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Kate Carr

Pre-Pregnancy and Postnatal Nutritional Care for Patients – With Kate Carr

Kate Carr

Pre-Pregnancy and Postnatal Nutritional Care for Patients

Today we welcome Functional Nutritionist Kate Carr to Wellness by Designs.

Kate specialises in reproductive medicine and brings a wealth of knowledge to today’s episode. Tune in as we delve deep into the world of fertility and how to gear our patients for better outcomes.

Kate talks us through critical assessments, essential macro and micronutrients required for healthy conception, microbiome health and mitochondrial health.

Listen in as Kate also touches on the fallout from the OCP and the mental health effects of COVID-19 on her patients.

About Kate:

Kate Is a Holistic Clinical Nutritionist, Educator and Yoga Therapist.

Kates approach involves providing nutrient-rich options as food in its medicinal space to enable you to operate at your optimum state. It can dictate mood (endorphins, stress relief), sleep, energy, health and HORMONES.

Kate divides her time between clients, lecturing at the undergraduate level, mentoring and spending quality time with her family.

Kate is passionate about women’s health, specifically natural fertility management, providing pre and postnatal conception plans for women and men. Teachings come from avid learnings, a lot of research and personal experience. She aims to assist women in becoming mums and being genuinely content, confident and thriving throughout the journey.

 

Connect with Kate:

Email: Kate@amanihealth.com.au
website: https://amanihealth.com.au
Insta: @katecarrnutrition
LinkedIn: linkedin.com/in/kate-carr-fertility

 

References:

TGA Levomefolic acid  https://www.tga.gov.au/folate-and-folic-acid-use-listed-medicines

TGA B6 Doses, Safety, Adverse effects: https://www.tga.gov.au/alert/vitamin-b6-pyridoxine 

ABS Nutrient Values: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/australian-health-survey-usual-nutrient-intakes/latest-release#vitamins

Lily Nichols: lilynicholsrdn.com

Dr Christiane Northrop: Website 

Christ Masterjohn: https://chrismasterjohnphd.com/

Transcript

Introduction

Andrew: This is “Wellness by Designs”, and I’m your host, Andrew Whitfield-Cook. Today we are joined by Kate Carr, a functional nutritionist who cares about pre-pregnancy and postpartum nutritional care for her patients. Welcome to “Wellness by Designs” Kate, how are you going?

Kate: I’m well, thanks, Andrew. How are you?

Andrew: I’m really well, thank you. Thank you so much for joining us today. I know you’re very busy with your practice. Now I want to warn everyone first that this could be a little bit of a detailed podcast. So, if we run out of time, Kate, are you amenable to rejoin us back on “Wellness by Designs” to another stage? Is that okay?

Kate: Yes, that would be wonderful.

Andrew: Wonderful. Preface is set. So, Kate, let’s start with your approach to care.

Kate: So, Andrew, so I deal primarily with fertility. So, reproductive medicine is sort of where I like to angle my sort of passion, and it’s dealing with preconception pregnancy postpartum. And I guess the whole way that I approach it is to thrive and not survive the whole journey of pregnancy. When women are able to, you know, feel better about themselves during and after a birth, also during the pregnancy, it’s all about enabling them that power to enjoy the process because life is too short. So, if we can thrive, then ultimately, we’ve got a happy woman and happy baby.

Andrew: So, how early do you see, not just women, but couples along their pregnancy journey? Like, do you specialize in the pre-fertility area and follow them right through, or do you see many patients really at this, you know, I was going to say postpartum, that’s wrong, at their pre-pregnancy stage.

Kate: The best case is always when they come to see me prior to wanting to conceive. So that could be six months, a year, 18 months prior. There’s some really, sort of, you know, women out there who are quite aware that there’s more involved than just the, you know, active conception. So, ideally, that’s the timeframe, but I must admit a lot of women probably do, and couples seek me out when they want to be pregnant yesterday, and they’ve been trying for a few months. And if with those women and couples, then it’s a case that I’ll see them throughout their journey. And in third trimester, we really try to work hard to set them up for postpartum as well.

Andrew: Got you, okay. But where we are talking about preconception care, you know, the immediate, I mean, it’s almost misogynistic to think it’s almost like, oh, well that’s the woman’s job. No, it’s not. There’s a male involved in this as well. The message that we’ve been taught, though, is that we need to see the male far earlier than the female because of spermatogenesis and the processes that go on there, how long it takes for a good sperm to be formed if you like. So can you take us through this timeline of when you would preferentially see patients, both male and female, and what’s the prep timeline for them?

Kate: This is where it can go down the rabbit hole, Andrew, and it’s how long do you have? Look, we’re very good at trying to make people feel better about themselves and the situation. When it comes to evolution, the ovary hasn’t changed for women; for girls, we’re born with a X amount of eggs, and this comes in utero from your mother. By the time we get to age 30, we potentially are down to 95% of some of our eggs, and it just goes downhill from there. So, if we did a better job at educating on pregnancy or preconception as opposed to sort of preventing pregnancy, I feel we could have a better outlook on this in society because you’re right. Men will come in, and they will be the last one to come in, or they’ll be forced to come in. Or it’s a case of the woman has to convey the message to the husband after the consultation. And that comes from the idea that sperm does regenerate, and it takes, you know, three months worth of really good sort of a preconception protocol with supplements, good diet, no alcohol, no mobile phone in your pocket, no laptop on your lap. That can really help, change things dramatically for a male. However, for a woman, we are born with what eggs we have, and the reality is, the longer they’re on the shelf, the quality declines.

So my goal is when working with any woman is to, it doesn’t matter what quantity is left. Let’s make that quantity optimal. And that the energy that’s required, the mitochondrial aspect of, you know, the O side itself, is astronomical. It’s more than one heartbeat, the energy that’s required in that transformation. So, we say 120 days in that’s 120 days, not for that egg too, you know, burst from the follicle but to actually really accumulate so much energy to allow it to be it’s absolute best and retain nutrients and have everything on sort of standby. So, 120 days, but, you know, ideally, it’s a lot more, a lot longer than that.

Andrew: Yeah. But, you know, that’s flipped on its head, that notion that, you know, it’s the sperm that has the energy, it’s the sperm that has the, you know, stacked mitochondria behind the head, in front of the tail so that it can wiggle its way forward in the millions that only one will…So, there’s this whole concept of in energy is the male thing, we’re talking about that there’s a substantial amount of energy required for the egg. This is the whole flip.

Kate: Yeah. The research today, we are very much, it’s about, you know, women power and it’s the women’s egg that chooses the sperm, not which is the strongest and breakthrough. It’s now, which egg will we decide, which sperm will we allow to come through?

Andrew: Can we discuss that a little bit, because this is so interesting about, and it’s a lesson that men need to learn, really. It’s the woman that chooses, or it’s the egg that chooses the male sperm, not the strongest sperm that gets through.

Kate: Yeah. Correct.

Andrew: Can we talk a little bit about this? What are the mechanisms that govern this?

Kate: The mechanisms it’s still very unknown, Andrew. We still don’t completely know. And this is where there’s a little bit of magic in fertility. There’s, of course, everything from microbiome to, you know, actual genetics here at play. But I can’t say I have a definitive answer as to how that actually unfolds. I just know that’s where we’re at in our discovery of conception.

Andrew: It’s a pity there’s not a questionnaire there saying, will you do the washing up? Will you unstack the dishwasher?

Kate: Exactly.

Andrew: Yeah. So, I know we’ve sort of got off track there, but tell us a little bit about the assessments that you use with couples. When we’re talking about both male and female issues with spermatogenesis and God, I hope I’m gonna get this right over, ovogenesis, that’s wrong. Ovogenesis. Can you talk us a little bit about the assessments that you have for both couples and particularly given that, as you say, it’s mainly women that come and see you, the men have to be dragged along. Do you send a questionnaire home with the female, with the woman? I should say.

Kate: This comes a lot in the preconception sort of questionnaire that I send out to couples or women before they come to see me. So they really know how detailed I want to get with them. And this is not just about what blood work they have or what other prior testing. It really comes down to a nutrition basis as well. Family history is very important, but ultimately prior to me seeing a couple, it’s finding out whether they’re gonna work, whether we are gonna be able to work together as well, because of my own, sort of ways that I would consider that would be the best way to work around this. It’s, like, I’ve done the research, I’ve done the study, I’ve seen it happen. If you are ultimately going to dig your heel and saying, no, that still want the outcome, then that’s something we have to sort of discuss together. But if we are looking at labs, we’re looking at serum. We’re looking at her mineral analysis stool testing. For man, it’s yes, it’s the, you know, it’s the profile of all their heavy metal toxicities as well as the sperm. You know, it’s a whole spider web of testing that can happen during this process and whether it starts straight away or three months in is something that I work with them depending on what background they’re coming from. Is it a first pregnancy, a second pregnancy, miscarriage, history, all of those details?

Andrew: Do you find with men who have sperm issues that there is often always an issue with heavy metal toxicity or some other toxicant? Like, for instance, I mean, we’ve got CCA from copper logs, so chromium copper arsenic, but there’s also the persistent organic chlorine pollutants. So, the pops which have, you know, bind to our hydrocarbon receptors, da, da, da. So, do you find a distinct correlation with occupation of males with regards to toxicants, or do you find that we are just living in a toxic world and even, you know, a sales executive driving around in his car all day will have toxic issues and executives as the welder, you know? Is there any correlation that you see, or do you find that you see occupational specifics?

Kate: There’s definitely occupational specifics. And as you said, whether it’s the landscaper coming in or it’s the businessmen, they both have their own, you know, pros and cons of how they live their life and lifestyle. We definitely already live in a toxic world, so that needs to be addressed. But it’s the simple things. It’s the blue light. It’s the, you know, it’s our environment, the air we breathe, the food we eat. You know, that’s such a big foundation, and then their profession is sort of the extra box that has to be looked at. Because as I said, is it the mobile phone in the trousers? Is it the laptop on the knees is, you know, are they actually getting any vitamin D from the sunshine? Like, it’s a myriad of things, but definitely, when it comes to heavy metals, you know, men like women, we have the ability to store it, and we drink from plastic bottles. And do you sweat? Like, it’s simple questions like that because it’s lymphatic, it’s, you know, a gentle detoxification every day is good for everybody.

Andrew: And because of our burgeoning waste lines, we know, I mean, I think Australia was fifth at one stage, there was some taunt that we had won the fattest nation on earth some years ago, but I think we’ve, thankfully we’ve lessened. I think Mexico is the worst at the moment, but we’ve certainly got burgeoning waste lines. We’ve certainly succumbed to that most dangerous of words, which is convenience. Do you find that exercise, just pure movement has a bearing on spermatogenesis and healthy sperm in males? You’re talking about sweating, for instance.

Kate: Yes. Without a doubt. And I like to tell my clients that stagnation no different to a, you know, a river that doesn’t move. If we have stagnation in the body, then things are gonna accumulate that we don’t want that. So, moving is a big part of everyday life to actually get things, you know, circulating but sweating, for instance, is just, we know that if somebody sweats that there’s a gentle detoxification happening all the time because skin is one way to eliminate excess.

Andrew: Got you. Okay. So do you advocate even just mild exercise for somebody who’s beginning this journey, and isn’t used to physical exercise, even just exercising together with their partner, you know, doing some yoga stretches, I mean, heaven forbid they’d go for a run, but maybe, but, you know, cycling. Things that don’t just end up being an exercise but also end up being a meeting, a connection as partners for them. Do you advocate that sort of thing for them?

Kate: Yes, without a doubt. Particularly those I’ve had couples who don’t exercise at all, and they’ve come to see me. And I say, well, the first things first, can we start a daily walk? Is there something where you two can meet in the middle, for instance, whether it be some men definitely aren’t interested in yoga? Still, maybe Pilates might be something because even Pilates and the diaphragm and the abdominal breathing. That’s a really good massage for that particular region of the body, particularly for a woman. You’re massaging all those internal organs, and no different to acupuncture when we sort of put a little bit of pressure somewhere, and we circulate the blood. It’s very healing. So anything they can do together and get a little bit of, you know, heart rate up there that is very beneficial.

Andrew: I loved doing Pilates. I thought it was hilarious. We have this vision. Certainly, males might that there’s this graceful raising of the leg and things like that. I’ve never sweated so much in my life. Thank you, Sarah, down at [inaudible 00:16:08]. But there was also a lot of like, oh, crap, when I tried to, we are not flexible. Forgive me, sorry, Kate.

Kate: I was gonna say and cramping probably, too.

Andrew: I could not believe the things that women can do as movements that males, it’s embarrassing. So, you know, you mentioned blue light and things like that, laptops on the thighs and mobiles in the pockets. You know, thank God we’ve grown out of the era of tight genes. We are now in the grunge era where things are loose. So there isn’t that constraint of the at testicles which has got to do with temperature and affecting spermatogenesis. But what other simple things do males really need to do? And forgive me for harping on males. I’ll go into the female portion too. But what are the simple things that males really, really need to take notice of when they’re looking after their sperm so that they can deliver the best option, to be chosen by their female partner?

Kate: When it gets to the nitty-gritty, not only is it, you know, your basics of nutrition and what are you exposed to, it really comes back to frequent ejaculation, sperm. Old sperm’s no good to conception. We need constantly that sperm renewal, and that comes from every two to three days of an ejaculation so that things start to get moving. So it’s part of the preconception for men.

Andrew: Now, their advice an interesting thing. If you are talking about somebody who, a male who comes from a toxic environment, let’s pick on welders, is it advisable that they have frequent ejaculation at least first to get rid of the old sperm rather than resolving that tissue to be recycled into new sperm? Is it better to just get rid of that while they’re preparing their bodies for the pure best healthy sperm, again, to be chosen by a healthy ovum?

Kate: Definitely. So, we can look at all their nutrients. We can look at [inaudible 00:18:53] support that, yeah, frequent ejaculation will help rid what you don’t want, rid what you don’t need.

Andrew: Yeah. That’s right. Now, females don’t have that option. So, how then do we best manage the female’s health, the woman’s health with regards to healthy ova?

Kate: So, healthy ovum. So we’re looking always at the quality, and that comes from, so we’re looking at the exposome science of environment foods, what sort of goes into our body, but also what’s gonna assist in that mitochondrial event, that huge event that requires so much energy. And that comes from making sure we’re not in a depleted state. It looks at the history of medication, history of illness, how much inflammation is in the body, is the immune system strong because these are all things that we know are compromised during pregnancy. And that’s, I guess my key message is to people is the biggest indication or thing we’re concerned about is that women don’t just get to that positive pregnancy test it about, you know, it’s the thriving pregnancy and the thriving baby. So, they’re one thing that I work, make sure I really sort of give that strong message about, it’s not just this positive pregnancy test. We need to make sure that everything from here on, particularly in first trimester when there’s so much happening in the body, there’s all those adequate stores to make this child to be a healthy adult, to be a healthy human being later in life. Not to have worries, trisomies and things like that, other complications that will go on in the pregnancy, let alone with the baby when they’re in the outside world.

Andrew: Yeah. There was something I read years ago, and that was actually, I think, it had to do with folic acid. Now, here’s a can of worms about folic acid versus folate and the issue of potential unmetabolized folic acid. This is something I’m only just learning about. So, forgive me. But I learned many, many years ago when we didn’t have the choice of folate metabolites, active folic, folic acid metabolites, that folic acid, adequate folic acid was actually helping a woman’s body to enable what’s called [inaudible 00:21:34], i.e., if there is a damaged ova blastocyst that it was actually, although it’s a horrible process for a woman to go through a miscarriage, it was actually a protective mechanism to say, “I’m sorry, this blastocyst, this fetus is damaged. It wasn’t going to fare well. We have to eject it.” So, along that lines, how much do you concentrate on folate metabolites B12 versus general nutrition versus specific stuff for, you know, toxicants and things like that. I guess this is a timeline question. Where do we go from here? That’s a very convoluted question, Kate. I’m so sorry.

Kate: It’s completely fine. So, I guess when it comes to folate, folic acid, methyl folate, we have come a long way. So, it was of the early 1990s that we realized that women who were supplemented with folic acid, it or folate, or had adequate in their diet, that we prevented a lot of neuro tube defects, which resulted in either miscarriage or had to, result in an abortion, sadly. So, when we learnt this, we definitely have jumped on the bandwagon and run. However, this is where it comes down to forms. And what we supplement with is if we supplement with not the best form, then this is where something like folic acid can accumulate in the body and raise homocysteine levels. So if we have high homocysteine, that also, unfortunately, creates pregnancy complications. So when we’re looking at particular forms, particularly like methyl folate, that’s gonna be much more beneficial to the body in the sense that it’s much more reduced and absorbable. And then we also need things like B12, and again, in a form that’s quite absorbable to the body, that’s going to allow it to be utilized and create that methylation process. That’s really essential to, again, conception.

Andrew: And what about other things like choline, you know, we’ve got serine, we’ve got B6, we’ve got methionine. I’m just thinking about the whole methylation cycle. It’s going around in my head biopterin. What do you think are the key nutrients we really need to concentrate on? And do you think it’s worthwhile just giving a multi as an insurance type thing, because there’s been this concentration of, you know, if you have “A healthy diet” you don’t need any nutritional supplementation? I’ve looked on the Australian Bureau of Statistics at the amount of both men and women who are deficient in even B6.

Kate: Yeah.

Andrew: That warrants a multi.

Kate: Yes, it does. And it’s not just B6 and B12 folate, magnesium, you know, copper is essential in the iron recycling process as is vitamin A, and that’s something that we are, you know, still trying to remedy the controversy of, along with your vitamin E, so your antioxidants, anything that’s going to break down this damage, this oxidation, which is very important. Again, when it comes to the older, you are with conception, and let’s be honest, a lot of people are conceiving later in life, and where there’s a unrealistic in my view reliance on medicine to warrant that because you’re right, it’s not just, I meet people who have this incredibly clean and [inaudible 00:25:36] and, you know, magazine-style diet. However, that’s not feeding their body. It looks good, and it sounds good. Still, ultimately, if we’re not meeting the fat requirement, the protein requirement, and even the complex carbohydrate requirement, our body works from almost a top-down approach when it comes to conception because if our brain, when it comes to the HPO access or the HPA access if our brain does not feel safe and secure, then ovulation might not even occur.

So, you know, we want to continue down this rabbit hole. We even need to make sure somebody’s ovulating. And if they’re ovulating, is it an optimal egg that time, or are we still in a place of trying to replenish nutrients and stores due to medications, or OCP or, the PCOS. Various conditions that come with, you know, insulin resistance or cortisol awakening response it’s all disturbed because of blue light. So, you know, it’s sorry I’ve taken myself down a rabbit hole now, but it’s just, there’s so much important. But when it comes to choline, you know, that’s essential for mom’s health, bab’s health in utero and postpartum, particularly as is DHA. They’re all essential in wanting to create an optimal pregnancy and a, you know, a thriving mom and a thriving baby.

Andrew: You know, I once had a conversation with a doctor who disdained vitamins, and I was asking him about the value of fish oil. And he said, I just tell my patients to eat fish. And I said, “How’s that working for you?” So, can I ask you of the patients that you see, given that these are going to be patients more aligned to wanting change in dietary modification, how much acceptance, how many of your patients eat fish regularly? And I know that’s a stat but as a guess.

Kate: 50% would.

Andrew: Right. So there’s 50% who don’t, who require some sort of EPA DHA supplementation. This is the thing that stuns me. It’s kind of like dietary guidelines. It’s well, just eat that, they don’t.

Kate: Exactly.

Andrew: So, how much work do you have to do on it’s not just reinforcing it. You have to be beating people over the head about the usefulness of these nutrients. And if they’re not going to get them from the diet, then they’ve got to get it from somewhere, or a supplement’s the only answer if they refuse dietary modification. So, what sort of stuff do you use, and how much do you have to beat them with it?

Kate: Absolutely, Andrew. So, we start with a very nutrient-dense approach firstly, and I am very heavy on supplements. I’ll admit that straight up. But in firstly, it’ll be about foods and whatever goes into that mouth of yours, what are we getting out of it? So, it is a nutrient-dense approach, and how can we optimize what you are eating? Because even if it’s a case of bioorganic and biodynamic and, you know, every label under the sun, if the soil’s depleted, then the food’s also going to be depleted. And that goes for meat as well. It’s, you know, it’s not just a grass-fed and organic and free-range. It’s, you know, if it comes back to the soil, then there’s ultimately going to be a sort of depreciation thereof availability. So, the food is first approach, and then it gets definitely topped up with supplementation. And that’s also because of it’s the energy required in this process. So the mitochondrial side of it, so that’s with the CoQ10 or [inaudible 00:29:51], but then it comes back to the nutrient levels. So, you know, we’re not always going to get adequate, you know, vitamin E and C, and things like that from our diet. So having a, you know, a therapeutic prenatal is paramount in my opinion, because it covers those bases because some days we don’t eat as well as we should. And some days, we might be…our body might be busy doing something else as opposed to absorbing nutrients because it also comes down to a microbiome and a gut. And if there’s any, you know, infections that are potentially preventing the absorption there. And we know with someone, if they’ve had a history of the oral contraceptive pill, there’s definitely a depletion of nutrients that have perhaps been happening for ten years, that we need to look at, you know, not just getting to a baseline, but getting to an optimal level.

So again, this comes back to, in my preconception, sort of conversation with people is that I’d say this is going to be a heavy supplement protocol. And this is not just, you know, for the case of me wanting you to buy ten different supplements. It’s about the health of you and the health of that child and the child’s health for the next 80 years as well. So, it’s really trying to get people to, you know, just let me guide you for a little bit so that we can make this the best experience possible.

Andrew: Yeah. What you actually mentioned there was intergenerational health, and I actually spoke to Matt Muer, who’s a vet, and he’s talking about intergenerational health with pets. Not just starting with the parent, but the grandparent of the thing that you need healthy. I mean, we’ve really got to expand our minds. Humans are horrible at this. We really need to increase. I love the way that you’re talking about this. Well, it is. Like, we know that we’ve seen from what was a DEAs [inaudible 00:31:57] the effects on the daughters of the mother who took DEAs. So, we know that these intergenerational health issues occur. Now we have to think about optimizing that health. It’s wonderful that you are thinking about that. Now, we could spend all day on this pre-pregnancy stuff because it, I mean, seriously, it’s a seminar, it’s a book. So I’d love to have your back sometime on “Wellness by Designs”, but let’s move on to postpartum care. Now, this is something that I’m a registered nurse. I thought I was gonna be fine with helping my wife through her pregnancy and things like that. I was hopeless. I was absolutely hopeless. And talking about postpartum stuff, well, there’s no rule book for that one. This is something that disgusts me with healthcare. Take us through what you find and what you’ve changed up your patients after they have a baby, a healthy baby, which they’ve now got at home.

Kate: Yeah. So I work with my clients in third trimester on this because I know that it takes…You get the baby home, and again, there’s a bit of a preconceived idea that you can stop your multi, you can stop your prenatal, you can stop all those supplements that you took preconception and just put them by the wayside because everybody says, oh, your baby will get what your baby needs or your body will make the milk that it needs to feed the baby, and it’ll be nutrient-dense. However, again, this comes back to, we don’t like to offend people because the reality is, and we know this, that if the mother is not consuming enough nutrients, the nutrients aren’t going to flow onto the baby. If the nutrients aren’t in the woman’s body, there’s nothing to flow onto the baby. And we’ve seen this the level of fat a woman needs is the milk. What fatty composition does it have? We know this with DHJ. We know this with choline that even B12 and we know this from vegetarian and vegan, mothers that if they don’t supplement that there can be real detrimental, sort of effects on the child that aren’t able to be irreversible because of the effects that B12 has to the brain development of the fetus, but also the baby. So, if those things are devoid postpartum, then it just creates this cascade of events. And that’s not even bringing into the anxiety and depression as a result of sleep deprivation, the cortisol disruption, insulin which all of a sudden you create all these carbohydrates because of the lack of sleep. And then the next day, continue that roller coaster of, you know, emotions and not getting out in the sunshine and one during…are you doing a good job? So, it was interesting. It was my grandmother who told me this that she had said, “Katie anxious mothers create anxious milk.” And there was no science in that, but there was a lot of logic in it. And I could definitely find science in that now that I know what I know.

Andrew: Oh. Particularly as we are seeing with, you know, subsequent siblings and the stress of motherhood and the effects that it has on further siblings, you know, it’s quite incredible what’s coming up now. I love that you mentioned sunlight because I can still remember. This is a book put out by the RACGP, the Royal College of Australian, sorry, Royal Australian College of GPs. And it was called “The Red Book.” So, it was basically a handbook of how to practice. And this is an older version which has now been corrected. Thank goodness, because I can still remember this red book saying babies should receive no direct sunlight. Now I get the issue. I understand the issue of sunburn. I mean, in the Queensland sun, you know, I see people walking along the beach, and I’m going, “Please, please put that hood down, please come on, it’s baking.” You know, I get the issue of sunburn, but we are not moles. We live on the earth, not under it. It flabbergasted me that this thing was a handbook for good care. So, I’m so glad you talk about sunlight. But with regards to cortisol, stress, and we could go off on here talking about a rabbit hole about men pulling their weight by helping the mom and having a, like a shift, if you like. You know, like Lee and I used to, Lee liked to get earlier sleep. I was a night out, so I’d stay up until 12 or something, and Lee would do the earlier hours. But what other sort of practical tips can you give us and our couples to help ease the stress manage the sort of regimen of raising a newborn baby?

Kate: Yeah. I would say ultimately. It’s have the plan. If you can have a plan, then you feel like you have a little bit of a safeguard, particularly when there’s the, you know, the brain fog from the sleepless nights. And I’ll be honest. I don’t always plan to educate the woman on how their partner or should play a role in this because that can be a sensitive area. So, I will go down the path of how can I help you best in regards to, is it having the meal prep ideas? Is it having sort of different places where you can ultimately get things pretty quickly? And for me, that always comes back to having their food and supplements on standby, because sometimes you can’t control anything else, but what you can control is, you know, what you put in your mouth each day, the amount of water you drink. If stress or anxiety is, or depression is even a concern from previous years and months before, then it’s something we definitely need to consider going forward and what support program can we perhaps look to that might help. And look, I’ve even investigated postpartum dos for people that come in purely just for, you know, the aid of the mother for no other reasons. So, and look, that is an unfortunate part of today’s society. We don’t have that village aspect we did probably 60 years, 100 years ago. So it is about making sure those tools are there. And ultimately, I feel if the woman feels good, we can work with that.

Andrew: Gotcha. I mean, there’s a whole lesson there for the extended family, which of course is eroding away, but more so nowadays, you know, I mean, I think you are still in lockdown, you’re in Sydney. So, this is even compounded worse by not even being able to access family members that might offer you support, and they’re in there lies this sort of increased risk of postpartum depression, PPD. Tell us a little bit about that. How do you help women manage that or lookout for red flags, and what indeed are you finding the effects of COVID-19 on mental health in your couples?

Kate: Yeah, I found it was a lonely experience for a lot of women, particularly, and the couples, particularly if they had for their first child, but also if they’d had difficulties getting to that point of bringing home a child as well because of losses previously. Because let’s be real, nothing prepares you to bring home a baby or look after it or deal with sleep deprivation. Some people really, really need their sleep. And that is a question that I’ll ask prior to them, you know, about to give birth. I’m like, how are you going to go with sleep deprivation? Are you someone who really need to, and they might say, they’re fine, but their husband absolutely needs it, or they’re not fine, but their husband will be great, you know, without a whole heap of sleep. So when it comes to depression, I really, I ultimately will, I will go heavy on supplements. I’ll go heavy on their essential fatty acids. I will keep that inflammation low because it’s a case of, we know that when that’s all exacerbated, and the hormones are going, you know, a rollercoaster right after birth, they drop off very quickly. And it can ultimately leave you feeling pretty scattered and depleted because of that really quick effect of having all these feel-good hormones or [inaudible 00:41:24] there in your arms. Now you sleep-deprived, and you’re feeling pretty, you know, dehydrated and exhausted. So, it’s a case of really looking at essential fatty acid to ultimately, you know, anything for the brain that’s going to help recover and replenish.

Andrew: Okay. So, PPD, tell us a little bit about the red flags. Do the red flags for postpartum depression appear at birth with a lack of bonding, or a concern in the mother that they’re not bonding with their baby, or do you see them occurring later on, or is there just a whole spectrum going on? Tell us a little bit about what you look for.

Kate: Look, there’s a whole spectrum. And when it comes to how they sort of…PPD can be diagnosed up until 12 months postpartum, and this is due to the effect of again, yeah, up to 12 months, you can still have PPD. And this is because of nutrition depletion and how it gets worse with sleep deprivation. And obviously not looking after yourself the same way you did prior to conception. So look, somebody can come to me and say they suffered depression in their 20s and that’s a, you know, that’s an easy red flag to go, okay, we can work with this. Somebody else has come to me who has been to conceive. They’ve been on antidepressants or SSRIs. And the only way they’ve been able to conceive is to come off them in that’s due to a whole other hormonal cascade effect that SSRIs do on the, you know, HPO access. But what hit hardest are the people who have no history of depression or anxiety, and they might not get it in those first few days of baby’s birth, but they might get it in two months later, eight weeks, between six and eight weeks, there’s another real big drop of hormones. And also, that sort of tends to mark the timeframe where a lot of people stop checking in or families start dropping off. So, given COVID-19 and people potentially A, didn’t want people around to visit the baby, but B, people haven’t had mothers or mothers-in-law or friends to come around and even just make a cup of tea. There’s been a real sense of how do we meet these women still feel like they’ve got a support network when it’s all done virtually. And to be honest, it’s hard, Andrew. Like, there’s no way people can always put on a front, and COVID-19 has allowed people to potentially put on that front and get away with it much easier. And that’s the hard part. There’s much more out of our control now.

Andrew: Yeah. Kate, there is so much that we wanted to cover, so much more than what we wanted to cover today. I would like to invite you back so that we can go through doses, a particular case history, and indeed maybe delve into if males get postpartum depression and some other issues. But just as a last quick question, so that at least pracs can have some direction, some future direction for learning. What sort of references, what resources do you rely on? Do you recommend people learn from?

Kate: For practitioners particularly, you’re always coming back to, you know, the indoctrine health, and that’s whether it’s, you know, listening to podcasts by Carrie Jones, who’s amazing. Or Chris Master John is a nutritional biochemist. He really gets into the nitty-gritty of pathways and feedback loops. And, you know, they’re wonderful people to check out, but then if you’re really looking at a nutrition sort of side, it’s Lily Nickles. But, you know, there’s so many to now in our field, and it’s wonderful because we can’t all cover the, you know, the one topic adequately, we come from it from different angles. So, you know, they’re my top three [inaudible 00:45:41]

Andrew: Brilliant. Kate Carr, thank you so much for taking us through this. This is such an important topic. One that for years has just languish, we haven’t had any postpartum support, which you are giving to your patients out of good care. And thank you for your care of your patients. Well done to you, but thank you for joining us on “Wellness by Designs” today.

Kate: Thanks, Andrew. It’s been a pleasure.

Andrew: And we welcome you back soon. So thank you, everyone, of course, us for joining us today. Remember, you can catch up on all the other podcasts. We’ll put up the show notes, of course, to today’s podcast on the designsforhealth.com.au website, including some of those reference materials so that you can learn. And remember that we’ll be back with another one, another podcast with Kate Carr later. So, thank you very much. I’m Andrew Whitfield-Cook, and this is “Wellness by Designs.”