Dr Jim Parker: Obstetrics and Gynaecology

Today, we're going to explore women's health. And women's health, whether you're a woman or not, is important because we all know women and they're an important part of our lives. They're known as the backbones of growth and a progressing nation.

My guest today is Dr Jim Parker. Jim has been an obstetrician, gynaecologist, and endoscopic surgeon. He has a wide range of researches with a particular interest in evidence-based medicine and the application of those findings to clinical practise. I always have been blown away by his encyclopaedic knowledge, which I am very keen to share with you today.

Health Podcast Highlights

Dr Jim Parker: Obstetrics and Gynaecology Introduction

Well, today we’re going to explore women’s health. And women’s health, whether you’re a woman or not, is important because we all know women and they’re an important part of our lives, either as partners, wives, mothers, daughters, sisters, friends, colleagues, work colleagues. 

So understanding what is going on and actually, it’s a little more complicated than many men understand. And actually, it may be a little more complicated than even many women are willing to acknowledge that this is a really important topic.

So my guest today is Dr. Jim Parker. Jim has been an obstetrician, gynaecologist, and endoscopic surgeon. He started his academic career in chiropractic but went on to complete a Bachelor of Science degree at the University of New South Wales with a major in anatomy in 1981. 

He obtained a Bachelor of Medicine degree in 1986 and worked in general practise and then went on to get a Diploma of Obstetrics and eventually a Specialist Fellowship in Obstetrics and Gynaecology in 1999.

Look, he has a wide range of research interests with a particular interest in evidence-based medicine and the application of those findings to clinical practise. He’s published extensively, and we’re going to hear a lot about some of the things that he has explored in research. He’s been involved in training, research, academic and educational roles since 1982. 

He has a number of collaborative research projects with academics and clinicians in Australia and internationally, and he’s currently the Honorary Clinical Senior Lecturer in the School of Medicine at the University of Wollongong.

He’s actively involved still to this day, involved in teaching, examining, and research activities, and I have so been looking forward to talking to him for some time now. 

I first met him at the Australasian College of Nutritional Environmental Medicine, where he has lectured extensively, and I have always been blown away by his encyclopaedic knowledge, which I was very keen to share with you today. I hope you enjoy this conversation I had with Dr Jim Packer

Podcast Transcript

Dr Ron Ehrlich: [00:00:00] I’d like to acknowledge the traditional owners of the land of which I am recording this podcast, the Gadigal people and the Eora Nation, and pay my respects to their elders past, present, and emerging. 

Hello and welcome to Unstress, my name is Dr Ron Ehrlich. Well, today we’re going to explore women’s health. And women’s health, whether you’re a woman or not, is important because we all know women and they’re an important part of our lives, either as partners, wives, mothers, daughters, sisters, friends, colleagues, work colleagues. 

So understanding what is going on and actually, it’s a little more complicated than many men understand. And actually, it may be a little more complicated than even many women are willing to acknowledge that this is a really important topic.

Dr Ron Ehrlich: [00:00:54] So my guest today is Dr. Jim Parker. Jim has been an obstetrician, gynaecologist, and endoscopic surgeon. He started his academic career in chiropractic but went on to complete a Bachelor of Science degree at the University of New South Wales with a major in anatomy in 1981. 

He obtained a Bachelor of Medicine degree in 1986 and worked in general practise and then went on to get a Diploma of Obstetrics and eventually a Specialist Fellowship in Obstetrics and Gynaecology in 1999.

Look, he has a wide range of research interests with a particular interest in evidence-based medicine and the application of those findings to clinical practise. He’s published extensively, and we’re going to hear a lot about some of the things that he has explored in research. 

He’s been involved in training, research, academic and educational roles since 1982. He has a number of collaborative research projects with academics and clinicians in Australia and internationally, and he’s currently the Honorary Clinical Senior Lecturer in the School of Medicine at the University of Wollongong.

Dr Ron Ehrlich: [00:02:07] He’s actively involved still to this day, involved in teaching, examining, and research activities, and I have so been looking forward to talking to him for some time now. 

I first met him at the Australasian College of Nutritional Environmental Medicine, where he has lectured extensively, and I have always been blown away by his encyclopaedic knowledge, which I was very keen to share with you today. I hope you enjoy this conversation I had with Dr Jim Packer. Welcome to the show, Jim.

Dr Jim Parker: [00:02:42] Thank you, Ron. Good to see you again.

Dr Ron Ehrlich: [00:02:43] Good to see you too. And good to see you looking so well, Jim, I’ve been looking forward to having you on as a guest. Gosh, since we first met at ACNEM, at the Australasian College of Nutritional and Environmental Medicine many years ago. Listen, you’re a gynae-obstetrician. I know you’re not in practise anymore. But what typically comes into your practise? 

What is an OB-GYN and what do they do?

Dr Jim Parker: [00:03:05] I sort of frame it in a sense in a historical perspective, really. And that’s the way I really look at obstetrics and gynaecology. I think it just gives me a broader overview and keeps me in touch with where it all came from, you know? So I could probably give you a bit of a historical perspective and then fit in some of my own experiences? 

Dr Ron Ehrlich: [00:03:29] Yeah, great.

Dr Jim Parker: [00:03:30] And you know how it all fits into nutritional and environmental medicine, which sort of I’ve been interested in for many, many years. But I guess I look at the nutritional and environmental medicine stuff more from an evolutionary point of view. How do we, as a species, best survive in our current environment based on all of our evolutionary history and how we’re probably set up to live in the past, you know? 

And I think that probably sort of meshes in with a lot of the stuff that you’ve written over the years and all the more recent stuff that I’ve written on polycystic ovary syndrome, too, which is, you know, really part of the chronic disease epidemic that we’re finding ourselves at the moment.

Dr Jim Parker: [00:04:17] I mean, obviously, we’ve got a whole new pandemic than what a year ago. We were talking about the triple pandemics of undernutrition, overnutrition, obesity, diabetes, and then meshing that in with climate change, the so-called global pandemic. 

But now we’re totally being surpassed and usurped by the latest one. But those pandemics are still running along, and they’re the things that sort of occupy us now.

Dr Jim Parker: [00:04:52] So, you know, how does obstetrics and gynaecology? How does it fit into all of that system? It’s got components of everything in it. And if you think that the first Australian Medical School was set up in 1885 in Sydney Uni. And there was no discipline of obstetrics and gynaecology then. It was either medicine or surgery. 

And, of course, medicine was mainly naturopathic and herbal medicine. The pharmacopoeia that we had then just wasn’t very great. And surgery was extremely rudimentary and life-threatening. And we certainly wouldn’t be doing caesarean sections very often the things that obstetricians do every day now. 

Dr Ron Ehrlich: [00:05:41] Hmm.

Dr Jim Parker: [00:05:42] Then, you know, we’re just beginning to get the beginnings of anaesthetic and an aseptic technique that allow us to do that. And so when you look at obstetrics and gynaecology, gynaecology has got medical and surgical aspects just like those two big disciplines of medicine. So it’s got all the hormonal therapies with the pill and menopause. 

And then it’s got the surgical aspects like treating cancer of the cervix and ovarian tumours and endometriosis and bladder and prolapse problems. So gynaecology has got both medicine and surgery in it. And so as obstetrics.

Dr Ron Ehrlich: [00:06:21] Hmm.

Dr Jim Parker: [00:06:22] And that’s probably something that people don’t really realise much about. In 1880, all obstetrics was operative obstetrics — what we call manipulative obstetrics. The baby didn’t fit out or something happened to labour. It had to come out through the vagina. 

We just didn’t do caesarean sections in history before that, or it was extremely rare. So obstetricians had to be skilled and trained in getting babies out. In all sorts of amazing and bad situations, of course, but the priority was always and is now: maternal survival.

Dr Ron Ehrlich: [00:07:05] Right.

Dr Jim Parker: [00:07:06] The mother has to survive first, unfortunately, ahead of the baby. 

Dr Ron Ehrlich: [00:07:11] Hmm.

Dr Jim Parker: [00:07:12] And in those times, a lot of babies didn’t survive or a lot more. But in fact, a lot of mothers didn’t survive. And that’s what we call maternal mortality — that is death in pregnancy or within six weeks after that. 

Yeah. So obstetricians are faced with all of those medical and surgical problems. For instance, if you take a problem like ectopic pregnancy and that’s something that I’ve done a lot of research on and treated hundreds and hundreds of women for.

Dr Ron Ehrlich: [00:07:41] Well, just before you go on, Jim, give us Ectopic Pregnancy 101. 

What is an ectopic pregnancy?

Dr Jim Parker: [00:07:46] Yeah. Well, ectopic pregnancy is when the pregnancy lands in the tube outside of the uterus. So the tube takes the egg from the ovary into the uterus, and it takes seven days for that egg to get in there. And if it gets fertilised in the tube, which it always does, and gets stuck there, then it grows and develops there in the is not very forgiving. 

Whereas once you get into the uterus, the placenta can grow into the uterus and the baby can grow up to the size of a beach ball, basically a 40-week pregnancy. In the tube, once that placenta starts to erode into the tube, which is very thin, there are some big blood vessels under there.

 And once it hits those blood vessels, you get catastrophic bleeding. And in 1880, when the first medical school at Sydney was set up, the mortality rate, the death rate from ectopic pregnancy was 80%.

Dr Ron Ehrlich: [00:08:44] Wow.

Dr Jim Parker: [00:08:45] That means if you got an ectopic pregnancy, it was likely you were going to die.

Dr Ron Ehrlich: [00:08:50] And what was the length, what would be the maximum length that an ectopic pregnancy? I mean, imagine it going on for eighth, 10th, 12th.. wouldn’t go that long, wouldn’t it? How many weeks?

How long can you carry an ectopic pregnancy? 

Dr Jim Parker: [00:09:01] No. Most of them ruptures are in the fourth to eighth-week mark. Yeah, it doesn’t take too long because pregnancy survived by burrowing into the mother and forming a blood supply.

Dr Ron Ehrlich: [00:09:13] Hmm. 

Dr Jim Parker: [00:09:13] And so that’s their job. So if they rupture very quickly and then you get an internal haemorrhage and you hit it either clots and it stops, then you survive. That was the 20% or you, unfortunately, bleed together, and that was 80%. And that’s one to two percent of all pregnancies. So all back through prehistoric history, one to two percent of all women have died because of that.

Dr Ron Ehrlich: [00:09:40] Wow. 

Dr Jim Parker: [00:09:41] And in fact, this maternal mortality – death rate – was about one percent throughout history. So one percent of women of all ages died in childbirth. We talk about it in deaths per 100000 live births, so that’s a thousand eight hundred to a thousand women that die per 100000 like this. Wow. 

And to put that in perspective, in Australia, there’s 300000 pregnancies a year and a lot. So that means every year we have about 20 to 25 maternal deaths in Australia.

Dr Ron Ehrlich: [00:10:18] Still to this day?

Dr Jim Parker: [00:10:20] Still today. Hmm. Well, but unfortunately, some places in the Third World, like Sub-Saharan Africa have still got rates back in at prehistoric level. And have, you know, a real catastrophe in this sort of way of our journey, there’s like lots of different little paths that you keep going down, so if you think that 80% of women with ectopic pregnancy, that’s one to two percent of all pregnancies died in 1880.

The medical school set up, we’ve got surgery and medicine. And what happened then was the revolution in surgery, the introduction of laparotomy, which is open surgery. Because ectopic pregnancy is the absolute simplest thing to treat. It’s just a little bleeding blood vessel.

Soon, as you make an opening in the abdomen, put your hand on, you just squeeze the blood vessel and the patient’s side. It’s as simple as that. So hundreds of thousands of women have died all throughout history and all throughout evolution, just because we couldn’t grab one little blood vessel with our fingers.

Dr Ron Ehrlich: [00:11:31] And laparoscopy refers to the opening of the abdominal cavity? 

Dr Jim Parker: [00:11:34] Laparotomy.

Dr Ron Ehrlich: [00:11:35] Laparotomy. Laparotomy.

Dr Jim Parker: [00:11:36] Yeah, and that was the first revolution in surgery to go on in colleges. And between 1880 and 1910, the mortality death rate from ectopic pregnancy dropped from 90 to 10%.

Dr Ron Ehrlich: [00:11:49] Wow. 

Dr Jim Parker: [00:11:50] So that was a big revolution, saved a lot of lives.

Dr Ron Ehrlich: [00:11:54] But I wonder whether there’s been another transition to and that is when we look back at in evolutionary history, I’m not sure when the average, at what age women, well females, were giving birth? You know, evolutionary speaking. And so one other big change that’s occurred is women, you know, people are having babies older.

Evolution and change: People having babies at an older age

Dr Jim Parker: [00:12:17] Yeah. 

Dr Ron Ehrlich: [00:12:18] And so that’s one aspect. And the other one is people have become far more risk-averse.

Dr Jim Parker: [00:12:25] Hmm. Yep. Now, both of those things are important around then. The average age of first birth in Australia now is 30. It definitely wasn’t 38 in evolutionary history and the average —

Dr Ron Ehrlich: [00:12:38] What would it have been? Evolutionarily speaking.

Dr Jim Parker: [00:12:40] It would have been in the teenage years. The average number of babies that women had was about eight.

Dr Ron Ehrlich: [00:12:47] Wow.

Dr Jim Parker: [00:12:47] And of course, we’re way down on that now, and so every time you have a baby, the risk of maternal death goes up as well because the three main causes of maternal death in westernised cultures and that includes in developing countries now is (1) haemorrhage; (2) infection; and (3) pre-eclampsia or blood pressure problems.

And they’re all totally preventable. So right at the moment, there are 300000 maternal deaths in the world every year. 99% of those are preventable and 99% happened in the developing world from those causes. 

Dr Jim Parker: [00:13:25] We don’t lose women very often from any of those causes. Now we lose women because of motor vehicle accidents and heart problems and whatever other things, but not haemorrhage, infection, and pre-eclampsia. We treat all those things and prevent them. 

Dr Ron Ehrlich: [00:13:43] Jim, you know, a few episodes ago, I did a podcast with, you’re going to be very impressed by this, an integrative gastroenterologist. Yes?

How does nutritional and environmental medicine impact obstetrics and gynaecology?

Dr Jim Parker: [00:13:53] Yes. Right. Yeah.

Dr Ron Ehrlich: [00:13:54] There is such a thing just as there is an integrative obstetrician-gynaecologist. And I was really intrigued to see how important nutrition played a role in his life and his professional work.

From your experience with nutritional and environmental medicine has been a really intense one. You’ve lectured extensively. How did those principles of nutritional, environmental medicine impact your practise?

Dr Jim Parker: [00:14:23] Well, again, you’ve got to look at it from a historical perspective. So this is one of my really great mentors, was an obstetrician called Alan Houston. And interestingly enough, he was born in 1927. Two years after the first LNG school was set up in Australia, and it changes in his lifetime really have corresponded with the changes in obstetrics and gynaecology. 

And it’s interesting to look at that. But what I was going to mention about him is that the first research paper he wrote in 1957 was a study looking at the value of fibre and a high fibre diet for the treatment of pre-eclampsia or blood pressure. 

Dr Ron Ehrlich: [00:15:13] Hmm. 

Dr Jim Parker: [00:15:14] And we just don’t realise that people, especially in all this talk about LNG. Doctors have been thinking about nutrition for a long, long time. And what he did in that study was in Hobart at the time working there. 

He just looked at women who delivered with pre-eclampsia and took their diet histories and then took a comparable sample of women without preeclampsia and took their diet histories and found that there was a significant difference in the amount of fibre and therefore obviously plant-based nutrients. By default, that they got in their diet.

Dr Ron Ehrlich: [00:15:48] Hmm. 

Laparotomy and techniques on how to perform surgery 

Dr Jim Parker: [00:15:48] And you know obviously, he had a lifelong interest in that as well. But his life really was tied up with all of the changes in obstetrics and gynaecology that happened over that time. So we talked about laparotomy coming in around the turn of the century. But the Great Dorian’s and Masters whether people like this fellow Victor Bonney had to invent all of these techniques for surgery, so they make a hole in the abdomen and put their hands in. 

And he came up with the idea, look, wouldn’t a mask be a good idea and a pair of gloves? And wouldn’t it be good if we use some antiseptic to wash down the skin? And then what about a few instruments to hold things apart instead of doing it with your hands? So these guys had to invent everything from scratch?

Dr Ron Ehrlich: [00:16:40] It’s mind-boggling.

Dr Jim Parker: [00:16:43] But the interesting thing is, 30 years later, he trained a fellow called John Stallworthy. This is in the UK, and 30 years later, Alan went there. Every obstetrician and gynaecologist trained up until the 1990s in Australia went to England for their senior training. It’s just the historical thing that we did. 

So what Alan got when he went to England in 1955, so he learnt techniques of surgery of John Stallworthy, who learnt them from Victor Bonney who invented them in 1905 and then he taught Alan Houston was in specialist gynaecological practise, actively practising for 60 years. 

Dr Ron Ehrlich: [00:17:27] Wow.

Dr Jim Parker: [00:17:28] And I met him in the late 1990s when he was 17, and he and I operated. And he taught me the techniques of John Stallworth in Victor Bonney. That will really not change too much, but he had changed him a little bit, but the basics were there. They had been passed down for 100 years only through those three people to me and dozens and dozens of other gynaecologists doing surgery. 

Dr Ron Ehrlich: [00:17:57] Interestingly, talking about Alan Houston, who had this incredible surgical experience, he had still at that time, and I’m assuming others as well, bother to ask about diet in their patients. 

And you mentioned at the beginning of this whole thing about how naturopathy, you know, we didn’t have the pharmacopoeia to deal with it. It’s almost like in the last 50 or 40 or 50 years, it’s been this pause because for a thousand years before, in medicine, it’s been our only tool to look at these kinds of things nutritional, environmental stuff. And now here we are again, revisiting it. 

Dr Jim Parker: [00:18:39] There. Look. By the end of the 1990s, we had learnt to do every operation in gynaecology through the telescope.

Dr Ron Ehrlich: [00:18:49] That’s incredible. 

Dr Jim Parker: [00:18:50] That’s big ovarian cysts, fibroids, hysterectomy, prolapse, bladder operations, we could do everything by the end of the 1990s. 

Dr Ron Ehrlich: [00:19:01] Was that developed in Australia?

Dr Jim Parker: [00:19:03] All over the world.

Dr Ron Ehrlich: [00:19:04] All over the world.

Dr Jim Parker: [00:19:04] And we went to international conferences. We invited international people. 

Dr Ron Ehrlich: [00:19:10] I mean, that would have been just, I mean, totally, totally revolutionary. 

Reflections on nutritional and environmental medicine in focus

Dr Jim Parker: [00:19:14] It was heady days. But anyway, let’s move on to the nutritional health side of it because I think the nutritional side of it, of course, is also based on history. So as I’ve said before, obstetricians, have always been a leader in nutritional medicine. 

We prescribe more nutrients to our patients than any other practitioner in medical and practise because, for instance, we give folic acid to every pregnant woman in Australia, and that’s 300000 for start. So we’ve got 300000 pregnant women that we see ten times each in pregnancy. So that’s roughly three thousand three hundred by ten point three million antenatal visits.

Dr Ron Ehrlich: [00:20:06] Yeah.

Dr Jim Parker: [00:20:07] Each one of those people, we’re assessing for various things, but we give the folate, the folic acid to try and give it to every pregnant woman. So that’s a lot of nutrients that we give out. We recommend that all pregnant women have iodine now because our foods are deficient in iodine and we know that iodine deficiency affects thyroid function and brain development and IQ and all those sorts of things.

Dr Ron Ehrlich: [00:20:34] And Jim is, I mean, I did a programme with Professor Creswell Eastman many years ago who told me that iodine was the biggest deficiency in the world. 

Dr Jim Parker: [00:20:43] Yeah, I’d have to disagree with him, man, even though that might be a big thing to do.

Dr Ron Ehrlich: [00:20:48] OK. OK. 

Dr Jim Parker: [00:20:48] Because iron deficiency is from our point of view, from the obstetric point of view, the biggest deficiency in both obstetrics and gynaecology patients. And of course, that’s just another nutrient that we give out to all our patients.

Dr Ron Ehrlich: [00:21:03] Yeah.

Dr Jim Parker: [00:21:04] And some of us talk to our patients about how to get some of those nutrients and say iron from your diet. Hmm. But if someone’s and they make and they’re bleeding a lot in a gynaecological sense or they’re anaemic in pregnancy because they’ve been breastfeeding and had pregnancies run on top of the other or for whatever reason, green leafy vegetables, dried fruits, and apricots, they eat meat, you know, get your dietary sources of iron. But also, we don’t supplement those people with iron as well.

Dr Jim Parker: [00:21:38] So to obstetricians and gynaecologists, iron deficiency is the biggest nutrient deficiency. Then, of course, we recommend folate and iodine. We recommend, the Perinatal Society of Australia, or the specialist group of obstetricians that give out the recommendations on all of this, the recommended testing every woman for Vitamin D. 

Dr Ron Ehrlich: [00:22:04] Right. 

Dr Jim Parker: [00:22:05] We know that Vitamin D affects so many functions in the human body, and we can get Vitamin D levels up obviously. We would mostly prefer people get it from sunlight. But we can get it up by supplementing people in pregnancy and make a difference in outcomes is. So we’ve got all these various nutrients. The latest one to creep in now is omega-three fatty acids or fish oil. Fish oil is now being strongly recommended as a prevention for pre-term labour.

Pre-term labour and prematurity

Dr Jim Parker: [00:22:38] Now, preterm labour and prematurity are the single largest cause of babies passing away and not making it in our current world, and we call preterm delivery before 37 weeks. A very preterm delivery before 34 weeks and extreme preterm delivery before 30. So virtually every baby born before 30 weeks needs to go onto a ventilator. 

And up to about 50% between 30 and 34 weeks and less than 10%, 5% or so after 34 weeks, so the more developed the baby is at the time it’s born, the less intensive care and nutrition and feeding and temperature control and everything else that we have to do as doctors and paediatricians, anything that we can do to help prevent preterm birth or improve outcomes.

Dr Jim Parker: [00:23:38] And just on my own personal side, I was very fortunate in the early 90s to be involved in the development of a test for predicting preterm delivery. And that’s a swab test, just like you’d have a COVID test. Exactly the same, but it’s taken in the vagina. And we put it in a vial like a pregnancy test and it goes positive or negative. And we did it. We did. 

I led the first study in Australia that tested that test, called Foetal fibronectin for predicting preterm delivery. And we interviewed every patient and enrolled them in this study. We took the swab, put them all away, and then after they delivered, we went and analysed it and see how good a predictor it was. And 99% negative predictive value. If it was negative, the patient didn’t deliver.

Dr Ron Ehrlich: [00:24:30] And what was the testing again? Just reminds us.

Dr Jim Parker: [00:24:34] It’s testing this protein called fibronectin. Knowing the placenta grows from the baby if you like into the mother, something’s going to stick it there. It’s got to have glue, and that glue is a protein, or part of it is this fibronectin. That’s the glue between the baby and the mother that holds the placenta there. 

So if you’re going into pre-term labour and some of that protein is released into the vagina and you do a swab and it’s there, it tells us you might be going to deliver. Because a lot of women come in in labour contracting and they don’t go on to deliver. But unfortunately, we don’t, up until then, we don’t know who is going to deliver. So we’d have to put a drip up and we treated them with intravenous ventolin. 

Now, if you’ve ever had a puff of ventolin for asthma, you will know that after a couple of puffs, you get very jittery and shaky. Well, multiply that 100 times and run it into your vein and it’s the most unpleasant treatment, but it stops labour in a lot of women.

Dr Ron Ehrlich: [00:25:34] Well, so women coming in now and labour have a swab put it into a vial and you know, pretty well, whether they’re in, they went to the –.

Dr Jim Parker: [00:25:41] Yes. So it’s not good at, but it’s a bit complicated, but it’s not good at predicting who will deliver. But it a very, very —

Dr Ron Ehrlich: [00:25:48] You can send them home with confidence.

Dr Jim Parker: [00:25:52] Well, I’ll get on to that in a sec because that is an interesting part of the story as well. The other treatment we had to give those women is an injection of steroids to ripen the baby’s lung. They came in pre-term labour and were going to deliver baby early. 

The reason why babies die pre-term is because their lungs aren’t developed. So we give them this treatment of steroids, which was a revolutionary treatment developed in New Zealand, actually, and that would ripen the lungs. But it had its potential problems as well so.

Dr Ron Ehrlich: [00:26:27] And how young? How preterm can babies survive, foetus survive?

How young can pre-term babies/foetus survive?

Dr Jim Parker: [00:26:33] Well, since I started, it’s gone down and down since I started, but it’s down to 23 weeks now.

Dr Ron Ehrlich: [00:26:40] That’s incredible.

Dr Jim Parker: [00:26:41] But you really don’t want to be in that group. 

Dr Ron Ehrlich: [00:26:43] No.

Dr Jim Parker: [00:26:43] But we won’t go there.

Dr Ron Ehrlich: [00:26:44] No, no, that’s fine.

Dr Jim Parker: [00:26:45] So just looking at the pre-term labour and the fibronectin that test now is in every hospital in Australia. But what we did after that, we started using it. And then if the test was negative, we didn’t treat those women. They just died for a day or two till the contractions stopped and we sent them home like you suggested, we used to keep them for a week because we’re too scared to send them home. 

And we got women from all over Victoria coming to the Royal Women’s Hospital that was all transported by plane or by road ambulance at massive cost to the community. And when I went to Newcastle, we introduced the test there because Newcastle was the referral base for all of western New South Wales, Dubbo, Orange, all those places.

Dr Jim Parker: [00:27:34] So we did a study of some of the people there, did a study where we swabbed people in those remote areas if they went into pre-term labour, and then we didn’t transfer them. 

So instead of transferring them to a big Sydney hospital where there was intensive care, having to find accommodation for the family, treat them with all these treatments, which were very unpleasant, and then find that they’d settle down and a week later send them home, we didn’t have to do that. So that test has been quite helpful and revolutionary in an obstetrics house in itself. And I was lucky to play a part.

Dr Ron Ehrlich: [00:28:13] And you’ve mentioned these nutritional interventions, which are common. Common in the field of obstetrics. When we think about mothers getting older and we think about the deficiencies which are now common, then I think whether it is the most or not, that iodine is certainly, an iron is certainly, and Vitamin D is certainly a major deficiency that we’re faced with. 

Current challenges in the world of obstetrics

Dr Jim Parker: [00:28:41] Oh yeah.

Dr Ron Ehrlich: [00:28:41] It’s a big one. And we could talk about the flow-on effects of Vitamin D in this current pandemic and all that we might digress too much. But my point is that you’ve got the old women and these more common deficiencies because of poor diet. I mean, we’re really setting up some challenges here for the world of obstetrics.

Dr Jim Parker: [00:29:02] Well, that’s the world I live in now, Ron. You’ve moved me to the present, we’ve been talking a lot of history, but that’s a world of gestational diabetes and polycystic ovary syndrome and chronic disease. 

Dr Ron Ehrlich: [00:29:15] Yeah.

Dr Jim Parker: [00:29:15] So we’ve gone from laparotomy in the early 1900s.. 

Dr Ron Ehrlich: [00:29:19] Yeah.

Dr Jim Parker: [00:29:19] To laparoscopy in the late 1900s and doing every operation laparoscopically and getting people home after one or two days instead of a week in the hospital, less pain, back to work in two weeks instead of six weeks. 

But, you know, I’ve seen that revolution. But in the 2000s, that started to sort of level out a bit, and then we’re really looking at data and evidence, you know, fine-tuning a lot of those things.

And I mentioned ectopic pregnancy. In 1990, virtually 100% of ectopics were treated by open surgery in Australia. We did all that research through the 90s. We trained gynaecologists all over the country. It took twenty-five years until 2015 before the rate of laparotomy open surgery dropped to 10%, which is where it is now. And there’s just some we can’t do through a telescope.

Dr Ron Ehrlich: [00:30:21] Well, we can’t anyway. We can’t deliver babies that way, can we, though?

Dr Jim Parker: [00:30:25] We will go there. So but what’s happened is a lot of medical treatments like the Marina IUD and all sorts of things now have changed the amount of surgery we do in gynaecology. And what’s happened is a lot of the chronic epidemic, chronic disease epidemic, things have become more important. 

So in the last 10 years, there’s a lot more focus on lifestyle and nutritional environmental factors that might be involved in pre-eclampsia contributing to pre-term delivery, causing endometriosis, period pain, and of course the big ones in obstetrics, is gestational diabetes. Diabetes in pregnancy. That’s 10% of every pregnant patient in Australia. And in gynaecology, polycystic ovary syndrome, which is, as you know, I’ve written and lectured a lot about.

Dr Ron Ehrlich: [00:31:23] Yes. Now I wanted to ask you about that because, well, even before, well, both actually, because often women’s periods have been dismissed in this kind of oh way, having a period kind of thing. And we’ve done a programme about a year or two on endometriosis, and it shocked me to learn that it took some time out on average seven to 14 years to get a diagnosis of endometriosis.

Tell us about endometriosis, but we’re going to polycystic ovarian because I know you’ve just recently written in an article and a journal on it. But let’s touch on endometriosis. What is it? How big a problem is?

Menstruation and endometriosis

Dr Jim Parker: [00:32:00] It probably affects about 10% of reproductive-age women. 

Dr Ron Ehrlich: [00:32:05] Wow.

Dr Jim Parker: [00:32:06] It’s when the lining of the uterus grows outside the uterus in the pelvis. And it’s quite a strange disease if you like. And that you can put a telescope in and have a look and find a small amount of endometriosis causing a massive amount of symptoms — lots of pain, pelvic pain, painful intercourse, infertility, a whole range of symptoms. Or you can sometimes find massive amounts of endometriosis that don’t cause too much symptoms.

Dr Jim Parker: [00:32:40] Mostly, they do, but, and in that situation, you can have large cysts on the ovaries that are like concrete. The bowel stuck to it, the bladder stuck to it, the ureter. And I specialised in complicated and difficult surgery throughout all of my careers, starting with that initial laparoscopy thing.

 And endometriosis surgery is probably one of the most complicated types of surgery you can do. We did it, initially, when I started my training, it was all done by open surgery, by some very fantastic surgeons. But we quickly moved through the 90s to doing it all through the telescope, but dissecting bowel and working within, you know, half a millimetre off the ureter. That’s a risky, difficult surgery.

Dr Ron Ehrlich: [00:33:29] And very, very, a very long duration too, I imagine?

Dr Jim Parker: [00:33:31] Three, four hours. Yup.

Dr Ron Ehrlich: [00:33:33] Wow.

And you’re trying to conserve the ovary in the uterus, trying to avoid hysterectomy and removing the uterus, and putting a younger woman into menopause. So, yeah, so there’s that surgical side of it that’s become an important part of our treatment. 

But unfortunately, there’s almost certainly is a large lifestyle component. And for whatever reason, there’s a high recurrence rate. About a third of women will get a recurrence of endometriosis in the next five years. So and then we’ve got to get you to go back and do more surgery or try and suppress it somehow with hormonal treatment and things like that.

Dr Ron Ehrlich: [00:34:16] Jim, when you say 10% of women of reproductive age, put a number on that. How many women are there in Australia of reproductive age?

Dr Jim Parker: [00:34:24] Well, we can go a bit more than that. There’s nearly, I looked it up today. There’s seven point there’s this sort of calendar thing or numbers thing on the internet that tells you the population of the world, and it’s just turning over two million miles an hour increasing, but at 7.9 billion at the moment. So let’s just say eight — half of those are men, half are women. 

And half of the women are reproductive age 15 to 50. So when it comes to polycystic ovary syndrome, which affects reproductive-age women, particularly, that’s half of the world’s population and we know it affects about 10% as well. So that’s about 200 million worldwide that we know are affected.

Polycystic ovary syndrome (PCOS)

Dr Jim Parker: [00:35:10] Now you mentioned polycystic ovary. So I’ll just give you a quick summary of that. It’s a good problem because women with polycystic ovary syndrome present in adolescence and it’s a metabolic problem. Now metabolism is how the body makes stores and uses energy. 

The human body is all about energy balance, balancing that energy with what’s happening in the environment. So if it’s a cold environment, we need to burn more energy to make temperature. We need to move to get food or go to a work order. 

So what the human body is perfectly evolved to do is to adapt to our environment and change all of our internal physiology and metabolism to match up with what the needs are in a particular environmental situation.

Dr Jim Parker: [00:35:59] Now, obviously, we are evolutionarily evolved and adapted for a different environment than what we’re in. This is only the last 200 years of industrialisation. We are evolved for millions of years to a different environment where there was food scarcity, where we had to be on our feet moving all day long, where when the sun went down, we went to bed and when it came, you know, you can work out without doing too many studies or anything. What common sense we would have been involved to do without being able to get into the finer details.

And what we think is going on with polycystic ovary syndrome, it’s a mismatch between our evolutionary adaptation to that environment. Those genes are now put in our current environment where we’ve got continuous high calorie high glycaemic food availability, sedentary behaviour, sleep disturbance, and circadian dysfunction, and obviously stress from every direction that we look at. 

And those things affect our metabolism and our physiology in such a way that it gives us problems with our sugar metabolism, glucose metabolism, particularly insulin, what we call insulin resistance, and it affects our fertility.

Dr Jim Parker: [00:37:24] If you’ve got problems with your metabolism and energy availability, you won’t reproduce. No animal does that. And reproduction is turned off in those situations, and that’s what happens with polycystic ovary syndrome. And we’ve got so much evidence now coming together that supports that. 

And now a group of researchers in the last 18 months we’ve written five papers now on this. And four of them are published and one is still under review. 

And the first paper was just a review paper that looked at the four different areas that were involved in this evolutionary model. That is the genetics. Then what happens in utero. Because when a sperm and an egg come together, they’ve got their genetic profile. But that’s the hard way, but they’ve also got software. 

That’s the epigenetics that controls what turns on and turns off various genes. What makes your brown eyes blue eyes tall, short? Or any other characteristic you like to think of? Those genes are all there. They have to be turned on.

Dr Jim Parker: [00:38:33] So when the sperm and egg come together, all of that software programme from the mother and the father is wiped completely and a new software programme is instigated. And that’s you. That’s your personalised genetic programme and how you’re going to function in the world. 

And of course, when you are growing and developing in the uterus, all of that programming can be affected by the mother’s behaviour, the mother’s stress, the mother’s diet, endocrine disrupting chemicals, which we know across the placenta in big numbers and can be measured in the foetus. 

We don’t know their exact effects because it’s almost impossible to work that out, but we know that they’re there. Are all these things affect our genetic programming and set us up for diseases — like heart disease and diabetes and polycystic ovary syndrome later in life.

Dr Jim Parker: [00:39:30] And then there’s after you were born. All the lifestyle influences that affect that software in that genetic programming. And then, of course, after puberty, when girls get all the hormone changes and stop to menstruate, they develop the symptoms of polycystic ovary syndrome — acne, hair growth, irregular periods, and in their 20s start to get fertility problems. 

And we know that lifestyle and environmental effects have a very big impact and probably really the only impact because we’ve searched and searched and searched for a genetic cause of why 10% of the world’s reproductive women get this problem.

Dr Jim Parker: [00:40:14] There isn’t any genetic cause that we can find. There are genes associated with it, but they’re all associated with metabolism, reproduction, and almost certainly their normal genes, variants, what we call polymorphisms that are affected by our diet and environment and what we have now that really adds a lot of evidence from weight to this sort of thinking is that we know we can reverse all this in adolescence and 20-year-old women by changing their diet, by eliminating those environmental chemicals.

And just two years ago, the largest set of guidelines ever produced on the planet in Medicine were produced for the treatment and diagnosis of polycystic ovary syndrome and the number one recommendation: there are 160 recommendations, 200 pages, 3500 research collaborators that put this document together, simultaneously published in three of the biggest medical journal. I’ve never seen that before.

Dr Jim Parker: [00:41:22] Number one recommendation: (1) diet and lifestyle for the treatment of polycystic ovary syndrome. So we’ve reversed that. We said, well, hang on if you can treat it and reverse it with diet, wouldn’t that indicate diet might actually be causing it as well? No one wants to say that, but we have we’ve put our hand up. We’ve produced all the evidence and now it’s out there for people who argue in discussions and has a think about, you know. 

Dr Ron Ehrlich: [00:41:55] So Jim, 10% of the women of reproductive age also, that’s putting aside the endometriosis as well. With PCOS, 10% is the figure?

Dr Jim Parker: [00:42:08] And then you add on to that fibroids, which is like four, 40%. 

Dr Ron Ehrlich: [00:42:13] Tell us about fibroids. I haven’t gone.. You know. 

Dr Jim Parker: [00:42:17] I’m just mentioning the other problems in gynaecology and then add on to that prolapse. So in other words, all the problems that we deal with in gynaecology basically affect all women. Not every woman has every problem, but every woman has some gynaecological problem during their life and needs to see a gynaecologist.

Dr Ron Ehrlich: [00:42:39] Now, now we’ve talked about women of reproductive age, but what about you know when that is, when we reach menopause? What are some of the challenges of menopause and how can we minimise? I’m guessing we’re going to go down this path. Not surprisingly, of diet and lifestyle. But tell us about menopause and some of the challenges that occur there.

The challenges of menopause

Dr Jim Parker: [00:43:00] Yeah. Well, again, that’s another very big topic, and it’s got a lot of historical background of great interest. So in the 1990s, hormone replacement therapy was gospel. You could not get up at a meeting and say anything against hormone replacement therapy. 

You would definitely be shouted down by a whole lot of people who had been looking at the research that had come out over the previous 20 years, in support of hormone replacement therapy, not just for the treatment of symptoms, the hot flushes, and vaginal dryness, but prevention of all the problems that increase after menopause in women.

Dr Jim Parker: [00:43:41] So before menopause, women are relatively protected from cardiovascular disease, even obesity and diabetes. And once oestrogen falls and drops off after menopause, when the ovaries stop producing oestrogen, all of those chronic conditions increase. 

And it’s all related to the metabolism of oestrogen and how it affects the body. And so oestrogen is a big thing. And once it drops off, all of these metabolic problems in increase after menopause and hormone replacement therapy is what were sort of briefly talking about. 

Then in 2002 came out the Women’s Health Initiative Study. Showing that hormone replacement therapy increased the risk for breast cancer, and it didn’t make any difference to cardiovascular disease in a whole load of other things that suddenly there was a 90% drop off in prescriptions for hormone replacement therapy in an extremely short time.

Dr Ron Ehrlich: [00:44:44] Hmm.

Dr Jim Parker: [00:44:45] And this is one of the things that happens in medicine now when a big international persuasive trial comes out with evidence like this, it can have an instant and massive effect on clinical practise. So the term breech trial that came out in the late 90s showed a higher mortality rate in babies born vaginally than by caesarian. 

The big randomised trial to either vaginal delivery of caesarian bank was the end of the vaginal breech delivery. And all babies, the majority of babies in Australia and around the world that present that way now, which is about one percent to a couple of percent of all babies are now born by caesarean instead of vaginally because of that one trial. 

Dr Jim Parker: [00:45:35] So similar thing happened with hormone replacement therapy and that is what that hormone replacement therapy is. The problem is, a lot of people have been on it for a long time and that was perfectly happy with it because it controlled the considerable symptoms. 

You’re waking up overnight, sweating and soaking your bed, and having to change the sheets. And it’s affecting your mood and everything else that goes with it. You’ll pretty well take anything if you get rid of it. And funnily enough, a small dose of oestrogen gets rid of it universally, because that’s what caused it.

Dr Jim Parker: [00:46:10] So we’ve got all the debate between synthetic hormone replacement therapy and bioidentical hormone replacement therapy that’s been going in the conventional nutritional environmental field for over all of those years. And outcomes the women’s health initiative and hits it on the head. So slowly, people are very analysed the data and got more follow up data and looked at it and looked at it and found that the initial reports and results weren’t right.

You could write a movie on the goings-on with this and the way it all worked and the committee of people that were involved in the trial and the decisions they made because of political and media pressure. And you know, it’s a story of intrigue as the right story to read, but we won’t go down there.

Dr Jim Parker: [00:47:03] But anyway, last year, Felice Gersh wrote an absolutely groundbreaking study, analysing all of these complicated issues that have been going on for 40 years, including the Women’s Health Initiative and all the reports that have come since. Saying that we should be using the appropriate dose in women that want to have hormone replacement therapy, and she’s totally resolved the debate on bioidentical versus synthetic hormone replacement. 

So we had bio-identical, then pharmaceutical companies developed oestrogens that were the same as human oestrogen and progesterone that were the same as human progesterone. So they called that body identical. Because I didn’t want to conflict with the existing bioidentical paradigm and police sort of that’s just confuse people. 

So she’s just called the whole thing now body identical. So we’ve got past biosynthetic and we’re talking about body identical now. So there’s no point in taking bio-identical hormones when we have exactly the same hormones as is in the human body. Available through prescriptions and the proper TGA approval.

Dr Ron Ehrlich: [00:48:34] And the conclusion of Felice was that an appropriate level was okay. What was there? What was the final conclusion about just that that an appropriate level was okay with limited side effects?

Dr Jim Parker: [00:48:49] Yeah, and with great ethics. So the previous, say what came back in slowly after the Women’s Health Initiative is using the lowest dose for the shortest period. So we’re not sure it’s cause breast cancer. I know, it hasn’t. We’ve read that people are scared to use it. So we said we’ll use the lowest dose for the shortest period. And police have said that all that data applies to synthetic oestrogen and progesterone. 

It doesn’t apply to natural oestrogen and progesterone that we’ve got now, which you can get an oestrogen patch and a progesterone tablet and that gives you — Anyway, her argument, which is a good argument, is taking the appropriate dose to give symptom relief for those people with symptoms and take it for the appropriate amount of time.

Dr Ron Ehrlich: [00:49:40] And how common is HRT taken appropriately now?

Dr Jim Parker: [00:49:45] Yeah, it’s definitely increased again. But you know, after the Women’s Health Initiative, bio-identical prescriptions went up fairly significantly. But of course, they haven’t been tested with the same rigour. They have been tested, and there really haven’t been found to be too many problems. But no one’s done the same study to show whether they cause breast cancer or they don’t, you know?

Dr Ron Ehrlich: [00:50:08] But apart from HRT, women.. Are there are other interventions or things that women can do as they approach or are in menopause that can minimise some of those unpleasant side effects, if you like.

Interventions women can use to minimise painful side effects of menopause

Dr Jim Parker: [00:50:22] Yeah, and it’s the same as every other thing that we treat. Our lifestyle is the first protocol for everything, and then you’ve got some as well soy-based products and all sorts of things that people can use. So Japanese and Asian women have a lot less menopausal symptoms.

Dr Ron Ehrlich: [00:50:43] But soy, those kinds of soy products now, you know, because there’s soy and there’s soya. Is there a difference in what type of soy is fermented versus soy just across the board? Soy is okay?

Dr Jim Parker: [00:50:55] Yeah. Look, I think that’s a difficult question to answer without going to exactly to all the studies and analysing, you know? But it’s like, obviously, you want a healthy diet and you don’t want to be having a high glycemic diet that’s giving you big spikes of insulin and then hypoglycaemic episodes that make you hungry and make you anxious. 

You know, on top of the fact that you’re getting hot flushes and things so you don’t want a diet that’s giving you vascular instability when you’ve got a metabolic change that’s already giving you that. So you don’t want to be not sleeping and getting your light exposure up until late at night, you don’t be eating to 9-10 o’clock at night. You know, all the same, things that we talk about with lifestyle for everything else apply to menopause as well. Yeah.

Dr Ron Ehrlich: [00:51:46] Now, Jim, you’re now in your career path because you are only, well, you were only born in 1955. So the a long way to go and your mentor started doing his Ph.D. at 87. I think I heard you saying I wouldn’t be surprised to hear similar story coming from you. You’re now teaching in med school at University of Wollongong. 

And I’ve had, you know, we’ve heard from so many doctors that nutritional medicine is hardly touched on. It’s not even considered at med school, even though it’s clearly implicated in almost everything we talk about. What do you see? How what are your observations about medical education moving forward? Are you optimistic?

Current observations about medical education

Dr Jim Parker: [00:52:28] Yeah. Well, I’ve only really started getting involved again in the last year I was. I’ve been teaching medical students up until a few years ago for 30 something years before that on a regular basis. But teaching them gynaecology topics. But I must admit, in the last ten years, everything that I taught them had a nutritional and environmental flavour as well. I talked about polycystic ovary syndrome or any of these nutrients in pregnancy and whatever. 

Dr Jim Parker: [00:52:56] You know, I’ve always brought that into it, but I just finished during the final year medical student examinations, which is a three-part thing, taking 60 students through simulated patient exams with multiple stations over three separate occasions. And I obviously did the obstetrics and gynaecology part of it, but I was so impressed with the standard of young doctors coming through now. 

And this is a graduate programme, not an undergraduate programme, but their level of knowledge and professionalism was fantastic. But the problem is it’s a four-year course, a graduate programme, and I learnt the whole of everything I’ve just been talking about. That’s happened in our last 100 years.

Dr Jim Parker: [00:53:40] In four years? Yeah, we want to get more nutrition and we’re working that into it. But are you going to take out asthma? Are you going to take out postpartum haemorrhage and bleeding in pregnancy? Like, you know, we’ve got to add on to everything, so you’ve got to integrate it and slowly do that. But having said that, looking at the other academics that are working here. 

A lot of those people are involved in nutritional environmental projects and big projects. There’s one project where they’re enrolling women in pregnancy and then they’re enrolling their mothers and they’re following up the babies for years to come. So where are you going to get three generations of information, and they’re looking at the dietary and nutritional things in that as well. 

There’s many projects going on that involve lifestyle, you know, it’s just that that’s part of the revolution that’s happening in medicine now that I was mentioning before. I think this is the current revolution.

Dr Ron Ehrlich: [00:54:39] I think most of us, most practitioners would recognise, particularly nowadays, that your education doesn’t end when you graduate. In fact, quite the opposite. It really is the beginning of lifelong learning, and I think that’s what makes health such an interesting profession. 

But Jim, I could sit and talk to you all day. I mean, you know, as a husband, as the father of two women, young women and as a grandfather of a granddaughter, you know, I’m learning, learning, learning.

Dr Ron Ehrlich: [00:55:11] But listen, let’s I just want to finish up and take a step back here from your role as a doctor over so many years, as an educator, because we are all on this health journey together through life in this modern world. 

Dr Jim Parker: [00:55:20] We are.

Dr Ron Ehrlich: [00:55:23] As an individual, what do you think is one of the biggest challenges or the biggest challenges for us as individuals on that journey?

The Biggest Health Challenge

Dr Jim Parker: [00:55:32] I guess we all want to make a contribution to society and to people’s health. You know? I have drawers and drawers and drawers full of cards and letters and gifts from patients.

Dr Ron Ehrlich: [00:55:44] Right, right.

Dr Jim Parker: [00:55:45] Hundreds of them. And that is a folder with hundreds. It’s got hundreds in that one folder.

Dr Ron Ehrlich: [00:55:50] Yeah.

Dr Jim Parker: [00:55:51] My pay in obstetrics and gynaecology, it’s a different world. Your patients, you see them all the way through pregnancy. I’ve been there 24 hours a day. I delivered 95% of all the babies and at one stage I was delivering 300 a year as well as doing all the operations and those people know this is part of the life of an obstetrician. Soon as I turn up with the problem, I’ll be there and sort it out. 

The biggest problem is that it’s life-threatening. And so you make a bond with patients when you talk about my personal satisfaction, if you like or you know, that is the single one thing of everything I might have ever told you, that is the only thing that really, really impacts me to tell you the truth, you know?

Dr Jim Parker: [00:56:43] When you have a bit of a down day, you just start to read a couple of those letters that people have written and the way it’s impacted their lives through all the dramas and disasters that happen in childbirth. It’s just been an amazing career to have both obstetrics and guiding. 

And as you said, I’m doing it a bit differently now, but I’m still doing it. I’m definitely trying to share my wisdom. That’s the combination of knowledge and experience. You get over 40 years of doing this.

Dr Jim Parker: [00:57:16] With new doctors coming through. I’m supervising two doctors now. We just started three weeks ago on a 12-month research project on insulin resistance and the effect of diet and lifestyle on insulin resistance. That’s one way we can get it into the curriculum. And those people, those two people, hopefully after 12 months, will be committed nutritional and environmental because they will have done a lot of work, you know? 

But, you know, similarly teaching I don’t teach you obstetrics skills, ob-gyne skills anymore at the moment, but I probably will be. I can hand over all of that experience that other people have handed to me, the allegations that picked it up over a hundred years. It’s just a continuing chain that goes on. 

But yeah, the most important thing actually to me, and you don’t get that in your private life is all these relationships with thousands of patients. I’ve probably supervised 100000 deliveries. I’ve delivered thousand. I’ve operated on eight to 10000 people. I’ve done a lot of work basically.

Dr Ron Ehrlich: [00:58:26] Yes. Well, Jim, thank you so much for today and thank you so much for sharing your wisdom and your experience with us today. I really enjoyed talking to you.

Dr Jim Parker: [00:58:35] Yeah. Thanks, Ron. Thanks for the opportunity.


Dr Ron Ehrlich: [00:58:41] Well, I’ve been looking forward to talking to Jim, and boy, did we cover some territory there, and I think it’s something that we really all need to be aware of. I mean, mind-boggling to think how widespread these problems are like endometriosis. We did a programme on that some years ago where we established that endometriosis in Australia affects 700000 women.

And globally, as Jim pointed out, most 200 million through 10% of women of childbearing age. And similarly for PCOS. So these are huge problems which are affecting people around us all the time, whether we are aware of it or not. But that’s why this programme and this raising this level of awareness is just so important, not just for women. 

Obviously, women are far more aware of this than men are, but we as men also need to be aware of these issues and endometriosis rather shockingly, as I learnt from my last programme, takes between seven and 14 years to establish a diagnosis. So imagine the frustration and the pain and discomfort that goes on and people are being told, Well, it’s just your period, but actually, it could be much more than that.

Dr Ron Ehrlich: [01:00:02] And I love the way Jim also incorporates nutritional and environmental medicine into practise. Since encouraging to hear that Obstetricians and Gynaecologists have been incorporating into their practise for many years through folate, iron supplements, vitamin D supplements, etc. 

But of course, as we know, if your regular listen to this, there is so much more than two or three nutrients. I was so looking forward to talking to Jim for such a long time because I have heard him lecture many times and at the Australasian College of Nutritional Environmental Medicine, I’ve always been struck by his encyclopaedic knowledge. And he did not disappoint today. 

Dr Ron Ehrlich: [01:00:43] Don’t forget to leave a review on iTunes or on Google Play, whatever you’re listening to. We recently did an IGTV Q&A, which was interesting, and I enjoyed it, and I’m hoping to do more of that so stay tuned to that. If you’re not following me on Instagram. Please do. It keeps you up to date. 

And of course, don’t forget to download the Unstress with Dr Ron Ehrlich app. Yes. Easier said than done, but there it is. That’ll keep you informed of all the latest podcasts and things that are going on, so I hope this finds you well. Until next time. This is Dr Ron Ehrlich. Be well.


This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.