No Holiday For The Thyroid

Just because most of us have been on holidays doesn’t mean the thyroid knowledge wagon has stopped or even slowed!  Always amazed at what we continue to discover about the complex working of this amazing gland and how its health impacts so much of the rest of the body and of course our babies’ bodies! So I thought I’d give you a quick recap of an important study published while you were at the beach/in the bush/in bed ;)…

  • A Finnish prospective cohort study of over 3000 pregnancies by Heikkinnen et al has revealed that at 16yo, offspring from these pregnancies, had a 1.56 increased rate of unhealthy weight and a 2.5 greater likelihood of meeting criteria for metabolic syndrome, if their mothers were thyroperoxidase antibody (TPO) positive during their first trimester
  • TPO antibodies affect up to 20% of pregnancies but in this study they defined ‘TPO positive’ as those women with levels ≥ 167.7 IU/mL (the 95th centile in this sample)
  • What adds to the noteworthiness of this news is that:
    • More than half (55%) of the TPO positive mothers were classified as euthyroid during their pregnancy, suggesting that the effect was not driven by maternal  hormone concentrations
    • The offspring of mothers with actual thyroid dysfunction did not show any statistically significantly greater risk of cardiometabolic issues
    • The offspring of hyperthyroid mothers in fact demonstrated significantly better insulin sensitivity at 16yo than children of euthyroid mothers
    • Thyroglobulin Abs over the 95th centile (≥ 47.7 IU/mL) did not correlate with any increase in cardiometabolic risks for their children

When we consider the substantial evidence of poorer maternal cardiometabolic outcomes for women who are hypothyroid during pregnancy – it would seem that the abnormal thyroid hormones are most impacting for mum but in fact the TPO Abs the most detrimental for bub! (more…)

It’s Landed At Last! Aka ‘Kids’ Guts Can Be Mental’ [ft. Threadworm] Recording

Standing at the podium, I looked down at my notes & slowly read out the title of my presentation to the hundreds of people attending, ‘Paediatric Digestive Issues & Neurocognitive Abnormalities’ and briefly froze thinking, Holy Heck (!) this is someone else’s presentation!  Seriously. No, this is not one of my work stress dreams.  This happened. I thought…oh my how am I going to deliver this, it sounds very complex and lofty and scary!!

Then I saw my scribbled hand notes on the page, the unofficial name I had affectionately given this presentation as I researched, compiled my case studies and brought it into being, months prior and I instantly relaxed…oh…Kids’ Guts Are Mental…now that I have some serious experience with and something to say about! (more…)

Sunshine Doesn’t Come In A Capsule..Last Time I Checked

Have you been a bit vitamin D trigger happy?  Does a patient’s low blood 25(OH)D test result have you reaching for a vitamin D supplement like the rest of us?  Yes…you might need to listen up then. Sunshine doesn’t come in a bottle.  That’s right, if your patient’s problem stems from inadequate sun exposure, have a guess what the best remedy is.  I’m not meaning to sound flippant but I think in all my ‘complex highbrow nutritional understanding’, occasionally (ahem), I have lost sight of the simple truths. (more…)

Can You Help Me Out Here?

Woman confused thinking seeks a solution, paper card with question mark on her head. Doubtful young female in glasses studio shot on black

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…)

It Won’t Happen Overnight but it Will Happen

hair

…Chronic Kidney Disease (CKD) that is! That’s the ad we really need broadcast on prime time tv.  On par with osteoporosis and other conditions that ‘seemingly appear out of nowhere’ in people’s 60s and beyond, there’s a potent combination of ignorance (patients) and denial (health professionals) at play it seems, when it comes to discussing the earliest signs of CKD that typically start decades before you’ll ever get a ‘diagnosis’. Being specialists in preventative health care – this is something we need to have firmly on our radar in terms of early identification and also in our repertoire when it comes to risk reduction.  Most of us know about water intake and all the medical risks for renal impairment but are we equally onto the critical role that mild acidosis plays in driving this condition?

It’s not just me. Promise.

Check this out. (more…)

We Have A Winner… Among Many!

dang sarah

Last week I threw down a challenge.  Following on from the ruffling of many feathers regarding Jason Hawrelak’s report that dietary saturated fat increases uptake of endotoxins from the gut,  I provided his reference list in support of this claim, effectively saying, “if you don’t like his findings, then make your own informed conclusions but make sure you read all the evidence first”.  I offered a prize to everyone who made an attempt and a year’s free subscription to Update in Under 30, to the person who produced arguably the best summary.

I’ve said it before and I will say it again, and again, and again: Our professional community abounds with extraordinary individuals. 

People’s response to this challenge proved that once again. (more…)

Are you feeling your AGE?

Saggy skin

Ever got to the end of a day or a week and felt like this?  Or woken up to find your skin looking like this?! Just quietly, me too.  When my son was about 3 he was sitting in the back of my car with my mum (she would have been in her early 70s) and he asked how people get wrinkles.  We told him it was from having a fun life with lots of laughter, to which he replied out loud while still staring intently at my mother’s face, ‘Wow Grandma! You must have had the best life ever!’ I digress.

I personally am not a crusader of anti-ageing (seen my pics recently?!!) but my recent research into effectively reducing Advanced Glycation End-products (AGE) via the diet, to in turn potentially lower both my risk of tuckshop arms AND just about every other disease you can name (cardiometabolic, neurodegenerative, psychiatric, malignant, you name it), got me sitting up and paying attention! (more…)

Joining the Campfire Conversation

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So you’ve heard part of that BIMA story…now here’s the rest. To be honest, I was pretty surprised to win anything given I’ve spent the last 20 years ‘agitating’, challenging the misinformation and strongholds of the big companies etc. Funnily enough, in my post award ceremony interview, my interviewer dished up the biggest compliment of the evening when he said, “Rachel, we all know you can’t be bought!” 

Nutritional & naturopathic medicine is an exciting dynamic field that is growing its evidence base every day but we need to be vigilant about our sources of information, their credibility etc.  I know that what motivates me the most to share what I know is the desperate need for independent voices, free from commercial bias that can help us move our medicine forward on solid ground.  (more…)

Did we Leave Oestrogen in the 80s?

1980s

Duck duck GOOSE! Do you know this game?  That’s how I’m feeling with oestrogen – high-high-high-LOW!-of late. Likely similar to your experience, the majority of my female clients battle with oestrogen dominance, therefore I get so used to looking for it, expecting it: the high Cu, the profoundly elevated SHBG, maybe a raised ESR.  So much so that sometimes the low ones can catch you out, especially of course when it happens in women way way before menopause.

We’re so resolved to hear bad press about oestrogen and to be armed ready to saturate our patients with broccoli extracts of the highest order – do we remember the clinical features and markers of an oestrogen deficit and know what to do with those women who simply don’t have enough? (more…)

Welcoming a New Member to the Family!

Welcoming a new member

I just want to scream with joy…and then keep on screaming with utter frustration!  Last week I presented the culmination of months of work looking into the extraordinary manifold relationships between thyroid health, fertility, pregnancy & post-partum health for mum and bub.

The findings are breathtaking: whether it’s about being able to put thyroid Abs firmly on the ‘Must Screen’ list for preconception care, given their ability to double-quadruple the rate of early miscarriage or their propensity for triggering post-partum thyroiditis in 50% of women who possess them or being able to state emphatically that maternal low iodine (prior to conception as well as during pregnancy) remains the number one risk for the thyroid’s healthy transition to pregnancy.  The evidence is overwhelming that we need to pay very close attention to the thyroid. (more…)

Digging Deeper Into Thyroid

digging deeper

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…)

Misunderstandings & Mistakes – I’ve Made a Few!

Picture3Yep, I’ve had them…and made them.  I often hear practitioners say they cringe when they think back about the patients they saw in the first year because of the vastly greater knowledge they have now.  I do too. But my mistakes are more recent than that!

 I know more this week than I did last, and that is a good thing…right?!  For me and most practitioners, there is acknowledgement that our learning is infinite, ongoing, without end.  This is a source of excitement for me, not a negative.  The light-bulb moments are deeply satisfying – those moments when I become enlightened about a mistake I’ve been making, or a misunderstanding I have had. (more…)

Final Day for Update in Under 30 Podcast Subscription Special Offer!

Copy of Doreen SchweglerNaturopath & Medical scientist

Make the most of this special offer! If you become a 12 month subscriber before the end of January (that’s tomorrow!) you receive 10% off ALL individual mentoring sessions in 2017!

And just so you know what we have in store for you as an Update in Under 30 Subscriber this month: Rachel’s kicking off the year with ‘Melatonin – Misunderstandings and Mistakes’ – an amazing clinical update about what we are getting right and wrong with Melatonin.  This podcast answers in particular, one of the most common sources of fascination & frustration for clinicians, the reasons behind the Melatonin non-responder. We’ve all encountered patients who have taken Melatonin for sleep problems and reported no benefit, or initially responded and then lost efficacy quickly, or even patients who experienced insomnia after taking. What does this tell you about your patient and what should you do to resolve this and better still, prevent it?  Now we know. (more…)

1 Week Podcast Subscription Special Offer

maria-harpasnaturopath

 

Have you heard what everyone is saying about the “Update in Under 30 Podcasts”? But more importantly, have you heard about “Update in Under 30 Podcasts”… fullstop?! If you’ve somehow missed out on being a subscriber & receiving these monthly gems over the last few years, you MUST read on … These dynamic podcasts will help you keep abreast of the latest must-knows in integrative medicine. Focused on one key issue at a time, Rachel details all the salient points so that you don’t have to trawl through all the primary evidence yourself. In Under 30! Each podcast represents unbiased education that can contribute to your CPE points and is delivered to your inbox every month for under $13 a month… how easy is that! (more…)

Are you Listening for the Good News?

Want to start 2017 with some good news?  Sometimes working with patients challenged by mental health I get scared.  A well-known colleague of mine introduced me to the notion of the ‘clinician in crisis’. The practitioner who, in the face of their patient’s extraordinary pain & distress feels overcome by the need to Do Something…Anything.  Over time I have learned to spot, what we call a ‘desperation prescription’, the patient who is on 3+ psych medications all from different drug classes and still remains tragically symptomatic. It is potentially frightening stuff.  I’ve had the same experience with patients using herbs and nutrients.  The patient’s biological drivers may seem straight forward on paper, but they fail to respond as predicted.  Nobody has a 100% success rate…not me, not Ben Lynch, not Kelly Brogan…as much as their marketing machines might make you think otherwise. (more…)

Are Hormones Driving the Autoimmune Bus?

old-fashioned-driver

Back a few weeks ago I had the pleasure of presenting at the Integria Symposium and the even greater pleasure of listening to some of the fabulous speakers …you see I’ve heard my stuff before! 😉 The ‘Mosaic of Autoimmunity’ was delivered by the very funny and knowledgeable Professor Yehuda Shoenfeld, who reiterated the sequence of events now well recognised to precede and precipitate autoimmunity: genetic susceptibility + endocrine context + environmental trigger –>autoimmunity.

Clinicians know that overwhelmingly women dominate when it comes to autoimmune disease epidemiology and most understand that this is a consequence of oestrogen’s immunostimulatory effects.  Professor Shoenfeld, described the female, or E2 dominant, immune system as being ‘super charged’ and that increased rates of autoimmune diseases were a reflection of this. Sometimes practitioners do initially great work with a/immune clients – clearing up the diet & gut, ensuring vitamin D adequacy etc and then get ‘stuck’ or plateau with antibody levels that ‘won’t budge’.  Going back and checking the hormonal contribution in the case is often indicated. If the patient has an unhealthy E2 dominance and /or impaired detoxification and clearance of this hormone then working on this aspect often kickstarts the next stage of improvement.

A new thing to me (I know I’m a bit slow sometimes 🙁 )  was his mention of the potential link also with high prolactin (PRL).  The literature on this is extensive and hyperprolactinemia (HPRL), even just mild elevations, have been correlated with a very long list of both systemic and organ specific diseases including: (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…)

Is Your Rep a Good Rep?

 

Recently a practitioner lamented that because of her clinic location she didn’t see company reps very often & felt this was a barrier to her staying current with her clinical knowledge.  Of course, I had to beg to differ.

We’re quick to judge the medical profession for their reliance on commercial sources of CPD, overwhelmingly provided of course by the ‘drug reps’ but it seems we’re less fazed or concerned about ourselves being equally reliant, unduly influenced and misguided (might I add) by the people employed by the CAM manufacturers expressly to encourage us to sell more of their products! How does that make sense? 

I go back to my very repetitive mantra: always be mindful of who delivers you the message/information etc. and what their agenda is.

By promoting their company’s products to us, focusing on the products’ strengths, ignoring or simply not making it a priority to know the limitations or weaknesses of the products or the evidence, ignoring or again simply not making it their business to know when superior products are being produced by competitors or when new evidence comes to light that puts into question their products, reps are only doing what they’re employed to do.  But is it helpful and is it ok? (more…)

Iodine Excess in Action

 

I’m only human & there are some questions that do make me silently groan & invisibly (I hope!) roll my eyes.  One is the old chestnut:  “but the Japanese consume on average 7mg of iodine a day!” which is typically offered up as a rationale for the need for mega dosing of iodine in everyone.  This is of course only a partial truth & the missing bits make all the difference!  The Japanese have some of the highest rates of thyroid disease in the world & this is in part, attributed to their high iodine exposure.  Secondly, it’s simplistic & flawed to isolate one characteristic of a whole diet & not appreciate that its effect or impact is mitigated by the context of the entire diet & lifestyle of that population.  In the case of the Japanese, for example, this includes relatively intake of isoflavones, key goitrogens which will reduce the bioavailability of the iodine both within the gut & at the thyroid. Harrumph!  I love iodine & am frequently suspicious of a deficiency in my clients, however, like many nutrients feel that our ultimate objective is for optimal nutrition…not excessive.

Am I just a conservative scaredy cat perpetuating fear around this topic in the industry?  Well…..no.  There is accumulating international evidence of big spikes in autoimmune thyroid disease diagnoses following the introduction of iodine fortification programs in previously iodine deficient countries such as Greece, Turkey & Brazil.  There is of course evidence as well that iodine supplementation in Grave’s & Hashimoto’s disease can lead to delayed recovery or worsening of the condition. (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

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