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…)
In spite of several advantages of salivary hormone assessment, one important piece of information you miss out on when you do this rather than blood assays, is the SHBG result. Sex hormone binding globulin is a protein produced in the liver that, as the name suggests, binds our sex hormones rendering them inactive and therefore buffering us against their full potency. They bind the sex hormones to different degrees – the androgens most potently and oestradiol to a lesser extent but curiously it’s higher oestrogen that represents the major hormonal driver of increased SHBG production (including synthetic oestrogens). (more…)
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:
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.
Globulins…ever thought much about them? Me neither really unless they were clearly below range which made me consider immune impairment but recently Dr. Michael Hayter, who I am co-presenting the Diagnostics Master Class (Health Masters Live) with, inspired me to take a closer look! Globulins are typically reported in your patients’ E/LFTs or standard chemistry and they refer to a big group of molecules including CRP, transferrin, lipoproteins and yes all the immunoglobulins/antibodies. (more…)
I often say that if my surname was Rubin I wouldn’t be able to resist calling my son Billy. I am sure the joke would be lost on 90% of people & certainly on my poor child who might never forgive me but never on me – I get a giggle every time 🙂 Recently, I’ve been reading a lot of scientific literature on bilirubin, previously regarded as simply the end waste product of haem, it’s now attracting huge interest as a biomarker of oxidative stress. There’s still lots of ongoing debate & contradictory research findings but here’s the general consensus so far…bilirubin is an antioxidant (particularly protective against peroxyl radicals & lipid oxidation although the latter is still being hotly debated). Not surprisingly then, several studies have shown that smokers for example, consistently have lower total bilirubin blood values, indicative of their greater oxidative stress & yes, smoking cessation leads to partial correction of this (O’Malley et al. 2014 Smoking Cessation Is Followed by Increases in Serum Bilirubin, an Endogenous Antioxidant Associated With Lower Risk of Lung Cancer and Cardiovascular Disease) A recent study also found a positive correlation between higher flavonoid rich fruit & vegetable intake and total bilirubin (Laprinzi & Mahoney 2014 Association Between Flavonoid-Rich Fruit and Vegetable Consumption and Total Serum Bilirubin).
On top of this, there is a wave of epidemiological research to currently surf, suggesting inverse relationships between total bilirubin levels and several diseases: hypertension & CVD, T2DM, metabolic syndrome, MS, renal disease, IBD, lung cancer and the list goes on. The sort of cut-off point being talked about is a result < 10 µmol/L being associated with the highest risk. What remains unclear is whether lower bilirubin levels are actually risk-promoting or whether they are just a signal of the individual’s oxidative stress.
Total bilirubin (aka Indirect or Unconjugated bilirubin) values are typically included in most pathology company’s basic general chemistry or E/LFT panels which means most of your patients already have had this test performed in the previous 12 months. So next time you’re looking at patient results check out their bilirubin values and if they have bilirubin levels consistently <10µmol/Lconsider how you might better support your patient manage their oxidative burden to reduce risk of future disease and if you’re hitting the mark the bilirubin level should rise 🙂
Want to know more about Bilirubin and Pathology interpretation in general – Rachel is collaborating with Dr. Michael Hayter to present an online Master Class in Diagnostics starting this week. For more information check out Health Masters Live https://www.healthmasterslive.com/product/clinical-diagnostics-masterclass/?mc_cid=cfd82dd367&mc_eid=014c831228
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…
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 some 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! 🙂
A few years ago I heard Felice Jacka, Associate Professor (Deakin University), speak about her research linking mental health to certain Western dietary patterns and possibly many of you have already heard me rave about her work. This year I had the pleasure of hearing her again at the recent Science of Nutrition in Medicine Conference and guess what I learned this time? Felice is actually Alf Jacka’s daughter…I know I’m a bit slow sometimes. For those of you still going, “Huh?” – I am guessing you’re not from Victoria and certainly didn’t study at Southern School of Natural Therapies. Alf Jacka is considered by many, a pioneer of naturopathy in Australia and he established SSNT. So I was thoroughly delighted when Felice, who is a very highly regarded researcher, made reference to her late father, & naturopaths generally, as being trail blazers: articulating many of the physiological drivers behind mental health decades before they turn up in the mainstream zeitgeist e.g. digestive health & the central importance of microbiota, excess glutamate activity in addiction. Felice’s key interest lies in how we can prevent depression and mental illness at a population level via diet and she seems keen to essentially bring a more holistic perspective to the often reductionist world of health research.
I also recently attended the annual Biobalance Conference one (yes I truly have nothing else to do with my weekends!) which had Jerome Sarris on the bill. Many of you will be aware of Jerome who is a Senior Research Fellow at The University of Melbourne, following completion of his doctorate at The University of Queensland in the field of psychiatry. Again, some of you would have heard me mention his work in previous posts – he’s attracted more than $4 million in grants and has published some very high impact papers on the use of CAM in psychiatry. Personally, I find his review papers demonstrate a deeper understanding of CAM so clearly lacking in those written by non-naturopaths i.e. the others miss the point and he generally gets it and can find a way of putting voice to naturopathic nutrition in the forum of a scientific dialogue.
Anyway, at Biobalance, another speaker on the bill essentially suggested (possibly unintentionally) that naturopaths had less of a grasp of complex nutrition than integrative GPs and much to my delight, Jerome, a keynote speaker, responded by identifying himself first and foremost as a naturopath and then saying on the matter , “Ahem…I don’t agree at all”…or something to that effect. It was a great moment.
So fellow naturopaths and integrative practitioners, be assured that we are being beautifully represented by these trailblazers & if you’re interested in getting into research yourself – I suspect there’s never been a better time.
