“It’s like building a house.
You don’t put up the
weathervane first, you need to
put in the foundations, build
the walls, the roof, then put
the weathervane on top.
You’ve GOT to go through
the basics, if you miss the
basics, you’re missing a
golden opportunity.” Jeremy Hill
Essential Health. Cottesloe, WA
Malnutrition Exists in Western World
Frank nutrient deficiencies found in 10-
20% westernised populations.
Much higher for marginal deficiencies
(e.g. 40-50% adults with B12 insufficiency).
Scholey A. et al. Proc Nutr Soc. 2018 Feb;77(1):73-83.
doi: 10.1017/S0029665117004025.
The Difference Between Optimal
and Suboptimal Nutrition
Young LM, et al. Nutrients. 2020 Sep 28;12(10):2964. doi: 10.3390/nu12102964.
Lower mood disturbance
Lower perceived stress
Better cognitive processing
Sub-Optimal
Optimal
Case study
Tala, 55Initial
PrescriptionFollow-ups Results Investigations
Presentation
& History
Current symptoms:
- Hospitalised for severe subacute
thyroiditis
- Fever, severe neck pain, raised
inflammatory proteins and free T4
- Prescribed prednisolone (60 mg
daily)
History:
- Muscle and joint pain
- Restless leg syndrome (RLS) for
10 years. Intermittent use of
Pramipexole.
- 6 years menopause
Case study
Tala, 55Presentation
& History
Initial
PrescriptionFollow-up ResultsInvestigations
Pathology results:
- Erythrocyte sedimentation rate (ESR) 105 mm/hr (0- 29 mm/hr)
- C-reactive protein (CRP) 145 mg/L (< 5 mg/L)
- Free T4 35 pmol/L (15-25 pmol/L)
Case study
Tala, 55Presentation
& HistoryResultsInvestigations
Initial
Prescription
3 months later:
- Patient presented with fatigue
- Muscle and joint pain, and
RLS still present
- Prednisolone dosage 10 mg
daily
Investigations:
- TSH: 21 mU/L (0.3-3.0 mU/L)
- Free T4 8.5 pmol/L (15-25 pmol/L)
Treatment:
- Prescribed thyroxine 100 mcg/d
which resulted in severe palpitations
- Thyroxine halved, then discontinued
Follow-up
Case study
Tala, 55Presentation
& HistoryResultsInvestigations
Initial
Prescription
Haematology results:
- Hb 140 g/L (120-160 g/L)
- Ferritin 27 μg/L (30-220 μg/L)
- Liver, kidney and coeliac disease,
and occult blood all negative
- Prescribed intravenous (IV) ferrous
sulphate
After 12 months:
- Still receiving IV ferrous sulphate
- Ferritin 100 μg/L
- Symptoms had gradually
disappeared
Follow-up
A Case of Mistaken
Identity?
Iron deficiency with or without
anaemia impairs thyroid function
• Blunts thyroid response to
thyrotropin-releasing hormone
• Impairs thyroid peroxidase activity
• Lowers peripheral thyroid hormone
concentrations
• Lowers T4 to T3 conversion
A Case of Mistaken Identity?
• Banday TH, Bhat SB, Bhat SB, Bashir S, Naveed S. Incipient iron deficiency in primary hypothyroidism.
Thyroid Res Prac. 2018 Sep 1;15(3):138.
• Dahiya K, Verma M, Dhankhar R, Ghalaut VS, Ghalaut PS, Sachdeva A, et al. Thyroid profile and iron
metabolism: mutual relationship in hypothyroidism. Biomed Res. 2016 Apr 14;27(4).
• Khatiwada S, Gelal B, Baral N, Lamsal M. Association between iron status and thyroid function in Nepalese
children. Thyroid Res. 2016 Jan 27;9:2. doi: 10.1186/s13044-016-0031-0.
Case study
Ava, 41Initial
PrescriptionFollow-up Results Investigations
Presentation
& History
Current symptoms:
- Fatigue – low energy (4/10)
- Brain fog
- Diagnosed with adenomyosis
- Underlying gut issues
Current supplements:
- High Purity, Low Reflux,
Concentrated Fish Oil
- High Bioavailability Magnesium
(Meta Mag®) with active B6
- Spirulina
- Progesterone - 100 mg daily
Case study
Ava, 41Presentation
& History
Initial
PrescriptionFollow-up ResultsInvestigations
Pathology results:
- Iron – 16 μmol/L (10-30 μmol/L)
- Trans sat – 28% (20-40%)
- Ferritin - 51 μg/L (30-220 μg/L)
Case study
Ava, 41Presentation
& HistoryFollow-up ResultsInvestigations
Initial
Prescription
Initial supplement prescription:
- High Potency Vegetarian Iron with 5-MTHF
Diet/Lifestyle:
- Patient did not wish to increase intake of red meat
Case study
Ava, 41Presentation
& History
Initial
PrescriptionFollow-upInvestigations Results
51
60
46
48
50
52
54
56
58
60
62
May-20 Aug-20
Ferritin (μg/L)
Energy increased 4/10 to
7/10 one month after iron
supplementation.
Subclinical Iron Deficiency:
A Diagnostic Challenge
SymptomsBackground
information
Differential
diagnosis
Ferritin
interpretation
Sawada T, et al. Biol Trace Elem Res. 2014 Jun;159(1-3):22-31. doi: 10.1007/s12011-014-9963-1;
Soppi ET. Clin Case Rep. 2018 Apr 17;6(6):1082-1086. doi: 10.1002/ccr3.1529.
Deciphering Iron Deficiency in
the Presence of Inflammation
Ferritin: <100 μg/L
OR
Ferritin: 100 - 300 μg/L with
Transferrin saturation < 20%
Dignass A, et al. Int J Chronic Dis. 2018 Mar 18;2018:9394060. doi: 10.1155/2018/9394060.
Clinical Considerations of Testing
Accurate and reliable? Clinically valid? Clinical utility?
How accurate and reliable is
the test?
Does it accurately monitor
nutritional recovery?
How likely will the test improve
patient outcomes?
Camp KM, Trujillo E. Position of the Academy of Nutrition and Dietetics:
nutritional genomics. J Acad Nutr Diet. 2014 Feb;114(2):299-312.
The Choices for
IroningOut a Solution
IRON
SUPPLEMENTATION
Meta Fe®
High Potency Vegetarian Iron
with 5-MTHF
Treatment Maintenance
Iron and Lactobacillus plantarum
299v to Support Iron Absorption
• Correcting and preventing iron
deficiency and iron deficient
anaemia
• Improving fatigue
• Increase iron absorption
• Support energy levels
• Gut health and general
wellbeing
Vitamin C and L. plantarum 299v
Enhance Iron Absorption
Stomach
• Vitamin C forms a
chelate with iron
• Increases iron
solubility of pH 2-11
• L. plantarum
299v increases
iron absorption
• Supports
beneficial gut
microbiome
L. plantarum 299v Enhances
Iron Absorption
0
5
10
15
20
25
30
35
40
45
50
Ferritin
μg/L
Lp299vFe baseline Lp299vFe post trial
Fe baseline Fe post trial
L. plantarum 299v
(1010
CFU) + iron
(20 mg)
Iron (20 mg)
Axling U, et al. Nutrients. 2020 Apr 30;12(5):1279. doi: 10.3390/nu12051279.
12 weeks Ferritin
70%
42%
L. plantarum 299v For
Better Gut Health
L. plantarum
299v
Placebo
44%
18%18%
36%
4 weeks
Nobaek S, et al. Am J Gastroenterol. 2000 May;95(5):1231-8.
doi: 10.1111/j.1572-0241.2000.02015.x.
The Many Faces of Vitamin B12 Deficiency
Wolffenbuttel BHR, et al. Mayo Clin Proc Innov Qual Outcomes. 2019 May 27;3(2):200-214.
doi: 10.1016/j.mayocpiqo.2019.03.002.
• Depression
• Severe peripheral
neuropathy
• Skin lesions
Vit B12: 51 pmol/L
• Fatigue & sleepiness
• Numbness in hands
• Dizziness
• Exertional dyspnoea
• Problems with word
finding
Vit B12: 112 pmol/L
• Fatigue
• Difficulties
concentrating
• Executing difficult tasks
Vit B12: 249 pmol/L
• Asymptomatic
Vit B12: 94 pmol/L
When to Test for Vitamin B12 Deficiency
Risk factors:
• Vegetarians/ vegans
• Patients 65+
• Gastric surgery
• Atrophic gastritis
• H. pylori infections
• Malabsorption
conditions (Coeliac
disease, IBD)
Clinical Signs & Symptoms
Neuromotor Neuropsychiatric Haematological
Australian Government Department of Health and Aging. 2013 Jul.
Available at: https://www1.health.gov.au/internet/main/publishing.nsf/content/
7C28F0B6D06F9FFCCA257EB9001D769B/$File/Vitamin%20B12%20testing%20Protocol.pdf.
GlossitisStomatitis
Clinical applications
• Management of hyperhomocysteinaemia
• Stress and mood support
• Cardiovascular support
Ingredients
Pyridoxal 5-phosphate monohydrate (Vitamin B6)
Riboflavin 5-phosphate sodium (Vitamin B2)
Co-methylcobalamin (Vitamin B12)
5-methyltetrahydrofolate
B12/Folate (5-MTHF) for Cellular Health
Modern Drivers Compromising Nutrition
• Australian Institute of Health and Welfare [Internet]. Australia: AIHW; 2020. Poor diet; 2019 Jul 18 [cited
2020 Nov 23]. Available from: https://www.aihw.gov.au/reports/food-nutrition/poor-diet/contents/poor-
diet-in-adults
• Azzolino D, Passarelli PC, De Angelis P, Piccirillo GB, D'Addona A, Cesari M. Poor oral health as a
determinant of malnutrition and sarcopenia. Nutrients. 2019 Nov 29;11(12):2898. doi:
10.3390/nu11122898.
• Barve S, Chen SY, Kirpich I, Watson WH, Mcclain C. Development, prevention, and treatment of alcohol-
induced organ injury: the role of nutrition. Alcohol Res. 2017;38(2):289-302.
• Gazey C. Effects of soil acidity [Internet]. South Perth, WA: Department of Primary Industries and Regional
Development; 2018 [updated 2018 Sept 17; cited: 2020 Nov 18]. Available from:
https://www.agric.wa.gov.au/soil-acidity/effects-soil-acidity?page=0%2C1
• Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term
nutritional issues. World J Diabetes. 2017 Nov 15;8(11):464-474. doi: 10.4239/wjd.v8.i11.464.
• Raatz SK, Jahns L, Johnson LK, Scheett A, Carriquiry A, Lemieux A, et al. Smokers report lower intake of
key nutrients than nonsmokers, yet both fall short of meeting recommended intakes. Nutr Res. 2017
Sep;45:30-37. doi: 10.1016/j.nutres.2017.07.010..
• Weyant C, Brandeau ML, Burke M, Lobell DB, Bendavid E, Basu S. Anticipated burden and mitigation of
carbon-dioxide-induced nutritional deficiencies and related diseases: A simulation modeling study. PLoS
Med. 2018 Jul 3;15(7):e1002586. doi: 10.1371/journal.pmed.1002586.
Soil pH Determines Nutritional Values
Gazey C. Effects of soil acidity [Internet]. 2018. Available from:
https://www.agric.wa.gov.au/soil-acidity/effects-soil-acidity?page=0%2C1
Barański M, et al. Br J Nutr. 2014 Sep 14;112(5):794-811. doi: 10.1017/S0007114514001366;
Environmental Working Group (EWG). 2020.
Available from: https://www.ewg.org/foodnews/dirty-dozen.php.
Is organic food more
nutritious? (Or just less toxic)
The Dirty (Bakers) Dozen:
1. Strawberries
2. Spinach
3. Kale
4. Nectarines
5. Apples
6. Grapes
7. Peaches
8. Cherries
9. Pears
10. Tomatoes
11. Celery
12. Potatoes
13. Hot peppers
“Its easy to snack healthy
at work!
I get vitamin C from coffee,
vitamin D from donuts,
vitamin B from bagels….”
Most Australians Adults Eat
Inadequate Fruit and Vegetables
Australian Institute of Health and Welfare. 2019.
Available from: https://www.aihw.gov.au/reports/food-nutrition/poor-diet/contents/poor-diet-in-adults
~6% eat 5 serves
vegetables
~50% eat 2 serves
fruit
EVERYDAY MINERAL
AND VITAMIN
SUPPLEMENTATION
Broad spectrum
mineral and vitamin
replenishment
Selecting the Best Multi
for Your Patient
Premium Strength
Multivitamin with
Activated B's and
Bioavailable
Minerals
Female Nutritional
Support with
Broccoli
High Strength
Multivitamin
Female
Multivitamin
Male
Multivitamin Multi-Minerals
High Absorption
Multi Mineral with
Apple Cider
Vinegar
Men’s Multi with
Milk Thistle
Missing Nutrients in
a Poorly Planned
Vegan Diet
• Calcium
• Iodine
• Iron
• Omega-3 fatty acids
(DHA/EPA)
• Vitamin B12
• Vitamin D
Protudjer JLP, et al. BMC Pediatr. 2020 Jul 10;20(1):341.
doi: 10.1186/s12887-020-02236-0.
Plant Based Meat Substitutes are a Promising Alternative
Soy/Pea Protein
Plant based vs.
animal based meat
study• Promote muscle synthesis
• Improve blood cholesterol
• Improve insulin levels
• Increase satiety• TMAO
• LDL-cholesterol
• Weight
Mycoprotein
Con:
• Potential allergy reaction
(low)
• Bottin JH, Swann JR, Cropp E, Chambers ES, Ford HE, Ghatei MA et al. Mycoprotein reduces energy intake and
postprandial insulin release without altering glucagon-like peptide-1 and peptide tyrosine-tyrosine concentrations in
healthy overweight and obese adults: a randomised-controlled trial. Br J Nutr. 2016 Jul;116(2):360-74. doi:
10.1017/S0007114516001872.
• Cherta-Murillo A, Lett AM, Frampton J, Chambers ES, Finnigan TJA, Frost GS. Effects of mycoprotein on glycaemic
control and energy intake in humans: a systematic review. Br J Nutr. 2020 Jun 28;123(12):1321-1332. doi:
10.1017/S0007114520000756.
• Coelho MOC, Monteyne AJ, Dirks ML, Finnigan TJA, Stephens FB, Wall BT. Daily mycoprotein consumption for 1
week does not affect insulin sensitivity or glycaemic control but modulates the plasma lipidome in healthy adults: a
randomised controlled trial. Br J Nutr. 2020 Jul 14:1-14. doi: 10.1017/S0007114520002524.
• Colosimo R, Mulet-Cabero AI, Warren FJ, Edwards CH, Finnigan TJA, Wilde PJ. Mycoprotein ingredient structure
reduces lipolysis and binds bile salts during simulated gastrointestinal digestion. Food Funct. 2020 Nov 26. doi:
10.1039/d0fo02002h.
• Finnigan TJA, Wall BT, Wilde PJ, Stephens FB, Taylor SL, Freedman MR. Mycoprotein: The future of nutritious
nonmeat protein, a symposium review. Curr Dev Nutr. 2019 Apr 4;3(6):nzz021. doi: 10.1093/cdn/nzz021.
Plant Based Meat Substitutes are
a Promising Alternative
Plant Based Meat Substitutes are
a Promising Alternative
• Jacobson MF, DePorter J. Self-reported adverse reactions associated with mycoprotein (Quorn-brand) containing
foods. Ann Allergy Asthma Immunol. 2018 Jun;120(6):626-630. doi: 10.1016/j.anai.2018.03.020.
• Harris HC, Edwards CA, Morrison DJ. Short chain fatty acid production from mycoprotein and mycoprotein fibre in
an in vitro fermentation model. Nutrients. 2019 Apr 8;11(4):800. doi: 10.3390/nu11040800.
• Souza Filho PF, Andersson D, Ferreira JA, Taherzadeh MJ. Mycoprotein: environmental impact and health aspects.
World J Microbiol Biotechnol. 2019 Sep 23;35(10):147. doi: 10.1007/s11274-019-2723-9.
• Souza Filho PF, Nair RB, Andersson D, Lennartsson PR, Taherzadeh MJ. Vegan-mycoprotein concentrate from pea-
processing industry byproduct using edible filamentous fungi. Fungal Biol Biotechnol. 2018 Apr 2;5:5. doi:
10.1186/s40694-018-0050-9.
Case study
Anya, 66Initial
PrescriptionFollow-up Results Investigations
Presentation
& History
Current symptoms:
- Lethargy and extreme fatigue
- Weight gain despite efforts to
reduce calories
- Constipation and distension
- Hot flashes
History:
- Onset of symptoms was 2
years prior
- She had undergone the
menopause at age 50 and
had no significant symptoms
at that time
Case study
Anya, 66Presentation
& History
Initial
PrescriptionFollow-up ResultsInvestigations
Pathology results:
- TSH 4.82 (0.3-3.0 mU/L)
- Patient also had a mild
neutropaenia
- Anti-TPO antibodies and anti-Tg
antibodies undetectable
- Morning urine iodine 22 μg/L
(100-199 μg/L)
Diet analysis:
- Patient consumed one portion
of fish per week and one
portion of goats cheese per
week. No other iodine
containing foods.
Case study
Anya, 66Presentation
& HistoryResultsInvestigations Follow-up
Initial
Prescription
Supplements:
- 75 μg/ day of iodine
- Multivitamin/mineral
supplement with moderate
amounts of zinc, selenium, B
vitamins, vitamin C and
vitamin A.
Diet recommendations:
- Increase fish intake to four portions
per week
- Increase consumption of foods high
in zinc and selenium
- Increase fiber intake to support
digestion
Case study
Anya, 66Presentation
& HistoryResultsInvestigations
Initial
PrescriptionFollow-up
After 3 months:
- Energy and well being markedly improved
- No longer fatigued
- Beginning to lose weight
- Complete cessation of hot flashes
- Digestion markedly improved having well formed bowel
movement daily.
Case study
Anya, 66Presentation
& HistoryInvestigations
Initial
PrescriptionFollow-up Results
4.82
2.17
0
1
2
3
4
5
6
Baseline 3 months later
TSH (mU/L)
22
132
0
20
40
60
80
100
120
140
Baseline 3 months later
Urinary Iodine (μg/L)
Iodine For Thyroid Health And Pregnancy Support
Clinical applications
• Iodine deficiency
• Primary hypothyroidism/ underactive thyroid
• Pregnancy/ lactation support
Ingredients
Potassium iodide (Iodine)
Going Beyond
Urinary Iodine Concentration/Excretion (UIC/UIE)
Consider 4 components to assess iodine status
Clinical
manifestations
UIC/UIE Thyroid
stimulating
hormone
Dietary
analysis
Wright C, et al. J Nutri Med Diet Care. 2018;4:028. doi: 10.23937/2572-3278.1510028.
Tracking Diets Accurately Is Challenging
2622 kcal 2078 kcal 2044 kcal 1984 kcal
Doubly labelled
water24 hour recall 3 day diet diary
Food frequency
questionnaire
Scagliusi FB, et al. J Am Diet Assoc. 2008 Dec;108(12):2031-40.
doi: 10.1016/j.jada.2008.09.012.
Use the Right Tool for the Job
Food frequency
questionnairesDiet diaries
Nutrient analysis Weight loss
Multi-pass 24
hour recall Apps
• Time intensive
• Highly
accessible
• Only relies on
short-term
memory
• Improves
accuracy of
diet diaries
• Time intensive
• Relies on long-
term memory
• Avoids impact
of seasonality
• More
appropriate for
research
purposes
• Increased
functionality
• Increased
compliance
• Accessibility
(smart phone,
technical
literacy)
• Limited
accuracy –
changes
behaviour
• Improves
weight loss
Apps
• Increased
functionality
• Increased
compliance
• Accessibility
(smart phone,
technical
literacy)
Laitner MH, et al. Eat Behav. 2016 Apr;21:193-7. doi: 10.1016/j.eatbeh.2016.03.005;
Wharton CM, et al. J Nutr Educ Behav. 2014 Sep-Oct;46(5):440-4. doi: 10.1016/j.jneb.2014.04.291.
Strategies that Increase Diet Change Success
Desroches S, et al. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD008722.
doi:10.1002/14651858.CD008722.pub2;
Mattei J, et al. Front Nutr. 2020 Aug 14;7:114. doi: 10.3389/fnut.2020.00114.
Personalised orientation
Setting short-term health
and personal goals, and
contracts
Making gradual dietary
changes
Social and family support
Nutritional tools (recipes,
food lists, examples of portion
sizes, etc.)
Feedback on self monitoring
Are Lectins as Much of a Problem
as we Once Thought?
High dose isolated legume
lectin/raw legume flours
shown to impair the integrity
of intestinal mucosa
Animal studies Animal and human studies
Functional food/
nutraceutical agent
Combined as part of a balanced diet lectins
can be beneficial and anti-inflammatory,
increasing SCFA, gut barrier integrity, and
the microbiome
Monk JM, et al. J Nutr Biochem. 2015 Jul;26(7):752-60. doi: 10.1016/j.jnutbio.2015.02.003;
Petroski W, et al. Nutrients. 2020 Sep 24;12(10):2929. doi: 10.3390/nu12102929;
Ramadass B, et al. Dig Dis Sci. 2010 Oct;55(10):2778-84. doi: 10.1007/s10620-010-1359-2.
How to Reduce Lectins
Petroski W, et al. Nutrients. 2020 Sep 24;12(10):2929. doi: 10.3390/nu12102929.
Soaking AutoclavingBoiling FermentingGerminating
Petroski W, et al. Nutrients. 2020 Sep 24;12(10):2929. doi: 10.3390/nu12102929;
Taylor EN, et al. J Am Soc Nephrol. 2009 Oct;20(10):2253-9. doi: 10.1681/ASN.2009030276.
Dietary Oxalates Not a Major Risk
Factor for Stone Formation
5,645
kidney
stones
Calcium,
Potassium,
Magnesium,
Oxalate,
Vitamin C
Incidence of
kidney stone
formation by
40 – 45%
DASH-style
diet
241,766
participants
followed-up over a
combined 50 years
Considerations for Individuals
Concerned About Oxalates
Ca2+
Oxalate
Primary considerations:
Calcium – 1200 mg per day
Other:
Increase intake of potassium
Increase intake of magnesium
Omega-3 – 1500 mg per day
In addition, for those with IBD with kidney stones/risk of:
If hyperoxaluria is present
Restrict dietary fat to 40-60 g per day
Lower oxalate intake
Medical management
Cholestyramine and/or pancreatic enzyme replacement
Vitamin B6
Magnesium supplementation
Surgical management
• Borghi L, Schianchi T, Meschi T, Guerra A, Allegri F, Maggiore U, et al. Comparison of two diets for the prevention
of recurrent stones in idiopathic hypercalciuria. N Engl J Med. 2002 Jan 10;346(2):77-84. doi:
10.1056/NEJMoa010369.
• Gaspar SR, Mendonça T, Oliveira P, Oliveira T, Dias J, Lopes T. Urolithiasis and Crohn's disease. Urol Ann. 2016
Jul-Sep;8(3):297-304. doi: 10.4103/0974-7796.184879.
• Prochaska ML, Taylor EN, Curhan GC. Insights into nephrolithiasis from the nurses’ health studies. Am J Public
Health. 2016 Sep;106(9):1638-43. doi: 10.2105/AJPH.2016.303319.
Considerations for Individuals
Concerned About Oxalates
Reducing the Impact of Oxalates
Like lectins, the cooking, preparation and processing of foods can impact
oxalate content and, therefore, mineral availability of food items.
Petroski W, et al. Nutrients. 2020 Sep 24;12(10):2929. doi: 10.3390/nu12102929.
Boiling SteamingSoaking Pairing with
calcium foods
Phytates
Cons:
• Strong chelator of
minerals
• Insoluble in neutral
pH
• Cannot be digested
by human enzymes
Pros:
• Potential to work as an
antioxidant
• Potential benefits
referred to in animal
studies/mechanistic
studies
Petroski W, et al. Nutrients. 2020 Sep 24;12(10):2929. doi: 10.3390/nu12102929.
How to Reduce Phytates Through
Traditional Cooking Methods
Petroski W, et al. Nutrients. 2020 Sep 24;12(10):2929. doi: 10.3390/nu12102929.
Soaking FermentingBoiling Germinating
Barriers Surrounding Calcium Intake
in Female Adolescents
• Belief that dairy products cause weight gain
• Cost
• Self diagnosed lactose intolerance
• Parental and peer-influence
• Replacement of milk with soft drinks
• Poorly planned vegan diet
Clough PA. Doctoral dissertation, University of Otago. 2019.
Available from: https://ourarchive.otago.ac.nz/bitstream/handle/
10523/10025/CloughP2019MDiet.pdf?sequence=1&isAllowed=y
Ensuring Adequate Calcium Intake
CALCIUM
SUPPLEMENTATION
Calcium
hydroxyapatite
Hydroxyapatite and Soy for
Osteoporosis
Maintenance
Hydroxyapatite Complex for
Complete Bone Support
• Promotes calcium absorption
and retention
• Osteoporosis
• Optimising bone growth and
improving bone mass
• Supporting adequate calcium
intake especially during pregnancy
and in post menopause
• Assists in maintaining peak bone
mass
Treatment
67% of inflammatory
bowel disease (IBD)
patients restrict fibre
rich foods, fruits and
vegetables and dairy to
avoid a disease
relapse
Schink M, et al. J Nutr Food Sci. 2017;7(6):10-4172.
doi: 10.4172/2155-9600.1000642.
Repleting Serum Zinc Levels in IBD
for Better Clinical Outcomes
Hospitalisations Surgeries Disease-related
complications
Siva S, et al. Inflamm Bowel Dis. 2017 Jan;23(1):152-157.
doi: 10.1097/MIB.0000000000000989.
ZINC
SUPPLEMENTATION
Meta Zn®
Highly Bioavailable Zinc
High Bioavailability Zinc
with Vitamin C
Treatment Maintenance
High Bioavailability Zinc
with P5P
• Zinc replenishment
• Brain and cognitive function
• Skin integrity and wound healing
• Reproductive health
• Immune support
Obesity and Smoking Lowers Omega-3-Index
Smokers
1.82%
Overweight
2.92%
Obese
2.39%
Healthy controls
4.27%
Ghazzawi HA,et al. Rivista Italiana Delle Sostanze Grasse. 2020 Jan 1;97(1):15-20.
High Purity, Low Reflux,
Concentrated Fish Oil Vegan DHA and EPA
Ingredients
Concentrated omega-3 triglycerides
Eicosapentaenoic acid (EPA)
Docosahexaenoic acid (DHA)
Ingredients
DHA/EPA rich Schizochytrium algal oil
Docosahexaenoic acid (DHA)
Eicosapentaenoic acid (EPA)
Clinical applications:
• Cognition and brain function
• Inflammatory conditions
• Pregnancy and lactation
• Cardiovascular disease
• Nervous system support
Serum 25(OH)D 20% Lower in Obese Individuals
Walsh JS, et al. Curr Opin Endocrinol Diabetes Obes. 2017 Dec;24(6):389-394.
doi: 10.1097/MED.0000000000000371.
Serum 25(OH)D Association With
Disease Risk Prevention
25 nmol/L Rickets
50 nmol/L
75 nmol/L
80 nmol/L
95 nmol/L
100 nmol/L
Osteoporotic fractures
Premature mortality, depression
Diabetes, cardiovascular disease
Falls, upper respiratory tract infections
Cancer
Pludowski P, et al. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol.
2018 Jan 1; 175:125-35. doi: 10.10016/j.jsbmb.2017.01.021.
Vitamin D3
Clinical applications
• Individuals at risk of vitamin D deficiency
• Support musculoskeletal health
• Chronic disease
Ingredients
Colecalciferol (vitamin D)
Long Term PPI use can Impair
Magnesium Absorption
Suppressed gastric acid
can interfere with passive
and active magnesium
absorption
Gröber U. Int J Mol Sci. 2019 Apr 28;20(9):2094. doi: 10.3390/ijms20092094.
The Aetiology of Chronic Latent
Magnesium Deficiency
Chronic Mg Imbalance Total Body Mg Deficit
Clinical picture:
Asymptomatic OR
nonspecific
Serum total Mg
concentration
‘normal’
Costello RB, et al. Adv Nutr. 2016 Nov 15;7(6):977-993. doi: 10.3945/an.116.012765.
A Case for an Evidence-Based
Serum Magnesium Reference Range
Symptomatic
Hypomagnesemia
Asymptomatic
Hypomagnesemia
Symptomatic
Hypermagnesemia
Asymptomatic
Hypermagnesemia
Chronic Latent Magnesium
Deficiency (CLMD)
Current Reference Interval
Proposed Reference
Interval for Health
0.500 0.750 0.850 0.955 2.000
Costello RB, et al. Adv Nutr. 2016 Nov 15;7(6):977-993. doi: 10.3945/an.116.012765.
Suggestive Criteria for Assessing
Magnesium Deficiency
Disease
State
T2D
CVD
Osteoporosis
Gröber U. Int J Mol Sci. 2019 Apr 28;20(9):2094. doi: 10.3390/ijms20092094;
Workinger JL, et al. Nutrients. 2018 Sep 1;10(9):1202. doi: 10.3390/nu10091202.
‘Many nutritional experts feel
the ideal intake for magnesium should be
based on the body weight (e.g., 4–6 mg per kg/day)’
High Bioavailability Magnesium Powder with active Bs
High Bioavailability Magnesium (Meta Mag®) with active B6
Magnesium Supplement for Kids
Clinically Effective Magnesium
MAGNESIUM
SUPPLEMENTATION
Meta Mag®
Meta Mag®
Magnesium,
Taurine and
Glutamine
for Stress
Stress Energy Sleep Pain Women CVD
Everyday Magnesium Replenishment
Mental and
Physical
Energy
Powder
Magnesium
with Lutein
and
Zeaxanthin
for Sleep
Pattern
Support
Meta Mag®
Magnesium
Bisglycinate,
Corydalis and
California
Poppy for
Pain
Magnesium
and Broccoli
for Women's
Health
High Potency
Taurine,
Glycine and
Magnesium for
Cardiovascular
Health
What Does Personalised Medicine
Mean to Our Patients?
Patient-Practitioner relationship
Holistic and integrative care
Personal growth: “I want to be empowered by
my healthcare encounter”
Self-activation: Personal autonomy and the
self-healing power
Wellbeing: Including emotional wellbeing
Franzel B, et al. BMC Complement Altern Med. 2013 Jun 3;13:124.
doi: 10.1186/1472-6882-13-124.
Case study
Sue, 45Initial
PrescriptionFollow-up ResultsInvestigations
Current symptoms (June 2020):
- Obesity (105 kg)
- Fatigue (energy at 5/10)
- Depression
- Poor memory
- Insomnia and restless sleep
- Joint pain (worse during evening)
- Numbness, pins and needles in extremities
- Headaches once per month
- Fluid retention
- GI bloating, flatulence and constipation
- Reflux (relies on antacids and PPIs)
- Hair loss
History:
- Pneumonia and asthma during
childhood
- Constant gut issues and stress-induced
psoriasis in teens
- Gastric band inserted after second child
(2005)
- Gastric band removed and gastric
sleeve inserted (2015)
- Prone to urinary tract infections –
regularly uses minocycline 2 to 3 times
per year
“I feel like I have a block in my body”
Presentation
& History
Case study
Sue, 45Presentation
& History
Initial
PrescriptionFollow-up Results
Pathology results (June 2020):
• Ferritin – 36 μg/L (30 – 220 μg/L)
• Haemoglobin – 127 g/L (120 – 160 g/L)
• Serum folate – 8.7 nmol/L (7 – 40
nmol/L)
• Serum vitamin B12 – 353 pmol/L (350 –
850 pmol/L)
• Serum magnesium – 0.83 mmol/L
• (0.75 – 0.95 mmol/L)
• Vitamin D – 48 nmol/L (> 75 nmol/L)
• ESR – 38 mm/hr (0-29 mm/hr)
• hsCRP – 2.13 mg/L (< 1 mg/L)
• Homocysteine – 7.6 μmol/L (5 –
15 μmol/L)
• Insulin – 9 mU/L (2-12 mU/L)
• TSH – 1.01 mU/L (0.3 – 3.0
mU/L)
• T4 – 11 pmol/L (15 – 25 pmol/L)
• TPO antibodies – not present
Investigations
Case study
Sue, 45Presentation
& HistoryFollow-up ResultsInvestigations
Supplements:
• Milk Thistle, Green Tea and Amino Acids for Optimal Detox
• High Strength, Researched Probiotic Strain
Diet/Lifestyle Recommendations:
• Increase water intake to one litre per day
• Prescribed breakfast smoothie: Milk Thistle, Green Tea and Amino Acids for Optimal
Detox, collagen protein powder, berries, almond milk, water, fibre and cinnamon.
• Follow gluten free (GF) diet (created by nutritionist)
• Manual lymphatic drainage massage one to two times per month.
Initial
Prescription
Case study
Sue, 45Presentation
& History
Initial
PrescriptionResultsInvestigations
3rd
Consult (Aug 2020):
- Stress levels are high from risk of
unemployment
- Increased heartburn due to stress
- Following GF diet 80% of time
- No headache this month
- Sleeping through the night
3rd
Consult Prescription Additions:
- IV ferrous sulphate
- Intramuscular (IM) vitamin B12
- High Potency Vegetarian Iron with 5-MTHF
- High Bioavailability Magnesium (Meta
Mag®) with active B6
- Vitamin D3 and vitamin K2
- Children’s Gut, Liver and Detoxification
Support
- Antimicrobial herbs including Allium sativa
Follow-up
Case study
Sue, 45Presentation
& History
Initial
PrescriptionResultsInvestigations
4th
Consult (Sept 2020):
- Now dairy free, 80% GF
- Having smoothie for breakfast
- Experiencing less heartburn and no
longer reliant on PPIs and antacids
- Bloating had reduced significantly
- Still experiencing joint pain
- Insomnia returning a few nights per
week
5th
Consult (Nov 2020):
- Patient felt inflamed and stressed
- Headaches returned
- Reflux increased
- Due to changes at work, patient chose
to cut back on intake of supplements
- Felt overwhelmed with GF diet plan
“I’ve been off track again”
Follow-up
Case study
Sue, 45Presentation
& History
Initial
PrescriptionResultsInvestigations
6th
Consult (Nov 2020):
- Patient diligent with supplements and diet
- Removed sugar and coffee from diet,
increased water intake to 1.5 L
- Mood and sleep significantly better
- Energy increased to 6/10
- Bowel movements regular and easy to pass
- Heartburn reduced
- No longer experiencing joint pain
- Walking 1 to 2 nights per week
- Having lymphatic drainage massage once in
past month
7th
Consult (Dec 2020):
- Had period previous week and felt
more tired and emotional
- Hadn’t exercised much due to being
tired
- Noticed when stressed her sleep was
more restless
- No headaches or joint pain
- Bowel movements still regular and easy
to pass
Follow-up
Case study
Sue, 45Presentation
& History
Initial
PrescriptionResultsInvestigations Follow-up
Pathology results (December 2020):
• Ferritin – 865 μg/L (30 – 220 μg/L)
• Serum folate – 16.8 nmol/L (7 – 40
nmol/L)
• Serum vitamin B12 – 1218 pmol/L
• (350 – 850 pmol/L)
• ESR – 22 mm/hr (0 – 29 mm/hr)
• hsCRP – 2.0 mg/L (< 1 mg/L)
• Insulin – 8 mU/L (2 – 12 mU/L)
Prescription changes:
• Zinc supplement (elemental dose
30 mg/tablet) – 1 tablet daily with
food
Case study
Sue, 45Presenting
& History
Initial
PrescriptionFollow-upInvestigations Results
Case kindly provided by Naomi Rogan,
Clinic: Hills Natural Health Centre. Glen Forest, WA
0
100
200
300
400
500
600
700
800
900
1000
Ferritin
July Nov
Patient has been experiencing
peeling of hands and feet and
feeling itchy since last IV iron infusion
ESR has reduced from 38 mm/hr to
27 mm/hr (0-29 mm/hr) and TSAT is
27% (20-40%)