Exploding Brain Juice

explosionDoes your brain feel like it’s going to explode, spilling brain-juice everywhere, when you do 2 weekend conferences in a row? Or is that just me?  I have returned to my desk after the Integria Symposium and then the Australasian Society of Lifestyle Medicine conferences with ants in my pants.  I can barely sit still.  No caffeine required.  

Right now I want to talk ASLM because it’s fresh in my mind from the weekend but geez where to start?  I was testing the water going to this one.  What would a conference about ‘Lifestyle Medicine’ pitched primarily at doctors look like? Would it be a bit light? Would it be token lip service to CAM with no recognition of the need to also make a paradigm shift?  Well strap yourselves in guys because what I heard from their outstanding keynote speakers (Mark Wahlqvist, Michael Berk, Bob Brown…yes you heard right..I said Bob Brown!) were some of the most holistic naturopathic teaching points about individual, population and global health that I have heard in a long time.  These 3 speakers in particular were mesmerising – to naturopaths (yes there were a smattering of nats there) as well as to GPs, specialists and other attending allied health professionals (more…)

Your Burning Zinc Questions Answered

question-1018843_960_720

Most practitioners are pretty knowledgeable about Zinc and are quick to recognise a deficiency and the opportunities for zinc supplementation as an effective therapy and those same practitioners are often plagued by nagging questions that come up, in spite of loads of clinical experience, like:

  • Are plasma and serum zinc levels interchangeable?
  • What does zinc adequacy look like?  Is it just a single number on a page or do we always have to factor in copper levels and get the ratio right as well?
  • What can I expect from zinc supplementation in terms of changes to the patient’s plasma zinc?
  • What should I do when a patient’s zinc marker is refractory to the intervention?
  • Is there really a significant difference between the different supplemental forms available?

(more…)

Uncovering Unhealthy Bones Earlier

bonesRecently, while I was touring around the country talking all things Acid Base (!), I spent a bit of time talking to practitioners about the limitations of our current protocols and assessment tools for detecting ‘Bad Bones’.  I was surrounded by a sea of nodding heads and when I offered a solution in the form of additional bone health markers, I could see light bulbs going on all over the room 🙂

 We all appreciate that osteoporosis develops over a lifetime not overnight, yet the current screening recommendation in most countries suggests that women at the ripe old age of > 65yrs and men >70yrs undergo their FIRST (!) BMD scan!  The only exception to this rule is that they recommend an earlier scan in those individuals at high risk…ahem….does anyone here not have their hand up??   (more…)

Are You Questioning CoQ10?

detective-156647_960_720I like to fancy myself as a bit of Supplement Sleuth!  I love working with herbs, nutrients and nutraceuticals but I am not blinded to the fact that manufacturers and suppliers, whatever their form of medicine, are large competitive businesses that ultimately need to sell product and want to sell more.  Often practitioners & patients are surprised when I say things like, ‘It’s vitamin C not something sophisticated – go buy something cheap as long as it ticks these boxes…”.  In contrast, there are some nutrients and nutraceuticals at the other end of the spectrum, that evoke my compete attention around form, delivery method etc. and I would never send my patient out the door to get these anywhere else.

A few times recently, I’ve been asked by praccies, ‘What’s the deal with CoQ10 and ubiquinol V ubiquinone/ubidecarenone forms?’ and I can hear in their tone that they posses a healthy scepticism when being sold the latest and greatest supplement! ‘Should all my patients be using the ubiquinol form or just some?’, ‘Is it really worth the premium price?’.  Great questions all of them 🙂 (more…)

Buckets of Busy Mums

IMG_3153

I know my busy mum patients think I am probably not to be taken literally when I say, ‘Cook buckets of extras every time you step foot inside the kitchen’, but I am.  My slow cooker and my ‘buckets’ are two of my favourite kitchen resources I couldn’t live without.  Check out my fridge.  These ‘buckets’ can keep a family of up to 6 or 7 (yes my family size changes at each meal) going for almost a week. There are additional buckets of main meals (soups, slow cooks, curries) waiting in the wings in our freezer for when the shelves start to look bare.

Our ‘buckets’ mean that our kids, who don’t really ‘do’ snacks or a lot of (ab)normal processed foods, can see the menu for breakfast (yes, their absolute favourite breakfast is soup), self-serve leftover options to take to school and satiate themselves during the after school feeding frenzy! Gold. (more…)

A New Mental Health Education Initiative in July!

Listen to the Wave (2)

“Access the Experts with Rachel Arthur” is a month long intensive webinar series focusing on the best of Mental Health Education. Every Thursday night for the month of July, Rachel will be interviewing a hand-picked guest speaker about a particular area of expertise in Mental Health.

Each speaker is a clinician with years of experience (from a psychologist, to a GP, to psychiatrists) who Rachel has worked with and/or been mentored by and she is thrilled that these interviews create an avenue to share their incredible & very practical knowledge with a wider audience.

Rachel’s role as the interviewer will be a feature of the webinar series – ensuring you get the best of each speaker; translating the complex into easy-to-understand concepts and clinically relevant content that you can start applying immediately. (more…)

Anti-Epileptic Medications & Nutrient Interactions 101

meds

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…)

What Does the new RACGP Guideline re Naturopathic Requests Mean?

medical-563427__180

It’s taken a little while for me to collect my thoughts on this one. Initially there was a little flash of anger, frustration and a good deal of huffing and puffing when I heard about the RACGP guidelines recommending GPs say no to any requests from naturopaths for further investigation of their shared patients… but I’m over that now. In an interview on 702 ABC Sydney radio last week, Stephen Eddy, the vice president of ATMS, responded to these guidelines by suggesting that a blanket directive for GPs to ignore all requests from all naturopaths about all testing didn’t really sound sensible or appropriate. Here here! Surely, in the pursuit of evidence based medicine and discerning practice decisions, each case should be considered on an individual basis.  I think Stephen Eddy gives GPs more credit for being able to make these judgements than their own association! (more…)

The Beauty of the Basics

raspberry-582834_960_720

Howdy practitioners – I’ve had an inspiring month of clients.  Not because I cured anyone, answered some major riddle previously unsolved by modern medicine or any of these enormous tasks we or our patients often set ourselves but rather because I got back to basics.  Many of you will know that I spend most of my practice time working at the pointy end of complex chronic multi-system disease and while it is deeply satisfying when you have a breakthrough with someone’s health, it is challenging.  Often I am the last bastion, my clients have been referred to me and therefore typically have already addressed their diet and other health behaviours to a certain extent.  So unlike perhaps many naturopaths, I don’t spend most of my time in practice talking about food and doing the grassroots education that is at the core of naturopathic medicine (in my humble opinion) 😉

This month was different.  I had a bunch of clients who, while they did have pointy end (that’s a technical term!) multi-system disease, e.g. one client alone had retinal detachment, coronary stents, a genetic bone disease, NAFLD and a liver abscess, they clearly hadn’t been educated about food in the way that we do so well and which can make such a huge impact on a person’s life and health.

(more…)

Turning the Spotlight on the Low Dopamine Depressive

 

cloud-655543_960_720

Low dopamine as an underpinning cause of depression, anxiety and even addiction (illicit drugs, sex, gambling) has been gaining increased recognition in research.  In spite of this there are no antidepressants currently on the Australian market that address dopamine specifically and therefore patients with this pathophysiology often fall through the gaps, failing to get efficacy from pharmaceuticals.  Many of these patients are subsequently diagnosed with ADHD as well, which has disordered dopamine as part of its aetiology, and are prescribed dexamethasone as well.  The dexamethasone, being a stimulant that helps significantly to improve dopamine, is typically the drug that has more of a positive impact than the anti-depressants on these patients however, still fails to really solve the issue and can come with many side effects.

Since the 1990s the term ‘Reward Deficiency Syndrome’ was coined to describe a subset of these individuals whose brains are effectively under-equipped with dopaminergic activity in certain key areas.  This is the result of a less common genotype coding for our D2 receptor in the brain.  Far from being rare, this genotype is reported to be present in 30% of Americans, however, the magnitude of problems associated with it can vary from mild to severe depending on many other genetic and environmental factors.

(more…)

Correcting Urinary Iodine Results – A Newsflash!

urine

Howdy hard working praccies 🙂  well I received a very interesting email this week from someone asking me if I thought her urinary iodine result was accurate or if, as I have written about previously (https://rachelarthur.com.au/concentrating-concentration-getting-urinary-iodine-right/),  it needed to be corrected for the creatinine content of her urine.  Her raw iodine result was 24ug/L which suggests severe iodine deficiency.  Her referring doctor however had also asked for creatinine and applied the creatinine correction formula I have previously described:

Iodine (mcg) ÷ Creatinine (mmol) X 8.85 = Corrected Iodine  – which changed her result to 265 mcg/gCR which suggests she is NOT iodine deficient at all

She then asked another doctor to review the result who had told her 24ug/L was correct in the first place as ‘pathology companies automatically correct for the concentration of the urine’. Naturally the individual found the difference in opinions and results absolutely striking and ultimately disconcerting so she thought she’d ask me.

It was good to get this email because it made me go and check my facts, get in touch with all the major mainstream pathology companies we deal with and ask their labs ‘Do you or do you not automatically correct for creatinine when you report urinary iodine results?’  I was worried I had given you guys some bad advice 🙁  …here’s what I found out: (more…)

Dump The Dairy But Not the Calcium?

 

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…)

Hold the DHA in Mental Health?

About a decade ago there was a lot of excitement about using fish oils in the management of mental health, so much so even the American Psychiatric Association developed recommendations suggesting that people with mood, impulse control & psychotic disorders should all consume 1g EPA + DHA per day… but then what happened?

Ask most health professionals (GPs, psychiatrists, naturopaths & nutritionists alike) today whether fish oils are their first choice in mental health nutritional interventions and you’ll frequently get a, ‘No’ and I include myself in that.

Let’s retrace our steps to find out how we got here.  The epidemiological evidence linking low omega 3 intake to myriad mental health problems in terms of susceptibility, incidence and severity is almost overwhelming. For example, depression rates are 10 times higher in countries with limited seafood intake and post-partum depression 10-50 times higher (Kendall-Tackett, 2010).

Noaghiul & Hibbeln postulated that countries where individuals consumed less than ≈ 450-680g of seafood per person per week demonstrated the highest rates of affective disorders (2003). One study of 33 000 women with low omega-3 intake were found to have an increased risk of psychotic symptoms (Goren & Tewksbury 2011) and it goes on.  Then, we have other evidence also pointing in the direction of fish oils, such as the general consensus that excess unchecked inflammation is evident in many mental health conditions (Maes et al 2013).  Numerous intervention studies using fish oils as stand-alone or adjunctive treatments have been published. Interventions have included high dose omega 3 (no specific EPA/DHA breakdown), EPA alone, ethyl-EPA, high DHA, blends with high DHA:EPA ratio, flaxseed oil etc. etc. (more…)

The Inclusive Specialist?

 

Lots of great conversations with practitioners following my recent post on the need to specialise – really thought provoking & clarifying ones which makes me think it’s been a good conversation starter. Key things that have come up for people are:

  • How do I choose my area of speciality…e.g. is a spin the bottle approach required?
  • Is specialisation sensible when you’re only just starting out or should you be taking everyone and anyone to begin with?
  • Is specialising even naturopathic given we have a holistic approach to health?? …e.g. I might say, I only do gut but for my IBS patients there’s a whole lot of stress management & mental health stuff that needs addressing along the way

Great questions 🙂 Now remember, all I’m offering here is my opinion, I don’t think there is a definitive answer to these but I think we should keep the conversation going as a way of keeping us thinking about the way we choose to practice rather than assuming there’s only one way to be a naturopath in clinic. (more…)

Money and Meaning?

I had one of those conversations with a friend recently in which he was wondering out loud about what the point of it all is.  Now don’t panic…this is not ‘suicidal ideation over a cuppa’ kind of stuff … no this is the regular existential crises that many of us experience about what it is we’re doing with our lives as opposed to what perhaps we should be doing, or as a good psychologist might frame it asking ourselves the question, ‘do my values align with my actions & choices in life?’.  Maybe it’s my age, maybe it’s where we live but I find this is a conversation that’s coming up increasingly regularly amongst friends, colleagues and clients.

The wrestle between being V doing, earning V giving  and perhaps money V meaning is such an age-old one and I think particularly pertinent to people in our profession. We’ve chosen the road less travelled, we’ve opted for a career that (chances are..) we knew was likely to earn less (money, respect, fame! 😉 ) than a lot of other paths we could have chosen and yet most of us hold the almost endangered position of being able to say, “I love what I do”.  (more…)

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…)

What Do You Do For Post-Partum Hashimoto’s Thyroiditis?

 

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…)

Who gives an RDW about RDW?

Ever noticed that thing called RDW (red cell distribution width) reported in your patients’ haematology results? Given that this parameter is currently regarded as one of the most important & earliest markers of a wide range of serious diseases, you might start paying some more attention to it from now on!

Dr. Michael Hayter, cleverly refers to RDW as being a reflection of the ‘Quality Control’ of an individual’s red blood cell synthesis.

As it’s a measure of how similar or dissimilar our rbcs are in terms of size, smaller values (suggesting homogeneous rbcs) are regarded as healthy, while higher RDWs suggest that some part of  rbc synthesis and/or clearance process is faulty.

This makes perfect sense in the context of nutritional anaemias like iron and B12/folate which all produce elevated RDW results but new research proposes that this rbc size disparity is also a common linking feature in just about every major disease, often predating diagnosis or in cases of established pathology signalling progression and warning of imminent poor outcomes for the individual.

There have been 100s of papers published just in the past 4 years on this topic and the findings are nothing if not dramatic. One of the biggest things I’ve realised is that, while Australian pathology companies suggest that all RDW results < 16% are acceptable, in the light of these new associations, a more accurate cut-off is probably around 13.5%! The big question now to answer is, is the increased RDW a passive marker of pathology or actively involved in the pathogenesis of these major diseases. For now, we should be scrutinising our patients’ RDW results more closely and being alert to what these markers are telling us about our clients threats & risks. I’ve recorded a 30min audio summarising all the information I’ve come across on this topic and how to apply it in your patients which you can access here.

Alternatively, if you’re happy to chomp into some juicy journal articles yourself then check out these ones to start with

https://jaha.ahajournals.org/content/3/4/e001109.full

https://www.researchgate.net/profile/Fabian_Sanchis-Gomar/publication/269930590_Red_blood_cell_distribution_width_A_simple_parameter_with_multiple_clinical_applications/links/5499b0e50cf2d6581ab15143.pdf

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…)