April 2013

Dear Dr. XXX

I am writing to follow-up on your phone call this week to me as I am deeply upset by the tone of the whole phone call and how it ended. It is not in my nature to hang up however you were bordering on abusive to me on the call and I could see no point in listening to this. I apologise for my termination of the call and if this upset your day; this was not my intent. I do not allow my clients to permit people to speak to them this way, nor do I feel I should be subject to this either. Nor should I do similar to you and we were both going nowhere fast! Saying this, I do understand from where you are coming from, and I would like to explain more about me, my qualifications and my approach. We both have the same issue at heart; that of patient care, research driven advice, and the importance of CPD and qualifications. So yes I understand where you were coming from and perhaps we both could have handled the call better.

I take offence but absolutely understand your remarks about my

not being a dietician. I have a problem with the qualifications and knowledge base of a vast number of nutritionists/ nutritional therapists in this country also; as in Ireland unlike the UK the title is not regulated. Anyone that does a weekend course can call themselves same, there is an overwhelming amount of misinformation, misleading claims and well quite honestly dangerous advice out there. I feel as passionate about this as you do, for the protection of our patients. Qualifications are not everything, I put my hand up now that I know more about what I don’t know, than what I know, and this keeps me driven in the quest to always push myself to learn more. However for your peace of mind, let me explain more about my qualifications:

I 6 A’d out of 8 subjects in my leaving certificate. By preference I would have chosen medicine but my parents didn’t want me to burn myself out on a medical degree, so I studied pharmacy instead. I have 16 years of clinical experience in both the UK where I managed many large pharmacies, acted as consultant pharmacist to nursing homes and medical practices as well as here in Ireland working as a locum.

I retrained in Nutritional therapy in the UK in 2000, choosing nutritional therapy over dietetics as this believe it or not is more open to an holistic approach and also with my medical background, the learning as you would expect for yourself also, is relatively easy when you are blessed with a medical base. I am professionally associated with BANT; the British Association for Applied Nutrition and Nutritional Therapy (www.bant.org.uk/). This organisation enforces strict ethical codes of practice and also requests CPD as a crucial necessity for membership, similar to the Irish Pharmaceutical Society. I am also a Senior Associate member of the Royal Society of Medicine, by nature of my many years clinical experience.

All this means nothing however unless I qualify this with the fact that I am continually researching, reading, attending seminars in the UK and USA, and shadowing the works of the medical leaders in the field of functional medicine and sports nutrition that I am blessed to personally know such as Dr Mark Houston (cardiovascular specialist), Dr Jeffrey Bland, Charles Poliquin (top sports physiologist), Dr Mae Wan Ho, etc. I also partake in online learning with the IFM (institute of functional medicine), IFIM (Institute of functional and integrative medicine) and whatever else I can get my hands on. I am known for my dedication to further learning, my ability to get to the bottom of health conditions that often consultants cannot, and also my attention to the patient as I spend close to 2 hours alone with each patient in consultation. Several doctors around the country refer patients on to me to figure out what it up, along with a raft of their test results and bloods as I am known to be excellent at reading and interpreting these from a functional perspective. My list of bloods to you most certainly was not randomly printed off the internet. I have also in the past worked mutually with Dr Brian Moore, a bloods specialist, in the care of Ireland’s top athletes (see here http://ie.linkedin.com/pub/brian-moore-phd/13/934/4b7)

I have also to date worked with the IRFU for 4 years, numerous Olympic athletes, sports teams and individuals; however my passion and expertise lies in the areas of chronic fatigue, gastrointestinal problems, auto-immune conditions, infertility/ fertility, cardiovascular disease, etc. I am uncomfortable ranting on about my qualifications however I feel that this is important based on our call yesterday so that you understand my approach.

I whole heartedly agree with the comments you made regarding Vitamin D. You are correct in quoting the established recommendations; however this is not the same as the established ‘research’. And since the IOM’s updated guidance on Vitamin D there has been much debate from leading scientists in the field of Vitamin D research that they did not base their recommendations in accurate up to date science or a fair interpretation of such (http://www.vitamindcouncil.org/news-archive/2010/vitamin-d-council-statement-on-fnb-vitamin-d-report/). Vitamin D is a hormone in the body and is essential for pretty much every system and organ. We know that optimal levels support the endocrine systems, nervous system, musculoskeletal system, immune system, gastrointestinal health, fertility, and also protects against cancer and infection and optimises immune system function. Here is a lovely synopsis http://www.charlespoliquin.com/Blog/tabid/130/EntryId/410/25-Excellent-Reasons-to-Take-Vitamin-D.aspx.

Personally I have only seen one optimal Vitamin D in my patients and I have seen many that are very low. Saying this, these findings were as expected as the patients in question suffered with conditions such as MS, arthritis, chronic fatigue and so on. There is a dearth of studies related to Ireland however some have been done by Thomas Hill, please see here http://www.ncl.ac.uk/afrd/staff/profile/tom.hill#tab_publications. I agree the tests are expensive however when you read the research, and consider that countries such as Canada invested in Vitamin D research and not the swine flu vaccine in the height of swine flu craziness you cannot ignore the importance of testing our patients and optimising Vitamin D levels. We have one of the highest incidences of MS in the world and auto-immune conditions and immune dysfunction is an increasing problem, all of which can be modulated by optimising Vitamin D levels; consider the outcomes of optimising Vitamin D levels in these patients and more, on morbidity and mortality outcomes as well as medication cost. The costs and inconvenience of the tests and treatment with Vitamin D pale into comparison. Based on clinical research we need to be recommending at least 5,000 IU daily to just maintain stores; higher for treatment. Twice weekly or once weekly bolus doses have been found to work better, possibly because this mimics the way we store sunlight as vitamin D in our bodies (this is only a personal insight that has yet to be documented).

If I may link a few fascinating websites for your own reading should you like to delve further into this amazing topic.

http://www.vitamind.hk/general-health/vitamin-d-deficiency-how-did-we-all-get-so-low

http://www.vitamindcouncil.org/about-vitamin-d/vitamin-d-deficiency/am-i-vitamin-d-deficient/

Pub med lists reams and reams of vitamin D related papers, however the above two sites provide more concise synopsis of the research.

Thank you Dr XXX for spending the time to read my letter

Andrea Cullen

Nutritional Therapist (Dip Raw, MBANT), Pharmacist (MPSI) and Senior Associate Member of the Royal Society of Medicine