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But does it make you doubt yourself & all your knowledge when it does? When you personally suffer a health condition, from the small to the significant, does it always come with a double diagnosis; a bad bout of imposter syndrome being added for good measure? Do you think things like, ‘How can I be advising […]
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S!ck Happens
But does it make you doubt yourself & all your knowledge when it does? When you personally suffer a health condition, from the small to the significant, does it always come with a double diagnosis; a bad bout of imposter syndrome being added for good measure? Do you think things like, ‘How can I be advising others when this is actually, in truth, my own (lack of) health?!’ That’s normal. Not helpful, of course. Nor rational, reasonable, appropriate or proportionate. But when you work in health, being unrelentingly hard on yourself about absolutely anything that looks or sounds or feels like less than optimal, is unfortunately an occupational hazard. ‘Well, what kind of an expert or an ad for health, am I then?!’ But sick happens to us all.
I don’t think we talk about this enough.
For most of us health is not a job, it’s an identity. And an identifier, used by others, of us. Friends, family, neighbours, networks. Almost everyone else just has a job right?! Instead we live a life...that is the embodiment of our occupation. That’s a good thing of course – we hope we’re in a position to act on the information we have about health in our own lives & are able to walk the talk. But that doesn’t ever make us invulnerable to disease or immunis (a Latin adjective that originally indicated freedom from obligations but evolved into the medical concept of being protected from disease: ala immunity). But holding the two truths: I am a health practitioner & I am unwell – can cause us to crumble.
I recently got a voice message from a practitioner I’ve known & mentored for a long time.
I could hear her fear & a bit of free-fall, as she told me she had been diagnosed with a substantial oestrogen dependent growth.
She didn’t speak per se to a sense of shame or her crisis of confidence in her own competence as a clinician but having been there myself, and many times (!), she didn’t need to. I sent her a voice message back along the lines of this, not making assumptions but offering gentle reassurance that if this was where she was going in her head – it was not uncommon or even unexpected but entirely misplaced. Her relief was palpable. Then I referred her to someone that knows all about this BS that can go on in our brains because she herself has been both an incredibly effective health professional caring for thousands of patients and has experienced several major health issues throughout her career. And tbh I see this as one of this practitioner’s serious super-powers🦸♀️
Her experiences of poor health only add to her expertise – they don’t diminish it.
Likewise I know other practitioners who are diabetic, have had their bowel removed, have heart conditions, ongoing infertility, total burn out, all different types of cancer – you name it – and I regularly refer to them all. Not only for their firsthand experience & unmatched expertise in these particular presentations but for something bigger than that they share with those in their care: fortitude, pragmatism & their understanding, with all of their being, that no matter how good your nutrition, how regulated your nervous system, nor how pristine your environment…Sick Happens.
If instead we feel the pressure to keep pretending we’re above illness – to imply that optimal wellness is a question only of will & your willingness to do the work!
Well that short-changes us all of the kind of super-power support I know is possible & we all deserve – and ensures the cycle of silence continues. I’ve been sharing a lot lately about what perimenopause has put in my path – as both obstacles and opportunities for fresh insight & understanding about this transition for women & myself. Now tell me, what’s been happening with you 🤗
Image by Eugenia Pan via Unsplash
Food Cancel Culture is Alive & Unwell 🫤😦😞
Take a moment to reflect honestly on your (ouch!), or alternatively ‘our’ collective (if that’s more comfortable) opinions over time regarding each of these: Butter. Coffee. Spinach. Red meat. I could go on and on…and tragically, on some more. The total number of ‘opinions’ each of us have had will be largely determined by simply how long we’ve been in nutrition. And yes this tracks even pre-social media 😞 There’s an understandable, in fact, entirely acceptable element to this. Discoveries that fuel truly new thinking in nutrition are rarely linear or even predictable. These discoveries are disjointed with often big delays in between, many a contradictory finding, a juxtaposition to juggle & U-turns are not uncommon. The science can be so complicated & confusing it’s hard to sell it to ourselves, let alone others – so we turn them into stories. Problems arise when that’s all they become – stories – especially those that follow a familiar narrative arc:
Narrative simplification → Splitting → Moralisation
Narrative Simplification – Complex biology becomes a clean story.
Nutrition science is inherently messy because nutrients & non-nutrient elements of food all interact, context matters, dose, timing, and physiology all alter outcomes and individuals have individual responses! But complexity doesn’t travel well, so we compress it. This food is ‘flammable’ avoid in inflammation. Eating this is good for your gut. Don’t include this ‘disruptor’ in your diet if your value your hormonal health. A nuanced, conditional & complex body of evidence becomes a one liner that’s easier to sell.
Suspect simplification when any food ceases to be healthy inclusions for some individuals some of the time – instead its now either for everyone or no-one!
Splitting – Foods become heroes or villains.
Once our stories get so simplified that they lose lost sight of the (ever evolving) science, it’s an easy 1,2,3 into binary, black & white thinking. Foods (or nutrients or forms of nutrients) get elevated to the giddy heights of hero-status – from which they’ll inevitably fall in the future – but until that time they are objectified as: right, helpful, health-full, optimal for all. While others are demonised to death! Attributed anti-health super-villain powers – good for no one. And to be eaten never. The phenomenon of splitting is cognitively efficient, so it appeals to our overloaded brains, yes. And in a crowded information landscape, clarity – even false clarity -is the winner of people’s attention. But biology doesn’t operate in binaries. And hey, aren’t we supposed to favour holism over reductionism and personalised prescribing over population based dietary advice?
Moralisation – Food becomes a proxy for virtue.
Once foods are sorted into good and bad, it’s just another step (to the left ala Rocky Horror Picture Show!) into extrapolating about the moral virtues of the individual eating them! Clearly, the people eating these foods can be subsequently seen to also be either good or bad. Vigilant or careless, Disciplined or lazy. Informed or ignorant. Now we’re no longer just discussing food—we’re making moral judgements about its consumer. If you cared about X you wouldn’t be eating that. If you understand anything about nutrition you’d know not to eat Z. This is where Food Cancel Culture emerges. And a new cycle kicks off: a food we previously loved, or at the very least liked, becomes loathed. But spoiler alert! – if you do continue to seek out the (ever-evolving) science & accordingly critically review your ‘stories’…this opinion is not your end destination.
Once you see the cycle, you can choose not to perpetuate it.
No more heroes. No more villains.
Just a quieter commitment to letting the science -not the story- lead.
Feeling Pressure To Be An ‘Early Adopter’?
I often feel on the outer even among my peers. I recall a period during which I was a regular invited speaker at an event, where I was increasingly the odd one out from the others & their escalating unified chant of the same single solution: the GAPS diet. I could say this was simply because being passionate about personalised prescribing, I am protocol-proof💪 🏋️♀️ but that’s not the whole story. When you imagine you’re on the outer even from ‘your own’, it leads to self-doubt: 🤔Maybe I’m the dinosaur here because I’m not an early adopter of this! Behind the 🎱 because I feel the need to wait until there’s more evidence. I took a bet each way & excused myself from future programs.
And while it’s both alarming & personally affirming to note that the spruiking of this ‘universal solution’ has slowed if not stopped since the GAPS gold rush around 2010, there’s a new one, in fact several new ones since – that repeat the pattern.
I think the inclination for early-adoption, or the self-doubt if you don’t, both make sense for us as a profession, in particular. We’re innovative by nature, rebels at heart and we’ve been gaslit that many times by conventional ‘consensus’ science & the dominant ‘only-pharmaceuticals-fix’ thinking, that we’ve lost count. We were told that leaky gut was a lie, a period of instability prior to menopause was nothing more than attention-seeking & non IgE adverse food effects a figment of our imaginations! So, naturally we’ve lost a bit of faith 😔
But equally, when we look back over the salves we’ve been sequentially sold as the latest & greatest protocol & panacea:
Anti-candida
Blood type diet
Lectin-free
Paleo (where is butter coffee – haven’t seen him around these days?)
Auto-immune protocol
Carnivore
(I could go on but feel free to add any I’ve missed)
it should provide us with some perspective.
This is not the same as saying these don’t work for anyone or that there’s no merit to any element of these approaches in some patients. In fact, it’s often the case that these have stemmed from a scientific understanding of an aspect of health that was/is often overlooked by medicine. To boot it attracted some good google reviews from early adopters. Jane Does gives this diet: ⭐⭐⭐⭐⭐ But then that original insight or innovative idea becomes distorted & damaging through over-generalisation, misapplication, ignoring any evidence of the diet’s negatives and ignoring all other aspects – including the very individual nature of us individuals!
I saw this video of Jason Hawrelak & his patient, Alma-Jade, on socials the other day and I just appreciated it so much,
So, I asked Jason if I could share it.
So, if you sometimes feel on the outer because you’re not always an early adopter, you might be amongst some good company 🤗🤓
How’s Your B6 Situationship?
Completely breaking up would have been easier for everyone. But cutting the cord isn’t an option because she’s everywhere. She remains essential, beneficial & yes, indicated in some patients as part of their prescription. But her ‘toxic nature’, exposed via excess supplemental intake, is something we shouldn’t turn away from either. So, a ‘situationship’ has emerged involving intense emotions, a lack of clarity & consistency about how we feel, the nature of this new relationship between B6 & us & accordingly, ‘how we should act’. I mean, are we even still friends?? Practitioners seem to be responding to this relationship shift in very different ways…
Ghosting – suddenly ceasing all communication, without warning or goodbye -removed from our shelves & thought processes seemingly overnight.
Slow Fade – gradually pull away, including B6 less & less in your thoughts about the nutrition of patients, either as a potential deficiency or as part of their remedy… then not at all
Benching – storing B6 in a mental “maybe” file or “just in case” folder, remembering the benefits she can bring to some patients but not willing to play her on the pitch right now.
Orbiting – No longer speaking directly… but obsessively watching from afar. Reading every article, every social media post, every case report, every opinion piece. Quietly consumed by everything being said about our ex
Either way B6 is orbiting us! Because even if we did want to ‘forget we ever met’, our patients bring her into almost every consult: they’re ‘seeing’ her, did see her, have experienced awful adverse effects as a result, or are filled with worry that they will. And we’re (rightly) rethinking every product on the shelf, including those we’ve used successfully for years with seemingly ‘no problems’ and reassessing them in this new light. This is tough terrain. Especially when it starts to erode our very own identity as the experts in nutrition.
The bar for attributing blame to B6 is currently incredibly low – and everyone is doing it.
Any altered sensation? Are you taking anything with B6? You are? Well, bingo!
This is where things are getting messy and very misleading
Even those ‘diagnosed’ by way of B6 blood levels, reveal to me, those doing the diagnosing have not read the research – because there is no concentration of any B6 biomarker that consistently in any way correlates with its neurological toxicity, for a start! I’ve heard B6 being blamed for paraesthesia that are not bilateral or do not fit the characteristic distribution pattern of small sensory fibre neuropathy (stocking glove +/- facial). Heck! I’ve heard of some that aren’t even sensory or peripheral, instead it’s about dizziness and altered hearing etc. Hellooooooo 📣 There is no convincing evidence that B6 toxicity produces central nervous system involvement — not in mechanistic work, not in clinical descriptions, not in animal studies nor the broader literature. I’ve been talking with many practitioners recently about this issue and how we should respond – to the valid concerns of their patients, to the very real threat posed by B6 containing supplements as well as the need to keep using these in some, to the enormous concern & confusion caused by these misdiagnoses.
One of the things I’ve been saying repeatedly is, ‘Remember you’re the expert in the room.‘
But, of course that’s only if you are. Being the expert is never permanent. It isn’t something you achieve once and then keep forever without effort. And of course it’s relative to who else is in the room. Nutrition as a science is wonderfully dynamic, & accordingly our understanding of something, can go ‘out of date’, seemingly overnight. So if you’re sitting with someone who’s seen a neurologist — especially one with a clear diagnostic pathway & ideally biopsy findings — and you haven’t kept up with this aspect of B6, your role will be to listen and learn. But if you have read the literature… If you understand what B6 toxicity is — and what it is not — and a patient’s GP is confidently pointing at B6 containing supplements while the clinical picture simply doesn’t fit… Then back yourself. Respectfully. Calmly. And get busy finding the real cause. 🔎
Because good clinical nutrition isn’t about choosing sides – It’s about staying evidence-literate enough to know when B6 deserves the blame and when it’s just an easy-out to accuse your ex of everything!
If you want to be more confident about:
The mechanism behind B6 toxicity – the evidence from across the board
Risk reducers – dose, duration, timing & how to co-prescribe to minimise risk
Risk amplifiers including patients on certain medications
The role of genetic susceptibility
What ‘recovery’ looks like after reducing intake
The best questions to clarify the cause of any altered sensation
The most common causes & their unmissable clues
Other nutrients implicated in organic nerve damage including B1 B9 B12 & Zn
The role of testing
Novel Iron Options – But Which Form When?
The iron options available to us have undergone a ‘Grand-Designs-Scale’ reno. And whether your taste is for supplements that offer more food-like forms (I’m thinking an off-grid rammed earth, built into a hill) or you welcome nutrition borrowing from the best that drug development has to offer us (Neofuturistic architecture?) – there’s something for everyone! These novel forms parallel newly identified means of iron uptake in our gut which completely rewrite our ideas on iron digestion, absorption & regulation. So if you’re still choosing iron products based on:’ organic, soluble and in its ferrous state’ – baby your ideas are out of date!
Because lo and behold that’s not in fact how iron occurs in our food
&
Surprise surprise – our digestive system is designed for the forms that do
Those forms include iron di & tripeptides, members of the large family of ferritins from either animals or plants, in addition to dear old haem. That’s right, while there might be a sprinkle of (Fe) citrate in your kim chi, there’s no bisglycinate in your borlotti beans, no iron fumurate in your fennel & no (Fe) sulphate anywhere to be seen (unless of course someone snuck in some as fortification)! So all these, organic (except SO4), soluble and ferrous forms (except citrate) are reliant on DMT1 transporters and are actually at a disadvantage compared with our newly discovered funky food forms & the curious ways they find to get across the intestines.
Including a range of phytoferritins present in most legumes – especially soy and the common pea.
Pea-Ferritin products anyone?
But this is just a small part of their story that you need to understand to know in which scenarios a supplement like this makes most sense. And equally the progeny of elite engineering: Iron Polymaltose (aka Maltofer) and Ferric Pyrophosphate nanoparticles (aka Sunactive, Lipofer) have their advantages in some patients and presentations and therefore also their place. As we wrap up the Supplement Boom Series putting all that we’ve learned into these final two episodes on iron has been nothing short of thrilling! 🤓
If Iron is important in your practice then you’re going to get enormous value out of these two recent episodes
Image Engin Akyurt via Unsplash
One of our most popular past episodes explored the relative efficacy of the many iron supplements on the market. Since then, the landscape has changed dramatically. New and novel forms have emerged — including haem iron products, phytoferritins, nanoparticles, dermal patches, and more — each claiming to solve long-standing issues with iron interventions. In this episode, we begin by retracing the evolution of iron as one of nutritional medicine’s most commonly prescribed interventions. From there, we examine the renewed interest in food as medicine and food-like forms: molasses and grape syrup, offal, iron-rich herbal tonics, and naturally iron-containing mineral waters.
In this second part of our iron investigation, we take the following forms to task: haem, plant ferritins, iron polymaltose & nanoparticles of ferric pyrophosphate. Discussing in detail each of their unique dynamics regarding digestion, absorption and regulation of iron. Ultimately it answers the questions when to use each form and why.
Listen in as we revisit some of our long-held assumptions about what makes a “good” iron form and hold them up against emerging evidence that is reshaping our understanding of digestion, absorption, regulation etc. It’s time to rethink iron — and update old ideas in light of new science.
TRE & Perimenopausal PTH Problems
While we’re on the topic of perimenopause –and will we ever get off it btw because quite frankly there’s so much that needs to be said?!– I need to bang the drum some more about bone health & our role in that. During our recent all-things-peri-education-event I said, this is the time when our bones adopt the ‘brace position’. You know the one before the plane crashes?🛬 Unless. Unless we use it instead as the ultimate window of opportunity to preserve the existing BMD – better yet, even build on this, which, of course, only resistance training can claim.
So let me guess what comes to mind supplement wise for preservation of BMD?
Vitamin D? K2? and Calcium?
Most of us are well past the point of believing that it’s just about taking enough of these 3. Neither the evidence nor our own clinical experience supports that. Bone metabolism & its heath is far more multifaceted and, in particular, nutritionally complex than this. So while I left the crude Calcium concept (you know, it’s the major mineral component so load ’em up) for dead a long time ago, I use Calcium almost always during perimenopause for two reasons. Firstly, most women’s intake is grossly inadequate – and I am talking here with respect to the most well-supported recommendation for daily intake and optimal bones of 800mg, not the ridiculous RDI (this is something we discuss – all RDIs and how to rationalise these in light of levels of evidence in the Nutrient Prescribers’ Program – so if you want refs just ask). The second reason to prescribe Calcium is to put pause on any increase in PTH & therefore STOP! its pilfering in its tracks. Like right here right now in this moment.
PTH is an acute responder to any dip in Calcium
…Within seconds it surges
Within minutes the GIT becomes ‘leaky’ to increase Calcium’s paracellular uptake
Within 1-3hrs the bones have been tapped
PTH peaks first thing in the morning partly in response to an endogenous circadian rhythm but also because, quite simply, we’ve been fasting and no new Calcium has come into the system. So what if we extend our overnight fasting? The PTH gets higher and stays up for longer, resulting in more negative impact on the bones. And SO many women have embraced TRE or at least extended overnight fasting – for good reasons, right? But are you assessing the impact this is having on one of the most modifiable risk factors for osteoporosis? I am and I’ve just had this conversation again with yet another woman. We had sequential PTH measures one at 7.20am (PTH 4.7 pmol/L), one at 8.30am (PTH 5.3 pmol/L) – both are too high for optimal BMD preservation. But the real issue is she doesn’t actually eat her breakfast usually until about 10! This translates to a very long period of exposure not only to high PTH but peak cortisol concentrations to boot. She was taking enough Calcium (and doing everything else right) but I had to tweak the timing of her first dose… and then we had to try and reconcile this with her TRE.
For a patient like this with that tendency for the PTH to push up too high – the 1st dose of Calcium must be within 2hrs of waking
Compared with other supplements it’s an easy one to take (not a gastric irritant like some) & with just 50-100ml of whatever milk or substitute you prefer is an easy ask before hitting the gym or the pavement or the desk! Alternatively, of course, if someone is not adhering extended overnight fasting, you just bring breakfast forward & ensure it’s a calcium rich choice. This is what I mean when I say science drives the most successful prescribing…not the bad most basic of nutritional science that SCREAMS, ”Deliver Ca to those bones like a concrete-mixer. Just pour it in!”
Nope.
The exceptional science that reveals the real nuance of how nutrients work and how then to employ them to achieve the very best results.
And if now you’re rushing to reach for Calcium but have questions about best form and dose, duration and combinations…and are hungry to experience the same level of confidence prescribing all the other nutrients to boot…well might I suggest 🤓
The Nutrient Prescribers’ Program offers you a complete revolution in the way you practice
Dynamically delivered across 11 modules which will answer just about every question you’ve ever had (What form? When? How much? How often? For how long? What with?) And all the others you haven’t thought about yet!
Or want to understand the parathyroid better as well as be across some other common things missed or ‘mistaken’ as menopause? Yes? Then check out this episode
Image by Erdei Gréta via Unsplash
A Perimenopausal P.S.
It’s 2022 and I am celebrating my 50th with friends. Within just a few months of this I have left a 14 year long relationship & relocated to a new town where I know no one. Next up, I’m undertaking an 11 day solo hike across the island of Kythira in Greece and at its completion I call a meeting with my team back in Aus to say, ‘It’s over. The thing I have loved doing for so long, group mentoring, it’s a wrap.” With each and every seemingly sudden decision I made across this period, the spectrum of responses included surprise, disbelief and shock. And numerous times, I genuinely asked myself, ‘Is this a breakthrough or a breakdown?’
I’ve never experienced vasomotor symptoms, even cycle changes of any great significance, nothing that might act as some kind of signpost. So like so many other women, I wasn’t able to know it and name it, for the most part.
But this is perimenopause.
All I had was what I was experiencing: a dramatically reduced bandwidth. Not the classic irritable woman trope. Just that I couldn’t do as much without some kind of inflated cost to myself which came in a variety of forms. And when I overrode ‘new me capacity’ with ‘old me expectations’, the wheels started to wobble, especially cognitively. Scary sh*t, right? When Rhiannon and I spoke this week on perimenopause to many of you, I mentioned I dislike the term ‘brain fog’ as a description of what happens for women during this stage. It’s diminutive. Minimising. Yet the evidence of its impact is breathtakingly BIG. Almost a third of women during perimenopause cut their work hours and more than 1 in 10 consider quitting work altogether. In addition to this, suicide rates jump up by 48% in women between the ages of 45 and 54 – where for men it increases only by 1.4%. This is not just some kind of bad mood of middle age – it’s a FEMALE physiological rollercoaster.
Amongst the attendees at our event there were a few tears being shed, as several shared with me afterwards that literally it was our conversation, right here, right now, that had enabled them to see at last, their own perimenopausal picture.
Me too
It wasn’t until we were prepping for this perimenopause conversation that I literally learned my increased susceptibility to injury with exercise over the last year comes courtesy of the same bloody carnival-house-of-horrors-big-dipper mash-up. Again, thanks Rhi! And what about my cognitive concerns and what, early on, seemed like a pathological drop off in drive?? I was lucky. Without knowing what I was doing , all those big decisions I made from 50, turned out to be the right ones, in the sense that I deloaded. Which just happens to be my top rec for all women during perimenopause. Wherever and in whatever way they can – accept and better yet embrace the ‘new you capacity’. Because once I did this my cognitive concerns etc disappeared and I realised there’s nothing wrong with me just what I was asking of me… and what the world asks of women too, by the way.
Anyway, I normally wouldn’t have posted such a personal P.S but some of you shared so honestly with me, I felt anything else wouldn’t be right. A big thank you to Give Back Health for such an innovative format than enabled something more valuable to be shared. Let’s keep the conversation going.
Image by Ukrainian photographer Kateryna Hliznitsova via Unsplash
Another Immersion Into Vietnamese Cuisine🍜
Just back from my 6th…🤔 or 7th… trip to Vietnam. But this one was different – made all the more special, as I was visiting family🤗 Which meant I got to eat and enjoy things, I myself, despite being there so often, was never previously game to try mostly due to the ‘what exactly is that’ factor! Apart from being simply DELISH real-deal Vietnamese cuisine reminds me of some core health eating principles that I like to aspire to at home.
There’s always room for more Greens
We could — and should — always add more. Into the hot pot or the pho. Wrapped inside or around that crackling savoury pancake. Or simply piled high on the table for everyone to help themselves. I mean, my usual ratio of Added Greens : Actual Dish is already pretty ambitious. At home, whatever I’m eating is typically buried under rocket, baby spinach, and whatever fresh herbs I can get my hands on. The “main meal” often functions more like structural support. But the ratio in Vietnamese cuisine defies both maths and physics. A platter of greens arrives that dwarfs the original dish. Mountains of mint, Thai basil, perilla, lettuce, water spinach. You add a handful. Then another. Then another. And somehow… it all fits. Greens as far as the eye can see! Not as a garnish or an afterthought but a ‘do not pass go do not collect $200’ directive!
And growing your own is essential to feed this level of ingestion addiction
Whether it’s a small plot on an abandoned lot, a couple of polystyrene boxes on the footpath, a window box in an apartment up high – everyone tries to grow their own Greens.
Dine out on Diversity
That’s right – that’s Greens –plural. It’s a tumbling twirling ever-changing and inclusive mix! So inclusive that even non-greens, like beansprouts and long curls of finely cut banana blossom are welcomed into the fray. The mushrooms incorporated into dishes are multiple varieties rarely ‘mono’ and noodles ain’t noodles, though they may look similar, made from regular or red rice, tapioca, wheat etc. And while pork is a firm favourite amongst many, there’s all kinds including snake, eels and snails.
And if we’re going to eat the Animal – Eat every bit of it
No muscle-meat madness like most of us silly whities in the West! Prawn heads are a delicacy and of course, offal is everyday fodder, with cubes of blood common, entrails as well. Nutritionally superior, environmentally sensible. While I do a bit better each time I visit I still have a long way to go on this one!
Plant proteins accompany the animal ones
Other dishes feature tofu, peanuts, mung beans and other legumes – not as an alternative but for everyone as an add-on to any meal.
Small bowls allow endless sampling from these smorgasbords!
Yet another aspect that seems to defy physics. You eat and eat and eat your fill…but you don’t overeat! Thanks, in part, to the tiny bowls and chopsticks no doubt!
There’s a lot to love and learn from other cultures and their cuisines ❤️
Image c/o Stephy Nguyen❤️ – thanks for making me eat eel!🪱
We Each See Success Differently
Not just differently in terms of how we view other peoples’ success but also how we recognise it within ourselves, or where we perceive ourselves to be in relationship to that ‘goal’. Our ‘identifiers’ will be as unique as we are. What we’ve had modelled within our family, first & foremost, then maybe our peers and our profession. We renovate and remodel our ideas as we go, through our own experiences & evolution.
I asked AI to list the most successful naturopaths in Australia & a ‘curious’ conversation ensued...
The first list it generated crowned Amie Steel our 👑 thanks to her incredible contribution to research & academia. Next up an extremely high-profile naturopath that, no doubt, came to AI’s attention as a result of the enormous number of ads they run. Last on the list, a dragnet of names pulled from association newsletters and other media. However, not ALL associations, just ANPA and NHAA?! And nobody tell him, but Kerry didn’t make the cut 🤐
When I pointed out this omission (and several others!) the LLM always of course had an answer…
It went along the lines of, “Oh, I see the problem, you’re defining success differently”
Naturally, followed by, “I can generate a new list based on your definition” (just you watch😂)
But throughout this exchange I was force-fed clues about how ‘it’ would define success, including some brutal-truths apparently I needed to hear, such as, “Clinics alone rarely compete financially with product, IP, or corporate power.” Am I being overly-woke & it’s actually just all about the cold hard Ca$h?…I’ve seen behind the veil too many times to be fooled by that one. Attributions of success based on visible bling can blind us to the rest of the story.
I’ve sat with a LOT of naturopaths I would regard as successful.
I’ve seen their success take different shapes & forms – independent of their income
For example, 20+ years of consulting that has seen them through all the stages & phases of their family life, with the flexibility they needed. Or establishing a practice that was able to employ others, better yet, ‘bring them up’ with loads of support, informal mentoring and great modelling that can otherwise be hard to find in our profession. There are those whose love of learning & growth ensured they found all kinds of pivot points along the path – resulting in time spent in corporate, in academia, in aspects of associated industry etc. Then there’s those that started out in stella-supporting roles for others, running those desks, those dispensaries, those website dashboards like divas! – only to at last be ready to take flight and do the thing they wanted all along – be in practice. And, of course, there are amongst us some awesome entrepreneurs who might make it look like they’re living it large on 🚩Easy St, but in fact, they are themselves absolutely extraordinary powerhouses fuelled by their own sense of purpose. And these are just the conversations I had last week!
Tell me what shape and form has your success taken?
Image by Javier Esteban via Unsplash
No Please. Mansplain It To Me
Seriously, hold my beer. A pattern has come to my attention that warrants calling out. A social media manosphere of sorts. You see I have these ‘Facebook fellas’, let’s just say, who appear out of nowhere, as in, they are not people I know, not in truth even my peers, & certainly not people with academic or experiential acumen I might look up to. And they only materialise on my posts in the comments section to execute what they seem to think is their big mic drop moment. Their comments go,‘HEY! HEY YOU! YOU’VE GOT THIS ALL WRONG. I UNDERSTAND IT BETTER. LISTEN UP!’ Yes, bold & CAPSLOCK-all-intended because, while plain text doesn’t possess tone, it apparently can deliver at different decibels and comment such as these are always dialled up to DISTORTION. Well Chuck, or Chad or Hank or whatever your name is. I tell you what you clearly don’t understand…
Evidence
Science
Nutrition
Academic Discourse & Debate
let alone Basic Manners or Online Etiquette
And sorry but it has to be said….
Women’s Health Better Than Women
Because to have whatever-his-name-is tell me, and all women, for example. that if we need to use iron supplements we don’t actually understand iron and we’re doing it wrong…well…. For those of us that have spent years studying nutrition as part of our qualifications, then yet more years, if not decades, applying it in the real world, while always updating our understanding based on the very latest evidence…while perhaps even in countries affected by food insecurity and most of our lives menstruating…well we may beg to differ. But the real rockstar ‘tude is when I actually take the time to engage, offering some alternative things for them to reflect on and respond to, about physiology or pathology or the intricacies of a micronutrient’s LADME+R and their response. Well there isn’t one. So I’ve stopped taking the bait.
Because they’re not here to engage in an intelligent exchange – they are here to dominate
They don’t want to discuss – they actually want to shout you down – shut you down
And they’re certainly not here to learn…
So let me say this, if this is your MO my mansplaining FB Fellas get out of my comments and off my page….because as one of your better brothers, Bruce Lee, put it “A wise man can learn more from a foolish question than a fool can learn from a wise answer”.
By the way…these ‘FB FELLAs’ don’t actually look like this according to their profile pics…but ‘it’s the vibe of the thing’…right?!😉
Photo by Alen Kajtezovic on Unsplash
Having the Conversation💬
There was indeed food & drink & merriment galore but a good holiday season for me is about having the conversations. With family, friends, my professional peers. This is the real feast. In this strange period between one year and the next, portals appear to open up of a different space-time continuum. With the work-clock temporarily paused and screens no longer screaming for our attention, it allows many to engage more deeply, more reflectively. The conversations I’ve had the privilege to participate in & the people I’ve shared those with, are as diverse as we are & reflect something as multi-dimensional as all the ways we may find ourselves working in this space called ‘health’.
From those living life on the edge thanks to big business enterprises – to tales from the trenches of solo-practitioners
Educators impacted by institutional changes and the illusion of an ‘all-knowing’ generative AI
Pioneers of practice or prescribing models
Individuals beautifully representing us on the global stage (research) just as much as at a local level (retail)
Elders asking themselves, ‘What’s next for naturopathy?”
I listen lots & say little. It’s all grist for the mill that is my mind and I never quite know where, with all this input, my thoughts will end up. But I do know this is the nourishment I need to continue caring deeply about the profession whilst also updating my understanding of what being a nat/nut/herbalist/IM doctor means for many of you. And to reflect on my own role. As you may know, career-wise I have closed a door, to let others open. Mentoring hundreds of practitioners every year for over a decade was a great privilege. Delivering training in diagnostics and establishing frameworks for nutritional prescribing – are just some big highlights across decades of delivering education and training to all kinds of health professionals. And I am so proud of what I have produced and contributed to our collective knowledge.
Ideally, healthcare education providers shouldn’t feel like businesses at all — they should feel like institutions in formation
We have some exceptional home-grown examples around us, who are indeed institutions forming in front of our eyes. However, other aspects of the educational and mentoring landscape today are almost unrecognisable. I worry it’s being driven more by profit than purpose and is being delivered, on occasion, by those overflowing with enthusiasm but not experience. Just more food for thought. The conversations keep coming and I welcome them all.
It’s Not Me – It’s Iodine…Promise
I know you know I’ve had a very public falling out with iodine. First up, I was its biggest fan then over about a decade I became its very vocal detractor. So what happened to create such a change of heart? It’s undeniable that our dietary intake increased and simultaneously the iodine amounts in supplements, without any accounting for the former. And bingo! Bad stuff happens.
And now the NHMRC is about to lower the levels deemed safe for exactly this reason.
Yes you heard me. A full review of the Iodine NRVs is underway and while no changes to the RDIs are being proposed, they have recognised a need to reduce Iodine’s UL recommendations for almost all age groups (except young children). Why? Because the science absolutely supports it. And you know what? I say the sooner the better.
Because currently, we have crazily high iodine quantities in our prenatals in particular. With companies promoting & priding themselves on pushing their iodine content up to the maximal permissible level, providing the full RDI for pregnant or breastfeeding women.
So that presumes these women aren’t getting ANY dietary iodine so we have to supplement the lot? Despite all the most recent data even on just ‘average’ iodine intake revealing women of reproductive age consume 125-150mcg/d from the ‘average diet’ alone. Yet we’re dosing our TTC clients, the same women that are on these nutrient-dense diets we recommend during precon and pregnancy, with the another 220-300mcg/d. And we’re also assuming they have ZERO thyroid antibodies then?!
Because you would never willingly mix these high iodine exposures with pre-existing thyroid antibodies in a pregnant milieu. Right?….
So it seems like we have to have this conversation and change our prescribing practices right now, whether we want to or not. So why don’t we support each other to do that well? Dig into the science together, get all our questions answered, collaborate on new, more evidence-backed & personalised prescribing for pregnancy. We need to stop and act now to protect our professional reputation and role in preconception and pregnancy care not find ourselves to be on the wrong side of health history with supplement safety.
Cracking the Case Series: Postpartum Thyroiditis – Risks in the Rearview, Remedies & Resolution
Odds are, you see women who are trying to conceive or are already pregnant. Odds also are that their likelihood of developing postpartum thyroiditis might be higher than most, but do you always know how to spot this? And from there, how to optimally assess them moving forward to know how their static risks they started with, are responding under the influence of pregnancy and postpartum physiology. If we can be clear about this and their shifting PPT propensity, then what we have is an opportunity for effective risk mitigation. In this PPT case we take a look in the rear view at what her risks were, where we could have redressed these and now ask the question, how to treat the PPT and avert permanent hypothyroidism. This case discussion comes together with an extraordinarily helpful clinical tool summarising assessment timepoints and interpretation along with appropriate treatment with each new level of risk identified.
Join our upcoming Watch Party on Tuesday 2 December at 6pm AEDT to have all your burning questions answered. This will include a BONUS discussion regarding iodine supplementation. You can purchase Postpartum Thyroiditis – Risks in the Rearview, Remedies & Resolution here. Or the full second series of Cracking the Case, which includes this episode along with 4 other clinically relevant cases. Click here to purchase.
Cosmeceuticals the new kids on the block for nutrient delivery?
“Cosmeceutical” sits between cosmetics and pharmaceuticals and probably makes you think of serums and skincare, and of course many of these products’ ‘active agents’ are in our lane: Retinol, Biotin, Collagen, Liposomal C and herbs. However, the new kids on the Cosmeceutical block are in fact patches, creams and gels all applied to the skin but whose claims suggest they supply us with nutrients and herbs, at least intradermally, if not systemically. But this term, for those seeking good science among us, should make us shudder because it’s just a portmanteau marketing peeps came up with, it’s not a legally recognised category — and in turn it is outside of the regulation of the TGA & FSANZ.
It’s a marketing term. That’s it.
So while the claims might sound clinical — “active ingredients,” “targeted results,” “scientifically formulated” — the truth is, they don’t go through the same scrutiny as real therapeutic goods. No mandatory testing. No ingredient oversight. No required proof. And even claims they offer our patients ‘transdermal delivery’ are often unfounded and any effects are only ever skin-deep.
When we think our usual supplements and entry points into the body aren’t hitting the mark in some patients, we start to think outside the box – certainly ‘around the gut’
And of course this can make sense and a successful solution, e.g. IM B12 in the case of IF anomalies. However, if ‘getting around the gut’ means we’re prescribing products that fall into the Cosmeceutical category and are about as regulated as face glitter(!) I think there’s some weighty cautions and concerns. And can I say with all due respect…I used to think more patients were refractory than I do now.
So what changed?
The more research I read the more I had to accept that the way I had been taught to prescribe nutrients – didn’t in fact stack up with the very latest science. So I completely changed my prescribing practices…just let me know when you’re ready to learn too…
In the meantime…
Dermal Delivery – Is It Just Skin Deep?
With nutrient delivery options of patches, gels, creams and more on the rise, the promise of absorption via the skin is being sold as simple and seamless—but is it really? This episode unpacks the difficult path nutrients must take to initially enter the epidermis and then (more difficult yet) make it out the other side and to the rest of the body. Rachel identifies which essential vitamins & minerals as well as nutraceuticals, in their natural state, are ‘permitted passage’. In addition to this she describes exactly the nature and number of modifications necessary for others to circumvent the skin’s barrier function. Under the Cosmeceutical category, and subject to even less regulation than our breakfast cereal, claims of ‘transdermal delivery’ (having actions beneath & beyond the skin) are being applied to products whose effects may be strictly skin-deep.
You can purchase Dermal Delivery – Is It Just Skin Deep? 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.
This is a Love Letter♥️
To the people who make up our profession…
I’m just back from attending the opening of the Melbourne Apothecary/ Mecca collaboration in Melbourne CBD as one of Charmaine & Carly’s VIPPPs… Very Impressed Proud Privileged People
Everyone who knew I was attending wants to know the details of this extraordinary evening & describe what these women (and a TEAM of awesome individuals alongside them) have created and achieved. I can only respond with a GIF that conveys…I don’t have the words, my mind is truly blown. And it is.
This is the culmination of 2 years of their non-stop efforts. Pitching, planning, problem-solving & preparing, on a scale that most of us can not even imagine. But it’s also off the back of Charmaine’s 20+years of doing more of the same, running pioneering fertility practices in Melbourne. These guys impress the pants off me. But it’s not just them.
I’m surrounded by nats, nuts and herbalists who have collectively achieved almost anything and almost everything. Some have established food production farms, others grow medicinal herbs at scale, build apothecaries either large and small, set up annual conferences to educate their colleagues and communities, write and publish books, have launched a podcast, go work for government, set up patient programs, run ground-breaking group consults, work in research taking our great work global, open a clinic in rural and regional locations etc etc. And the new grads I’ve witnessed take their very first steps, crafting and creating their very own business branding and logo, perhaps setting up an online business. And for those of us a little more seasoned…maybe to have just kept on keeping on, to have faced barriers and re-routed, to have fallen down and got back up again…seriously…it is all impressive.
So look around and you might just fall in love all over again too. We only need to see ourselves to be inspired ♥️
That’s A Wrap!🎬
What a delightful high to finish our group mentoring programs on 🤓🤸 We know the calibre of practitioners that commit strongly to their ongoing education and upskilling. We see this in action via myriad reflections – check out just some examples of our most recent members of our alumni:
I’ve been mentoring with you for 5 years now… I’m pretty sure I was changing nappies in the first year… then I just had FOMO every year thereafter, so I would sign up AGAIN …. & AGAIN… & AGAIN!
Leanne (Groups include: New Graduates, Cracking the Case, The Nutrient Prescriber’s Program)
I have been looking to deepen my understanding of nutrient prescribing since years. Here in Austria/Germany I have a lot of orthomolecular medicine studies, but all of that was not what I was looking for. And I now found what I was looking for and I am deeply grateful.
Mariella (The Nutrient Prescriber’s Program)
I am getting ready to go in a few minutes as have a 3pm client Rachel. I am feeling a bit sad as this is the last one…I can’t say thank you enough for all my many years of mentoring – what you have taught me is beyond priceless. A thousand thank yous Rachel.
Amanda (Mentee stalwart since 2018 ;))
Having the ability to ask qs as we go through and at the end now is so valuable which is why I always take the (live) mentoring option when possible. I am hoping there will be a Watch Party for Mastercourse II at some point?
Leila (New Graduates, MasterCourse I, The Nutrient Prescriber’s Program)
I could never allow myself to miss out on the Update in Under 30. They are far too valuable.
Dagmar (Student Pathology Hub, Update in Under 30 subscriber since 2018)
We see you all and we celebrate you! And for those of you buying a little online education to sneak in a lil’ Sunday session, those sending emails starting with: “I’ve done every single thing of yours on ‘X’ and just want to check my understanding about’…. the OS practitioners that get up at sparrow’s fart to make 1:1 mentoring sessions with me etc etc etc.
Watch out for these kick-arse clinicians coming your way! Another hot batch fresh out of the RAN oven!!
Let Me Tuck You In & Tell You A Little Story…
Are you ready for your bedtime story? Ok well snuggle in close and let’s get comfy because it’s a goodun! It’s ‘The Story of Supplements’ and how the contemporary practice of nutritional medicine in most countries became supplement-centric. I’ve been thinking about this a lot. And the more I’ve been able to unpack the history of nutrition and how this literally bumped into and then overtook naturopathic practice the more apparent the things that have ‘shaped’ us became…and strap yourself in because it’s actually a rollicking sequence of events 🤓🤯
Maybe you know bits of this? Like the earliest isolation of vitamins in the early 1900s and the role the Great Depression played as a catalyst for the development of the RDAs? But that was just the start and what’s more telling is all that followed – from the 50s successful ‘micronutrient minimalism’ and making nutrition ‘a matter of state’, to the swinging 60s and Dylan’s dietary forecasting (the times were indeed a’changin’!). Beyond this was the boon of big hair in the 80s and greedy reductionism of the 90s. And yes I AM still describing pivotal periods in nutritional science that literally form our prescribing habits and preferences today!
Oh and then then the dawning 🌅 of complexity science arrives with the 2000s with all of its -omes and -omics…..and let’s face it, a lot of ‘oh sh*t’#*@^ moments as we realised the road reductionistic science has lead us down ESPECIALLY wrt something as innately holistic as nutrition and nourishment 🫣
Supplements offer us awesome opportunities as both prescribers and patients but given ALL their history they are curious bedfellows for a profession that prides ourselves on all that’s ‘natural’. But maybe that’s not you? Unattached to the original principles of nature cure and all that, you’re a more modern day supplement-slinging EBM enthusiast 💁 Ok this is still a story you need to hear and get ready for awkward 💁💁
This signals the start of a little series as part of our Update in Under 30 in which we’re going to be looking at trends and truths, innovation and illusions, rewilding of remedies versus some serious ‘wild washing’ and the ‘wild west’ that parts of this associated industry has become …but first we need to have a lil history lesson because hindsight is a wonderful thing and to understand who we are and why we do what we do today we have to unpack our yesterday 🤨
Following The Supplement Story
(The Supplement Boom Series)
This episode takes a deep dive into how we arrived at our current, often supplement-centric, approach to nutritional medicine. Reflecting on the roots of this practice and the pivotal influences—both clinical and commercial—that have shaped it over the decades. What are the implications of our growing reliance on ‘nutrition in a bottle’, even as we continue to champion ‘Food First’?
With insights into the unintended consequences of single-nutrient prescribing and prescriptions bigger than our hair in the 80’s, this episode challenges us to revisit the supplement story—past, present, and future.
You can purchase Following The Supplement Story 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.
Our Pregnant Episode Had A Baby Or 2!🐣🐣
If you listened to our latest Update in Under 30 episode on Postpartum Thyroiditis and how to implement an optimal risk assessment (before, during & after pregnancy), you’ll have been expecting this new arrival with much anticipation 🐣🤓 because the true value of accurately predicting risk, and at the earliest possible time-point only becomes realised, when we successfully avert or reduce that risk, right?!
And guess what?
The science has well and truly spoken on this one.
However, because success has only been demonstrated with nutritional & nuanced nutritional interventions at that, mainstream medicine sadly has no 👂ears👂 to hear it.
That’s right. Thyroxine, as a preventer during pregnancy or following the birth, has failed to reduce risk – so too yet more iodine…oh lord…not more iodine!! So, as is the case in many conditions where there’s no pharmaceutical fix, there’s no reason to risk assess if you’ve got nothing to offer! We’re in a very different position, with all the tools in our existing dispensary, in addition to our strong foundation in food as medicine. Accordingly here comes part 2 of our PPT – Risks…and now the Remedies and a case workup on a patient where we look at her risks in the rear-view and look ahead to remedies to resolve this condition now. Yep, we been busy this last month with 3 hatchlings🐣🐣🐣 in total and no cyclone to be seen 😶 Stay safe you all!
Postpartum Thyroiditis Risks…
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 post-partum.
Postpartum Thyroiditis …& Remedies
Accurately identifying women at an increased risk of developing postpartum thyroiditis only makes sense if we have evidence-backed means to successfully mitigate this risk. As a follow up to our recent related episode on this topic, this one is all about the remedies to implement at each level of identified risk, while also discussing how to treat both a hyperthyroid and hypothyroid phase, should the condition come to fruition. This recording comes together with an extraordinarily helpful clinical tool, a visual summary of what to assess, when along with the appropriate treatment with each new level of risk identified.
You can purchase Postpartum Thyroiditis Risks… here & Postpartum Thyroiditis …& Remedies here. If you are an Update in Under 30 Subscriber, you will find both episodes 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: Postpartum Thyroiditis: Risks in the Rearview, Remedies & Resolution
Odds are, you see women who are trying to conceive or are already pregnant. Odds also are that their likelihood of developing postpartum thyroiditis might be higher than most, but do you always know how to spot this? And from there, how to optimally assess them moving forward to know how their static risks they started with, are responding under the influence of pregnancy and postpartum physiology. If we can be clear about this and their shifting PPT propensity, then what we have is an opportunity for effective risk mitigation. In this PPT case we take a look in the rear view at what her risks were, where we could have redressed these and now ask the question, how to treat the PPT and avert permanent hypothyroidism. This case discussion comes together with an extraordinarily helpful clinical tool summarising assessment timepoints and interpretation along with appropriate treatment with each new level of risk identified.
You can purchase this Cracking the Case episode: Postpartum Thyroiditis: Risks in the Rearview, Remedies & Resolution here.
Are We Abandoning Our OGs?
‘Good v Better v Best’, is often the value statement attached to each new nutritional product innovation as it enters the market…making the existing and older forms, according to the pattern, ‘Bad’…or ‘Inactive’, certainly ‘Superseded’ etc. But changing the form of any given nutrient, simply results in changes in one or more aspects of its pharmacokinetics (liberation, absorption, distribution, metabolism, elimination), or the homeostatic response of the individual (regulation). That’s how it can produce different effects & evoke different outcomes – that’s why we say, ‘Form Determines Function’
NRC & NMN have their niche actions but can’t fulfil our needs for niacinamide: the OG of B3
LIkewise, MK7 while a boon for our bones, is MIA when it comes to the full suite of actions we require from the essential K1
& [shock horror!] Magnesium oxide & sulphate both continue to constitute ‘the form that fits best’ in a number of applications
And when it comes to the options we have on offer for Vitamin D, sunlight [the OG of all OGs 😎] Cholecalciferol, Calcifediol & Calcitriol, there is a ‘prescription pocket’ each one occupies. Every one a different tool for a slightly different job: ‘all wrenches but for differently sized bolts’. But do you always know, ‘Which form when?’
Vitamin D Decisions – Which Form Fits Best
Every prescription is the culmination of numerous individual decisions we have made, from choice of form to different aspects of dosing and sometimes this happens understandably on autopilot. We all have ‘favourite forms’ and ‘familiar formulations’, but it is important to remember that every decision we make is an active one that can make a difference to overall outcomes. In this episode we dig into the decision-making process regarding Vitamin D forms to ensure we know how to answer the question: Which Form When?
You can purchase Vitamin D Decisions – Which Form Fits Best here. If you are an Update in Under 30 Subscriber, you will find it 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.