Avoiding Overwhelm In Clinic

So…a 40 something female walks into your clinic with depression & anxiety…sounds common enough right?  But here’s the twist: she’s already seen another practitioner who ran a range of investigations revealing she has pyrroles, high copper levels & is homozygous for the C677T MTHFR mutation. Her medical history includes significant use of Ecstasy and a partial thyroidectomy due to nodules & she has persistently high TSH.  But wait there’s more!…The first practitioner upon discovering all of this put the patient on 12 different products which included zinc, B6, evening primrose oil, vitamin D, thyroid support etc etc.  And guess what…the patient feels worse!

Frequently our patients are just as complex as this case & sometimes our attempts to narrow the treatment focus through thorough investigation instead leaves us feeling we now have even more things we need to deal with than before! Feeling overwhelmed?? Often! At risk of completely overwhelming the client as well?  Definitely!  And a reflex to throw your whole dispensary at a client never ends well. (more…)

Nutritional Science & Debate in Action

 

Last weekend I attended the Science of Nutrition in Medicine Conference in Melbourne https://nutritionmedicine.org.au/enews/2015-02-06-Program.html and for those of you that didn’t make it I can tell you, it wasn’t your regular CPE event.  I’m not sure if the debate inside the presentations or outside in the breaks was more interesting but I can say that I haven’t seen this much stimulated thought, heated discussion and passion at company run events.  Why? (more…)

Top 10 Investigations in Mental Health Patients

One of the most common questions I’m asked is whether I have a ‘set list’ of tests that I request for every patient.  Of course there is no ‘one size fits all’ in health & each patient presents with their own novel combination of issues & investigative challenges, however, years of clinical experience have taught me which pathology parameters are the most clinically meaningful.

Asking yourself, ‘Will the results of this test determine my thoughts about treatment & therefore ultimately the clinical outcome for my patient?’, before referring for any investigation is a good habit to get into.

Many of us are increasingly aware of the changing environment around pathology testing, which includes reduced access to some tests in mainstream pathology.  Rbc folate has had its subsidy withdrawn which means if we request this we’re now likely to receive a serum value or nothing.  But does this matter? (more…)

Learning the Language of Men’s Endocrine Health

 

We should all be as skilled in investigating & treating male hormone imbalances as we are female ones, yet this is often not the case.  A lack of confidence in this area, which seems to be an issue for many, in particular will compromise our ability to question male clients comprehensively and effectively about their reproductive health and ultimately reduce our capacity for making good clinical decisions and achieving the best outcomes for them.  If you’re female, how would you feel seeing a male practitioner who doesn’t ask you about your menstrual cycle in detail?

Many of us are at risk of committing similar crimes but we need not be. (more…)

The Sleep Prescription

How often do you find yourself writing sleep prescriptions for your patients?  I do – frequently. I’ll include in my recommendations something like – ‘nap for 20 minutes every alternate day’ or, ‘commit to getting into bed 1 hour earlier 3 nights this week’ or ‘establish a bedtime routine for yourself – something that loosely follows the winning formula of bath, book, bed’.

You see I reckon we humans have tricked ourselves into thinking we can negotiate our way out of almost everything: good food choices, adequate clean water, perpetual motion etc. I mean often people come to us looking for the shortcut let’s be honest…e.g.  “I’m not great with the food side so what should I be taking??”

But when it comes to matters of slumber I explain to my patients that sleep sufficiency (both quantitatively & qualitatively) is non-negotiable in the health equation. To put it another way, sufficient sleep is Wellbeing 101, step 1! 

I don’t have anything I can prescribe that can make up for a shortfall…seriously…just a prescription for more sleep!

(more…)

Is This Your Month to Start Mentoring?

We’re ready to begin another year of group mentoring from this Tuesday and we’ve got just 6 spots in total still available across all our time slots! Maybe you’ve heard the buzz about the sessions from some of our mentees over the past few years & are tempted but have been holding back or deliberating…now’s the perfect time to join in, while we’re all coming back from a break and the groups are reforming and settling.  To boot we’re offering newcomers, a special 6 month package to get you started: attend yourself (or if necessary receive an audio recording when you’re unable to) all sessions from January to June at a reduced price https://rachelarthur.com.au/product/special-6mth-group-mentoring-package/ (more…)

End of Year CD Clearance

As we head rapidly towards the change over of our calendars we would like to offer you a special on the very best educational recordings from 2014 – buy 2 CDs before Jan 31st and receive one complimentary Premium Audio Recording of your choice  OR purchase 4 CDs and receive a 3 month Premium Audio subscription for free

It’s been a busy year during which Rachel has delivered 7 very successful new seminars in the area of mental health and  beyond, most notably fortifying her role as a leader in the field of diagnostics and pathology interpretation.  This has included collaborations with ACNEM, Biomedica, Health Masters Live, MINDD and Nutrition Care, however, each recording is classic Rachel – full of fresh perspectives on diagnosis & treatment, colourful analogies  & humour.  In case you missed some of these this year or want a copy for keeps – here’s a quick summary of the 2014 recordings included in this end of year offer: (more…)

Mental Health – The Real Story

“Two great speakers – inspirational in the first half and bang on in the second – I now know how much I don’t know”

Just out now in time for Christmas…no seriously though… this year I had the good fortune to team up with Biomedica and in particular Rachel McDonald and we delivered a 3 hour seminar called Mental Health in Holistic Practice.  The intention behind this collaboration was to shift the education focus for practitioners from a prescription based approach, to one really about the clinical reality of managing mental health clients.  Probably most of you will agree that the ‘treatment’ counts for only a portion of the positive outcomes in your patients and this is particularly true in clients challenged with mental health issues. After more than 20 years in practice working in this area, I’m keen to share what I’ve learned so other practitioners can get there much much faster! (more…)

Roaccutane, depression & nutrition – the links

We’re all aware of the reported link between Isotretinoin (aka Roaccutane, Accure, Oratane), originally listed by the FDA in 1982 for the treatment of severe treatment refractory cystic acne, and depression & suicidality in some individuals.  Any suggestion of causality however remains hotly debated by the manufacturer of course & there is a recent small RCT not only refuting a relationship but claiming that via effectively resolving acne, patients’ depressive features decrease on this drug (Marron, Tomas-Aragones, Boira.  Anxiety, depression, quality of life and patient satisfaction in acne patients treated with oral isotretinoin. Acta Derm Venereol. 2013 Nov;93(6):701-6.). However most of us have read the media reports regarding tragic case studies, are aware of the warnings listed on the package insert and have met patients whose mental health problems appear to have been precipitated by use of the drug.  (more…)

I’m coming to Sydney!

So far this year I’ve been doing most of my presenting online which has been fantastic because we can all be in our PJs and no one’s the wiser (except now!!) but I do miss the face to face seminars where sometimes the real magic happens thanks to the two-way dynamic between you and me!

So guess what?  I’m coming to Sydney on the 31st August (and then Brisbane 6th September and then Melbourne 13th September) to touch base with many of you again.  I’m joining forces with Rachel McDonald from Biomedica to talk about the real world application of naturopathy in mental health conditions.  (more…)

Get the 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… seriously!

Recently I had the pleasure of presenting a webinar for Biomedica completely and utterly focussed on N-acetyl cysteine – its key actions, pharmacokinetics, applications and contraindications.  In the process of researching for the webinar I learnt so much and to my surprise found even I was under-utilising my favourite supplement! How familiar are you with its application in cystic fibrosis,  fertility, biofilm eradication etc. etc ?  Not to mention, it’s incredible versatility in mental health.  Recently, buoyed by some new research suggesting the efficacy in severe glutamate excess of much higher doses than previously studied for depression and bipolar, I have stepped up my doses in patients with some forms of addiction, OCD, refractory insomnia to 4g/d with great results!  I could talk all day about NAC but perhaps for a starter if you missed the webinar you might want to listen to the recording?  We have the Clinical Knack of NAC now available as a CD with audio and notes for purchase on the website:

https://rachelarthur.com.au/product-category/audio/

This in-depth 1 hour webinar offers practitioners new to NAC, the practical knowledge and tools they need to start using it effectively and for the practitioner already dispensing it, to really broaden their understanding of indications , correct many misunderstandings and get the latest research on the why, when and how to use it.  From reproductive to respiratory health, from heavy metal burdens to biofilms and athletes to addicts, this webinar covers the latest information about NAC’s real therapeutic potential.  Having been a favourite nutraceutical/prescription of Rachel’s for some time, she punctuates the presentation with many of her own cases.  

Something on my MINDD

I briefly mentioned in a previous post Dr. Robyn Cosford’s inspiring opening speech at this year’s MINDD conference.   A key point she made was the growing gap between what’s regarded as normal and what is actually healthy. 

Having worked in general practice for decades, Robyn provided us with one illustration after another – Type 2 diabetes, previously called adult-onset diabetes, now not infrequently diagnosed in primary school aged children; delayed speech and learning difficulties in male toddlers which many increasingly regard as ‘normal’; precocious puberty in girls; escalating rates of depression and anxiety in children and adolescents…Robyn asked us as practitioners to be vigilant about helping patients to distinguish between what has become perceived as ‘normal’ and what is actually healthy.

In my MINDD presentation this year I talked about the mental health challenges faced by young men and I expressed a similar concern: that when we witness extensive aberrant behaviour in young men we are prone to rationalise it.  Are we mistakenly attributing these signs of dis-ease in males as simply being an initiation into Australian culture?  When you hear of young men exhibiting binge drinking behaviour, does it set off the same alarms as it would if your patient was female and if not….why not? 

As part of a broader discussion of the issues, I presented two cases of young men with mental health problems – both from very different sides of the tracks, one gifted and the other a struggler but one of the features they shared included the way their use of alcohol & other substances had passively been condoned by society instead of being seen as a call for help.  We can help these young men but only once we’ve acknowledged there’s a problem. So now I’m extending Robyn’s plea and ask you to be vigilant in making the distinction between ‘normal’ and healthy… when mothers relay stories of their son’s ‘antics’, when brothers, cousins & uncles temporarily ‘go off the rails’,  when young men reluctantly present for a quick fix…

If you missed the presentation and are interested in the full recording check out  https://rachelarthur.com.au/product/new-young-white-men-mental-health-challengers-face-mindd-conference1hr-total-50/

 

P5P V Pyridoxine supplements – when and why?

I’ve been curious about the push towards using so-called ‘active forms’ of B vitamins over the last 10 years in nutritional medicine – particularly with regard to B6 (pyridoxal-5-phosphate) and B2 (riboflavin 5’-phospate aka FMN) in light of substantial research demonstrating that these phosphorylated forms will in fact be dephosphorylated prior to uptake in the small intestine (Gropper, Smith & Groff Advanced Nutrition & Human Metabolism 2005) – so initially it seemed we were being encouraged to pay more for something that ultimately gave us less of the same vitamin. Funnily enough the only established scientific way to ensure uptake of the active forms in their intact active states is to use very high doses – however supplements containing either active B6 or B2 consistently offer very low doses compared with the regular supplements, so this seemed to rule this out as an explanation.

In spite of my scepticism & encouraged by the Pfeiffer approach, I got into using P5P and had to suspend my disbelief in the face of good clinical results.

However finally at the MINDD conference last week, scientist Woody McGinnis at last made sense of this riddle for me!

McGinnis, who some of you might know as previously being a key researcher at the Pfeiffer Institute which specialises in nutritional and integrative management of mental health & behavioural disorders, confessed that he had also struggled with concept of P5P supplementation from a scientific perspective until Bill Walsh suggested that this form was particularly indicated for the ‘lean malabsorbers’.

What Woody essentially took from this was that patients with leaky guts could absorb the P5P intact &  would ultimately benefit from this form.  Adding to this is my understanding that the dephosphorylation process for P5P in the gut occurs via ALP – a zinc dependent enzyme found in the brush border of the small intestine…so here you have the double whammy – if your patient is a malabsorber AND zinc deficient (which of course commonly go together) they are the ones picking up the P5P perfectly and for the rest of us perhaps the pyridoxine will do.

Woody also attested to this with his story of his own pyrroluric son who initially only responded to P5P but in his teens (with significantly improved gut health) appeared to stop responding – at which point Woody switched him to the higher dose pyridoxine with fantastic results…..Aaahhhh at last my scientific curiosity has been quenched! 🙂

MINDD moments 2014

I was honoured to speak at the MINDD conference again this year.  MINDD is an organisation that really sets itself apart by providing incredible hands on support for parents, carers and practitioners in the area of integrative mental health management and one of the key strengths is the sense of community they’ve developed secondary to this.  A key message echoed by numerous speakers was the enhanced clinical benefits for patients when a truly whole health, multi-modality approach is taken – from naturopathy to psychology, from neurology to audiology, from building biology to biological markers and so on.

And just to put the brakes on the whole ‘genes are us’ movement that is currently sweeping Australian integrative medicine, Dr. Robyn Cosford (a highly-regarded integrative GP) kicked off the whole weekend with a presentation that included a study of some of the oldest Okinawan individuals and their genetic profiles.  These individuals aged well over 100 and fighting fit each possessed hundreds of genes currently thought to be associated with chronic disease: cardiovascular, diabetes, cancer.  Robyn reminds us all that while genetics loads the gun it is our diet, lifestyle and environment that actually pulls the trigger!

While I was inspired by the research and insight offered by clinicians and scientists from various modalities, I was reminded again, that no one individual can be across it all and to attempt is to fail or become exhausted in the process and this of course is where the community bit comes in – we need a network of integrative individuals to refer between and support each patient & my experience this weekend suggests these events certainly build that community.  Our job is to practice within our scope and know when and where these other therapies and approaches are indicated and to develop a good referral network.   So many great speakers this year and this time I actually managed to sit still and enjoy some of these so I’ll be bringing you the highlights over the next couple of weeks so stay tuned! 🙂

Young White Men & Missed Mental Health Diagnoses

We’ve all heard about the higher incidence of mood disorders (depression, anxiety etc.) in women and chances are we’ve all seen this reflected in the dominance of female clients who present seeking help but what’s this really telling us?  Many of us are aware that men are more likely to ‘self-medicate’ with alcohol and other substances, as a maladaptive way of dealing with the psychological stressors, however, the lesser talked about fact is that substance induced (i.e. cannabis etc.) psychotic disorders are significantly more prevalent in men and occur at younger ages than women (Bogren et al 2010) and substance use & abuse is commonly not sufficiently explored or adequately diagnosed in general practice amongst male patients.  Oh dear…what else do we need to know?

The results of a large English survey on mental health and help-seeking behaviour published in 2005 found that men were less likely than women to say that they would seek help (OR=0.78, 95% CI 0.72–0.88,P<0.001). The preferred reported source of help was friends or relatives with 63.1% saying they would seek help from this source.  In addition to this and somewhat, more alarmingly, the WHO reports that “doctors are more likely to diagnose depression in women compared with men, even when they have similar scores on standardised measures of depression or present with identical symptoms.”  https://www.who.int/mental_health/prevention/genderwomen/en/ So even when males do finally present for help, often, the mental health problem is being overlooked or missed.

One theme that keeps coming up in research is the ongoing associated stigma for men with mental health issues.  A study published in 2008, conducted by two National Institute of Mental Health postdoctoral fellows in mental health care policy at Harvard Medical School, investigated the effect of gender, race and socioeconomic status on psychosocial barriers to mental health care and found that white males were most likely to mistrust the mental health care system and were also likely to perceive mental illness as a stigma and therefore avoid formal mental health care https://www.sciencedaily.com/releases/2008/09/080908125123.htm

In my practice we actually have a high proportion of males presenting with mental health concerns, admittedly, our practice specialises in this area so that may be a key reason for this and in many instances the appointment has been instigated or driven by a concerned mother, a wife etc.  Regardless, I’ve found that many men really struggle & it’s made somewhat more complicated by the role they are expected to play in society. I think the key message is not to reinforce gender based stereotypes on our patients, have the confidence to explore mental health with male patients, their vulnerabilities, concerns etc. as much as you would your female patients. Make sure you thoroughly assess their substance use and take heart there is a lot we can do for these individuals, the first step is recognising there’s a problem.

Rachel will be speaking on Young White Men & the Mental Health Challenges They Face at the MINDD International Forum in Sydney June 14-15th.  For more information and bookings check out: https://mindd.org/forum/mind2014.html