Countdown is on for 2021 Group Mentoring

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 a total 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 admin@rachelarthur.com.au.

The Clinical Knack of the NAC Break

I feel a bit Trumpy…because whenever someone says ‘N-acetyl cysteine’, I want to reply, “Big fan, I’m a big fan”.  And yes that’s an uncomfortable awareness. But unlike he who shall not be mentioned, I can qualify my statement and provide supportive evidence, both of the research and real-world varieties.  So, of course, can so many of you as well. I know of fertility specialists who place it in PCOS patients’ preconception prescriptions and respiratory specialists who regard it highly in COPD, CF and a range of other conditions. And I am a signed up supporter of its adjunctive use in many psychiatric conditions. Then there’s the biofilm-breaking buffs… 

This is where non-believers might be tempted to call ‘Snake-oil!’ 

How can one very simple tricked-up amino acid possibly contribute to the health of so many systems?  Oh, just via the chameleon qualities of its chemistry of course!  As a rate limiting ingredient and precursor of GSH, as well as a potent mucolytic agent and and and…we get it.  We surrender!  But I want us all to back up here just a few steps. As a mucolytic agent…renowned for biofilm busting…hmmm. I prescribe a lot of NAC for a lot of people for a lot of days-weeks-months….because all the research in mental health points to it being a long-term intervention.  I’ve heard Professor Michael Berk say, that patients still on it at 2 years had even more improvements than they had experienced at the 6 month mark and of course mental health, for most, is a chronic illness, so no one is surprised. 

But we can’t contain its chameleon chemical qualities.  Given orally, it will be having effects within the gut of these individuals on the way through…and not all biofilms should be busted, right?! 

So what to do? Well thankfully, NAC is not something that patients rely on for short term acute effects, that would then make missing doses problematic – like pharmaceutical psychiatric medications, and some CAM options as well potentially, like SAMe and SJW. So a regular sNAC break is likely to be free from negative impact for those with mental health issues and in fact, beneficial long term. With all this in mind, we’re now using a dosing model of taking weekends off from this supplement – which works for most.  Do we have any concrete research to say this makes sense and doesn’t compromise efficacy yet?  Well no, and don’t hold your breath, because research can be very reductionistic (you heard it here first LOL) and there is a lack of consideration of the effects on an individual as a whole. The psych researchers are not measuring the impact of all interventions on the microbome of patients (yet!) and the gut researchers not always monitoring the mind.  But we clinicians can pioneer the path, fuelled by two old buddies of mine: first do no harm & least medicine, best medicine, right?

Oh and has anyone managed to open a tub of NAC and not accidentally snort some?…I don’t have anything else to add or a solution, I am genuinely asking if this is humanly possible 😂

The Clinical Knack of NAC

“There are few complementary medicines that come onto the market with such a bang, opening up genuinely new therapeutic options for the effective management of such a broad range of health complaints.  N-acetyl cysteine stands out for this reason and has changed the way I practice”  Rachel Arthur

Want to learn more about its diverse applications? Check this out

 

Can You Hear Creatine Coming?!!

If you’re like me, Creatine as a therapeutic option for psychiatric & neurological disorders, has been stalking you for years. Lurking in the shadows, only showing its face occasionally to say, ‘Hey, I’m not all about body building and sports you know, you should check me out some time!’  But, haunted by the ghosts of yesteryear  & all the wanna-be-muscle-men I served working in retail in my 20s, and scared off by the very mention of ‘sports’, I have kept running briskly walking, beyond Creatine’s clutches. Until now.

The evidence of the essentiality of Creatine for healthy brain function is undeniable and together with a wealth of pre-clinical data which likens the impact of oral Creatine to both fluoxetine, in terms of its ability to stimulate and support healthy neurogenesis, and ketamine, in relation to its fast acting glutamate inhibition, we need to at last all finally face our friendly stalker!

Thrilling as this amassed evidence is, to date the number of actual RCTs using Creatine in mental health patients, including treatment resistant depression, bipolar affective disorder, schizophrenia etc. is still too few and their sample sizes suffer from ‘smallness’ to boot, making it clear that we a long way away from a clinical consensus.  Regardless, Creatine seems too important a therapeutic option to ignore while we await new larger studies and a trial of this supplement in many of our patients could be all the n=1 proof we need for its benefit to many.  The skill we need to develop now is being able to identify those patients most likely affected by CNS creatine depletion. But if we follow the trail of crumbs… they clearly lead us to those at risk, due either to impaired production (amino acid and micronutrient shortfalls, most commonly) or those experiencing increased requirements (vegetarians, vegans, the elderly, high histamine??)…we are likely to recognise our patients likely to benefit the most.

While our CAM dispensary already offers us some great nutraceutical & herbal options for helping our depressed patients, I am always on the look out for more.  Especially when these represent more upstream approaches…providing true building blocks for brain health, rather than just XXX the signals

Creatine and its colleagues (carnitine, choline and many micronutrients) fit this bill.  Building blocks are beautiful things.  Are a more ‘grassroots approach’ and accordingly, generally less expensive to boot.  I’m doing more and more augmenting of my most reliable CAM antidepressants, with creatine and select aminos these days and being rewarded with great results.  If you want to learn how to use Creatine supplements as part of a multi-pronged approach for your patients’ brains rather than their brawn…then there’s no better place to hear about it than here and, I guess, at last, there’s no time like now.   🙂

 

Creatine – The Brain Builder Part 2
Creatine for brain building over brawn, begs the question,  ‘What is the ultimate supplement regime when trying to maximise uptake into our mind not our muscles?’  So much important groundwork has been done in the field of sports science to determine basic bioavailability and pharmacokinetics of this nutraceutical, we can certainly borrow much from this – but what do we do differently?  This second instalment on ‘Creatine the Brain Builder’, does the complete number crunch for dosages and regimes, expected onset of action, necessary duration of use, cautions and contraindications and much much more!

When we recap the contemporary science of shared pathophysiology in mental health, we have: oxidative stress, impaired neurogenesis, monoamine deficits, glutamate excess, hypometabolism & mitochondrial dysfunction.  When we ask researchers which of these supplemental Creatine might be able to assist with, we get hits at each and every point.  Turns out, Creatine’s capacity for enhancing performance is not limited to athletes but can be capitalised on for anyone vulnerable to a CNS shortfall.  Ignored for far too long, this economic and impactful brain nutrient is coming to the fore for psychiatric and neurological disorders.

 

The latest Update in Under 30 has landed!!!

You can purchase Creatine – The Brain Builder Part 1 and Part 2 here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

Creatine Supplements: Brain Over Brawn

I think I’m finally able to put my ‘late-90s-Creatine-frontline-trauma’ behind me.  Back then, like many good nats in training, I was working the trenches of the health food stores and was faced on a daily basis with two types of men with two types of Creatine questions. The first type was scrawny and would ask, ‘will taking this help me build muscle?’, the second, built like the proverbial brick *&#@ house, asking, ‘will it help me build more muscle?’ Cue, eye roll.  Come on… any of you current or ex apothecaries, pharmacy or retail assistants…you know exactly what I’m talking about!!! So deep was this trauma that I put Creatine as a supplement, into the ‘strictly sports folder’ in my brain (the bit in the deep dark back with other rarely accessed items) and never gave it much thought when I left retail and moved exclusively into private practice. Even back when I was a sub-editor for the Braun and Cohen 4th edition, it was apparently still too soon. 

A great colleague of mine, Emily Bradley, had written the chapter on Creatine and, in doing so, presented compelling case to reconsider this supplement as offering great therapeutic potential well outside of the sports-field.
That one was accidental 😂

I actually remember reading that chapter, especially the sections on Creatine supplementation for neurological & psychiatric conditions and thinking….WOW…who knew?! ??!! Well, clearly Emily for one 🙄 and also every author and researcher whose work she had read…so that made quite a lot of people actually!  But another [ahem 😳] several years had to pass before the research into Creatine and the argument that this has been a grossly over-looked CAM option in mental health, beat down my door and finally got my full attention.  Better late than never.  And boy, do we all have some catching up to do! 

Let’s start with 5 fun facts:
1. Creatine is critical for energy – like cellular currency it ‘tops’ back up our funds, after increased spending, everywhere, including the brain
2. The Brain consumes >20% of our resting energy expenditure & is fifth on the organ list in terms of highest concentration of this molecule
3. Creatine CNS depletion is a thing – and it happens in a wide variety of scenarios – from the seemingly benign (like chronic sleep deprivation) to the more sinister (neurodegeneration)
4. This then leads to higher Glutamate, Oxidative Stress & a spell of other sorts of ‘brain badness’
5. Oral supplementation can cross the BBB and ‘refuel’ the brain and correct the Creatine deficit

Out of the thousand or so pages of research on this topic, I’ve just indulged in, there are several great reviews to pick from…it’s a tough call to make but perhaps this older one by Patricia Allen remains my favourite. This marks the beginning of a new era…I’m putting the trauma behind me & moving on & hope you’ll come along too!

When we recap the contemporary science of shared pathophysiology in mental health, we have: oxidative stress, impaired neurogenesis, monoamine deficits, glutamate excess, hypometabolism & mitochondrial dysfunction.  When we ask researchers which of these supplemental Creatine might be able to assist with, we get hits at each and every point.  Turns out, Creatine’s capacity for enhancing performance is not limited to athletes but can be capitalised on for anyone vulnerable to a CNS shortfall.  Ignored for far too long, this economic and impactful brain nutrient is coming to the fore for psychiatric and neurological disorders.

 

The latest Update in Under 30 has landed!!!

You can purchase Creatine – The Brain Builder Part 1 here.
If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account.
You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audio’s and resources here.

Hanging Out For The Histamine Handshake?!

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!!😅

Update in Under 30: Histamine Imbalance in Mental Health

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.

Have You Met Your Hype-Guy?

About 15 years ago I was introduced to histamine, the neurotransmitter.  Before that, I only knew him (come on…it has to be, right? Histamine) as an immune molecule, an allergy mediator, a chemotactic agent of chaos! Given my interest & previous work in mental health, I knew the rest of the chemical cast pretty well. There was Sunny Serotonin, Dance-Party Dopamine, Nervous Noradrenaline & Go-Go Glutamate. So it came as a bit of shock to realise that an equally important member of this cast had never had a mention in all my previous education…

‘Hype-Guy Histamine’

With 64K neurons dedicated to its production & an extensive axon network all over our brains to ensure its excitatory effects are felt everywhere…I was a bit embarrassed we hadn’t met sooner!  I’m not Robinson Carusoe in that regard though, our awareness and recognition of this key neurotransmitter has been snail-like in its pace and progress. A recent review paper on the development and evolution of antihistamines kicks off the conversation with, ‘Oh, so histamine is just another neurotransmitter now’…which gave me a bit of a laugh.  Seems like we were all duped…even the dudes making the drugs to block it! But once I did meet Histamine, the neurotransmitter, it really did change my clinical practise, forever.  And as I have gotten to know him better and better over the last 15 years, how his excesses and deficiencies present in my patients and how best to manage these, I can confirm, it is far from the answer to every patient’s prescription for mental health but this an imbalance is evident, addressing it is exceptionally effective and I remain forever grateful to those that have contributed to my learning in this area, passing on the knowledge from its originators: Car Pfeiffer & Abraham Hoffer.  These pioneers of orthomolecular psychiatry gave Histamine a platform and presence that no one else had or would for decades still to come. 

And now every practitioner and their pet poodle seems to want to talk about Histamine!
But, my friends let me tell you, CNS Histamine imbalance has little to do with eating tuna, umami flavours and the state of your gut!

Hype-Guy Histamine is made on-site, in your brain.  We don’t import it in over the BBB mountain range.  So, in terms of a histamine imbalance in your neurochemistry, we need to narrow in on the noggin and get crystal clear about what could be behind such an imbalance and therefore how to tailor treatment to address each cause.  I owe a lot to those who first taught me this model and I think it’s time the model had a mini-makeover, thanks to our vastly improved understanding of Histamine, methylation, genes, mast cells, behaviour driven biology etc etc. etc.  that has been generated now mainstream medicine has finally met Histamine, the neurotransmitter! 🥳🥳 And now, be warned folks, contemporary psychiatric pharmacy has its sights set on histamine as a key target for new medication development and the improved management of mental health.  Better late than never, I guess.  Have you met your Hype-Guy Histamine?

 

Histamine Imbalances in Mental Health
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 amounts, 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 practice 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 two hugely helpful clinical resources, will give you the confidence to recognise and remedy this important imbalance in mental health.

 

The latest Update in Under 30 has landed!!!

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

It’s True

I’ve a confession to make, I took the batteries out of our smoke detector in our kitchen. Why?  You know why.  Because it went off all the time, with what I like to call, friendly fires…you know, heating oil for poppadoms, a rush of steam upwards from a hot pot on the stove with its lid removed, gosh even toasting your bread a little too vigorously would do it! Taking the batteries out, stopped the alarming alarm (!) and quelled my need to always keep a tall stool and ‘whooshing’ implement nearby, in preparedness for the next smoke activated siren. But of course this is not a solution.  There are consequences.

I recently realised this was the best analogy I had for many patients who have experienced significant trauma.  Particularly when this trauma has occurred during childhood, there is potential that they too have effectively ‘taken the batteries out of the ‘smoke alarms’

This has been documented in a proportion of individuals affected with PTSD for example and is believed to be due to the ‘re-calibration’ or ‘rewiring’ of their HPA axis in response to excess ‘over-activation’.  So because their internal ‘alarm system’ had been so consistently activated, the chronic hypercortisolism evokes a down-regulation of their glucocorticoid receptors, as a means to ‘turning down the volume’ or…removing the batteries.  Let’s think about this.  If your patient has, let’s say, 5 receptors for cortisol compared with 50, their receptors will be ‘filled’ quickly with only minimal amounts of cortisol.  This receptor ‘fullness’ however is detected by the brain which in turn then shuts off the ACTH release.  But really there was only a small amount of cortisol. The threshold for the negative feedback inhibition (cortisol –> no more cortisol) is very low and patients can end up with too little.  Wouldn’t they have less stress, then, feel better then?

In spite of all the name-calling Cortisol is not the criminal he’s been made out to be.
Cortisol 
≠ Stress.
Cortisol in fact offers a way out of stress – the means to physically resolve the stressor.  So too little…feels awful.

Patients of mine who have been shown to be affected by this hypocortisolism present as extremely anxious with poor stress tolerance, in fact if I didn’t know differently, I would have imagined they had ‘over-activation’ of their SNS not under.  When I speak with them I try to find different ways to describe why this down-regulation of their HPA can contribute to their mental health challenges. I talk about Cortisol being akin to clothes…no one wants to leave the house without it, or a raincoat that we really need because one day inevitably its going to rain and we’re going to be out in it…its protective.  But from now on I think I might confess about my battery-less smoke alarms.  Yes I can cook toast without getting startled by screeching sirens now…but I could also burn down my house…which clearly doesn’t rid me of stress and anxiety…

From the Update in Under 30 Archives – Investigating the HPA

Anxiety, high stress, poor sleep – it all sounds like high cortisol right?  But did you know that these are all features of abnormally low cortisol as well, which underscores why accurate adrenal assessment is so important.  This Premium Audio takes you through all the investigations you have at your hands, from clinical markers (Pupil response, Rogoff’s sign etc.) to the strengths and weaknesses of blood, urine and saliva assessment.  It identifies the variables you need to consider and how to accurately interpret your patients’ findings. 

If you’re already an Update in Under 30 Subscriber – you’ve got this! Just log on and go to your Active Content.
If you’re not and would like to download this recording and resource then click here!

The Platelet Puzzle in Psychiatry

We’re midway through mentoring 2020 and we’ve temporarily shifted gear out of case presentations and into dedicated time for answering praccies toughest questions…and oh man, I love these opportunities!  This year in our Mental Health Primer Group, there are clinicians whose questioning…nEVeR sTOps. [insert: excited squeal] and that means I have an excuse to dig deeper, go further, read more research and ensure I can provide answers confident of their comprehensiveness and that they reflect all the contemporary information to date. So amongst stiff competition – here’s my favourite from the gIAnT piLE on my desk right now…

“We often hear that the bulk of our body’s serotonin is in our platelets – so do platelets (counts, activity etc) have a role in mental health?”

Well, I’m so glad you asked! Yes, 99% of your body’s serotonin is found inside your platelets.  Where did this come from?  From the plasma. How did it get there? Using the identical transporter mechanisms that your neurons do.  Sounds like all the pieces fit right…oooooh so low platelets might drive low serotonin and poor mood and and and…

No. 
You may get excited when you get a box of jigsaw pieces but you must first complete the puzzle and ensure everything is in its rightful place.

Platelets are linked to depression but not as a cause but as a consequence.  Because their transporter systems & receptors for serotonin are virtually identical to those in the CNS, they suffer from the same serotonin deficit…in spite of a relative abundance in the plasma they’re floating in.   So really platelets are of interest in mental health as a more accessible way of studying and understanding neurochemical regulation in the brains of those affected.  Did she just say neurochemicalS…as in, plural.  I sure did.  Because healthy platelets contain a whole plethora of substances, even a relatively large quantity BDNF, the concentration of which also becomes  severely compromised in the platelets of depressed individuals.  So it seems like its tough-talkin’ Tuesday and just to bust a few more moves myths while we’re here…

Your platelets get their 5HT from the plasma
Your neurons make it themselves
Platelet numbers are not indicative of your 5HT producing capacity…anywhere
Therefore treatment objectives that speak to platelet numbers or platelet activity are clearly non-sensical
A bit like measuring serotonin derivatives in your urine…and imagining that reflects the <1% from your CNS….hey?

Yes.  That’s what I said.  Want to learn more?  Please do. A great review paper by Marlene Williams, from the World Journal of Psychiatry, for starters, anyone? 🙂

If this last point is news to you…sounds like you really Need to Start  Here!  Accurate Pathology Interpretation

Don’t be fooled by the false promises of functional tests.  Make sure all the pieces of the puzzle fit to actually make something sensible, accurate, reproducible and meaningful. Mainstream pathology results actually offer a goldmine of information and insight about your patients However to realise their full value and make the most accurate interpretations we need to first learn more about ‘lab language’, upskill in finding our way around reports which are packed with a surprising amount of hidden extras, demystify reference ranges and then develop a logical critical process we can apply to every result of any patient to get the real take-home. Packaged with numerous specifically developed resources to aid in your application of these skills this is a foundational offering that changes practices.

SSRIs – A Weight On Some Patient’s Minds

Given 1 in 8 Australians right now are taking an antidepressant, chances are you’re seeing a lot of clients on these, especially the SSRIs.  Erica McIntyre (fellow naturopath) and colleagues, found that in fact, mental health diagnoses affect about 43% of individuals who choose to seek help from a naturopath or herbalist, so clearly this is across all of our waiting rooms. Accordingly, by this stage in your clinical career you’ve probably seen more than 1 patient taking the identical SSRI – e.g. Citalopram (aka Lexapro or Cipramil)  Have you also by now, therefore come to ‘expect the unexpected’, when it comes to patients on the same prescription, in terms of ‘weight effects’? The majority not reporting this to be a major concern or issue but the occasional client, experiencing such significant weight gain, they may even have seen this as a reason to discontinue the medication.  So what’s up with that then?  Don’t we all wish we knew for certain!  But getting our heads around the potential mechanisms is important for our patients, in terms of making more informed choices, as well as offering us insight perhaps into their neurobiological nuances.

Some of you will know, this used to be my place of business.  

I have a background in the pharmaceutical industry, specifically psychiatric meds, more specifically SSRIs and even I find every time I duck-dive back into the literature I come up with more ‘fish’ – critical new information about mechanisms, secondary and unexpected actions, unforeseen benefits, barriers and yes, some sad or bad new detail.  Consequently, I always field lots of questions about SSRIs in our mentoring sessions & one that often comes up is why some patients gain weight on SSRIs. What’s most curious to many, is how the weight effects of antidepressants can be hard to predict.  There is not a consistent pattern across any specific antidepressant class, nor just 1 or 2 medications within a class, that will do it, while the others never will. This is in contrast to the many determinations and drivers for who will or won’t get discontinuation syndrome. So what mechanisms might be behind such an individualistic weight response and is there any way to predict or prevent this? 

Here we find ourselves again with the question that keeps all IM practitioners awake at night:
But why?
But why??
But why???!

A worthy question indeed. According to comprehensive reviews of this issue: there are still multiple candidates – one is the incidental histamine blocking that some SSRIs exhibit (could this flag someone low in histamine to start with??), while others still hold some suspicion over an old foe, elevated prolactin, that we can see in a minority of patients on these meds…easy to measure and confirm or refute, right?  But always ask your patients first, How has your diet changed over this same period?  How has your activity changed? You may of course find, you need look no further.  People can give you the answer on a platter with things like, “I just relaxed a lot more: about what I ate and my weight”…Bingo!  As always, the patient in front of you is their own little ultimate black-box…🧐

Leaving Anti-Depressants Behind

Never our call to make, but with 1 in 8 Australians at any time taking antidepressants, playing a supportive role for patients wishing to discontinue their antidepressant medication is common.  So what do we know, about how to really do this well, what to expect and how to perhaps mitigate some of the bumps that might lie ahead.  What in our artillery should we go in armed with either during the discontinuation or, better still, beforehand?  This Update in Under 30 outline the key principles of patient prescriptions in this context and may assist patients, in their desire to truly leave the antidepressants behind.

 

If you are an Update in Under 30 Subscriber, this is a previously release episode and you will need to search for it to find this in your library of UU30’s that are in your online account. 
Not an Update in Under 30 Subscriber? To access this episode and the entire library of Update in Under 30 audio’s and resources become a subscriber here.

 

When Your Day Ends On A Happy Note

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

The ‘Perfect’ TSH?

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:

  1. What is this (metabolite, analyte, binding agent, plasma protein etc)?
  2. 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?
  3. How have the reference ranges been determined for this lab – who am I comparing my patient to?
  4. Therefore, what is the significance of a result that is: ‘normal’, ‘low normal’, ‘high normal’, below or above the range?
  5. Does this value ‘fit’ with my patient?
  6. What else could explain an unexpected result?
  7. How strong is my level of evidence?
  8. What do I need to do from here to confirm or refute this?
  9. 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.

‘Copper Excess’ In A Child?!….Really??

Copper deficiency happens in kids, so does copper toxicity and both are serious concerns, but do we know when to accurately call either?  First, we have to know ‘normal’. If we know what normal Serum Copper values look like in children, then we can easily spot those falling below or above this, right? That’s the first hurdle we tend to knock over and break a toe on!  Being a mineral whose levels vary widely in soil from country to country, globally, the differences in reference ranges are breathtaking & absurd. Add to that, that copper is a key mineral in kids, driving huge demand for it during key periods of development, so the range for pre-schoolers isn’t the same as the primary or high schoolers – not that your lab is flagging that. Unhelpful? Yes.  Dangerous, even? Potentially.

To diagnose ‘Copper Excess’ in a child is a big call to make.

One, because most practitioners are unaware just how much Copper a child really needs at each age & two, high copper is often a messenger for something else going on and then three,  the primary objective based on this diagnosis becomes to lower their Copper but we could be either shooting the messenger or missing the mark all together…right?

Copper excess does happen but not nearly as often as practitioners believe it does.  And in kids, the fall-out from such misdiagnosis is bigger. And missing a Copper deficiency? (because we’re not as well-trained to recognise it and because Copper has been sadly demonised)  Likely to have myriad negative impacts at this vulnerable age…almost none of which generate symptoms or a distinct clinical picture e.g. secondary iron deficiency, low neutrophils without necessarily compromised immunity.  But what about the holy grail get-out of jail adjective: ‘relative’. You know, ‘this is at least a Copper excess relative to their Zinc?’

Well, to form this opinion you’re likely calculating the Zn:Cu ratio and applying an ideal adult value of 1:1 but show me the primary evidence that supports this for kids…anywhere?  The Zn & Cu relationship shifts as we move through life-stages and in fact Copper is supposed to dominate through a lot of our childhood so…ummmmm…no.

HTMA Copper side-steps all of this?..double no.

I used to make the same mistake re Zn:Cu, I may have even taught you this?!🤦‍♀️  But as so often happens, a week spent in all the original scientific data and I’ve emerged a changed practitioner! Having been part of perpetuating this problematic premise in the past, I am determined to get the correct message out there to as many practitioners as possible.  So help me spread the word on Copper in Kids – by telling others that this mineral is so critical to kids compared with adults, they will often have higher levels than ‘us’ and that until you’ve applied the right age-appropriate reference range and ruled out confounders you can’t possibly make a call on Copper. I mean, we kind of knew this all along, with healthy pregnancy Copper values being exponentially higher being a giant clue. Turns out kids’ ‘Copper Age’ extends way beyond the womb.

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.

 

So, What Kind Of Drunk Are You?

I know, timing, huh?! It’s almost like I’ve been sniffing around your recycling bins but I didn’t need to of course, at this time of year it’s a fairly safe bet you’re madly winding it back a tad from your most outrageous annual alcohol imbibing. And so are all our patients.  To me, extracting accurate information succinctly from patients regarding their alcohol use can be one slippery little sucker. It’s one of the questions people tend to give you a very tidied up answer to, or in fact they’re in such denial they can’t be considered a reliable witness.  Think about it.  Being a non-habitual drinker myself, I can appear almost saintly when reporting my daily consumption, “None”…but that omits the ‘other me’ that might show up at a conference gala dinner or some live music event, with my volume controls adjusted significantly up…ergh…firsthand accounts anyone? And how often does that happen?  Well anywhere between 4 times a week and once a month.  See what I mean?

While I’m sure you’ve probably heard me say before, I ask every patient who does drink, what kind of drunk they are because it can hint at their underlying neurobiology, there is a new study that suggests, using a very short 4 item UCLA RRHDS survey, we can categorise patients alcohol use and misuse into 3 types:

Reward  Relief Habit

and in doing so, also be better able to identify the best way to manage them as well.

I’ve been interested in addiction neurobiology for a long time and very much resonate with the work of Koob, which in layman’s terms proposes that we seek intoxication initially for the ‘high’ and then with dependence, we continue to seek it to appease the terrible lows of withdrawal.  It has long been known that alcohol use disorder is heterogeneous – there are different types and accordingly the kind of generalised treatment of these individuals proves extremely hit and miss. But articulating the different types and their distinct drivers and solutions has been fraught. Like what makes one alcoholic the functional type who in addition to their long-lunches is a CEO and the one who can’t keep their job?  Is it just socioeconomic context or something more?  Why are some types of alcoholism deemed also to run more in families and while others aren’t? There are clearly major difference in pathophysiology but what are they?  More recently these 3 groups have emerged and this recent study confirms the value particularly in the distinction between those who drink driven by reward and those for relief + habit. It’s a great read but here are some key take-homes:

Relief Habit

These individuals drink to cope or resolve a negative experience and therefore a driven by negative reinforcement. As a group they present with more depressive features and have more anxious traits than those ‘reward drinkers’. So the key to managing these patients is to offer treatment that also appeases their negative physical and psychological experiences with sedation, anxiolytics, glutamatergic modulation. (Hint this is where Taurine really shines, in this group!!)

Reward

These individuals drink to feel good so they are driven by positive reinforcement and therefore the approach to the helping them should be quite different, with lifestyle recommendations that offer other options for  mood elevation such as exercise etc as well and herbal and nutritional approaches.( Hint hint…not the key group for Taurine, more like Tyrosine and Saffron etc)

So….back to my question…what kind of drunk are you? As a nation of over-consumers by nature, this is a question we need to ask all our patients

Mastering Mental Health: New Assessments and Management Resources in Your Clinic (2hrs)

Rachel introduces you to new clinical tools that 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.

New Goals & Some Good News (At Last!) in Gilbert’s Syndrome

 

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.

 

We Know – But Do They?

When a teenage girl presents seeking her first oral contraceptive pill (OCP) script, what information is she privy to that enables her to make an informed decision? Read the insert inside the box? Please. Which 50 year old, let alone 15 year old does that? Forget it! What might her doctor tell her? Perhaps about clotting risk, as part of their determination of the suitability of this form of contraception for her but is there any discussion about the potential for adverse mood effects? A recent study of over 1,000 teenage girls followed over more than a decade adds to other evidence that suggests this should be flagged as a consideration prior to the prescription being written.

Most integrative health practitioners not only know about the potential negative impact on mood from OCP use in women but we’ve observed firsthand the havoc it has wreaked in some teenage girls’ and women’s lives.

A very experienced practitioner I know says, ‘if I am hearing mood instability and then I see a significantly elevated serum copper and or cortisol in these girls that’s when I just say to have to say to them, you know I don’t think this is the best contraception for you!’

This latest study did not find higher rates of depression across all OCP users in this group of 16-25 year olds but when they looked at this at different ages they found its use increased depression scores and was associated specifically with more crying, eating problems and hypersomnia. The discussion around the enhanced vulnerability at this younger age compared with older girls centres on the relative immaturity of their CNS. But wait, I hear you critical thinking clinicians ask, perhaps those teenage girls had more depressive features prior to starting the OCP.  Good thinking 99! And the answer is…maybe…but the relationship goes both ways: from the related Medscape Continuing Medical Educational Activity

“For 16-year-old girls, the association was weakened after adjusting for depressive symptoms before use of OCPs, but the findings remained significant. This suggests that the relationship between OCP use and depressive symptoms could be bidirectional…For instance, 16-year-old OCP users were more sexually active and had more stressful events, as well as more menstruation-related pain and acne, than their counterparts in the nonuser group. Analyses showed that all these factors weakened the association, although none diminished it.”

The commentary surrounding this latest study is essentially 1) this is not the first study to find an association and others have been more able to demonstrate that COCP use predated the mood disorder in those affected and 2) those exhibiting higher depressive scores did not actually score strongly for anhedonia or sadness which are the most typical features in adult depression – so perhaps we are missing some of these negatively impacted young women.  Awareness regarding reproductive psychology is rapidly growing and in Australia we are fortunate to have emerging hubs to seek help and specialist advice in this area, such as the important work of Professor Jayashri Kulkarni and colleagues out of the Women’s Mental Health Clinic.  I’ve referred patients, both when a patient’s mental health appears to be caused or aggravated by use of hormonal agents but which they can’t not use for various reasons and for those small number of women in whom I feel hormonal management may in fact offer a psychiatric solution. So again I am asking, while we know & mainstream medicine increasingly knows about this association…who’s telling these young women?

What’s the OCP really doing? An update on the physiological impact 
How many of your clients are on a combination OCP?  Do you know the full extent of the physiological impact as a result and are you able to identify to key pathology indicators of the size of that impact?

We’re all aware that in theory OCP use correlates with a range of elevated risks but in reality many females will make the decision that the pros, in terms of contraception or control of acne etc., outweigh the cons.  What if we could provide more individualised advice by looking to their pathology results and identifying and quantifying specific danger signs for each individual?  This approach enables us to better support patients who chose this form of contraception and to accurately identify those that should be be encouraged to find other safer options more biochemically suited to them. Learn more here.

While You Were Sleeping

Remember the days when we had the brain all back-to-front & upside down?   Anatomy & physiology told us it was an island, completely protected by the blood-brain-barrier from pathology in the rest of the body, that it was incapable of regeneration after damage and that it didn’t have its own lymphatic system. All wrong. Which presents a problem, the CNS is absolutely in trouble if other parts of our body are (!), but also some solutions: plasticity and the brain’s own capacity for cleaning up after itself. New research has revealed more about this critical CNS cleansing and what is likely to get in the way of this

The latest Medscape update on this is quite poetic, speaking to the movement of body fluids like tides within the human body. 

“They found that the blood flow to the brain diminishes, allowing for an influx of cerebrospinal fluid (CSF), washing away the day’s detritus of proteins and other waste substances that might harm the brain if they aren’t cleared out.”

But these particular tide times are restricted to sleep – having never been identified during awake states & even more specifically only during our Deep Sleep, the period of slowest brainwave activity.  The speculation is, of course, given sleep issues predate or are a feature of neurological and mental health conditions, that perhaps this comes back to the impeded process of waste removal that accompanies this and how this may contribute to accelerated negative neurological change.  For example, beta-amyloid proteins are well known to be removed most rapidly during our sleep and this week I’ve been faced with a small mob of patients who have substantial cognitive impairment risk from a genetic standpoint (e.g. Apo E 4 carriers in families riddled with dementia) but their unmanaged long-standing insomnia plus or minus OSA is likely just AS risky.  So here we are again back at one of the key non-negotiables for health: Sleep.

I often say to my patients, ‘There is nothing I can give you in a bottle or a blend than can do one 100th of what healthy (quantity & quality) sleep can do for your wellbeing today or for preventing health issues for you in the future’ 

And then I say it out loud again when no one else is around just to ensure we’re all aware of that 😉

Want an Update on Inflamed Brain Science?

The brain is no longer considered an immunoprivileged organ separated from immune cells by the blood-brain barrier, with research revealing numerous interactions between the neurological and immune systems. A large body of evidence now shows that these interactions, in particular an imbalance in pro-oxidant & antioxidant systems, play a clinically relevant role in the mental health issues of our patients and may go some way to explain why patients with chronic inflammation frequently present with mood and cognitive issues.  Identifying and addressing the source of the inflammation (musculoskeletal, gastrointestinal etc.) therefore potentially addresses the underpinning cause and creates a ‘win-win’ scenario for patients. This updated recording aptly named: The Inflamed Brain, covers all this and more!

Does Holistic Health Include The Hardest Workers?

Did someone explain the kidneys are like a really important, not to be forgotten, under-estimated, ignored or under-valued kind of organ in your training as a naturopath? No, me neither.  I mean I know Buchu and Uva and Zea (on a first name basis only, clearly!) and …no actually, I’m done.  But seriously, it didn’t take too long in practice to stumble across a whole lot of bad when kidneys aren’t getting the attention they warrant and equally to develop a slight obsession with renal markers in all of my patients not just because of their incredible impact on whole health but also because of what ‘lay beneath’.

As you might suspect, I get sent labs all the time from practitioners. Stop no! That is not an invitation!   

Often it’s client’s renal markers which I do appreciate because it tells me there is an increasing number of praccies that absolutely have done some post-grad DIY knowledge building about these bean-shaped babies and their critical contribution to health. The results might come with a question like, “What’s going on with their kidneys?!” [insert worried face emoji of choosing] 

To which my reply is often… “not much but boy do we need to talk about your patient’s GIT microbiome! [or] mental health! [or] sarcopenia!”

Say what?  Yes abnormalities within the renal markers: urea, creatinine and uric acid may be a reflection of renal issues.  But if you know where each of these molecules enters the blood,exits the body and all the interesting good & bad they can get up to in between…then the patterns speak less (if at all in some instances) to what’s going down in the kidneys but instead give you an incredible insight into key issues all over the body: from the gut to the brain.  But wait there’s more!  Want to know what’s the latest and greatest in management of advanced renal disease? Treat the gut to lower the urea.  What about managing mania? Add in a gout treatment to lower uric acidDang!  This is holistic health at its best with those poor kidneys no longer being left out in the cold!

“Who knew urea, creatinine, GFR and uric acid could be such a Goldmine….Mind…officially…blown!” New Graduate Mentee 2019

Want an Opportunity for ‘XXX sized’ up-skilling in Renal Markers & Health?

Most practitioners graduated with not much more than a few ‘kidney’ herbs and an under-appreciation of the contribution renal health makes to wellbeing. It’s not just about waste and water.  In reality, the kidneys are pivotal in just about every major element: blood, bones, pH balance, methylation, control of oxidative stress, the GIT microbiome and more!  And we are seeing the impact of this in our patients in all sorts of subtle and not so subtle presentations.  This new instalment in diagnostics, brings the renal system into the spotlight so we can confidently identify and better manage its critical contribution.  In addition to this, just like with other routine labs such as LFTs, we unpack how these so-called ‘renal markers’ can flag a plethora of other insights into your patients, from reflecting (un)healthy muscle mass to calculating  individual dietary protein adequacy, from key ‘danger and distress’ signals in response to disturbed metabolism, oxidative stress to certain types of GIT dysbiosis!  We call this Renal Markers: Explained, Expanded and Exploded because these routine labs can deliver XXX sized insights into your patients.

Group Mentoring…What’s it all about?

 

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 simply improving 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 admin@rachelarthur.com.au.

 

Get Plugged Into The Brain’s Trust…

Forehead USB not required. Phew.  All that is required, is a real thirst for new knowledge, rapid development of your diagnostic skills and a willingness to commit an hour every month to tap into your new Brain’s Trust: Rachel and a collection of colleagues with a shared desire (general practice or mental health-focused) and similar level of experience to you – new graduate, medical, naturopathic or dual qualification.  And take one great leap forward closer to being the practitioner you want to be.

The Rachel Arthur Group Mentoring Program has the longest (7 years and counting!!) and most impressive track record of practitioner satisfaction for value for money and meeting clinician’s key learning outcomes.

And the long-awaited good news is…we will offer our New Graduate Program, which debuted this year to much critical acclaim, again in 2020!

Being part of the 12-month group program allows you to connect to a community of like-minded, similarly-skilled practitioners in a structured teaching environment either via case-based presentations (regular groups) or via an interactive curriculum (New Graduates, Mental Health Introduction). You’ll be plugged into 11 other practitioners and together with Rachel’s brain, you’ll receive the knowledge and confidence to assess, investigate and manage no matter who and what walks through the door. Our profession thrives when we thrive as individuals and central to this is building networks of ‘similar others’ in order to find your tribe and benefit from the ‘collective’.

“Rachel is a wealth of information, she has such a knack for breaking down cases. All case presentations no matter how complex are nicely deconstructed into bite sized bits of information that’s easy to digest and take away and put into practice. This mentorship program is worth its weight in gold, it shows you how to deconstruct cases, develop knowledge, gain greater clinical insights and you’ve got a fabulous base of other knowledge practitioners you can ask questions. Can’t wait for the rest of the cases! And you can count me in as a second year mentee next year.” – Megan

In Group Mentoring you’ll be learning core clinical skills that you can apply in realtime to your practice and be able to ask questions along the way. The most valued aspect of the mentoring is the ability to discuss practice experiences with the mentor and to hear and learn from all the group members, sharing experiences, knowledge and learning as we go during the sessions.The bonus of these sessions is you’ll find your tribe, gain support and radically build your toolkit.

I love witnessing every practitioner’s growth, I want everyone to find mentors to support them in their career in integrative health. – Rachel

“Having the group session each month, as well as having Basecamp to bounce ideas around in, is a reassuring connection to know is there if I need it. Having just started practice this year and working in an environment without other Nat’s around, I have noticed the occasional feeling of isolation. So having the monthly catch up keeps me feeling connected to other clinicians and gives me exposure to other cases and perspectives that I wouldn’t have otherwise had.” – Georgie

 

Going by the landslide of registrations for 2019, Group Mentoring is fast becoming a popular choice and could be an integrative part of your practice & your career progression.

So if being part of the community excites you and if the thought of learning and benefiting from a collective knowledge base that is strong and pulls on expertise outside of our own, now’s the time to join the conversation through Group Mentoring.

2020 Group Mentoring Program Applications Open in October!

Read all about it here or email admin@rachelarthur.com.au to let us know you are interested.

A Case of Stoned Sperm?

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!!”

Oh lordy…

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.

I’ve been aware of the potential negative effect on male fertility, in particular, for over a decade and while we undoubtedly need more targeted research on this topic to reach a consensus, the evidence base to date points to lower LH +/- testosterone and impaired sperm quality and motility.  Certainly not perhaps what tonic-seeking patients know they’re signing up for.

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…?

Getting Men’s Hormones Right

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.