I’ve just finished laughing along to yet another comedy routine making fun of the current gen’s ‘obsession with water’. This comedian was nostalgic for the old days when, every week or so, we’d just ‘wet our tongue on a water fountain’ and that was our dehydration sorted! And while I laughed along and I am against the trend of fashion accessories masquerading as expensive water bottles right now …on that note though for a laugh, please do yourself a favour and watch Will Anderson’s take on this!!But here’s what is being missed in it all…
If you’ve studied nutrition anytime in the last century you would have been taught that 20% of our fluids comes from our food. Am I right? Remember all those calculations you had to do with dietary intake records etc? You’re welcome lol
But that was then and this is now. And UPF now make up a much MUCH larger piece of most people’s dietary pie (pardon the obvious pun!) and especially the younger generations. So what might this mean in terms of water intake?
An increased overall need for water due to excessive Sodium – the oldest & most potent dietary diuretic we know! Together with less actual fluid in our food
All up, according to some scribbly ‘back of the envelope calculations’, that could mean that those of us eating the most processed diets will in fact need approximately an extra 800ml!!! Yep. Deviation from expected fluid provision from our food = 300 mL + Increased requirements due to Sodium running rough-shot = 500 mL → ≈800 mL/day extra. So, put that in your designer water accessory and suck on it!
No really…please do I’m part mumma and half water-hog and I worry about everyone’s hydration!!!
Water & Our Kidneys – Helping or Harassing?
It seems almost farcical to question the merits of hydration for our renal health but is this actually the truism we have been lead to believe? Where does the recommendation of ‘8 glasses a day’ come from and what is the level of evidence to support it and in whom? Or should we in fact be setting our sights on output ie. 24 hr urinary volume, over input. Do all kidneys love water – or does this relationship change with the progressive impairment seen in CKD which affects up to 30% of our middle-aged population? When does hydration become harassment?
You can purchase Water & Our Kidneys – Helping or Harassing? here. If you are an Update in Under 30 Subscriber, you will this episode 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 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.
Last week I had the pleasure & privilege of spending time with REAL practitioners discussing a REAL case & being part of a REAL discussion and a REAL exchange of all our ideas & experiences. I know, how quaint! Because unlike the AI apps we’re all increasingly interacting with, we’re clinicians and we take theory from the safe confines of ‘science’ and test-run it in the real world: dealing with patients, pathology, products alike, everyday. As a result, as is so often the case, the ultimate gifts came from our interactive Q & A and chatbox, in the form of our opportunity for genuine exchange of ideas & experiences.
Comparing real world costs for pay out of pocket providers of Lp(a) labs (& a hot tip on those not charging at all!)
All the tentacle topics that extend out octopus style from one presentation or pathology marker: ‘While we’re here what should ferritin be for lowest CVD risk in women?”
Cross-referencing with other content from other education sources – putting it out there for everyone to benefit from -“Now I know why they assess Lp(a) in chronic UTI presentations!”
Genuine unfettered product suggestions, reviews & even whispers about new ones allegedly in the pipeline.
With information overload at all of our fingertips, what we need most right now is something else. Real cases rather than random facts (& factoids). Thoughtful application of ideas instead of AI slop. An opportunity for debate and discussion based on real world clinical encounters rather than just duelling between our respective LLM VAs…is this sounding familiar?
Because fountains of facts at our fingertips doesn’t actually increase our knowledge effectively…We need to go retro and get real!
Because, if you ever want to truly check you understand something correctly – AI is not the place. Not even for the theory be warned!!! Intentionally designed to ‘people-please’ to ensure you pick ‘IT’ and stay engaged, always…I mean come on…the premise that ‘the customer is always right’ is a dangerous one in this context, right?! In fact, this latest study describes how overwhelmingly sycophantic LLM are. “Sycophancy essentially means that the model trusts the user to say correct things,” says Jasper Dekoninck, a data science PhD student at the Swiss Federal Institute of Technology in Zurich. “Knowing that these models are sycophantic makes me very wary whenever I give them some problem,” he adds. “I always double-check everything that they write.” IYKYK!
“What an excellent insight and nuanced perspective!” it tells me on the regular…sheesh easy way to boost my ego and dangerously lead us all on our march towards the death of facts, science, objective knowledge…
So we are ALL apparently right. You are when you ask, but your patients are too…even when they and we are not!
Cracking the Case Series: 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 Uncovering Cardiovascular Risk: Elevated Lipoprotein (a) here. Or purchase the full second series of Cracking the Case, which includes this episode along with 4 other clinically relevant cases. Click here to purchase.
Orodispersible nutritional medicines are a colourful crew (buccal sprays, ‘melts’, lozenges, gummies galore) with mixed agendas: tasty (patient preferences & increased access); topical (therapeutic agents for the oral cavity itself) and transmucosal (a shortcut for nutrients into systemic circulation). And across the board their popularity is on the rise among complementary medicine consumers. Simultaneously, pressure continues to build for companies to carve out points of difference from their competitors’ products which all contain, let’s face it, the same ol’ nutritional ingredients…any new vitamins or minerals come your way of late? Right?!
One increasingly employed option is to ‘deliver them differently’ – whether that’s via the skin, across the inside of your cheek, under the tongue or offering an explosion in your mouth!
But in terms of how this actually impacts their actions, applications and efficacy – are you across these? Does the science stack up for some of the nut med newbies like GSH buccal spray? And are our old & gold offerings like sublingual B12 still secure in their superiority? I’ve done a deep dive on them all, assessing each on its own merits and I was surprised by what I found out!
This is the fifth episode in our Supplement Boom Series. A series that finally takes the time to reflect on the R & D space within comp meds and nutritional medicine, especially.
I’ve been racing to keep pace with all the new product offerings so that we can confidently prescribe in response to science not a hard sell. I’ve been investigating the new shapes and forms our supplements are taking especially as a response to the rapidly changing commercial landscape within which are some seismic shifts in customer values. Isn’t that us? As prescribers & experts in nutrition you might think that but we’re small fry in this equation – the biggest piece of that pie is the public – the end-stage consumers… And given the almost universal appeal of any option that suggests speed…So ‘rapidly dissolving’ is inferred and heard as, rapidly repleting’ by the lay person. But is it?
Melt-in-the-Mouth Medicine – Pros, Cons & Clinical Pearls
Orodispersible nutritional medicines have burst onto the scene in all shapes, flavours, and ambitions. In Melt-in-the-Mouth Medicines – Pros, Cons & Clinical Pearls, we unravel the three main subtypes—those designed to be tasty, topical, or truly transmucosal—and ask whether each actually delivers on its promises. From clever convenience to questionable claims, we explore the science (and sales spin) behind this rapidly growing delivery format, and share key clinical insights to help you discern when these fast-dissolving formulations offer genuine therapeutic gains—and when they might just leave a bad taste.
You can purchase Melt-in-the-Mouth Medicine – Pros, Cons & Clinical Pearls 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.
I keep rescue chooks from battery farms & recently two have been quite sick – so I sought the advice of the all-knowing & all-round extraordinary Mother Clucker who heads up this organisation. Up and down the highway I went, to their chook HQ & quasi-hospital. Every time I returned with more vials of powders, pills, emulsions, tubing to get the goods into their guts directly, stern instructions about the need to separate them out, both from the flock & each other (one is currently housed in a half wine barrel!), monitor how much water they’re consuming, observe their poos, palpate some part of chook anatomy called a crop (I had to google it) & be ready to report back every detail… and tbh my brain blanketed with post-it notes. But I also left each time inspired, incredibly motivated by the all-knowing Mother Clucker, committed to doing the best for my little ex-battery battlers.
But the execution…ai y iyi! It’s a full-time job…on top of my full-time job. And only one of these feeds me because my gals are all living out their best retirement at my place. Oh, and then there’s my other pets, my plants, my domestics & gosh I really do need to fit in sleep at some stage! I wanted to scream, ‘Hey Mother-Clucker! Chook-care is not the only thing I got going on over here!!’ Inevitably I falter then fail & then am riddled with remorse about it. Another visit…another injection of information overload, I come home re-committed & the cycle starts again.
But suddenly it dawned on me that this is perhaps how some of my patients felt in the past
So, let me ask you, who are you as a clinician now compared to who you were when you first graduated? After you’d been out in practice a while? Or even more recently than that, say, before the ‘big P’ changed all our practice realities? I was a boss lady.
My big asks of everyone, my patients, my colleagues & certainly myself, came from a good place, of course. I was a fountain of knowledge, capable of ‘fixing’ them, if they took my advice, all my advice, on board.
Often of course, just like me, they failed & then (worse yet) felt bad about themselves. They imagined themselves to be at fault, but I was. I was asking too much. Overloading them with info, expecting they had a truly remarkable capacity for change, beyond what behavioural science suggests is likely and that nothing else in their lives would get in the way of this prescription. As a clinician some lessons are giant quantum leaps, but many are more like microdosing, it takes a long time of incremental insights but only after you’ve hit some threshold do you make the change and for me this was one of those.
But once you learn this lesson: the need to meet our patients where they are, individualise treatment to their readiness for change, co-create the prescription with them so they are already increasing the odds of its success, etc. Well, you’ll never be so hard on any human (including yourself) hopefully ever again.
Compliance Changers – Strategies for Success
At the end of an information & insight heavy appointment, formulating a list of products and doses for our patients to take can feel like a bit of a ‘tada moment’, like a magician pulling a rabbit out of the hat. “Here is the solution – now off you go!” Research tells us, however, that treatment-plans that are a co-creation between you and your patient – evolving from a discussion that not only allows them a voice, but a major role in the decision making – are far more likely to succeed. While we are the authority on our medicines, our patients are the authority on what makes them tick & what’s likely to succeed, in terms of taste, texture, temperature & timing! This is called Patient Centred Prescribing and together with some other tips tricks and hacks I share with you in this episode, can really increase patient buy-in, compliance and therefore bring your treatment plan to fruition and fulfilment!
You can purchase Compliance Changers – Strategies for Success here. If you are an Update in Under 30 Subscriber, you will find this 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 should have known. Right after I wrote my most recent blog on two essential updates in adolescent health – HealthEd released a podcast on Spotting Eating Disorder Red Flags in Children that lit my brain up like a pinball machine! Because I know for many it’s hard to access things on HealthEd given you do need to register and registration is somewhat restricted, I was trying so hard to sit on my hands BUT this 45min discussion with Michelle Boyd, a general paediatrician but specialist in this area, was sooooooo overflowing with really nuanced practice-changing information (potentially equalling life changing info for those individuals affected)…well, I just could not stay quiet 🤐 So while only listening to the whole episode yourself will do it justice…here are some critical concepts in the interim.
The number of children admitted to Australian children’s hospitals for eating disorders doubled in one year (2020-2021)
We all meticulously measure growth in young children – Why stop during such a critical growth stage such as adolescence & what do we miss if we do?
Any weight loss during this period is a red flag – and should be approached with a non-judgemental open curiosity What’s new? What’s changed?How does this feel?
Many screening tools for eating disorders used in adults are too blunt for this age-group and will undo your open & curious approach – use the Children’s Eating Attitude Test (ChEAT) instead & only administer the EDEQ to better understand the severity, if an eating disorder is confirmed.
Don’t leave this differential til last – thinking you’ll investigate every other possible explanation first, e.g. functional or organic GIT dx etc – this is a dangerous practice.
Dr. Boyd’s approach and advice to other health practitioners about how to keep EDs high up in your differentials while continuing to practice due diligence in your work up, is to flag it directly with the individual and their family, something along the lines of: “I am worried there’s an element of an eating disorder that underpins this, that’s really important for us to better understand and address for us to make the fastest improvements on how you feel”
I have a voracious and varied appetite for medical research but two things came up recently that I thought I just had to share:
Energy Drinks Increase Suicide Risk
Under the heading of, ‘New Red Flag for Mental Health’ Medscape reported on a meta-analysis involving 1.5 million participants, aged 15-48yrs, associating intake of energy drinks with substantial increases in both suicidal thoughts and actions. An increased risk was present even with irregular intake, such as once a month (still 37% higher). However, the most regular consumers, drinking energy drinks most days, demonstrated an almost 300% increase! In stark contrast, heavy coffee consumers (2 cups or more per day) were protected….Hmmmm I kinda had to question at this point whether they had adequately accounted for age as a variable. Because let’s face it, sadly these drinks and these types of feelings and thoughts of self-harm go together with the adolescent age and stage, much more so than any other.
So perhaps the contrast between the two beverage consumption patterns might be somewhat overstated in this study but this is not the first piece of research finding fault with energy drinks and our kids’ mental health – several large studies in different countries have raised the alarm before.
In an attempt to explain the difference, several theories have been put forward, including that it could be the combination of ingredients in energy drinks, especially the high sugar content, that specifically produce the perfect storm. Alternatively, however, as energy drinks typically contain anywhere between 75 to 300 mg per beverage and are usually consumed in much larger quantities than coffee, as a result of their intense sweetness – perhaps caffeine (not anything else in the energy drinks) is the only issue and this is just the result of extreme excess. Whatever the real reason, the important editorial note here is that specifically asking about energy drink intake should form part of our mental health screens in all individuals. Duly noted!
Next up… the incredible overlap in presenting features & yet missed opp for Ax of OSA(S) in kids attracting ADHD labels
So…every individual child flagged for ADHD should in fact undergo ‘at least one comprehensive in-house (not at home!) sleep study’ according to paediatric experts, because it could be the real reason behind these attention issues or is certainly making them worse and at-home assessments are notoriously unreliable in this age group. The trick is we’re not getting our usual triggers for referral because OSAS in kids and adolescents occurs outside of usual risk profiles and red flags in adults – it’s not necessarily linked to obesity nor snoring – though they note that if a child or adolescent exhibits, ‘ sleep talking, sleepwalking, sleep paralysis, and nightmares’ this in fact can be suggestive of OSAS. This article also speaks to the incredibly high rate of OSA in individual with Down’s Syndrome (>50%) I was today years old and a little late to this learning!
CPAP is not the solution in kids and with management of OSA in general becoming far more innovative – recognising and remedy-ing this could have enormous benefits for that individual, their health and their sense of self, for the rest of their lives.
“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.
Have you been tempted to prescribe nutrients in a cream in patients who aren’t responding to oral treatments? Or perhaps you’ve had patients come in all ‘patched’ already! Either way it seems like now is a great time for us to revisit the topics of skin anatomy, physiology and specifically its absorptive capacity.
As a get around for orally-intolerant patients, the skin, our ultimate barrier is a surprise suggestion…but we’d be wrong to view it as impenetrable.
Thankfully, there are clear criteria that must be met for anything (nutrient, nutraceutical, herb, drug, hormone, neurotransmitter etc etc) to be permitted passage. ..at least into the skin. Getting through all the cells of the dermis and then out the other side to the circulation to boost blood levels and produce actions elsewhere?… Well that’s akin to a backwards triple pike off the high platform! So which nutrients naturally make sense as topical or intradermal agents of change, great for a range of dermatological presentations ?
And which, either in their natural state, or with the assistance of cutting edge dermatological technologies, offer us truly transdermal treatments?
Where nutritional medicine trends take us – we must follow! So come with me and get confident when nutrients delivered via the skin are indeed viable 🐾
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.
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.
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 ♥️
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!!
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.
Most of you reading this are either currently trying to run a business or have given that a red hot crack in the past- it’s full of challenges isn’t it? In most cases, the bulk of the hard work that has to happen to keep the doors open, is the stuff ‘unseen’ by others.
It’s the ‘non-billable’ hours It’s the mountains of ‘administrivia’ It’s all the favours and things you share for free stuff, because that’s just how you roll It’s the millions of little things that it’s quicker for you to do than explain to someone else so you can delegate It’s the fact that because it’s your business you think about it always, work on it on your weekends, never truly take time-out
And the money you make today doesn’t reflect your labour today but all your efforts over all the years, from when you first undertook your training to every bit of money and time you’ve invested into it since. Me too. #passiveincomeisamythI am so proud & feel so privileged to have built this business, employed the people I have (mostly naturopaths), and guided the hard work we’ve collectively put in to produce all our training and educational offerings, over all these years. I chose this path, of really investing in people, and being indulgent with my own time to research things until I knew they were right. Work and rework all our teaching tools, until I was certain that they really were the best way to, ‘tell the story and make it stick’. It has been my choice not to take short-cuts and find ‘cheats’ to increase our bottom line. And if I had my time over I would do just the same because of all the incredibly amazingly awesome people in our profession who constantly remind me (just spontaneously 🤗), why I do what I do.
There are so many passionate, incredibly motivated, ethical practitioners in our profession that it honestly, gives me goosebumps & keeps me going
And often it’s these same people who alert me to the ‘ugly’. They tell me about a range of transgressions and sometimes those are against me and my business. Like sharing log-in details for a product you purchased for individual-use only. Yep, I routinely receive tip-offs from individuals working in all different domains: academia, retail, large companies providing products & services, multi-practitioner practices. Sharing your log-in details for training is as old as the hills, but the impact of this act is not quite on par with putting something exotic on the self-checkout scale & indicating it’s onions. I am not a multi-national. For almost 20 years I’ve actually never had a salary or paid sick leave. Education is not the icing on my income… it is our whole team’s ‘everything’.
There are way more good people in our profession than there are others. But for those outliers – please – business owner to business owner – think about your actions and how your business would fare in the face of people not paying what you are owed
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.
Paediatricians repeat this adage often. It acts as an important reminder about adjusting dose for children’s reduced weights. But that’s only the start of, what is, an almost entirely different solar system we need to immerse ourselves in. Diagnosis is different too. Because children demonstrate physiological responses and regulatory systems not seen in others. They’ve got a whole different rulebook they’re playing by & you need to know it. Then there’s the absence of the first-person narrative in infancy. And once verbal, definitive symptoms are scarce, instead the ubiquitous and ambiguous ‘sore tummy’. What can the child tell you themselves and accurately? All together these lead to a much greater reliance on the practitioner’s astute observation of signs. And what about paediatric pathology interpretation? – An entirely different beast!
That’s if there’s to be any blood🩸spilt at all.
Name a parent that wants to put their child through any pain, worry, stress or angst that isn’t entirely necessary. Correct. As a result, results themselves are actually hard to come by. Health professionals too are often averse to recommending testing unless absolutely necessary, instead they’re performed opportunistically – the child’s in hospital for something else; “Let’s take a look at some labs”, they say. That’s how we often end up finding out about things. That’s how this family, that we discuss in our Cracking the Case session, found out their youngest had anaemia. Which triggered a test in the older seriously-fatigued sibling and *bingo* we then knew one more thing they both had in common!
But in spite of us doing this baby-thing blind most of the time. As in, we test everything while they’re inside ‘the temple’ while pregnant, and then once they’re out we’re winging it! Iron issues and anaemia are actually uncommon.
You heard me. Contrary to popular perception, babies are born with a whopping iron surplus and are built to build blood. Which is only trumped by the need to survive infections. And yes the clever among you recognise that the two do have conflicting iron agendas! So when we know a child actually is anaemic we should be all-ears and alert to all contributing causes (yes, plural). Beige baby foods have been the mainstay instead of ‘premasticated everything’, in so-called developed countries, ever since the agricultural revolution. Under-consuming iron is the norm in pre-schoolers and yet anaemia is uncommon. So diet alone is unlikely to be the full explanation…look again. We have had the great privilege to present two such cases that have everything to teach us about how to listen to these stories and look at the labs through the very distinct lens of paediatrics – not only in terms of iron studies and FBEs but white cell differentials and more.
Because our babes’ blood is precious, accurate interpretation is essential. But how to read non-fasting collections? Oh yes kids keep it really real!
And how do we manage without repetition of the labs for monitoring their response to treatment? Which understandably seems excessive to mum, especially when ‘they seem better now’.
Well come along and find out…
A Pair of Paediatric Anaemias
Two young siblings both present with anaemia. With the same parents, similar birth stories, breastfeeding pattern, same introduction of solids and ongoing food patterns, can we assume that the underpinning cause is the same? And like all young kids everywhere, do they just need ‘more iron’? While we’re led to believe ‘iron issues’ are simply ‘par for the course’ in infants & preschoolers, rates of anaemia in countries such as Australia in this age group are actually <5%. Therefore instead, we should view any anaemia presentation, and more broadly, every ‘iron issue’, as a call to action to identify all the causes & contributions unique to the individual.
The work-up of each sibling, which includes a checklist of 6, often unseen, factors that drive iron deficiency in kids, reveals what the children do have in common and what sets each apart and in turn identifies differences in the course of action that should follow.
Along the way you are offered an opportunity to review in detail your knowledge of iron homeostasis and how to read pathology results from this informed place, as well as learn something new about this mineral’s unique regulation at every age & stage of childhood. This recording comes with a separate clinical tool which creates a framework for understanding all the real reasons behind iron deficiency in other paediatric patients in your practice. It is a bumper offering, with bonuses galore!
You can purchase this Cracking the Case episode: A Pair of Paediatric Anaemias: Forecasting & Fixing Iron Issues here.
In yet another timely reminder that information alone does not produce behaviour change – Exhibit A – myself. The unspoken beauty of living in the Byron shire is that when any festivals come to town so too does the flu & to the entire community, whether you attended it or not. And it’s reliably never a middle of the road virus, with its bacterial back-up band, but something that wandered in from the set of Mad Max Beyond Thunderdome (my personal fave in the series). But I had already forgotten the Easter Bluesfest and mistakenly thought it a grand idea to get out and about for a boogie amongst all kinds of festival-folk!
When I got the first little clues I responded from an informed ‘information-centric’ place
And all my training, my knowledge, my years of clinical experience, took the shape of supplements and potions and teas and lotions
I threw absolutely everything at it
…except rest.
I couldn’t stop I had delivery deadlines, I told myself and my team. “I’ll just push through these presentations,” I croaked. Increasingly aware I had definitely undone the efforts of my own immune system and that this was madness, I told myself, ‘I’ll rest just as soon as I can’. Then two days of complete collapse. Rest repair recovery. I wake up on the other side and know absolutely that order has been restored. I’ve finally given my immunity and this recovery process what nothing in a bottle ever could: Convalescence. I want to sing it from the rafters! I am in first year naturopathy all over again, enlightened, inspired, evangelical even (I know we were annoying).
And I feel amazing 🌟 The sun has come out again 🌈
Both metaphorically mentally but literally too
and there’s this light lovely breeze, perfect for airing rooms and doing washing, lots of it, and brush-cutting and…
I kid you not…I have learned nothing…🤐
When will I ever transfer the incredible therapeutic value of convalescence into my long-term memory?!🙄 Anyone else?
