Oh no, it’s her again 🙁 I mean the chick in the photostock image not the other ‘her’, me. I know. It’s the end of another mammoth year, you’re tired, worn out, used-up all your brain-power quota (a little projection?) and I can hear you begging for mercy when I start a sentence with…”So you think you know….” followed by, “blah blah blah Iron,” but hear me out.
Correctly identifying & managing iron issues is a bread & butter part of our business, right?
With Iron deficiency affecting an estimated 1 in 5 women and Iron excess almost another 1 in 5 – patients with one form of iron imbalance or another tend to be over-represented in waiting rooms.
Anyone can spot overt iron deficiency anaemia or full-blown haemochromatosis but many health professionals find the ‘in-betweens’ confusing and fail to recognise some key patterns we see over and over again, that spell out clearly your patient’s current relationship-status with this essential mineral. This often results in giving iron when it wasn’t needed and missing it when it was. If you’re imagining someone else, i.e. the person who ordered the Iron Studies for your patient, will step in and accurately interpret the more curly results can I just say D-O-N’-T...they’re often as perplexed or even more so than you. After starting this conversation a year ago with So you think you know how to Treat Iron Deficiency, & its baby sister, So you think know the best Iron Supplements, our (imaginary) switchboard went crazy. While practitioners got the message loud and clear about how to improve the likelihood of treatment success in iron deficient patients, hot on the heels of this came email, after fax, after carrier pigeon, with examples of patients’ Iron Studies, the ‘somewhere in between ones’, accompanied by the equivalent of a dog head tilt…aka ‘I don’t get it’.
And this is to be expected.
What were you taught about reading Iron Studies? Was it made out to be all about ferritin? And TSH is a solid stand-alone marker of thyroid health, right? 😉
Were you introduced to the other essential parameters included in Iron Studies, explained how they contribute to your diagnosis and reveal important details about the patient’s ability to regulate this mineral or not? About when to dose and when to hold your fire?
Nah…I didn’t think so. But it’s up to us, people, to hone our skills in Iron Study interpretation…because individualised nutrition is our ‘thang’ and more than any other nutritional assessment, this collection of markers, actually allows us to go beyond the ‘one size fits all’ model…everyone must have X of this and Z of that in their blood tests…and see each patient’s actual individualised need and relationship with this mineral. In the latest Update in Under 30, I introduce you to 3 key players in iron assessment and the insights each offers become so clear, you’ll be able to read any combination or permutation of iron results that walk through your door. To boot, I’ve included a wizz-bang cheat-sheet of those iron patterns that are frequently seen and rarely recognised, including one totally novel one that I’ve never talked about before…to make your job even easier and put you well and truly ahead of the pack in understanding iron nutrition. It’s Christmas…and as the mantra goes…we can always fit just a little more in at Christmas time, right? 😉
Overt Iron Deficiency Anaemia or Haemochromatosis aside…do you understand the critical insights markers like transferrin and its saturation reveal about your patients iron status? Most practitioners don’t and as a result give iron when they shouldn’t and fail to sometimes when they should. This audio complete with an amazing cheat sheet for interpreting your patients Iron Study results will sharpen your skills around iron assessment, enabling you to recognise the real story of your patients’ relationship with iron.
Hear all about it by listening by my latest Update in Under 30: So You Think You Know How To Read Iron Studies? For all Update in Under 30 Subscribers, it’s now available in your online account and if you are not a subscriber you can purchase this individually here.
And then you don’t, right? Because if my experience is anything to go by, there are some patients that just don’t respond to the usual iron repletion strategies. Depending on how low their ferritin is, this can then precipitate ‘practitioner panic’ (we’ve all had it right?!) where we’re inclined to go higher & higher with the dose and number of doses per day. Typically, this also fails. I hear about this from other practitioners all the time and I see the ‘normal’ doses of iron sneaking up and up. Remember the days when we couldn’t get a non-pharmacy supplement with over 5mg elemental iron in it and now we have > 20mg? But still, I hear you say, this fades into insignificance when you think about the standard medical model for iron correction which provides 100-200mg/day and you’re right.
Gee… after hundreds of years of knowing about this deficiency and being the most common deficiency word-wide, you’d think we had our supplemental regime nailed.
But that’s where you’d be wrong. (more…)
Can you help me out here? My memory has failed me. Someone, somewhere (Mel? Syd? Auckland? Online during a mentoring session? In a Mullumbimby supermarket?!), in the past month asked me for this paper documenting the increased pain perception reported by subjects given IV saline with a slightly acidic pH compared to a neutral preparation. Quite an extraordinary illustration of the potency of small pH changes in the ECF and the impact this can have on our pain perception. This study is one Professor Vormann has previously talked about and as I’m touring with the fabulous German Professor right now I said, ‘Sure!’…then seemingly instantly erased from my mind who made this request! Is it you?
This month is a fabulous blur of travelling & speaking, getting back face to face with everyone at a bunch of seminars & conferences, which I love but I do forget some days where I am, who I am and exactly what I have promised and to whom! (more…)
I’ve been known to give calcium more attention than most and now I feel vindicated. Serum calcium, of course is not a reflection of your calcium intake, calcium losses nor overall calcium status. In this regard it is totally useless. But my fixation is about what even slight variations away from healthy levels of this mineral can reveal.
You’ve probably heard me openly scorn the parathyroid glands
“How hard can it be? These glands have just 1 job: keep the blood calcium in range! Snort!”
And that is exactly why it is so meaningful when this appears to be a ‘big ask’ and the serum calcium slips under 2.2 mmol/L or over 2.45 mmol/L & so potent given the huge chain of physiological reactions that follow from such a small shift – producing profoundly negative effects on vascular dynamics, neurological function etc. (more…)
Let’s play a little word association game:
I say ‘Fibroids’ – you say, ‘Oestrogen’.
I say ‘Cyclic Breast Pain’ and you say, ‘Ouch!’ [because it just slipped out] but then you say, ‘Prolactin’, right? Me too.
Prolactin driven breast pain’s most characteristic form is the premenstrual ‘oh my goodness get these off me!!’ kind, with patients experiencing anything from burning, aching, bruised feelings and acute hypersensitivity to touch, which builds in intensity for days leading up to their bleed. Of course cyclic mastalgia can progress to being full-time mastalgia in women whose breasts start to exhibit structural tissue change in the form of cysts, fibrosis and ultimately fibrocystic breast disease. If you’ve ever experienced even a day of mastalgia it is truly hard to conceive there are so many women (about 50% of premenopausal women!!) living with it daily.
Adding to our concerns about this so-called ‘benign breast disease’ (BBD) is that researchers are now certain it’s a significant risk factor for breast cancer, with women with any form of BBD experiencing at least a doubling of risk of a subsequent breast cancer diagnosis, while those women with proliferative BBD exhibiting a risk of 3.5X that of women without BBD. Castells et al 2015 (more…)
Whenever I talk to practitioners about thyroid health, like I recently did at MINDD, I can guarantee I’m going to get 2 questions:
- Shouldn’t we aim for the high iodine intake of Japanese?
- Can we use the patch test for testing iodine levels in our patients?
I am so glad you asked. The answers are no and no.
I am a nutter for minerals and iodine just won’t go away right now. Too little = a problem, too much = often the same problems. To boot we are faced with radically contrasting views on assessment and dosage and just about everything iodine related. It’s not you – it’s iodine. Trust me it’s a complex little mineral that requires some extra thought and caution. If you imagine the Japanese have no thyroid problems – correct that big myth right now by reading this scientific paper that refers to health problems that result from too much dietary iodine. It also explains that the typical first step in treating hypothyroidism in Japan is to reduce their iodine intake! (more…)
I keep hearing the name, ‘Molly’: “I think I’ll use ‘Molly’ for this patient” or “A bit of ‘Molly’ might go well with the zinc for their high copper”... a moment of confusion on my behalf, (Molly who?) and then the slightly late…’ooooooooh Molybdenum’. Gotta love a trace mineral that is having it’s heyday…right?…right?
There are often jokes made about how little time medical degrees dedicate to teaching nutrition in general – was it 1 lecture or 3? – but let’s be honest, who among any of us really knows the ins and outs of this transition metal. I reckon we spent maybe 15 mins in my undergraduate on it and that was BC (Before Computers!) so I am guessing that 15mins has expanded about a gooooooogle times and we’ve come to a more comprehensive perspective. What do we need to update on? (more…)
Have you still got some thyroid patients that don’t fit any sort of traditional thyroid disease model and are difficult to get results with? Oh yes me too… and watch out…I’ve been spending the last few weeks with my nose firmly embedded in hundreds of articles digging around for more answers. As I am presenting on thyroid conditions for ACNEM in Adelaide March 18-19th, I couldn’t resist going back to the literature to see if by delving a little deeper again I could come up with some more answers to these weird, wacky and hard to treat thyroid presentations that we’re increasingly seeing and guess what…I think I’ve found a few gems. (more…)
Ok here’s a gripe I’m having currently. I have a number of patients who are taking anti-epileptic drugs (AEDs) and most of these are children who require them for seizure control. Naturally, working alongside such serious pathology and these critical medications requires a conservative and evidence based approach to ensure the safety of any added intervention. Fortunately, this is something I would like to think is one of my strengths. When these patients present seeking nutritional support, I typically refer them for investigations that can help to clarify what, if any, nutrients are imbalanced because of their long-term AED use or perhaps because of other independent reasons that may compromise they’re overall wellbeing. I feel that in such a vulnerable population I need to confirm nutritional deficiencies to check my assumptions, prove a need for supplementation and prevent against any excess or creation of further imbalance…and by doing so, I can adhere to my motto of least medicine, is best medicine.
The fact is AEDs are notoriously associated with a long list of potential negative nutrient interactions and the evidence to support this is extensive, this includes but is not limited to: folate, B12, B3, B6, zinc & vitamin D and the deficiencies potentially produced by the AEDs can be quite severe depending on a range of individual factors. For many of these nutrients, the research goes further and has shown that correction of the deficiency leads to better drug efficacy – therefore adjunctive nutritional monitoring and correction would seem like a real ‘win win’ situation.
(Stargrove,MB. et al. Herb, Nutrient & Drug Interactions – Clinical Implications & Therapeutic Strategies. 2008) (more…)
It’s not sexy but it is one of my favourite deficiencies. Favourite because it’s incredibly common…make no bones about it (tee hee)! Favourite because a deficiency is actually reasonably easy to recognise once you know how (watch increasing phosphate levels especially over 1.2 mmol/L in particular in adults) rather than wait for a recognisable clinical deficiency picture because if you wait for this your patient will have probably had osteopenia if not osteoporosis for a decade already! Favourite lastly, but most importantly, because correction of a calcium deficiency has led to some of the most diverse but impressive improvements in people’s health that I have seen – from better menstrual regularity and less luteal phase symptoms (see the fascinating research on this also by Thys-Jacobs 2007 https://press.endocrine.org/doi/full/10.1210/jc.2006-2726) to improved pain control in fibromyalgia. (more…)
Like all thyroid disease, post-partum thyroid conditions seem to be on the rise – and often they rewrite the rule book when it comes to thyroid pathology & its management. Therefore for many of us it can add an extra element of uncertainty about how to help these clients.
One of our graduate practitioners has a great example of this, a 33yo female who developed late gestational diabetes and is now struggling with a new baby and an autoimmune thyroid disease! What would you do? Does post-partum thyroiditis have unique triggers/drivers that require specific treatment? What can you/should you be doing differently because she is still breastfeeding? What’s the likely progression/prognosis?
This is your invitation to come along and find out the answers to these questions and more. During our live graduate mentoring session on Monday 15th June at 3.30pm AEST we’ll work through all aspects of the case, from history to presentation and from looking for clues in her pathology results to where to start with treatment. (more…)
These days it seems like patients can almost be divided into two groups: those that have a tendency to iron overload and those that struggle most of their lives just to keep ferritin in the red…and what a struggle it can be. So many clients have spent years taking every form of iron there is in high doses, trying to improve their intake of dietary sources, working on their digestion etc etc but still those numbers can fail to really pick up. (more…)
Over 20 years ago (ouch!) while studying at Southern School of Natural Therapies, I heard for the first time that calcium perhaps had a ‘dark side’! At the time, and still to a large extent now, calcium is publicly portrayed as something you simply can’t get enough of and 20yrs ago this idea was almost heresy! Certainly in the eyes of the dairy corporation at least 🙂 Yet there had been a long-standing concept in naturopathic nutrition that the distinction between calcium’s healing and harm all came down to where it resided in the body, e.g. bones Vs blood vessels. Last week Medscape ran an editorial espousing the same concept. (more…)
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…)
“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…)
Just been speaking on the thyroid at ACNEM last week and am finding that practitioners across the board are getting more and more curly thyroid cases. One scenario that we increasingly see is something that might be described as ‘T3 resistance’, when your patient’s T3 value looks healthy but they continue to manifest the signs and symptoms of hypothyroidism. There are several differentials to consider of course (more…)
As Rachel says in this month’s From My Desk to Yours, “I had to do it sooner or later, we have to talk about Zinc.”
Rachel has been talking about Zinc for years.
Here are some of the items you might like to catch up on to brush up your background on this important mineral.
Do we need to rethink zinc?
Dynamic Balance I – Iodine, Selenium, Iron, Zinc, Calcium & Magnesium
Coeliac disease presents as behavioural problems