Integrative Psychiatry is an inspiring area to work in & its evidence base, acceptance and recognition of potency is rapidly growing & offering more patients, more. Going beyond the ‘neurotransmitter imbalance model’ for each presenting diagnosis helps us to see the unique mix of biological & psychological drivers in each individual who presents seeking our help. However sometimes I believe, we find ourselves falling into looking through the lens of just another short-list of alternate models: What kind of methylation imbalance does this person have? What sort of Zn, Cu issues?
While I am so grateful for having learned these tools and watched them be very successful in a portion of my mental health clients, they are simply not the answer for everyone. We need to keep our thinking and practices dynamic and up to date, to reflect the incredible increase in research in new areas of integrative psychiatry, such that more of our patients can benefit and that we can continue to think beyond the box…even if that box itself was originally so progressive!
What do you know, for example, about abnormal purine metabolism in mania and using serum urate as a BPAD prognostic marker in depressed patients? Think you can simply be guided by the reference range provided, think again. What could good old LFTs reveal about our patient’s mental health vulnerabilities and what have we potentially misunderstood about copper in this area, particularly in children?
I appreciate Zinc’s role in mental health as much as the next integrative practitioner. Okay, given my 20K word thesis manifesto, more. But increasingly I am seeing mental health patients who need treatment with different tools. This upcoming ACNEM Mental Health Module in Perth is on point: thinking outside of, outside the box!
While the above only speaks to what I’m presenting, I know Dr. Sanjeev Sharma will also be sharing his wealth of individualised management insights and he’s a big fan of addressing Chronic MIld Metabolic Acidosis as an early treatment objective. Maybe we all need to hear why? And I am so looking forward to getting a PTSD update from Christabelle and hear all about the research into therapeutic keto-diets in psychiatry from Cliff Harvey…haven’t read all those papers to know which conditions and when this approach shows merit? No, most of us haven’t. That’s the point of outsourcing our up-skilling to colleagues who we know are across these more than us and to boot have the clinical experience to ‘make real the research’. As I’ve said before, given the content of this upcoming ACNEM Mental Health program, I wish I wasn’t presenting really, so I could just kick back and take it all in, uninterrupted. But alas, I have some important new information on reading basic bloods through a mental health lens to share! I really hope to see you all there. Let’s get out of the rut of 3-4 nutritional approaches to mental health and make the most of the explosion of research and shared clinical experience.
ACNEM Face-to-Face Training
Fremantle, 27-28 July 2019 at the Esplanade Hotel Fremantle by Rydges
Oh and while you’re here…did you know the research into both beta-casomorphins and IgG casein reactions in relation to certain mental health diagnoses has taken some giant steps forward in the last couple of years? You should. Milk Madness is back and it’s via two distinct mechanisms – identifying which might be at play in your patients & correct management is now clearer than before. Want to get up to date in this area of mental health – check out our UU30 recordings: Milk Madness part 1 & part 2
I’ve had a bit of ‘a bee in my bonnet’ this year. I heard that! Ok, arguably it extends a little further back…like my whole career! But if you’ve seen the topics I’ve been speaking on at conferences in recent months, you’ll know exactly the soapbox I’ve climbed up onto. Inter-professional communication & collaboration. My particular focus (naturally 😉 ) has been current issues regarding the sharing of, and access to, pathology results for our shared-care patients. However, in the face of several distinct threats to the practise of both naturopathy and medicine in Australia of late, especially in the form of anti-collaborative rhetoric/push affecting both professions right now (read PHI reforms, promptly followed by proposed MBA review..if you haven’t read this regressive and repressive set of recommendations you seriously must), the question of how to improve collaboration in order to ultimately serve our patients better, has never been more urgent.
Last week, at the ICCMR conference, I outlined the current barriers for naturopaths to accessing patients’ pathology results (current and historical) and the heightened risks that this results in, either because of incomplete information or because of the subsequent direct pathology referring by naturopaths. Yes, bypassing the GP and another set of trained eyes on your patients labs comes with risks. I also spoke to the opportunities that await us if we can overcome this: in terms of improved patient outcomes, reduced risk, more economically responsible public health budget spending etc. etc. need I go on?! In the Q & A following my presentation, a doctor in the audience made two very important contributions, which deserve some additional air…she said:
“Shouldn’t the patient ultimately own their own pathology results? Then it would be a case of them electing who has access to these: their GP, their naturopath, their osteopath. Rather than the other way around – after all, we are all supposed to be members of their health care team, right?”
She said it. Not me. But I applaud her. She’s right of course. Right now, under the current proposed changes, we and integrative health care delivery and patients’ right to choose and self-direct their healthcare and public health budgetary burden…are all under threat of de-evolving. Right at the time when, with the current chronic disease burden and predicted public health budget blowouts, it should be all hands to the pump! Who has ever conducted a cost-benefit analysis of what integrative health care (successful patient sharing between naturopaths and GPs /specialists) saves the government? No one is my guess and when I proposed I do exactly this for my PhD on a particular parameter some years back, I was not so subtly told, that in spite of a great application, given the primary funding of the research group was from government, and a clear conflict of interest with the head researcher who was also a government advisor, ” my proposal was not in line with the current directives”. Yep.
Last week, a dear mentee of mine mentioned that a GP one of her patients sees responded to her respectful correspondence regarding their shared patient with absolute terror, citing possible de-registration if they are seen to be collaborating or interacting with her in any way…assuming the MBA changes go through. This doctor then decided the lesser risk, was to cease communication with this other key member of the patient’s health care team, not refer the patient for any follow up investigations (including those representative of basic duty of care) and certainly not enable access to any pathology results for this patient from the past or in the future. My mentee’s exemplary response to this doctor:
“My apologies for placing you in an uncomfortable position. I do understand the restrictions and guidelines GPs must work within for Medicare and AHPRA and understand that as you are the requesting practitioner you are liable for any pathology referred for. I make this clear to all my patients and that my referrals are on a request base only and it is up to yourself or the requesting GP for the final decision. I only try and request pathology through a GP or other medical practitioner to try and minimise both risks (of only myself viewing these labs) and unnecessary costs to the patient.
…’X’ has currently been seeking medical and alternative treatment for over 2 years and yet has had no change, if not a worsening of his condition and when I saw them 2 weeks ago, it was my understanding that not even basic assessment of full blood count, liver function and other general health markers had been completed. I had advised X that not all pathology may be covered under Medicare, and to come back to me so I could send him privately for those tests not able to be completed under Medicare. My apologies this was not made clear to you at the time of his appointment.
I take pride in my evidence-based approach to nutritional health in my practice, and work frequently with other patients’ medical practitioners in supporting their health. Thank you for your time and I appreciate your thoughts on this matter”
If the patients’ best interests are no longer the primary goal, as decided by bureaucrats, both government and organisational, is it time to ask the actual health professionals to please stand up?! Is it tipi-talk time for practitioners from all disciplines? Growl over.
Want to ensure you are writing professionally to other health care practitioners? Then our recording and resource Dear Doctor, is for you!
In this 45min podcast Rachel succinctly covers the serious Do’s and Don’ts for your professional letter writing. Rachel gives step-by-step instructions and examples for key phrasing and clear medical justifications, what terms to use when in order to come across respectfully, and how to present urgent red flags without sensationalising. This podcast is will help your professional letters improve collaboration for you and your patients need.
Not long ago, Kathryn Simpson and I were sharing a hotel room on yet another work trip to somewhere. The lights were out, it was way past our bedtime and we were just gasbagging incessantly like a couple of teens, when a thought pops into my head:
“Hey Kathryn, back when you were my student, did you ever imagine this scenario in the future – you know us being colleagues and friends and having slumber parties full of laughing?”, she replied, “Well no, but you know what I REALLY never could have imagined in my wildest dreams…the Australian Naturopathic Summit and you inviting me to be a co-founder of something that’s had such a big impact! That one I just didn’t see coming!”
Well to be honest, neither did I but sometimes I just have an idea that won’t leave me alone and is too important and too promising to ignore. Three years ago when I shared one of these, the vision of a national naturopathic conference by naturopaths for naturopaths, that would lift us all professionally, offer collaboration over competition and provide us the highest level of non-biased education, with Nirala Jacobi, turned out she’d been visited by the same thought bubble. Then I approached Kathryn, who was working for me at the time and pretty fresh out of uni but full of passion and drive about building a better ‘new’ naturopathic career path, one that supported rather than splintered those emerging out of great courses into a harsh, challenging professional space.
Time-travel forward to now, we are just 10 weeks(ish) out from erecting the chai tent, marquees and lanterns, for the second inception of this extraordinary thing called the Australian Naturopathic Summit 24-26th August at Lennox Head.
This is the culmination of 3 years of work from us, one paid project manager and the exceptional generosity of over 25 of our naturopathic idols, thought leaders and torch bearers who are donating their time to present plenaries, workshops, case studies, panel discussions… because they believe so strongly in the cause and the need for such an event.
If you think I am running out of breath between all these words..I am. This thing…has taken on a shape and life much greater than even we had envisioned.
If you follow the work I do – you’ll know that I am passionate about collaboration over competition. I could never have come to this place in my career without the input of many (some who remain on speed dial even now!) and through my mentoring programs, the infamous RAN internship and hopefully times we’ve come across each other…I’ve encouraged you to do the same and by doing so, grow bigger together. So just imagine the value of collaborating face-to-face…over 3 days…at a festival in Lennox Heads… ? And not just for 1 hour, but for 3 full days with 100’s of other practitioners from all areas, specialities and locations. Oh and if you’re thinking you’ll just have to wait ’til the next one’…SPOILER…there is no guarantee of a next one! Being a passion project that we 3 donate our time to, for you, it requires your support to keep it going.
So with saying all that…..(cajon roll…that’s a drum for you non-hippies)….It is with great excitement and enthusiasm that today I can announce a special deal for RAN subscribers. Yes….that’s you! Just like myself you all see a need to grow and build skills, knowledge, competence and confidence in the practice of naturopathic medicine. Come join the very best of your profession and take up this special offer to attend the second independent Australian Naturopathic Summit held in Lennox Head on 24-26 August.
To get 15% off a full 3 day pass enter Festival at the checkout
Book your tickets before they run out at www.australiannaturopathicsummit.com.au.
For information or questions about this special email firstname.lastname@example.org.
This summit is unprecedented in Australia for the following reasons:
- It is free from commercial bias
- It is about professional development, improving our practices and career paths, not products
- The primary objective is to support the Australian Naturopathic community, celebrating our diversity and creating a platform for our own Naturopathic torch-bearers in various areas (Practice, Research, Herbal Manufacture, Corporate Health, Entrepreneurship etc.) to help light the way for the broader professional community
This year our theme for ANS 2018 is ‘Coming Together On Common Ground’
Naturopathy has many different practices and paths,
but we all work for the same purpose, guided by the same principles.
The ANS 2018 program has three distinct themes across the 3 days…
- Friday 24 August: Custodians of the Vital Force
- Saturday 25 August: Upskilling Your Clinical Practice
- Sunday 26 August: The Business of Business Development
The morning of each day consists of plenary sessions followed by a lengthy lunch break that allows for networking, beach walking, guided outdoor meditation, perusing the vendor village, or simply enjoying the festival atmosphere in the beautiful outdoor location that our summit is surrounded by OR for those die-hards some amazing case studies presented by the likes of Jason Hawrelak, Dawn Whitten and Sandra Villella. Afternoon sessions are workshop-style, designed to be more interactive. There are plenty of workshops to choose from to keep you riveted and inspired.
We have created a jam-packed program to do just that.
Download your copy of the full program here!
ANS 2018 – come join the very best of your profession.
Book your tickets before they run out at www.australiannaturopathicsummit.com.au.
To get 15% off a full 3 day pass enter Festival at the checkout.
For information or questions about this special email email@example.com
Help!!! I’m about to share the stage at the 3rd International Acid-Base Symposium on the 25th-27th Jun, with the best acid-base researchers in the world, all of whom I actively stalk (well read and recite everything they’ve ever published but close enough!) I’m terrified and excited in equal doses…but urgently need to change my presentation approach because until now I’ve had the privileged position of simply fulfilling the town-crier role, announcing far and wide the findings of their incredible research into acid base physiology and their findings about impact of chronic mild metabolic acidosis. But I can’t quote Arnett to Arnett! I can’t tell Dawson-Hughes about the incredible insights of Dawson-Hughes’ large body of work in this area! Oh my Goodness (cue, shaking knees), I’m going to meet Thomas Remer…of Potential Renal Acid Load Formula Fame!!
Yes, my partner is a musician and through him I have brushed shoulders with all kinds of famous…but nothing that has made my heart beat quite this fast!
Must buy an autograph book for them to all sign.
Joking (kind of). (more…)
No, I haven’t gone crazy for the ‘caped crusader’… but I thought that would get your attention…. oh look it did! 😉
I’m off to Melbourne for the ACNEM Conference May 5-6th and Batmania was one of the interim names of this very cool and happenin’ town before it became known as Melbourne in 1837! Things have certainly changed in nutrition and the environment since then and as practitioners we now need to address sometimes very complex dynamics between genes, gut, nutrition and environmental health. Which, luckily enough this conference is all about!
This year’s theme for ACNEM is Health for Life – Mastering the Integrated Approach.
I am fortunate to be included in the exceptional speaker line-up (thanks for lovely sentiments many of you have expressed so far about that 🙂 ) I am presenting on ageing..which many of you know that I am suddenly now very interested in…getting old and all.
Standing at the podium, I looked down at my notes & slowly read out the title of my presentation to the hundreds of people attending, ‘Paediatric Digestive Issues & Neurocognitive Abnormalities’ and briefly froze thinking, Holy Heck (!) this is someone else’s presentation! Seriously. No, this is not one of my work stress dreams. This happened. I thought…oh my how am I going to deliver this, it sounds very complex and lofty and scary!!
Then I saw my scribbled hand notes on the page, the unofficial name I had affectionately given this presentation as I researched, compiled my case studies and brought it into being, months prior and I instantly relaxed…oh…Kids’ Guts Are Mental…now that I have some serious experience with and something to say about! (more…)
Can you help me out here? My memory has failed me. Someone, somewhere (Mel? Syd? Auckland? Online during a mentoring session? In a Mullumbimby supermarket?!), in the past month asked me for this paper documenting the increased pain perception reported by subjects given IV saline with a slightly acidic pH compared to a neutral preparation. Quite an extraordinary illustration of the potency of small pH changes in the ECF and the impact this can have on our pain perception. This study is one Professor Vormann has previously talked about and as I’m touring with the fabulous German Professor right now I said, ‘Sure!’…then seemingly instantly erased from my mind who made this request! Is it you?
This month is a fabulous blur of travelling & speaking, getting back face to face with everyone at a bunch of seminars & conferences, which I love but I do forget some days where I am, who I am and exactly what I have promised and to whom! (more…)
In an ASLM Tweet I shared this weekend, I mentioned our own ‘Gut Guru’, Jason Hawrelak reported dietary saturated fat (including coconut oil) increases GIT endotoxin uptake and boy did that stir the pot! The social media switchboard lit up! It’s ok I know there isn’t a switchboard anymore…but I am old school 😉 This got just about everybody talking on Twitter & Facebook…and thinking out there in the real world…which is good, right? And if you read to the end you will find prizes galore for those of you that want to add to this discussion 🙂 (more…)
My partner and I have a well rehearsed script whenever he is suffering from man flu, he says, “Am I going to die?” and I say “Yes, just not today.” First world peoples tend to specialise in the denial of several absolutes: like time & death. As Professor David Cameron-Smith, from the University of Auckland says, ‘old’ is something we always define as ‘other’. We are not old but we know people who are! I personally used to define ‘old’ as over 50 until that became rather close and uncomfortable at which point I noticed a completely unconscious increase in the lower limit! Now old is over 75 yrs…and stay tuned for more updates 😉
Similarly none of us are ageing, right? (more…)
I am frequently asked what scientific journals I subscribe to and often by the same practitioners over and over, because they can’t reconcile my answer: “None”. Yet I constantly have my head in the scientific literature, right? The two are not mutually exclusive, it’s just about knowing which free scientific and medical news-feeds are worth their weight in gold! If you really are digging into the itty-bitty detail of things these won’t answer all your questions on all your topics but they do a great job of 1) keeping you up to date with the big headlines in general medicine, or, with the use of alert systems and filters, just the areas of health you’re particularly interested in and 2) offering you a huge highly credible resource database that is easily searchable.
Point 1, Exhibit A 😉 :
Here’s just a few examples from the last month that popped into my inbox from Medscape that got my pulse racing:
Whenever I talk to practitioners about thyroid health, like I recently did at MINDD, I can guarantee I’m going to get 2 questions:
- Shouldn’t we aim for the high iodine intake of Japanese?
- Can we use the patch test for testing iodine levels in our patients?
I am so glad you asked. The answers are no and no.
I am a nutter for minerals and iodine just won’t go away right now. Too little = a problem, too much = often the same problems. To boot we are faced with radically contrasting views on assessment and dosage and just about everything iodine related. It’s not you – it’s iodine. Trust me it’s a complex little mineral that requires some extra thought and caution. If you imagine the Japanese have no thyroid problems – correct that big myth right now by reading this scientific paper that refers to health problems that result from too much dietary iodine. It also explains that the typical first step in treating hypothyroidism in Japan is to reduce their iodine intake! (more…)
Recently, I posted about my very positive experience of the AIMA NZ conference, prior to that I was gabbing on about the upcoming ACNEM Brain Health conference in Melbourne in May and now I am going for the conference hat trick! I want to revisit a really impacting lecture for me at last year’s Australasian Society of Lifestyle Medicine (ASLM) conference, delivered by the Emeritus Professor Mark L. Wahlqvist AO, BMedSc, MBBS, MD (Adelaide), MD (Uppsala), on the relationship between ecology and human health.
Why did I find his talk so impacting? Why should every integrative practitioner take the time to watch this? (more…)
Just back from a truly wonderful Australasian Integrative Medical Association (AIMA) conference in NZ. I don’t know what it is about the land of the long white cloud but they seem to produce some of the loveliest, most earnest health practitioners and this conference reflects this, setting itself apart each year as a result of its very organic mix of speakers (general practitioners, naturopaths, nurses, specialists) who are all equally embraced and lauded. To boot we had medical students invited to attend this year and guess what, these 20 or so med students…they stayed for the full weekend much to everyone’s surprise(!), loved it and want more. Really. At the AIMA NZ conference, on the two occasions I have spoken, I feel a sense of coming home…no I don’t mean I am about to move there (too cold!!) but I mean coming home to integrative medicine. (more…)
Duck duck GOOSE! Do you know this game? That’s how I’m feeling with oestrogen – high-high-high-LOW!-of late. Likely similar to your experience, the majority of my female clients battle with oestrogen dominance, therefore I get so used to looking for it, expecting it: the high Cu, the profoundly elevated SHBG, maybe a raised ESR. So much so that sometimes the low ones can catch you out, especially of course when it happens in women way way before menopause.
We’re so resolved to hear bad press about oestrogen and to be armed ready to saturate our patients with broccoli extracts of the highest order – do we remember the clinical features and markers of an oestrogen deficit and know what to do with those women who simply don’t have enough? (more…)
Got any patients on Natural Thyroid Extracts (NTE)? Me too…and I am finding it’s on the increase. What’s the deal? What do we need to understand about this form of thyroid replacement therapy to best monitor and manage those patients already on it or contemplating taking it? Does it really offer advantages to all hypothyroid patients or just to a subset of those and how would we recognise these people who might benefit the most?
NTE are marketed as being superior to synthetic thyroxine primarily based on the fact that they provide the patient with some T3 as well as T4 and in addition to that, being extracts of pig thyroid glands, there are other thyroid and iodine based actives e.g. mono and diiodotyrosine, present in the extracts. So in essence this is giving us more iodine and more of the other ingredients we need to make our own thyroid hormones. Based on this, many proponents of NTE say this is a major advantage over synthetic thyroxine replacement because it is more ‘holistic’ and it supports the patient’s gland in its own hormonogenesis. (more…)
That’s the word on integrative medicine street. I had a sense this was coming, not just a tightening of our terminology but also a challenge of the very concept of ‘adrenal burnout’. Hear me out. (more…)
Have you still got some thyroid patients that don’t fit any sort of traditional thyroid disease model and are difficult to get results with? Oh yes me too… and watch out…I’ve been spending the last few weeks with my nose firmly embedded in hundreds of articles digging around for more answers. As I am presenting on thyroid conditions for ACNEM in Adelaide March 18-19th, I couldn’t resist going back to the literature to see if by delving a little deeper again I could come up with some more answers to these weird, wacky and hard to treat thyroid presentations that we’re increasingly seeing and guess what…I think I’ve found a few gems. (more…)
Back a few weeks ago I had the pleasure of presenting at the Integria Symposium and the even greater pleasure of listening to some of the fabulous speakers …you see I’ve heard my stuff before! 😉 The ‘Mosaic of Autoimmunity’ was delivered by the very funny and knowledgeable Professor Yehuda Shoenfeld, who reiterated the sequence of events now well recognised to precede and precipitate autoimmunity: genetic susceptibility + endocrine context + environmental trigger –>autoimmunity.
Clinicians know that overwhelmingly women dominate when it comes to autoimmune disease epidemiology and most understand that this is a consequence of oestrogen’s immunostimulatory effects. Professor Shoenfeld, described the female, or E2 dominant, immune system as being ‘super charged’ and that increased rates of autoimmune diseases were a reflection of this. Sometimes practitioners do initially great work with a/immune clients – clearing up the diet & gut, ensuring vitamin D adequacy etc and then get ‘stuck’ or plateau with antibody levels that ‘won’t budge’. Going back and checking the hormonal contribution in the case is often indicated. If the patient has an unhealthy E2 dominance and /or impaired detoxification and clearance of this hormone then working on this aspect often kickstarts the next stage of improvement.
A new thing to me (I know I’m a bit slow sometimes 🙁 ) was his mention of the potential link also with high prolactin (PRL). The literature on this is extensive and hyperprolactinemia (HPRL), even just mild elevations, have been correlated with a very long list of both systemic and organ specific diseases including: (more…)
Does your brain feel like it’s going to explode, spilling brain-juice everywhere, when you do 2 weekend conferences in a row? Or is that just me? I have returned to my desk after the Integria Symposium and then the Australasian Society of Lifestyle Medicine conferences with ants in my pants. I can barely sit still. No caffeine required.
Right now I want to talk ASLM because it’s fresh in my mind from the weekend but geez where to start? I was testing the water going to this one. What would a conference about ‘Lifestyle Medicine’ pitched primarily at doctors look like? Would it be a bit light? Would it be token lip service to CAM with no recognition of the need to also make a paradigm shift? Well strap yourselves in guys because what I heard from their outstanding keynote speakers (Mark Wahlqvist, Michael Berk, Bob Brown…yes you heard right..I said Bob Brown!) were some of the most holistic naturopathic teaching points about individual, population and global health that I have heard in a long time. These 3 speakers in particular were mesmerising – to naturopaths (yes there were a smattering of nats there) as well as to GPs, specialists and other attending allied health professionals (more…)
“Access the Experts with Rachel Arthur” is a month long intensive webinar series focusing on the best of Mental Health Education. Every Thursday night for the month of July, Rachel will be interviewing a hand-picked guest speaker about a particular area of expertise in Mental Health.
Each speaker is a clinician with years of experience (from a psychologist, to a GP, to psychiatrists) who Rachel has worked with and/or been mentored by and she is thrilled that these interviews create an avenue to share their incredible & very practical knowledge with a wider audience.
Rachel’s role as the interviewer will be a feature of the webinar series – ensuring you get the best of each speaker; translating the complex into easy-to-understand concepts and clinically relevant content that you can start applying immediately. (more…)