TRANSCRIPT

[00:00:00] Julie: shout out to all my menopausal ladies because, um, I'm

[00:00:04] I'm wearing

[00:00:05] old t-shirt. Probably can't tell, but it's got, it's even got holes in the bottom of it. It's a favorite t-shirt. And I thought of getting changed, but I can't be fucked.

[00:00:16] Karinda: and I

[00:00:18] Julie: I'm a, I'm a post-menopausal woman, so, um, I can do whatever I want.

[00:00:23] Karinda: You absolutely can do whatever you want. And equally, if there's any premenstrual gals listening out there, I'm eating a very well, not very late lunch. I'm eating a late lunch. We are totally winging it. I smell like B.O,

[00:00:38] Julie: like.

[00:00:40] Karinda: So.

[00:00:41] Permission slips across the board.

[00:00:42] Julie: That's alright. this is not smell of

[00:00:44] Karinda: exactly. *Starts singing TNN Theme Song* Nah nah nah nah nah..

[00:00:50] Welcome to another episode of The Nuanced Naturopaths, and I think we managed to sync [00:01:00] that quite well over Zoom.

[00:01:01] Julie: I, I was gonna say, we are not the synchronized naturopaths.

[00:01:04] Karinda: Nearly got close. We're the nearly synchronized naturopaths. Uh, I'm Karinda

[00:01:12] Julie: and I am Julie.

[00:01:13] Karinda: and thank you for clicking or tapping on us today. And today we are talking about testing.

[00:01:21] Julie: Yes.

[00:01:22] Karinda: when it comes to health and medicine at one point or another there will often be a test. You might go to your gp. With a concern, and they're like, oh, okay, well let's do some blood tests and then we'll go from there. And then you might see a specialist and they're like, okay, well we need to do a scan, or we need to do some further tests.

[00:01:40] And then we go from there. You might see a naturopath and they say, okay, well we're gonna do some different kind of testing and then we'll see what that reveals.

[00:01:49] Julie: Mm-hmm.

[00:01:49] Karinda: there's all sorts. And I, I mean, do we, shall we start off with blood tests, given that it's kind of like the, the first line?

[00:01:57] Julie: Yeah. Yeah. And I think most people [00:02:00] have had a blood test and have, you know, or, or have them regularly. If you've got something, you know, a, a chronic health condition, you might have a regular blood test to, to keep an eye on things.

[00:02:14] Karinda: Hmm.

[00:02:15] Julie: and we don't look at pathology testing in the same way as your doctor does.

[00:02:22] I think we've said this in previous episodes,

[00:02:26] Karinda: Yeah. But sort of not on a broad spectrum, but. I mean, yeah, let's talk about what, what, what's the doctor looking at? What's the doctor looking for when they get a copy of those blood test results? Hashtag not all doctors.

[00:02:40] Julie: hashtag not all doctors. Yeah. Um, the vast majority of them are looking for something that's really out of range. they are looking for a clue that you might have a thyroid condition

[00:02:54] Karinda: yep,

[00:02:55] Julie: or something wrong in your liver,

[00:02:58] Karinda: Something really [00:03:00] frank and

[00:03:01] Julie: yeah.

[00:03:02] Karinda: outy.

[00:03:03] Julie: Yeah.

[00:03:04] Karinda: Yeah.

[00:03:04] Julie: Frank disease state. So,

[00:03:06] Karinda: Yeah.

[00:03:06] Julie: you have your reference range and if it's on one side of the line, you are totally fine. And if you're on the other side of the line, it's all bad.

[00:03:16] Karinda: Yeah, yeah, yeah, yeah, yeah, yeah. That, that, that, that's sort of how they see it. And so this will be the kind of results that on your, if you've got a copy of your results nearby, or if you can bring them to your mind's eye, these are the results that will either be bolded or they'll be in red text instead of black text.

[00:03:34] There may be an asterisk next to the result that you got, or, um, you may see a H or an L next to the result that you got indicating high or low.

[00:03:44] That's pretty much what the doctors are looking out for,

[00:03:47] Julie: Yeah.

[00:03:47] Karinda: When looking at general blood test results.

[00:03:49] Julie: Yeah. And so these tests are not necessarily the same set of tests every, every time, or for every person.

[00:03:59] Karinda: Mm-hmm.

[00:03:59] Julie: So the doctor [00:04:00] will tailor them to be looking for mm, different areas. So they might look at the, the blood chemistry, or they might look at your electrolytes. They might be looking at your thyroid.

[00:04:16] Karinda: I feel like cholesterol's always in there. Oh, but not actually looking at your thyroid. Is that what you were gonna say?

[00:04:21] Julie: Yeah, we'll get to that. It might be looking at your vitamin D or your B12.

[00:04:27] Karinda: Yep.

[00:04:27] Julie: But keep in mind that all of these measurements are measurements of those things found in your blood.

[00:04:36] Karinda: Yep.

[00:04:37] Julie: So importantly, if it's something that, is important to have in particular tissues, in your muscles in a particular organ, measuring it in your blood is an indication, but it's not a precise measure of what's in your muscles or in your organs or in your liver, you know, in your, [00:05:00] yeah.

[00:05:00] Karinda: Yep. So, and I think that actually brings a really good point that can be applied to a lot of different tests is that it's the stuff that's in your blood. Therefore it is really just a snapshot of a point in time.

[00:05:13] Julie: Yeah.

[00:05:14] Karinda: Yep. From one, from one medium of your body.

[00:05:18] Julie: Yeah.

[00:05:19] Karinda: Yeah.

[00:05:20] Julie: Although there are a couple of markers that do have greater longevity than, than a snapshot in time because you've got your HbA1c,

[00:05:30] Karinda: Which is reflective of blood sugar regulation over the last a hundred, 120 days.

[00:05:36] Julie: Thereabouts. Yeah. Yep.

[00:05:38] Karinda: ESR.

[00:05:39] Julie: ESR? That was the other one.

[00:05:41] Karinda: Reflective of inflammation that won't, you know, that that's sort of one that will take a little bit of time after the inflammatory event to actually come

[00:05:50] Julie: Hmm,

[00:05:51] Karinda: to be raised up, as a blood test result. But it will equally, it will take some time to come back down once the inflammation is, is resolved.

[00:05:59] [00:06:00] Well, perhaps let's lead into this

[00:06:02] Julie: Hmm.

[00:06:02] Karinda: Because of the nature of blood tests, they are heavily impacted, influenced, confounded by lots of different factors.

[00:06:10] Julie: Mm-hmm. Mm-hmm.

[00:06:12] Karinda: And this is why I, I just don't think the message is being, uh, spread enough in terms of accurate blood, uh, collection, in terms of fasting periods. So I feel like that that is just a really good practical tip to start us off.

[00:06:27] Julie: Yeah. Yeah. I, I, I think the thing that, now, you might see it pretty often too, that the, the fasting period.

[00:06:36] Karinda: Mm-hmm.

[00:06:36] Julie: so I have a lot of people that may be, we're already doing intermittent fasting or something along those lines, and they, or they see that it needs to be a fasted test, or I've told them that it, that it's, it's ideal to have, um, to be fasted that, and, um, they may fast too long,

[00:06:55] Karinda: Yes. Yep.

[00:06:56] Julie: Which

[00:06:56] Karinda: And too long?

[00:06:58] Julie: Too long, uh, well, more than [00:07:00] 12 hours.

[00:07:00] I, ideal is around about 10 hours,

[00:07:04] Karinda: Yep,

[00:07:05] Julie: but more than 12 hours is, is gonna start, um, stimulating a more of an inflammatory, um, response. And, um, that's going to impact on some of the results. I,

[00:07:17] Karinda: So at least eight hours of fasting, but no more than 1210 is the sweet spot.

[00:07:22] Julie: yeah.

[00:07:22] Karinda: Yep.

[00:07:23] Julie: Yep.

[00:07:24] Karinda: this is something that, that's something that came up with my mum recently where I was instructing her on how to do the accurate fasting. And she was like, well, I can tell you that every blood test I've ever gotten, I have been more, I haven't eaten food for, um, under 12 hours.

[00:07:38] Like it, her fasts had always been longer than 12 hours. And it makes me wonder, gosh, how much was that impacting the results? And similarly, she's a big morning exerciser. No exercise.

[00:07:50] Julie: Yeah.

[00:07:52] Karinda: Some practitioners, some holistic practitioners would say no strenuous exercise in the 48 hours before a blood test. Not just [00:08:00] the morning of.

[00:08:01] Julie: Mm hmm.

[00:08:02] Karinda: Again, 'cause exercise, especially when strenuous or intense can create a state in the body that can appear to be inflammatory.

[00:08:11] Um, similar to that, you know, excessive fasted state. It changes results. And that includes sex.

[00:08:22] Julie: Yeah. Well be, because there are, there are particular markers say, some of the liver panel markers that, that are measure measurements that can be skewed because the same molecule is released from muscle breakdown.

[00:08:42] Karinda: Mm-hmm.

[00:08:43] Julie: And, and when we do strenuous exercise, that's part of, part of that.

[00:08:48] Karinda: Yeah. Yeah.

[00:08:49] Julie: that's, that potentially can skew the, the, the, um, results.

[00:08:55] Karinda: And, and that's, that's actually again, quite relevant to what I was looking at with my mum. You sort of get to the [00:09:00] point where you are, you are having to differentiate between what's signaling a kind of anemia versus what is just signaling some higher red blood cell turnover, which will come as a result of exercise and muscle breakdown.

[00:09:14] And again, inflammatory markers can be up when there is higher presence of, um, fibrinogen in the blood. And that, that will be, if you're breaking down any muscles or even just getting a strain or a tear, just if, if you're a relatively active person, that can totally change the results.

[00:09:32] Julie: Hmm, hmm.

[00:09:33] Karinda: And I'm think I, now, I don't know about you as well, but I have a fair few patients who are

[00:09:39] really not fans of needles. And so I can't stress this advice enough just to like prevent having to like go get it rechecked, you know, in a month or the following week. Just get it right from the start. Now, my controversial advice, maybe controversial

[00:09:59] Julie: Ooh.[00:10:00]

[00:10:00] Karinda: unless it's a blood test where you specifically have to be fed, and I'm not, I don't even know,

[00:10:06] Julie: Hmm

[00:10:07] Karinda: you know, perhaps like a, a glucose tolerance test.

[00:10:11] You drink the sugary, sugary drink that they give you because we want to see how your insulin and blood sugar levels responds to that. Unless you are specifically instructed to be in a fed state, I think all blood tests should be conducted 8 to 12 hours fasted, just to reduce the number of variables that we're working with when we are looking at your results, and we are going, hang on, what was the snapshot in which you've got these bloods taken?

[00:10:39] The same goes for stress levels, and the same goes for if you are coming down with something or if you are actively sick, or if you've just recovered. That will also skew the results. So it's better to just, even if it's just a little sniffle or you maybe just start to feel that thing in the back of your throat.

[00:10:59] Julie: Yeah.

[00:10:59] Karinda: Just a little [00:11:00] cough. Oh, but you don't feel sick, you don't have a fever. You're not like stuck in bed with the flu.

[00:11:04] Julie: Yeah.

[00:11:05] Karinda: Just wait.

[00:11:07] Julie: Yeah.

[00:11:08] Karinda: wait.

[00:11:09] Julie: Absolutely. And being well hydrated as well

[00:11:14] Karinda: Mm-hmm.

[00:11:14] Julie: because, I mean, apart from anything else, it's gonna make it easier for the phlebotomist to be able to find a vein

[00:11:21] Karinda: Please. Yeah.

[00:11:22] Julie: be able to draw the blood. Um, but there are also markers that are altered if you, if you blood, if, if you, if you are not. have enough water in your body.

[00:11:32] Karinda: Yes. And, and again. And yes, absolutely. And again, it, um, great tip for people who are really afraid of needles and just don't like that experience. Yes, we want you to be fasted from food, which does include, you know, we don't want you drinking coffee or tea or a hot chocolate or you know, a soy milk something,

[00:11:52] Julie: Hmm

[00:11:53] Karinda: uh, before your test.

[00:11:54] Keep it to water only, but be really diligent about the amount of water you're [00:12:00] drinking. Now you gotta, it's, it, it can be a bit tricky 'cause you've gotta find the sweet spot.

[00:12:04] Julie: hmm.

[00:12:04] Karinda: Don't drink a ridiculous amount of water that is nothing at all, like what you would drink in a normal morning. Right. And, and this is where if you have the lead time.

[00:12:15] Start hydrating a bit better over the 48 hours before you get the blood test. Yeah,

[00:12:21] Julie: I, I always say the day before.

[00:12:23] Karinda: yeah. Start.

[00:12:25] Julie: just it you, you must have your minimum two liters of water

[00:12:31] Karinda: Yes,

[00:12:32] Julie: before and then have a big drink in the morning as well. And then, you

[00:12:36] Karinda: Yep.

[00:12:37] Julie: just topping up.

[00:12:38] Karinda: Yep. And I, I don't know if it's just me, but just I guess a couple of extra tips. I get really stretchy and I, I warm up my body. That's also gonna make the blood flow a little bit easier compared to if you're cold. So yes, avoid strenuous exercise, but do a little bit of, you know, bouncing on your heels or shaking out your joints and like, sort of just [00:13:00] squeezing, squeezing your fist together, doing some calf raises, something like that just to get a little bit more blood flow.

[00:13:07] Also, underrated tip, maybe with the fasting element, I actually found it harder than I thought it would be. I was calculating the time that my last meal would have to be if I didn't wanna go over the 12 hours

[00:13:22] Julie: Yeah.

[00:13:23] Karinda: to think about dinner time. And I had to, to figure it out. I had to look at what time the blood test collection center opens.

[00:13:32] Julie: Yep.

[00:13:33] Karinda: I had to get a gauge of how busy it may be when I first arrived. So do you get there before it opens and now look, if you get there, as soon as it opens, there will already be five to 10 people in queue because all the

[00:13:46] Julie: really?

[00:13:47] Karinda: Oh yeah, the oldies go there, they're ready. They know, especially if it's a Saturday morning, they are ready before the doors open.

[00:13:55] Julie: Yeah.

[00:13:55] Karinda: I think there are some Path labs that will let you book an appointment now. But [00:14:00] as far as I've seen, it still is very much that old school thing of you show up, you don't need an appointment, you get a number, you wait till your number's called. So when you are planning your fasting window, you need to consider that you might be in that waiting room for up to half an hour.

[00:14:17] Hopefully not too much longer than that. and if you're not sure, call the lab. Call the lab that you plan on going to say, Hey, look, how busy do you usually get on a this day morning? Do you recommend coming earlier? Can I book an appointment? You know, I'm trying to line it up with my eating window as simple as, so.

[00:14:34] Yeah, I had to do a little bit of mental gymnastics and calculations in my head to go, oh, I, I need to have food going into my body at like to make sure I'm going over that 12 hours. It, it was just, and I'm just sharing that because when I was figuring it out for myself, it was more maths than I anticipated, and I thought, people aren't doing this math

[00:14:56] Julie: Yeah. Yeah.

[00:14:57] Karinda: this is definitely not happening [00:15:00] across the board.

[00:15:00] So I, I feel like that's a good tip to share.

[00:15:04] Julie: And that's, so we, this is gonna be contradictory because for, for good circadian

[00:15:14] Karinda: Yes.

[00:15:15] Julie: we would tell people to eat between sunup and sundown.

[00:15:20] Karinda: Yes.

[00:15:20] Julie: but that doesn't preclude you in the case of having a blood test the next day of having a, an after dinner snack,

[00:15:29] Karinda: Yes, absolutely. And that.

[00:15:31] Julie: So,

[00:15:31] Karinda: Yeah.

[00:15:32] Julie: that's when your, your fasting window starts from your after dinner snack.

[00:15:37] Karinda: Yes. And thank you for mentioning that because that, that will make my partner feel very seen, because you could imagine his confusion when I'm fresh on the scene, I'm all over his routine. I'm being very diligent with, we need to eat dinner as early as possible. We need to pretend we're old people. We need to be eating dinner at five o'clock.

[00:15:54] We can't be waiting after the sun goes down. If it's dark, it's too late. I, I was just spewing all this [00:16:00] intensity and then we were both getting blood tests and I was like, yeah, look, we're gonna have to eat dinner at 9:00 PM Okay. So you gotta, you gotta, let's stretch it out or have Yeah. Have a little dessert.

[00:16:09] so yeah. Good thing to consider.

[00:16:11] Julie: Yeah. Yeah. And it doesn't have to be a sweet dessert

[00:16:14] Karinda: no, no.

[00:16:15] Julie: just because it's after dinner. It doesn't have to be a dessert. It could be a boiled egg.

[00:16:19] Karinda: Boiled egg. I think I might've gone for brown rice cakes with like a bit of salmon on it. Yeah.

[00:16:25] Julie: Nice.

[00:16:25] Karinda: Yep.

[00:16:26] Julie: Wild caught salmon. Of course.

[00:16:28] Karinda: Canned, but wild caught. Yes. Yes. I saw your, your recent post, we'll put that, we'll link him in the show notes.

[00:16:34] Julie: yeah. It just,

[00:16:35] Karinda: Great PSA, actually maybe we need to do a separate podcast that goes for five minutes where we just say, here's why we, please, dear God, don't want you putting any kind of Tasmanian or any kind of farm to salmon into your body, or supporting that industry for that matter.

[00:16:54] Julie: Yeah.

[00:16:54] Karinda: Yeah.

[00:16:55] Julie: Yeah. It's so many reasons

[00:16:57] Karinda: many

[00:16:58] Julie: Yep.

[00:16:59] Karinda: Takes me back to [00:17:00] my veganism days of getting on the, stepping on me podium and saying, you shouldn't eat this, and here's why. But the, but, but guys, but this is a really serious one. I, I'm not just being an annoying ex vegan. It's really fucked.

[00:17:14] Julie: It, uh, it really is.

[00:17:16] Karinda: Yeah.

[00:17:16] Julie: Yeah. so wanna talk about it now, but we probably should stick to topic and we'll talk about it after.

[00:17:24] Karinda: Yes, we, we will, we'll record another one. So I wanna kind of to wrap up, maybe to wrap up, we won't have other points, but for blood tests

[00:17:34] Julie: Yeah.

[00:17:35] Karinda: I did just wanna say, 'cause you led with your doctor will look at these differently

[00:17:40] Julie: yes.

[00:17:41] Karinda: I want to nudge towards, okay, so how do we look at blood tests? How is that different?

[00:17:46] And again, just like I said, not all doctors, not all naturopaths. Okay. Contrary to popular belief, we do not have a universal kind of training. We are not registered to practice in the exact same way. We [00:18:00] naturopaths rule practice differently. And that will have a range of different qualifications and levels of experience.

[00:18:04] So I'll speak for us because we have similar training including pro continuing professional education routes we've chosen to go down when it comes to pathology.

[00:18:15] Julie: Yep.

[00:18:16] Karinda: We will cross reference your result for whatever blood test it is we're looking at with what we call functional ranges, or you could also call them optimal ranges, where the standard reference range that will be on reported on your blood test result,

[00:18:35] on that piece of paper, that is based on frank disease states, as we mentioned. That reference range, depending on the marker, is derived from population average, population data. It's not accounting for differences in sex in age, in inactivity level genetics. It's not accounting for anything of that.

[00:18:56] It's just some of the general population. [00:19:00] Right.

[00:19:00] Julie: Hmm.

[00:19:00] Karinda: So it's already not tailored to you.

[00:19:03] Julie: Hmm.

[00:19:04] Karinda: We try to make it a bit better than that by looking at these functional ranges, which instead of just ruling out frank disease, functional ranges are geared towards what is actually optimal. What level would we like to see this thing at?

[00:19:20] And again, the practitioner needs to bring in the layers of discernment for who the individual is sitting in front of them. But these functional ranges tell us where do we want your level at? Not just to know that you are free from disease, but to know that your body is functioning optimally, your body is functioning, or this system or whatever this marker reflects in your body is functioning at its peak.

[00:19:46] So by using these functional ranges, there may be more that gets flagged. Compared to what the doctor says, but we, we are not look just looking for disease, we are looking for preventing illness. We're [00:20:00] looking for trends to see if something is sort of heading in a direction we don't want, just wanna see that it's in the clear.

[00:20:06] In this one instance, we wanna see, oh, hang on, what was it compared to last time? Or is it sort of getting close to that edge of being out of range? And we wanna make sure that you are as well as you could be, not just okay, not just not unwell.

[00:20:22] Julie: Mm

[00:20:23] Karinda: That's the best way I can summarize functional ranges.

[00:20:26] Julie: That was beautiful. That was, yeah. Really, really? Yeah.

[00:20:33] Karinda: Sorry.

[00:20:35] Julie: No, that was great. The only things that I would add to that is that one of the things that we can do is that we use a spreadsheet and we would have your historical blood tests in there. So I to people, send, send me all your tests. And they go, oh no, there's too many. No. Send them all. Send them all.

[00:20:57] I love that. More data's better, [00:21:00] because we can then look at what's your normal

[00:21:04] Karinda: Yes.

[00:21:04] Julie: Because these reference ranges apply to the entire population. And it's, it's just not reasonable to expect that a, a child or an elderly person or a, you know, I always say a 4-year-old girl or a 60-year-old male bo bodybuilder,

[00:21:25] Karinda: Mm.

[00:21:25] Julie: because it, it's just not reasonable to expect these different populations to have the same results, the same markers.

[00:21:35] Karinda: Yeah.

[00:21:36] Julie: So there's that. Um, and then something like what you were mentioning with your mum where she's always for longer.

[00:21:45] Karinda: Mm

[00:21:47] Julie: because there's a consistency there,

[00:21:50] Karinda: mm

[00:21:51] Julie: you can, it, it's still gonna alter the ranges, but you'll still see patterns

[00:21:57] Karinda: Yes. Yeah.

[00:21:58] Julie: those things. [00:22:00] So, you know, we are, we are looking at. Multiple markers combined with each other and, and how they may interact with each other.

[00:22:09] Karinda: Yeah.

[00:22:10] Julie: Hmm,

[00:22:11] Karinda: And I like that point on consistency actually. For anyone who's really hardcore and we, we know, we've got some hardcore fans who love following, they love following the rules, or they like a challenge. My challenge slash recommendation would be see how consistent or see how replicable you can make the two days and the morning of you get your blood tests.

[00:22:36] So like how consistent can you be in that? Can you eat the same thing the night before? Can you have the same amount of water? You know, try to see how consistent you can make it. Especially if you are one of those people who loves getting your blood tests done every year or every six months 'cause you just like to keep an eye on things.

[00:22:54] Um, I, I think that's just a nice little thing including season. Including the [00:23:00] season and the time of year that you get it tested.

[00:23:02] Julie: Yes.

[00:23:04] Karinda: Yeah.

[00:23:04] Julie: Because that's gonna change your vitamin D levels,

[00:23:08] Karinda: Yeah.

[00:23:08] Julie: which, which may alter, inflammatory markers, alter other things.

[00:23:18] Karinda: and also well. It's not a blood test, but I'm wondering if there's anything that would be reflected in a blood test about this. Maybe some of the red cell markers, but just we, we've recently learnt, uh, the extent to which season can have an impact on blood pressure and cardiovascular health. So if you get your blood pressure checked at the doctors, that may be influenced, likely will be influenced seasonally and depending on your sun exposure.

[00:23:51] Julie: Yeah.

[00:23:52] Karinda: that's some fun research that will go into another time.

[00:23:54] Julie: Yeah.

[00:23:55] Karinda: Um,

[00:23:56] Julie: I feel like we keep saying that we are gonna talk about [00:24:00] circadian, but we, and we will,

[00:24:02] Karinda: and will

[00:24:03] Julie: really go into depth.

[00:24:05] Karinda: Yeah. And it comes up with everything but yeah. So yeah, blood. Any other thing we wanna say about blood tests?

[00:24:13] Julie: I think you touched on it earlier, but I'd just like to highlight it a bit more, particularly around, blood sugar metabolism, is that when we are talking about these reference ranges being in particular population groups, it's the population that that tests.

[00:24:35] Karinda: Okay.

[00:24:35] Julie: it might, it might be a lab that's na nationwide, Australian wide, but if they are, say, predominantly in areas where there are more diabetics, for example, more type two diabetes, right. Um. The, when you are taking the, the, you know, the 95th [00:25:00] percentile of that group as the reference range. If a higher proportion of people in that group have higher blood sugar because more of them have diabetes, that alters

[00:25:14] Karinda: Yep.

[00:25:14] Julie: the reference range for that lab.

[00:25:18] Karinda: Mm-hmm.

[00:25:19] Julie: And that happens with more than, you know, not, not just the, the, um, blood sugar markers, but, but all markers. So as a, as a society where we, uh, in the western world generally, but spec specifically in Australia where we have more chronic disease, more autoimmune diseases. These reference ranges are getting skewed

[00:25:46] Karinda: Yeah.

[00:25:47] Julie: favor. So that normal, which is healthy to your gp, that, that those, you know, the [00:26:00] goalposts keep moving.

[00:26:01] Karinda: Yes. And, and when chronic disease is. Quite frankly, only on the rise. Um, we really needed to, we do really need to consider how much those goalposts are moving, and if we are measuring a goal, we need to look at the goalposts so that we are measuring them against, right.

[00:26:20] Julie: hmm.

[00:26:20] Karinda: and you know, actually I will call this out.

[00:26:22] My mom just said to me last night, um, that my stepdad was asking her like, oh, surely if you know these, these blood tests that Karin's ordered for you, surely if something was really wrong, the doctor would've ordered them. And it's like, well, what, what goalposts are you working with? What are your goals and

[00:26:41] Julie: Hm.

[00:26:42] Karinda: what goalposts are you aiming by?

[00:26:44] Because, you know, looking at some results, it's like, no, you, you have to check this, or this is the next best step. And, and sometimes your GP in, in totally good faith is just like, no, there's nothing [00:27:00] concerning here. And they're probably, they're probably comparing you to the really morbidly, unwell people that they see, of which they would see many.

[00:27:08] You've gotta consider the, the demographic that's also visiting the GPs most frequently. Right.

[00:27:13] Julie: Hmm.

[00:27:14] Karinda: And they're probably going, no, this person's healthy in comparison. This person's fine.

[00:27:17] Julie: Yeah. And, and, you know, they're, they're looking for, uh, someone that needs medication. many of their decisions are driven by, you know, not hashtag not all doctors, but predominantly that's what they're looking at. Does this person need to be medicated or not?

[00:27:38] Karinda: Because that's their toolkit.

[00:27:40] Julie: Yeah. And also they, they're working within a system, you know, in their defense,

[00:27:45] Karinda: Yeah.

[00:27:45] Julie: we've talked about this before, they're working within a system that is restricted. Medicare system pays for blood tests, but GPs that are prescribe over, [00:28:00] prescribing, um, have, can have great penalties. You know,

[00:28:04] Karinda: Yeah,

[00:28:04] Julie: have to pay back for tests that were over a certain limit

[00:28:09] Karinda: yeah,

[00:28:10] Julie: and, and they never know where those limits are. They'll just get a bill in the mail. I, I think some, one of my lecturers was talking about a GP friend of hers that got a $15,000 bill in the mail, like a warning letter.

[00:28:23] You, you know, you've getting close to over-prescribing.

[00:28:26] Karinda: Yeah. Yep.

[00:28:28] Julie: and then $15,000 bill.

[00:28:30] Karinda: You know.

[00:28:31] Julie: make you cautious, wouldn't it?

[00:28:33] Karinda: Yes, absolutely. And so, and, and that brings up a good point. How many clients have you had saying, yeah, my doctor said we don't need to test that? Or I, I requested these tests from my doctor. May, and this happens a lot. People start seeing naturopaths. The naturopath says, okay, well let's get a baseline.

[00:28:51] Here are all the, they don't have recent blood tests. Say, for example, naturopath says, here are all the things we would like to check in a really holistic checkup. Right, or, or [00:29:00] specific to your symptoms. Uh, I will say most of these you could get covered by Medicare. We're in Australia, a shout out to our US listeners, of which we've realized we have many.

[00:29:15] Julie: yeah.

[00:29:15] Karinda: Um,

[00:29:16] Julie: Hi.

[00:29:17] Karinda: so Medicare is different to the Medicaid, or I think there is Medicare in America, but not very different to what we've got here. Yeah,

[00:29:23] Julie: It's

[00:29:24] Karinda: so many tests will be Medicare covered, especially annually if you're not getting them tested more than once a year. For a lot of tests if you want to get them checked more frequently than annually, you need like a strong family history or one of your previous test results need to, needs to be so far above the range or under the range, something like that.

[00:29:45] So I'll say you can get most of these through your GP or a GP and it will be covered by Medicare And when budget is a really genuine concern, I focus on that because [00:30:00] I wanna make healthcare and information as accessible as possible.

[00:30:03] Julie: Yeah.

[00:30:03] Karinda: I always say if you come up against any issues with your gp, if they're reluctant to order these tests,

[00:30:10] Julie: Hmm.

[00:30:11] Karinda: let me know.

[00:30:11] And if you do have the budget for it, we can refer for these privately.

[00:30:17] Julie: Yep.

[00:30:17] Karinda: And if you have no other need to see your gp, you don't have to go through them. And then technically it takes the burden off the GP system where it's more acute care, it's more, you know, prescribing care and, you know, it keeps them under the threshold that they're concerned about in terms of ordering too many blood tests for people.

[00:30:34] So we do have that option, which I think some people may not know, they think maybe they can only get blood tests through their gp. You can get it through your naturopath depending on what, pathology providers your naturopath is, uh, connected with. It, it will just be out of pocket. So, and look, some people have the money.

[00:30:53] If you have the money and you don't wanna f around and, and waste any time. It's very direct to get it through and easy [00:31:00] to get it through a naturopath.

[00:31:01] Julie: hmm.

[00:31:01] It's not necessarily that expensive either. I mean, you know, that's, that's a relative thing. It depends what you are testing, but,

[00:31:08] Karinda: yes. Yeah.

[00:31:08] Julie: know, if you're, if you're, if you're only needing, you know, a couple of different markers, it could be as cheap as, you know, $50.

[00:31:17] Karinda: Yeah, yeah, yeah. And then, and that may be the case. You may be able to get your annual tests done at your gp, but maybe there's B12 or iron that you want to more closely monitor or folate something that you've been supplementing with. And the recommendation is, look, we don't wanna wait another year. We want to check this in six months.

[00:31:34] Get that done through your naturopath. It'll be a little bit out of pocket. Yeah. Less than a hundred dollars for a couple of markers. So yeah.

[00:31:41] Julie: Yeah. Yeah. Hmm.

[00:31:43] Karinda: So other testing.

[00:31:45] Julie: Other testing? Well, out, oh, well, let's just still stick with GP aligned testing.

[00:31:55] Karinda: Um.

[00:31:55] Julie: this is, yeah, well this is probably not something that you will come [00:32:00] across in your patient demographic. but I, I like to do a coronary artery calcium score,

[00:32:07] Karinda: Oh,

[00:32:08] Julie: For my older patients. Particularly where their GP might be prescribing, medications for cardiovascular issues. And what we wanna do is look at what's your five to 10 year risk for there being a cardiovascular event.

[00:32:28] Karinda: Mm-hmm.

[00:32:29] Julie: It's an ultrasound and it measures how much calcium is in some major blood vessels, right?

[00:32:36] And that measurement, it doesn't really need to be done again, but it's an indication of your risk for things like atherosclerosis, which can cause, stroke or uh, heart attack. That's something that if your GP is not keen and this, this came up recently the GP was, [00:33:00] well, you know, you are already on statins.

[00:33:03] You are already on. Yeah. So why would we need to test for that? It was like, well, we wanna know what the risk is so that we can do everything we can to, to reduce, you know, pre preventative medicine.

[00:33:18] Karinda: Yeah.

[00:33:20] Julie: And that's been really, really informative too. That's,

[00:33:25] Karinda: Mm,

[00:33:25] Julie: been great. Because of course we do have strategies to reduce blood pressure,

[00:33:29] Karinda: of course. Yeah. Of, oh my gosh,

[00:33:31] Julie: and, and we, we do have strategies to reduce cholesterol. That's a whole other thing of, its on its own.

[00:33:38] We don't necessarily treat cholesterol in the same way that, that your gp will, either

[00:33:44] Karinda: Yeah, yeah.

[00:33:44] Julie: we, we will look with a little bit more nuance.

[00:33:48] Karinda: Yes. Yeah, absolutely.

[00:33:50] Julie: Yeah.

[00:33:50] Karinda: And the other thing with the coronary calcium score, and for someone who's already on cardiovascular [00:34:00] influencing medications, it it like. That perspective of like, well, they're already on the medications. It's like, yeah, not considering like the quality of life that can be impacted as a result of like side effects from the medication.

[00:34:11] Or even just looking at it from a perspective of what if the con, the original concern is now resolved or is preventable through other strategies that we've worked on lifestyle or food or using certain herbal formulas or nutritional formulas. Would, is it not less of a burden on like the public healthcare system to like have them off that medication?

[00:34:34] And, and that's where like, and that's, that's where we can have a great play, a great role in as far as public health goes. Like, isn't it a good thing if less people need to be on effin, warfarin or statins, like, or, or less intense blood pressure medications than warfarin. Like, isn't that a good thing?

[00:34:57] Julie: Yeah. Oh, and combinations, you know, because [00:35:00] the older you get, the, the more you are likely to be accumulating the number of drugs that you're taking. and they, they interact with each other.

[00:35:10] Karinda: yes. Yeah.

[00:35:12] Julie: I had to a polite letter to a doctor because I had a patient that had developed a, a rash. And one of the interactions from these two medications that he was on was this rash that was concerning. You just have to be mindful

[00:35:31] Karinda: Mm,

[00:35:31] Julie: that when you start layering these medications upon each other that

[00:35:36] Karinda: yeah.

[00:35:37] Julie: that they can have side effects

[00:35:40] Karinda: Yep, yep.

[00:35:42] Julie: individually, and combined.

[00:35:43] Karinda: Yeah, and it's just so unfortunate that the, the target. The most at risk population for that is the older generation who will already be more prone to health issues outside of like medication side effects or medication to medication interactions. My [00:36:00] heart really breaks for 'em 'cause they just, they get the absolute short end of the stick I think, when it comes to conventional healthcare.

[00:36:07] Yep.

[00:36:08] Julie: Yeah.

[00:36:08] Karinda: Yep.

[00:36:09] Julie: Um, which leads me to one other test that is commonly done, and that is the, the bone density scan,

[00:36:18] Karinda: Oh, a DEXA scan?

[00:36:19] Julie: DEXA scan. Yeah. A great to have, it's using x-ray, multiple x-rays,

[00:36:29] Karinda: Mm-hmm.

[00:36:30] Julie: a test you wanna, you wanna be having on a regular basis. So it'll give you a T-score. It'll tell you basically how much calcium is in the bone matrix. There's more than calcium in the bone matrix

[00:36:47] Karinda: Mm.

[00:36:47] Julie: it strong. You

[00:36:48] Karinda: Yep.

[00:36:48] Julie: want flexibility in your bones.

[00:36:51] Karinda: Mm

[00:36:51] Julie: so, there's a new kind of testing using a, a sort of like an ultrasound, [00:37:00] which measures the same sites on the body.

[00:37:04] Karinda: mm

[00:37:04] Julie: And it will give a fragility score in addition to a T score.

[00:37:10] And again, you don't need to have a GP referral.

[00:37:14] Karinda: Okay.

[00:37:15] Julie: but if you link up with your naturopath and your naturopath can help interpret those scores for you and look at it against maybe previous DEXA scores.

[00:37:25] Karinda: Yeah. Beautiful. Oh, that sounds really good. So is that a thing where it doesn't require a GP referral, but therefore may come with a, a price tag?

[00:37:34] Julie: Yes.

[00:37:35] Karinda: Yeah.

[00:37:35] Julie: it's, it's, it's not onerous. I think it's about $240.

[00:37:42] Karinda: okay.

[00:37:43] Julie: I'm not sure if it's nationwide. I know that we do have one outlet here.

[00:37:48] Karinda: Okay,

[00:37:48] Julie: Um,

[00:37:49] Karinda: cool.

[00:37:49] Julie: Reach out to me if you are interested in finding out more about that, that testing. And I'll direct you to the nice people who sent me [00:38:00] reams of, lovely research about, about their testing method and how IT com compares to DEXA.

[00:38:06] Because the, the concern is that your bones are brittle and you have a fall, that you can have a break. If you have a break that hospitalizes you, if you're over 70, that can have other implications. It can in, in terms of, um, your longevity.

[00:38:28] Karinda: Hmm.

[00:38:28] Julie: So reducing, um, fractures is really important. But the drug therapy that's given when people are in osteoporosis, is quite, quite severe. And it increases the calcium deposition into the bones, but it makes them more brittle. So the outcome is not being achieved.

[00:38:55] Karinda: God.

[00:38:56] Julie: The outcome's gotta be reducing fracture, not [00:39:00] increasing bone calcium.,

[00:39:01] Karinda: Yeah.

[00:39:03] Julie: Mm-hmm.

[00:39:03] Karinda: And whole, equally a whole other rabbit hole where I'm sure there's a lot more information.

[00:39:08] Julie: yeah. Sorry. So we can, we can leave the, the, the world of conventional medicine and go fully functional now.

[00:39:19] Karinda: Yes.

[00:39:20] Hello, it's editing Corinda here. Just wanted to let you know that we recorded a mega episode for you, and we decided to split it into a two-parter. So this episode was all about the conventional testing that you can get done through your gp, the standard testing that we're more familiar with.

[00:39:36] And next episode, part two, coming soon, is it gonna be all about the functional testing. This is where it gets a little bit more interesting, a little bit more fun. A little bit more naturopathic. So they're 2 45 ish minute episodes. We hope you enjoyed part one, and we hope you stick around for part two, coming soon.

[00:39:54] Thank you for listening to another episode of The Nuanced Naturopaths. Be sure to [00:40:00] ask us any questions you have below. Engage with the polls and we'll catch you in the next one.