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…)
Recently a practitioner lamented that because of her clinic location she didn’t see company reps very often & felt this was a barrier to her staying current with her clinical knowledge. Of course, I had to beg to differ.
We’re quick to judge the medical profession for their reliance on commercial sources of CPD, overwhelmingly provided of course by the ‘drug reps’ but it seems we’re less fazed or concerned about ourselves being equally reliant, unduly influenced and misguided (might I add) by the people employed by the CAM manufacturers expressly to encourage us to sell more of their products! How does that make sense?
I go back to my very repetitive mantra: always be mindful of who delivers you the message/information etc. and what their agenda is.
By promoting their company’s products to us, focusing on the products’ strengths, ignoring or simply not making it a priority to know the limitations or weaknesses of the products or the evidence, ignoring or again simply not making it their business to know when superior products are being produced by competitors or when new evidence comes to light that puts into question their products,reps are only doing what they’re employed to do. But is it helpful and is it ok?(more…)
Last weekend I attended the Science of Nutrition in Medicine Conference in Melbourne https://nutritionmedicine.org.au/enews/2015-02-06-Program.html and for those of you that didn’t make it I can tell you, it wasn’t your regular CPE event. I’m not sure if the debate inside the presentations or outside in the breaks was more interesting but I can say that I haven’t seen this much stimulated thought, heated discussion and passion at company run events. Why? (more…)
I’ve booked my flights and packed my bags (at least in my mind!) already. The annual Science of Nutrition in Medicine Conference is on 2-3rd May in Melbourne & there’s one name on the bill that alone I would be attending for – Dr Robert Loblay. He’s the head of the Immunology unit at RPAH which specialises in the management & treatment of every possible type of food & chemical reaction (including all the ones the average medico would suggest are impossible/unreal or psychosomatic). By the way he also a strong interest in bioethics so this makes for a great combination in this field. He helped put together the RPAH diet and book ‘Friendly Foods’, which is such a great clinical resource for patients with food intolerances.
The way I approach food reactions in clinic has been heavily influenced by his work and because the RPAH unit is working everyday with some of the most severe, complex and unusual reactions, when he talks I listen!(more…)
So far this year I’ve been doing most of my presenting online which has been fantastic because we can all be in our PJs and no one’s the wiser (except now!!) but I do miss the face to face seminars where sometimes the real magic happens thanks to the two-way dynamic between you and me!
So guess what? I’m coming to Sydney on the 31st August (and then Brisbane 6th September and then Melbourne 13th September) to touch base with many of you again. I’m joining forces with Rachel McDonald from Biomedica to talk about the real world application of naturopathy in mental health conditions. (more…)
I briefly mentioned in a previous post Dr. Robyn Cosford’s inspiring opening speech at this year’s MINDD conference. A key point she made was the growing gap between what’s regarded as normal and what is actually healthy.
Having worked in general practice for decades, Robyn provided us with one illustration after another – Type 2 diabetes, previously called adult-onset diabetes, now not infrequently diagnosed in primary school aged children; delayed speech and learning difficulties in male toddlers which many increasingly regard as ‘normal’; precocious puberty in girls; escalating rates of depression and anxiety in children and adolescents…Robyn asked us as practitioners to be vigilant about helping patients to distinguish between what has become perceived as ‘normal’ and what is actually healthy.
In my MINDD presentation this year I talked about the mental health challenges faced by young men and I expressed a similar concern: that when we witness extensive aberrant behaviour in young men we are prone to rationalise it. Are we mistakenly attributing these signs of dis-ease in males as simply being an initiation into Australian culture? When you hear of young men exhibiting binge drinking behaviour, does it set off the same alarms as it would if your patient was female and if not….why not?
As part of a broader discussion of the issues, I presented two cases of young men with mental health problems – both from very different sides of the tracks, one gifted and the other a struggler but one of the features they shared included the way their use of alcohol & other substances had passively been condoned by society instead of being seen as a call for help. We can help these young men but only once we’ve acknowledged there’s a problem. So now I’m extending Robyn’s plea and ask you to be vigilant in making the distinction between ‘normal’ and healthy… when mothers relay stories of their son’s ‘antics’, when brothers, cousins & uncles temporarily ‘go off the rails’, when young men reluctantly present for a quick fix…
I’ve been curious about the push towards using so-called ‘active forms’ of B vitamins over the last 10 years in nutritional medicine – particularly with regard to B6 (pyridoxal-5-phosphate) and B2 (riboflavin 5’-phospate aka FMN) in light of substantial research demonstrating that these phosphorylated forms will in fact be dephosphorylated prior to uptake in the small intestine (Gropper, Smith & Groff Advanced Nutrition & Human Metabolism 2005) – so initially it seemed we were being encouraged to pay more for something that ultimately gave us less of the same vitamin. Funnily enough the only established scientific way to ensure uptake of the active forms in their intact active states is to use very high doses – however supplements containing either active B6 or B2 consistently offer very low doses compared with the regular supplements, so this seemed to rule this out as an explanation.
In spite of my scepticism & encouraged by the Pfeiffer approach, I got into using P5P and had to suspend my disbelief in the face of some good clinical results.
However finally at the MINDD conference last week, scientist Woody McGinnis at last made sense of this riddle for me!
McGinnis, who some of you might know as previously being a key researcher at the Pfeiffer Institute which specialises in nutritional and integrative management of mental health & behavioural disorders, confessed that he had also struggled with concept of P5P supplementation from a scientific perspective until Bill Walsh suggested that this form was particularly indicated for the ‘lean malabsorbers’.
What Woody essentially took from this was that patients with leaky guts could absorb the P5P intact & would ultimately benefit from this form. Adding to this is my understanding that the dephosphorylation process for P5P in the gut occurs via ALP – a zinc dependent enzyme found in the brush border of the small intestine…so here you have the double whammy – if your patient is a malabsorber AND zinc deficient (which of course commonly go together) they are the ones picking up the P5P perfectly and for the rest of us perhaps the pyridoxine will do.
Woody also attested to this with his story of his own pyrroluric son who initially only responded to P5P but in his teens (with significantly improved gut health) appeared to stop responding – at which point Woody switched him to the higher dose pyridoxine with fantastic results…..Aaahhhh at last my scientific curiosity has been quenched! 🙂
I was honoured to speak at the MINDD conference again this year. MINDD is an organisation that really sets itself apart by providing incredible hands on support for parents, carers and practitioners in the area of integrative mental health management and one of the key strengths is the sense of community they’ve developed secondary to this. A key message echoed by numerous speakers was the enhanced clinical benefits for patients when a truly whole health, multi-modality approach is taken – from naturopathy to psychology, from neurology to audiology, from building biology to biological markers and so on.
And just to put the brakes on the whole ‘genes are us’ movement that is currently sweeping Australian integrative medicine, Dr. Robyn Cosford (a highly-regarded integrative GP) kicked off the whole weekend with a presentation that included a study of some of the oldest Okinawan individuals and their genetic profiles. These individuals aged well over 100 and fighting fit each possessed hundreds of genes currently thought to be associated with chronic disease: cardiovascular, diabetes, cancer. Robyn reminds us all that while genetics loads the gun it is our diet, lifestyle and environment that actually pulls the trigger!
While I was inspired by the research and insight offered by clinicians and scientists from various modalities, I was reminded again, that no one individual can be across it all and to attempt is to fail or become exhausted in the process and this of course is where the communitybit comes in – we need a network of integrative individuals to refer between and support each patient & my experience this weekend suggests these events certainly build that community. Our job is to practice within our scope and know when and where these other therapies and approaches are indicated and to develop a good referral network. So many great speakers this year and this time I actually managed to sit still and enjoy some of these so I’ll be bringing you the highlights over the next couple of weeks so stay tuned! 🙂
A few years ago I heard Felice Jacka, Associate Professor (Deakin University), speak about her research linking mental health to certain Western dietary patterns and possibly many of you have already heard me rave about her work. This year I had the pleasure of hearing her again at the recent Science of Nutrition in Medicine Conference and guess what I learned this time? Felice is actually Alf Jacka’s daughter…I know I’m a bit slow sometimes. For those of you still going, “Huh?” – I am guessing you’re not from Victoria and certainly didn’t study at Southern School of Natural Therapies. Alf Jacka is considered by many, a pioneer of naturopathy in Australia and he established SSNT. So I was thoroughly delighted when Felice, who is a very highly regarded researcher, made reference to her late father, & naturopaths generally, as being trail blazers: articulating many of the physiological drivers behind mental health decades before they turn up in the mainstream zeitgeist e.g. digestive health & the central importance of microbiota, excess glutamate activity in addiction. Felice’s key interest lies in how we can prevent depression and mental illness at a population level via diet and she seems keen to essentially bring a more holistic perspective to the often reductionist world of health research.
I also recently attended the annual Biobalance Conference one (yes I truly have nothing else to do with my weekends!) which had Jerome Sarris on the bill. Many of you will be aware of Jerome who is a Senior Research Fellow at The University of Melbourne, following completion of his doctorate at The University of Queensland in the field of psychiatry. Again, some of you would have heard me mention his work in previous posts – he’s attracted more than $4 million in grants and has published some very high impact papers on the use of CAM in psychiatry. Personally, I find his review papers demonstrate a deeper understanding of CAM so clearly lacking in those written by non-naturopaths i.e. the others miss the point and he generally gets it and can find a way of putting voice to naturopathic nutrition in the forum of a scientific dialogue.
Anyway, at Biobalance, another speaker on the bill essentially suggested (possibly unintentionally) that naturopaths had less of a grasp of complex nutrition than integrative GPs and much to my delight, Jerome, a keynote speaker, responded by identifying himself first and foremost as a naturopath and then saying on the matter , “Ahem…I don’t agree at all”…or something to that effect. It was a great moment.
So fellow naturopaths and integrative practitioners, be assured that we are being beautifully represented by these trailblazers & if you’re interested in getting into research yourself – I suspect there’s never been a better time.
Also presenting at the Science of Nutrition in Medicine Conference this year was Professor Eastman who is a world-renowned Australian endocrinologist with a primary interest in global iodine deficiency. He is also Deputy Chairman elect of the International Council for the Control of Iodine Deficiency Disorders (ICCIDD) and is frequently consulted by Australian health authorities and medical groups on the issue of iodine deficiency in Australia. Boy did he have some things to say…and it kind of went like this:
Substantial epidemiological research has shown that 95% of euthyroid patients have a TSH between 0.04-2.5 mIU/L (note the current reference range suggests results < 4 mIU/L are okay, Eastman strongly refutes this)
The mean TSH in adisease free population is actually 1.5 mIU/L
In fact Professor Eastman was emphatic that the meanTSH in iodine replete individuals is actually 1 mIU/L
While acknowledging the limitations of spot urinary iodine testing for the assessment of individual iodine status, he genuinely seemed at a loss to understand GPs reluctance to refer for this test when patients exhibit risk factors for hypothyroidism and in his article (Screening for thyroid disease and iodine deficiency. Eastman CJ. Pathology. 2012 Feb;44(2):153-9.) he argues strongly for screening of all mature age women, pregnant women (1st trimester) and school children, using the urinary iodine and TSH together
And while we’re stirring the pot how about this: Professor Eastman says that hyperthyroid individuals who have a low urinary iodine result should still be given judicious iodine! Such sacrilege!!
But wait…before you get too excited and join the ‘too much iodine is never enough… just look how much the Japanese eat’ camp…I was very relieved to hear Professor Eastman remind the audience that while the Japanese diet does provide substantially more iodine than the Western one, it is not without problems, with very high rates of thyroid disease especially thyroid cancer and in fact, Japanese health authorities are concerned about excessive intake and are currently investigating ways to cut back. And lastly, if you’re not convinced by this, he says perhaps you should talk to one of the many litigants in the current class action against Bonsoy, who developed severe thyroid diseases thanks to excessive iodine exposure from the milk (7.5mg/cup)!
So keep arguing for urinary iodine assessment and for addressing individuals with ‘within range reference results’ for TSH that are clearly not healthy ones. Check out Professor Eastman’s article, there’s a goldmine of information in there and while we’re talking about incredible resources in nutritional medicine – take a moment out to thank Dr. Tini Gruner (previously from Southern Cross University) for her significant contribution to naturopathic nutrition education in Australia. She was a mentor and inspiration to me and many others. She sadly passed away this week and we will miss her dearly.
What an absolute pleasure to attend this conference this weekend just gone, where the presenters were researchers, most of them internationally acclaimed in their respective area and to find what they had to say SO clinically relevant and to find the presenters SO unafraid of bucking the norm (be that the NHMRC dietary guidelines, folate fortification, the use of broad TSH reference ranges, the refusal by many medicos to use urinary iodine testing of individual patients etc. etc.).
Then to boot – to be able to ask them questions! Want to know about N-acetyl cysteine? – How about asking Dr. Michael Berk the Australian researcher who ran the first human studies in psychiatry and is the most prolific research of NAC yourself?!
I’d attended the inaugural conference some years ago in Sydney and, while there were less attendees this time around on the Gold Coast (must be our horrible weather! ), I thought the format and quality was just as good. While I certainly saw some familiar faces – I would have loved to see more – I think we’ve got to make the most of these independent sources of information, because, while we can get some great ideas and tips from company seminars – there will always ultimately be a barrow to push and some bias. I found this to be true, most disappointingly even at last year’s NHAA conference where so many of the main speakers ultimately had a vested interest and a product to sell the audience. Given that’s supposed to be independent that was even more appalling I thought. The Science of Nutrition in Medicine Conference is of course not free of all sponsorship but I didn’t see any bias permeate into the presentations from this. So major congrats to the organisers of this one (ACNEM, CSIRO & NSA), mark it on your calendar for next year as a probable must-see and over the next few weeks I’m going to bring you some of the key highlights from what I heard – that might just change the way you practice! Very inspiring 🙂
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 
), I thought the format and quality was just as good. While I certainly saw some familiar faces – I would have loved to see more – I think we’ve got to make the most of these independent sources of information, because, while we can get some great ideas and tips from company seminars – there will always ultimately be a barrow to push and some bias. I found this to be true, most disappointingly even at last year’s NHAA conference where so many of the main speakers ultimately had a vested interest and a product to sell the audience. Given that’s supposed to be independent that was even more appalling I thought. The Science of Nutrition in Medicine Conference is of course not free of all sponsorship but I didn’t see any bias permeate into the presentations from this. So major congrats to the organisers of this one (ACNEM, CSIRO & NSA), mark it on your calendar for next year as a probable must-see and over the next few weeks I’m going to bring you some of the key highlights from what I heard – that might just change the way you practice! Very inspiring 🙂