You Might Want to Write This Number Down

No you’re right, it’s not long enough to be a Hemsworth’s mobile number but actually it’s more sought after ūüėȬ†If you’re up to date with reading & recognising all the different patterns of Iron Studies & the stories they tell, which is a daily business for most of us, then you will know by heart the striking pattern we call, ‘Pseudo Iron Deficiency’. You know the one where your patient’s serum iron & transferrin saturation are mischievously trying to trick you into thinking you need to give this patient iron…when in fact this is absolutely not what they need!¬†

This is of course the result of the redistribution of iron during inflammation – iron is actively removed from the blood and¬† sequestered in the liver instead.¬† It’s designed to protect us from bacterial bogeymen, which is how our stone-age bodies interpret all inflammation of course.¬†

Doesn’t sound familiar? Ok you need to start here or even embrace a full overhaul of all things iron here.

But for those of you nodding so hard you’re at risk of doing yourself an injury, this number is for you.¬†¬† We’ve often talked about the redistributional increase in patients’ ferritin levels in non-specific terms: it goes up..but by how much?¬† Of course we would like to know because no one is fooling us with this transiently inflated value…but can we make an estimation as to what this person’s ferritin will drop to once this inflammation is resolved?¬†Yes.

X 0.67

Write it down. Consider a tattoo, perhaps?

This glorious magic number comes from Thurnham et al paper in 2010¬†who did the number crunching on over 30 studies involving almost 9,000 individuals to determine the mathematical relationship between inflammatory states & markers and the reciprocal increases in ferritin.¬† Their work is exceptional in that it also differentiates between incubation (pre-symptoms), early and late coalescence periods (if you want to differentiate your patients in this way and get even more specific then you need to read the paper), however, overall when we see a patient who has a CRP ‚Č•5 mg /dL , we can multiply their ferritin by 0.67 and get a lot closer to the¬†truth of their iron stores. Oh and another important detail they revealed, this magnitude of ferritin increase is more likely seen in women or those with baseline (non-inflamed) values < 100 ug/L..so generally more applicable to women than men.¬†Thanks Thurnham and colleagues and the lovely Cheryl, my previous intern who brought this paper to my attention…you just took the guessing out of this extremely common clinical scenario ūüôā¬†

We’re not deaf…we heard that stampede of Iron-Inundated Practitioners! The Iron Package is for you!

Our recordings and clinical resources for improving your skill-set in¬†all things iron¬†including,¬†your accuracy of diagnosing deficiencies, pseudo-deficiencies & excesses, plus radically rethinking the best treatment approaches for each scenario‚Ķhave been some of our most popular.¬†Because nailing iron (pardon the pun) is harder than we were all lead to believe and at least 1 ‚Äėiron maiden‚Äô or ‚Äėiron man‚Äô walks into our practice every day, right?¬†So we‚Äôve brought together 5 extremely popular UU30‚Äôs on Iron into one bundle for the price of 4! So if you‚Äôre more than ready to graduate from ‚Äėiron school‚Äô, now‚Äôs your best chance!

 

 

 

Where Do All The Nutrients Go?

Those ‘still-believers’ look away now.¬† One of the great myths, misconceptions and misunderstandings in nutritional medicine is that supplementation with specific nutrients will produce change specifically in one system, or pathway, which just happens to be the one that the practitioner has determined would benefit most/is targeting.¬†¬† Let me explain myself a bit better. When we give patients any nutrient, in the cases where it’s not simply to correct a global deficiency & therefore improve levels all round, it’s typically on the basis of a specific desirable therapeutic benefit, e.g. some magnesium to help their GABA production…, additional B3 would improve their mitochondria.¬† Beautiful on paper…but like sending a letter to Santa in reality (I did warn you!)

Truth Bomb No.1: There are nutrient distribution pecking orders that have nothing to do with who you ‘addressed’ it to

This dictates that when something is given orally, for most nutrients, the gut itself has first dibs.¬†¬†So the cells of your digestive tract meet their needs before any other part of your body gets a look in. Sometimes the digestive system’s needs can be quite substantial and leave little for any other part of the body…not mentioning any names (ahem) Glutamine!

Truth Bomb No.2: En route to the ‘target’, these nutrients get delivered and distributed to many other tissues – with possibly not so desirable or intended effects!

You may determine that a patient needs iron because their ferritin hasn’t got a pulse…so you keep giving them daily high dose oral iron to ‘fix’ this…not realising you’re making their GIT dysbiosis and gut inflammation worse in the process.¬† Or you feel their mysterious ‘methylation cycle’, happening predominantly in the liver and kidneys, could do with a folate delivery…perhaps ignoring the very worrying fact that their colon may have already had a ‘gut full’. Literally.¬† Hence the concerns and caution against supplementing with folate in patients with established colorectal cancer.¬†¬†So is bypassing the gut via IM or IV nutrients the answer…well yes and no…but mostly no. Read on…

Truth Bomb No.3: Those pathways that use the nutrient you’re supplementing, that are most active in the patient’s body currently – which is determined by many factors¬† (genes, physiology, feedback circuits, pathophysiology) and rarely simply by the availability of nutrients – will take take the next lion’s share of that¬†nutrient

Wanting to nutritionally support someone’s thyroid, you know tyrosine is the backbone of the thyroid hormones, so you include this in the hypothyroid prescription. Will it help?¬† Who knows? Being a non-essential amino acid the body exhibits very complex regulation of its distribution and use – with thyroid precursor availability being only one job on a very long list! And if this was in a patient who is regularly smoking cannabis, due to upregulation of the tyrosine hydroxylase enzyme – there is likely to be more of the supplement headed for even more dopamine production and very little or none reaching in fact your intended target.¬† And don’t get me (re)started on Glutamine – supplements of which in an anxious and glutamate dominated patient will make…G.L.U.T.A.M.A.T.E…right…not GABA! ūüôĀ

Sorry, I know, it hurts right? But these are essential teachings, that tend to have been over-looked or under-played I find, in nutrition education, regardless of training: nutritionists, naturopaths, IM doctors, dual qualification practitioners remedial therapists.¬† Nutritional medicine is a wonderful and potent modality when it’s done well…but we need to revisit some core truths and principles that many of us have missed out on, to ensure we’re not writing letters to Santa.

Want to revisit your core nutritional knowledge which will cover this and much much more? 

Let’s start with Micronutrients. Let’s talk make sense of the over-arching nutrition principles, that will profoundly change your understanding and application of this modality¬† Truly understanding the ‘big’ concepts, so often overlooked, or incorrectly taught, ensures you get the critical ‘small’ detail in your nutritional prescriptions right. In this 4 hour recording, together with key clinical tools, we talk about the tough stuff: dose-response curves, active versus passive stores and excretory pathways and ooh lah lah…the myth of taking ‘activated vitamins’.¬† Even those who felt well trained – will find a lot in this critical review that is new, insightful and truly practise-changing!

A Package Packed With Iron, Iron & Even More Help With Iron

 

 

We’re not deaf…we heard that stampede of Iron-Inundated Practitioners!

Our recordings and clinical resources for improving your skill-set in all things iron including,¬†your accuracy of diagnosing deficiencies, pseudo-deficiencies & excesses, plus radically rethinking the best treatment approaches for each scenario…have been some of our most popular. Because nailing iron (pardon the pun) is harder than we were all lead to believe and at least 1 ‘iron maiden’ or ‘iron man’ walks into our practice every day, right?¬†So we’ve brought together 5 extremely popular UU30’s on Iron into one bundle for the price of 4! So if you’re more than ready to graduate from ‘iron school’, now’s your best chance!

1. So You Think You Know How to Read Iron Studies? (‚ȧ30 min audio + Cheat Sheet)

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.

2. Pseudo Iron Deficiency (‚ȧ30 minute audio)

The most common mistake made in the interpretation of Iron Studies is this one: confusing inflammation driven iron ‚Äėhiding‚Äô with a genuine iron deficiency.¬† Worse still, following through and giving such a patient oral iron ‚Äď when in fact it is at its most ‚Äėtoxic‚Äô to them.
This audio together with some key patient pathology examples will prevent you ever falling for this one! Learn how to recognise a ‚ÄėPseudo Iron Deficiency‚Äô in a heartbeat!

3. Iron Overload… But not as you know it (‚ȧ30 minute audio)

We’re increasingly seeing high ferritin levels in our patients and getting more comfortable referring those patients for gene testing of the haemochromatosis mutations; but, do you know how to distinguish between high ferritin levels that are likely to be genetic and those that are not?  This can save you and your patient time and money and there are some strong road signs you need to know.  In addition to this, what could cause ferritin results in the hundreds if it’s not genetic nor inflammation?  This Update in Under 30 summary will help you streamline your investigations and add a whole new dimension to understanding iron overload…but not as you know it!

4. So You Think You Know How To Treat Iron Deficiency? (‚ȧ30 min audio)

And then you don’t.¬† The reality is we all struggle at times with correcting low ferritin or iron deficiency anaemia¬† – so what have we got wrong?¬† In spite of being the most common nutritional deficiency worldwide, the traditional treatment approaches to supplementation have been rudimentary, falling under the hit hard and heavy model e.g. 70mg TIDS, and are relatively unconvincing in terms of success. New research into iron homeostasis¬† has revealed why these prescriptions are all wrong and what even us low-dosers need to do to get it more right, more often!

5. So You Think You Know the Best Iron Supplement, Right?!¬† (‚ȧ30 min audio + Iron Supplement Guide)

Iron supplementation, regardless of brand, presents us with some major challenges: low efficacy, poor tolerability & high toxicity – in terms of oxidative stress, inflammation (local and systemic) and detrimental effects on patients’ microbiome.¬†¬†What should we look for to minimise these issues & enhance our patients’ chance of success.¬† Which nutritional adjuvants are likely to turn a non-responder into a success story and how do we tailor the approach for each patient? It’s not what you’ve been taught nor is it what you think! This comes with a bonus clinical tool, a fabulous easy reference guide – to help you individualise your approach to iron deficiency and increase your likelihood of success.

You’ll never look at iron studies or your iron-challenged patients the same way.

Listen to these audios straight away in your online account.
To purchase the Iron Package click here.

Are You a Quercetin Queen (or King)?

Did you and all your patients survive Spring?¬† Have you had a chance to restock the shelves with all the big-gun-Quercetin-products for the next allergy onslaught…or maybe for patients presenting with other conditions that respond well to this, like leaky gut, asthma, MCAS, Grave’s disease?¬† Either way…can I ask you a Quiet Quercetin Question…how high do you go?¬†

I ask this because I know myself to be pretty heavy-handed at times, especially in those severely affected by traditional allergies..and the results are so impressive for patients and practitioners alike, it’s easy to perhaps get very enthusiastic with this approach, with doses sneaking higher and higher… if a little is so good then a lot must be great!

“Severe eczema and allergic asthma – [Insert preferred big-gun-Quercetin-product] 2 three times a day – STAT!”

And we use it across all patients, right?¬† I love it in kids, teens and adults, men and women.¬†¬†So I kind of stopped dead in my tracks when a colleague recently said…”I do the same…buckets of Quercetin especially over hayfever season but Rach, what about it’s phyto-oestrogenic effects? Should we be worried?” Ah…yup…that’s right…being a flavanoid…it has them. Now let’s be clear about one thing, unlike¬† some practitioners I am NOT, I repeat, NOT against phytoestrogens nor even (ahem) soy ūüėČ but the question was great because it got me thinking…at high-end supplement doses we are producing levels in the body 100s if not 1000s of times higher than a fruit and vegetable rich diet ever can….is it time we knew a little bit more about what Quercetin does at this level, or is suspected of doing and not just the benefits. Therefore we can be more informed about who we should not be so generous or so long-term with our big Quercetin prescriptions?

So I started busying myself in the literature and it turns out THERE IS A LOT OF LITERATURE!

[Note to said colleague who asked me question, you owe me some sleep] But at least I got an answer! 

If you want a bit of DIY drilling then this Andes et al paper is an excellent overview of quercetin supplementation safety concerns…but it doesn’t cover everything.¬† We need to talk.¬† We need to talk about that dang estrogen aspect but it’s bigger than that – you see Quercetin doesn’t just engage with oestrogen receptors like a ‘normal’ phytoestrogen…it messes with levels of this hormone via several other paths…and where does that lead us…?¬† Listen in to the latest UU30 Querctin – Are We Pushing the Limits? and you’ll know exactly our destination. This is important for the Quercetin Queens (both male and female) among us…and that’s like…everyone…right? ūüôā

Quercetin has become an absolute go-to treatment for many practitioners faced with patients affected with allergies and high histamine.¬† It is in this context, that often we find ourselves using large amounts over long periods. Supplemental quercetin exhibits a 5-20 fold higher bioavailability than its dietary counterpart, therefore increasing body levels beyond what a diet could ever achieve. This introduces more potent novel actions: anti-thyroid, pro-oestrogenic, detoxification disrupting…are we pushing the limits of desirable effects and introducing some undesirable ones and who should we be most conservative in?

Hear all about it by listening by my latest Update in Under 30: Quercetin РAre We Pushing the Limits?
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.

Ready, Aim…Don’t Fire!

Oral sex. There I said it.¬† Last month when I talked about Helicobacter pylori and where people might ‘catch’ this – if they didn’t inherit the little critter from their mum or family as an infant – we thankfully were able to rule out kissing as a source of transmission between couples P.H.E.W…but I sort of got shy (Who, you, Rachel?!!) and danced a little bit around the question of whether other forms of sexual contact represent a possible route of exposure (pardon the pun).¬† Until a lovely colleague after listening to Blowing the lid on H.pylori-who gets it & why – said, ‘Now seriously Rach, are you trying to say, oral sex may be an issue?’ Well…ahem…maybe.¬† You see, remember what I said about candida being a vector for H.pylori and therefore H.pylori being present in the vaginas of women who have this bacteria residing in their stomachs. Ok…enough of that now I am blushing..but if you want to read more on this grab this article in BMJ from 2000 by Eslick who discusses (and seems a little too interested in, can I just say), the risks of H.pylori transmission via a myriad of sexual activities.

A month has passed since that last UU30 edition and it’s time for another instalment. This month, I’ve taken the giant leap forward many of you requested, into the fascinating realm of how best to manage H.pylori positive patients, in whom this bacteria really does constitute a pathogen.

Do we just try with multiple relentless antimicrobials to blast holes in this critter, a lot like the conventional approach…which, thanks to its significant capacity for developing resistance, is like aiming at a constantly moving target,…or…?

I’ve got a very different suggestion and approach.¬†¬† Increasingly we realise that the GIT microbiome is a vulnerable & dynamic balancing act and as a result,¬†when treating patients with confirmed parasites, or worms or potentially (but not always) pathogenic bacteria such as H.pylori, most of us are doing much less ‘weeding’, less ‘eradicating’ and definitely less ‘shooting at things only to hit others’, these days.¬† Instead we think about how we can best change the environment.¬† So, what is it about someone’s stomach that opens the door to H. pylori and lets it in, and then perpetually ‘feeds’ it to ensure it stays longer and wreaks some real havoc, we identify & treat what about this over-friendly stomach is amenable to rehabilitation? As it turns out…that’s a lot.

And surely if add to our antimicrobials a larger focus on¬†rejuvenating the gastric environment of H.pylori patients, to control the growth and activity of this bacteria, and in some cases even kick it out of the big brother house altogether…the chances of relapse and reinfection (a big one in this condition) will be dramatically less..not to mention the broader benefits on the greater GIT function, now the stomach has been remediated.

Or you could just keep trying to hit the moving bulls-eye?

For a bacteria identified just a few decades ago as being a cause of chronic gastritis, atrophic gastritis and gastric carcinoma, the escalation of number of antibiotics used to eradicate it (4 at last count¬†+ PPI) has been nothing short of breathtaking.¬† A management approach more consistent with both integrative medicine and with an improved understanding of the delicate microbiome includes a bigger focus on changing the gastric environment to ‘remove the welcome mat’. What do we know about how to do this successfully? It turns out…quite a lot.

 

Hear all about it by listening by my latest Update in Under 30: H.pylori РEradicate or Rehabilitate?
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.

Special offer for RAN subscribers…

Not long ago, Kathryn Simpson and I were sharing a hotel room on yet another work trip to somewhere. The lights were out, it was way past our bedtime and we were just gasbagging incessantly like a couple of teens, when a thought pops into my head:

“Hey Kathryn, back when you were my student, did you ever imagine this scenario in the future – you know us being colleagues and friends and having slumber parties full of laughing?”, she replied, “Well no, but you know what I REALLY never could have imagined in my wildest dreams…the Australian Naturopathic Summit and you inviting me to be a co-founder of something that’s had such a big impact! That one I just didn’t see coming!”

Well to be honest, neither did I but sometimes I just have an idea that won’t leave me alone and is too important and too promising to ignore. Three years ago when I shared one of these, the vision of a national naturopathic conference by naturopaths for naturopaths, that would lift us all professionally, offer collaboration over competition and provide us the highest level of non-biased education, with Nirala Jacobi, turned out she’d been visited by the same thought bubble.¬† Then I approached Kathryn, who was working for me at the time and pretty fresh out of uni but full of passion and drive about building a better ‘new’ naturopathic career path, one that supported rather than splintered those emerging out of great courses into a harsh, challenging professional space.

Time-travel forward to now, we are just 10 weeks(ish) out from erecting the chai tent, marquees and lanterns, for the second inception of this extraordinary thing called the Australian Naturopathic Summit 24-26th August at Lennox Head.

This is the culmination of 3 years of work from us, one paid project manager and the exceptional generosity of over 25 of our naturopathic idols, thought leaders and torch bearers who are donating their time to present plenaries, workshops, case studies, panel discussions… because they believe so strongly in the cause and the need for such an event.¬†

If you think I am running out of breath between all these words..I am. This thing…has taken on a shape and life much greater than even we had envisioned.

If you follow the work I do – you’ll know that I am passionate about collaboration over competition.¬† I could never have come to this place in my career without the input of many (some who remain on speed dial even now!) and through my mentoring programs, the infamous RAN internship and hopefully times we’ve come across each other…I’ve encouraged you to do the same and by doing so, grow bigger together.¬†¬†So just imagine the value of collaborating face-to-face…over 3 days…at a festival in Lennox Heads… ? And not just for 1 hour, but for 3 full days with 100‚Äôs of other practitioners from all areas, specialities and locations.¬†Oh and if you’re thinking you’ll just have to wait ’til the next one’…SPOILER…there is no guarantee of a next one! Being a passion project that we 3 donate our time to, for you, it requires your support to keep it going.

So with saying all that…..(cajon roll…that’s a drum for you non-hippies)….It is with great excitement and enthusiasm that today I can announce a special deal for RAN subscribers. Yes‚Ķ.that‚Äôs you! Just like myself you all see a need to grow and build skills, knowledge, competence and confidence in the practice of naturopathic medicine. Come join the very best of your profession and take up this special offer to attend the second independent¬†Australian Naturopathic Summit held in Lennox Head on 24-26 August.

To get 15% off a full 3 day pass enter Festival at the checkout

Book your tickets before they run out at  www.australiannaturopathicsummit.com.au.
For information or questions about this special email hello@australiannaturopathicsummit.com.au.

This summit is unprecedented in Australia for the following reasons:

  • It is free from commercial bias
  • It is about professional development, improving our practices and career paths, not products
  • The primary objective is to support the Australian Naturopathic community, celebrating our diversity and creating a platform for our own Naturopathic torch-bearers in various areas (Practice, Research, Herbal Manufacture, Corporate Health, Entrepreneurship etc.) to help light the way for the broader professional community

This year our theme for ANS 2018 is ‚ÄėComing Together On Common Ground‚Äô
Naturopathy has many different practices and paths,
but we all work for the same purpose, guided by the same principles.

The ANS 2018 program has three distinct themes across the 3 days…

  • Friday 24 August: Custodians of the Vital Force
  • Saturday 25 August: Upskilling Your Clinical Practice
  • Sunday 26 August: The Business of Business Development

The morning of each day consists of plenary sessions followed by a lengthy lunch break that allows for networking, beach walking, guided outdoor meditation, perusing the vendor village, or simply enjoying the festival atmosphere in the beautiful outdoor location that our summit is surrounded by OR for those die-hards some amazing case studies presented by the likes of Jason Hawrelak, Dawn Whitten and Sandra Villella.  Afternoon sessions are workshop-style, designed to be more interactive. There are plenty of workshops to choose from to keep you riveted and inspired.

We have created a jam-packed program to do just that.
Download your copy of the full program here!

ANS 2018 ‚Äď come join the very best of your profession.

Book your tickets before they run out at  www.australiannaturopathicsummit.com.au.
To get 15% off a full 3 day pass enter Festival at the checkout.
For information or questions about this special email hello@australiannaturopathicsummit.com.au


Enough said.

Have I Got Your Attention Now?

You know I’m not one to raise my voice and make scene.

Ok, I always raise my voice and make a scene, but only when I think something really warrants our attention and the issue of under-recognised, under-estimated and mismanaged chronic worms, demands our attention.¬† I’ve been talking about this ever since the first patient stepped into my clinic, a young girl with severe mood issues who just happened to also have treatment-resistant chronic threadworm, and since then, as the volume of patients I see affected by this has grown, so too has the volume of my message. And there’s actually so much to say.

Chronic worm problems don’t always come with an itchy bottom calling card. In fact, many individuals don’t have any of the telltale signs you might be used to screening for.¬† Recent research suggests adult men, in particular, are commonly asymptomatic when infected with them (Boga et al 2016)

So what alerts us as practitioners to the possibility of chronic worms – so many things…but here’s just some thought bubbles to get you started.

Are you treating patients with recurrent or treatment-resistant Dientamoeba fragilis?

Are you seeing women who have thrush-like symptoms, in spite of negative swabs and no benefit from antifungals?

Are you faced with families coming undone because of one child’s behaviour whether that’s aggression, defiance, emotional lability or just serious sleep problems? (more…)

I’ve Had a Gut Full of Glutamine!

“I always give some Glutamine to heal their leaky gut”

Cue pained expression on my face.¬† No, I’m not a fan.¬† I take that back, I have no problem with the amino acid itself and I’m still in awe of its incredible multifaceted role in the gut.¬† What I do have a giant issue with is the mismatch between everything we are being told Glutamine is going to help our patients with, and the dosages that apparently will do that, and the reality.¬†¬† I know, I’m attacking the Holy Grail of Gut Health 101….right?¬†But it’s time to set the record straight. Firstly, where’s the evidence at in terms of Glutamine interventions in GIT pathology, particularly in relation to reducing excessive intestinal permeability and improving lining integrity¬†¬†Well if you’re a rat – Good news!¬† Rats’ GITs have a greater dependence on Glutamine than ours, a deficiency of this amino produces clear reproducible negative effects and supplementation fixes these brilliantly!

But if you’re treating humans not rats – well – the evidence & the case for Glutamine for the Gut is not so straight forward or impressive. (more…)

GORD, It’s Hard to Sleep In Pregnancy!

Just finished talking with the fearless fertility naturopathic specialist, Rhiannon Hardingham, who wanted to let me know that after listening to my Update in Under 30:¬†Silent Reflux she’s had a lot of success treating both GORD and insomnia in her pregnant patients. That calls for double the celebration …YAY! YAY!¬†

‘What’s the magic answer?’, I hear you ask… (more…)

Iodine – Questions & Confusion Need Clearing Up!

That’s me…always questioning the ‘status quo’ and Iodine is¬† the perfect example!¬†¬†The interview I did on this important subject with Andrew Whitfield-Cook from FxMedicine, covers a lot of key areas of confusion & underscores why it’s so critical all health practitioners get clarity on this topic.¬†‘It’s just a matter of geography’.

You know, I say to people, we can make vitamins ourselves, we can get all sorts of¬† other organisms including animals, bacteria and plants to make vitamins for us, and then eat those…but minerals…our source of minerals…well it all comes down to the rocks and the soil our food itself is grown or fed on.¬† And iodine is profoundly influenced by these factors. (more…)

So You Think You Know How to Treat Iron Deficiency?

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…)

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…)

This is the Threadworm Answer You’ve Been Asking About..I repeat

this is an announcement

I had the privilege of presenting at the Integria GIT Symposium last weekend.¬†¬†For those of you who attended, you’ve gone back to your clinic with a bunch of new ideas and inspiration I hope…oh and a new respect, terror and watchfulness for threadworm thanks to me!¬†¬†In my presentation I outlined the many presentations of this infestation, what to watch for and the risk of chronic recurrence due,in particular, to a reduced ability for some individuals to produce chondroitin sulfate which renders the GIT environment hostile to worms.¬†

Chronic threadworm is a huge & grossly under-recognised issue in paediatrics, often presenting as behavioural & cognitive disorders (and these can be severe), bruxism, enuresis etc. of course, but another presentation typically missed is vulvovaginitis, vulval pain or UTI like sx in young girls. (more…)

No Patch on Iodine Testing

 

Untitled

¬† Whenever I talk to practitioners about thyroid health, like I recently did at MINDD,¬†I can guarantee I’m going to get 2 questions:

  1. Shouldn’t we aim for the¬†high iodine intake of Japanese?
  2. 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…)

Pig Thyroid For Who?

pigGot any patients on Natural Thyroid Extracts (NTE)?¬† Me too…and I am finding it’s on the increase. ¬†What’s the deal? ¬†What do we need to understand about this form of thyroid replacement therapy to best¬†monitor and manage those¬†patients already¬†on it or contemplating taking it? Does it really offer advantages to all hypothyroid patients or just to a subset of those and how would we recognise these people who might benefit the most?

NTE are marketed as being superior to synthetic thyroxine primarily based on the fact that they provide the patient with some T3 as well as T4 and in addition to that, being extracts of pig thyroid glands, there are other thyroid and iodine based actives¬†e.g. mono and diiodotyrosine, present in the extracts.¬† So in essence this is giving us more iodine and more of the other ingredients we need to make our own thyroid hormones. ¬†Based on this, many proponents of NTE say this is a major advantage over synthetic thyroxine replacement because it is more ‘holistic’ and it supports the patient’s gland in its own hormonogenesis. ¬† (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…)

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 rather than pharmaceuticals 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 skepticism 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 ūüôā (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‚Äôre quick to judge the medical profession for their reliance on commercial sources of CPD, overwhelmingly provided of course by the ‚Äėdrug reps‚Äô but it seems we‚Äôre 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‚Äôs 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‚Äôre employed to do.¬† But is it helpful and is it ok? (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 ‚Äď 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‚Äôll 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…)

Do We Need to Relearn Something Old about Addressing Iron Deficiency?

 

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‚Ķand 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…)

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