Well, obviously(!)…this has been a year heavy on pathology interpretation for me and the huge number of practitioners who’ve just spent the last 6 months taking that learning journey with me. I celebrate and congratulate them all for their commitment to their own professional development and also their investment, in what is arguably, the most potent yet overlooked set of skills of any health professional… the ability to read bloods. Basic bloods. Mainstream labs. No…but to really read them. Backed by all the scientific understanding about what these parameters actually are, how they perform and what they (dis)prove e.g. subclinical inflammation and ramped up oxidative stress – not an informed guess but mappable…right there but where no one else can apparently see it! But I digress!
Actually what I wanted to discuss was the whole erroneous notion of ‘normal’.
No, I am not speaking from the heart about my personal quirks, sense of humour or dress sense but rather the incorrect assumption that a reference range defines ‘normal’ and that our answer for each patient and each result is, a Yes or a No!
In this brilliant article by Whyte & Kelly published in the BMJ they spell out this falsehood succinctly. They note that the term ‘normal range’ has slipped into medical language from the misunderstanding that all lab results follow a Gaussian (aka bell shaped curve & later referred to as ‘normal distribution’) pattern but many simply don’t. So for some parameters a result near the ‘middle of the reference interval’ constitutes aspirational whereas for others it spells danger. Add to this, that these reference intervals are mathematically determined to reflect the expected values of 95% of your patient population (mean +/- 2 SD either side) so…that means the chance of a YES…”Your patient’s results are ABNORMAL!”… is just 5%. And hey…who said all the values within the reference range are all equally “normal” or better yet, healthy?! Not these authors, nor I, nor the praccies who’ve just done our course. So while, in many regards, these goalposts are too wide, they are also too narrow – typically only representing a subset of adults age-wise and Caucasians, yes they are both ageist and racist (yep, I said it!). And if our practitioners have learnt anything it’s about keeping an ol’ eagle eye on the sneaky intra-individual shift! Only spotted, of course, if you know your patient’s normal (not theirs compared to anyone else…just theirs) and then spot a shift. [I can hear they’re shushing 🤫me…they’ve got it already, alright!!]
So this is music 🎻to my ears, from Whyte & Kelly: “The intraindividual variation in laboratory values is usually much smaller than the interindividual variability (ie, the variation in the population). Variation in the concentration of an analyte, if significantly outside of a patient’s usual values (but still within the reference interval), could be a sign of early or latent disease”
ps I know your type and know that is EXACTLY the kind of weird nerdy thing you have planned for your break…you should see my summer fun list!!! 😅
MasterCourse 1: Comprehensive Diagnostics is a self-paced online program due for release in December. The course has pver 18 hours of video presentations plus 2 free bonus sessions 1) Accurate Pathology Interpretation Starts Here and 2) Patient Pathology Manager and access to resources and tools within, for your own use. This is a pre-requisite for MasterCourse II that will be delivered live in 2021.
This skillset has been found by many to be biggest ‘game-changer’ in Integrative Health You can view the full course outline here.
We are getting ready to launch our new look Group Mentoring for 2021! We are now counting down the weeks days (gULp!!) until we open up applications for Group Mentoring next year. We’re keeping everything our practitioners have told us they love, over the past 8 years, and simply improving the formula, with some great new bonuses for 2021!
So with 2 weeks to go, we’d thought we’d introduce what’s on offer.
Live sessions are starting in February for 2021. January is often a period when we’re recovering from ‘recovering’ e.g. Christmas holidays, so we thought it would be good to start a month later this time around, in February when everyone’s recharged and ready to get back in the swing. There will be 10 live sessions in 2021 starting Feb and ending November.
Fly on the wall options on offer! Want to present a case? Great! Not ready or have enough time to present one? Great! Having successfully launched the ‘fly on the wall’ (non-presenting participants) experience this year we’ve been left in no doubt that practitioners loved this & continued to learn just as much as those in the ‘hot-seat’. Hence, it’s back again!
BONUS: Update in Under 30 Subscription is now included for those in General Group Mentoring (GM1 or GM2), either of our Mental Health Groups (Primer & MH Applied) or to those in our MasterCourse Alumni (not included for New Graduates)You gain access to the ENTIRE back catalogue of Rachel’s UU30 recordings (30 min podcasts), with atotal value of over $1800, and receive a new podcast each month for 12 months. For those mentees who are already current subscribers, when your subscription expires in 2021, you’ll get to renew for free! This provides you with even more of an opportunity to drill down and dig deeper into certain areas that we routinely come across in our session cases and content. This gives you a much greater opportunity to seriously expand your learning in those areas most relevant to you.
We’ve broadened your 30% discount to ALL Rachel Arthur Nutrition products on our website for 2021.
Certificate for CPE Hour
Here’s what one of our mentees had to say this year…
“I’ve listened to the recording of the live mentoring sessions multiple times and sooo sooo much goodness in each session. I love how your mind works Rachel. This is also my second year in mentoring and I am so grateful for this safe space to continue to enlarge our thinking. I learn something new every single time. I am also loving the update in under 30 – that is also changing my practice with every single listen. Eg the ones regarding interpreting iron studies and prescribing. TOTAL GAME CHANGER. I was a novice in iron prescription kind of going with whatever my patients Dr’s were prescribing but then understood why they were getting such crappy results – both in actual improvements in their iron test results but also negative symptoms. Honestly, the combination of mentoring with the little individual nuggets in the updates is totally transforming my practice so I’m so grateful. Rachel please keep mentoring forever. I love it.” – Bek DiMauro, Functional Nutritionist, Adelaide
We have a great range of groups to choose from. Whether your a nervous newbie or have 15+ years experience…
General Group Mentoring – our regular case presentation groups, with one practitioner presenting a case each month, or just listen in.
New Graduate Groups – great opportunity for New Grads to build confidence as they leap from student to practitioner, or for practitioners wanting to refresh their core clinical skills such as MindMaps, Pathology, Case Taking etc
New Grad Next Level group – for graduates of the New Graduate 2021 group to continue to build on your skills and apply all the great learning from this year to real client cases.
Mental Health Primer – topic based tutes & interactive sessions to build on your knowledge in the role of naturopathic medicine in Mental Health – from screening tools to key management issues, specialist diagnostics and beyond.
Mental Health Applied – practitioners presenting their client cases with a focus on primarily Mental Health presentations.
MasterCourse Alumni Monthly – NEW for 2021 – Participants from this year’s MasterCourse In Comprehensive Diagnostics can continue to build on their knowledge and application of Pathology interpretation with this Live monthly session and online community.
For all those Mentoring Virgins 😇out there wanting a clearer understanding of what it’s really like to be part of my group mentoring, this video is a little snippet from a session with one of my groups. This year has flown by and I have thoroughly enjoyed working with each fabulous group of dedicated ‘life-long learners’.
And don’t forget some of the offerings our Group Mentoring already reliably provides – the high level of applied knowledge, our incredible Basecamp platform for communication and support between sessions and our ongoing sharing of pearls of knowledge from my 22+ years of experience and research together with the collective wisdom and know-how of each group.
Can you see yourself in this collective?
REGISTRATIONS OPEN 9 November!
Information on how to apply will be released soon, to find out more click here. Join the waiting list now so you won’t miss out by sending us an email on firstname.lastname@example.org.
As a health practitioner, you are always actively building: your reputation, your practice and your knowledge.There’s theoretical …and then there’s applied. Some of the biggest leaps we take forward as practitioners come with being shown how (rather than told) & then being forced to ‘do the work’ ourselves, rather than being exposed to simply more information, be that about pathology, patient prescriptions or practice structure! The slogan ‘Just Do It!’, might have already been nabbed and TMed by a huge corporate beast, but this doesn’t undo the universal truth of it! Prefer your mantras to come from mystical philosophers rather than monster multinationals? How about this then?
I hear and I forget. I see and I remember. I do and I understand. Confucius
This mentoring community that I am a part of, we are about applied learning. We learn by doing. We learn, not just through each individual’s patient encounters but through the collective clinical experience. We make what can otherwise be an isolating experience of constantly, seemingly, reinventing the wheel, if not many wheels (!), into one of collegiality and ‘using the force’. If you haven’t experienced Group Mentoring with me previously and are thinking about next year being your year (see below to find out more about our 2021 offerings), we put together this fun little video here to get across that mentoring isn’t about a conversation between just two people.
So….HoW dO YoU gET FroM HeRE tO tHeRe?
With Group Mentoring you’ll be learning, through the application of core clinical skills, improved patient questioning, methodical information gathering, evidence based answer finding & getting access to resources that you can apply in real-time in your own practice.
“Having the group session each month, as well as having Basecamp to bounce ideas around in, is a reassuring connection to know is there if I need it. Having just started practice this year and working in an environment without other Nats around, I have noticed the occasional feeling of isolation. So having the monthly catch up keeps me feeling connected to other clinicians and gives me exposure to other cases and perspectives that I wouldn’t have otherwise had.” – Georgie
We have a range of groups on offer to suit all levels and most types of integrative health modalities. Go to our Group Mentoring page to discover the groups and bonus extras on offer for 2021.
Going by the landslide registrations for 2020, our ongoing excellent retention rate of practitioners from year to year & our already overflowing waitlist for 2021, the reputation of RAN Group Mentoring is highly regarded and a popular choice.
So, if being part of our community excites you and if the thought of learning and applying collective knowledge from expertise outside of our own, now’s the time to put your hat 🎩 in the ring, put your hand up ✋🏼 & join the conversation 📣 through Group Mentoring.
Recently a mentee reported that when attending an in-person training event (remember those, everyone?!) she approached a sponsor’s stand, promoting practitioner training in the nutritional management of mental health, based on the pioneering work of American scientist, Carl Pfeiffer. But when she and her nat buddy started asking questions, those manning the stand asked whether they were doctors and then, upon finding out they were naturopaths, encouraged them ‘to move along – this information isn’t for you then’. Or something to that effect…Ouch!
While I know a little about the decision behind offering this training only to doctors and specialists at this time, and I do understand that organisation’s reasoning, I also want to reassure you, this doesn’t mean that Pfeiffer’s important work, and the efforts of those that have followed him, is out of bounds to others.
No one can copyright cortisol or TM TSH, right? Equally, Histamine is his own man. Carl Pfeiffer and others brought histamine, the neurotransmitter to centre stage and many of us working in mental health remain eternally grateful for this. But CNS histamine has come a long way since then…and is currently a very hot topic in modern molecular psychiatry where they are always looking for new drug targets, given shooting at the previous ones, risked taking ‘an eye out’! The recognition of histamine as a key player in mood, cognitive and behaviour has been long overdue but is absolutely here now! Just give this search term a whirl in PubMed: histamine AND psychiatry, and you’ll be hit with quite the crush of citations!
An abundance of important info at your fingertips…no secret handshake required.
It was, in part, this story that inspired me to record an Update in Under 30 on Histamine Imbalance in Mental Health. Just the proverbial straw on the proverbial camel really, after years of examining, experimenting and experiencing the incredible results some patients can achieve when this imbalance is identified and redressed. So I’ve done my darndest to pull together those years of hands-on helping histamine imbalanced patients with the latest literature in under 30 minutes!! Surprise! I failed!There is a lot to convey but you’ll also be surprised by what I don’t say…there’s no infinitely long list of personality peculiarities that fit with too much or too little. Nor is there a didactic discourse about absolute treatment dos and don’ts. I’m communicating the common ground between the original evidence, clinical empiricism and contemporary neuroscience. So this month, consider the ‘under 30’ bit, merely a ‘Serving suggestion’…which would necessitate you playing it 1.5 X speed…go on, I dare you!!😅
About 15 years ago I was introduced to Histamine as a neurotransmitter. Not the allergy mediator or the ‘basophil baddy’ but rather this prolific and potent neurochemical we all produce in our brains which, in the right amount, regulates almost every biological rhythm, helps with memory and mood & much more. Being able to recognise excesses or deficiencies of CNS histamine in mental health presentations and, ever since then, fine-tuning my ability to support patients with these, has changed my practise forever and has been the key to some of my patients’ greatest recovery stories. Forever grateful to the pioneers of this model, 70 years on, the model is ready for a mini-makeover, to bring it in line with the current scientific understanding of histamine, methylation, genes and much more. This recording, together with a hugely helpful clinical resource, will give you the confidence to recognise and remedy this important imbalance in mental health. If you want to download this recording click here.
A conscientious early career practitioner digging deep into GS research and upskilling, recently sent me a message to ask if I knew that the correct pronunciation of the condition was ‘Zheelbairs’…as in..imagine you’re French and say the word through a pencil moustache and barely opened lips! My answer? ‘Yes (or should that be Oui Oui!), but I gave up pronouncing it correctly when I realised no one in my very Aussie audience could make the connection between my fickle French impersonation and the word G-I-L-B-E-R-T-S on the screen”… 😂😂😂
Ok I know many of you imagine I read nothing else but Gilbert’s Syndrome guff and that not a day would pass without those sweet words passing my lips! But you know what? That’s not completely true 😂 But my series of mentoring sessions yesterday did end on another happy note, with both the final case presented being a Gilbert’s one (overt oestrogen excess, likely bile stasis etc) and then stumbling across this paper that I hadn’t seen before a longitudinal study of 100 Egyptians with GS, tracking their bloods and health experiences. I know you also imagine that I have a direct line with God in terms of receiving Gilbert’s research the second it gets published…again not completely true 😂 and somehow I had missed this one!
It’s not the greatest research in terms of sample size and methodology but hey beggars can’t be choosers and when you’re a condition with whom the word BENIGN is so commonly associated…you’re always begging for something: attention, validation, research crumbs!
So the practitioner presenting this case, actually asked a great question…”do I put these patients on everything you’ve talked about as having potential efficacy in GS and set and forget?” The answer of course is no. But it is good to clarify. The bulk of the heavy therapeutic lifting is always the education of these patients – what choices they need to make and perhaps make differently to get the best out of their body. The non-negotiable for me, is the direct glucuronidation support which for me typically would be cruciferae based and then if needed glucomannan (I now use this as much as possible instead of Calcium D glucurate…missed the reason why?…check this out). The next treatment tier is dictated by how the GS principally presents for the patient in front of me: GIT – choose any additional treatments to work on this aspect of the disorder (motility agents, bile thinners, fat digestion support) or Psych: mitigating and managing the longer half life of both dopamine and oestrogen and the potential imbalances that ensue. Throwing the entire dispensary at these patients (like any other) is often unpopular…especially when we know this is not something ‘solvable’ so in fact we need to aim for sustainable instead.
But following this approach has brought so many of my patients long-lasting benefits and a far better experience of their health that they are super grateful for. Now that’s a happy note to end on 🙂
A Guide to Gilberts Package It all started way back when with ‘Gilberts Girls’…then came ‘Gilberts Guts’ because that is such a common source of unexplained hard to define gut dysfunction in patients…then latest instalment was news from the research frontier in Gilbert’s Syndrome, which is nothing short of thrilling, rewriting our thoughts on what medications and supplements (!!) are the most problematic, significantly improved dietary management of these clients, how to track their progress more accurately and why completely normalising their bilirubin is not the goal…hey did someone say…longer telomeres?! 😉 Included are kickass desktop clinical reference that comes with this months UU30 that aids a better understanding and clear treatment directives in your GS patients. All of these are combined for the newcomers in this Guide to Gilbert’s Package
A Guide to Gilbert’s package is 3 Update in Under 30 episodes combined into one
– Gilbert’s Girls; Gilbert’s Guts and Gilbert’s – New Goals & Good News.
If you are already an UU30 Subscriber you will already have access to these episodes in your ‘active content of your online’ account. Or you can purchase this complete package here
Have you been told somewhere by someone that the ‘perfect’ TSH is 1.5 mIU/L? This is a wonderful, terrible & wonderfully terrible example of ‘magical numbers medicine’. As a push-back against the published reference ranges we’re given, that are so wide you could drive a truck through them, there has been an over-correction by some, leading to the myth of ‘magic numbers’. We can narrow the reference range substantially for many parameters with good rationale, make no mistake about that but once we start setting ‘aspirational goals’ that are explicitly rigid…well we’ve done 2 things 1) forgotten about the patient to whom this result belongs and 2) disregarded viewing each result as part of a ‘pattern’, that we must piece together and make sense of.
Back to TSH then… if my obese patient had a value of 1.5 mIU/L this in fact would be woefully inadequate.
Also too low for any patient, no matter their size, if their T4 is low and we’d like a higher value as well for risk minimisation in our elderly clients too.
But the same result would be excessively & worringly high in my patient who’s undergone thyroidectomy.
Being given a list of ‘magic numbers’ will never replace learning labs correctly. When we do this, we come to truly know that meaning can only be made of the markers when you can answer the following questions:
What is this (metabolite, analyte, binding agent, plasma protein etc)?
What do I know about its physiological and biochemical context – what is its role and regulation in the blood, what moves it and to what magnitude?
How have the reference ranges been determined for this lab – who am I comparing my patient to?
Therefore, what is the significance of a result that is: ‘normal’, ‘low normal’, ‘high normal’, below or above the range?
Does this value ‘fit’ with my patient?
What else could explain an unexpected result?
How strong is my level of evidence?
What do I need to do from here to confirm or refute this?
And a few more 😉
Realising the full value of any test result in terms of what it reveals about the person sitting in front of you, requires these skills. Unfortunately, in contrast a list of magic numbers will often lead you astray. And building your scientific knowledge about labs will not only help you avoid the pitfalls of pathology but will strengthen your pathophysiology prowess in surprising ways, saving your patients a packet in terms of additional extraneous testing and help you truly personalise your prescriptions…because the ‘invisible (biochemical individuality, oxidative stress, genetic probabilities, subclinical states, imbalanced or burdened processes etc) just became visible’. I started requesting lab results early in my career and years later was lucky enough to be taken under the wing of Dr. Tini Gruner. I found some of our shared notes, from 10 years ago, scribbled all over patient results recently and I was struck by just how lucky I was to have her encouragement to really pursue my interest and how she was a guiding force about learning to recognise pathology patterns over single parameters. A decade on I can confess, much of clinical and educative success has come off the back of this foundational skill-set and I know, this is true for so many I’ve taught too.
“The guidance I’ve received over the years from Rachel in relation to pathology interpretation has been one of the most valuable (and fascinating) investments I’ve made as a clinician. Her teachings have filled gaps in my knowledge base I never knew needed filling and have significantly enhanced my understanding of the inner workings of the body! Rachel has an incredible ability to make the numbers that patient’s so often present us with, both understandable and clinically meaningful. The knowledge I’ve gained by investing in this skillset has paid off in dividends and I’m certain will continue to do so into the future.”
Stacey Curcio – Cultivating Wellness
I hope you’ll join me for the most exciting up-skilling opportunity in learning labs yet. Oh…and all this talk about thyroid testing..that’s just a serving suggestion 😉 this year my MasterCourse is focused on the most routine labs of all: ELFTs, FBE, WCC, Lipid and Glucose Panels…an absolute treasure trove of free integrative health information about your patient!
This skillset has been found by many to be biggest ‘game-changer’ in Integrative Medicine!
There are limited places. To sign up for the MasterCourse: Comprehensive Diagnostics click here. For more information about the program click here.
Sometimes I think I must be psychic..or is that psychotic? Don’t answer that, it’s a bad Byron Bay in-joke. I had literally just recorded my Update in Under 30 Copper in Kids and this excellent new study was published that same week, assessing and comparing trace minerals in age-matched ADHD and neurotypical kids. Snap! ✨ First, a moment of panic…because believe it or not, there are very few rigorous studies that have looked into this and so I had already read them all cover to cover and could confidently say, I had a grip on the literature. Gasp…’ will it have a different finding and challenge the much broader story about the excessive demonising of this mineral in kids health?’ Everyone take a big breath out…no.
But if you’re someone who thinks you’re seeing Copper toxicity in kids, you can keep taking a big breath in and while you’re at it a huge bit of new information:
Copper Excess is Normal in Children.
Every investigation of blood Copper levels in kids has reached the same conclusion and this latest one by a Russian group of researchers renowned for their work in Copper agrees. So the ideas that we have about optimal in terms of mineral balance for adults may stand, but can not and should not be applied to children. The elusive 1:1 relationship between Cu and Zn, for example, considered aspirational in optimising the mental health of big people, is absolutely not desirable or even healthy, in little ones. Why is it so? I hear you ask (…because you loved those old Cadbury chocolate ads with the crazy Professor as much as I did) Well, essentially because kids need more Copper than us, as a simple result of their increased growth requirements: blood vessels, bones, brains…Cu is a critical player in them all and more. And while we (and when I say ‘we’ I mean ‘I’) may be passionately passionate about Zinc’s importance, turns out, in paediatrics, it really does play second fiddle to Cu and should.
This new contribution to the Cu & Zn in ADHD kids debate did find that compared with neurotypical kids, their Cu:Zn was higher BUT – **and this is the really important bit **- as has been shown in a similar cohort before, the shift in relationship between the two was due in fact to lower Zinc levels NOT higher Copper.
So, I guess when you think about it…Zinc perhaps really does still deserve all our loving attention we give it 😂…we just need to rethink the whole negative attention we tend to mistakenly give Copper!
Copper, as a kingpin in angiogenesis, brain & bone building & iron regulation is a critical mineral during paediatric development. So much so, the kind of blood levels we see in a primary schooler might cause alarm if we saw them in an adult. So too their Zn:Cu. But higher blood Copper and more Copper than Zinc are not just healthy but perhaps necessary during certain paediatric periods. This recording redefines normal, low and high with a great clinical desktop tool to help you better interpret these labs, as well as reviewing the top causes and consequences of both types of Copper imbalance in kids.
The latest Update in Under 30 has landed. You can purchase January’s episode, Copper in Kids here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
-Your RAN Online Account has a NEW LOOK!!-
Next time your log in, you will experience a more user friendly way to search, view, listen and download your resources. Find out what’s new here.
Earlier this year at a Mental Health Training for IM doctors, 3 practitioners (myself, a doctor & a psychiatrist) walked into a bar…not really, but we did each present a case study of challenging patient & in whom we had some great outcomes. All 3 patients presented happened to have Gilbert’s Syndrome. Just in case you’re wondering if there was a secret Gilbert Syndrome Conference you didn’t get an invite to, no. Or that perhaps there was premeditation and intention on the organisers behalf for a bit of sub-theme and focus, no. While this was purely coincidental it does speak rather loudly to a couple of things though.
Patients with Gilbert’s syndrome are likely to be over-represented in our client base especially among those presenting with psychiatric and/or gut issues (and both presentations frustratingly for them, very hard to diagnose, define, pigeon hole etc) and secondly, even though their genes underpin their biological susceptibility to such health problems, great outcomes are really possible.
One of the challenges comes from the medical dismissiveness of this genetic issue as simply ‘benign hyperbilirubinemia’. This has lead to a lack of diagnosis in patients affected and when it is incidentally picked up on routine bloods, a lack of follow up education about what having approx. 30% less phase 2 glucuronidation activity, in their gut and their liver, is really likely to mean, not to mention radically altered bile composition and digestion (!) and how they can make better choices in light of this. Similarly this year in our Mental Health Specialist Mentoring Group, the issue of reduced efficacy and tolerance of psychiatric medications, in those with Gilbert’s, raised its head over and over again. Given that so many drugs within the psychiatric class add at the very least to the ‘substrate load’ of the UGT system, if not frankly inhibit some members of this enzyme family, as this paper (check out Table 2…superb!) shared by my colleague, Kate Worsfold, points out, it actually shouldn’t come as a surprise.
But there is a change a’coming with an influx of research leading to improved understanding of this seemingly mercurial malady, resolving many riddles, identifying new key ways to help these patients and at last….some exceptionally good news for those with Gilbert’s.
For example, when I started this conversation back in 2013 with the Update in Under 30 Gilbert’s Girls, that was in response to seeing so many women at the time presenting with significant imbalances in both their sex hormones and their neurobiology as a result of their UGT impairment. But of course it was never meant to imply GS is just a girl thing! In fact there is a 3:1 dominance of men with this condition and some very good reasons as to why: more red blood cells and more testosterone…the former being the primary source of bilirubin and the later a terrifically powerful UGT inhibitor. The news from the research frontier is nothing short of thrilling, rewriting our thoughts on what medications and supplements (!!) are the most problematic, improved dietary management, how to track their progress more accurately and why completely normalising their bilirubin is not the goal…hey did someone say…longer telomeres?! 😉
The latest Update in Under 30 has landed: Gilbert’s – New Goals and Good News and my team has gone all out in producing a brilliant desktop reference to go with this recording that aids better understanding and clear treatment aims for your GS patients.
You can purchase Gilbert’s: New Goals & Good News here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
**But if you’re just joining us & this important conversation now,
ideally get the basics and backstory first and purchase all 3 key episodes in ‘A Guide to Gilbert’s Package’
-Your RAN Online Account has a NEW LOOK!!-
Next time your log in, you will experience a more user friendly way to search, view, listen and download your resources. Find out what’s new here.
I take my job to heart. When someone asked me recently to choose the single value that spoke most to me personally I couldn’t seem to go past, ‘Purpose’. I feel very honoured to have contributed to the learning of so many health professionals in their undergraduate and so many more in their professional careers following graduation and I know that with this comes huge responsibility. Second on my values list (again, possibly unsurprising) is Empowerment & coming in with a photo finish at 3rd:Integrity. Discernment and critical thinking (about information, about research, about reflective practice) are perhaps the eggs in this souffle, helping us all to rise up.
As part of our critical thinking we need to accept a few truisms:
Research changes Experience changes Knowledge changes
Information is not static. So we need to ask ourselves, how long ago did I learn this? How long since I’ve checked it is still correct? And just because perhaps this information came out of the mouth of our mentors or teachers, makes it no less up for regular review. I’m trying to undertake these internal audits on a regular basis. Typically they’re prompted by bloody good questions my mentees have asked me. A question I can’t answer or, more to the point, I can’t answer with full confidence I’ve double-checked my old beliefs and understandings against new evidence recently…these almost always provoke a lost night of sleep for me. Not from sleeplessness per se but due to immersing myself in the latest research and performing a mini informal lit review, bringing out all my old beliefs/evidence etc. Marie Kondo style and asking do they still spark joy✨ (in light of the latest evidence)?! And yes sometimes there’s a little bit of heartache when you have to let your old tightly held beliefs and understandings go 😢
The 1st update is about N-acetyl cysteine. Some of you may have heard me previously question the efficacy of the vegan form. Now that all but 1 Australian product is vegan, produced from bacterial fermentation or purely synthetic, I was wayyyyyyyy overdue to check the validity of my old ideas. Let the record show, I was wrong. Unlike some other nutraceuticals like chondroitin sulphate, wherein the source radically changes the overall structure of the molecule and therefore its uptake and actions – the same is simply not true for NAC.
So those ducks, & their NAC rich feathers, can all sleep a little easier at last…phew! Now the 2nd internal audit well that did cause some tears for me…
We often identify patients who could do with a little glucuronidation first aid: marked dysbiosis, Gilbert’s syndrome, oestrogen excess, cancer risk (especially bowel, breast & prostate) and one of our nutritional go-to’s has typically been Calcium D Glucurate. While there is ample evidence that one of CDG’s metabolites: 1,4 GL – inhibits beta-glucuronidase, is an antioxidant, platelet activation inhibitor and generally all-round good guy to have onboard, new research strongly challenges that oral CDG will convert to this at levels sufficient to support this detoxification pathway. Sounds like we’re overdue for an update on this supplement and when and where it might be useful in addition to how to find the real deal in real food!
For all those Mentoring Virgins 😇out there wanting a clearer understanding of what it’s really like to be part of my group mentoring, this video is a little snippet from a session with one of my groups. This year has flown by and I have thoroughly enjoyed working with each fabulous group of dedicated ‘life-long learners’.
OH YES!!…and the real announcement is…..(drum roll)… It’s that time of the year….Applications open next week for GROUP MENTORING in 2020!
As a result of the generous feedback and insights from our current Mentees, we are always fine tuning our program & level of service. Yep…it just keeps getting better and better every year!! We are keeping everything that so many practitioners have told us they love from the past 7 years (wow….have I been doing it for that long?!) and simplyimproving the already incredibly popular formula, with some great new features for 2020.
New 15min Follow up with one on one with me! via Zoom for those cases that have been presented in our group mentoring sessions. This is a brand new format to follow up on how your client is going after the session – what’s working, and what’s happening now, what should you do next? Rachel will spend 15 mins with you on Zoom 1-2 months after you presented your client case. The recording will then be uploaded to Basecamp so the whole group can catch up on the progress and extend our learning opportunities again.
We’ve expanded our mentees 30% discount to ALL Rachel Arthur Nutrition products on our website for 2020.When you join the Group Mentoring Program, you will receive a discount code that you can use for any and all purchases on Rachel’s website throughout 2020– the Update in Under 30 subscriptions, Audio and Video recordings, Packages on Pathology, Thyroid, Iron.
Certificate for CPE Hours– we’ve done this for the last 2 years and will continue to do so to make your CPE easier at your end
General and Specialist Groups – we’ve had a great response to our specialist groups this year, and we are offering these again in 2020, so you can choose from:
General Group Mentoring–our regular case presentation groups, with practitioners taking turns to present a case, or just listen in. Yes, this ‘fly on the wall option’ which we’ve come to learn is preferred by some praccies (due to a lack of time, good cases or confidence) is finally getting formalised for 2020!
GP dedicated Group – this depends on our final numbers of applicants for 2020. This year we had a combined group of GPs and naturopaths with advanced standing, which has worked well. Either way, we have a good track record in catering to the needs of doctors, medical specialists and dual qualified naturopaths (osteo, psychology etc).
New Graduate Groups – great opportunity for New Grads to build confidence as they leap from student to practitioner, or for practitioners wanting to refresh their core clinical skills such as MindMaps, Pathology, Improved Case Taking etc.
Mental Health Primer Group – topic based to build on your knowledge in the role of naturopathic medicine in Mental Health – from screening tools to key management issues, specialist diagnostics and beyond.
Mental Health General Group Mentoring – practitioners presenting their client cases with a focus on primarily Mental Health presentations.
“I believe the mentoring you are offering is allowing me to develop myself into the type of practitioner that I want to be.
I really aim to provide evidence based treatments, and wish to utilise pathology testing results as one of the major diagnostics in my practice. I can see that every mentoring session with you brings me closer to that, filling my knowledge gaps every time. You and your knowledge base is so inspiring, and I only hope that one day I will know close to some of what you know!” – Andrea Robertson
And don’t forget some of the offerings our Group Mentoring consistently delivers as part of your program – the opportunity to learn every month via high level applied knowledge not theoretical and to see it in action with tracking and updates on patient progress, our incredible online resource sharing platform for communication and support between sessions and the opportunity for sharing of pearls of knowledge from my 20+ years of experience and research together with the collective wisdom and know-how of each unique group.
“I am one of Rachel’s New Grad mentees. My first year out has been pretty overwhelming and I wanted to let Rachel know that I have been watching the zoom sessions and have learned so much to take my clinical confidence and practice to the next level. She has an amazing gift of nailing the important aspects of practice and giving useful usable information that brings together the fuzz of everything you have learned and ties it all up with a neat bow with her pearls of wisdom every month. I plan to be a mentee again next year (and for many years I suspect)” – Bek Di Mauro
REGISTRATIONS OPEN 14 October!
To read more about the program click here. Information on how to apply will be released on 14 October. Join the waiting list now so you won’t miss out by sending us an email on email@example.com.
There I said it. It was always going to happen. I’m ok, thanks for asking. This week we had a case of a woman diagnosed with MS in her late 20s. That was 5 years ago and she’s been medicated ever since with an immunosuppressant and she is understandably very nervous about taking any complementary medicine that would pull against this medication, interfering with its actions. Her concerns extended to zinc supplementation in spite of her plasma zinc being 7 umol/L. That’s right, 7. Zinc STAT, right? But slow up there everyone, her apprehension is not necessarily unfounded.
The top nutritional research topics in MS are: Vitamin D (for der…we all knew that, right?), Vitamin A and Zinc. The fan-mail for the first two, as key immuno-modulators in both prevention and in established conditions, is almost at stalker level.
In contrast Zinc attracts both fan and hate mail.
Although the jury is far from in, there’s growing concern that while extracellular levels of Zinc may appear low in MS (that includes of course plasma/serum values) the same individual may actually have elevated levels inside their cells and more specifically inside their CNS.Gulp. But wait there’s more. There is a hypothesis that Zinc dysregulation may be a pathophysiological driver in MS. Double Gulp. My (nutritional) soul mate has shown a potential dark side finally and is sitting under a cloud of suspicion. So what do we need to do differently?
And specifically in regard to Zinc status in your MS patients? Well my advice is don’t rely on a plasma/serum Zinc alone – but couple this with an rbc Zn to ensure there is no sign of intracellular accumulation at play before you make a decision about treatment. Not a perfect solution, but while we’re unlikely outside of research to ever be able to measure CNS zinc concentrations, a reasonable approach. An unchecked zinc deficiency is in no-one’s interests either, including your MS patients – so it’s about gathering the best quality information you can to walk that fine line of adequacy not excess. And if you’re still reeling at the very thought that Zinc has a dark side – remember I did warn you…in Mastering Micronutrients – which is essentially a series of truth-bombs one of which, is every nutrient has a sting in its tail, a U-shaped dose response and a dark side. We need to get to know them all.
Let’s make sense of the over-arching nutrition principles, that will profoundly change your understanding and application of this modality Truly understanding the ‘big’ concepts, so often overlooked, or incorrectly taught, ensures you get the critical ‘small’ detail in your nutritional prescriptions right. In this 4 hour recording, together with key clinical tools, we talk about the tough stuff: dose-response curves, active versus passive stores and excretory pathways and ooh lah lah…the myth of taking ‘activated vitamins’. Even those who feel satisfied with their original training – will find a lot in this critical review that is new, insightful and truly practise-changing!
Tonic. Homeostatic modulator. These terms and concepts, which have a long tradition in herbal medicine (and let’s be clear, were considered yet another example of the wishy-washiness of the modality) are being appropriated by some areas of mainstream medicine right now. Cheer up ‘leaky gut’, you’re no longer alone! And arguably misappropriated by the public’s very ‘lay’ interpretation of the science on medicinal cannabis and its subsequent elevation to panacea, of late.
“So many of my patients are telling me they’re taking Cannabis now, just as a tonic”, says yet another practitioner to me recently, “No, not for pain, they’re young and fit but they take it because it’s a homeostatic regulator!!”
The capacity to maintain homeostasis, and particularly in the face of adversity or imbalance, is a sign of the vitality of the individual, according to what I remember from naturopathic philosophy (and have truly taken on and observed firsthand)…so just back up there a tad and explain to me how this one herb proposes to do this for everyone on a one-size-fits-all-fashion? As confessed in an earlier communication, I am a cannabis convert. But only in the sense of appreciating the niche areas where it is likely to offer true therapeutic benefits. I still have the words of warning from the brilliant Professor Michael Lintzeris, the Director of the Drug & Alcohol Services, South East Sydney Local Health District; Conjoint Professor, Division of Addiction Medicine etc., ringing in my ears, pleading with health practitioners to not ‘fall’ for cannabis in the way we have previously ‘fallen’ (so far and landed so badly) for the panaceas of the past: opiates and benzodiazepines. Most notable major omission for me, in an otherwise rigorous scientific debate of late, is any discussion about its potential for impacting fertility.
There is in fact evidence to suggest ‘sperm under the influence’…’lose their way’ and are less effective at finding and fertilising the egg. Sorry but the image always makes me chuckle…stoned sperm. ‘Hey, dude where’s my egg?!’ style. But it’s not funny when impaired fertility is a problem affecting so many these days, and we still are guilty of over-focusing on ‘her’ and under-assessing ‘him’…and lo and behold it could be his chronic cannabis use to blame. We had a case recently, years of unprotected sex, daily cannabis, no baby, no dots connected. We may think this is a handy incidental contraceptive for young men sitting on couches with cones (one mum recently said as much to me) but for the rest…?
As practitioners we should know as much about investigating and treating male hormone imbalances as we do female ones, yet this is often not the case. While we are increasingly aware of everyone’s exposure to lifestyle & environmental endocrine disruptors and the fragility of the HPO axis, we sometimes fail to recognise that the reproductive health of our male patients is equally under threat. This is clearly demonstrated by generally diminishing levels of testosterone amongst men and increasingly early onset of andropause. These issues then become barriers to achieving success in other health areas with your clients, mood, metabolism, fertility and beyond. Learn more here
I’d love to continue this conversation with you… so join me and be part of my ongoing dialog on this and my other blogs by following my Facebook page.
Following an important weekend of discussing mental health from a more balanced perspective (that’s my new less provocative term for ‘integrative’ or dare I even mumble…holistic) in Perth for ACNEM, I remain alert but not alarmed of how much is still to be revealed in this area. Recently, for example, in our mental health dedicated mentoring group, we discussed a case of a somewhat atypical schizophrenia presentation in a middle-age female migrant. Fortunately, I co-chair these sessions with an incredible clinical psychologist who was quick to pick up that no CNS auto-antibodies had been tested, and given the peculiarities of the case they should have. This is a relatively new area, in terms of more mainstream acceptance of this as a differential in some psychiatric presentations and provision of these tests now through mainstream labs, but it would appear it is far from common knowledge. Then I read this brilliant article and…well I think we all need to read it. Here are some snippets…
“Scientists had previously noted that certain autoimmune diseases, such as lupus, were associated with psychosis. And they’d begun to suspect that some infections might, by activating the immune system, contribute to psychiatric conditions. But Dalmau provided meticulous proof that the immune system could attack the brain. The development of a test for the disorder, and the fact that very sick patients could recover with treatment, prompted a wave of interest in autoimmune conditions of the central nervous system. In total, scientists have identified about two dozen others—including dementia-like conditions, epilepsies, and a Parkinson’s-like “stiff person” syndrome—and many experts suspect that more exist…
Robert Yolken, a scientist at Johns Hopkins University, estimates that about one-third of schizophrenics show signs of immune activation (though he adds that this could be related to other factors, such as smoking and obesity). And autoimmune diseases are more common among schizophrenics and their immediate families than among the general population, which could hint at a shared genetic vulnerability.”
There are some potent practical take-homes in this article embedded especially within the story of an 11-year-old boy who was admitted to hospital with profound psychiatric features – initially misdiagnosed and managed as BPAD and later found to have autoimmune encephalitis. First and foremost: psychiatric conditions develop gradually. When there is an acute onset in the absence of an acute trauma – the possibility of a biological (esp autoimmune) driver should be elevated in your differentials. And the mother of this boy, now aged 21 and having undergone 5 relapses and recoveries in between, virtually echoes the thoughts and findings of Carl Pfeiffer half a century ago, when she says, “Too often, psychosis is seen as the disease itself but psychosis is like a fever, it’s a symptom of a lot of different illnesses.” Important for thought.
Could dairy intake in susceptible individuals be a risk promoter for mental health problems? In addition to evidence of the exorphin derivatives from certain caseins interacting with our endogenous opiate system discussed in part 1, we now look at the evidence in support of other milk madness mechanisms. Specifically, the IgG and IgA antibodies about what this tells us about the patient sitting in front of us about their gut generally and about their mental health risks, specifically. The literature in this area dates back to the 1970s but the findings of more recent and more rigorous research are compelling. Find out more here.
I was at the Medicinal Cannabis (MC) in Mental Health Conference run by GHI on the weekend and I have to confess, I inhaled. Seriously, deeply, inhaled. Just as I had hoped, this was a very high level of information on this important topic, delivered by outstanding presenters: from authorised Australian MC prescribers, to the head American researcher of the largest MC trial to be run in psychiatry – from brilliant pharmacognosists whose every day is spent immersed in complex cannabis chemistry to our very own national (naturopathic) treasure, Justin Sinclair. I left there with thousands of words typed into my laptop, and about a thousand more in my brain, spilling out onto anyone who stood still long enough. Ahem…thank you my dear tolerant family & friends 😉
Let’s be clear. I am not in a position to prescribe medicinal cannabis. Nor do I want to, right now. But like me, patient purchases off the green market in response to DIY diagnosis and prescribing are on the up and up. I have felt concern and apprehension about this but not known enough to engage in any conversation. Now, watch out… I’m finding my words!
I left the conference with a much clearer sense of the patients and presentations for whom it may prove medicinal – most obviously for those conditions outlined in the WHO review including nausea and vomiting in cancer and pain refractory to other analgesics. In addition to this, we were privileged to hear from a mum and son who have had to employ cannabis for the last half a dozen years following his diagnosis of an inoperable brain tumour, that originally robbed him of his literacy, his joy of reading and his overall quality of life, with high frequency seizures and intractable vomiting etc. MC has remarkably given much of this back to him. And I remain optimistic about future potential uses in psychiatry – especially within certain PTSD cohorts thanks to this small but promising study by Greer et al in 2014. Inspired by this paper and her extensive experience treating war veterans with PTSD, Dr. Sue Sisley, who spoke at the conference, executed a similar study of 6000 veterans for a MC inhalation trial. I’ve got a spoiler for you…the study failed – publication pending.
But before you add 1 + 1 and get 3.879…let me tell you, there is nothing as powerful and revealing as hearing researchers talk firsthand about their trials. When Sue put up actual photos of the medicinal cannabis they were supplied with for this study…the room collectively let out a giant Gasp!
It was brown, full of stem and…wait for it…mould. Yup. But that is what they, and as Sue poignantly pointed out, & what every other group of American researchers who run studies on MC as opposed to synthetics or extracts, have to use. So…are any negative outcome a surprise? No. But it will no doubt be interpreted as a sign that we shouldn’t pursue research in the area of MC and PTSD. We should. Have I completely ditched my concerns about negative mental health impact from cannabis? Absolutely not. And Professor Michael Lintzeris, the Director of the Drug & Alcohol Services South East Sydney Local Health District; Conjoint Professor, Division of Addiction Medicine etc., spoke eloquently & comprehensively to this inherent duality of this herb in this regard. Even the most isolated and lauded (non-intoxicating) constituent of cannabis can be both help and hindrance to anxiety and depression sufferers and most clearly, Michael warned us not to make MC the opiates and benzodiazepine panacea promises of the past, buying the rhetoric of ‘no tolerance, no dependence, no risk’. How each individual’s mood and mental state responds to MC, whole plant, extracts or isolated constituents, from anxiogenic to anxiolytic and from depressant to antidepressant, has been clearly demonstrated to differ according to genes, ‘endocannabinoid tone’, route of administration and dose. Seems like all roads lead to an individualised health care approach & prescription…yet again 😉
Need a road map to think your way through the integrative work-up of your Mental Health patients?
In Mastering Mental health: New Assessments & Management Resources in your Clinic, Rachel introduces you to new clinical tools that she has been developing to help us all better master the maze of mental health. With so many possible biological drivers: from methylation to inflammation and from gonads to gut, these tools can help you quickly identify those most relevant to each patient and also outline the strategies necessary for redressing these. This presentation comes with an extensive library of resources including pdf of Assessments Tools and Case Study Notes.
Breaking up is hard to do (sounds like the name of a song!) but it shouldn’t be! I got an email this week from one of my gorgeous long-term mentees in the vein of a ‘Dear John’ letter. She carefully, beautifully gently let me know… “I’ve found someone else…”
“This is not an easy decision as I have major Rachel Arthur FOMO and visions of my knowledge falling down a deep crevice and never coming back. My motivation for this decision is related to my strong interest in women’s health. I have an increasing number of complex cases around this topic and have sought extra mentoring and I am turning into a mentoring junkie. Now there is nothing wrong with this in theory and a recent post you did about all the mentoring you do and mentors having mentors I saw as sign to keep on seeking mentorship but again that was the RA FOMO speaking… Anyway, I have struggled with the perception this might relay – that I think I’ve got it all covered and I simply don’t but I do think this is the right thing for me at this time.
Thank you Rachel for the exponential help you have provided me since I started mentoring in 2017 and for the level of knowledge and commitment you bring to our profession. I am truly grateful and proud to have been a RA mentee.”
This email really made me really smile – how can this not be good news??? This type of letter or break-up email can have the sender feeling a bit apprehensive about a possible negative response but as I read the email I couldn’t suppress a smile from ear to ear! Not because I’ve got one less person to mentor and more time for lazing around Byron’s beaches with all the instamummies 😉 but for me there was nothing but good news in this development… I love witnessing this practitioner’s growth, their movement into a new field of specialisation and I celebrate this decision. I still have my own mentors…and not just one by the way, but several due to the expertise of each – mental health; herbalist; heavy metals etc. It’s always about finding the best brain’s trust for the job at hand.
I want everyone to find their best mentors to support them in each & every stage of their career
as an integrative health practitioner.
Over the years I’ve received amazing feedback on my mentoring services and often the misperception that my knowledge infinite! Yes I am a journal junkie and I do have 20+ years practice under my belt but…I believe a good mentor has their own mentors. Your mentors may change over time to strengthen different muscles or skill sets and it’s knowing where to look for answers, how to always apply critical thinking and developing your own brains trust tha.
Rachel’s hugely popular New Graduate Group Mentoring, which launched this year, is designed to help anyone who wants support transitioning from student (or lapsed practitioner!) to Naturopathic or Nutrition clinicians with a difference! This online 11 month program is a great way to develop your confidence, skills and knowledge. The bonus with these sessions is you’ll find your tribe, gain support and radically build your toolkit. Applications for 2020 open in October – you can put your name on our wait-list now for this and all other groups by emailing us at firstname.lastname@example.org.
Those ‘still-believers’ look away now. One of the great myths, misconceptions and misunderstandings in nutritional medicine is that supplementation with specific nutrients will produce change specifically in one system, or pathway, which just happens to be the one that the practitioner has determined would benefit most/is targeting. Let me explain myself a bit better. When we give patients any nutrient, in the cases where it’s not simply to correct a global deficiency & therefore improve levels all round, it’s typically on the basis of a specific desirable therapeutic benefit, e.g. some magnesium to help their GABA production…, additional B3 would improve their mitochondria. Beautiful on paper…but like sending a letter to Santa in reality (I did warn you!)
Truth Bomb No.1: There are nutrient distribution pecking orders that have nothing to do with who you ‘addressed’ it to
This dictates that when something is given orally, for most nutrients, the gut itself has first dibs. So the cells of your digestive tract meet their needs before any other part of your body gets a look in. Sometimes the digestive system’s needs can be quite substantial and leave little for any other part of the body…not mentioning any names (ahem) Glutamine!
Truth Bomb No.2: En route to the ‘target’, these nutrients get delivered and distributed to many other tissues – with possibly not so desirable or intended effects!
You may determine that a patient needs iron because their ferritin hasn’t got a pulse…so you keep giving them daily high dose oral iron to ‘fix’ this…not realising you’re making their GIT dysbiosis and gut inflammation worse in the process. Or you feel their mysterious ‘methylation cycle’, happening predominantly in the liver and kidneys, could do with a folate delivery…perhaps ignoring the very worrying fact that their colon may have already had a ‘gut full’. Literally. Hence the concerns and caution against supplementing with folate in patients with established colorectal cancer. So is bypassing the gut via IM or IV nutrients the answer…well yes and no…but mostly no. Read on…
Truth Bomb No.3: Those pathways that use the nutrient you’re supplementing, that are most active in the patient’s body currently – which is determined by many factors (genes, physiology, feedback circuits, pathophysiology) and rarely simply by the availability of nutrients – will take take the next lion’s share of that nutrient
Wanting to nutritionally support someone’s thyroid, you know tyrosine is the backbone of the thyroid hormones, so you include this in the hypothyroid prescription. Will it help? Who knows? Being a non-essential amino acid the body exhibits very complex regulation of its distribution and use – with thyroid precursor availability being only one job on a very long list! And if this was in a patient who is regularly smoking cannabis, due to upregulation of the tyrosine hydroxylase enzyme – there is likely to be more of the supplement headed for even more dopamine production and very little or none reaching in fact your intended target. And don’t get me (re)started on Glutamine – supplements of which in an anxious and glutamate dominated patient will make…G.L.U.T.A.M.A.T.E…right…not GABA! 🙁
Sorry, I know, it hurts right? But these are essential teachings, that tend to have been over-looked or under-played I find, in nutrition education, regardless of training: nutritionists, naturopaths, IM doctors, dual qualification practitioners remedial therapists. Nutritional medicine is a wonderful and potent modality when it’s done well…but we need to revisit some core truths and principles that many of us have missed out on, to ensure we’re not writing letters to Santa.
Let’s start with Micronutrients. Let’s talk make sense of the over-arching nutrition principles, that will profoundly change your understanding and application of this modality Truly understanding the ‘big’ concepts, so often overlooked, or incorrectly taught, ensures you get the critical ‘small’ detail in your nutritional prescriptions right. In this 4 hour recording, together with key clinical tools, we talk about the tough stuff: dose-response curves, active versus passive stores and excretory pathways and ooh lah lah…the myth of taking ‘activated vitamins’. Even those who felt well trained – will find a lot in this critical review that is new, insightful and truly practise-changing!
When I was studying my under-graduate I imagined my clinic was going to be full of them: well patients wanting to maintain or even improve upon their wellness. Turns out…not so much…all the really really sick people have taken their spots and the former has been listed as an endangered species. But I do catch glimpses of them, as I am sure we all do, in their natural habitat, with over-flowing baskets at the organic grocery store or farmer’s market, routinely up the front of the pilates class and also sometimes in our clinics. So now that naturopathy, by consumer demand, not practitioner intent, has transitioned so much into the ‘unwellness space’, do we know anymore what to do with the well ones??
I heard some great talks at the NHAA conference recently. One, in particular, was by my stellar colleague, Liza Oates, who observed that contemporary naturopaths tend to respond to these clients in 1 of 2 ways:
a) Unaccustomed to a patient who eats, exercises, sleeps and balances their work & non-work worlds better than themselves…PANIC…
b) Dig deep back through the dusty archives of their personal & family medical history until they FIND A PROBLEM THEY CAN TREAT!!! such as, ‘Once I was constipated for a couple of days’ or, ‘Once I took a course of antibiotics’.
I know…we’re hilarious…we have to laugh at ourselves 😉 Liza offered up some great ideas about how to approach our consults with these patients. Many of her tips, however, could be applied to the rest of our patients as well to gather some really valuable insights. And it’s always great to hear from someone who has been seeing patients over decades…there’s so much to be gained from those who’ve gone before us (or alongside us…in my case!) and can speak to these firsthand lessons. Here are just a few of her pearls
The ‘not stressed’ patient
We encounter a lot of people who can misreport their stress levels, not because they are trying to lead us astray but that’s that slippery slope of self-reporting & the possibility that someone has normalised their ‘load’. Liza says she likes to step away from that potential trigger word, ‘stress’ and instead ask, ” What are your tell-tale signs when the demands exceed your capacity?”
This is not so that we can fulfil option b) mentioned at the beginning…digging desperately to find some unwellness to treat – but rather as an aid for both practitioner and patient alike to understand better that individual’s response to their psychosocial environment.
Ask them to design their own health retreat
If they reply, “I would start every day with a little meditation and yoga, a chai and then a healthy hot meal”, then these can be translated into little goals we can set to bring some of their ‘best self ‘ into their every day. It also helps to better understand their values, individualised self-soothing and self-care & great prescriptions to begin with, given they’re telling you they are already at contemplation in terms of their readiness for behavioural change. They’re not going to require too much convincing – they’re already converts they just need permission and support to implement.
And if you’re sitting there reading this and thinking, ‘Hey! These are exactly the patients I want my clinic full of”…then to hear more of Liza & Greg Connolly’s commentary and insights about how the wellness space has been hijacked by others and how naturopathy needs to move centre-stage in this increasingly popular trend, take a listen to this interview they recorded at the conference.
This UU30 recording from our back catalogue on the behavioural change model and how it impacts patients’ response to our advice is a key element in developing a professional approach that actually works. Unless practitioners are aware of the way that patients approach changing their dietary behaviour or exercise regimes, they the mystery of non-compliance will never be solved!
Hear Hear…on all levels, right. But this is actually the first recommendation of an easy to read patient resource for families dealing with adolescent depression, that you and your patients can access here. As lovely as the picture above makes parenting look, the one to one (or even 2 to 1) ratio isn’t realistic or necessarily optimal for anyone. I think we can all make a great addition to any parent’s team, especially given the emphasis these recommendations place on nutrition, sleep and exercise as being central to improving mental health…full-stop..and in this age group.
But while some things are the same between depressed adolescent and adults, there are important differences we need to be aware of: like the best assessment tools and the barriers for teenagers (and parents) in admitting there is an issue. Think, parent guilt and over-attribution, standing defiantly on the top rung of that ladder!
They also mention different types of therapy for this age-group and I have to say the old CBT…oh yes it gets wheeled out yet again…really does offer something, given the kind of kids I’ve seen this work a treat on. This is a developmental staged characterised by curiosity and a desire to understand more about the real stuff of life…rather than the soft focus lens we got them to look through in primary school. I’ve seen teenagers benefit enormously from sitting with a good psychologist or GP who can explain the ‘brain mechanics’ of depression, or anxiety (amygdala activation that sends the frontal lobe executive control offline etc). They love the demystification and, in the best cases, feel re-empowered by this knowledge. Not perfect for every teenage but it does work for many. And then there’s the parental advice to discuss suicidal ideation.
Yes parents, even more than practitioners, fear the ‘planting of seeds’ when contemplating this topic with their teens but the opposite is true. This paper is hot on the heels of an editorial, revealing that 50% of parents were unaware of their teenager’s suicidal thoughts.
There is much to be gained from the ‘knowing’ and so much to lose from avoiding this one. It’s the beginning of another school year (at any level) and with this can bring significant stressors and provocation for mental health challenges. Let’s encourage every parent, to get themselves a team and take our own place in that invaluable roadside assist crew.
This is a succinct recap of the many investigative paths we need to follow when presented with kids or teenagers with behavioural disorders. From grass roots dietary assessment through to the key pathology testing that is most helpful in clarifying the role & treatment approach of integrative nutrition for each individual child.
So you’ve gone to all the effort. Be that writing referral letters suggesting some pathology investigations might be warranted or you’ve coached your patients endlessly to get copies of ones done elsewhere so that you may be privy to their findings. Worse still, you’ve directly requested the pathology, with your patient paying out of pocket for the tests. Then the results come in and they look…well wrong. You, as the conscientious clinician, typically do 3 things:
Step 1 Spend hours pouring over & over the labs and back over the case notes
Step 2 Worry about the new differential diagnoses that are now suddenly seemingly a possibility in your patient. It doesn’t look good.
Step 3 Doubt your own pathology reading ability, ‘Hey maybe I just don’t understand these bloods like I thought I did’
But (often)…it’s not you, it’s them.
And that’s what I often explain to practitioners who contact me (step 4). You see sometimes what they’re losing sleep over are what I call, Bad Bloods. Occasionally, the fault of the pathology company…but way way way more often the fault of the patient and the referring practitioner, who has not educated the patient correctly about what to do and not do prior to blood collection for certain tests. I am excited to see how many practitioners are competent with pathology reading these days and building their skills and confidence all the time, that’s why it is so so disheartening for the practitioners (and for me as a mother hen mentor) when they lose time (& sleep) getting to Step 3 when they should be able to spot ‘Bad Bloods’ fast. There are 7 classic give-away patterns.
Will are unlikely to know every quirk of every blood test our patients will ever have done, but knowing what constitutes the ideal time and conditions for the most commonly performed ones, can go a long way to minimising any future Bad Bloods between you and patient as well. This includes things like exercise, alcohol intake, duration fasting and even sexual intimacy…yup!
This month’s Update in Under 30 installment Beware of Bad Bloodsteaches you the 7 patterns to watch for and provides you with a great resource stipulating the best collection conditions for the most common blood tests. Don’t let Bad Blood come between you and your patient, the right diagnosis & management or just some well-deserved sleep!
Good practitioners are being led to bad conclusions by some patients’ pathology results. Not because they can’t interpret them or the testing has no merit but because they just don’t know when to discard a set because they are ‘bad’. Occasionally, the fault of the pathology company but much more often the fault of the patient and the referring practitioner, who has not educated the patient correctly about what to do and not do prior to blood collection for certain tests. This recording clearly describes the 7 classic give-away patterns of ‘Bad Bloods’ which will enable you to spot them fast in the future. In addition to this. while we are unlikely to know the idiosyncrasies of very lab our patients will ever have done, knowing the ideal collection times and conditions for the most common ones assists you and your patients to avoid any in the future – handy clinic resource included.
Well who’d have thunk?! I had no idea cigarettes contain sugar and turns out about 95% of smokers don’t either, according to this recently published article! Now while we’re not purporting this is going to be of caloric significance enough to prove a deal-breaker for the ‘I Quit Sugar’ devotees and others watching their waistlines 😉 its presence in cigarettes is far from benign for other reasons…
“Sugars naturally occur in tobacco leaf but are also commonly added to cigarettes by tobacco companies.
Added sugar increases levels of toxic chemicals in cigarette smoke. “
Never mind that we have a long list of much more terrifying chemicals more commonly known by smokers to be found in their affectionately-named, cancer sticks! Maybe our current overwhelming fear (for some!) of sugar might be the great tipping point in their decision-making process?! I’m not sure but it’s worth a try…one final factor to build on the already impressive impact of our anti-smoking public health campaign here in Australia? I still meet clients who eat ‘organic’, regularly do pilates or yoga but still confess to slipping in ‘social ciggies’ on the side, – do you?! So for this popular patient paradox anything is worth a try…perhaps tell them about the sugar! 😉