It was only a matter of time, right? A 30-something patient presents with new pathology results saying she’d already asked AI to interpret them 🤖🤯 “Had a little chat with Chatty,” she tells me, “and already it’s flagging things my GP didn’t’!” Naturally, she’s tickled by this relatively new opportunity for what appears to be an independent second opinion, as a result of some simple tinkering on her keyboard. I watch her eyebrows rise to emphasise how impressed she is. She thinks she’s cracked the code, cut the cord of dependency to her doctor, or any other health professional for blood test interpretation. But is it true?
I was forced into being an early-adopter of AI in terms of large language models by my offspring, who argued that if I wasn’t on the front foot with these new technologies I would instead get crushed under its Big Foot 👾 Like every next gen, they gave me the, ‘look this is happening anyway so you may as well quit the denial’, talk
And because of that I’ve had a long lead-time to play around with these applications in a work setting and know how to play to their strengths, and accordingly the very short list of things they can be good for, but am always acutely aware of serious shortcomings, e.g. hallucinations, calculations, confirmation bias. Oh yes me and my team have found over time you can pretty much talk AI into anything…it is the jury and it loves to be led! So I’m long long long past the honeymoon period with these kinds of AI offerings but appreciate others aren’t. Like this patient with her pathology results and her rush to acquire an opinion from AI who shared the interpretation of her results with me, so I could check my own predictions about what it would be well and not so…and yeah they were all to be expected. Let’s just take one little example of that: her total bilirubin is consistently in the teens. Did chatGPT flag this as Gilbert’s syndrome? Of course not, as it’s technically ‘within range’. Does she have Gilbert’s Syndrome – absolutely.
But AI is incapable of really replacing us humans, as diagnosticians & practitioners because, as I heard someone say in an interview, ‘it effectively just parrots back the ‘average’ of all online information, most of which is of rather average quality to begin with!
So if AI assisted pathology interpretation is really just an echo chamber for what is the average of all online information: unquestioning adherence to reference ranges, where only results outside of this attract comment and even their interpretation is, at best, ‘average’ then I ain’t out of a job anytime soon and neither are you! A strength of this software is pattern recognition, essential in the realm of results interpretation, so that could be perceived as an added advantage. But helloooooooooooooooooo as holistic health care providers are we not all about pattern recognition?!
A favourite quote of a health care professional working in prevention and lifestyle medicine says:
“At the risk of seeming Luddite, the future of lifestyle medicine is humanistic rather than technological” Gray et al., 2020
And any practitioner keen to embrace AI with the intention of saving themselves ‘on average 15mins of non-billable time per client reviewing pathology results’…Sorry, but this says straight up you’re not doing it right. Because if you were it’d be taking longer 😉, you’d know it is the single most satisfying element of patient work up that you never want to give up and you’d absolutely know, that AI can never replace real knowledge, rigorous diagnostic reasoning & appropriate taking into account of the very real individual these results belong to 👊🤓🎤
NB AI was not used to write this blog…it would have been much better if it had have though & also would have definitely saved me some time! 😂Now THAT is a good use for these AI
The primary objective of MasterCourse I is to realise the true value we can extract from the most commonly performed labs.
Accordingly, this training is appropriate for any health professional who considers standard medical blood tests as part of their patient assessment and work-up, including (but not limited to) naturopaths, nutritionists, herbalists, osteopaths, chiropractors, physiotherapists, midwives, nurse practitioners and doctors.
They said it couldn’t be done. They said your Lipoprotein (a) level was purely the result of a genetic lottery and if you lose, you lose and there’s nothing you nor your doctor can do to change that. Lp(a) doesn’t play by the rules that apply to anyone else, including all other lipoproteins, you see.
What makes LDL-C come down makes Lp(a) go up! And that confused everyone championing a LFHC diet for lipid management in the 90s to now!
But recently some brave researchers have stuck their head above the parapet with their proposal that lipid management, especially in the context of cardiovascular risk reduction, might need to be 😲*GASP*😲 personalised! That it isn’t always about LDL lowering and in fact in someone with elevated Lp(a) that would amplify the issue because, I repeat, what makes LDL-C come down makes Lp(a) go up! You heard it here folks! So instead of saturated fat as the saboteur and statins as the salve, the roles are reversed in any attempt to reduce levels of this rogue lipoprotein.
But given that your Lp(a) is for life – any approach to lowering its level has to be lifelong too
So even if we have some nifty tricks (old diets can learn new ones indeed! 😉) to successfully lower Lp(a) we must undertake a critical cost-benefit analysis unique to each individual. Ensuring we’re clear about how much of a reduction is required to produce real change in outcomes; how sustainable (on all levels) this approach is for the individual and what we’ve gained on one hand, we haven’t lost in the other. We need to be alert to swings & roundabouts in order to combine risk mitigation with overall improved health in cardiovascular medicine.
A New Era in Cardiovascular Risk: Lowering Lp(a)
This episode describes in detail all the natural interventions (CoQ10, Carnitine, Gingko, Niacin, Dietary change etc) we can use forlowering Lipoprotein (a). It clears up the confusion regarding how they compare and in particular how and why the degree of efficacy can be patient specific. And why therefore a series of short trials of single agents is the only way to establish their true effectiveness in any given individual but equally, why ‘stacking’ of these will often ultimately be necessary for maximising risk reduction. A case discussion of a successful strategy in a 57Y female marries the research with the real world, as we answer all-important questions: How low can she go? How low to make meaningful change regarding her cardiovascular outcomes? And is what’s required to keep her Lp(a) low, sustainable and health-promoting all round as a ‘forever prescription’?
You can purchase A New Era in Cardiovascular Risk: Lp(a) here. If you are an Update in Under 30 Subscriber, you will this episode waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Cracking the Case: Uncovering Cardiovascular Risk – Elevated Lipoprotein (a)
How do you conduct a comprehensive cardiovascular risk assessment? It should always include a Lipoprotein (a) result, having been declared the biomarker with the strongest indication of causality in both atherosclerosis & valvular aortic stenosis. But what use is getting this tested, if, when we identify increased risk due to elevated results, we have no means to lower it? Until now. This is a 57 year old female with a striking personal and family medical history, a peachy coronary calcium score, mildly elevated LDL-C but significantly elevated Lp(a). We describe in detail the meaningfulness of this, as one element in our understanding of her overall inter-connected health story and reveal the prescription and approach that got results. We also discuss the challenge that is inherent in both ‘uncovering risk’ in someone while remaining on the right side of hope vs despair and of the nature of CVD risk reduction which requires lifelong management.
You can purchase this Cracking the Case episode: Uncovering Cardiovascular Risk: Elevated Lipoprotein (a) here.
Well this topic has certainly got us all talking. My inbox overfloweth! Good. Because in the current online climate of ‘Sacred Super Foods’ for kids, this conversation has to happen. I’m not batting for ‘beige baby foods’, however, with trends like this, my concern is that the kernel of truth they might have been based on, has been buried under a mountain of marketing and opportunities for monetisation. In my last blog I ruffled some serious feathers by saying, contrary to popular perception – iron deficiency & iron-deficiency anaemia is not a universal experience in Australian & NZ pre-schoolers. One of the common questions I had in response to this was, ‘but is this just being missed in most because so few are actually having their iron tested?’ Great thought and the answer to this and to my opening question: Are We Under-testing Toddlers, more generally, is….
No
In addition to, ‘name a parent that is going to opt for any not strictly necessary pain or stress for their child, there are some other solid reasons not to reflexively refer for testing 🧪Major misconceptions about which parameters are accurate at each age, e.g. Serum B12, even Transcobalamin II? – absolutely not. 💩Misuse of adult testing in paediatric patients, e.g. microbiome & gut tests only validated in individuals > 18yrs 😲😤 📈Even in those more tried & true tests like LFTs, Iron studies, reference ranges are ‘descriptive’ not what’s actually desirable, & popular ‘goals’ like S Ferritin of 50 mcg/L without foundation 🤯 🩸🩸 Every blood draw takes a little more iron & given it’s like gold in toddlers, any extra loss is significant & needs accounting for
And my answer is also….
Yes
Iron is an Achilles in kids’ nutrition but it’s of course not unique in that regard…think zinc, as one example of an equally worthy worry! 🎢But when the RDI suggests 1-3yo need MORE iron than men, well, ‘Houston, we have a problem!’👩🚀
Therefore ‘inadequate intake’🌾 is common but how then is deficiency & anaemia not?! (10% and 3%, respectively according to the latest Australian general population research 🧪)
Which means a) somebody got something wrong here & b) we should be alert to the exception, the child that isn’t thriving & in a way that’s consistent with iron inadequacy and be proactive with pathology tests rather than the most common context, which is, ‘Well they were in hospital for tonsillectomy when they had their first blood test and lo and behold they’re anaemic!”
But if you’re going steal some blood, you better be certain you know what to look for, right?! Because let me repeat…kids are not little adults…certainly not when it comes to assessment either! Our recent ‘Pair of Paediatric Anaemias taught us all about accurate interpretation and how it can identify individualised aetiology but also completely personalises the prescription.
A Pair of Paediatric Anaemias
Two young siblings both present with anaemia. With the same parents, similar birth stories, breastfeeding pattern, same introduction of solids and ongoing food patterns, can we assume that the underpinning cause is the same? And like all young kids everywhere, do they just need ‘more iron’? While we’re led to believe ‘iron issues’ are simply ‘par for the course’ in infants & preschoolers, rates of anaemia in countries such as Australia in this age group are actually <5%. Therefore instead, we should view any anaemia presentation, and more broadly, every ‘iron issue’, as a call to action to identify all the causes & contributions unique to the individual.
The work-up of each sibling, which includes a checklist of 6, often unseen, factors that drive iron deficiency in kids, reveals what the children do have in common and what sets each apart and in turn identifies differences in the course of action that should follow.
Along the way you are offered an opportunity to review in detail your knowledge of iron homeostasis and how to read pathology results from this informed place, as well as learn something new about this mineral’s unique regulation at every age & stage of childhood. This recording comes with a separate clinical tool which creates a framework for understanding all the real reasons behind iron deficiency in other paediatric patients in your practice. It is a bumper offering, with bonuses galore!
You can purchase this Cracking the Case episode: A Pair of Paediatric Anaemias: Forecasting & Fixing Iron Issues here.
Paediatricians repeat this adage often. It acts as an important reminder about adjusting dose for children’s reduced weights. But that’s only the start of, what is, an almost entirely different solar system we need to immerse ourselves in. Diagnosis is different too. Because children demonstrate physiological responses and regulatory systems not seen in others. They’ve got a whole different rulebook they’re playing by & you need to know it. Then there’s the absence of the first-person narrative in infancy. And once verbal, definitive symptoms are scarce, instead the ubiquitous and ambiguous ‘sore tummy’. What can the child tell you themselves and accurately? All together these lead to a much greater reliance on the practitioner’s astute observation of signs. And what about paediatric pathology interpretation? – An entirely different beast!
That’s if there’s to be any blood🩸spilt at all.
Name a parent that wants to put their child through any pain, worry, stress or angst that isn’t entirely necessary. Correct. As a result, results themselves are actually hard to come by. Health professionals too are often averse to recommending testing unless absolutely necessary, instead they’re performed opportunistically – the child’s in hospital for something else; “Let’s take a look at some labs”, they say. That’s how we often end up finding out about things. That’s how this family, that we discuss in our Cracking the Case session, found out their youngest had anaemia. Which triggered a test in the older seriously-fatigued sibling and *bingo* we then knew one more thing they both had in common!
But in spite of us doing this baby-thing blind most of the time. As in, we test everything while they’re inside ‘the temple’ while pregnant, and then once they’re out we’re winging it! Iron issues and anaemia are actually uncommon.
You heard me. Contrary to popular perception, babies are born with a whopping iron surplus and are built to build blood. Which is only trumped by the need to survive infections. And yes the clever among you recognise that the two do have conflicting iron agendas! So when we know a child actually is anaemic we should be all-ears and alert to all contributing causes (yes, plural). Beige baby foods have been the mainstay instead of ‘premasticated everything’, in so-called developed countries, ever since the agricultural revolution. Under-consuming iron is the norm in pre-schoolers and yet anaemia is uncommon. So diet alone is unlikely to be the full explanation…look again. We have had the great privilege to present two such cases that have everything to teach us about how to listen to these stories and look at the labs through the very distinct lens of paediatrics – not only in terms of iron studies and FBEs but white cell differentials and more.
Because our babes’ blood is precious, accurate interpretation is essential. But how to read non-fasting collections? Oh yes kids keep it really real!
And how do we manage without repetition of the labs for monitoring their response to treatment? Which understandably seems excessive to mum, especially when ‘they seem better now’.
Well come along and find out…
A Pair of Paediatric Anaemias
Two young siblings both present with anaemia. With the same parents, similar birth stories, breastfeeding pattern, same introduction of solids and ongoing food patterns, can we assume that the underpinning cause is the same? And like all young kids everywhere, do they just need ‘more iron’? While we’re led to believe ‘iron issues’ are simply ‘par for the course’ in infants & preschoolers, rates of anaemia in countries such as Australia in this age group are actually <5%. Therefore instead, we should view any anaemia presentation, and more broadly, every ‘iron issue’, as a call to action to identify all the causes & contributions unique to the individual.
The work-up of each sibling, which includes a checklist of 6, often unseen, factors that drive iron deficiency in kids, reveals what the children do have in common and what sets each apart and in turn identifies differences in the course of action that should follow.
Along the way you are offered an opportunity to review in detail your knowledge of iron homeostasis and how to read pathology results from this informed place, as well as learn something new about this mineral’s unique regulation at every age & stage of childhood. This recording comes with a separate clinical tool which creates a framework for understanding all the real reasons behind iron deficiency in other paediatric patients in your practice. It is a bumper offering, with bonuses galore!
You can purchase this Cracking the Case episode: A Pair of Paediatric Anaemias: Forecasting & Fixing Iron Issues here.
In yet another timely reminder that information alone does not produce behaviour change – Exhibit A – myself. The unspoken beauty of living in the Byron shire is that when any festivals come to town so too does the flu & to the entire community, whether you attended it or not. And it’s reliably never a middle of the road virus, with its bacterial back-up band, but something that wandered in from the set of Mad Max Beyond Thunderdome (my personal fave in the series). But I had already forgotten the Easter Bluesfest and mistakenly thought it a grand idea to get out and about for a boogie amongst all kinds of festival-folk!
When I got the first little clues I responded from an informed ‘information-centric’ place
And all my training, my knowledge, my years of clinical experience, took the shape of supplements and potions and teas and lotions
I threw absolutely everything at it
…except rest.
I couldn’t stop I had delivery deadlines, I told myself and my team. “I’ll just push through these presentations,” I croaked. Increasingly aware I had definitely undone the efforts of my own immune system and that this was madness, I told myself, ‘I’ll rest just as soon as I can’. Then two days of complete collapse. Rest repair recovery. I wake up on the other side and know absolutely that order has been restored. I’ve finally given my immunity and this recovery process what nothing in a bottle ever could: Convalescence. I want to sing it from the rafters! I am in first year naturopathy all over again, enlightened, inspired, evangelical even (I know we were annoying).
And I feel amazing 🌟 The sun has come out again 🌈
Both metaphorically mentally but literally too
and there’s this light lovely breeze, perfect for airing rooms and doing washing, lots of it, and brush-cutting and…
I kid you not…I have learned nothing…🤐
When will I ever transfer the incredible therapeutic value of convalescence into my long-term memory?!🙄 Anyone else?
While it seems like every second patient is on statins in Australia, NZ, America and most developed countries, over the age of 70, they actually are!
But can you name a patient who has had their Lipoprotein (a) measured and is being managed for this by their GP?
So while the controversy and contention surrounding the “curse” cholesterol places on our cardiovascular health continues to rage, general practice guidelines are full of green lights for statin prescriptions but what if I told you that there’s another lipoprotein that is more atherogenic, more directly implicated in arterial disease & whose levels are more powerfully predictive of atherosclerotic disease and valvular aortic stenosis…than any other biomarker we have? Well, I just did.And so did all these global authorities!!!
But you and your statin-saturated patients are unlikely to hear about this lipoprotein because there’s ‘no drug for that’, right? In fact, up until recently we’ve all been told there’s nothing you can do to lower an elevated level and accordingly reduce the associated risk…guess what…new research says we can! Yes, it’s finally time to switch off the snooze function on this one and tune into what could be the most important test your patient takes.
A New Era in Cardiovascular Risk: Lp(a)
”If there’s no pill there’s no ill”, is a cynical saying about how the availability of pharmaceutical-fixes determines the practice of mainstream medicine. In the case of Lipoprotein (a), reported to exhibit the strongest independent correlation with both atherosclerosis and valvular aortic stenosis causation, in the face of its complete omission in general practice guidelines, this would seem particularly apt. Instead, the fixation in prevention and management of cardiovascular disease has almost exclusively been on things we have drugs for: like cholesterol. But at long last national and international heart health authorities are conceding this is a biomarker that offers insight &, especially given its independence from all traditional risk factors (hyperlipidaemia, diabetes, smoking etc), helps to identify and avert the CVD “no one saw coming”!
You can purchase A New Era in Cardiovascular Risk: Lp(a) here. If you are an Update in Under 30 Subscriber, you will this episode waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Cracking the Case: Uncovering Cardiovascular Risk – Elevated Lipoprotein (a)
How do you conduct a comprehensive cardiovascular risk assessment? It should always include a Lipoprotein (a) result, having been declared the biomarker with the strongest indication of causality in both atherosclerosis & valvular aortic stenosis. But what use is getting this tested, if, when we identify increased risk due to elevated results, we have no means to lower it? Until now. This is a 57 year old female with a striking personal and family medical history, a peachy coronary calcium score, mildly elevated LDL-C but significantly elevated Lp(a). We describe in detail the meaningfulness of this, as one element in our understanding of her overall inter-connected health story and reveal the prescription and approach that got results. We also discuss the challenge that is inherent in both ‘uncovering risk’ in someone while remaining on the right side of hope vs despair and of the nature of CVD risk reduction which requires lifelong management.
You can purchase this Cracking the Case episode: Uncovering Cardiovascular Risk: Elevated Lipoprotein (a) here.
Ok everyone, we need to stay calm, which I know is the biggest challenge with something this serious, but let’s focus on the steps we all need to take:
Step 2: Inform all your patients – not just the ones you have prescribed these to this year, all your patients can potentially pass this essential information on to others who might be affected. Practice your real due diligence, and email your entire client base. We need to spread the word fast to limit the fallout for those of you old enough to remember theBonsoy debacle, the magnitude of the error in iodine doses in these products is on scale with that – potentially providing people with 200mg (6,000 X UL) of Iodine) per serve
Step 3: Update your understanding of how an iodine excess can affect individuals, the markers and the manifestations – especially regarding delayed presentations & pathology resulting from cumulative exposure. This is something we will need to keep assessing & screening for over the coming months in these clients via not just TSH but repeat thyroid Ab assays.
Step 4:Conduct a risk-benefit analysis in each individual for the case of additional Selenium. This nutrient naturally has its own U-shaped dose response and adverse effects if we overshoot the mark but anyone who has been potentially consuming an iodine excess will, as a direct consequence, have a greater need for Selenium to protect the thyroid against damage from this. Iodine & Selenium are intrinsically integrated with one another in nature, in every diet, in our physiology and, accordingly, doses should be never considered in isolation.
Step 5: Know where to actually direct your anger! This is not the fault of these brands – though I note how fast some were to inform practitioners while others took their own sweet time, which is truly reprehensible. The blame lays squarely with the manufacturer, the only company name not being publicly shared and shamed! This manufacturer substituted a new unapproved raw material for their K-Iodide in January into their production line. The manufacturer worked this out retrospectively late last week and started contacting companies to alert them Friday evening!!! And for those inclined to TGA-bashing…it ain’t the time! At least we have a regulatory authority to respond – send out alerts to everyone etc.
Step 6: If you stock these products contact your supplier to enquire about your rightful reimbursement while not forgetting number 5! All these companies (practitioner only) are suffering a stain on their name that they had no power to prevent. It’s the manufacturer that needs to make amends here….big time.
This is so incredibly unfortunate…
😨 Of all the nutrients – the risks of iodine excess is something I talk about OFTEN and especially of late in pregnancy!! …and
😨 of all the products – it is these HUGE HITTERS in terms of numbers out there on shelves, in circulation & currently being consumed and
😨 of all the patient populations – two of the most vulnerable
Let us know if you have other suggestions regarding steps we, as individual practitioners and, as a professional community, should be taking in response to this
Wanna see behind the curtain here? Sometimes in my pursuit of perfect clarity I go totally OTT. <GASP👀> But when you know that for women diagnosed with Postpartum thyroiditis it was likely to have been missed or misattributed for months to, ‘You’ve had a baby! Of course you’re…(insert adjective)!’, yet for up to 50% it will result in permanent hypothyroidism…well I guess PPT is a good reason to go OTT.
Oh and don’t get me started on the complete lack of risk assessment and mitigation for women. Your risk is different from her risk is different from mine…and how these risks behave under the influence of pregnancy is what we need to watch. Just like in Hashimoto’s disease, this condition has a long prodrome – so its diagnosis is only a ‘surprise!’ for those who choose not to see!
So in pursuit of perfect clarity regarding exactly when, and precisely how, we should dynamically assess a woman’s risk and then, better yet, what research backed risk reduction strategies should be implemented at every step, I may have got a little carried away 🙄 Now on the other side of reading and summarising and then re-reading approximately 200 published research articles and reviews, quantitatively analysing ever single prenatal formula on the Australian market, recording 2 episodes of Update in Under 30 (which tbh took the better part of my working and general waking hours for more days than I am prepared to admit!) and with my tireless and tenacious team, designing a clinical reference tool to summarise all this, just for you(!) I can confirm clarity is indeed where we’ve arrived…and also beddy byes 💤😴
Postpartum thyroiditis – Risks (part 1) available now…& Remedies (Part 2 soon to be released)
Postpartum thyroiditis is said to affect 1 in 20 Australian women but in reality the rates are much higher and the risk much greater in many of our patients. Given up to 50% of patients diagnosed with PPT will end up with permanent hypothyroidism, a risk assessment radar that works in real time to better predict, pre-empt and prevent the condition is essential. Summarising the research we showcase both baseline risks prior to conception and the best schedule for thyroid health monitoring throughout pregnancy and postpartum.
You can purchase Postpartum Thyroiditis Risks… here. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
If you’ve been following the story of ‘my little white spot’ you’ll know that it’s part of me keeping myself (& my whole new framework for nutrition prescribing as per the Nutrient Prescriber’s Program) extremely accountable! Based on all the very latest research that speaks to down-regulation of ZIP transporters in the gut when Zinc is dosed daily at levels beyond what is achievable with food, and after 30 years of dosing daily, I finally gave up the gear! For about a year now I’ve taken my Zinc supplement just twice a week and am reaping the rewards and singing my success from the rooftops!
So imagine my rather large intake of oxygen when I spotted this rather elongated version of a ‘spot’ right at the very base of my exposed thumbnail, yesterday! So, has my greatly reduced regime led me to the lion’s den of a deficiency at last?
To answer this we must first talk timeframes. Nail markings are a look in the rear-view, right? They do not speak necessarily to today but to an event, inadequate Zinc or other, that occurred at the time this nail was being made by nail matrix cells hidden from view under the proximal nail fold. Therefore, significant time has to have passed before we actually get to see these. Do you know how to read that timeline? And how that timeline might change in individuals experiencing different rates of (nail) growth, e.g. pregnancy, senescence, hypothyroidism, protein inadequacy etc. Establishing this understanding for each individual enables us then to accurately interpret any anomalies & similarly, I reckon I’ve just confirmed my nail ‘transit time’ 💩🤣 so to speak!
My year started with appendicitis and an appendectomy 6 weeks ago almost to the day 🤯
So if we accept my time-travel theory, what then do we take the marking itself to mean? Was it that the lower Zinc doses suddenly caught up with me making my appendix sad & sick? Was it direct trauma to the finger and nail bed around this same period that I’ve long ago forgotten about, in all the excitement over my misbehaving appendix? Was it that the infection, surgery and associated stress of the event probably produced a transient secondary Zinc shortfall? All the evidence says I can exclude the first option but even I can’t be certain which of the last two are true. Knowing the real power of nutrition, however, I am leaning toward the latter. As a total nutrition nerd, I’m tempted to try and recreate the event as an experiment to test my theory…just jokes…but should there be a ‘next time’ for a hospital visit, a general anaesthetic etc. I will be keeping a close eye on whatever clears the cuticle 6 wks later!
Oh and apologies for the ugly pics! I was never meant to be a nail model, I enjoy working on my bush block and eating blueberries far too much. These should come with a warning 🙄
Our new batch of Nutrient Prescriber’s are currently under construction 🔨👷♀️👷♂️ And even though there’s already brain juice flying everywhere—we’re only 1 module in – so if you’re having FOMO it’s not too late to join. Alternatively, you can do the whole program at your own pace without the pack…but I gotta say…the praccies in this pack 🐺🐺🐺 are fun to run with & you get the benefit of hearing all their questions, thoughts, experiences, input and answers to boot!
I have a lot of random interactions with health professionals when we happen to find ourselves on the same patch of real world out there. Two weeks ago someone served me in a local health food store and at the end of the transaction said, “I went to that Australian Naturopathic conference that was held here – now which one are you?” I knew immediately what she meant 😂 I said my first name, then mentioned I was actually on my way to see one of the other directors, Kathryn, and as I was leaving she said, “See you next time Kathryn!”👋
Then just last week I was in Launceston sitting in the sun in the mall and a woman walked by and waved. Given I suffer terrible face-blindness (in case you ever think I’m just being rude!) I was worried I knew her but had forgotten, so I waved back. Five minutes later we met again in a shop and with all the smiling & waving already done, she asks, “Do I know you?” I answer that I’m not sure but she follows up with, “You’re a naturopath right? 👍 You’re Rachel?👍 Greg’s wife from Devonport? 🙅♀️🙅♀️ Ahhhhh I guess 2 out of 4 ain’t bad 😂 Turns out I’m not as memorable as I had imagined 🤣
Just 24hrs later I’m at a wedding & someone who I do know & they do in fact know me (can confirm, name, profession, context, location etc. all check out 😅) proceeds to say, “I’m trying to work out what you mean in your latest emails.” I look at them with confusion about their confusion and then they add with incredulity, “Are you actually not going to do mentoring anymore?!”🤯
Ahhhhh yes that is exactly what I mean – I’m not doing a John Farnham here folks!
I have loved meeting up every month with hundreds of practitioners across the 13 years. It’s been an absolute honour to play such a consistent part in all of your professional development, witnessing your individual growth, challenging myself as much as you, while constantly adapting to changes in the profession and, let’s face it, the whole information, education, health landscape! We’ve worked up hundreds of complex cases together, supported a whole next generation of new grads to transition to clinicians who really stand out from the pack, offered many the opportunity to up-skill in mental health and most recently, we became the proud parents of hundreds of !NEW! Nutrient Prescribers – who really are the experts in nutritional medicine now. At one stage I was running 16 separate groups that met every month from February to November, then we expanded the group sizes to cut down the number of groups necessary, then we shortened the year, shortened it again, went to just half a year…yeah the pattern was patent for all to see…next stop…no more monthly mentoring.
Now of course I will not disappear all together…well maybe for a bit but I’ll be back! And my existing educational material will remain available on the website.
My intention is to keep contributing to the education & professional development of my peeps but not in the way I have been.
My compulsion to innovate rather than replicate has kicked in big time
Do I know what’s next? A break. After that? Maybe another lil break 😅 But no honestly, we don’t as yet have any clear vision about future offerings at this time…maybe that will come with a break. And if you ever see me in the same patch of real world out there – please do come up and say hello – whoever you think I am 😂
Keen to join me this one last time?
The Nutrient Prescriber’s Mentoring Program – a structured process for creating prescriptions that’s systematic, scientific and more likely to produce successful outcomes. Join here
Cracking the Case mentoring – curated cases that will build your skills in complex case work-ups, condition specific knowledge, prescription decisions and pathology interpretation. Join here
New Graduate Group Mentoring – supporting your transition from student to naturopathic powerhouse, you will find your tribe, gain support and radically build your toolkit. Join here
Wouldn’t life be a breeze if there was a calculation telling us how much to prescribe of a given nutrient for every different patient to take them out of deficiency, into repletion or even optimal? Well there is.Kinda
If the nutrient in question is Vitamin D there have been several different loading dose calculations proposed and studied. You just plug in your patient details, such as their Vitamin D result and their weight…out pops the ‘total amount of Vit D required’ to get them from there to over that finish line, as well as a prediction for how long that will take. So is it really that simple?
Ahhhhhh….no
There are 5 factors we need to consider in every decision about dose and these formulas only account for a few. There are plenty of patients for whom the predicted dose and duration would be incorrect but it works well for others. And there’s the rather small GIANT issue of Vit D assay inaccuracy to contend with too. And what happens when we choose to use a different form? Instead of using cholecalciferol which these formulas are based on, we’re employing calcifediol or, we go all ala ‘Nature Cure’ and prescribe sunshine!!☀️😎🤯 How very retro?!
Do you always know how to answer the questions, “How much?” “How often & for how long?”
Like how many minutes of sun exposure (before 10am and after 2pm) produces the equivalent of 1000 IU D? If you’re in Townsville Vs Tassie? If it’s March Vs May? The failure to recognise ambient UVB as the single greatest contributor to meeting our Vit D requirements is like giving someone a protein shake under the illusion that’s their ‘protein requirements done’! And not knowing how to prescribe sunshine safely and effectively – means we’re unnecessarily prescribing yet more pills instead. Just sayin’ 🤓
Vitamin D Decisions – What Dose Delivers The Benefit
In this continued unpacking of how to personalise & potentise our prescriptions we introduce a framework to aid us in our decisions about dose. Current beliefs about supplemental Vitamin D purport the benefit occurs when we attain a given blood level. While this suggests a certain simplicity: how big is the deficit – therefore how much D do we need – this is far from the whole story. In this episode we introduce and debate the merits of Loading Dose Calculations as a means to determine the dose and duration of treatment required for each individual – looking at who these do(n’t) apply to but also discuss dose issues specific to other forms including sunshine.
You can purchase Vitamin D Decisions – Which Dose Delivers The Benefit here. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
How has your start to 2025 been?
Mine has been humbling thanks to the grumbling of my appendix over 2 days, so much so that on the 3rd day it was forcibly ‘removed from its place of residence’!
Being unwell brings up all sorts of stuff for me. Many questions (Why do we still not really understand the aetiology of appendicitis in adults? How is it possible that RLQ tenderness was my only symptom with a CRP of 17 and neutrophils of 10X?! ) and a mini-existential crisis: I mean being a health professional who’s ‘sick’, makes me feel not only confused (‘But I live such a healthy life compared to most!!’ and ‘I thought I knew stuff!’) but also a sense of shame.
As peddlers of ‘wellness’ we feel we should never suffer illness, right?! The inner-academic (the sensible one😂) says, ‘That’s such an antiquated binary view of things….surely we’re all just different proportions of wellness & illness, at different times of our lives?’ However, I’m acutely aware ‘purism’ or ‘perfectionism’ continues to infiltrate my, and my profession’s ideology – which I personally have to work on pushing back against.
In a broader sense, re-examining these core beliefs & the prescribing practices that flow from them and, as a result being personally brought down a peg or 10, is really just a continuation of my 2024. Last year I developed The Nutrient Prescriber’s Program and in doing so, put an end to my own ‘age of innocence’. Or should that be ‘age of arrogance’? Both. In spite of being known for my knowledge in nutrition and teaching at universities and colleges, delivering foundational nutrition education to doctors etc, when we dedicated the year to researching the very latest evidence about each micronutrient, in order to create a clear prescribing framework and answer the questions: What form? How much? How often? and For how long? I was shocked by the revelation about just how wrong I have been about so many things.
But I had no choice but to keep delving into the discomfort – praccies were waiting, already engaged by the first few modules & their minds already blown.
Writing each new module we pushed into new frontiers, new ways of thinking, with respect to form, dose, timing, duration, combinations etc. I’m not going to lie, it was a scary ride, for us all(!) but an essential one – because you can’t grow if you’re not prepared to know. When celebrities accept awards and start by saying, ‘This is so humbling’, it always confuses me…I think, no, humbling would be losing! And as heath professionals, being humbled, would be recognising where we’re wrong, being prepared to push back against our desire to stay the same and stay safe (not challenge ourselves) and instead seek the honest answers. Both our original training in nutrition and our prescribing practices are based on beliefs that don’t stack up in the light of day. It’s true. This year I wish you the courage to undertake this journey of relearning nutrition with me.
Are you ready for a revolution in nutritional prescribing?
The Nutrient Prescriber’s Programis a structured process for creating prescriptions that’s systematic, scientific and more likely to produce successful outcomes. You’ll gain a reliable and robust framework to answer key questions such as: Which form? How much? How often? And, for how long?
Dive into the pharmacokinetics of micronutrients, their various uptake pathways in different scenarios, how they work in networks & how co-prescribing in the right ratios is essential for efficacy and safety, rather than as ‘single nutrient solutions’.
Join us in February for Rachel’s last year of mentoring or work through 10 transformative modules at your own pace.Click here for more details…
It’s important for all of us, as people who spend our working life caring for others, to routinely take time out to really care for ourselves. Across my 3 decade long career there have been many occasions when I ended the year in the red, my ‘personal account’ completely overdrawn, so to speak. In recent years I have gotten a lot better at this but you know what, I wish I and everyone else said ‘yes to less’ sooner in our lives and pushed back hard against the culture and myth of busyness.
As practitioners of naturopathic and integrative medicine, we, more than others, know this modern preoccupation is at odds with living a life of health, balance and wellness. We educate, inform and advocate for others on a daily basis to slow down and prioritise health yet how often do we miss the memo ourselves?
‘Really caring for ourselves’, may constitute something very individual for each one of us. There’s no right or wrong. In October I went to Greece (again!) with just a ferry ticket to Kythira, an island I’d plucked off the map, and a return flight in a month. Anyone who heard of my [lack of] plans was stunned: staying so long on one island, one made of mountains and without public transport and at the end of summer when much would be closed or closing! But this enabled me to make things up as I went along and thanks to incredible intel from the only Kytherian I know (an awesome Aussie naturopath of course!!!), once there I decided to do an 11-day solo supported walk of the island. Just me, a day pack and each day a new destination & someone’s home to rest my head and be fed. This is as close as I get to ‘weightlessness’. It’s so essential & energising when we take some of our own medicine. Yep, I am finishing this year ‘back in the black’, baby! [couldn’t resist the ACDC ⚡ reference😂]
By virtue of our profession we all have an ongoing relationship with science but the nature of that may differ. Slave? Submissive? Subscriber? Sceptic? Or of course it could be all of these on different occasions depending on the science in question! But as integrative health practitioners we straddle the chasm between two very different planets & paradigms at times: the reductionism of science & the holism of our philosophy and principles & our medicines. At times, that straddle can become almost the splits(!) and can be just as painful & fraught with clash & conflict as it sounds!
I struggle and I see others struggle too – to make sense of the evidence in a way that doesn’t deny our core beliefs & understanding.
A practitioner who’d just undertaken the Nutrient Prescriber’s Program shared with me that via another training she’d been told, that according to an RCT, 30mg of Zinc TIDS for 3mo was affective in acne rosacea. She said, “but now that I’ve done the NPP I would seriously rethink that approach.” When we hear about successful studies employing nutrition or herbs in a given presentation, it’s tempting, given this evidence of efficacy, to simply replicate that remedy in our patients but this then is only EBM, not Integrative EBM, not personalised, not holistic, not crafted, not curated and arguably a substandard, certainly suboptimal, use of our medicines. Single nutrient or herbal solutions are not how we prescribe and they often push up the dose required to get a desired response. And in going high, we run the very real risk of creating imbalances and other unintended effects. For example, who tracked the bone turnover markers and Hb precursors of these individuals? Two biomarkers established to be negatively impacted by a Zinc excess without due consideration of its critical micronutrient relationships, ratios and ripple effects! Successful scientific studies using our medicines make a sensible place to start our thinking about what to use in particular presentations but not a place to stop! We should not shirk our much more developed & holistic understanding of our modality nor abandon individualised care.🎤
From RCTs to Real Patients in Hashimoto’s Thyroiditis If you’re an evidence-based practitioner you recognise the value of a well-conducted RCT, however, if we were limited to replicating those successful interventions from RCTs investigating CAM, the resultant prescription would be neither integrative or holistic! The success of scientific enquiry is in large part attributable to its ability to standardise (subjects in a sample, single nutrient or herb interventions administered at a one-size-fits-all dose) but success in integrative health demands individualisation. So, how do we marry the two paradigms? In this episode Rachel talks you through the journey we must undertake in order to apply the findings of RCTs to real patients to arrive at our desired destination: Evidence Based (Yet!) Integrative Medicine, using the nutritional management of Hashimoto’s thyroiditis as an illustration.
You can purchase From RCTs to Real Patients in Hashimoto’s Thyroiditishere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
In January, after 30 years I finally got off the gear. That’s how long I’d been taking good quality, high dose (minimum 20mg elemental) zinc daily for. Originally the rationale was I was a vegetarian. Then the 20 years that followed my reintroduction of meat saw me continue the practice, born of the belief & ’empirical evidence’ that I was healthier when I took it than when I didn’t, especially with respect to my immunity.
And on the surface that certainly seemed correct. If I lapsed, went for a period without, I would invariably quickly get sick and then some time later a white spot or two would emerge on my fingernail to mark the occasion retrospectively.
So like many others I was scared to go without it. But as I’ve mentioned, I decided last year to go on a research gathering and reading expedition of the very latest science on all micronutrients including best practices when it comes to their supplementation and lo and behold what did I find? Discomfort. Challenge. My world, or prescribing practices at least, turned upside down.
The science (employing a variety of excellent methodologies to produce very high level evidence for those wondering and playing devil’s advocate!) says, Don’t Dose Daily. Not if you’re using 20mg or more per day.
In fact when you do, you create a dependency of sorts. You heard me but I will say it again for those in the back: when you give this amount daily you shut down your GIT ZIP transporters (and potentially target tissue ones as well) which makes you less and less effective at absorbing zinc. But what about my ’empirical evidence’ that daily dosing worked because every time I took a break I got sick?? Yes well that’s what I now recognise as ‘dependency dosing’.
So what happened when I got off the gear after 30 years, aligning my prescribing practice with the research and dosing zinc only twice a week?
I got better. I have not been sick once this year. My iron levels increased, my plasma zinc levels stayed exactly the same and I’ve been able to take less magnesium because the zinc is no longer pushing it out. And every individual for whom I initiated the same change reports back the same or very similar findings. Oh and don’t be surprised when that lil’ white spot comes a calling. It took until about June for mine to appear about midway along the length of my pinky nail and just now it has almost reached the end of my nail. Just there to mark the occasion…not to signal a current deficiency (because that is not how nail signs work right…they have a long lag time before they reflect a shortfall and repletion!). And of course in spite of still taking my zinc only twice a week there has not been another…So, so long little white spot and goodbye dependency dosing 👋🏼
Now anyone who did our Nutrient Prescriber’s Program this year knows all about ‘dependency dosing’ and the need to work with the science of regulation, synergism, ratios etc rather than against it. These practitioners know the most effective way to prescribe zinc for the correction of a deficiency and supplementation of primary or secondary shortfall….and much muCH MUCH more! But if you missed out…
The Nutrient Prescriber’s Program is a structured process for creating prescriptions that’s systematic, scientific and more likely to produce successful outcomes. You’ll gain a reliable and robust framework to answer key questions such as: Which form? How much? How often? And, for how long?
Dive into the pharmacokinetics of micronutrients, their various uptake pathways in different scenarios, how they work in networks & how co-prescribing in the right ratios is essential for efficacy and safety, rather than as ‘single nutrient solutions’.
Join us for mentoring in 2025 or work through 10 transformative modules at your own pace. Click here for more details…
Are you ready to reexamine the science when it comes to nutritional prescribing?
Testimonial: Anna Sangster, Naturopath Perth Health & Fertility “I am very glad I did this course. I feel it should be taught in every naturopathic college to ensure the intricacies of prescribing are understood. A key point Rachel makes early on is paramount – the impact your nutritional prescription has, is not influenced by your wish or desire when prescribing it. Understanding how a micronutrient is broken down, absorbed, carried through the body, metabolised, utilised, eliminated and all of the regulatory controls the body has in place when it comes to our micronutrients means we can then prescribe accurately with greater certainty in the desired outcome.
The course brings to our attention how micronutrients interact together in the body, how and which micronutrients are stored, how they move from mouth to target tissue, how inflammation or fatty liver may impact your prescription, how understanding hormonal impacts on regulation and circadian rhythms means we can optimise our prescribing, how a micronutrient is eliminated so we can ensure our prescription is safe.Understanding micronutrient ratios and how your prescription may unknowingly be causing undesired impacts in unintended places, these are just a few of the things covered. This course is a tool to sharpen your prescribing and take your treatment to a whole new level. This is what our profession needs.”
We’re weirdos in the nutrition world, right? Tell you something you don’t know?!😅 Ok, how about this, with respect to sodium, our positions, perspective and for some of us, prescriptions set us completely apart.
Say the word, ‘sodium’ to a room filled by any other health profession and they’ll chant in unison, ‘restriction’ In a room full of nats, nuts, herbies & integrative medicos you’ll get a very different response, in fact several! But arguably the top 2 would be: ‘Essential’ and ‘Adrenals’
My voice would be loud amongst that chorus, of course 🙄 📣 but in good company 📣 📣 However, just as recent research has rewritten endocrinology chapters on the adrenals and HPA dysfunction in the last decade, are we across how this affects sodium’s sophisticated regulation and response to varying intakes? In our previous Update in Under 30 episode we discussed the micromanaged minerals (Ca, Fe, Iodine and Sodium) and were left in no doubt, that due to its critical roles in our basic moment by moment survival, sodium is the most micromanaged of all…we’re subject to relentless regulation to prevent a sodium shortfall. Hmmmmmmmmm so how do we fare in the contemporary context of consuming about 10 times more than necessary?
What’s the significance of adrenal dysfunction and could salt offer part of the solution in these cases, just as we were promised in a very popular book 30 years ago – that almost no one owns (anymore) but everyone knows!
I am SO glad you asked…
The Salt Solution in ‘Adrenal Fatigue’? While the concept of ‘adrenal fatigue’ has gone out of favour, has the practice of recommending salt as part of the ‘solution’ in low cortisol clients? And should it? The fact that sodium is so rarely a talking point in integrative health compared with mainstream medicine is a talking point itself! In this episode we not only discuss those interprofessional points of difference, we also ask the question: should the only sodium related recommendations be about restriction, or can some patients actually fall short? We also reexamine the intrinsic links between this micromanaged mineral and our adrenals.
You can purchase The Salt Solution in ‘Adrenal Fatigue’?here. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Some days I feel as old as the hills & others like a new sprout just making its way up out of the earth, especially in relation to my professional knowledge.
It’s absolutely true I’ve been around the block a few (zillion) times, building up substantial knowledge and experience which fosters clinical practice and prescribing behaviours that can feel as familiar and comfortable as my favourite trackky dacks! I am sure you can relate. But then along comes new information from our clinical experiences or revelatory research about health presentations & their underlying causes, diagnostic understandings, the way our medicines work (and don’t) and it’s like a fresh strong breeze has blown through my mind, unsettling, challenging and above all re-inspiring me all over again about who we are and what we do.
I relearn, I adapt and I change how I practice and teach. And that’s what keeps me mentoring. If I was still saying all the same things I did 20 years ago when I taught so many of you as undergrads, or even 10 or 5 years ago, I’d be ready to hang my hat up. But every year this process of renewal, of removing the comfy trackky dacks for something far less comfortable (office like and appropriate!) is repeated. And never more so than in the last 12months. You see, last year our entire team undertook an intensely focussed 10 months gathering and reading all the very latest in nutritional science and, quite simply, it blew all of our minds! 🤯🤯🤯🤯 (that’s all 4 of us!)
That’s what’s behind our new ground-breaking & practice changing The Nutrient Prescriber’s Program, which we are offering as a supported mentoring program in the first half of 2025. If you have seen some of the first testimonials coming through from our alumni you’ll know this is not to be missed!
But if getting out of your prescribing trackky dacks right this second fills you with terror 😳 you can ease your way into this new thinking and approach to prescribing via our other mentoring offerings – especially our highly popular and celebrated: Cracking the Case. Check out Alison’s comment below about her experience this year of this entirely new format and the accelerated outcomes you get with this applied-based style of mentoring and support.
“Another fantastic course run by Rachel and her team. It always leaves me questionning what I am doing with my clients and how can I better help them with the evidence based research Rachel presents. I am so glad I have access to this information and find myself continually going back to the course for the evidence presented to help with client plans, especially those tricky cases. Thank you so much Rachel, I’m in awe of your brain and knowledge!” Alison Bramley NZ Naturopath & Cracking the Case mentee
And while I may be getting old(er) I am delighted to still have so much to offer the lil’ chicks of the clinic – our emerging next gen leaders – fresh out of their training or returning to practice after a time away. What a privilege to foster such growth in these grads via our New Grads program.
We’re taking registrations right now for all 3 mentoring programs for 2025 – and I can’t wait to see you there. Let’s all get out of those too-comfortable trackky dacks together ! Welcome challenge and then come out stronger on the other side – more competent and confident in the clinic than ever before!
Ever feel like you’re trying to improve people’s mineral levels but you’re not getting the results you should? Does it seem that despite making good product choices and doses, there’s something that keeps derailing or rerouting where these minerals end up? It could be you’re doing battle with what I call, rigorous and relentless regulation.
As one of the many goodies from our recently wrapped-up Nutrient Prescriber’s Program, we went where nobody in nutrition seems to want to go…into the misty mountains of micronutrient regulation!
Think about it, outside of iron, regulation is rarely discussed and therefore often we’re failing to factor it in which can explain why some prescriptions fail, but all essential micronutrients are subject to some degree of regulatory control. The body’s ability to adjust all the ‘dials’, turning ‘up’ or ‘down’ absorption, changing the distribution of a nutrient (that’s the re-routing!) or its metabolism, increasing or reducing its elimination, is a cornerstone feature of nutritional homeostasis. It enables the individual to respond moment by moment to their changing intakes and needs. But to what extent each individual micronutrient is regulated – which covers the whole spectrum from ‘loose and limited’ to ‘like your life depends on it!’ – and the ‘hormonal housekeepers’ responsible and nature of this narrative, is as individual and weird and quirky as all the nutrients themselves!
‘Back up there!’ I hear you shout! ‘Some minerals are regulated ‘like our life depends on it?!’
You heard me and yes. This is indeed a massive bit we’ve been missing in our understanding of prescribing minerals. Are we protected equally against deficiency and excesses? What’s the ‘cost’ to our health if we are constantly responding to an imbalance on either side? To our thyroid? To our adrenals? To our cardiovascular system? Well I am delighted you asked and happy to answer all those questions and more…join me in the latest Update in Under 30 episode complete with another kick-arse clinical desktop reference! 🤓💪
Working with Micromanaged Minerals Striking differences in our regulatory control over each essential micronutrient reveals a lot about their provision in the Palaeolithic diet (scarce vs abundant), as well as their importance (or not) for our short-term survival. This is especially true for our most micromanaged minerals or the “big 4”: iron, iodine, calcium and sodium. Whose regulatory design was perhaps purpose-built for the paleo period but now battles with our contemporary context. This presents us with a range of challenges but also some opportunities to be better able to ‘read the regulatory signals’ and in turn, personalise and perfect our prescriptions. This episode includes a great desktop reference for ease of use in your clinic
You can purchase Working with Micromanaged Minerals here. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Isn’t it always the case that when something takes on personal significance – ‘we’ give it more attention? Whether that ‘we’ is a country, a group of researchers, a practitioner or a patient. Let me explain…
🌍Denmark, among many other European countries, I love your hyperfocus!
Having regulated Nickel content of certain consumer goods since the 1990s they continue to monitor compliance, exposures, calculating not only food content but other sources and correlate changes in these with the impact on Danes & their Nickel related dermatitis!! Recent research, for example, picking up that many common kitchen kettles were leaching Nickel – which lead to their subsequent removal from sale! Sadly, ‘down south’ there’s no such regulation or interest and so our ongoing Nickel exposure continues to go unchecked.
😎😎 Two retired scientists personally affected by severe Nickel Allergy, motivated to make more information available for everyone – I can’t thank you enough!
These two researchers have together created the most up to date, evidence based, full referenced Nickel food tables in addition to a bunch of other invaluable resources for practitioners and patients alike…helping us take huge steps forward in understanding how to undertake the Low Nickel diet with the scientific rigour it requires. And as part of this, identifying previous invisible sources of oral Nickel exposure by way of our SUPPLEMENTS!😲 Yes you heard me 😥
👩⚕️The practitioners who keep bringing me their Nickel Allergy cases & sharing the success stories of our approach!
You know who you are! Since learning about Nickel allergy you’ve become dogged in diagnosing in your patients with skin/gut presentations and determined to do better all the time! I salute you and I celebrate your successes with you! 🤓
🤕The affected patients who continue to teach us about Nickel Allergy by way of sharing all their experiences
So thanks to everyone above 👆 I keep learning & expanding my understanding, my tool kit and can keep sharing these with you – check out the latest Update in Under 30 to reap these rewards 👇🤓
New Tools For Lowering Nickel
As many of us move into a new area of practice, the recognition, management and treatment of Nickel allergy, we find ourselves in search of more scientific support. Given most of our patients will not have access to the proper investigations required to confirm Nickel as the culprit, there’s almost total reliance and emphasis on the diagnostic dietary intervention: The Low Nickel Diet. Questions about how to undertake this correctly and in a way that ensures sound conclusions are reached, in addition to, the equally important question, ‘What happens next?’, are answered in this episode which is accompanied by the very latest referenced Low Nickel diet resources
You can purchase New Tools for Lowering Nickel here. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
These days it’s all about who you know right? So if we applied that same mindset to rating and ranking our organs then the kidneys would’ve amassed the largest number of followers, ‘top fan badges’, likes, watches, you name it. The kidneys are nothing if not ‘connected’ – with reciprocal relationships with our vascular, neurological & respiratory systems, liver, haematopoietic tissue and…🥁
We’re forever in debt to the 1960s ✌ The decade that brought us all peace love and mung beans but more importantly (!) an awareness about the connection between our gut and our kidneys.
Their union becoming more ‘official’ when someone first applied the term, ‘Gut-Kidney Axis’, in research around 2010 and ever since attracting the attention of researchers, nephrologists and now naturopaths alike! These two organs are involved in significant ‘job-sharing’ which typically works well for us, ensuring our survival (generally a feature of a good day at the office in my opinion!) through their combined efforts of noxious waste removal. This is especially when they both ‘bring their A game’. Many of us know that in severe renal impairment the negative ripple effects on gut function are substantial but how often are we thinking about it the other way around. How does the gut dysfunction or disease in a patient actually drive renal impairment? Let me count the ways!!
There’s a rapidly growing body of evidence attesting to the causative, or at least contributory role, things such as coeliac & inflammatory bowel diseases, abnormally increased intestinal permeability, dysbiosis and even periodontal disease can play in causing kidney conditions, and more generally, chronic kidney disease (CKD).
This places our food preferences, our bugs, their biome, by-products and our barrier integrity all at the forefront of the gut’s ‘good guy’ status when it comes to kidney care. This is important to know, not only for the purpose of understanding why someone with ‘no traditional CKD risks’ presents with CKD but also to arm us with solutions and opportunities for course correction when they do. I started this conversation in last month’s Update in Under 30 episode: CKD- Causes Catalyst & Contributors, talking about our urgent need to ‘broaden the lens’ when working up cases of CKD but in the latest episode I’ve taken a very targeted look just at the role of gut dysfunction and disease – including a very intentional discussion of IgA nephropathy (a strong link between the two) that is grossly over-represented in Australia and NZ and therefore a ‘must know’ for us all 🤓
When GIT Dysfunction Drives Kidney Dx
The gut is a ‘good guy’ when it comes to supporting renal function for the majority of us via a balance of bugs, their beneficial by-products and an intact barrier. Additionally, there is direct job-sharing with respect to elimination of wastes. However, if the gut ‘goes down’ due to disease or even, on occasion, just dysfunction, this can then add substantially to the vulnerability, burden and risk of renal decline. The gut-kidney axis offers many advantages including a key point of indirect access for treatment of renal impairment when this bidirectionality goes ‘bad’. In particular we take note of IgA nephropathy – a prevalent and under-recognised cause of intrinsic renal disease that is a potent illustration of this.
You can purchase When GIT Dysfunction Drives Kidney Diseasehere. If you are an Update in Under 30 Subscriber, you will find it waiting for you in youronline account.You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
In January, after 30 years I finally got off the gear. That’s how long I’d been taking good quality, high dose (minimum 20mg elemental) zinc daily for. Originally the rationale was I was a vegetarian. Then the 20 years that followed my reintroduction of meat saw me continue the practice, born of the belief & ’empirical evidence’ that I was healthier when I took it than when I didn’t, especially with respect to my immunity.
