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 🤗
Anyone else? Or should that be…’Everyone else?‘ 🙄Because if I had a dollar for every cracking encounter I’ve had with people that included this line, I wouldn’t be writing this line – so too, if I’d been persuaded by the push-back against this lovely little legume. It just happened again the other night, out to dinner with relatives. But my all-time favourite Soy Scream Scene was when I was invited to meet a ‘wellness celebrity’. We caught up in a cafe & when I ordered my beverage of choice, she just about leapt across the table (entirely unnecessary given her elevated volume) to shout, “I can’t believe you drink soy?!” I think she felt it was her civic duty that the entire balcony benefitted from her wisdom – or at least just a way to ensure more individuals had clocked her presence 😎
And these encounters, of course,are not limited to those without qualifications.
That’s not to say that I expect, or ever desire, those of us that do to be unified on all issues. That sounds far from ideal. We’re free thinkers after all and each of us has been privy to different information & our own experiences. Me siding with soy (& not in all individuals or instances ofc!) is both personal and professional. On the n=1 front, I was 18, living my best life in Byron Bay (which often did not include shoes) when I was introduced to soy milk in lieu of cow’s. I loved it. Never having been a big fan of the old moo juice and less & less as a teenager, I preferred the taste, the texture, the principle. I was a vego. (Side-note: ‘plant-based’ was not invented until long after the 80s!) So, I also got right into plant proteins – namely tofu & tempeh. Miso was our main go-to as a way to add flavour to our cooking, even lacquering toast with it as a tasty spread! Ahhhh my glory days & mine were swimming in soy!
Go forward a few years &, having readjusted to the rigors of footwear, I am sitting in a lecture room listening to my herbal medicine teacher talking us through the chemical structure, physiological functions & potential applications of isoflavones.
I have a vivid visual memory of the whiteboard and her words. These were none of the reasons I loved this legume but I was enthralled by the revelation about its potential role as a health intervention. I still am. Because despite the sequential Soy Scream Scenes that have punctuated my life – I think the body of evidence demonstrating its beneficial effects is too large to ignore and why would we? Either it’s because of evidence that is well out of date (feeding babies infant formula made from soy flour!), a hypothetical that has since been disproven (clinically meaningful goitrogen) or mis and dis information. But look I get it! Check out soy’s wrap sheet – it’s not for the faint (food) hearted !
Potentially allergenic, as well as interacting with our immune cells in other myriad ways!
Agriculturally it’s one of the biggest mono-crops & a major contributor to deforestation, heavy on the pesticides, and often GMO
So, if we were cops profiling for potential culprits in a case of: farting, digestive discomfort, unexplained nutritional deficiencies, hypothyroidism, immune issues, food allergy, reproductive disorders or gout – certainly bring the guy in for questioning! (among a LONG list of other food and also non-food items included in the line-up!) And ensure you’ve read the research & understood all of the evidence enough to know what is plausible (theoretical but without in vivo real world confirmation), possible (it has been shown to happen but not commonly) & probable (it’s deserving of its place on your list of differentials but is still just a suspect, not a certainty). If all this sounds sizeable (and it is) then get the cheat notes. We just recorded an Update in Under 30 episode on the very latest evidence for SIFs in perimenopause including an update on adverse effects 🤓
Oh & if you’re qualified in nutrition I don’t need to tell you to choose: locally grown, organic, non GMO, whole forms, which you ferment frequently & include as part of a balanced diet, right? But is that any different from your advice generally about good eating principles? 🙄
Image by Alexander Krivitskiy via Unsplash
Soy’s Second Act in Perimenopauseexplores how one of nutrition’s most debated foods has moved from early promise, through backlash, into a far more nuanced clinical role. This episode unpacks receptor selectivity, equol, bone preservation, vasomotor symptoms, and why SERMS such as isoflavones may matter most during a phase defined by instability. This is a fresh look at where soy genuinely earns its place in modern peri/menopause care.
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 🤗🤓
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 causedby 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!
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
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
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
I certainly pride myself on possessing an impressive level of endurance for an argument, as most of you surely know 😊 But the record for this is held by all practitioners of nutritional medicine. Because we’ve actually been debating the same 3 facets of what makes a good iron form since the late 1800s!🤯 Inorganic vs organic, soluble vs insoluble and ferrous vs ferric state! And for those playing along at home, I heard that & I have to tell you your ideas about iron have passed their ‘best before’!
Even the idea that these 3 aspects are central to the success of any oral iron supplement. Wrong. You’re welcome 🙂
Because this ignores all that we’ve learned (and had to unlearn) of late about iron digestion, absorption& regulation. And I would know! Eight years ago I released an episode, the ‘definitive’ download called, ‘So You Think You Know The Best Iron Supplement’. Recently, I re-listened to it like this 🙉 thinking it too might be past its use-by. But you know what? It isn’t. I was right about the lack of difference in overall efficacy between bisglycinate, citrate, gluconate, [insert any non-haem chelate or salt] & even sulphate forms! But that was then and this is POW! 💥
That’s the sound that’s made as yet another new supplement hits the market & throws us all into the ropes of the boxing ring 🥊 Leaving us scrambling to keep up, catch up & keep our heads off the canvas with all the new must knows!
Which now includes knowing all the important stuff about every new iron option…and there are a lot! From patches to (nano)particles, the resurgence of rewilded ‘herbal’ iron tonics, pea and other plant ferritins and of course organ meats and so SO much more. These new preparations are wildly different. Not only as a reflection of different product preferences, as an extension of our principles and prescribing philosophy but the very way they behave in our digestive tracts and beyond is not the same. And accordingly, each form arguably a particular ‘fit’ for a certain clinical context. So, are you absolutely clear about which form of iron when? Best you go check your ‘best befores’ on your beliefs about iron supplements….I’ll wait 😉
Image by Melpo Tsiliaki via Unsplash
Iron – Primal Nutrient to Primetime Prescription
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.
To do this properly, 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.
You can purchase Iron: Primal Nutrient to Primetime Prescription 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.
Did you know that any supplement that ‘identifies as a food’ is subject to the same regulations as a sugary breakfast cereal? Yep. So in spite of 30% sugar content – the packaging and all advertising around said cereal, claims it’s a great source of…
PROTEIN Bs IRON
!
It’s a pretty low bar right?! Same same for ‘Superfood’ based supplements. Whether that’s freeze dried vegetable powder, whose marketing suggests it substitutes for ‘X serves of greens a day’, when in fact it provides the equivalent of less than 1/2 cup of kale, or ‘Oceanic sources of Magnesium’, which is actually Mg hydroxide – the oldest laxative around, or absolutely any of the offal offerings on the market right now – the scope for what you can say about your supplement is outrageously broad. Oh and you don’t need any independent analysis of its actual nutritional composition. And even if you did spend the money to have this performed (which is the case for only 1/8 of these offal offering companies we contacted in Australia) – you don’t need to declare what’s actually in there – outside of those mandated in food: kj, macros, sodium. Because you identify as a food! In addition to this, label warnings are not necessary and the so-called ‘RDIs’ applied are generally lower than our actual requirements – certainly as women, let alone pregnant or breastfeeding – but in spite of this you can state absolutes like, ‘This supplement provides 100% of the RDI’! Even when it doesn’t for the key demographic you’re marketing to! Oh and where were you made? Same place as the sugary cereal. A factory that specialises in UPF production!
Sounds a lot different from our regular heavily regulated supplements right?
But chances are even us trained professionals have fallen for ‘comparing the pair’ – based on what’s stated on their label and in their marketing.
Let alone the poor confused consumers!!
Now of course Offal is so ‘in’ right now because of its word association with: ‘Wild’, ‘Ancestral’, ‘Primal’. All mega marketing levers currently employed for crushing the competition. But has anyone really thought the offal offerings through, based on everything I’ve just outlined? And like most ‘Superfood Supplements’ you’d be streets ahead (nutritionally, economically, environmentally) if you just ate it. I mean have you done the maths on 3g of liver or spleen? Do you know what its food equivalent actually is?
No??? Banh mi peeps!🙄 I mean do yourselves a Foie gras and the Morcilla maths!!!
Yes it’s time we had a talk about our Offal Obsession and all so-called ‘Superfood’ supps…so if you just follow me🚶♂️ 👣
Offal Obsessions & Superfood Supps – Rewilded or Just Wild?
In pursuit of prescriptions that better align with our philosophy and principles, product development that implies a ‘rewilding’ of our remedies is appealing to many practitioners. And our motto of ‘food first’ appears to marry nicely with the increasing options for easily ingesting medicinal foods (algae, offal, ‘supergreens’, berries), in the form of capsules, pleasant-tasting powders etc. However, what’s often not understood when selecting these kinds of supplements are all the other things we’re agreeing to, which are implicit to all supplements ‘identifying as a food’ rather than a medicine. This is the third episode in our Supplement Boom series, where we get real about what ‘Superfoods’ and our current Offal Obsession are truly offering us and the key concerns and cautions.
You can purchase Offal Obsessions & Superfood Suppshere. 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.
I can guess when you graduated from your training to be a nat/nut/IM GP just by how you complete this sentence, ‘In student clinic my supplementing style would’ve been best described as…’
a) Lots of lecithin, Brewer’s yeast, some rosehip based Vit C with bioflavonoids b) Every patient pretty much got some P.P.M.P. alternating with P.C.I.P. c) Chelates of every kind – Fe, Mg, Zn d) Activated everything – absolutely everything must be methylated & every mineral is best served as a citrate or bisglycinate e) Nanoparticles, Liposomes, Intermediate hormones (calcifediol) f) Offal capsules? Oyster Zinc, anyone?
What have I missed? We gotta laugh, right 😂. This is not unique to us, of course, we could play the same game with the prescribing practices in any health profession. It’s par for the course when R underpins D (in R&D). It’s also a reminder that we’re mere mortals, subject to overwhelm when faced with a tsunami of treatment options and the meteoric rise of marketing claims about the superiority of every single new supplement to hit the market. But like every open market, the progression of product development has been shaped by trends as much as by truths. There has been some inspiring innovation and some very impacting illusions of that, along the way.
So, do you know how to distinguish between the two?
The latest Update in Under 30 episode is the second in our ‘Supplement Boom’ series and it’s all about better equipping us to be able to do just that. Along the way, I describe the current fork in the road we’re faced with when it comes to styles of supplements – on one side is an attempt to return to our ‘food-as-medicine’ roots with more food-like-forms of nutrients, and on the other, increased adoption of knowledge & developments from the pharmaceutical industry for greater medicalisation of our supplements. We’re so fortunate this fork in the road doesn’t force us into only one. We can reap the benefits of both, pick and choose the product paradigm that is the best fit for each patient and presentation, even create in the one prescription the perfect combination of the two.
But on both ‘sides’ of the supplement styles (‘pure as snow’ v ‘potent as f*ck’😯)
There’s a real mixed bag of innovation and illusion buried under an enormous amount of BS, bravado and spin
We need to have a system for supplement sleuthing that helps us to quickly see through the spin. Look no further…
The Supplement Boom Series: Innovation or Illusion
When every new supplement claims to be superior — “Best bioavailability!”, “Enhanced tissue delivery!”, “Optimally active!” — it’s hard to keep up, let alone cut through the noise. Some novel nutrient forms and delivery systems represent genuine scientific progress. Others? Just the illusion of it. Right now, we’re standing at a fork in the road: one path pushes us toward more food-like, nature-inspired forms & formulations; the other embraces high-tech innovations borrowed from pharma. Both offer real breakthroughs — and their fair share of smoke and mirrors. So how do you tell the difference? That’s exactly what I’m about to unpack…this is going to get juicy!
You can purchase Innovation or Illusionhere. 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.
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.
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.
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.
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.
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 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.
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.
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.
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.
‘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 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.
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.
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.
