How Curious Should We Be… As Health Practitioners

Now, this week’s episode was with the very, I think she’s terrific, Professor Julia Rucklidge—a Professor of Psychology from Canterbury University in Christchurch, New Zealand. The episode is called rather appealingly, The Better Brain, which references her book, which she co-authored with Professor Bonnie Kaplan and was released in April of this year.

Micronutrients and Improving Mental Health

Julia talks about the use of nutrients and specifically micronutrients and improving mental health and it’s such an interesting conversation. Actually, coincidentally, in the same week that I was talking to Julia, there was also a wonderful article published in the Journal of Oncology coming out just last week, which talked about the use of micronutrients and improving immune function in Oncology.

I’ve said before that I think, you know, the study of the basic sciences is just so important. Anatomy, physiology, biochemistry, that’s all of the processes that go on in all of your cells from the moment you are conceived to the moment you die. Biochemistry is pretty important. Histology – the study of cells – because after all, we are made up of, what is it, 50 trillion cells, not to mention 10 times more microbes. There’s a lot of cells going on and knowing how they work is a very important part of health.

Now, one of the things that Julia said in my discussion with her, which really got me thinking a lot, and that was, it’s important for health practitioners to have both scepticism and curiosity. I thought, yeah, that is a really good combination because you have to be a little sceptical. You can’t believe everything that you were told. 

By the same token, you should be curious, which kind of got me thinking about at what point do most medical practitioners’ curiosity actually kick in? Because so often the study of nutrition and in particular micronutrients — now micronutrients, you may not be familiar with that term, but you’d certainly be familiar with things like iron, magnesium, calcium, zinc, selenium, there are something like 50 or so elements within the periodic table — that we need to function properly.

Think of our Lives as a Book

To fully understand that, I had another wonderful conversation with Dr Sarah Myhill, who is a doctor specialising in chronic fatigue, and that episode will be coming out in another few weeks. She said something to me in the same week that I was interviewing Julia, which I just thought made so much sense. 

That was if you think of our lives as a book, and that book begins from the moment of conception, goes through our life in utero, as a newborn, as an infant, as a toddler, as a child, as a teenager, as an adolescent, young adult, etc, and you think of your life literally as a book written out using all 26 letters of the alphabet. Here’s the critical part, you get to use all twenty-six letters of the alphabet. Well, micronutrients are a bit like that. Our body needs those 50 or so micronutrients to write the story of our life or to write it as well as it possibly can be written.

But what if I said to you, I’m going to get you to take ten of those letters out of your book of life? I’m going to get you to take A, B, C, D, E, F, etc.. The first ten letters. Let’s take the first ten letters up to J. Now let’s also include K as well. Let’s take those eleven letters out of the alphabet. Well, all of a sudden your book starts to look a little bit confused. 

In fact, it doesn’t make that much sense and understanding the role that biochemistry plays in that is really important. It’s interesting when we talk about the curiosity of health practitioners, the question is: At what point in their professional development does that curiosity kick in?

Why is it important to study the human body?

I know for myself, I studied dentistry for five years. The first two years were these subjects, which, “Look, once I got through them, I could get on with really studying dentistry and really what it was all about.” Those subjects.. Anatomy? Yeah, I passed that. Physiology? Sure. I learnt how the body’s systems work, the respiratory system, the digestive system, the immune system. You know, I learnt all about that. Why? What blood does is it tracks around the body.. passed all those exams. Biochemistry? Oh, my God. So complicated. 

You had to learn all those processes that go on in the human body and all those annoying cofactors and vitamins and minerals that you need to take the next step forward to the next step, to the next step, to the next step to make a body function optimally. I Can’t wait to pass that exam. Thank God we got through that.

Then I got into third year and boy, did I start to learn what dentistry was all about. And for doctors in their second or third year, they start to learn or they did, when I was going through start to learn about pathology, the study of disease. Is that an infection? Is it inflammation? Is it cancer? Is that cancer malignant or benign? These were all important questions. 

We learnt about pharmacology, which was how we were going to manage those diseases. Now, this was really interesting. This was what medicine and dentistry were all about. But why is it if the model is just to manage chronic disease, what about if I wanted to learn about what actually caused that disease?

Well, I learnt fairly early on in my career. In fact, a year after I graduated, when I was asked to give a talk to a study group, what actually it was two or three years after I graduated when I was asked to give a talk to a study group on nutrition. I thought, oh, actually, there is something here. 

I began my first course in nutrition, which came to me as cassettes. There was no such thing as online and it was the International Academy of Nutrition in 1981 where I did my first course. That was the beginning of my curiosity in things that I had ignored in the first two years of my degree, which turned out to be really important because it explained why things go wrong. I think that’s quite important.

So scepticism and curiosity. Yes, I get that. I think it’s very important. You know, I think curiosity should start from the very beginning of our training and really to understand how the human body works and what goes wrong when it doesn’t. If I was to remove 10 or 11 letters from your alphabet in your book of life, your book of life would not make as much sense as it could if we used all 26 letters.

Similarly, if we don’t use all of the nutrients that we need to make our biochemistry work in our cells that make our physiology work optimally, then things start to go wrong and those things are preventable chronic degenerative diseases like heart disease, cancer, autoimmune conditions of which there are almost a hundred diabetes, mental health issues, etc.

Randomised Controlled Trial (RCT)

In this episode with Julia Rucklidge, she has done a great deal of research on the influence of micronutrients, on brain health, on mental health. She also expresses her frustration with RCTs. Now RCT stands for Randomised Control Studies (sic) [Correction: Randomised Controlled Trial). Now, this is stats, another very important issue, which I think you as a member of the public, we’re all patients, but as a member of the public, it’s important to understand this Randomised Controlled Trials, which are now held up to be the gold standard in medicine.

I think we have bought into a system that is flawed and it’s flawed for many reasons. I’m not the only one who says this because it’s very difficult, I think, to discern the difference between evidence-based medicine and evidence-based marketing. 

You see the vast majority of the science in medicine, and I think it’s conservatively estimated to be around 70% is paid for by the pharmaceutical industry. The pharmaceutical industry’s ultimate goal is to find blockbuster drugs and now blockbuster drugs are classified, I think, as generating about a billion dollars worth of sales. 

There are many, many blockbuster drugs — statins, anti-cholesterol drugs like Lipitor, Crestor, or are good examples of that, antidepressant drugs are another good example of that. Drugs that prevent reflux, heartburn, indigestion like Nexium, proton pump inhibitors. They’re other blockbuster drugs. 

And of course, how do you do a trial for a drug? You take one drug and compare it to a sugar pill and you find out whether that drug is more effective for dealing with the problem at hand than the sugar pill. That is called a randomised controlled study because you don’t tell the person who is taking, in the study, who is taking the drug, which they’re getting. So that’s the randomised control.

Double-blind randomised control means you don’t tell the practitioner either. That has become the gold standard and we have bought into this and I quote here the work of Stanford University Professor John Ioannidis. Now, John Ioannidis is perhaps one of the most cited academics in the world. I mean, almost 200 000 citations, which is extraordinary because if you’ve ever written an academic journal and you’ve been cited or repeated by other researchers, 10, 15, 20, 30, 50, a thousand times, you’re doing incredibly well.

Well, his work’s been quoted almost 200 000 times. I think he’s worth listening to. He says there’s a difference between that evidence-based medicine has been hijacked by the pharmaceutical industry who funds the science in medicine. This is relevant to our discussion with Julia because she cites her frustration with this as the gold standard of determining whether something is effective or not

When we come to studying micronutrients, then it becomes really problematic because it would be like me saying, I’m going to study electricity. What I’m going to do is I’m going to take a light switch and I’m going to just put it in the wall and I’m going to switch that’s not going to be connected to anything. 

I’m going to switch it on and on and see whether it causes the electricity to go on and off. And I go, oh, no, it doesn’t. Well, the light switch has not passed the randomised control. Some are switched on and some are switched connected to. But it’s unclear. It suggests that perhaps the light switch is connected. What if I just did one on the wire on its own and thought, well, I’m going to check the wire and see whether that is what provides electricity? Or maybe I would burn some coal? No, that doesn’t do it either. It turns out that I need the coal or actually, let’s say sunlight or wind or wave. There are so many alternatives. That’s a whole other story. 

But for the time being, let’s look at coal, which generates a turbine, which then stores energy and generates that energy through an electrical wire, which comes to our house. I use the light switch to switch it on and I guess what? All of those things were important in delivering electricity to my home. But if I picked out any one of those and tested it and delivered that electricity, it would show that that has no effect.

Similarly, if I was doing a study on Vitamin D, for example, and thought Vitamin D, I’m going to look at Vitamin D on its own. It’s such a flawed model for testing micronutrients or nutrients in our bodies because that’s not how it works. 

If you’ve been a regular listener to our podcast, you will know that you can’t assimilate Vitamin D without magnesium at least, and many other micronutrients along the way. They all interact and that is the frustration of Randomised Controlled Trials when it comes to the human body, to the biochemistry of the human body, to the histology of the human body, to the immune function and physiology of the human body.

Anyway, it was such a great episode. It got me thinking a lot about scepticism, good curiosity: when does that kick in. The shortcomings of randomised controlled trials. It also reminded me and I’ll give you a little preview here of another wonderful podcast coming up very soon with Professor Pasi Sahlberg. 

Now, he is a world leader in education. Yes, we covered that as well. But the reason I mention it to you is one of the things that we discussed. There are elements that are important in our education, in our modern world, and that is relevant to this discussion and every discussion we really have. He discussed four critical Cs, if you like — Critical thinking, Communication, Collaboration, and Creativity. That’s the four critical Cs that we should be really basing our education system on. 

Again, Critical thinking, Communication, Collaboration, and Creativity arm our children for the new world, for the modern world we live in and to that, I would add to more Cs — Curiosity and Compassion. Anyway, I think this week is well worth watching, listening to. I hope this finds you well.

 

This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, they should consult with an appropriately qualified medical practitioner. Guests in this podcast express their opinions, experiences, and conclusions.