted, in spite of the claim we consider the ‘whole patient’, the whole health story! Interesting, hey? Nod to those working on the ‘sex’ bit in holistic health: Moira Bradfield-Strydom, Sage King, Monica Francia, Daniel Robson…love ya work!  Now for the drugs! Do you know what recreational substances can reveal about your patients’ neurochemistry?

Finding out about your patient’s historical or current psychoactive appetites and adventures (and yes that could be as commonplace as alcohol), is not purely for the purpose of collecting yet more data on their ‘health behaviours’. Nor yet another cue for casting judgement! It is an opportunity to take a can-opener to their cranium, open that baby up & take a look inside.  Without making a single incision!

But there’s a bunch of background knowledge you need to polish up on re psychoactive MoA and what each part of your patients’ experience (1st vs subsequent exposures, threshold for intoxication, the nature of the intoxication itself, & the possible aftermath) can reveal – as an inventory of their CNS materials and machinery.  All the while having a process to follow to ensure your evidence is leading you to the right and reasonable conclusion. Come with me and let’s follow the trail of breadcrumbs your patients recreational substance experiences have laid out for you…🐓

 Our Brain On Drugs – What Recreational Substances Reveal Part 1

Ever wondered why not everyone loves MDMA given it’s the ultimate love drug? Or why some of your clients are exquisitely sensitive to the aftermath of psychoactives and routinely, reliably experience ‘rebound’, in the following days while others ‘bounce’ seamlessly from a big night into the boardroom the very next morning?  What do these things tell you about the state of play of their neurotransmitters & their neurochemistry? So much more than you expect and given the only validated accurate assessment of an individual’s neurotransmitters is via lumbar puncture…with far less pain and inconvenience.  This is the first of a 2 part discussion.

&

Our Brain On Drugs – What Recreational Substances Reveal Part 1 Part 2

The 2nd part of this discussion goes into the detail of the MoA of each recreational drug class and what our patients’ encounters with these reveal about their neurochemistry. It also includes a resource we’ve developed to help you follow a process, in your review and rate the quality of evidence you have, to ensure your extrapolation and interpretation are well-founded.  **WARNING OVERSIZE LOAD AHEAD** There is a bonus case discussion that puts into action everything outlined in both parts and the process of qualifying the evidence. 

 

You can purchase individually Our Brain on Drugs – What Recreational Substances Reveal Part 1 here and Part 2 here
or become an Update in Under 30 Subscriber to access both episodes plus the entire library (100+ episodes) of Update in Under 30 audio’s and resources here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.

I’m Against Absolutes

And health, no matter which side you sit on, seems to be particularly plagued by them.  I (incorrectly) recall my 4 year degree as being a series of deep personal losses, some favourite food, then caffeine, then alcohol etc etc.😂 Likewise, I’m aware that naturopathy & integrative health’s ‘voice’ in the ‘conversation’, could arguably be perceived as mostly a negative one – as in, ‘No. Never. Not good. No, not even a little bit?!’  But I love both playing devil’s advocate & reading the research (ALL the research – even the stuff that doesn’t support my views and position GASP!~) so I am less in favour of absolutisms.  This came up recently when I suggested alcohol may improve iron uptake 😬

Practitioners’ responses were 1 of 2 types: humorous dismissal (“steak & beer for breakfast – at last a naturopathic prescription I can support!”) or horror. 
But why are we so attached to the absolutes in spite of contradictory evidence?

Let me ask you this: is coffee bad? Full stop? Period? The end? Or is it the most concentrated source of antioxidants consumed in the average Western diet? Does it improve bile flow, peristalsis and at higher levels actually protect the liver against damage? Clearly, we need to read all the evidence, including, the favourable and make individual decisions about ‘what serves and what sabotages’, for each patient. But do we? Or do we imagine we only get membership to the ‘Ultimate Integrative Health-club’ when we adhere to blanket bans? 

Similarly I, like many of you, see a LOT of iron deficient women –  & a fair chunk of these have been incorrectly labelled, ‘refractory’ because the conventional correction strategies (high doses everyday) don’t actually make sense. But like you guys too, I’m always on the hunt for new ways to improve iron absorption in these women, so I can hit them & their gut with less. That’s why I shared the research regarding alternate day dosing, and taking a supplement within an hour of exercise and now, I dare to ask if a tipple could be helpful?

While we know that both ‘GOOD’ (exercise) & ‘BAD’ (alcohol) health behaviours increase gut permeability, which sounds ‘BAD’, right?
But could this be ‘GOOD’ for some?

This has certainly been demonstrated in relation to exercise & iron but most of the research investigating how alcohol intake effects iron uptake and status is based on alcohol abuse. The study below, however, based on a large sample of non, mild, moderate & heavy drinkers captured in NHANES data – is a very well written and reasoned article, such that it can exclude liver damage, inflammation and HFE mutations as other explanations for the better iron status, in drinkers. And it found:

“Consumption of up to 2 alcoholic drinks/day seems to be associated with reduced risk of iron deficiency and iron deficiency anemia without a concomitant increase in the risk of iron overload” and “Any amount of alcohol consumption was associated with a statistically significant 42% reduction in the risk of iron deficiency anemia (OR, 0.58; 95% CI, 0.4–0.8).”
Ioannu et al 2004

   I challenge you to read it for yourself and challenge your absolutes!🤓

Oh and just in case you’re thinking, “Have we all misdiagnosed iron deficiency and it’s actually a Copper deficiency underneath?”  because last year the fashion was everyone was copper toxic and now this year someone’s making noise saying everyone is copper deficient !!! (Absolute? Anyone?!) Ah, no.  Copper deficiency, as a cause of iron deficiency and anaemia, has been around for about as long as nutritional medicine itself.  It is absolutely a thing.  But in the absolute minority of people.  And if you go back to some basic maths & compare and contrast Fe & Cu at each level: 1) requirements almost 20mg Vs < 2mg 2) average intake (inadequate Vs adequate) 3) bioavailability (Fe < 20% more typically < 10% in a modern low meat diet Vs Cu  is typically >50% ) and do some basic sums I call, ‘Menstrual Maths’ – You’ll likely deduce that inadequate iron intake and uptake, given our losses, is in fact the common culprit and a ‘coldie’ may be more beneficial than copper in most!  Can y’all stop asking me about that now – pretty please?

 

So You Think You Know How To Treat Iron Deficiency?

And then you don’t.  The reality is we all struggle at times with correcting low ferritin or iron deficiency anaemia  – so what have we got wrong?  In spite of being the most common nutritional deficiency worldwide, the traditional treatment approaches to supplementation have been rudimentary, falling under the hit hard and heavy model e.g. 70mg TIDS, and are relatively unconvincing in terms of success. New research into iron homeostasis has revealed why these prescriptions are all wrong and what even us low-dosers need to do, to get it more right, more often!

Did you know you can subscribe to these?  We deliver at the end of each month, just add a 12-month subscription to your cart and Rachel’s latest research is on it’s way to you!

 

That ‘Throat Feeling’

Is my sore throat COVID-19 or not? | OSF HealthCare

“My 7yo daughter was frequently distressed, telling me she had that ‘throat feeling’.”

As you can imagine, mum offered up a smorgasbord of suggestions to help her try and describe it: Can you swallow ok? Does it burn or taste funny? Where is it? Is it hard, soft, moving, give me a rating out of ten….so many, but she just couldn’t. When it was really bad, her daughter said she also felt it in her sternum. The first doctor attributed it to ‘stress’ & mum understood why. Her 7yo is a bit of a worrier and while the ‘throat feeling’ was distressing, stress, itself, seemed to also perhaps bring this on. But by the time they made an appointment with their regular family GP, mum had noticed her daughter’s sx were worse with heavy, fatty, high meat meals & that she was burping excessively especially with the night time meal also. So, when their switched-on doctor heard these very careful observations, he referred her for a urea breath test (UBT) for H.pylori.

‘Miss 7’ blew 1200 on the UBT
the decision limit is 200, to confirm the presence of the bacteria in significant amounts

As I’ve said previously, there are (sadly for ‘Miss 7’ & myself) no prizes for the highest score on this particular test.  In fact, I spoke with a gastroenterologist last week who said, really it remains so debateable about the significance of the overall result (?size or virulence of colony) that results should probably be more considered like a pregnancy test: a simple yes or no!  But this together with her sx was a clear yes. GP recommended triple antibiotic therapy which sadly produced vomiting in Ms 7 within a few days. GP contacted paediatric gastroenterologists to get some advice, which was: don’t treat unless symptomatic. Back to square 1.

“In the meantime, I had done Rachel’s two UU30 episodes on H.pylori, so I told him what ‘we’ would do (polyphenols plus cranberry juice plus Zn carnosine plus deal with the hypochlorhydria). GP  says. “Ok, then let’s do it and then let’s breath test again in 3-6 months.

She has now breath tested at 200 and symptoms are non existent!”

Mum contacts me to relay the success story & give me the credit but mum is completely minimising her extraordinary actions that produced this outcome. Firstly, not resting with the ‘stress’ diagnosis. I have seen several children who present in very similar ways to Miss 7, YES! they are anxious, YES! parents might tell you they are the ‘worrying-type’ but when combined with these upper GIT sx I have found they test positive for H pylori more often than they don’t.  And how clever is this mother’s medicine?

“I recognised it was worst after birthday parties where she has eaten too much and done cartwheels or run around (we now talk about recognising when she has a ‘full bucket’. We talk about the fact that her tummy takes a little bit more time to process food it means her bucket fills and she needs a bit of extra time to let it do it’s job before she adds more food to the bucket otherwise it spills over and she feels rubbish. She finds that analogy useful as she can feel her bucket getting full at birthday parties and when she gets the feeling, she knows why and doesn’t freak out.”

 

H.pylori – Eradicate or Rehabilitate?
For a bacteria identified just a few decades ago as being a cause of chronic gastritis, atrophic gastritis and gastric carcinoma, the escalation in the number of antibiotics used to eradicate it (4 at last count + PPI) has been nothing short of breath-taking.  A management approach more consistent with both integrative medicine and with an improved understanding of the delicate microbiome focuses on changing the gastric environment to ‘remove the welcome mat’. What do we know about how to do this successfully? It turns out…quite a lot.

What Good Can Come From ‘Getting on the Gear’

When was the last time you ‘got on the gear?’. Wait, am I showing my age?🙄  The afore mentioned ‘gear’ could be beers or GnTs, weed or hooch, eccies or pingers, ‘nose candy’ or blow. I could keep going! While, anything beyond alcohol, might be purely a historical tale for many of us – during a [ahem] ‘very different phase of our lives’, Australian research tells us that the patients who come to see naturopaths are just as likely to drink alcohol as those that don’t and are in fact about 40% more likely, to have used marijuana or other illicit drugs in the past 12mo.  And this was the women in their 30s!  You heard me.

Now, this is not a call to action, to dob in a dabbler. 

This is instead a wake-up call for all of us, regarding the best insight into our patient’s neurochemistry, that is right there in the patient’s psychoactive substance encounters.

Because let’s get 1 thing clear, straight up – the ONLY valid, accurate, reliable pathology test for the measurement of neurotransmitters is a lumbar puncture.  Correct. And anyway, if you’ve been following psychiatric research this millennium, you’ll know that the belief that neurotransmitter quantities are the whole story (or even main players) in neurochemistry, is fatally flawed.  So, whether your patient’s ‘alcohol or other’ is purely in the past or in the present, this line of questioning and what it can reveal to you about their neurochemical nuances (high or low dopaminergic tone, shortfall in serotonin, high or low histamine etc) is gold. 

Because no recreational substance BYO

Instead they raid your stocks and supplies, get your brain to develop ‘bigger ears’ for some signals over others.  Their effects are purely a manipulation of the patient’s existing materials and machinery. And accordingly, here is the great reveal. So, a 30 something patient of mine reports dabbling in all sorts during her teens and twenties. She relays pretty ‘expected experiences’ with each substance – remember these psychoactives are known quantities, we know a lot about which buttons they push and I so I concur that her responses were anticipated & typical. Maybe if anything, she is able to recognise that she had a lower threshold for intoxication compared with other first time users.  “But MDMA,” she says, “I don’t get it and boy I tried! Several times!” So, while everyone else felt the love in the room, danced all night to the fantazzmical beats and the orgasmic-optic light show…she felt like she’d taken nothing at all.  Aha! This of course would prompt me to ask more questions to help clarify both her serotonergic tone & other instances where she might have encountered oxytocin.  And the real insights about her neurochemical milieu (strengths, weaknesses, balance and imbalance) start to form, so too the best way to support her. Don’t miss the real reveal in your patient’s story – that offers to lift the lid on their cranium and let you take a look inside.

Our Brain on Drugs – What Recreational Substances Reveal Pt 1

Ever wondered why not everyone loves MDMA given it’s the ultimate love drug? Or why some of your clients are exquisitely sensitive to the aftermath of psychoactives and routinely, reliably experience ‘rebound’, in the following days while others ‘bounce’ seamlessly from a big night into the boardroom the very next morning?  What do these things tell you about the state of play of their neurotransmitters & their neurochemistry? So much more than you expect and given the only validated accurate assessment of an individual’s neurotransmitters is via lumbar puncture…with far less pain and inconvenience.  This is the first of a 2 part discussion.

 

You can purchase Our Brain on Drugs – What Recreational Substances Reveal Pt 1 here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

This

There’s probably some poignant lines from a rap song everyone knows that I could insert here but, alas, Gold FM doesn’t play anything produced after 1999, so I’m none the wiser. What I’m trying to bring to mind, is the potential clash between our reality & our response: we’re not all gonna get instafamous, so the majority of us should probably curb the buy-now-pay-later spending and establish some contingency plans.  And while it might seem like I’m just picking on the young folk, this can happen at any age and stage of life. These, in psycho-speak are called Positive Illusions, and are one of the concerns psychologists have about the potential impact of exclusively focussing on ‘the positives’, aka Positive Psychology (PP). 

Cue: ‘Strengths wheels’, Goal Visualisations, Gratitude journals etc etc

There’s a lot to like about this Gen Z offspring of psychology.  And perhaps, as integrative health professionals, a ready-made romance, given both tribes (them & us) believe in health being something beyond the mere absence of disease. That and the fact they give due recognition to the role diet & exercise play in our mental wellbeing…how truly thrilling! Over the last 20 years PPIs (Positive Psychology Interventions not the other ones!) have become so pervasive: schools, workplaces, we’re in an age of the National Happiness Index, we’re overflowing with positivity, spilling over the lip of your coffee mug, emblazoned with ‘You’re Awesome!’ or ‘You’ve Got This!'(Just in case we forget momentarily) But we need to explore the science for and against, to better discern when these messages and tools are a help in clinic and in our patients, and when potentially a hindrance, worse still, a harm.

😁POSITIVITY😁
is extremely popular right now, but an obsession with it & rejection of all things negative (thoughts, feelings, experiences pasted over by something nicer and brighter!) is not necessarily a balanced recipe for mental wellbeing, according to the science.

PP has made a wonderful contribution to how we think and talk about our mental wellness as opposed to just our mental illness. However, there is a critical context in here that’s important for clinicians to understand, in order to use it well, and some thought-provoking criticisms and counter-balances that will help us all avoid becoming as (in)effective as a slogan on a coffee mug.  Oh and guess what guys?  Assessment first 🤓💪 this takes the guess work out of whether your patient is a good candidate for PPIs and we’ve included two in this latest Update in Under 30 – even a validated mental health screen that only uses positive language for those averse to those nasty negative thoughts and feelings!

 

UU30 Positive Psychology Its likability & limits
The ideas behind Positive Psychology may resonate deeply with integrative health professionals, for good reason.  We have in common a belief that ‘the absence of disease’ does not constitute health & that prevention is better than cure.  And PPIs have become so popularised they have permeated into schools, workplaces and most people’s therapeutic interactions, e.g. gratitude exercises, identifying our strengths via a strengths wheel, self-compassion. But do we know the limits of positive psychology? Do we know who it works for and what it means when it ‘doesn’t deliver’  mental wellness?
You can purchase Positive Psychology Its likability & limits here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

Were We Wrong – Is B6 Da Bomb?

And not in a good way, right. While we’ve known about the potential for peripheral neuropathy with excess B6 supplementation since the 1980s, currently there’s a seismic shift in our sense of safety even with previously regarded ‘safe’ levels.  You may have heard individual whispers, or the chorus of voices coming together, both here and overseas, belonging to members of the public who report suffering sensory nerve impairment with as little as 2mg/d!  Is this a mess of mis-diagnosis, false attribution & nocebo? Perhaps for some, but certainly not for all.

How could this be the case given the many RCTs employing hundreds of mgs per day over months, with no such events recorded? 
How could this be given, your (?), certainly my, high dose prescriptions, with only 1 case of quickly reversed, peripheral neuropathy in over 20 years, on my books?
The pieces of this complex paradoxical pyridoxine puzzle are coming to light.

Is it the form?, the dose? the duration? individual differences in B6 metabolism & toxicity threshold? amplification of risk secondary to levels of other nutrients, or the use of certain medications?  Yes. And we need to understand each element to better tailor every B6 prescription to the individual & mitigate risk. I have spent the best part of this month reading almost every paper on this from the 1970s to last month and I am now alarmed but more importantly, alert, to what prescription practice changes we can all make to lessen the risk, and control the power of B6.  It’s been the most compelling deep-dive. Because in spite of a clear TGA warning issued last year that likely prompted the quiet removal of high dose products from market, it would seem none of the companies have the courage to have this difficult conversation with us 🙁 I invite you to ‘feel the fear & do it anyway’ & listen in to our latest Update in Under 30.

 

Haven’t we always known that nutritional medicine is a potent prescription?  Now thanks to more sophisticated research we have a much greater understanding of this and of both the intended and unintended effects of micronutrient supplements that have the potential to achieve supra-physiological levels.  B6 metabolism is arguably the most complex of the Bs – involving 6 different forms, at least 2 of which are active – and exhibiting some of the most complicated regulatory control designed to both harness the power & limit the accompanying risks.  Excess B6 supplementation, however, has long been known to present as peripheral neuropathy in some individuals and case reports of this are growing, at lower and lower doses. New information has come to light to help us understand the why, the how and better still how to mitigate risk to our patients.
You can purchase Dynamics and Dangers of B6 – Controlling the Power here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

Naturopathic Nanna’s Club

I’m 100% confident that, as a professional group, among our highest values about healthy, preferable, food choices, would be characteristics like: ‘as close to nature as possible’, ‘unrefined’, ‘unprocessed’, ‘unadulterated’.  Tell me I’m wrong.

So, when I keep hearing about NEW! “Never seen before” (read: never in nature) modified (read: more processed, adulterated) nutritional supplements: water soluble vitamin D, fat soluble C, bioflavonoids with unprecedented (read unnatural) bioavailability

I’m left wondering what these companies are missing about their customer group (because we are clear about our valuing of nature & what’s natural & have a desire to minimise exposures to things that are not, right?

or what are we missing here, in the clear conflict of our core values these constitute?

I think if we find ourselves forsaking this core value & prescribing highly modified, unnatural supps, it’s the result of both hype & fear.  The hype is self-explanatory and I’ve written recently on how modifications exponentially increase profit margins for companies, all the while possibly reducing ours because patients are spending more on product and therefore there is less left over for the practitioner fees 🙁 [The ones spending hours with them face to face, not to mention years & thousands on our training]  The fear is perhaps less apparent, more insidious.  The fear is that we’re not using the best, being the most effective, and deeper still, inevitably that we will fail to action our patients return to health. This is a big one. I think it’s pervasive, if not omnipresent, and works as a motivator for many positive actions by practitioners – like engaging in further education, reading that latest journal edition on your lonesome laptop when you could be streaming some series on a shared sofa. But this same fear can also undermine us, overwhelm us and shake our tree of trust, that we believe to be so firmly rooted within us, of the healing power of nature.

So while my position sometimes makes me feel very ‘old school’, I’m not suggesting we return to nutritional prescriptions composed exclusively of bee pollen & brewer’s yeast and I absolutely recognise and respond to an individual who has very specific barriers to benefiting from nutrients in their natural normal forms.
But let’s be clear, they are a minority.

Some of you will know naturopath Dawn Whitten & know that she is one of my mentors.  I’ve had the benefit of speaking with her over the years about herbal prescriptions but also about the principles & philosophy behind our practice & in one of many conversations she told me that a key objective she has with her patients is to rebuild their trust in their body, their own biological resilience (I love this concept and that’s a talk for another time!) and ultimately in nature. Well jeepers Dawn – how did you get to be so wise so young?  But isn’t that central to vis medicatrix naturae? Maybe that Naturopathic Nanna’s club isn’t so fuddy-duddy after all.  Want to join us?

Speaking of using nutrients in their most natural state for the best health outcomes – the best B3 is probably not what you think!!….
The Balance of B3

Most of us have been taught to ‘balance the Bs’ when supplementing, which discourages the use of single B vitamins in case this interferes with the regulation and roles of others. In reality, outside of a couple of dynamic duos like B12 and folate, there is little concrete information & evidence of this. In the case specifically of B3, however, we now know, the risk of an excess of the most common B3 forms found in supplements and fortified foods, results not only in disruption of other nutrients but imbalanced B3 biochemistry itself. Given B3, in its coenzyme form NAD+, is regarded as highly valued currency in the prevention of many diseases, as well as the key to our optimal health and longevity, it’s critical to understand the different forms and functions of the various B3 sources.

 

 

Good Great Better Brilliant…

I’m experiencing some serious POTTS exhaustion – how about you?  No, not POTS, POTTS: Preposterous Over The Top Selling of supplements, which seems to be at an all time high even amongst our practitioner brands.  I saw a product name recently that included the word, ‘supreme’!*^#  Is the choice of nutritional supplements now on par with selecting our pizza toppings?

When I previously delivered university lectures on population nutrition & the role of the food industry – we acknowledged that all the processing, packaging, and promoting the food industry invests in, creates a market and a source of competition that essentially doesn’t exist for their primary whole-food ingredients.

Take apples.  How can we increase the profit margin on a humble apple? Aside from organic V conventional farming, the price that any of us would pay is pretty narrow and fixed.  But send that apple to the factory to make juice (and chuck in some added vitamins to boot so you can feature this on the label!!), puree and package it in the most non-biodegradable way for kiddies, dice and stew the stuff and put it in little plastic tubs for the slightly older or throw in a long list of nasties with ‘essence of apple’ to make sauce for idk and suddenly you have the capacity for mark-up, an exponentially expanded profit margin & ‘something to say and something to sell’.  In supplement companies, it’s not as far from this as you might imagine. Because nutrition (**WHAT A SURPRISE**) is a lot like primary whole-food ingredients – how does vitamin C compete with vitamin C? Hey,  make it liposomal!! And the nanoparticles that we’re fearful of in our sunscreens and cosmetics..let’s use the same technology for our ingestives!! YES!!! Ummm any one recall, our fears re folic acid?  Just asking…

Then I see the promotion of bioflavonoid supplements that have been modified to exhibit **UNPRECEDENTED BIOAVAILABILITY** and I am like, ‘Um, why?’ Given these show very low uptake across the gut naturally and research now speaks to a primary MOA or pivot point in their efficacy being the result of their interaction with our microbiota & digestive environs…

I propose that ‘practitioner only supplements’ come under the same plain packaging restrictions placed on tobacco in Australia [I am joking but only just].  Remove the bright shiny distracting graphics and hyperbolic descriptors and only state the full ingredients and excipients list plus source where relevant. Let’s bring it back to simple(?) science, basic quality ingredients and affordable effective products for our patients.  Then let’s see if we can spot the difference 🧐

The Supplement Sleuth

Rachel loves nothing better than breaking through marketing babble and spin to get to the truth about supplements – their real strengths, niches, weaknesses, contraindications, therapeutic doses and best forms & therefore there is a dedicated section of her website with resources and recordings that do just this, here. These include reviews on B3, B12, Folate, Selenium, Zinc & Iron (of course!), Calcium D Glucurate, Co Q10, Quercetin, high dose Vitamin D and Fish oils for Mental health. These are a mix of Update in Under 30 recordings and longer presentations and her library is ever expanding!  So, if you have a supplement you think needs some serious sleuthing on – send us an email…we’re always sniffing around for more!!

How Much Can You…?

“How much can you misbehave & get away with it?” I listened with fresh ears, as a practitioner asked my son this question recently. I use similar ones with my own patients but hearing it from someone else, I could sit back and appreciate its true purpose and how well it achieves this. Most of us adjust our behaviours, when we can, to ‘manage’ things that cause us problems.

Sure I can eat food I haven’t made myself
………..but once a week is my max. or ‘X’ flares

My energy is pretty good
…… but 1 night of poor sleep & I’m back on ’empty’

No impaired alcohol tolerance
………I just never have more than 1

My [insert: gut, skin, energy, immunity, mood] is not a problem
………as long as I don’t miss a dose (of supplement/medication etc)

And sometimes this ‘adjustment’ (or avoidance) is unconscious. Hence the beauty of the question: How much can you get away with, coupled with our understanding of how much ‘room to move’ there should be in a patient who is truly well.  So the teenage to early 20s patient sitting in front of us, theoretically, should be in their prime of wide mischief margins, and we are alerted to individuals in this age group who are having to live like an older person, needing to exhibit vigilance around early bedtimes and allowing themselves almost no indiscretions.  In contrast, as we age, we understand too, the margin for mischief narrows. Our over-50s selves are unlikely to get away with half as much as did in years gone by but we shouldn’t require the stricter self-care hypervigilance of our senior selves.  

And for the patient who answers ‘no’ to everything on your GIT or stress/mood screening questions, for clarification, follow them up with, “and how much can you get away with and still have no issues?”

You may very quickly get a different understanding of what lies beneath and how much ‘management’ is required to maintain ‘balance’ or ‘no symptoms’ or ‘health’ 🧐

MasterCourse in Comprehensive Diagnostics – Let’s Do It Together! 
**Our Watch Party & 6wk training starts 8th July**

The primary objective of MasterCourse I is to realise the true value we can extract from the most commonly performed labs (ELFTs, FBE, WCC, Lipids & Glucose) which constitute the largest biochemical dataset we have on almost every patient. By learning how to comprehensively interpret these labs in an integrated medical framework, using the very latest science, we can extract the gold often buried in this goldmine.  Accordingly, we prove ourselves to be the greatest asset to our patients, to other health professionals we are sharing care of patients with and we cut the cost of additional expensive testing, that is less well understood and validated.

MasterCourse I will help you access that gold and has been intentionally designed to match each lesson with real learning– with the time spent in theory and in application.  Delivered across 24+ hrs of streaming video sessions with bonus pre-sessions, audios, resources and tools – this MasterCourse is likely to be a genuine game-changer for the way you practise and the potency of your patient prescriptions.

Present But Not The Problem

Something’s just come up today again and I think we need to talk about it.  A positive result on a stool PCR microbiome test for H. pylori, understandably, might be heard as a clear call to action to go in guns blazing with an eradication approach.  But is it?  Trust me, I’ve had more than my fair share of battles with this bug & can understand being keen to have it be gone BUT first things first, let’s be clear about what the result speaks to.  

Does it say, “Here!  Look over here!  Here’s the source of your patient’s GIT distress,”  or even, “Here’s a pathogen that has taken up residence in their GIT and is a risk for future dx!”

No, not necessarily. It speaks to its presence.

And that may be only fleetingly, as it passes through.  I’ve seen it before and so have many other experienced practitioners: a positive stool PCR that is at odds with the results of gold standard H.pylori testing, the UBT, faecal antigens or blood serology, all freely available through the GP.  And the reality is, if you have a negative UBT, there’s no urease production, the trademark trouble-making of this bug. If you have negative blood serology, your immune system has never ‘met’ this bug or, in the minority of cases, you’ve tested in that brief early exposure window prior to antibody production (2wks) so you should retest within the month, to confirm or refute. And if you don’t have any faecal antigen…it ain’t in da’ house…so to speak 😅 If there’s something new here, then have a quick read of Medscape’s great work-up summary.  So, clearly we need to confirm before we open fire.

 We (me included) have been so single-minded about increasing the ‘sensitivity’ with our testing methods, we may have left ‘specificity’, in broader sense, behind & that creates a new problem.

This leads us and the patient down the garden path of false attribution and time and money wasted ‘treating’ a ghost gut issue. And no one wants to be put on a pylori protocol when they really didn’t need to.  Trust me 🙄 But if someone does come back confirmed, well then…

H.pylori – Eradicate or Rehabilitate?

For a bacteria identified just a few decades ago as being a cause of chronic gastritis, atrophic gastritis and gastric carcinoma, the escalation of number of antibiotics used to eradicate it (4 at last count + PPI) has been nothing short of breath-taking.  A management approach more consistent with both integrative medicine and with an improved understanding of the delicate microbiome focuses on changing the gastric environment to ‘remove the welcome mat’. What do we know about how to do this successfully? It turns out…quite a lot.

Well…Does He Need Iron?!

If I could be granted 1 wish regarding all health professionals, it would be that we were all competent in reading Iron Studies.  Think that’s overstating the issue? Or not a bodacious enough way to ‘spend’ my wish? I don’t. Especially when you consider the impact of GPs in this space. 

This 57Y male was asked to make a follow up appointment with his doctor, to discuss his ‘abnormal’ results which he was informed constitute Iron deficiency. 
Consequently he was was advised to start an iron supplement! #@!*

Your thoughts?  Revoke this doctors medical licence?  Insist on some very du jour ‘re-training’ at the very least?  I mean, if you think this Iron pattern flags a deficiency or shortfall, then you’re as good as reading a map upside down and back to front…and written in a foreign language!! The ‘Ls’ in his latest labs flag he has suppressed transferrin, indicative of negative feedback inhibition of GIT uptake of this mineral, secondary to healthy stores or inflammation. And it’s not just that more iron is not indicated but that more iron in fact presents a patient like this with increased and unnecessary risk: to their microbiome, intestinal wall health, even according to the larger longer studies a potential correlation with colorectal cancer risk, if taken long term. Let alone the whole cardiovascular conundrum.  Better still this same patient was told a few years back that he might have iron overload!  Again the ‘map’ could only have been being read, upside down, back to front to reach such a conclusion! 

So the one patient in just a few years by 2 different doctors has been diagnosed incorrectly with 2 different iron issues. Yep.

And sadly I have sooooo many more cases of missed and mis-diagnoses with regard to this mineral.  The latest RCPA Position Statement on the Use of Iron Studies, underscores that assessment of iron status and GPs competence in knowing when to do this and how to interpret, is an important part of core general practice. Given it “is the commonest nutritional deficiency state in Australia and is significantly under-diagnosed” This succinct document offers a quick crash course in Iron nutrition for doctors and it hits all the right marks with advice about not ordering ferritin as a stand-alone because “the interactive nature of the three components allows for more accurate interpretation” and this simple but sage advice:

Transferrin, iron transport protein, tends to increase in ID…
A better strategy (than being tricked by Serum Fe) is to report transferrin saturation.
A low transferrin saturation in the setting of an equivocal ferritin level is suggestive of iron deficiency.
An elevated transferrin saturation is the first manifestation of iron overload.

I mean seriously, do doctors read these RAGCP resources & recommendations, or is it just me? 🤓😂  

Need a rip-roaring review on how to really read iron studies?  Or know another health professional who does?!! Consider this Easter Educational Gift Instead of Eggs!!
So You Think You Know How To Read Iron Studies?
Overt Iron Deficiency Anaemia or Haemochromatosis aside…do you understand the critical insights markers like transferrin and its saturation reveal about your patients iron status?  Most practitioners don’t and as a result give iron when they shouldn’t and fail to sometimes when they should.  This audio complete with an amazing cheat sheet for interpreting your patients Iron Study results will sharpen your skills around iron assessment, enabling you to recognise the real story of your patients’ relationship with iron.

 

I’m Gonna Take My Vitamins…They’re Good For You, They’re Good For You!

Don’t know this thrash anthem for all nutritional medicine practitioners written by Supernova about 20 years ago?  Do yourself a favour and check it out!! It makes me laugh to the point of tears every time.  What also got me giggling recently was a coffee catch-up with a fellow nat (relax, it was decaf people!) Both being active women approaching the half century we found common ground discussing our ‘war wounds’. She, an ankle injury, me, lax ligaments in my knee thanks to touch football minus any pre-season prep whatsoever. I was waxing lyrical about the wonders of swimming, which I’ve taken up to heal said gammy knee, at which point she asked, “What are you taking for it?” 

My mouth dropped open & nothing came out…because the answer was *!NOTHING!*😂
At which point, she mentions a couple of supplements I have *!ON MY SHELF!* that really helped her ankle 😂😂

I text her 3 days later with, “Man, our medicines really work!!”  You see, like the song says,  I do ‘take my vitamins’ and ‘they’re good for you! Good for you!’ – just this physician health yourself thing can be a blinking full time occupation sometimes! Anyway, it got me thinking about how we choose the products we do.  So turmeric caps are part of my new regime and they seem to be working a treat. I stock one brand only.  Now how did I come to that decision amongst an ocean of options?!  Well in this instance, I had asked a colleague who works OTC and dispenses a variety of turmeric products en masse – better still she sees those people come back either for more…or not.  I’ve found asking my well-placed peers about these kind of products invaluable!! But there are so many different ways each and everyone of us may have made product choices – ethical concerns, personal experience, research, a teacher, mentor or rep’s influence.  Anyone who has done the UTAS post-grad, of course, has exhaustively analysed the options, complete with comprehensive spreadsheets of all comparative products…god love these guys!! But for the rest of us mere mortals, how do we make such choices?

Let’s just talk turmeric for now, I’d love to know…

My gorgeous sister first brought this ditty to my attention & we’ve had a wonderful trip down memory lane today (with our elderly mother as our hostage as we both belt out the lyrics in laughter down the speaker phone)…she’d be cross if she didn’t get the credit here, rightly so 🤣

I’m gonna take my vitamins!
(Vitamins! Vitamins!)
You better take your vitamins!
(They’re good for you! They’re good for you!)

You better take your vitamins,
Two by two!
Two by two!

Do You Remember?

I’ve seen two 20-year-old young men in my practice this last month who’ve already made a lasting impression on me. The first, is buff, full of cheek and humour while deeply engaged with his health, earnest in his desire to understand his 7 years of daily upper gastric pain, for which he has read much, changed his diet & given up what most 20 year olds would consider their rite of passage and right (late nights and alcohol).  The second is pale, gaunt, neuro-atypical, full of tics and avoiding eye contact at the beginning of each consult, only to look me solidly in the eyes as he reveals incredible insight about ‘being different’ & his desire to be able to engage with something/anything so that he can live a more normal life, by the end. What do they have in common?

They’re 20 & trying to make their way in the world.  
Undertaking all these newly autonomous actions, previously taken care of by parents, including fronting up to a health professional with concerns, seeking understanding and support.

The first, in spite of 7 years of gastric pain and irritation (I can see mum took him to a GP with similar concerns at 13 years & again at 15!!), self-reported extreme worsening with gluten exposure and a family history of similar GIT issues, was not offered a single investigation by the GP they visited but was given a month long trial of a PPI.  I caught him 3 days in.  Was he feeling less pain? Yes?  What does this mean? He has gastritis at best, something more sinister at worst? Does it reveal the cause? Not one iota. But tests for H.pylori, coeliac disease and a few other basic labs, might.  Does it offer a long-term solution?  Nope – even the GP said , ‘Now this will probably help but you won’t be able to stay on this too long!” While up to 80% reductions in gastric acid, will definitely lessen gastric irritation and pain for most, will a month ‘fix’ anything?  Unlikely. Especially when the well-documented withdrawal rebound effect kicks in, once he stops!  After a month of actual stomach repair work, he’s feeling dramatically better and yes, we’re still pushing for those test results.

The second 20yo, was seeking a mental health care plan from a GP he’d never seen before.  He walked out after 15minutes instead with an SSRI.

With a diagnosis of Asperger’s at 12, ADD at 13 and a series of high level neurocognitive assessments and stimulant trials – how could anyone make an informed decision about appropriate medication for this neurobiologically complex individual in 15mins, while simultaneously ignoring his request for hands-on psychological support?  I was a bit stunned. He was too. How long, and how much effort and courage, will it take for him to make another appointment, get himself back to a medical clinic and ask again? He struggles to remember to eat.  I’m glad he came. I can’t offer all of the services and support he needs, far from it, but I can listen long enough to ‘see him’, acknowledge that his personal priorities and values are valid and in turn, direct mine in terms of how best to support him.  I can also try to encourage him not to give up on getting the support from others he desires and desperately needs. This is not gender specific of course – I’ve heard similar stories from young women.  I remember being 20 – perhaps all health professionals need to take a moment to remember what that was like too? 🤔🤗

 

Someone Say Sulphur?

That’s not a word you hear often spoken by people practising nutritional medicine. Which is odd. I mean outside of the whole, ‘I’m not good with sulphites so I just have to add these magic drops into my glass of red so I can knock back my share,” often overheard at our conferences… it’s like this essential macromineral, pivotal to human health for things like barrier function, antioxidant defence and our basic ability to create the white cells for immune defence (for that matter), detoxification, musculoskeletal tissue integrity etc has just not received its due attention from us. Not entirely surprising given 1) there’s no RDI and 2) there’s no lab test to assess an individual’s status and how about 3) because we were never taught about it! 

But the biggest ‘call to action’ here is that, in spite of items 1, 2 & 3, we’re ‘prescribing’ Sulphur Strategies all the time!

Take one of my favourite examples; GAGs. Glycosaminoglycans like Glucosamine sulphate (not the crappy, found to be not as effective, other forms that we now see more commonly) hit the headlines back in the noughties as an effective arthritis remedy. This is one of the 100s of our body’s ‘end products’ of its endogenous Sulphur Stream.  We naturally make this in adequate amounts to ensure the integrity of our joints (and many other tissues of course!) when we have enough Sulphur in the ‘top pool’ (organic Sulphur) to trickle down to the 2nd pool (Inorganic Sulphur), therefore creating a constant essential supply of something known as ‘the universal Sulphur donor’ – ‘PAPs’, to its friends 😉 Like a waterfall, it helps to have a good flow from the top to increase the likelihood we’ll have anything to ‘show’ at the bottom. 

So when we give a patient Glucosamine Sulphate it may well help. Or not. But did we ‘treat the cause’ of their Sulphur problem? Should we have treated higher up, increasing the size of either the organic or inorganic pool to have improved and widened the benefits for their health? Or, as is equally common, actually identified why someone might need more Sulphur than most – due to increased demand and losses?

Herein lies my reason for liking this particular Sulphur story so much. The common medication that places the highest ‘demand’ on Sulphur (due to its need for detoxification) is paracetamol. There’s no debate regarding this – just absolute scientific consensus. NSAIDs and steroids also negatively affect the Sulphur status of individuals, as does Vitamin D deficiency and chronic mild metabolic acidosis. Now how commonly are these phenomena co-occurring in our patients afflicted with arthritis?  And traditionally of course, what was the remedy for arthritis? Sulphur springs.

Unseen Sulphur – Time To Take A  Look
If you don’t have a clear picture of the gross daily requirements, determinants of altered individual needs, sources, regulation & associated deficiency picture of Sulphur, you’re not alone.  Turns out this essential macromineral remains ‘unseen’ by most, even though you’re probably writing prescriptions every day that have Sulphur as their key component.  From the simple: Taurine, N-acetyl cysteine, Protein powders, to the sublime: Brassica extracts & concentrates, N-acetyl Glucosamine, Alpha Lipoic acid etc. In order to use these Sulphur strategies successfully and safely, however, we need to fill in the missing detail on its metabolism, the difference between the ‘organic’ and ‘inorganic pools’, how regulation regularly goes wrong even in those seemingly consuming enough and how to balance the risks of this reactive medicine with its substantial therapeutic value.  This recording comes with a great clinical tool to help you, at last, see the Sulphur strategy most indicated for your patient.

 

You can purchase Unseen Sulphur – Time to Take a Look here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

Priming Your Practice For Mental Health

28 years ago I was in the midst of my own mental health crisis
24 years ago
I graduated
20 years ago I dipped my toe into first year uni psychology units

18 years ago I worked in psychoactive medicines with a pharmaceutical company
16 years ago I began combining all my learning (pharmaceutical, psychological, naturopathic) to truly reinvent & optimise my approach to supporting patients with mental health presentations
…And every day since I’ve remained passionate that we can offer an important and potent contribution in the management of mental health, when we do it well, and I want all of us to do it well.

So 2 years ago I started the Mental Health Primer Mentoring, to do just that.

Every year I learn more about mental health (from patients, mentees, mentors and via my ongoing active research) and each year this learning is reflected back into the content for the Mental Health Primer.  It’s an exciting dynamic process.  I don’t share the same beliefs I did, 5 years ago on certain testing and a few treatments, the research has moved on and in the last year alone I have refined my models for CNS histamine imbalance, reacquainted myself with a couple of old forgotten friends prescription-wise, which are working well, and discovered a couple of totally new BFFs!  In this group, we keep it real, nothing stayed and static, no questions unaskable.  And by mapping out and really taking the time to learn a tried and true ‘process’ by which we can navigate our way with seeing, recognising and supporting each individual in front of you, we feel confident in designing truly individualised mental health management approaches

“Honestly, I have to say all of it was valuable.  The info re neurotransmitters, pathology,
questionnaires – truly brilliant. Changed the way I practice!” 
– Chris, Naturopath

“Very relevant to myself and practice, as it will completely change some of my
treatment methods and gave me more confidence.” – Di, Naturopath 

The Mental Health Primer Group gives you 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 and 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.

Our Mental Health Primer Mentoring Group is topic based and here are some of the ones we cover…

MH Safety – Keeping You and Your Patients with Mental Health Problems Safe
Neurobiology in a Nutshell – Digging Deeper into the Diagnoses
Questions and Case Taking Skills
Mental Health Assessments – Learning How to Use the Best Tools Out There
Interpretation of Pathology Markers Through a Mental Health Lens
Referring & Referral Letters for Mental Health Case;
Treatment Options in Mental Health
Boundaries, Barriers & Behaviour Change in Mental Health Management

I hope you are 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.  Now is the time to step up to that plate en masse as soon as we can.

If you’re interested in joining our Mental Health Primer Group for 2021
then email us at admin@rachelarthur.com.au to receive your application.

For more information on Group Mentoring and the extra bonuses you have access to click here.
APPLICATIONS CLOSE 22 NOVEMBER

Boundary Breaches

Well that got tongues talking!  We’ve cried, and we’ve laughed, hearing from practitioners about their ‘over-delivering donkey experiences’ for 2020. We’ve heard many memorable & relatable tales of either failures to set the best boundaries or even, in instances when we do, patients’  incredible dexterity to scale these in single leaps, ala James Bond style.
Practitioner: “On the very same day we talked about this important and ignored topic, I’d received an email at 9am from a patient asking for advice and a 2nd opinion about the prospect of surgery (first mention of this and clearly outside my scope!!!!), which they wanted before they saw the surgeon in 2 hours!!”
Sometimes it’s not patients, but professional colleagues (& friends)! I personally took an urgent call on Sunday morning from one of my psych colleagues, only because she is a dear friend, only to discover she needed help regarding a friend with mental health escalation…ah…yup…nup. Her blurred boundaries breached mine and then I bugged another colleague out of hours for further assistance…bad boundary blurring behaviour all round!  We’ve been talking about the uncomfortable truth that a lack of healthy boundaries is a fast track to burn out for health professionals in group mentoring and the end of the year is always…opportune!
Mentee: “I felt challenged in a way where I was reviewing my own boundaries from an overall perspective over a period of time.  I’ve worked in retail for 15 years now (as a student nat initially and then as a qualified naturopath) and I still find myself questioning how far I will go in certain respects especially when it comes to mental health (or people who appear vulnerable).  When I was initially in practice I found my boundaries challenged to another degree, where I would accept every person who came through the door, whether I felt ready or not, or willing to take on the case, which essentially led me to burning out. 
Now as I get ready to start again in practice, I feel more prepared to set clear boundaries from the get go (give myself permission to do that) and check in with myself if I feel they are about to be crossed or not in alignment with me.  It feels like an important and healthy assessment tool to utilise as a health care practitioner.”
As a profession we need to pool some solutions. 
Instead of the reflexive, ‘Just pop me an email if you have any questions’, at the end of each consult which can constitute the equivalent of a blank cheque (!!), perhaps we can say, “If you need to clarify any advice I’ve given you today drop me an email and for any other questions that arise, we can decide whether we need to bring your next appt forward or schedule a between appointment phone consult”   Or if you’re a practitioner who sees the value (and there is much research to support this) in increased touch points with patients, for better compliance and improved outcomes, then structure your billing accordingly.  This from one of our cluey new grad mentees, ‘If you want to offer this add-on time as part of your service then you need to account for it e.g. shave 15 mins off the actual face to face time that they’ve been charged for, so as to have this ‘up your sleeve’ for this express purpose.  They breed ’em smart these days!  Love it!  
The end of the year is such an important time for reflection. What have you learned this year about your professional boundaries? Got some tips you’d like to share?