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Supporting Endometriosis Naturopathically with Kate Powe

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Supporting Endometriosis Naturopathically with Kate Powe

According to recent statistics in Australia, the health care costs associated with endometriosis total more than double of that of diabetes.

Kate Powe navigated her own path to diagnosis and management of endometriosis and where it led her, was into a new career in natural medicine. Kate now specialises in women's health issues including endometriosis, PMS, PCOS, methylation and weight management where her patients reap the benefits of her first-hand experience. Kate has a truly wholistic approach, recognising the role that orthodox management plays in managing these complex, hormonally-driven disorders, whilst also supporting her patients with the best evidence-based, herbal and nutritional interventions.

Today on FX Medicine, Kate takes us through her own journey with endometriosis and her favourite tried and true treatment approaches. 

Covered in this episode

[00:45] Introducing Kate Powe
[01:42] Kate's journey with Endometriosis
[04:56] The prevalence of Endometriosis
[06:29] Navigating endometriosis with patients
[10:42] Resource suggestions for practitioners
[12:22] Referrals and working with medical team
[14:18] Blending medicine and naturopathic philosophies
[16:32] Controlling inflammation
[19:23] Where hormonal interventions fall down
[21:43] Progesterone vs. Progestins
[24:01] The pros and cons of Mirena
[26:14] Complementary medicines alongside medical treatments
[30:22] Dietary interventions
[32:36] Prioritising therapeutic interventions
[40:26] Mind-body medicine for Endo
[42:51] Thanks to Kate for joining us


Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining me on the line today is Kate Powe, who's a Sydney-based naturopath with a passion for helping women restore their hormonal balance and achieve whole body health.  
 
Kate's passion for women's health is borne of her own battles with hormonal issues and endometriosis, a confounding condition to say the least. It was through her own journey of healing that she was drawn into the world of natural medicine. Now, she lives and breathes it with busy clinical practices and as a sought-after writer and blogger. She's a self-professed biochemistry and pathology nerd who loves blending evidence-based science with the ancient wisdom of herbal and lifestyle choices for healing. Her interests include MTHFR-methylation issues, women's health hormones, endometriosis, PMS, nutritional ketosis, low-carb, high-fat diets, and others.  
 
Kate, I warmly welcome you to talk about endometriosis and your journey with that condition today. 
 
Kate: Thank you, Andrew. It's really lovely to be here. Thank you. 
 
Andrew: Now, Kate, as we've discussed, you have your own journey, but I think... Can you take our listeners through your background? Because I love this ‘nerding’, this ‘nerding out’ of the biochemistry, and I think it is often overlooked, indeed even trivialized by certain comedians and medical professionals who say, you know, "What is an evidence-based vitamin blah blah blah?" They'll say, "That's medicine." That's absolute rubbish. You can't patent it, and therefore a pharmaceutical won't put the marketing and evidence into it. You can't patent an egg. So, talk to us about your background and how did you come to specialize in women's health.  
 
Kate: Yeah, well, I guess, you know, my background actually was in, you know, corporate industry, sort of, software, and investment banking, and that sort of thing. And I guess I’ve always had a bit of a passion for, you know, both that scientific sort of model of things, but as well this sort of esoteric, you know, fascination between humans and our potential for healing, and change, and growth, and so I'm interested in both aspects, I guess, a bit of a detective.  
 
So, through my own journey of, you know, endometriosis, I guess I'd been suffering since my late sort of teens and early 20s with really severe, heavy cycles, and bleeding, and, you know, depression, and bloating, and all the things that go along with endo. And it had a massive impact on my own corporate life, and how I could perform in my role. Socially, you know, on a work level relationship, everything.  
 
So, I guess I'd been put through the gamut of medical solutions to endo. So, I'd been on multiple types of the pill, oral contraceptive pills, of progestins, of a whole pile of things, and nothing really worked for me. So I guess it was, you know, out of my own desperation in my 30s that I finally went to a GP who had the foresight to finally be the one that, you know...a GP that picked up that it's endo.  
 
And, from there, I sort of went, "What? What's that? I've never heard of it before." And that really sparked my interest then to think, "Okay, I need to delve into this and find out what it is and why it's taken so long for someone to diagnose this condition in me? And how can I heal it?” Either medically or naturopathically. I had interest in both, because as you said, it's a... For me, the passion comes from looking into the biochemistry of the body and what's the body doing on a mental, emotional level as well as a literal, physical… how did it get there? What's the process of it happening in my body? 

So, it sort of sparked this interest in naturopathy but also in that really understanding the mechanism of the disease and what's happening. And that's an ongoing process. I don't think anyone has the absolute answer, but it's just a fascinating journey to explore. 
 
Andrew: No, I think this is one of the, to me, confounding and frustrating. It makes me want to scream, seriously. That, like, with the prevalence of endometriosis that we don't know about, and the absolute...it's not just frustration. Like, some ladies are in absolute agony. I've heard of stories, you know, of people, losing their bladder, and having fistulas, and things like that. Like, this is not a little bit of bloating and cramping. I think this is way trivialized, and I think it's abhorrently misdiagnosed. Given its prevalence and its commonality, it's abhorrently under-looked into. Why? 
 
Kate: Absolutely, absolutely. And the frustrating thing... I find it… This is astounding to me. So, just on a statistical level, the cost per woman of endometriosis in Australia is over $12,000. And, looking at larger diseases, say diabetes, which is, you know, a warranted condition which we all need to look into, but that's one of the most targeted, you know, chronic conditions in Australia. It costs, directly, healthcare cost, just $1 billion annually. Whereas, endo is $2.5 billion directly in healthcare cost. And we just don't have information out there on it. And, as you said, women are chronically underdiagnosed, and nobody is taking this condition seriously. So, we're on a mission. 
 
Andrew: So, given that you've been on that end, the patient end of the diagnosis yourself, what insight can you give for our listeners, our practitioners, on how to approach, or reassure clients, or even to look further?  
 
Kate: Yeah. So, I guess the nice thing about having experienced it, is always it gives me an eagle-eye for detecting so it’s on my radar 24/7, and it's my mission to help other people have it on their radar, too, other practitioners. But, you know, supporting clients, it's really to take them seriously and to reassure them that their level of pain or symptoms aren't normal, and they're not crazy, and they have a right to, you know, really talk about it.  
 
You know, I'm amazed at some of what women are putting up with, and I think... I just don't know how you're functioning at that level, but women are quite good at sucking it up, and just doing it. So, I guess to be a sounding board, and also to encourage them to... You know, some women come to me and say they've been to a GP and it's not endo. And I'm like, "Okay, so how did they know that?" 
 
Andrew: How did you arrive at that...? 
 
Kate: How did you arrive at that conclusion? Astounding, the number of women that come and say, "I had an ultrasound, and it's not there." So, we'll talk about that, but that's definitely not a diagnostic tool of endo. And some women have had endo surgery, have had a laparoscopy, and may have said that it's been, you know, taken care of, but they've had immediate pain afterwards and it's never resolved. And my question is always about, "How good was the surgeon? Did you ask for a second or a third opinion?" or "Just because you have had endo surgery, doesn't mean it's completely resolved. It does depend on the surgeon, the technique they used, whether all of it was removed." 
 
Andrew: Or indeed what about adhesions and things like that? 
 
Kate: Absolutely, absolutely. So I think we have to be a little bit more savvy, and a little bit less just taking the first opinion or, you know, be a bit more educated about what it is, and what you need to look for, and to keep jumping up and down, and asking questions. If you're not feeling better, go for a second, third, fourth opinion, and find out what issue is there. 
 
Andrew: So, Kate, women's health is obviously not everybody's forte. I've got to ask from a male perspective; What tips and advice can you give practitioners on how to navigate this condition area? Indeed, for males especially, how to be more aware of women's issues in this regard? 
 
Kate: Yeah. I guess the first thing is don't be afraid to ask. You know, it's kind of almost like mental health as well. Some people are a little bit, "Ooh, it's women's issues." We don't want to sort of go there, or talk about it. But I think it's really important just to be upfront and honest, and really ask and delve into what are they experiencing? What are they going through? Like, how bad is this for them? Because the support, as we said, is not just about physical, but it's also mentally, you know, how to support them mentally and emotionally through the stress and the strain of going through, you know, women's health conditions.  
 
And I guess, you know, there's also the idea that women's health sometimes is simple. Like, it's just “oh you just give them Vitex or licorice and peony, and that's all women's health issue is.” Whereas...or it’s a bit of PMS, and that's kind of... Whereas, I think if you're really niche into that area, you know, there are so many different areas to look at in women's health that have so many different tentacles that you can delve into. So, you know, whether that's infertility and pregnancy, or whether that's in endo and more chronic inflammation diseases, or whether that goes back into gut health and methylation, there's just so many areas to look at.  
 
So, yeah, I guess it's just asking the right questions, and doing the research as well yourself and getting some good mentorship in there as well. So, you know, attending seminars and finding really good mentors who can help you through that area as well. 
 
Andrew: Okay. So, talking about that issue, practitioners. You know, we often get taught by commercial interests. Where should we rather be looking? And I'm going to spruik one here, like my heroine for female conditions, and that is Ruth Trickey enjoying her retirement in the Northern Rivers now. Hi, Ruth. 

But, what other resources can you point Australian practitioners to where they can get really good advice? Endometriosis.org, for instance?  
 
Kate: Yeah, definitely. That's a fantastic resource there. And I will say, just to be a bit careful, sometimes those endo groups can be a bit, I don't know, antagonistic, but Endo Australia is fantastic. 

There's some great practitioners out there who are really leading the forefront in the area, too. So people like Lara Briden is an amazing hormone expert. You know, Rachel Arthur is brilliant. They're not specializing in hormones but just such a wealth of knowledge. And Andrew Orr is another fantastic guy that's doing a lot of work with endo as well.  
 
So, it's seeking out those people who are quite specialized or quite, you know, broad in their approach, and just learning as much as you can from them. 
 
Andrew: Yes, indeed. For our listeners, Lara Briden has The Period Repair Manual which, to me, is a seminal text, but have you done any work yourself? Have you written any books, or blogs, or...? 
 
Kate: Yeah, yeah. I've got several blogs on my website which you're more than happy to look at, and also I've got an e-book out as well called Beyond PMS - Understanding Endometriosis. So, that's available as an endo resource for people as well. 
 
Andrew: Wonderful. So, going back to that question that we spoke about at the beginning, how often do you find endometriosis is missed or undiagnosed in the women that you're seeing? And what do you do? Do you refer them back to certain practitioners like, you know, Dr Natasha Andreadis?  
 
Kate: Yeah, look, all the time, it is so commonly missed. I would say, you know, 90% of my clients that come in have never even heard of it or, as I said, it's on my radar all the time, and I immediately refer them back to a GP at least to get, you know, a diagnosis, and further investigation via laparoscopy or, you know, transvaginal ultrasound, just to try and pick up anything else that's there. 

People are quite amazed like I was when I was first diagnosed, because just people don't know what it is, or have not heard of it before. And I think it gives them relief to think, "Oh, this could be, you know..."  
 
Andrew: The answer to my woes. 
 
Kate: "...a condition rather than me just suffering through PMS or a bad period." 
 
Andrew: Yeah, I do like Lara Briden's words that, you know, it is not women's destiny to suffer from periods all their life. That is not a normal state of being, you know? I'm not religious... 
 
Kate: And that real re-education. 
 
Andrew: Yeah, that's right. I am not religious at all, but it is certainly not from eating an apple, you know?  
 
Kate: Yeah, correct. 
 
Andrew: That whole... Argh.. don't get me started on that. 
 
Kate: And Lara is also very great about, you know, women aren't just more men. You know, like, a lot of medical diagnoses and research has been done on men, and we just transpose it onto women. But we're completely different beings and hormonally completely different. So, we do need to start focusing on women's health as quite a specialized area. 
 
Andrew: Absolutely, absolutely. Looking into that, when you're referring back to a GP, do you have recommendations that you make? And how do you begin a dialogue for, let's say, you know, a GP that might not be open to natural therapies?  
 
Kate: Yeah, and there are a lot of them. So, it's great if you can find...like, actually, there are some great…I'll start this by saying there’s some fantastic gynos out there who are open to naturopathic sort of, you know, complementary treatments so that's great. 

But, look, I'm also not averse to medical interventions where it's needed, because again I think this is such a chronic, systemic, you know, inflammation-based disease that we need to put the patient first basically, and not trying to, you know, manage it because we believe naturopathically over medically. It's not about us. It's about the patient.  

Andrew: Thank you.
 
Kate: So, I do definitely... Here's my little rundown. This is how I start basically, and usually it's, this if, you know, pain management. So things like I will use ibuprofen when relevant. You know, when pain killers, natural medicines haven't worked. Ibuprofen can actually cut bleeding by half which is a fantastic, you know, result for someone that's really bleeding heavily, and has a ferritin of 8, or something. So, it's almost about stemming what's happening initially, and then working through naturopathically to fix, and mop up, and reduce inflammation, etc.  
 
And there's other medical intervention that I often ask to have investigated by a GP as well. So, I might look...if menorrhagia is a really strong part of the picture, to look at things like...to first get them checked for, you know, any bleeding or clotting disorders. So, have both panels run, but a drug like tranexamic acid or Cyklokapron is really great if there's no history of stroke, or thromboembolism, or that sort of thing. It's great at stemming bleeding. It's a great antihemorrhagic. So, again, as a temporary measure to sort of stop-gap until we can work out, you know, a longer-term process, then those sort of medications, I think, are quite useful. 
 
Andrew: Can I ask you to delve a little bit into the inflammatory nature of bleeding and the use of things like, potentially maybe, fish oil where most practitioners might think that it might be an anticoagulant action instead of its anti-inflammatory action on inhibiting bleeding certainly in periods? 
 
Kate: To be honest, I usually use that more via, you know, food and diet. And, in fact, I quite like things like evening primrose oil. So, for me, that level, even though... It's the gamma-linolenic acid. So even though it's... Omega-6 works on that really nice prostaglandin reduction.  
 
Andrew: Yep, EG1. 
 
Kate: Things like… Yeah, fish oil is fantastic as well, but tend for pain, I quite like... And EPOs have kind of gone off the radar. It was really big in the '80s, and then it just disappeared. And I'm like, "Oh, it's like so daggy now to think having EPOs." And it's hard to find, but I think that's... Yeah, I quite like using EPO as well as an anti-inflammatory agent.  
 
Andrew: EPO is an interesting agent. You know, it was touted for eczema by David Horrobin, but in his obituary, it was noted that he was "perhaps the greatest snake oil salesman of the 20th century," and that was somebody who worked with him.  
 
Kate: Wow. 
 
Andrew: Yeah, because all of the research that he did was from institutions that he had a hand in, and all of the independent research showed a negative effect, but that was with eczema.  
 
So, there's a few things of note. One, we've moved on from just this, "There's an eicosanoid pathway, and it all works perfectly in every patient that we see. It's only that we need to give the substrates." Wrong! Let's look about nutrition, about how the enzymes transfer those sorts of substrates. So that's the first one. And the other one is methylation. 

But, the last thing is that evening primrose for atopic dermatitis might actually work as long as you had simple things like zinc, B6, magnesium in with it. To help that cascade work. But you're right. It seems to have fallen off the radar as the flavor of the month. However, it has use. Indeed a colleague of mine uses it well. 
 
Kate: Right, yeah. And there's a myriad of different... you know, I use quite a lot of other, you know, herbs and other different supplements especially with endo. So, I guess it depends also if you're trying to target what the presentation of the endo is. You know, not every person presents the same symptoms. So if it's more pain and inflammation, you are going to look more at, you know, the COX and the inflammatory pathway. Whereas, if it's more, you know, bleeding, or infertility, or whatever, then there's other things you're going to look at as well on the inflammatory side.  
 
Andrew: Right. So given that the main medical therapy is various hormonal preparations, and pain killers to manage, what are your thoughts about that? How much further should we be looking?  
 
Kate: On pain killers or...? 
 
Andrew: And OCP, hormonally-driven therapies. 
 
Kate: Yeah. Yeah, right. And, look, again, there's a place for them, but it's not the be all and end all. So, you know, things like the OCP, the contraceptive pill, I mean obviously you're trying to...the idea behind them is trying to stop that hormonal... 
 
Andrew: Drivers. 
 
Kate: ...drivers, exactly, to shut down, you know, the hormonal impact on endometrial lesions. So, I'm not a great fan of the pill just purely because it's, you know, shutting down natural progesterone, and bone density, and mood, and weight gain, and all those sorts of things that go along with it. 

But, sometimes it's a last resort. Sometimes something like Mirena is a last resort, because at least that doesn't shut down or it shouldn't. It does not always happen, but it shouldn't shut down ovulation. It's a localised dose of progestin into the uterine lining so it's not just systemically going throughout the body. But I do find that Mirena where it can be really good for some women, it can be a complete disaster for others. And it seems to be quite black and white. You know, there doesn't seem to be an in-between that I've noticed with Mirena.  
 
So, you know, sometimes they need to be considered, but other times, I would be, you know, looking at other more natural treatments to see if we can stop that stimulation of estrogen on endometrial lesions. And I guess that's the other thing is that we have to remember that, especially with endometriosis, it's not necessarily a hormonal condition. It's stimulated by estrogen, or it's sensitive and responsive to the stimulation of estrogen…

Andrew: Yes. 
 
Kate: ...on the lesion. But it really is a disease of inflammation. So, the treatment has to look at more at the inflammation, and often that gets back to the gut, and, you know, those sorts of areas as well.  
 
Andrew: So you mentioned progestogen before, and I think this is something that needs to be differentiated against progesterone. Can you take us a little bit through this, and what does it mean? What are the differences? Because even GPs don't get this. They still say that word, "I'm giving you progesterone." No, you're not.  
 
Kate: Correct, correct. So they're two very different beasts. So when we're given synthetic hormones, synthetic progesterone in the oral contraceptive pill or, you know, in a number of other formats. It's the progestin which is a synthetic hormone. And it basically does almost the complete opposite of what your natural progesterone does. So what it doesn't do is create the metabolite allopregnanolone. So, ALLO is a really beautiful gabaminergic kind of... It helps with our calm, with sleep, with a whole pile of different things. Which is beautiful for our body, and that's what we obviously need. And it's those natural... I guess metabolites, the progesterone, that we're looking for. 

When we're given synthetic progestins, it can cause a whole pile of problems. Most notably bone density and bone loss as well. So, they're the sort of things we want to avoid. Being on the oral contraceptive pill can also increase insulin resistance. There's a whole pile of other things that it can do which isn't great for anyone with endo, or PCOS, or anything else.  
 
Andrew: So that's where I was going to go. What about the insulin resistance issues? 
 
Kate: Yeah, and they’re huge. This is the problem I get. We're trying to stem this overproduction of hormone on lesions, but it just causes a whole barrage of other issues, and insulin resistance is a really big one. And that's quite common in both. You know, we think of it as PCOS, we think insulin resistance equals PCOS, but it's actually quite common in endo women as well. So, you know, you're sort of putting a stop gap on one area to the problem but really creating different problems in other areas, I guess.  
 
Andrew: And do you find vast differences between things like, you know, medroxyprogesterone acetate, MPA, and the depo versions of those, or indeed the coil like Mirena? Do you find, like, vast differences with side effects or...?  
 
Kate: Look, well, it definitely comes down to the woman. I think that depo is quite devastating to women. I think it can have massive implications on their hormonal health, their ability to regain their cycle back. You know, skin, hair, acne, the whole thing, it really throws their system out for years and years afterwards. 

Mirena, as I said, it's a bit more hit and miss, but because it's localised, I think the effects aren't as devastating. However, the immediate side effects can be quite strong. 
 
Andrew: So, bleeding…?
 
Kate: Right, so either women respond, or seem to, respond really well to it where the bleeding will be minimised, and they'll sail through, and they think, "This is the best thing that's ever happened to me," or it can cause quite devastating bleeding, severe pain, and they just, you know, they get it out within 6 or 8 weeks, or they're okay with it again. So, yeah. 
 
Andrew: So do you find that there might be, with the Mirena coil, that there might be a period of...do I say the words ‘getting used to’ it? The body getting used to it, and they can then have a long-term benefit, or does it just not work and you have to get it out? 
 
Kate: Look, the theory, and what the theory behind it is that, yes, usually women need to leave it in for 6 months to sort of have it settle, if you like. But, you know, asking a woman to put up with that for 6 months, it's pretty ridiculous in my view. So, look, I do sort of suggest... If women sort of have had it in for a week and then go, "Oh, my God, this is devastating," I do tend to say, "Look, just give it another week or two to see how you go”, but if it's really... It's just you pretty can tell. If it's not going to work, it's not going to work. So, yeah, I then say, "Okay, it's not for you. Let's get it out, and let's look at other options." 
 
Andrew: So, let's say given that somebody had that treatment, and they did want to persevere and see how it goes in, you know, a few weeks, few months. What other treatments do you initiate on the natural side of things that might help the body settle that down? Like, for instance, do you use herbal styptics like good ol' shepherd's purse, or licorice and peony, or things like that? Do you look at instituting these, or do you leave well alone? 
 
Kate: Yeah, absolutely. And, again, it's great because endo, you know, as we said, is really about inflammation so we don't need to put a lot of hormonally herbal support around it. So once, you know, if you have something like a Mirena in there, then that's okay. We leave that to do its job. But there's a lot we can do around reducing inflammation throughout the body, helping your gut bacteria. Definitely styptics. So, styptics, like you mentioned, Capsella and also Panax noto are great sort of for that.  
 
Andrew: Do you ever use cranesbill? 
 
Kate: I don't, no. Actually, I haven't used that. No. 
 
Andrew: What are your favorites? What do you tend to get the best results with? 
 
Kate: Yeah, so look, I have a couple of favorites for different reasons. So, any berberine herb is my number one herb for treating endo. Because endo's actually linked to the presence of lipopolysaccharides. Which are endotoxins in the outer membrane of the gram-negative bacteria. So all those Klebsiella, and Pseudomonas, and H. pylori, and E. Coli, and that sort of thing that we find in, you know, CDSA’s often. 

And it's also linked to inflammatory cytokines, like interleukin 6 and TNF alpha, that sort of thing. So, those berberine herbs are really great, because they block lipopolysaccharides, and they also, you know, help with the antimicrobial and bacterial side of things. Inflammation, they repair, intestinal permeability. So, if there is any of that autoimmune potential... There's a bit of a diverse topic as to whether endo is autoimmune or not, but if there's any sort of potential with that, then it helps that as well. 

So those sort of herbs like, Phellodendron’s my favorite, but goldenseal and Barberry and Oregon grape and all those sorts of ones are great gut sort of herbs. 
 
Andrew: Phellodendron's really coming into its own, isn't it? 
 
Kate: Oh it’s good right. It really, and its appearing more, it’s fantastic. I get really good results using that.  
 
Andrew: Sorry to interrupt you. Can I ask? Do you find using phellodendron...as opposed to the other high-berberine-containing herbs. Do you find because you said it also includes Kampo medicine in not directly but indirectly helping to reduce stressful states which induce cortisol up-regulation? So, not directly inhibiting cortisol, please, listeners. But do you find that that's useful in, like, a two-hit wonder, if you like, addressing this stressful state? Is that where you tend to use it? 
 
Kate: Yeah, yeah. And there are lots of different mechanisms of action, I guess, but that's exactly right because stress is an enormous player in the role of endo, and to modulate your immune system, and, like, you said, modulate cortisol, not sort of shut it down or ramp it up. 

That's a really important part of a holistic treatment for people with endo is to look after the stress state. So, absolutely, absolutely. And, you know, endo does tend to have a bit of a picture around it. It is slightly more, you know, on a mind-body level, it is a bit more sort for those people that are, you know, perfectionists and type A and...not necessarily type A, but just I think stress reduction is a really important part of the management of the disease as well. 
 
Andrew: And going on that line, you know, we know from very good research... I just mention this lady's name so often, because I adore her work, and that's Professor Felice Jacka.  
 
Kate:
Oh, she's brilliant. 
 
Andrew: Yeah. So when you're looking at dietary interventions with regards to helping somebody with their endo, do you find that many, indeed most of your patients, have an abhorrent Western diet with processed food? Do you have to use major dietary interventional changes, or do you find that they just need tweaks? What do you find the lay of the land is normally? 
 
Kate: Yeah. Look, I think it's about educating women on what a great, healthy diet is, and sometimes that can be masked, you know, depending on other factors that are going on. If they're a really high-histamine person, they might be thinking their diet is beautiful and clean, but they're eating a whole pile of inflammatory foods for them. 

So, it's a matter of taking a really good case, I guess, and going through what's right for them. But, you know, there are some basics obviously which especially are going to help endo, which are sort of taking them out, the major things like, you know, dairy and gluten are often quite inflammatory-type foods. There was an Italian study that showed, you know, less red meat and an increase in plant-based food has a significant reduction in endo.  
 
So, my own personal view on that is still I like to see a little bit of, you know, red meat but it's grass-fed and organic. It has a better omega-3 to omega-6 sort of ratio, and it's a really important for iron especially if they’re losing so much...blood loss, and I like a little bit of that sort of in there. 

But definitely a heavier...focus on plant-based diet, on liver-supporting foods. All those beautiful, you know, onion, and garlic, and artichoke, and apple, and all that sort of lovely dark, leafy greens, that sort of thing. Dandelion can be an amazing liver detoxifier. So, it's usually about tweaking, I think, most, and it's astounding, a lot of women are eating quite a great, healthy diet. So, it's a pile of different things. It's not just one aspect.  
 
Andrew: I guess you've got a certain captive audience because you've got somebody who is visiting a naturopath because they're already on that journey. If they're with the Domino's crowd or, you know, that sort of Pizza Hut pizza crowd, they're really not your targeted audience, you know? 

Kate: Right.

Andrew: Maybe one in a few, but, yeah. 
 
So, can I ask you, when you're talking about the real issues that might happen with at least some portion of ladies with endometriosis with regards to anemia, with flooding, and all that sort of thing. Granted that it's not necessarily like fibroids, I get that. But how do you stratify or prioritise your treatments? 

Kate: Yeah… tricky. 

Andrew: Do you go, you know, lifestyle first? And where do you look at nutritional herbal interventions? And what do you choose first?  
 
Kate: Yeah, it's a really good question, Andrew, because it's really tricky when you're presented with a myriad of things going on for these poor women. You go, "Where on Earth do I start?" So, for me, it's always trying symptomatic first, just to give them some relief. So, diet, they're obviously educated through, you know, any changes of diet that can help stop that inflammation. So, again, often dairy is taken out; those sorts of things that can cause inflammation and pain.  
 
Then I do look at things like styptics and what can I do to help the pain and bleeding, for example. So, you know, just getting back onto a herb. Pukatea is one of my favorites, because it contains these amazing alkaloids which are more phenol. I think it's one of the strongest analgesic and anodyne herbs that I use, and I love it. I love it for that aspect. 

And then looking at things like turmeric is such an easy thing to put in your diet, and to take as a supplement, as a high-dose supplement. So I use that kind of, you know, those sorts of things. I mean turmeric actually has an impact on endo itself, so it reduces endometrial lesions. It stops, you know, enzyme secretion which causes rapid tissue growth and cell growth within endo lesions.  
 
So, I think those sorts of basic things to put into a diet first. And obviously if there's iron deficiency anemia, and zinc, you know, low zinc that sort of thing, I'll definitely look at sort of propping up those things first. 

And then I will send them back to the GP and say, "Let's get this tested thoroughly. Let's get your full pathology done. Let's really find out what's going on." And it slowly, it’s educating them, it's a journey that we can't patch this disease up in one or two sessions or in a couple of weeks, you know? It is a long-term journey, and it's a matter of working with them to address whatever they're going through at the time. 
 
Andrew: Yeah, I'm so glad you mentioned pukatea. Thank you, Phil Rasmussen, for bringing this herb to Australia from New Zealand. 
 
Kate: Brilliant isn’t it? My Fave. 
 
Andrew: And he's a brilliant man I've got to say. I hope to podcast him soon. He's a pharmacist, he's a herbalist, and he uses the best of both worlds, and he's just got such a... This isn't an admiration. He's got such a cultural link, if you like, to the honorable use of Māori herbs. Brilliant, brilliant stuff he does. Really brilliant stuff he does. 
 
Kate: Yeah, great. And it's also dopaminergic, so it's even an antioxidant. It's got, I think, even for mental health, you know, just that, I think, as an all-around endo. I love it. 
 
Andrew: Brilliant, brilliant. And so without mentioning brands because we do choose to remain brand-less on FX Medicine but… unless there's specific research alluding to it. But, with regards to turmeric or curcumin, do you tend to use the "highly bioavailable formulations?"  
 
Kate: Look, it's really interesting. Even talking to some of the, you know, reps out there in different brands, there's a lot of info now to say that it's not necessarily the way it's delivered, even though we know that, you know, using pepper or using, you know, certain oil-based formulas helps... 
 
Andrew: We'll let the companies argue that one. 
 
Kate: Exactly, but even within this, they're sort of saying, "Look, it really is a matter of trying which one works for you." So sometimes it can be the lower-dose ones that work better, you know? So, I think it really is a matter of finding the right product for you, and whichever way you go. And, also just, you know, as I said, using it daily, using it in your cooking. So, again, I would use it using fat, using, you know, all those sorts of natural way of getting it into your body.  
 
Andrew: Yep, I think we need to remember, as naturopaths, whenever we get these new-fangled formulations, that you'll get various commercial interests crying “theirs is best, and the next rep comes in saying theirs is best.” We have to look further and say, "Well, where did all of this research start? Where did it come from?" It came from a cultural perspective of this...  
 
Kate: Right… Looking at cultural. 
 
Andrew: That's right.  
 
Kate: That's right, yeah. 
 
Andrew: So I love the culinary/therapeutic use of turmeric in things like cooking, you know? 
 
Kate: Absolutely. And the same goes for things like ginger. You know, it's got those same properties. It's such a beautiful and under...you know, we often think, "Oh, just stick a little bit of ginger in something." But it's such a beautiful herb. It's a great circ stim, for any of those sort of reducing blood stagnation and to increase that peripheral blood flow. And it's analgesic and lowers prostaglandins. And there's a whole pile of things which ginger does which we sort of forget about. 
 
Andrew: Yeah, that's right, and the hotter, the better. 
 
Kate: Yes, exactly. Love it. Get your body, yeah, stimulated. 
 
Andrew: What else? Like, you know, let's say, you know that given that certain populations don't like ginger, don't like licorice, I think these are two of the more common herbs where people have an aversion to. For instance, even in things like flavoring. Like, I'd use ginger even just in a very tiny dose just as a warming sort of agent. Some people would refuse it. What then do you do? How do you wind your way through therapy? 
 
Kate: I guess it is also finding out what they will like. And you're right. It's about working with the client. You know, you have to... It's no use saying you have to eat this, or do this, or take this when they're just like, it's not going to happen.  
 
So, you know, cruciferous vegetables, brassica family, some people love it, some people hate it. And I think, you know, they're fantastic, say all your brussel sprouts, and broccoli, and cabbage, and all those sorts of things for that liver, sort of, detoxification, and estrogen detoxification.  
 
On a supplement side, then there's lots of other things we can look at. Things like, you know... N-acetylcysteine is amazing. There was actually just a… and you know, so many ways to supplement that, which is great. There was a cohort study done on ovarian endometriomas that shows over 12 weeks. I think it was 600 milligrams, 3 times a day, prevented the growth of cysts and reduced the size of those existing cysts. So, that has a marked impact on endo specifically, and it's also fantastic for depression, and obviously the liver and detoxification side of things, making glutathione. So, NAC is one of my favorite sort of supplements in the treatment of endo. I think it's really useful. 
 
Andrew: And such a lovely aftertaste. 
 
Kate: There are some bitter ones out there. You do have to kind of work your way around. 
 
Andrew: Oh, mate, even with the flavored ones, I've had to love that beautiful aftertaste. I've gone, "Mmmm, there is sulphation happening right there in my mouth." 
 
Kate: Right there.  
 
Andrew: So, just on a wrap-up question, what about things like mind-body medicine, Kate? 
 
Kate: Yeah, really important, really important. And I think, for women especially, we often don't give ourselves permission to... 
 
Andrew: Be. 
 
Kate: ...go there, you know, to be, to rest, and actually that's across the board. I shouldn't say women especially but it is something that there's lots we can do. So I think taking that time out for yourself, so really looking into things like mediation, or mindfulness, or...you know, it sounds a bit trite but gratitude journaling. All those things really help put us in a state of being. 
 
Andrew: I'm so glad you mentioned that.  
 
Kate: We just forget it in a busy, busy, busy world. So, I think that's really important. And, there are, you know, other sort of techniques. There's abdominal massage. There's a few other things that specifically can help the symptomatic relief. 

But, I think the biggest thing is also just not letting the disease define who you are and finding mechanisms to manage that yourself. So it's quite hard when you've been battling this condition for a very long time. You can become quite cynical to people who are just like, "Oh, just take a tramadol," you know, and you get quite... So when a diagnosis is made, it is quite normal to sort of own it and then not want to let go of it, because you finally got validation that you have this disease. 
 
So, in my perspective, it's more about if we set up this mentality of it's an "us and them" attack within our body, or we have to fight this condition and it's a struggle, then we're really giving the power over to something else other than it's our body, it's still ourselves, and our immune response that's happening. So, if we work with our body, I guess, and treat it with kindness, and respect, and not hatred. Then we're more likely to learn, and grow, and heal through that process. So, whatever we can do. 
 
Andrew: I'm so glad you mentioned gratitude. It's something that Lise Alschuler constantly reminds me of, indeed my wife, constantly reminds me of having gratitude for things in your life, and how that... I'm not being esoteric, I'm rather physically-based, and I'm thinking, you know, just that gratitude can change biochemical processes... 
 
Kate: Oh, absolutely. 
 
Andrew: ...for the better. I love the way that you included that, so thank you so much. And I've got to say, like, obviously you are somebody who has owned, shall I say, this disease process…disorder, condition because of your personal journey. But I love the fact that you have taken charge of this and said, "I need to help others." And not just in a way that says, you know, "Let's go down the supplement bandwagon," but you look at the patient first, and whatever they need is whatever they need. 

So, Kate, I've got to say thank you so much for joining us on FX Medicine today, and I look forward to podcasting with you in the future on other conditions as well. 
 
Kate: Thank you, Andrew. It's been a real pleasure. Thank you. 
 
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.

Additional Resources

Kate Powe
Ruth Trickey
Endometriosis Australia
Lara Briden
Rachel Arthur
Andrew Orr
Lara Briden's Period Repair Manual
Kate Powe: Women's Health and Hormone Blog
ebook: Beyond PMS - Understanding Endometriosis by Kate Powe
David Horrobin
Phil Rasmussen: Herbalist


DISCLAIMER: 

The information provided on FX Medicine is for educational and informational purposes only. The information provided on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health.

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