Unpacking Nutrition Myths, & Supplement Dogma & Nutrient Nuance with Rachel Arthur
We had the pleasure of chatting with Rachel Arthur to unpack how nutrition dogma forms in naturopathic training and practice, why “more is better” thinking persists, and how marketing and practitioner insecurity can drive reflexive prescribing. Rachel challenges the common habit of blanket B-complex prescribing and how nutrient actions are regulated, relational, and rarely isolated.
We also explore reassurance as a clinical tool, the “medicine beyond the bottle” (language, hope, and expectancies), humility in the face of complexity (including microbiome effects of supplements), and nuanced examples like timing calcium to manage PTH and support bone health, plus common misreads of iron studies in shared care.
CONNECT WITH RACHEL:
The Supplement Boom Series which Rachel mentioned. Explore the history of nutritional science. Rachel has gifted Nuanced Nats listeners with 10% off when you enter the code NNSuppBoom at checkout!
If you’re looking to dip your toe into all this nutritional nuance, start with Following the Supplement Story here.
And if you’re a curious, open-minded practitioner craving nuanced, complex and thoughtful discussion, join us in Rachel’s Curious Minds Club
TIMESTAMPS
00:00 Welcome and Guest Intro
05:28 Dogma in Naturopathy
09:36 B Vitamins Prescribing Myth
13:51 Insecurity and Overprescribing
16:09 More Is Better Fallacy
25:53 Nutrition History and Supplement Boom
28:21 Reassuring Anxious Patients
32:46 Microbiome and Medicine Beyond Bottle
37:04 Knowledge Into Wisdom
38:55 Food First Flexibility
40:00 When Patients Demand Prescriptions
42:27 Iron Authority And Shared Care
46:22 Reading Iron Studies Right
48:38 Calcium Timing And Fasting
55:48 Nuanced Prescribing Over Kitchen Sink
57:21 Marketing Myths And Product Soothing
59:41 We Are Enough
01:04:53 Wrap Up And Resources
TRANSCRIPT
Karinda: Hello, and welcome back to another very special episode of The Nuanced Naturopaths. I'm Jul- I'm, I was gonna say I'm Julie. I'm Karinda.
Julie: I'm Julie.
Karinda: And we have a very special guest with us today who I think low-key Julie and I are both, um, fan-girling, quite intensely.
Julie: When you say low-key, I think we made that pretty obvious at the NHAA summit.
I th- I think there was some overt fangirling there, but
Karinda: Yeah. And actually, if I may, Rachel, [00:05:00] I am so pleased that we've spoken again because my first words to you, you at the NHAA summit was, "Thanks, Rachel Arthur." we just got off stage, and you're like, "Great job, guys." And I was like... And I really thought they were gonna be the last words you'd ever hear from me, so I'm really glad we didn't, uh, scare you off.
Rachel: No, not at all. Loved your enthusiasm.
Karinda: No, not at all. Enthusiasm. Awesome. Awesome. And we're keen to get enthusiastic today about all things, things nutrition, I think, in a nutshell, and just, like, the amount of misconception and confusing, conflicting information that's out there. You know, for us as health professionals, let alone for the general public who are trying to navigate their own health issues and, and their own, their own, um, recommendations, what they're being told at the pharmacy, in the doctor's office, by their naturopaths.
Julie: I think the dogma is the thing that I find [00:06:00] most interesting. The, the, the naturopathic dogma, but it's not limited to naturopaths. Those really strongly held beliefs that maybe don't have the substance. I'm wondering, what is the, what's the first time you ever encountered that?
And how did that impact you, you? Was that during your studies or after?
Rachel: Yeah, well, I th- I think you don't know dogma when you see it, right? And when you hear it. And, and so I would say dogma was throughout my training. And I think that, um, I wanna make it clear that I absolutely loved my undergraduate in naturopathy. I, even to this day, think it was brilliant. Um, but it was incorrect in lots of ways.
And part of the way that it was incorrect was as a result of dogma that was being passed down, that was just being recirculated and, you know, from, from one generation of lecturers to the next. [00:07:00] So, but I was so in awe of what I was learning and who was teaching me, and I think rightfully so, I have great respect for the lecturers that I had, that I didn't know it was dogma.
I, I didn't know that we were kind of... I, I guess one of the things, and this, this is why it's probably important to say you don't know dogma when you hear it, because you don't.
Julie: Yeah.
Rachel: I didn't know the history of, let's say, naturopathy. Okay, of course, there was a unit that we were supposed to do. Wasn't the best attendee for that unit, I've gotta say.
Um, but, um, uh, for me, more meaningfully, recently I unpacked the history of nutrition as a science, and that's when I went, "Oh my goodness. [00:08:00] Here's all the roads that nutrition took, and then nu- naturopathy took, and naturopathic nutrition took, that have brought us to here." And now I can see... I can understand today by unpacking yesterday, basically.
And now I see the dogma very, very clearly. Now, it's not to say I've just woken up in 2026 and I go, "Oh, there's... Oh, now I realize there's dogma." Because, of course, I think if people know anything about my career and, and kind of the things I've pursued with a passion, it's been to question everything. But I wanna say to everybody listening to this who has more recently graduated, including you two, like, love what you do, be in awe of what you're learning.
It is wonderful stuff, but it's not all true
Julie: Yeah. Yep.
Karinda: And I'm [00:09:00] wondering, can we just throw some, um, examples of these little like, uh, dogma bites, I guess we can call them, of like things that we do hear in our lectures or just in circles just for people to be able to recognize and go, yeah, shivers, I've heard that."
Rachel: Yes. Okay. So you asked me in preparation for this discussion today, you know, do I remember the first time when I went, "Oh, that's...
where where did that come from? Is that really true? Why am I practicing this way? Or why am I prescribing this way?" And to be honest, I'm too old, I can't remember. But I could give you a more recent example.
So, uh, I want to talk about B vitamins. Very uncool, very unsexy, right? B vitamins, because they're so... They're kind of entry-level, you know, nutritional prescribing. We just think, give someone a B complex, I don't know, 50 mgs of the major ones each, off they go. It's the least thinking we need to do [00:10:00] as a nutritional prescriber, and we're so relieved that it's the least thinking we need to do.
Bong-bong. Right? That's dogma right there.
Julie: Yeah
Rachel: So first of all, the first element of dogma there is that you prescribe the B vitamins together, like they're some brotherhood. They-- Do we understand that the B vitamins are collected as a group because they were discovered in a sequence? They have almost no other chemical relationship.
So I have said these guys are the junk drawer in your kitchen. They have, they are miscellaneous. We have just thrown in the first one we found and then the second one we found and... They're not remotely similar. They're not even siblings. And yet we go, "Oh, here. If you need B1, have some B2, [00:11:00] B3, B5, B6, B7, B9, B12."
B12 has a metal in the middle. It bears no resemblance to any other B vitamin. And then there's the dose. Oh my goodness. Show me a paper that says that 50 milligrams of B3 and B6 and whatever is safe, effective, makes sense. You won't find it. We've-- year researching. Basically undoing the dogma of nutritional prescribing, Julie.
Researching everything about each of the essential micronutrients. Historically, we went right back to their earliest papers of, you know, what a deficiency actually looks like and to the most up-to-date understandings of, you know, how, how we take them up, carry them around the body, how they... all of those sorts of things.
There is no evidence that [00:12:00] those doses make any sense with B vitamins. In fact, Blackmores funded two studies back, way back, where they looked at different doses of B vitamins. It was a small study, um, small sample of patients. But they looked at doses that were kind of like the chemist multi brand, you know, one milligram.
Around the 50. Then they did another product that had around about, let's say... I'm just using B3 as a, a proxy marker of the kind of respective doses of all the other Bs in these products. So the B3 was, you know, just a few milligrams in the chemist sort of low dose one, and then the next step up was sort of maybe 10 to 15 milligrams of B3, and then the next step up was 50 milligrams of B3.
But of course it wasn't just B3, these were all B complexes. Which dose worked? [00:13:00] The 10 to 15 milligram one, the one in the middle. No, the fif- And even still, that's not great science. That study, which suggested that the sweet spot was around about this 10 to 15 milligram mark or whatever, it needs replicating in larger samples and,
Julie: Yeah
Rachel: a study and y- you know, like...
So the way-- I mean, I think that that's probably gonna be very impactful for people to hear. Just that.
Julie: Mm-hmm.
Rachel: B complex. Great. This is easy street. This is something I don't need to give a lot of thought." By George, you need to give it a lot of thought. That is not the way to prescribe B vitamins.
Julie: Yeah
Karinda: Yep. I, I I actually wanna call myself out. A- and again, just as, like, a reference point and a, a resonance point for other [00:14:00] naturopaths and nutritionists and students listening. Uh, uh, 'cause I'm, I'm really trying to think about, okay, so how do we fall into these dogmatic practices? And I think for me, it's this sense of, especially when you're a new grad and a new praccy, sense of insecurity really, this sense of, am I doing enough for this patient?
And then,
Julie: Hmm
Karinda: you might have out, um, Henry Osiecki's, the Nutrient Bible, and you're looking at all the functions of the different Bs, and you're like, "Yeah, they need that. Yep, they need that indication. Yep, yep, yep. Oh, okay, I can just get a B, and then I know they're getting all that." And it's, uh, you've, th- it's in a multi, and it's like it does this thing to your brain where it's just like there's a kind of, oh, soothing, like, oh, at least they've got that covered, without even considering how these very different molecules are interacting when they are in, sitting in that capsule or that tablet together, let alone how they require different things to be broken down, digested, [00:15:00] absorbed.
Where are they absorbed? Are they all absorbed in the same area of the GIT? Probably not. Are they relying on different enzymes, different protein carriers, you know, whatever it is to, to get to the tissues where we're expecting them to have an action? Like, not the same in that way. But it, it's, it's weird how it's, like, oddly emotional and can kinda come down to insecurity.
We think we're not doing enough for our patients, give them, like, a cover-all, and we're like, "Oh, yeah, they'll be good to go on that."
Julie: 'Cause sometimes we've got patients that are expecting, you know, when they take something, they're gonna get the same kind of i- immediate reaction. They're gonna feel it in their body immediately like they do with a pharmaceutical. So there's, there's that kind of, give them something that they can get a quick result so that they'll come back for the rest of the treatment as well.
There's
Rachel: Yeah, I think, I think you're hitting on some really key points that are incredibly relevant. One, the [00:16:00] insecurity and, and this kind of, um, you know, we have to prove our worth. We have to go above and beyond so that there's, there's definitely gonna be an effect. But if we go back to that study, and again, it's very low-level evidence that needs rigorous retesting, there is no evidence that more is better.
There is no evidence in nutritional prescribing. I, I, I, you know, as part of that nu- nutrient prescribers program, I kept saying to all of our attendees who really hated me for a good part of a year because I was so confronting their dogma, our dogma, making them very uncomfortable, needing to unlearn a lot of untruths.
But I kept saying, "Show me the evidence that more is better. Show me. Just show me a paper."
Julie: Mm-hmm. Mm-hmm.
Rachel: And going back to what you were saying, Karinda, about, you know, this soothing effect, I really, really get [00:17:00] that. And, you know, we, we just want to feel that we are doing the best for the patient. We wanna feel that we are doing everything that we can.
And I think it's just... What, what came up for me was one
Karinda: with
Rachel: of
two thoughts there. One, which is gonna seem like a bit of a tangent, but I've shared the stage many times with an integrative psychiatrist who I have enormous respect for, and she, um, talks about keeping her prescription pad outside of the room.
And she said, "I don't have it on my desk. And the reason I don't have it on my desk is to make sure that I have really attended to everything I could in that room with that individual, and that it is a very conscious choice to get up from my chair and to walk out of that room and write a prescription for that patient."
Now, we sit back and we probably feel very superior, incorrectly so, thinking, "Well, of course you [00:18:00] should, you're a psychiatrist. You know, SSRIs are not lollies." But are we keeping the prescription pad outside of the room? No No. Our reflex is to prescribe.
Julie: Yeah.
Rachel: And the second thing that came up for me, Karinda, is, and I don't know, uh, why this just came up, but, but I, I certainly know it's a major element here, is the reason I got into naturopathy, and this...
We, we all have different reasons, but I got into naturopathy because I was in awe of nature. I am a nature child at heart. You know, I grew up in the environment, as in, you know, that's, that was my happy place, was being outdoors and digging in dirt and doing all that stuff. So how have we been manipulated or at least taken a [00:19:00] wrong path somewhere that we feel reassured by something completely not natural?
Because supplements are not natural. There is nothing about them that is natural. They're not natural as a concept. You know, you don't consume iron in isolation. There's no food that gives us iron without the rest. And they're not manufactured in a way that is natural. They are synthetic. They are coming...
You know, they're completely formulated and, and whatever. Very few are natural extracts, and they're insanely expensive. You know, we've looked into, uh, you know, a B complex that is truly natural, and the price would be incredibly prohibitive for patients. So that, you know, that kind of s- contradiction is what got me really thinking last year.
I was like, "Oh, you know, I've been such a big [00:20:00] prescriber and I've been a big dose queen, and I've done all these things, but how did I get here?" You know? Like, this seems a departure from what attracted me to naturopathy in the first place. I thought nature was the answer, so why have I made a departure from that?
And I can retrace it, and I'm sure we all can. If we look back and we go, "Oh, because of some dogma, because of some industry influence, because of my insecurity as a new graduate, because, because, because of this concept that pervades all areas of life that more is better," which is not true.
Julie: Mm-hmm. Mm-hmm. Yeah. It's interesting you say that 'cause I, I... Th- and this was one, one of the questions I had for you, 'cause I, I love this quote. So Hannah, Hannah Fry, who's a, a UK scientist, she said that, [00:21:00] uh, you know, paraphrasing it, but in a complex... In an increasingly complex world, to navigate it as a human and, and keep your nervous system calm and feeling safe, we tend to reduce things down to this sort of binary perspective.
It's good or it's bad, or it's, it- it's, you know, it's black or it's white. It's... And I wonder sometimes whether this is what's a little bit at play here, that, that, you know, w- th- people are trying to simplify it because it's so complex to understand. And, you know, human physiology is not simple to understand- simple at all.
And, you know, e- e- even just, just the, the nutrient side is, is
Rachel: Insanely complex.
Julie: Yeah. Yeah
Rachel: If you said to a biochemist more is better, they would boot you out of the room. They'd go, "You don't [00:22:00] understand anything about biochemistry, my friend." If you said to a physiologist more is better, if you suggested that any pathway to any of these people that truly know these fields of knowledge was going to be influenced by more of one nutrient, you'd just show yourself to be a nuff-nuff straightaway.
Like, that's not a thing. Biochemistry doesn't work on on-and-off switches. It's about ratios, and the nutrients never work in isolation. And even the nutrients, when we talk about nutrients, we're overwhelmingly talking about the ones we know about, that we've identified. We're not talking about the other elements of food that we have yet to elevate to that position.
Julie: Mm.
Rachel: So, you know, biochemists and physiologists are [00:23:00] being more holistic than we are, God forbid. But that's what... That's the point that we've come to.
Julie: Hmm, hmm.
Rachel: Because they will never go, "Oh, you could flick on that pathway just by giving some, you know, methyltetrahydrofolate." They'd be like, "Are you an idiot?" No pathway runs on one isolated nutrient.
Though, well, very, very few.
Julie: Yeah.
Rachel: So-
Julie: And, even then there's gonna be feedback loop, multiple feedback
Rachel: Feedback loops. M- yeah, and, and nutriti- every nutrient, as I've said to you guys, we recently were at the Vic Herbs meeting. You know, there, there's this idea that, uh, we, we keep adopting, uh, kind of pharmacological thinking with nutrition, which is a complete error because pharmacology is easier. You don't have a need for a drug.
There is no drug deficiency state. But we have clear [00:24:00] nutritional needs, and therefore we have intense regulation responses to keep it just in the right spot. This is far more complex than pharmacology, and yet we approach nutrition as if they're just green pharma. They're... It's not. Yeah.
Karinda: I think our, um, intuitions are onto something because I reckon at least half a dozen naturopath friends I've, I've spoken to when we reflect on our studies, and I, I'm sure Julie and I have had this conversation before, the one subject we all wanted to do over and over again was nutritional biochemistry. And I think 'cause our guts were just like, there is, there's more t- it is so complex. It's like when you go into that for the first time, half of it goes over your head. You might catch a couple of good tidbits and, you know, you learn about P5P and you're like, "Oh, J- oh, there's forms of B6?" You know? And but we, we all had this kind of [00:25:00] attraction to wanting to, like, revisit that.
And I also like what you said about, know, we come into it with this awe of nature, and nutritional biochemistry is, is very specific and very, very scientific, but we... it kind of just gets lumped in with all the other things that we learn in a very different way. and I mean, that alone is gonna give me a lot for
Rachel: Nutritional biochemistry reinforces the aura of nature, right? It doesn't support giving a B complex at 50 mgs each. They're far from it. It goes, "Well, actually B1 mostly works with magnesium." You know, it's all incredibly, dare I use the term, nuanced. It is incredibly nuanced.
Karinda: Yeah, yeah.
Rachel: And it's relational.
Karinda: Mm. Mm-hmm
Rachel: know, it's not the product on the shelf
Karinda: Well, and I was actually just gonna say, is it fair to say that a lot of this dogma ends up coming from marketing and [00:26:00] advertising, like, and, and companies where the big bucks are, and people have their favorite brands and their favorite products and?
Rachel: Sure.
Julie: Kulin
Rachel: I think it kicks it down the road. I don't think it comes from there. When I recorded the... You know, I said last year I became intensely interested in our history, and so I recorded a series called The Supplement Boom series. And I went right back and I said, "Right, let's get clear. How did we get here?
Let's, let's start at the beginning." So I started with literally the isolation of the first nutrient, and I followed it along through the '40s, '50s, '60s, '70s, and every decade it was like, "Oh my God. Oh, oh, that's what happened. Oh my God. Oh, now I see how we got here."
Julie: Mm-hmm.
Rachel: So literally, when you look at that timeline, it makes perfect sense that this wasn't originally industry-driven.
I mean, there's always been industry, associated industry that benefits, of course, if there's supplements to sell. [00:27:00] But that's not its origin story, actually. You know, the origin story of nutrition, and I won't take you through the whole timeline, but that series certainly does, uh, and beyond, is, you know, we, we were in a time during the war when we needed to ration food, and so the RDIs came about, and government decided nutrition was a public responsibility.
Da, da, da, da, da. You know, and you follow it along, and we went from concerns about undernutrition to then concerns about overnutrition, but, um, you know, chronic diet-related diseases. It all makes sense as you follow it along how we ended up here. Industry has just been a beneficiary, shall we say. Like, they have just bene- over and over again.
And right now they are benefiting big time, and I'm really, [00:28:00] really fired up about this because that is to our detriment. That is to our patients' detriment, and we, we need to turn this ship around.
Julie: Yeah, absolutely. I c- I can highly endorse that, um, supplement boom series.. Yeah, it was fabulous and really eye-opening.
Rachel: Yeah.
Julie: Yeah,
Rachel: One of the things that you asked about, um, you know, prior to this conversation was back to Hannah Fry, which I love what she says, you know, about we keep things simple because simple settles our nervous system. And you expanded on that, Julie, and you said, you know, patients need to have their nervous system settled as well.
If it all feels too complex, and they're feeling angst about, "Have I got all my nutrients? Am I well? Am I optimal?" You know, what do we do in the face of that? [00:29:00] And I... You know, how do you respond? And my thoughts on this is with reassurance. Like, that is our best tool.
Julie: Hmm.
Rachel: What I might be inclined to say to someone who-- And this is very common, like you guys are seeing it, I know how often this is presenting, that patients, it's like they've overheard things, whether that's online, in other media, in conversations with friends, that make them anxious that they are, deficient, imbalanced, unwell, you know, not gonna live forever, dare I say.
All of those sorts of things. And that, um, you know, they have to crack the code to, uh, resolve that. But the reassurance is very powerful. If perhaps we presented as saying to them, "Well, do you [00:30:00] know about the composition of air and how we, from that huge composition of air, we extract oxygen, we breathe it in, it travels through our blood, and ultimately it produces energy.
Do you know all the bits about that? Do you need to know all the bits about that?"
Julie: Mm.
Rachel: For it to happen? No. And what I would say to them is, you know, this is just yet another illustration that nature has our backs. We don't need to understand or overthink nature. We are designed to live on this earth, and we are designed to eat the foods that grow on this earth.
So, you don't have to understand oxygen extraction, you know, transpiration, respiration, Krebs [00:31:00] cycle, electron... You don't need to understand that for it to keep you alive and for you to be well. Likewise, nutrition does its thing for us. If we can follow some very simple principles, which is eat the foods that are grown on earth as much as possible, wherever possible, it has our backs.
That's what we were designed for.
Karinda: Oh, that's bloody beautiful. I- y- it's so funny. Like, I would always, uh, you know, often and, you know, for a long time I've... one of my mantras has been like, "The universe has my back." And I think about it in a very, like, spiritual ene- energetic way. I can't believe how much reverence I have for nature, and I've never leaned on that mantra as well, that nature has our backs.
And I think we need to, you know, you said reassurance is a big key, and I think for us to be able to reassure our patients, we need to have the confidence [00:32:00] in, in what we know, but it also in what we don't know and what is out of our control. And, yeah, we need to be able to communicate that effectively.
And I love that, I love that analogy. That's, uh, that's definitely going in my bank. And
Julie: Yeah,
Karinda: that,
Julie: me too
Karinda: something that I g- kind of would, you know, would go on about a few years ago but haven't really as of late, I, I would tell some patients, like, we need to have a little bit of mystery in the medicine. You can't know.
And I, I still don't know, maybe some people, I don't know, maybe it's person-dependent, but you can't know exactly how something is gonna work for- 'cause we actually can't even control that.
Rachel: We don't. We don't
Karinda: Yeah
Rachel: yet.
Julie: no,
Rachel: There are far too many variables in each individual. Like, even if you... You know, one of my big, um, passion projects at the moment is looking at how we unintentionally manipulate our microbiome through supplementation. Like, you give someone a B complex, I know I'm bashing the [00:33:00] Bs, but honestly, you give them any supplement and you think I'm giving them this for their biochemistry, for their energy pathways, for their nervous system.
Actually, you know what you fed first? Their bugs. And do you know the outcome of that or the upshot of the upshot of that? No. No, chances are you don't, because this is an emerging field of research, that we should have seen coming from a mile away, because we know if you change any element of the environment in which your gut bugs live, hello,
Karinda: gut bugs live
Rachel: you know, 100, 1,000 times the RDI of B1 or whatever it is, you're going to put a different pressure on the bugs and determine who survives and who thrives.
So, and that will change individual outcomes. So we don't know actually how everything is going to play out in each individual because there are [00:34:00] infinite variables, and that comes back to having some humility around that rather than trying to answer every question, which is... I think you, the three of us are agreeing, is not possible and not necessary and not desirable really.
The other thing that you just touched on there, Karinda, about saying to people there has to be some mystery in the medicine and, you know, the n- the need to, for reassurance with patients is another area I got really fascinated in, in the last year was, what I call "the medicine beyond the bottle", which is absolutely nothing that we prescribe and everything that we say and we do with our patients.
And one of the key elements of positive clinical outcomes is that your patient... Well, there's three elements behind this. One is that the sense that you've [00:35:00] conveyed that they matter. A second is, um, you know, encouraging, uh, what's called positive expectancies, so they have a positive expectation of outcomes.
And the third is that they experience something called active hope. Now, hope isn't optimism and, you know, I'm gonna win the lotto and, you know, any of that. It's, it's a very well-understood, quite complex, um, psychological phenomenon. It is like a muscle that we need to build in our patients as practitioners.
But when we're trying to point out every minutiae of, "Well, I think, you know, this biochemical pathway is flagging 'cause, you know, you might have a gene there that," da, da, da. That is the opposite of active hope. That often triggers a response in patients that, at the very least, things are beyond their [00:36:00] control.
What's determining their health is not something within them that they can actively, necessarily mitigate. It's, it's just a really interesting area. And so that's another one. You know, if we go back to that idea about why we got into naturopathy, and we're all saying we're all hippie kids really, and, you know, how have we lost that?
I think as part of those hippie kid kind of archetypes, weren't we all mindful about the power of language and the power of belief? And how have we made a departure from that, too, in our language, in our excessive pathologizing, in our loss of trust in nature?
Julie: Mm-hmm.
Rachel: You know? And I, uh, you know, I have to say straight up, if anybody's going, "Oh my God, she's drunk the Kool-Aid," you know, quite rightly so, because, you know, I've been a [00:37:00] huge pathologizer.
That... You know, pathology is my thing. And, um, I, I take responsibility for the part that I've played in our profession in that regard of saying, you know, "Dig deeper," you know, "Understand the minutiae," all of that sort of stuff. So there's nothing more annoying than an evangelical reformed, you know, naturopath.
That's me. Yeah. I, I think that one of the things that I think the three of us have talked about is there's knowledge and then there's wisdom. And I think what I'm experiencing now, I hope, is that transition from a whole lot of knowledge, that has its place, into the, you know, a little bit more wisdom.
Julie: Mm-hmm.
Rachel: Yeah.
And I think these are elements that come with this. The medicine that's beyond the bottle. What happened to my original motivation? What, [00:38:00] didn't I believe in nature? Didn't I believe in, um, the power of my words and the power of belief? Where, where has that gone in contemporary practice?
Julie: Well, maybe, maybe it's be- because we can't hold all of the things all of the time, it's, it's about evolving as a practitioner and constantly questioning and learning and reexamining in order to refine what things might be impo- most important for that person in front of me. So,
Rachel: Absolutely.
Julie: Because ultimately that's what we do, isn't it?
Is filter all of the information down and then apply it to the person in front of us. But it has to be a constant revisiting of, of every aspect
Rachel: It does, and it's o- you know, and, and so that requires, what I'm hearing from you, [00:39:00] Julie, some chameleon qualities, and I relate to that. Like, I'm all about food first, and I'm all about de-prescribing supplements, and I'm all about really much more discernment when it comes to when I prescribe and the doses I use.
But does that work for every patient? Hell no. Because patients come with their own belief system or their own agenda or their own expectations. And so, a food first, um, someone might throw that right back in my face. Ultimately, ideally, I wouldn't recommend a food first approach to the person who that wasn't a good fit for because I'd already sussed that out during the consult.
I'd already gone, "Ooh, no room for change here."
Julie: Yeah.
Rachel: "This is someone who wants a pill."
Julie: Mm-hmm.
Rachel: know, it might prompt me to question whether I'm the right practitioner for them now that I've become a reformed evangelical food first person. Um, but [00:40:00] yeah. And, you know, we, we have talked about this, the three of us, what happens when the patient really wants you to prescribe.
You know, the patient comes in and goes, "I'm trying to conceive. Give me everything." And you're like, "Strongly don't recommend everything. You know, that's, that doesn't fit with the science, actually. It's not an individual approach. I've seen everything. I've learnt a lot about you as an individual. It's not a good fit.
I wouldn't give you more folate. I wouldn't give you more iodine." I, you know. It's a tricky terrain. And so there, that chameleon kind of quality that we need. Use food first when it fits with the patient. Educate when they're ready for it. You know, we always, as you said, Julie, are, are tailoring to that individual in front of us, but we still have to remain the authority in the room.
I've had fights, [00:41:00] genuinely fights with patients, they didn't last long as my patient, who wanted me to prescribe iron, and I'm going- "Computer says no. Like, I have looked at every angle of your case, and there is no way that iron is helpful, beneficial, whatever." Um, I will never forget she was a lawyer, and that fight was legendary.
And in the end, I just said, "I'm not the practitioner for you." She was determined that IV iron, very topical today 'cause I just published something on how, uh, the most commonly used form of IV iron increases fracture rates. It's well-established, just a paper just came out. It's tragic. Awful, awful stuff, and it's being used over and over again in Australia in- incorrectly.
Anyway, this female lawyer, who was my patient, was like, "I need IV iron. That's what's gonna fix me." And I'm looking at the [00:42:00] iron studies and I'm looking at the FB and I'm going, "No. No, no, no." But she was so dogged in her belief that that was the fix. What can you do? I'm still the authority in the room, so I'm not gonna prescribe it.
Julie: Hmm,
Rachel: I just diplomatically said, "You'll need to see someone else."
Julie: Yeah.
Rachel: Yeah
Julie: uh, there's, there's also those, um, it's, uh, it Brilliant point that y- you're the authority in the room, but then when they leave that room, there are other authorities that they're speaking to that are, that
Rachel: Are there authorities? Yeah, it would depend about. You know, if you're saying ... Sorry, Julie, I didn't let you finish, but, you know, if they're going to AI, that's not an authority. If they're going to a doctor, that's not an authority on nutrition. That, you know, so okay, if they left my room and went to see one of you [00:43:00] guys or, you know, someone else, okay, they've got a, a con- contrasting opinions.
But is that what you meant or it's something else?
Julie: Oh, no, I was thinking particularly around iron thinking, the, you know, "my GP's told me I'm low in iron."
Rachel: Yeah. I know, it's so hard. It's so hard.
Julie: Uh, uh, I've had that conversation three times this week.
Rachel: Yeah, Julie. Oh, it's a rough road, isn't it? And look, the, the shortest end to that argument, which I'm not suggesting we use, would be to just say to the patient, "Just, um, ask your GP, uh, how much nutrition they did as part of their general practice training." Because I used to teach in the medical degree, um, just at Monash Uni, and I know back then and to this day, it's three hours across the whole degree unt- unless there's a particular institution that has changed its ways.
And Monash were [00:44:00] very progressive. They had electives that were around nutrition and sleep and psychology.
Julie: ம்
Rachel: how I got involved. You know, that would be a quick end to that argument about who's the authority in the room, right? But we don't wanna be too
Julie: Yeah.
Rachel: brutal. We need-
Julie: our patients off with a hand grenade.
Rachel: Yeah. We need to know that we're trying to-
It's beautiful when we can operate within a shared care environment, and we can make a patient feel safe across all of those relationships. So we try not to polarize, and we try not to contradict. But it is very hard when someone who's done three hours is saying, "No, you definitely need iron." And we've done more often than not three years, if not four in my case, five plus a thesis.
You know, where we're going, "No. No, you
Julie: ம்.
Rachel: don't need iron." That, that is a hard, that's, that's a hard, um, conflict [00:45:00] to, to navigate.
Julie: Mm. And am I right? Did I read somewhere that, uh, the, that the clinical guidelines for iron prescribing for GPs doesn't actually, it doesn't go far enough back to really incorporate the discovery of hepcidin?
Rachel: No, it do- um, mm, I couldn't speak to the most... I'd need to check my stuff today guidelines. Look, the, the incorporation of the understanding around iron regulation is penetrating general practice. More of... Thank God. More often than not, I hear now GPs saying, um, and these are not integrative GPs, these are, you know, regular GPs just saying, "Oh, don't take it every day."
Right? So
Julie: mmm
Rachel: knowledge which is about hepcidin [00:46:00] really or, um, and came from the Moretti paper which showed that, you know, uh, 24 hours after taking the first dose you're not picking up any more. Um, that bit of information is getting out there. Now, I'm not saying 100% of GPs are across that, but increasingly y- you know, you're getting there.
But we still have GPs who... We still have naturopaths, we still have dieticians who don't know how to read iron studies. You know?
Julie: Yeah
Rachel: I've got a brilliant example of a patient, he was a man in his 50s who by one GP was told he needed iron and, and then a subsequent iron study, uh, was performed and he was told that he possibly had iron overload.
Neither of those things were correct. Neither of those things. So in the first instance, he was told he needed iron because he was inflamed, [00:47:00] and so he'd removed all the iron from his blood. And the patie- the GP was not looking at the ferritin,
Julie: Hmm.
Rachel: but was looking at the serum iron being low and the transferrin saturation being low and saying, "Wow, you might need some iron."
Now this is a meat-eating 50-something-year-old male. He went and did another test. He didn't take the iron because I was like, "Are you joking?" Um, and then the next test which was performed, you know, uh, months later or whatever, uh, came back and this GP said, "Oh, I think you've got iron overload." I'm like, "I'll look at the results."
And it's because his serum iron and his transferrin saturation are very high. Ferritin was within range for, for a 50-something-year-old male. And I look at the timestamp and I go, "This was collected at," you know, whatever time it was, 11:00 AM. "How long had you been fasting for at that period?" And he said, [00:48:00] "Oh, 16 hours."
I said, "Okay, so you're mobilizing iron from stores because it is a natural response to that period of time of no food intake in terms of iron homeostasis that you will mobilize stores. So let's repeat the test with eight hours of fasting." Perfectly normal iron studies. So y- you know, wow. Um, forget about hepcidin.
Let's just read iron studies correctly as a good foundation. That'd be great.
Julie: Yeah.
Rachel: yeah. Yeah.
Karinda: And I feel like I read something of yours, ooh, I might be going six to eight weeks back now. Th- th- there's similar, a similar concept in terms of calcium regulation, right? If fasting, uh, ticks beyond a certain point, it will start
Rachel: Yes
Karinda: I won't say more. I'll let you say more about-[00:49:00]
Rachel: Okay, so look, this is where I get really excited about nutrition because when you go back to the science, get offline for God's sake, and the influencers, and the easy grabs, and the stories, and the supplements to sell, and you go back to the science, there is nothing short of, you know, uh, thrilling stuff that we're discovering.
And this is really, again, as you say, Karinda, it's a parallel with iron in the sense that, of course, calcium is intensely regulated. It's one of the most essential... Can I say that? It, it is an essential mineral, like all the other essential minerals, but I talk about criticality. So what I mean
Julie: Hmm.
Rachel: is you won't die from not enough, let's pick something, manganese, [00:50:00] right?
But you will die quite quickly if your blood calcium drops too low.
Julie: Yep
Rachel: You'll just die. Okay? So that's a criticality, uh, to this essential mineral. And I know calcium is very uncool right now. It has been f- forever in naturopathic nutrition, and I'd love to talk about heroes and villains, which do not belong, do not belong in nutrition.
But anyway, so calcium's a bit of a villain. I think it's an absolute hero. And, um, when you're, when you're not cons- when you haven't consumed calcium, let's say since dinner the night before, overnight, the natural response is going to be not, "Oh, my bones." It is literally, oh, calcium is critical in the blood to keep us alive because it is the major second messenger system in blood.
So it [00:51:00] gets your nerves working, it gets your muscles working, it, um, controls or normalizes blood clotting, blah, blah, blah, on and on. So when we fast overnight, the natural regulatory response to that lack of calcium coming in is the parathyroid glands will fire up and release PTH. That says to the gut, "Open up the doors, bring in any calcium that you can."
It says to the kidneys, "Hold on to any calcium that you can. Let's see no calcium going out in wee." And it has, you know, a cascade of changes to try and buoy that blood level of calcium during this period, even though it's hours of no intake. So one of the things, Karinda, I've been talking about is the key time to take calcium is first thing in the morning, because PTH is a little bugger.
It... When it [00:52:00] does that, in addition to it saying to the gut, "Open up the doors," and the kidneys, you know, "Lock all the doors," effectively, it taps your bones. And it's tapping your bones to mobilize the calcium to, you know, fill up the, the shortfall. And PTH rises are one of the most insidious contributors to poor bone mineral density throughout a lifetime. Right?
Ca- the concept that calcium works like concrete in your bones, like it's just a structural element, is so undervaluing calcium. It is so not the story. Like, it is one part of that story. But when you start to get to this finesse level of, oh, it's a circadian rhythm, and it's about fasting, and if I fast, and then the PTH rises, and it [00:53:00] taps my bones, and the calcium is leached, that's the rollercoaster we don't want to be on.
Because if you're on that day in, day out, which most women are overwhelmingly, especially women.
Julie: I was thinking about that, "the I don't eat breakfast 'cause I'm not hungry." Yeah.
Rachel: Exactly. Um, and we-- I've been in the fortunate position where I measure women's PTH who are doing extended fasting overnight, and I can show them. I go, "Look at this. That PTH surged at 8 a.m. because you didn't take that calcium." And I am, I'm a terrible finger-pointing bully with my patients, not really.
But it, it, it is this clear, opportunity then to show them when they took the calcium before they went to the gym, how the PTH didn't peak.
Julie: हूँ।
Rachel: see the PTH stayed nice and low. We want it under four at all times, ideally. And they didn't tap their bones, right? So this is, uh, [00:54:00] this is exquisite stuff.
This is what I thought... This is the real power of, nutritional prescribing. It-it's not about you should take a thousand milligrams of calcium a day 'cause, you know, bones are like concrete, and it's a major component of bones. It's about the intricacies of really, um, there's that word again, nuanced prescribing.
Uh, really understanding when to give it, how to give it. You know, I've got patients who are osteoporotic, um, or we've actually brought them back from osteoporosis to osteopenia. And, um, you know, we've got them doing, you know, that calcium before the gym in the morning, you know, and they literally just need to have a sip of something with it.
Like, you know, that I'm not really gonna, [00:55:00] you know, compromise their, their fasting, you know, ideals. And then we might take, you know, two hundred milligrams, two fifty milligrams before the gym, and then we might take it two other times in the day. And we're doing such intense monitoring of these patients that we know that this, exactly this pattern with all the other things we're doing, the very specialized, um, weightlifting program for bone mineral density building.
But when we put it all together, that is when their NTx, their bone telopeptides are at their lowest. That is when the PTH is under control. That is when... That is thrilling. That's what I think is the, the goal here.
Julie: Magic.
Rachel: Yeah.
Karinda: And I think based on that description, it's fair to say, like, compared to how we first started the conversation where I referenced, you know, oh, it feels soothing to, you know, prescribe and you feel like you're covering the bases. I feel like the [00:56:00] path that you're describing is one that for students, for naturopaths, I mean, certainly I felt it, path of nutritional integrity, nutritional specificity, um, d- devotion to nutritional biochemistry, it's a much more daunting path. It's harder. not a lot of fantastic CPE about it other than all of your body of work, right? It's, it, it's not done justice in the, in the degrees. So it can seem like this really harder path of like, oh, I need to learn this thing really intricately, but the payoff
Rachel: Is enormous.
Julie: Hmm. Hmm
Rachel: It's enormous.
Karinda: Yeah.
Rachel: It's really enormous. And, and you know, like I think going back to your really important point about our, our anxiety and our, and our certainty and, I mean, the volume of knowledge we've been asked to hold is [00:57:00] ridiculous. You know? It re- it, it, it's-- no one can hold all of that, you know?
Julie: ம், ம்.
Rachel: Don't ask me about herbs, you know, I'll sound really stupid. Um, so you know, but of course I did four years of herbal medicine.
Julie: Yeah
Rachel: so that's just me normalizing for people that I, you know, I can't speak at this level when it comes to herbs. I'd need to call a friend.
said that we feel really insecure and, And so the products and the promotion and the marketing of those products, that's where the soothing comes from, Karinda. And they know how to soothe. They say, "Oh, petal, doll, don't you worry your pretty little head about it. This is for bone repair.
This is for, um, mental calming. This..." If you saw inside the workings of these companies, and I have seen inside them, I have my spies, you would not be soothed at all. [00:58:00] You would know that the way these formulations come about are not scientific. We should not feel soothed by a product that has met a gap in the market at a certain price point, because that's actually how products come about.
I don't know if you know that.
Julie: Wow.
Rachel: Um, yes. So, uh, it is a shame that that's the story we're being sold about nutrition, when in fact the real, you know, reassurance would come about if we could go back to what we actually do know, and I mean scientifically about nutrition, and be discerning with how much we prescribe and all of those sorts of things, and know how to measure efficacy.
Because that's one of the big things I say. I like, we could throw the whole kitchen sink at [00:59:00] people on a wing and a prayer and a promise and a hope and a dream, you know, and, and not be able to effectively assess what's working, if anything's working, what's making things worse. We don't know, because we gave them everything in the kitchen sink, you know, effectively.
But when I give calcium like that or when I give iron or when I give iodine or when I give B1, I know what to look for in the pathology as well as the clinical picture to go, "That's it. Stay right there. Don't give them anything else. We've hit it. That's the sweet spot." Yeah.
Karinda: I feel like if we have one, uh, time for one more question to wrap it up,
Rachel: Mm.
Karinda: and I'm gonna go to one of Julie's fabulous questions. I think this will be a good concluder. If you could delete one belief from the
profession's collective head [01:00:00] overnight, what would it be and what would you want to grow in its place?
Rachel: Oh,
Julie: Mm-hmm.
Rachel: of your questions, can I just say? I could chat with you guys any day.
Julie: Oh, you're on!
Rachel: Okay, let's do it daily. People get sick of us, but it'll just be for us.
Julie: Yeah, fine.
Rachel: The one belief if I could, um, remove from our profession, and this gets me a little bit glassy-eyed and teary, is that we are not enough.
Because we are.
Julie: Yeah. Yeah.
Rachel: I think that going back to what you said about more is better, whether it's nutrition, whether it's car sizes, whether, whatever it is, unfortunately, um, really has pervaded our own [01:01:00] sense of professional identity. And what that means, and this links into everything we've been talking about, is that we just feel that the foundations aren't enough.
That, um, it has to, we have to find something, uh, more radical, and we have to, uh, extend out beyond where other people are practicing. We have to do post-graduate or just pick up on some crazy online rabbit hole that tells us, you know, this is the answer to all your patients' issues. Or we can't use B1 thiamine, we have to use, um, an analog of B1, benfotiamine.
Says who? Based on what? The science says no. You know, that we can't use vitamin D, we should use calcifediol, [01:02:00] uh, which is actually a pre-hormone. Mm, again, as a nature lover, that I didn't get into naturopathy thinking I was gonna be prescribing pre-hormones. I thought I might be re- recommending sunshine, which has a completely different effect, and you guys know this 'cause you lectured about this, right?
Has a completely different effect than any oral form of vitamin D. You know, and, and so I think that what I would grow in its place, is that we need to ha- you know that conversation that we had, I gave you that example of what I might say to a patient about you don't necessarily understand oxygen extraction and how that...
and you don't necessarily understand the mechanics of the electron transport chain, but it's all working, right? I think we need to have that conversation with ourselves a little bit, where it's like, you know, the awe that we entered this profession with- [01:03:00] That was legit. That's what we need to go back to.
Julie: Yeah.
Rachel: And we need to back ourselves in knowing that nature has our backs. Yeah.
Julie: I- it's brought a tear to my eye. It's
Rachel: I'm getting all goose pimples up and down my legs, man. This is too much for a Tuesday.
Julie: That's a beautiful place to, to, um, to round it off, isn't it?
Karinda: Y- yeah. And that, that's a sentiment that I, I, I'm gonna stoke the fire of that within myself and in my own practice and tell as many naturopaths as I have conversations with about that. And also remind our patients too, like man. Nature. Like, yeah.
Rachel: Yeah. Because that, it, [01:04:00] it, it's core in nutrition really does just support, you know, eat food that grows on Earth. It's m- you know, I'm not asking people to grind their own rice and, you know, whatever. I'm just saying primary foods, if you can just,
Julie: Yeah.
Rachel: that's all, that's all; a balanced, you know... God, I've turned into Rosemary Stanton all of a sudden.
I don't know if that predates you guys. It's showing my age.
Julie: no, no. No.
Karinda: Oh, it does for me.
Rachel: Julie. Yeah.
Julie: I'll explain it to you later, Karinda.
Rachel: Yeah. But yes, you know, like, I think, um, the world is in need of that kind of reassurance right now. Nutritional practice is desperately in need of that kind of reassurance right now.
Karinda: Yeah. Mm.
Julie: Brilliant.
Karinda: I think so, so, oh, but c- I cannot thank you enough, and yeah, don't, don't tempt us with a, a daily, we can do a daily [01:05:00] live stream. so I do wanna specifically shout out, um, as you mentioned, The Supplement Boom series, which is a seven-part series. I'm gonna go check that out, we will have the link for that, uh, in the show notes below, wherever you're listening to or watching this. I absolutely trust that anyone who's listened to this conversation has got at least one golden tidbit from it, if, but I'm sure there's multiple golden threads that they're now, they're now asking themselves a thousand other questions it. Thank you for what you bring to us, to the industry, the conversations that you keep alive.
Also, shout out to the Curious Minds Club for, you know, if there are practitioners listening that want to be a part of these nuanced and ask...
Julie: drink.
Karinda: Is, should've made it a what?
Julie: we should have a drinking game. Like drink, every time we say nuance, you gotta drink your water.
Rachel: That's it. That's it
Karinda: Love it. Um, so yeah, links to [01:06:00] everything will be below. Rachel, I'm speechless. I think I've felt a sense of this every time I've spoken to you. Can't thank you enough.
Julie: Yeah.
Rachel: Thank you, and can I just say the same back to you guys? Because I think, you know, as I said to you guys, I don't-- I know this is such a terrible public confession. I don't listen to podcasts, so I didn't, I didn't have prior knowledge of what you're doing. But just the conversations that we've had in person and the conversation today, the questions that you wanted to cover, like I am all here for it.
I think good on you.
Karinda: Yep. Thank you. That's I'll be thinking about that before I go to bed tonight, tell you that much.
Rachel: Right.
Julie: Me too, yeah.
Karinda: Thanks, Rachel.
Rachel: Thanks guys. Have a great day
Julie: Yeah, you too. See ya
