Taking integrative gynaecology to the masses, Dr Natasha Andreadis - aka Dr Tash is a little bit different. Not only does she have her own YouTube channel: Dr Tash TV, but she is also one of only a handful of medical doctors with specialised training in Reproductive Endocrinology and Fertility. Furthermore Dr Tash is open to the responsible use of nutrition and supplements where necessary to gain maximum benefit for her patients.
In today's podcast, Dr Tash takes us through the common factors affecting fertility, how our genes can affect the way women conceive and some practical care to enhance natural fertility.
Covered in this episode
[00:47] Introducing Dr Natasha Andreadis
[02:02] It all started from quitting sugar…
[06:19] Hospital food
[09:34] The birth of "Dr Tash TV"
[11:54] Following patient intuition
[13:54] Genetics in reproductive medicine
[21:00] Food and supplements
[24:37] Polycystic Ovarian Syndrome
[33:18] Communication, curiosity and open-mindedness
[34:42] Endometriosis perspective
[38:12] How important is iodine?
[40:20] Next podcast topic
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook, and joining me in the studio today is Dr Natasha Andreadis.
She's a certified reproductive endocrinologist and infertility specialist, that is CREI. This qualification is held only by a limited number of doctors in Australia and New Zealand. CREI sub-specialists are the most qualified of gynecologists who manage infertility and hormonal issues. But beyond this, Natasha is an integrative fertility specialist. She's currently completing further studies in nutritional and environmental medicine, and incorporates this focus into her daily practice, not only for the developing embryo that is exquisitely sensitive to diet and environment, but for children and adults.
She helps people restore and maintain good health and is actively involved in Sarah Wilson's I Quit Sugar Program. As a lecturer at Sydney University Medical School, Natasha inspires future doctors to adopt the same complete clinical approach.
And I warmly welcome you, Dr Tash, to FX Medicine. And we'll get into Dr Tash a little bit later.
Natasha: It's great to be here.
Andrew: Thank you so much for coming into the studio and joining us here.
Natasha: Thank you.
Andrew: I've got to ask, as a GP starting out, you've got all of this medical stuff in your brain, what the hell happened to you to embrace nutritional medicine?
Natasha: I suppose it started from a personal perspective. I mean I've always been interested in nutrition and a good diet and, you know, I come from a good Greek home where food is really, really important.
Andrew: This is really interesting to me, this family aspect.
Natasha: Very much so. And, you know, growing up, dad always used to say, "What are you doing eating out of a can? You should never eat out of a can. It's full of chemicals." And so, my parents have never opened a can in their lives.
Natasha: Yeah. And then, you know, fast forward many years later, what are we reading that, you know, there are bisphenols lining cans and that we really should be avoiding canned food. And I thought this old wisdom, you know, has constantly just been there but I've ignored it. And so...
Andrew: Because it's convenient.
Natasha: Very convenient. And I think it all pretty much started when I went from being a fellow to then finishing my ONG training in the reproductive medicine side of things. I then went into private practice. And I was able to actually manage patients the way I wanted to. So I was no longer a trainee to public hospital, but I was a private doctor. I was my own boss. And that, for me, I just had an immense amount of freedom to pretty much manage patients the way I thought was appropriate.
So, then I started looking into nutrition a bit further and it pretty much started from the fact that I had finished my exams. I'd gained a bit of weight, I felt off. I just didn't like the way I felt. So, I thought to myself, well, I want to go onto some detox diet or do something, there was something I needed to do. So, one day I remember walking into Dymocks and on George St here in Sydney and I saw Sarah Wilson's I Quit Sugar For Life, or, I Quit Sugar book. And I picked that up and I thought, "This is it." You know, I've got to focus on one ingredient which is sugar. And by just purely doing that, I lost weight, I felt so much better. And for me, it just then inspired my daily practice.
So, now, when I see patients and they have an issue with weight, or even if they don't have an issue with weight, if they're not eating well. It goes back to that first ingredient. Because I think it's less overwhelming for a patient to say, "Rather than go away and lose weight, let's just focus on this one thing."
Andrew: I've got to ask, you know, there's been some backlash, if you like, about the sugar movement. And I was just reading a couple the other day and one of them basically said, "Look, all food basically breaks down to sugar, even, you know, your proteins. You've got your glycogenic proteins and then you've got your ketogenic proteins." Notwithstanding a little bit of fat that goes into that, but they were basically sort of simplifying it down to sugar.
But I just…why don't they get the message that we're not talking about blood sugar, as in gluconeogenesis, glycogenesis. We're not talking about bodily manufacture of sugar, we're talking about the intake of excess, simplified, often powdered, or added sugar. Is that correct?
Andrew: Do they not read the book? Like, what is it? Why...
Natasha: It is that, it's education. It all stems from education and fear, you know.
Andrew: I don't get it.
Natasha: When you actually read that title, I Quit Sugar, it is overwhelming. And you will look at that and think, "Wait a minute, I cannot do that." And I think that title can sometimes, in a way, be a little bit misleading because it's not about quitting sugar.
It's about educating yourself about the different types of sugars and minimizing the bad sugars, and there are different sugars. So, I on my coffee table at work have Sarah Wilson's book but I also have That Sugar Film by, and the name of the amazing guy who made the documentary evades me, escapes me.
Andrew: I met him and nearly accosted him in the airport.
Natasha: Amazing, great book. So, I said to my patients, "Take a photo of the covers of those books and go and buy those books." And I like them because they are Australian authors, and a really good place to start. And I've had amazing outcomes from patients having just read those books.
Andrew: So, I guess comparing this with your hospital life, with patients who were on hospital food…
Natasha: Yep. Where we didn't even have time to ask them about nutrition. We're not timed, we weren't even asked, or trained...
Andrew: Somebody else will talk about that.
Natasha: That's right, to take that into account.
Andrew: Anybody who's been in and or worked in the hospital knows about hospital food. It's, you know, largely devoid of any appealing or nutritional value.
Natasha: Just not exciting.
Andrew: And it isn't exciting. It doesn't fit, you know, it's made for the masses. Notwithstanding that you would see people in hospital for a much shorter of time, but do you see any evidence of contrast between the types of foods or the types of benefits people would get from food in hospital compared to real food?
Natasha: Okay. Broth, people can make broth in their kitchen at home. Why don't we, and perhaps I don't know if they do serve broth in hospitals. But what an amazing thing to serve someone when they're healing. You know, when they're not able to eat much. But sip on this amazing nutrient dense broth.
Andrew: You’re just bringing back a memory for me.
Natasha: Yeah, and the colour, you know. I hope they still don't serve plain white bread in hospitals but maybe that's what people need when they're healing, just something basic. But I just remember looking at the food on those trays thinking, "How uninspiring."
Andrew: Wilted beans.
Natasha: Yeah, you know, and Coco Pops and Corn Flakes.
Andrew: And this is a good, healthy diet for you to heal, right?
Natasha: Not. Yeah, broth, bring back broth I say.
Andrew: Yeah. I remember Nigela Lawson talking about whenever she go to dinner at a friend's place if they had a chicken dish. She'd always ask them for the carcass of the chicken. She'd take it home and freeze it. And then she'd amass these carcasses and make her own broth. Can you take our listeners through what goes into a good broth?
Natasha: Sarah Wilson does that as well, and she kind of advertises that in her books, that that's what people should do. So, you get to a friend's place, there’s any leftover carcass? Take it home.
Okay, I would say where's the source of that meat from? You'd always want to know that. You know, is it organic, where does it come from? And I mean I've made broth using my slow cooker. And you just throw the bones in with some water, lots of herbs. You can add carrots, you could add peas. You can pretty much do whatever you want with a broth, and that's what's good about it. You can really make it your own flavour. And with the slow cooker, it's the easiest thing to make. And you can freeze it, you can put it in little pods and put it in your fridge. And then later on, take it out and use it as part of soup making or just to drink as a cup of tea. So, really easy and I often recommend patients look into broths, especially after healing post operation.
Andrew: Yeah. I was looking at one that they added lots of turmeric to it. And it's always...
Andrew: Yeah, really good anti-inflammatory.
Andrew: And of course, Pete Evans is, you know, he's been attacked a lot. An amazing man but he's really sort of, you know, charging forward in Australia with this sort of broth, sort of usage, and I applaud him for that.
But I've got to say, you know, you're a completely different cast from many of your colleagues. You take medicine to the people indeed with your YouTube channel, Dr Tash. And this is something it quite excites me, and I've got to say for any of our listeners out there, please look up YouTube and look up Dr Tash TV. Because you take it down, you take it through, but you take out the… you give them the important points. And relevant points for their care, particularly with fertility issues. What sparked you to start that?
Natasha: I… again, after my exams, I wanted to get creative because I had more time, and I have more independence to do whatever I wanted to do. And I wanted to make information available to my patients very easily. And in a consultation, which tend to be quite long, I can't, I don't have enough time to give them all the information that I think that they may need.
So, for example, we talk about magnesium and the benefits of magnesium. But I will say to a patient, I've got a video app of this, go up and have a look at it, and watch it in your own time. This is why I'm recommending magnesium. And I also learn a lot from actually making those videos, so it kind of forces me to do my own research. And, you know, I have a love and passion for food, so those videos that I've done up about food, like fennel and turmeric, again, a lot of fun.
But it's about making learning and sharing that information fun and accessible and free, you know. A lot of people ask me, "You must be making money from the YouTube channel." No, it actually cost me quite a lot of money to make those videos. But I get... They're very valuable for me and I get a lot out of that, and I know my patients do, too.
Andrew: People don't think about what goes into production of something, do they?
Natasha: That's right, yeah.
Andrew: They just see the end thing go…
Natasha: That's right, yeah. So, I like to interview people as well. So, I had a patient of mine who had thyroid cancer and she, using her intuition, pretty much diagnosed, or helped doctors make the diagnosis of thyroid cancer. And I interviewed her for one of my videos and I show that to patients who have had issues with, you know, trusting their own intuition or who have had thyroid cancer and need a bit of hope. So, yeah, I really enjoy it.
Andrew: That's a whole another podcast about how confronting, frustrating that can be for patients when they know that something's wrong but they can't... when they go and see a doctor, the doctor can't put it into a box. And so there is no definable box, where do they go? And they go from, you commonly see this and things, "I've been from doctor to doctor to doctor and finally I found..."
Natasha: In their intuition, you know, that inner voice is what keeps them going. And I think as doctors, you can't... I always ask someone, patients, "What does your intuition tell you?", you know. Always.
Andrew: Why don't doctors ask that question? Why… you're not taught that as a doctor. How do you handle that with colleagues? Like, with their more dogmatic approach? With their more medical approach? Why are you so different?
Natasha: Umm, maybe because I've kind of, I’ve follow more a spiritual path as well. And I think that in medicine and medical school, we should actually have a bit of more spiritual training, more mind-body medicine. We didn't have that at my med school. And I still don't think they had that at most med schools. And to understand that the human body is more… we're just more than flesh. And when it comes to my colleagues in discussing that, I know that everyone has an intuition and when we talk about intuition, they know what I'm talking about. So, I don't feel uncomfortable in discussing that with my colleagues. And if anything, I think it might be inspiring to some of them.
Andrew: Okay. So, how do you then handle criticism of your more conservative, I'm going to say dogmatic colleagues?
Natasha: I like to have discussions with people. So, if somebody does say criticise something I say, then I like to get into an in-depth discussion about that. I don't like running away from criticism. I like working with it. So, I take it pretty well actually but most of my colleagues are pretty good. And some of them are probably inspired by that openness.
Andrew: I hope so.
Andrew: Now, I've got to ask you about an avid area of interest of yours, and that is genetics. Tell us about what sparked your interest in this area? Because it's really, you know, it's in its infancy in its acceptance in medicine, despite there being a number of defined areas. You know, the usage of tamoxifen in certain genome, in certain alleles.
We know that, for instance, if people are on treatment for Helicobacter pylori, the triple treatment, triple therapy, that some people will not respond to the PPI as well. And so, they may have to double the dose to get that same sort of affect as anybody who doesn't have that allele. So, there are certain defined areas, they're not being used. Largely, they're not being used.
Andrew: And yet, there's this whole other area that I would say it's not even accepted yet, and yet it's well defined.
We know MTHFR is a defined thing with different alleles. What it affects, I think that's going to be the area of contention in medicine. But we know that, you know, certain people might have areas with fertility or neural tube defects with, and there's areas of about how people handle folic acid. Certain issues with, you know, cancer, or folic acid compared to folates or MTHF. How do you use genetics in your practice in a fertility arena?
Natasha: So, I suppose going back to your initial question which is how I got into it. Yeah.
Andrew: Five questions in one, sorry.
Natasha: Well, I did, yeah, a Masters of Reproductive Sciences in genetics at Sydney Uni. So, that's where my interest sparked. And then I, you know, as a fertility specialist, I talk about genetics in the patients all the time. So, I'm very comfortable in talking about, you know, doing a PCR testing, looking at genes for cystic fibrosis.
As part of fertility treatment, now, especially IVF, we are doing a lot of pre-implantation, genetic screening and diagnosis. So, that's very routine in reproductive medicine now. So, I can see that the technology is just going so quickly. That as a fertility specialist, you have to keep up with that. Now, what I find interesting is genetic panels that look at certain alleles that put you at risk of X, Y and Z. So they’re health and wellbeing panels for example.
So, from a personal perspective, I've done quite a lot of genetic tests on myself. From ancestry panels to panels looking at my risk of developing diabetes, cholesterol, inflammatory markers. So, I spent a couple of thousand dollars doing that. And it changed the way I live my life. So, for example, I have a lot of genetic markers that put me at risk of developing diabetes. Now, when I saw those markers I went, "Wow, I should check my HBA1c, my fasting glucose." And I was quite surprised because they were in the upper limit of normal. Now, I don't have any family history of diabetes on either side of my family.
Andrew: So, that was where I was going to go. So, no family history?
Natasha: No family history.
Andrew: But you have the alleles.
Natasha: But I have the alleles. But then you'll see how my parents live, very different to the way I live. So, you know, they don't eat out. Their stress levels are minimal. And I live a different life, I'm a doctor. I'm probably more stressed. I eat out a lot. Now, I realized then, "Okay, if I don't be careful then I might develop diabetes." So, up until then, I was, "Oh, I don't have any family history, I've got nothing to worry about."
Andrew: Right. So, this gets into the medical relevance of it. Because traditionally, we would ask a family history and that was how you would determine certain risk factors or preponderance for same. But it's kind of like, you know, the obesity gene. You know, you can have the OB OB gene or the DB gene. And if you don't have that lifestyle that predisposes it to you, you're fine. But if you start then to eat that gene, the gene will look after you. The gene will want you to "survive". Problem is you've now got too much of a good thing and you now get obese or diabetes.
Natasha: Epigenetics at its best.
Andrew: Yeah, absolutely, a nutrigenomics at its best.
Natasha: That's right.
Andrew: Why don't more doctors think about this though? Because they're still that...
Natasha: They’re unaware of it. So I've given a few talks about this and people are just not aware that these tests are available. But they are very much available.
For example, pharmacogenomics. So, my personal experience with that was I was walking past the Chemmart chemist, and saw that this test was available. I thought I'll just do it just to see out of interest what's going on with my genetic profile. And the day that I got my result, I had pretty bad period pain in the morning, quite intense. And I don't usually have really bad period pain. But anyway, it was quite bad, I was consulting. So, I thought I had to take something for pain relief and in my rooms I had some tramadol which I took. And I got severely nauseous to the point where I thought I was going to vomit, and no relief from the pain.
So, that afternoon I went to the chemist, got my results, and I cannot metabolize tramadol, so I should not take it. And I have a lot of gene changes which mean that I can't take a lot of drugs. And it was really interesting to me because I see a lot of women who are on anti-depressants prenatally and, you know, they're chopping and changing their anti-depressants because it's not working. They're trying to get pregnant.
So, you've got to balance whether they should be on a drug or not, given what we know about antidepressants and the effects of that on the fetus and the infant. So, if you do pharmacogenomic profiling in these patients, you can actually then say to them, "This is the drug that you should be taking." So, it just helps you target that, and it is widely available, you know.
Andrew: So, how do you balance the usefulness against the cost? Because there's some of those that are still quite at high cost.
Natasha: You know, they're not that expensive. This pharmacogenomic testing is only $150. But then, again, I am a doctor in a private setting and most people who see me are probably able to afford it. And I'm probably, for some other people, they would be out of reach. But in terms of genetic testing, it's pretty cheap. You know, when you do a genetic test you don't have to do it again.
Andrew: Very true.
Natasha: That's it. And the health and wellbeing profiles that I do through a company called Fitgenes is based in Melbourne. Four hundred odd dollars for a health and wellbeing panel that looks at inflammatory genes, cholesterol, fat metabolism, detoxification, cholesterol, really not that much money I think, for the value you get.
Andrew: Food and genes, is diet enough? Or do you employ judicious supplementation in your care? Like, for instance, we spoke earlier about MTHFR.
Natasha: Look, I believe that we should always start with the diet. And there are many people who don't need supplements because they are getting very good nutritious, nutrient-dense intake. But that's not most people. So, I like to… I don't really like using multivitamins. I like to target specific uses of supplements. For example, if someone has issues with muscle aches and pains, problems with sleeping then I would recommend a good magnesium at night. PMS, magnesium works beautifully, you know Lara Briden, in her book, wrote about that.
Andrew: Yeah. That's an interesting talk... This is more about leg cramps and PMS I think but there was an interesting debate, if you like, that went on between Thys-Jacobs and Guy Abrahams about calcium and magnesium for PMS, which is better?
What was interesting, so the lady who did the research, I can't remember her first name, Thys-Jacobs was her last name. She had the better trial. Hers was on calcium being positive for reducing cramps and PMS. Forgive my memory, but I think there was something that came out that she worked or had some association with Lederle, that at that stage was the...where the makers of Caltrate, calcium carbonate. Whereas, Guy Abrahams had a much lesser powered study in this and therefore was sort of lambasted.
But clinically, magnesium seems to be the hero. The problem is which magnesium? Don't want to go brands, but do you have a preference of type of magnesium? Like, you get your citrate or...
Natasha: Like, citrate, ox....
Andrew: …orotate. Even oxide can work. People are paranoid about oxide. Oxide’s great if you like, in massive amounts. If you want to do a bowel cleanse, it's called PicoPrep. But in small amounts…
Natasha: Yeah. My favorite is citrate.
Andrew: Your favorite is citrate?
Natasha: Yeah, yeah.
Andrew: Yeah, the Germans, like, they, it's citrate all the way. In the Americans, there's a lot of this diglycinate sort of thing. I find diglycinate work sort of quicker. But I've got clinicians that are dear to me, that taught me, mentored me, who are fans of the orotate. For heart, it seems to be orotate all the way, you know. So, you find that citrate works?
Natasha: Yeah, exactly. I mean if I was a heart physician, then I might be recommending a different type of magnesium. But I see a very different group of people. My patients tend to be in reproductive age groups so they're pretty generally quite healthy. And it's about maximising that health, getting people to be as healthy as possible for baby making. And that's what it's about.
Andrew: So, what dose of magnesium citrate do you use?
Natasha: About 200 to 400 milligrams of magnesium.
Andrew: Elemental magnesium.
Natasha: Yeah, yeah, per day.
Andrew: And no problems with bowel tolerance with that sort of dose?
Natasha: Some do but most don't. You know, I say start at 200 and then work up.
Andrew: And do you look at the, you know, traditional naturopathic type… let's call them clinical science of magnesium deficiency, you know, the ocular twitch, the nocturnal leg cramps, or do you just think about magnesium and its pharmacological sort of action?
Natasha: Good question. I usually just ask them, "How you're going on the magnesium?" And they will usually say, "I really like it." And if they don't say anything else then I won't go into it. Yeah, but no I generally I found it's very well tolerated.
Andrew: Yeah. You just said that many of your patients, most of your patients are pretty generally healthy. But Australia has a notorious, a dubious honour of being one of the fattest nations on earth and we're not getting thinner. So, about the issue with overweight and dare I say, underweightness in certain populations, excess people who exercise.
Andrew: What about issues affecting fertility like polycystic ovarian syndrome? Indeed, I've got to quickly ask you, should Australians be using polycystic ovarian syndrome, polycystic ovarian disease? Are they interchangeable or are there differences?
Natasha: I think at the moment, there's really no difference. In terminology, we know what it means. We know that you've got to know the definition...
Andrew: So PCOS, PCOD, same…
Natasha: Yeah, PCOS, generally fertility specialists talk about PCOS, we don't talk about disease. Yeah. I don't like using the word disease. I don't like using it. It's got kind of negative connotations.
But it's important for people to understand what the definition of PCOS is. So, the definition is we generally use the Rotterdam consensus 2003 or '04 it was, where we know it's distinct two out of three criteria. You know, you have polycystic ovaries on an ultrasound. You have two, is an ovulation or, you know, irregular periods. Three, acne, hirsutism, and biochemical evidence of high androgens, etc. So, two out of those three. And then after excluding for things like thyroid dysfunction and high prolactin.
So, I always find it's always important to actually say to a patient, "This is how we make the diagnosis of this condition. Yes, it's very common, 1 in, say, 10 women have this condition. And it's generally lifestyle driven." Most people who have this condition tend to be overweight and obese. But I see a lot of thin PCOS, and they tend to be the harder ones to manage. And they tend to almost have the most severe disease, I find. I’ve used the word ‘disease ‘,but manifestation, yeah, where they have quite bad acne, quite bad hirsutism.
Andrew: And yet they're fit-looking.
Natasha: Yeah, but
Natasha: Yeah, that's right. And that's where things, and looks can be deceiving in that way, you know.
Andrew: Indeed, I like you twigging my interest here because I'm thinking about somebody that I know who's had a horrible challenge with ongoing acne. And no GP has thought about looking deeper into the hormones. Indeed, this lady's got a genetic predisposition. She's got the cardiolipin antibody. And I've been really, why now are they just looking more at hormones here? She can't take the OCP so there's the, you know, she can't take a medicine for her acne.
Natasha: Are they addressing her diet and putting on supplements?
Andrew: And she's very, very healthy. So no, not an integrative GP. And I've been trying to get her to see one.
Natasha: Got her off dairy?
Andrew: Yeah, it's a whole conundrum...
Natasha: For a trial anyway.
Andrew: Extremely, extremely healthy young lady. Who's had this horrible challenge in her life. And she needs somebody to look into that area and nobody seems to be doing it. Anyway, getting back to PCOS, dietary intervention for PCOS, what's your favorite? What sort of things do you concentrate on?
Natasha: Sugar. So, refined sugar intake but also complex carbs, what type of complex carbs. You know, are you eating pasta, bread, potatoes, rice, are you eating a lot of that? So, we've got to look at starch as well and there is a genetic test you can do to look at someone's ability to metabolise starches. That gene is called AMY1. And I've got a very low AMY1.
Andrew: Can I ask though?
Andrew: If you have a predisposition for not being able to metabolise starches, metabolise them into fuel, like, where do you go from there? Does that mean that if you metabolise it better, that you have a greater preponderance for weight gain? Or if you metabolise it less, you have a greater…
Natasha: If you metabolise it better, you're less likely to gain weight. Your body can use it more effectively.
Andrew: And for fuel.
Andrew: Right, to burn.
Natasha: So the Chinese populations tend to have a higher AMY1 and perhaps that's probably because they eat a lot of rice, and genetically they have been adapted to that. So, that can be a very useful test to do because it helps motivate people. When they can see they've got a low AMY1, they'll go, "Oh, wow, that's why I can't really lose weight very easily because my diet is full of pasta and bread." And then they'll say, "Okay, I'll take those away now. I'll take those beige foods away and add a bit more color."
Andrew: Beige foods, I love it.
Natasha: Yeah. So, sugar is super important because we know that PCOS patients are more likely to develop type-2 diabetes. And in managing PCOS, a diet always comes first. It's the first thing we're trained to do which is one thing I've liked about my training. There's a lot of relevance in regards to food there. And in focusing on that one ingredient but also, you know, low GI, low glycemic index and load, you know, you can go into that as well with patients and I give them references to a couple of websites so they are familiar with what that means. And overwhelmingly, when you look at diets in fertility, and reproductive medicine, Mediterranean diet comes... It's always at the top, yeah.
Which means not that much we've made at all, it's more fish. And I think that's what people get confused because I think of Greek diet, for example, Souvlaki, lots of Souvlaki. Or as, in fact, when you go to Greece, meat is not that commonly eaten. It's more fish, particularly in the island regions, where they've done those longevity studies. Yeah.
Andrew: This is the thing that interest me about Ireland with the potato famine. Why didn't they eat more fish? But anyway.
Natasha: Yeah, that's a good point.
Andrew: Probably at the pub. I'm sorry. I'm going to get some criticism on FX Medicine.
Natasha: Well, potatoes are very nutritious, too, you know. But a bit starchy.
Andrew: A bit starchy. So, how do you handle then somebody that might have, you know, let's say irritable bowel syndrome? You need them on The Low FODMAP diet. And they've got a requirement for a low sugar type diet and you want to get a lot of these polyphenols of Mediterranean style. But some of those foods include high FODMAP foods. How do you then juggle that one?
Natasha: Look, I'll refer to specialists, like a good dietitian or an excellent nutritionist. So, yeah, that's beyond my expertise. So, there will be cases where it will be pretty simple but I can manage that. But in many cases I will go, "I'm referring you to somebody else." Yeah. That usually works quite well.
Andrew: And on that sort of point of dietary interventions, you know, I remember reading, was it a review of studies? And, you know, fertility specialists were basically saying that, you know, naturopathic nutritional intervention has no place in fertility, that it doesn't work. Well, hang on, polycystic ovarian syndrome is pretty well medically defined. So, I was just saying, well, how could they have reached that conclusion? What is the feeling of fertility specialists more conventional than yourself with regards to dietary intervention? Do they just not bother?
Natasha: No, they're opening up about that. Yeah, definitely. And I think more fertility specialists and general doctors are slowly accepting of that, and I do so slowly. But it's important to realise that 70% to 80% of our patients, those who are coming to us are already doing that. They were already seeing a dietitian and nutritionist, an acupuncturist, a naturopath. So, doctors are being exposed to that and they can't close their eyes on that anymore.
Andrew: They try.
Natasha: Yeah, they try but especially when a patient says to you, "I've seen an acupuncturist, and that's how my periods became regular again." How can you ignore that when that was the only thing that they did differently?
Andrew: I wait for the day that doctors become more open-minded rather than closing down the conversation with their patients. Because we know that patients are using natural medicines, they are. It's just whether you know about it. And maybe that will open up a more open, a more congenial dialogue between natural health practitioners and GPs. And get some good results for their patients. Because in the end that's what it's about. It's not about who's right, it's the patient's wellbeing.
Just moving on, I guess around that sort of area, what would you say are the top three issues which you see natural health practitioners, or indeed medical practitioners, not doing well? That they need to be more aware of for your patients?
Natasha: I'd say number one, communication. So, not communicating with each other. So, you should CC the naturopath into your letter. Let them know what you're doing and ask that naturopath to also CC you into correspondence as well.
Andrew: Uh-huh, nice.
Natasha: So, communication. Curiosity is the second one. So, being curious and being more open-minded. So, someone, a patient often will bring up something that you've never heard of. Then don't close it, don't close the door on that but rather ask about that in more detail. Look it up.
I mean I can't tell you how many times I've learned things from my patients than I've been explored myself and then offered to patient subsequently that have helped them a lot. And I think thirdly, being open-minded enough to ask questions. And, you know, we don't have to know anything, you won't ever know everything. And being more humble, not being humble enough, letting ego take over. That's one criticism I have.
Andrew: Two last quick questions and I know they are podcasts in their own right. But the first one is another fertility issue which is very common amongst younger women, endometriosis. Can you take us quickly through the aetiology? You know, we did a previous podcast which somebody criticised, and I take some of that criticism, part of it we refute. But what are the key issues that people can tweak, practitioners can tweak to take care of their patients with endometriosis?
Natasha: I mean aetiology we're not completely sure about. There are lots of theories, you know, is it genetic? Is it environmental? I think all… Is it auto-immune? I think all of those things will come into play.
Whenever managing someone with endometriosis, I think it's super important to take a multi-disciplinary approach. And to give patients options and to explore all options as well. And not to just go straight to the script pad and write the script for the pill. Because there was a recent article just recently in the Fertility Reproductive Medicine Journal, fertility, sterility. That basically said that the pill probably isn't the best thing for them.
Natasha: Yeah. You know, and we're probably been doing wrong by these women all this time. Because obviously the pills got estrogen in it. And why would you give estrogen to someone who...
Andrew: To an estrogen...
Andrew: Not estrogen-dominant.
Natasha: That's right. But maybe progesterone resistant condition? And, you know, progesterone versus progestins is very different. And that should be a whole podcast in itself.
Natasha: Because there are a lot of people who don't know the difference between the two. Multidisciplinary approach, so I use pelvic for physiotherapists. I use an advanced laparoscopic surgeon. So, if you've got endometriosis and you need to have it surgically removed, what's important for patients to realise and their practitioners, is that not all surgeons are created equally. So, I am not an advanced laparoscopic surgeon, you know, I will refer to my colleagues who do this surgery every day because it's not easy surgery. And some surgeons refer to endo, managing that, a bit like almost treating cancer, because it can be very invasive and difficult to treat.
Andrew: But then, they're turned tumors, they're termed lesions, correctly? Is that correct?
Natasha: Yeah. When you say lesions of endometriosis, you're actually seeing kind of, a speck of the process on a pelvic peritoneum for example.
That's where it's, you know, nutrition is a big thing, supplements, meditation, but also pain education. So, one very good pelvic floor physiotherapist that I work with, Heba Shaheed, has an interest in educating people about the neuroscience of pain. So, if we understand pain better, we're less likely to be sensitive to it. Because even though we say pain is in your brain, it's true. Pain is in your head. It is in your head because that's where pain is generated. Our brains generate pain, that sensation. So, education is key. And I often refer patients to read books on pain and managing that.
Andrew: I mean that can go into child birth and...
Andrew: You know, so many other...
Natasha: Every aspect of life. Neck pain, you know, shoulder pain. Pain is a very interesting area.
Andrew: Last quick question, iodine, championed by Professor Creswell Eastman. And it's been shown what do you know, Australia is an old continent. The soils have been washed clean of most things, one of them is iodine. How prevalent did you see it in your practice? Because, you know, despite Creswell Eastman's, you know, tearing at his brain because he just can't seem to get this message across. About the importance of iodine supplementation in some issues, in some instances. But we now, I think it was January 2010 or November 2010 that came out as a clinical guideline for all pregnant women to receive a supplement. Not supplemented food which it is, but an added supplement to women who are pregnant of iodine, 150 micrograms. Why aren't people listening about this? This is a public health guideline. Why don't they know about this?
Natasha: Slowly, people are becoming aware of it. I'd say all doctors are now pretty much aware of that. It's the patients that are not so aware. So, sometimes you'll get them coming in and saying, "Oh, I'm taking folate." But then you say, "How about iodine?" And you'll go into that. But I find it comes up not just in peri conception but also in PMS. So if someone has mastalgia, so breast pain. Breast pain is a very amendable to things like iodine supplementation, magnesium, B6. I find it...
Andrew: Avoidance of caffeine.
Natasha: Yeah, avoidance of caffeine, exactly.
Natasha: So, it's not just peri conception but in general health and gynecology find that it's very prevalent. And I often do urine testing.
Andrew: Do you, yeah, 24 hour?
Natasha: No. Usually a spot.
Andrew: A spot, yep.
Natasha: I don't always test though because I usually, I try and go on symptoms first, because I try and avoid the cost to the patient and to the system. And I find if you ask a very good detailed history and good questions, sometimes, often you can get away with not doing a test.
Andrew: I could chat with you for hours. Indeed, I'm going to invite you back to FX Medicine because there's so many other issues we need to cover.
Natasha: Yeah, progesterone versus progestins.
Andrew: Well, that's our next one.
Natasha: That's our next one.
Andrew: So, let's invite you back for another podcast, at another time.
Natasha: It would be my pleasure.
Andrew: And I just, I can't thank you enough. Not just for joining us on FX Medicine but for you being Dr Tash. Because as I said earlier, you really are taking medicine to the public, to the patients, to the streets. Where patients can be empowered, and they can then work with you as a colleague rather than sort of didactic approach that a lot of clinicians take. And I just can't thank you enough for that for what you do for your patients, so thank you…
Natasha: Thank you for having me.
Andrew: …Dr Andreadis for joining us in FX Medicine today.
Natasha: Thank you for having me on. I've always wanted to be on.
Andrew: That is my pleasure that.
Natasha: Thank you.
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook.
|Dr Natasha Andreadis|
|Dr Tash TV|
|I Quit Sugar|
|That Sugar Film|
|The Low FODMAP Diet|
|Professor Creswell Eastman|