“it’s like - metagenics institute

“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

Tala, 55 Case study

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


& 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

What tests would you

consider for this patient?

Case study



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

Case study


& History

Initial

PrescriptionFollow-upInvestigations Results

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.

Ava, 41Case study

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


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


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

https://www1.health.gov.au/internet/main/publishing.nsf/content/7C28F0B6D06F9FFCCA257EB9001D769B/$File/Vitamin%20B12%20testing%20Protocol.pdf

https://www1.health.gov.au/internet/main/publishing.nsf/content/7C28F0B6D06F9FFCCA257EB9001D769B/$File/Vitamin%20B12%20testing%20Protocol.pdf

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

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.

https://www.aihw.gov.au/reports/food-nutrition/poor-diet/contents/poor-diet-in-adults


Soil pH Determines Nutritional Values

Gazey C. Effects of soil acidity [Internet]. 2018. Available from:



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

https://www.ewg.org/foodnews/dirty-dozen.php

“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

https://www.aihw.gov.au/reports/food-nutrition/poor-diet/contents/poor-diet-in-adults

Nutrient Deficiencies

Still Exist

With a Healthy Diet

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.

Anya, 66Case Study

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


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


& 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



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


& 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


• 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

Lectins Oxalates PhytatesWhat’s the Real

Deal When it

Comes to

Anti-nutrients?

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.


Boiling SteamingSoaking Pairing with

calcium foods

Organic

Acid Test

Testing and Assessing Oxalate Levels?

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


How to Reduce Phytates Through

Traditional Cooking Methods


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

https://ourarchive.otago.ac.nz/bitstream/handle/10523/10025/CloughP2019MDiet.pdf?sequence=1&isAllowed=y

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


• 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.

Sue, 45Case study

Case study

Sue, 45Initial


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


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


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


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%)

“it’s like - metagenics institute

Documents