AKT – Integrative medicine

Deborah Foster, aged 47, presents with a 3-month history of fatigue and generalised aches. She works full time as a primary school teacher and reports difficulty concentrating, unrefreshing sleep, and occasional tension headaches. Blood tests ordered 2 months ago including FBE, TFTs, ESR, CRP, coeliac serology and iron studies were all normal.

She has tried paracetamol and a magnesium supplement without significant benefit. She has read online about acupuncture and wonders if it might help.

Relevant Medications: Nil regular. Relevant Past history: Nil significant. Relevant Social history: Lives with partner and 2 children. No alcohol, non-smoker. Does yoga twice weekly.

What is the MOST appropriate next step in her management?

Leonard White, aged 64, presents requesting natural treatment options for osteoarthritis of the knees. He is a retired gardener and finds it difficult to walk long distances. He has tried glucosamine and fish oil for the last year with no benefit.

Medications: Paracetamol PRN, no NSAIDs due to previous gastric ulcer. Past history: Hypertension, gastritis. Social: Lives alone, independent, regular walker, BMI 31.

On examination: Bony enlargement of both knees, mild effusion, reduced range of motion. No redness or warmth.

What is the MOST evidence-based complementary treatment to consider next?

Natalie McLean, aged 35, presents seeking advice about herbal treatments for anxiety. She has recently reduced her workload due to stress and reports palpitations, poor sleep, and frequent worry. She has declined pharmacological treatment in the past.

Relevant history: Mild generalised anxiety disorder diagnosed 2 years ago. Previous psychological therapy was beneficial but limited by cost.

Social: Works as a graphic designer. Lives with partner. No alcohol, no recreational drugs. Medications: Nil.

What is the MOST appropriate herbal treatment to trial based on current evidence?

Robert Tan, aged 59, presents with a 5-month history of chronic low back pain. He has completed a physiotherapy program and trialled NSAIDs without lasting benefit. He is otherwise well and wishes to avoid opioid analgesics. He asks whether mindfulness or meditation might help.

Past history: Hyperlipidaemia, controlled with atorvastatin. Social: Works in IT, sedentary job, walks dog daily. No mental health history. Normal neurology on exam.

What is the MOST appropriate advice regarding mindfulness-based interventions?

Anna Petrovska, aged 29, presents for preconception counselling. She is healthy but wishes to explore whether any natural supplements could improve her fertility. She has regular cycles and no known health issues. Her partner is 30 and well. They have been trying to conceive for 4 months.

Past history: Nil significant. Social: Works as a vet nurse. No alcohol or smoking. Diet includes meat, fruit, vegetables. Medications: None. Weight: BMI 22.

What is the MOST appropriate advice regarding evidence-based supplementation for fertility?

Margaret Zhou, aged 53, presents requesting advice on natural approaches to managing her menopausal symptoms. She reports bothersome hot flushes and sleep disturbance. She has a strong family history of breast cancer and is not keen on hormone therapy.

Medications: Nil. Relevant history: Normal mammograms, no personal cancer history. Non-smoker, drinks socially. Regular weight-bearing exercise.

What is the MOST evidence-based complementary option to consider for her vasomotor symptoms?

Alison D’Costa, aged 37, presents for advice on managing irritable bowel syndrome (IBS). She experiences alternating constipation and diarrhoea with bloating, worsened by stress. She has tried dietary modification with limited success and is open to integrative approaches.

Past history: Nil significant. Social: Works as a librarian. No smoking, drinks coffee daily. No red flags on history or examination.

What is the MOST evidence-based integrative treatment for symptom relief in IBS?

Jason Stewart, aged 46, presents with mild hypertension diagnosed last month (BP 144/92 mmHg). He is not keen to start medication yet and asks about dietary and natural options to lower his blood pressure. He has no other cardiovascular risk factors.

Medications: Nil. Past history: Nil. Social: Non-smoker, occasional alcohol. Diet: Omnivorous. BMI 27.5. ECG normal.

What is the MOST evidence-based nutritional supplement to consider recommending?

Rebecca Singh, aged 42, presents with chronic insomnia for over 6 months. She has difficulty both initiating and maintaining sleep. Sleep hygiene strategies have helped minimally. She is reluctant to use benzodiazepines and asks about natural remedies.

Relevant history: Mild GAD. No depression. No shift work or significant stressors. Medications: Nil. No alcohol or caffeine.

What is the MOST evidence-based herbal option to trial for chronic insomnia?

Yousef Barakat, aged 39, presents for management of allergic rhinitis. He experiences seasonal symptoms of nasal congestion, sneezing and itchy eyes. He has been using over-the-counter antihistamines with some relief. He is interested in non-pharmacological options.

Medications: Cetirizine PRN. Past history: Mild asthma. Social: No pets, non-smoker. Physical exam: Turbinate hypertrophy, clear nasal discharge.

What is the MOST appropriate evidence-based integrative approach to suggest?

Sarah Halliday, aged 32, presents with acne primarily affecting her jawline and chin, which worsens before her period. She has tried multiple topical treatments with limited success and is interested in exploring natural therapies.

Past history: Nil significant. Menstrual cycles regular. Medications: Nil. Social: Works as a schoolteacher. No smoking. BMI 23.

What is the MOST appropriate integrative option with evidence for hormonal acne in adult women?

Michael Rawiri, aged 57, presents requesting advice on reducing his risk of prostate cancer. He has a family history—his father was diagnosed at age 70. Michael is otherwise well and has a normal PSA level. He follows a Mediterranean-style diet and exercises regularly.

Past history: Hypercholesterolaemia. Medications: Atorvastatin. Social: Non-smoker, 1–2 drinks/week.

What is the MOST evidence-based supplement shown to support prostate health or reduce cancer risk?

Emily O’Connor, aged 28, presents with symptoms of premenstrual syndrome (PMS) including mood swings, breast tenderness, and bloating for several days before her period. She prefers to avoid hormonal contraception and asks about natural options.

Past history: Nil. Menstrual cycles regular. Medications: Nil. Social: No alcohol, vegetarian, exercises regularly.

What is the MOST evidence-based herbal therapy to trial for PMS?

Kevin Smith, aged 66, has chronic mild cognitive impairment. He and his daughter ask about supplements or lifestyle interventions that could help slow cognitive decline. He is independent in ADLs and has a normal MMSE of 27/30. MRI shows age-related changes only.

Past history: Hypertension, controlled. Medications: Perindopril. Social: Non-smoker, daily walks, eats a balanced diet.

What is the MOST evidence-based integrative intervention to recommend?

Amira Hassan, aged 44, presents with ongoing stress and fatigue. She works full-time and reports difficulty winding down in the evenings. Sleep is fragmented and she wakes unrefreshed. She has no symptoms of depression or anxiety. Blood tests including TSH and iron are normal.

She asks whether any adaptogenic herbs might help her energy and stress tolerance.

What is the MOST appropriate adaptogen to consider trialling based on current evidence?

Thomas Whitby, aged 61, presents for review of his type 2 diabetes. He has recently read about cinnamon supplements and asks whether they are beneficial. His HbA1c is 7.2% on metformin monotherapy, and he is motivated to improve this through lifestyle changes.

Past history: T2DM, hypertension. Medications: Metformin 1000 mg BD. Diet: Balanced, moderate carbohydrates. Weight stable. BMI 28. No hypoglycaemic episodes.

What is the MOST appropriate advice regarding cinnamon supplementation for glycaemic control?

Jenny Laithwaite, aged 49, presents with chronic migraines. She has 6–8 episodes per month, sometimes associated with photophobia and nausea. She has tried multiple preventive medications with limited success and is interested in exploring natural options.

Past history: Migraine with aura. Medications: Sumatriptan as needed. No daily preventer. No major comorbidities.

What is the MOST evidence-based natural supplement to consider for migraine prevention?

Alana Quok, aged 39, presents with persistent bloating and flatulence after meals. She has no weight loss, rectal bleeding or alarm features. Coeliac serology, FBE and CRP are normal. She wonders about the role of food sensitivity testing or alternative dietary approaches.

Diet: Eats gluten-free, low dairy. Social: Non-smoker, no alcohol. BMI 21.

What is the MOST appropriate next step in her dietary management?

Eleni Stratakis, aged 26, is a healthy woman presenting with mild pre-exam anxiety. She prefers to avoid pharmaceuticals and asks about natural options to help her stay calm and sleep better the night before her exams.

Past history: Nil. Medications: Nil. Sleep: 6–7 hours usually, but poor during exam time. No depressive symptoms.

What is the MOST appropriate integrative intervention to recommend?

Harriet Boyle, aged 70, presents with osteopenia diagnosed on DEXA. She is not yet eligible for bisphosphonate therapy. She is taking calcium and vitamin D and asks whether there are other natural options to support her bone health.

Past history: Osteopenia. Medications: Cholecalciferol, calcium citrate. Diet: Low dairy intake. Weight-bearing exercise daily.

What is the MOST evidence-based additional supplement to consider?

Nathan Waters, aged 31, presents with frequent colds and asks about natural ways to support his immune system during winter. He has no chronic illnesses and no specific deficiencies. He works in childcare and reports good sleep and nutrition.

Past history: Nil. Medications: Nil. Vaccinations: Up to date. Social: Non-smoker. BMI 24.

What is the MOST evidence-based supplement to reduce frequency of upper respiratory infections?

Claire Jennings, aged 45, presents with peri-menopausal symptoms including mood changes, sleep disruption and night sweats. She is open to trying natural therapies and prefers to avoid HRT due to family history of DVT.

Past history: Nil. Medications: None. Non-smoker, BMI 22. Normal recent bloods. Still menstruating irregularly.

Which of the following is MOST appropriate as a first-line herbal therapy for menopausal symptom relief?

David Nguyen, aged 36, has a history of generalised anxiety disorder and is interested in mindfulness meditation. He asks whether there is clinical evidence to support its use alongside psychological therapy.

Past history: GAD, well-controlled. Currently seeing psychologist fortnightly. No medications. Social: Works in IT. No substance use. Sleep: Good.

What is the MOST appropriate response regarding mindfulness meditation?

Layla Khoury, aged 29, presents with ongoing symptoms of recurrent thrush. She has had three episodes in the past six months. Swabs have confirmed Candida albicans. She has tried oral fluconazole with temporary relief. She asks about complementary options.

Past history: Recurrent vulvovaginal candidiasis. Medications: Nil regular. BMI 20. Non-smoker.

What is the MOST evidence-based adjunctive integrative therapy to reduce recurrence?

Raymond Catt, aged 72, presents seeking advice about memory and cognitive decline prevention. He has a strong family history of Alzheimer’s disease and is otherwise well. He wants to know whether any nootropic supplements are worthwhile.

Past history: Hyperlipidaemia, managed with rosuvastatin. Social: Retired teacher, eats healthily, non-smoker.

What is the MOST evidence-based supplement to suggest for cognitive support?

Freya McDonald, aged 34, presents with persistent dysmenorrhoea despite the use of NSAIDs. She prefers not to start hormonal contraception and is interested in natural therapies. Pelvic ultrasound was normal.

Past history: Nil significant. Cycles regular, no heavy bleeding. No systemic symptoms. BMI 23.

What is the MOST evidence-based integrative therapy for menstrual pain relief?

Samuel Ritchie, aged 40, presents with symptoms of mild depression including low mood, low energy and poor motivation. He is not suicidal and prefers to try a natural approach initially before considering medication.

Past history: Mild depression. No psychiatric hospitalisation. Medications: Nil. Social: Stable housing, works part-time, no substance use.

What is the MOST appropriate herbal supplement with evidence for mild to moderate depression?

Isabel Ng, aged 59, presents with hyperlipidaemia and asks about red yeast rice extract as an alternative to statins. Her total cholesterol is 6.8 mmol/L and LDL is 4.2 mmol/L. She has no cardiovascular disease and prefers not to take prescription medication unless necessary.

Past history: Nil. Non-smoker. BMI 24. No diabetes. Normal BP. QRISK3 score: 6%.

What is the MOST appropriate advice about red yeast rice extract?

Louise Palmer, aged 51, presents with fatigue and mild weight gain. She is euthyroid but reports symptoms often associated with adrenal fatigue, as described by her naturopath. She asks for your opinion on adrenal support supplements.

Past history: Nil. Medications: None. Bloods including TSH, cortisol, FBE and iron are normal. BMI 26.

What is the MOST appropriate response to the concept of ‘adrenal fatigue’?

Angela Esposito, aged 48, presents with concerns about environmental toxins and wishes to undergo detoxification. She has no specific symptoms and is otherwise well. She asks about heavy metal chelation and detox diets.

Past history: Nil. No occupational exposures. Medications: Nil. Normal recent blood tests.

What is the MOST appropriate response to her request?

Sasha Ibrahim, aged 39, presents for follow-up of irritable bowel symptoms. She has implemented a low FODMAP diet with significant improvement. She asks if any probiotics could now be added to support long-term gut health and prevent relapse.

Past history: IBS-D. No red flags. Medications: Nil. Social: Works as a chef. Non-smoker. BMI 23.

What is the MOST appropriate advice regarding probiotics in this situation?

Owen French, aged 62, is undergoing chemotherapy for colon cancer. He asks about complementary therapies to reduce treatment side effects. He has read about acupuncture and seeks your advice.

Past history: Stage 3 colon cancer. On FOLFOX regimen. Experiencing nausea and fatigue. Oncologist supportive of integrative care. Medications: Metoclopramide, ondansetron.

What is the MOST evidence-supported use of acupuncture in this context?

Tariq Singh, aged 25, presents with chronic eczema. He uses emollients and intermittent topical corticosteroids. He asks about natural approaches and has heard evening primrose oil may help.

Past history: Atopic dermatitis. No other allergies. BMI 22. Non-smoker. Medications: Nil.

What is the MOST accurate statement regarding evening primrose oil for eczema?

Liam Chan, aged 43, presents for a health check. He reports feeling increasingly stressed and tired. He has no clinical depression or anxiety, but wants to explore mindfulness-based programs. He prefers group settings and enjoys structured learning.

Past history: Nil. Medications: Nil. Sleep: 6 hours/night. Social: Works in finance. No alcohol or smoking.

Which intervention has the MOST evidence for reducing perceived stress and improving wellbeing?

Elena Petrov, aged 52, is recovering from a recent upper respiratory tract infection. She has persistent fatigue and asks about energy tonics. She has been offered a traditional Chinese herbal mixture containing ginseng and astragalus.

Past history: Asthma (well controlled), no current infection. Medications: Salbutamol PRN. No current symptoms except fatigue.

What is the MOST appropriate response regarding use of ginseng and astragalus in convalescence?

Monique Harvey, aged 41, presents with hot flushes, mood changes and poor sleep. She is perimenopausal and asks about natural options while she considers HRT. She has heard about soy and flaxseed.

Past history: Nil. BMI 24. Menstrual cycles irregular. No family history of breast cancer. No contraindications to phytoestrogens.

Which dietary intervention has the MOST evidence for mild menopausal symptom relief?

Graham Pinder, aged 66, has osteoarthritis of both knees. He is interested in glucosamine and chondroitin. He is already on regular paracetamol and uses a walking stick.

Past history: OA, hypertension. Medications: Paracetamol, perindopril. No allergies. BMI 29.

What is the MOST appropriate advice about glucosamine use?

Julia Weston, aged 36, is seeking natural options to support fertility. She and her partner have been trying to conceive for 7 months. She ovulates regularly. Investigations to date are normal for both partners. She asks about coenzyme Q10 supplementation.

Past history: Nil. Medications: Prenatal vitamins. BMI 22. Non-smoker. No alcohol. Regular cycle.

What is the MOST appropriate statement regarding CoQ10 and fertility?

Kevin Tran, aged 58, presents with mild hypertension. He has made dietary and exercise changes and asks about beetroot juice after reading it may lower blood pressure naturally.

Past history: Hypertension, mild. Medications: Nil. BMI 26. BP today: 138/88 mmHg.

What is the MOST accurate statement regarding beetroot juice in hypertension?

Olivia Munro, aged 47, presents with anxiety and disrupted sleep. She asks about lavender oil capsules as she finds lavender aroma relaxing. She has read about oral use for anxiety.

Past history: GAD. No depression. Medications: Nil. Social: Non-smoker, no alcohol. Normal thyroid function.

What is the MOST appropriate clinical advice regarding oral lavender oil?

Stephanie Yoon, aged 44, presents with chronic tension-type headaches. She has tried over-the-counter analgesics but prefers to avoid regular medication. She has read about magnesium and asks whether it may help.

Past history: Tension headaches. No migraines. Medications: Paracetamol PRN. Sleep and diet adequate. No red flags on history or examination.

What is the MOST accurate advice regarding magnesium for chronic tension headaches?

Arjun Patel, aged 35, presents with allergic rhinitis and asks about butterbur extract. He is looking for a non-sedating, natural antihistamine alternative for springtime use.

Past history: Hay fever. No asthma. Medications: Loratadine PRN. No known allergies.

What is the MOST appropriate advice regarding butterbur use?

Jessica Browne, aged 30, is interested in complementary therapies for polycystic ovary syndrome (PCOS). She experiences irregular periods and mild acne. Bloods show elevated LH:FSH ratio and mild insulin resistance. She asks about inositol supplements.

Past history: PCOS. No diabetes. Medications: None. BMI 26. Normal prolactin and thyroid.

What is the MOST evidence-based benefit of myo-inositol in PCOS?

Daniel Morris, aged 50, presents with concerns about sleep maintenance insomnia. He wakes multiple times and finds it hard to return to sleep. He has heard about melatonin use and asks your opinion.

Past history: Shift work-related insomnia. No OSA or depression. Medications: None.

What is the MOST appropriate advice about melatonin use in this context?

Chloe Zhang, aged 38, is interested in natural anti-inflammatory support for her mild rheumatoid arthritis. She is stable on methotrexate and asks whether turmeric (curcumin) supplements are useful adjuncts.

Past history: RA, stable. Medications: Methotrexate, folic acid. No liver disease. Normal bloods. Non-smoker.

What is the MOST accurate statement regarding turmeric use in rheumatoid arthritis?

Zane Mitchell, aged 22, is a university student experiencing recurrent episodes of functional abdominal pain and bloating. He reports no weight loss, blood in stool or family history of bowel disease. He asks about the role of peppermint oil capsules.

Past history: Functional gut symptoms. No red flags. Normal colonoscopy 1 year ago. BMI 23. No medications.

What is the MOST accurate statement about peppermint oil in this context?

Marissa Duong, aged 29, presents requesting natural support for mild depression. She prefers herbal treatments and has researched SAMe (S-adenosylmethionine). She asks whether it’s appropriate to try this supplement.

Past history: Mild depression. No bipolar disorder or suicidal ideation. Medications: None.

What is the MOST appropriate advice regarding SAMe?

Hamish Blackwood, aged 68, presents asking about natural ways to support his prostate health. He has mild LUTS and no history of prostate cancer. PSA is normal. He is considering taking saw palmetto extract.

Past history: BPH. Medications: None. No haematuria. No signs of infection. DRE: smooth, enlarged prostate.

What is the MOST accurate statement regarding saw palmetto use?

Nina Kapoor, aged 40, presents with long-standing fatigue. All relevant blood tests are normal including TSH, ferritin, coeliac screen and B12. She asks about rhodiola as a natural energy booster.

Past history: Unexplained fatigue. No mental health issues. BMI 22. No medications.

What is the MOST appropriate advice regarding rhodiola?

Pauline Harris, aged 59, has non-alcoholic fatty liver disease (NAFLD) diagnosed on ultrasound. She asks about the role of milk thistle (silymarin) in liver health. Her LFTs are mildly elevated. She is not on any hepatotoxic medications.

Past history: Hyperlipidaemia, NAFLD. Medications: Atorvastatin. BMI 29. No alcohol use.

What is the MOST accurate advice regarding milk thistle use?