Dr Oscar Serrallach – The Postnatal Depletion Cure

Dr Oscar Serrallach joins me to discuss postnatal depletion and the consequences of it. Whether you are a mother, know a mother or have a mother, this episode is relevant to you. Dr Oscar Serrallach combines nutritional, environmental and lifestyle medicine to discuss a topic that rarely gets much air time but has a huge impact on all of us.

Dr Oscar Serrallach – The Postnatal Depletion Cure Introduction

Now today’s episode focuses on postnatal depletion and the consequences of it, and before you think this doesn’t relate to you, the man or woman, then pause, look down. If you have a belly button and if you’ve gone through birth, then this is relevant to you. Okay, and another point to get your attention. We’ve all had a mother. We may know a mother. We may even be a mother. Well, stay tuned. This is, as I said, a really important show.

My guest today is Dr Oscar Serrallach. Now Oscar is a general medical practitioner and has for many years been dedicated to remaining at the cutting edge of wellness healthcare. His dedication led him down the path of studying and practising functional medicine while addressing the multifactorial aspects of health and wellbeing. He’s been on the board and served as the editor for the Australasian College of Nutritional and Environmental Medicine for many years and frequently presents for the college.

Oscar is well known in the field of postnatal health through personal family experience. He actually has three young children, a great learning experience for any practitioner, but also through the lens of functional integrative medicine. He came to realize the huge impact that nutritional, environmental and lifestyle have on the postnatal period, a period we have all been through. And the impact of it is, as you will hear, huge.

Oscar brings his knowledge of postnatal depletion and the fourth trimester, which traditionally has been thought to last for only a few months. But it really lasts for well, no, no, I’m not gonna. I’m not, I won’t spoil it. I’m going to leave it to Oscar. The Postnatal Depletion Cure is fabulous and he has also created a unique working environment working exclusively with a highly skilled and diverse team at the Health Lodge in Byron Bay, Northern New South Wales. I hope you enjoy this conversation I had with Dr Oscar Serrallach.

Podcast Transcript

Dr Ron Ehrlich: Hello and welcome to Unstress. I’m Dr Ron Ehrlich. Now today’s episode focuses on postnatal depletion and the consequences of it, and before you think this doesn’t relate to you, the man or woman, then pause, look down. If you have a belly button and if you’ve gone through birth, then this is relevant to you. Okay, and another point to get your attention. We’ve all had a mother. We may know a mother. We may even be a mother. Well, stay tuned. This is, as I said, a really important show.

My guest today is Dr Oscar Serrallach. Now Oscar is a general medical practitioner and has for many years been dedicated to remaining at the cutting edge of wellness healthcare. His dedication led him down the path of studying and practising functional medicine while addressing the multifactorial aspects of health and wellbeing. He’s been on the board and served as the editor for the Australasian College of Nutritional and Environmental Medicine for many years and frequently presents for the college.

Dr Ron Ehrlich: Oscar is well known in the field of postnatal health through personal family experience. He actually has three young children, a great learning experience for any practitioner, but also through the lens of functional integrative medicine. He came to realize the huge impact that nutritional, environmental and lifestyle have on the postnatal period, a period we have all been through. And the impact of it is, as you will hear, huge.

Oscar brings his knowledge of postnatal depletion and the fourth trimester, which traditionally has been thought to last for only a few months. But it really lasts for well, no, no, I’m not gonna. I’m not, I won’t spoil it. I’m going to leave it to Oscar. The Postnatal Depletion Cure is fabulous and he has also created a unique working environment working exclusively with a highly skilled and diverse team at the Health Lodge in Byron Bay, Northern New South Wales. I hope you enjoy this conversation I had with Dr Oscar Serrallach. Welcome to the show Oscar.

Dr Oscar Serrallach: Thanks, Ron. It’s great to be here. Looking forward to having our discussion today.

Dr Ron Ehrlich: Oscar, you know, I sat and listened to your presentation at a recent course that we were both at on postnatal depletion and there are so many questions I wanted to ask you, but I wondered if you might just share with us, cause I know you’re working up in Byron Bay, in Northern New South Wales, and you’ve got this amazing facility called the Health Lodge and I think it’s actually when I heard about it, I thought, gee, every health practitioner would be envious of this. Can you share with us a bit about your journey and segueing into the Health Lodge? Tell us about it.

Dr Oscar Serrallach: Yeah. So I come from an emergency medicine background and sort of moved into the world of sort of general practice. And one of the things I noticed with general practice is you’re often just working by yourself and silo into a department. And I kind of realized pretty quickly that after my training in GP that wasn’t really going to work for me as an ongoing sort of career. And I’m very interested in nutritional medicine.

I’ve grown up with homeopathy and so it was quite an easy transition into learning integrated medicine. I spent the next five years after finishing my GP training, just going to every ACNEM course that I could sort of get my hands on and just really, an amazing journey with just learning about as much broader aspect of lifestyle and nutrition and environmental medicine.

Dr Ron Ehrlich: Just to share with our listener, that acronym ACNEM is the Australasian College of Nutritional and Environmental Medicine of which you are, you and I are both proud members go on.

Dr Oscar Serrallach: Yeah. And so you get to meet great people when you’re sort of asking the right questions and going to the right events. And I met Brene Debois who’s a naturopath in Byron who had this vision to sort of start up, essentially in 21st century model around sort of health care. And so we set up the Health Lodge over four years ago and the vision around sort of the Health Lodge is really around a different delivery of health care, where we try to put the patient at the centre of the equation, not the doctor. So the idea of, you know, doctor centric, this is patient-centric and it’s a very, you know, when you kind of look at it at its core, it’s a very different way to sort of approach things.

You know, this idea of, if you’ve got a problem, you have to ring a medical centre to get an appointment, you have to kind of wait under the waiting room with sometimes sick people. And then you know, you’ve got a very short period of time to plead your case to the doctor. They don’t even know why you’re there. They’re sometimes running late, there’s not, it’s kind of a high-stress environment and a lot of people don’t represent themselves very well and that sort of short period.

I mean, it’s, when you kind of look at the medical model in that way, it’s a direct Pantageous to the client. And then so our idea of what if you put the patient in the centre of the equation that if the doctor doesn’t turn up for work, the patient’s still getting care.

Dr Oscar Serrallach: Whereas in the old one, there’s no kind of care going on. And so that was the vision I suppose. And you know, there are many people doing great work in Australia and overseas and The Health Lodge, it was kind of a refurbish backpack essentially, and so it’s got facilities for people to come and stay. So we have five rooms and people who want to do long health retreats, for example, can actually stay on-site and can receive care e during the day.

We’ve got yoga and the complex, we’ve got a mini sort of rooms with different types of practitioners. Everything from traditional Chinese medicine to Naturopathy to psychology. We’ve got visiting specialists coming in, a psychiatrist, a gynecologist, and we really pride ourselves on working as a team and we have these amazing, twice a week team meeting where everyone comes together and contributes.

And for me, that’s the special sauce of what we do. We have people coming in, sitting in on these meetings and just go, Wow, I’ve never seen anything like that before. And for me, that’s a real learning time. I offer my wisdom to the meeting and the meeting often will reflect back their wisdom. And so it’s a really, interesting sort of common ground, if you like, for the run to come together and talk about clients, obviously with their permission, and just having a different perspective now.

And I’ve learned sometimes incredible things with the osteopath might offer something that I had no idea about. This is giving you an insight into their story that you are just looking at the physical symptoms and the pathology and not realizing sort of the, how the story is a very big part of maybe why they’re not able to get better and many examples around that.

Dr Oscar Serrallach: But it just for me it’s a real privilege to be sort of a part of this. Everyone who works here really enjoys that sort of model and then the fact that people can actually stay here, it’s really interesting you actually have people living in your clinical model, kind of gives a different perspective on things in terms of what’s happening on the ground rather than people kind of presenting themselves nicely and then coming to the appointment and you kind of, you know, you can lose a lot of valuable information just and you know, we’re still working hard on trying to better the model, we’re far from perfect. We’re very hindered by things like software and even patient expectation. Even though people want to be moving into a patient centric model, people aren’t really quite fully ready for it either.

Dr Ron Ehrlich: Well, people have to be ready to engage. I mean the other model of what you mentioned about a practitioner centred approach is very much the practitioner, you know, patients surrendering care to their practitioner. And it takes us sort of a psychological leap, not just for the practitioner to engage in a patient-centred approach, but if it’s patient-centred, the patient has to be engaged as well.

Dr Oscar Serrallach: Well, they have to be engaged, they have to be enrolled and actually have to be the CEO of the project and they have to be doing the work in between appointments and returning in quite a different, in a very active way rather than what you’re alluding to is quite a passive way when you are now handing over your power as it would to the practitioner that you’ve kind of seen was telling me what to do, I might do it.

Dr Ron Ehrlich: Yeah, yeah, yeah. The thing also from the practitioner perspective because healthcare is pretty stressful and being in, in a busy practice where the appointments are seven, 10 or 15 minutes, which is typical of a lot of medical practices, it’s a very stressful environment and isolated environment to work in. So I can just imagine what these two meetings a week would be. So therapeutic and not apart from the learning experience of bringing all these different disciplines together, the impact that it has on each individual’s psychological wellbeing would be really, really important.

Dr Oscar Serrallach: Yeah. Well we’re like a family and it’s just, the meetings are almost like tuning where if each practitioner is like a different string on an instrument, we just kind of, it’s time and we’re going to see together and kind of remind ourselves of our goals and kind of what the common conversation is around. And I think that is very healthy for everyone each week. We can’t afford to be isolated and strength when we’re trying to do the healthcare. I mean it’s kind of a bizarre paradox.

Dr Ron Ehrlich: [inaudible] now you’ve written this book, the postnatal depletion and

Dr Oscar Serrallach: The Postnatal Depletion Cure.

Dr Ron Ehrlich: say it again. Postnatal depletion cure. Yeah. Yes. I’ve got the whole book here but, I wonder before we leapt into that, we might, I might ask you where are, where are we at in terms of pregnancies and births and mother’s response to this phenomenon, which we’ve all been part of.

Dr Oscar Serrallach: So just so I’m not too sure exactly what way that question’s kind of going wrong, but, you know, part of my journey with learning environmental medicine was I was starting a family and I’d come back from a conference and I’d be learning that hormones are about copper or about, you know, environmental toxicities. And I was kind of realizing it was a very exaggerated thing going on for mothers, that they had a lot of these kinds of issues, but they did something very unique about them too.

So part of my journey was realizing that there isn’t a lot of medical science around the postnatal period. There are heaps around pregnancy and the antenatal care, you know, I think would medicalize pregnancy, which is an unfortunate name for, but it’s actually a transformational experience that mothers are going through in terms of changes to the brain or modal system.

And their social IQ. A lot of these things kind of get this upgrade during pregnancy. And then we need to support mothers in that transition into motherhood. And mothers are obviously very important, you know, my wife jokes that we’re sort of talking about before is, you know, this idea of mother care is only relevant to people with a belly button. We know we all have a mother and we all are involved with mothers. And we don’t honour them in a way that we sort of used to.

And that is a very sort of unique biochemistry, psychology, it’s going on during that time. So my book, The Postnatal Depletion Cure was sort of born out of my journey with ACNEM, born out of just working with mothers and my own personal journey with my partner and having three kids on the scene.

How mothers can really suffer, in that postnatal period is not just in the first few months either. It can be in the years after that. There was a kind of a moment for me when an Australian study came out in 2014 that showed that the peak incidence of depression postnatally was four to five years after the birth of a child, but they couldn’t call it postnatal depression because the definition is it has to be within the first six months.

So I’m like, we’ve got this definition…this is why we aren’t seeing things. We’re kind of so locked into a way of looking at postnatal that we can’t even do the stretch to have a look at what’s going on beyond that. And so, I really like this term matrescence because it kind of combined this idea of pregnancy, the postnatal period and beyond, it’s a term that came out of anthropology, moved into psychology.

Dr Oscar Serrallach: Now worked its way more into biological sciences, but it’s like adolescence. It’s the becoming of an adult or adolescence, matrescence is the becoming of a mother. I believe matrescence is more biologically significant than adolescents. It’s a pretty big call but if we have a look at the brain changes, there’s more neurogenesis occurring during pregnancy than there is during an entire adolescent time and more neurons being laid down.

So the brain gets this massive upgrade during pregnancy for the mother. And we only go through adolescence once, a mother goes through matrescence and every time she’s sort of pregnant. Again we support adolescence through their transformation because we know it’s not an easy time and they’ve gotta get used to the new body and the new brain and, and hopefully then become a really good adult at the end of that.

We need to be doing a very similar thing with mothers and the mothers is a learned skill it’s not something that you sort of get a divine download during your labour, motherhood is a learned skill. We need to support mothers through that transition into matrescence just like we do with adolescence and so we have a really well, happy, adjusted sort of person at the end of that.

Dr Ron Ehrlich: Hmm. I think it’s very interesting that you should say this term was born out of anthropology because culturally over the hundreds of thousands and probably millions of years, but let’s say over hundreds of thousands of years, our tribe would have prepared us for this process of pregnancy, birth and beyond. And so interesting that it’s come out of anthropology because it’s where we may be seeing so many of our problems cause that kind of support, that kind of cultural support is just not there.

Dr Oscar Serrallach: Well, exactly. And a big part of my journey was when I was seeing the struggles that mothers were having, I just went to the library and went online and I started going, well, where are the textbooks? And there are a few studies on postpartum fatigue. You know, there was very little out there in the scientific space and it kept bringing me back to things called postpartum practices, which, of these old cultures as a project will sort of research. And at first, I was a little bit annoyed by that. Just going, come on I want science.

Not what we’re doing tens of thousands of years ago. But then I realized that there was a similarity between these cultures. I think I’ve clicked it about 90 different postpartum practices from different cultures and they all have a time of deep rest of honouring the mother of that, that she doesn’t have to engage in her role back into society for four to six weeks, sometimes a bit longer.

Dr Oscar Serrallach: And then she’s expected to turn up. And it’s quite a different way, but it’s really supported in that transition. And what I’ve come to realize is that time of deep rest for four to six weeks typically is a hormonal recovery time for mothers. So they can reset their hormonal system rather than staying in this very low hormonal state for months and possibly years after the birth of a child.

And all that comes with that in terms of mental health issues, hyper vigilance, physical health problems, sleep disturbance, weight gain, and the list is long. And it’s all these ended up being pretty much normalized because they’re common. But, just like diabetes in Australia, 50% of adults 50 years or above have diabetes, half of them don’t know.

But it’s so common that it’s been normalized in our society. You can’t say that having diabetes is normal. And so for me, having postpartum fatigue and a lot of these, you know, depression, anxiety, the mood disorders, weight gain and things postnatally and not, they may be very common, but you can’t tell me that they’re normal if you understand that the physiology of whats going on and what should be going on.

Dr Ron Ehrlich: Hmm. Wow. And well, what are some, I mean you’ve mentioned those challenges and I guess one thing is to build resilience prior to the pregnancy. Take us on the journey. I mean, if you were writing an ideal, guide which you’ve done, I’m sure you’ve covered this and you know what, tell us how to let’s start from before we lob into the problems. What would be an ideal way of preparing for pregnancy?

Dr Oscar Serrallach: Yeah, that’s a great question. This is where I really like to go to eventually because it’s like, servicing your car regularly you avoid a catastrophe on the highway, rather than having the tow truck number and then that’s kind of your, you know, your plan. A lot of us have this tow truck kind of mentality and aren’t even aware of the preventative stuff.

So ideally, you know, I’ve not liked to see mothers get into this, postnatal neuroinflammatory state that is depletion. So a big part of it for me is understanding a woman’s own physiology. So that’s a really, every woman’s obviously very different and part of that is understanding what foods are good for you and what foods aren’t. These idea of inflammagens just because one person corn or gluten is an inflammatory and for them, it might not be for someone else.

Dr Oscar Serrallach: And so this kind of a journey of just looking what foods agree with you and what foods don’t. Really understanding your individual sleep needs. I think now we’re living in a society where sleep is expendable and that’s a real starting point for getting depletion or fatigue postnatally if you are not having good sleep getting into things. A really big thing that I do, especially with my pregnant mothers, is to learn how to relax. It sounds almost ridiculous.

Dr Ron Ehrlich No, it sounds so aspirational.

Dr Oscar Serrallach But when you’re six months in with a newborn and it’s three o’clock in the morning and you haven’t slept in months and your child’s not sleeping, they’ve got reflux, that’s not the time to start learning how to relax. So getting that relaxation may look different for each sort of person. But a lot of it’s around having a practice. So the practice might be a meditation, it might be a yoga class and might even just having hobbies that provide a deep flow state.

So, you know, like some people find knitting or reading or you know, a lot of these things are actually really good for our nervous system or hormonal system, which are actually helping reset our stress system. We kind of hit road overtime or we know learn what’s kind of good for us. And we get annoyed by meditation because we find it hard until we kind of leave it, and when we don’t do hammock time very well.

So when we are to figurative to not literally in the hammock but in the hammock and we’re made to be relaxing, we’re often on social media, we’re kind of busy thinking about things and we don’t actually switch off. And so this idea of stress on stress, off stress, on stress off, which is actually really healthy mechanism. We actually do really well with stress on stress off, cause life is so busy, the 24/7 , rush, we just stress on, stress on, stress on, and so a big part of either conception work or during pregnancies, how do we engage the stress off button? What does it look like for you? And let’s start practising it because like I said, you know, when you’re deep in postnatal despair and struggling and you depleted as all hell, that’s not, it’s a very challenging time to start learning these other things.

So the pre-work is a lot around that. And then we’ll do testing to have a look at how nutritional state, are there any sort of signs of food inflammation, how your hormones are kind of looking and really about where someone’s inflammatory state is at. Because pregnancy is a controlled inflammatory state. We know all the problems associated with pregnancy, whether it be premature labour, would it be in preeclampsia, hypertension, gestational diabetes, those are pro-inflammatory States.

Dr Oscar Serrallach: And then postnatal depletion is definitely a inflammatory state as is depression, OCD and anxiety and those conditions postnatally are very different to prenatal depression, anxiety, OCD, because inflammation often isn’t in those sorts of things. So inflammation isn’t necessarily a bad thing. You need inflammation to be able to grow the placenta and grow the baby, but it has to be controlled. It’s a bit like a bank balance.

You know, you need enough money coming in and not bills being paid and just staying in the black and, and everything’s kind of good when you go into the red, when you’re already in the red from an inflammatory point, you’re going into a pregnancy, it’s going to make things a lot harder and moving forward.

Dr Ron Ehrlich: Moving onto the birth, cause obviously the birth it’s an exciting time, we think about the baby that’s been delivered, but there’s a placenta attached to that, isn’t there? And actually, I heard you speak of it and I heard you give a brief history of the birthday cake and I wondered if you might just share a little bit about the placenta and the birthday cake story with our listener.

Dr Oscar Serrallach: Yeah, for sure. I’m totally fascinated with the placenta, it’s an organ grown inside the model, but it belongs to the baby. Humans have invented quite an ancient type of placenta to enable enough fat to possibly enter to make the babies brain. When we think brain, obviously human infants are born way more prematurely than other apes and other mammals. And if you looked at a goat or pig placenta, it wouldn’t quite work to deliver enough fat to the baby’s brain.

So we’ve interestingly, we’ve reverted to a more primitive type. It allows much more fat across the placenta, but that is more prone to damage and placental dysfunction, and the placenta serves two masters and I suppose to serve the mother and child.  The first thing that the placenta does is actually put a hold on the mother’s stress response system because if it didn’t, she would pretty quickly reject this thing.

Dr Oscar Serrallach: That’s 50% foreign, the baby and the placenta and then it kind of produce 200 different hormones and marinates the mother in hormones. This is where all the brain changes come from. Estrogen for example, goes up 30 times above baseline in the third trimester, it goes up a thousand times above baseline in the days leading up to the birth, progesterone 10 times, cortisol three times above baseline in the third trimester.

So much cortisol, the stress hormone that if you or I had that amount of cortisol in our system we would be totally freaking out and not able to manage. But the placenta’s kind of doing a beautiful sort of juggle. And not only is the baby born at the time of birth, also the placenta is born and so the mother loses this hormonal factory controlling the stress response system.

And then she’s meant to start producing her own hormones and start upgrading stress responses. So this is why we have ideally four to six weeks of deep rest to allow that to kind of happen. And this is why it’s been an imperative amongst old coaches. And it’s not just a nice, fanciful, mythological kind of idea. It’s like we don’t do this. We’ve gone to this kind of strange world, of hypervigilance, anxiety and poor energy, which is what postnatal depletion is essentially about.

And then, you know, there were a couple of leading theories around the origins of the birthday cake, but the leading one is that a birthday cake is shaped like a placenta. We honour it every year at the birth of that particular person, and we cut it up into and share it and eat it. And so what historians think is that it’s actually a placental honouring ceremony that we do every year. Not only to honor the person, but to honor what brought them into the world. The placenta, unfortunately, it becomes just a sugar fest in the 21st century.

Dr Ron Ehrlich: Yeah. Which is adding to the cortisol and stress levels and neuroinflammation. It’s almost a, anyway, if you had a conspiracy theory, we won’t go there, but, but was it anthropologically where did cultures consume this? The placenta? I mean, that’s something I’ve heard about.

Dr Oscar Serrallach: I’m not aware of any ancient culture that will eat the placenta, even though it’s a very common thing that’s done nowadays to encapsulate the placenta and, I have a lot of clients saying that they have felt much better on the pregnancies with that happen than not. I’m not going to get in the way of that, its a very contentious issue on a number of different areas. But for me, I just tell mothers they need to honour the placenta, whether eating it is honouring that’s fine or burying it under a tree. But so many cultures have procedural honouring every year. And for me, you know, you can even look at it the birthday cake.

Dr Ron Ehrlich: No, I was just going to say, I’m never going to look at it the same again, actually, I’m going to look for an interesting recipe, which in some way reflects that. It could be an interesting challenge. Could be another book there Oscar, a follow-up book.

Dr Oscar Serrallach: More and more has been written about it, but it’s, it’s just something to have a conversation around. And if you have a look at a traditional birthday cake, it doesn’t have too much fancy stuff on it looks like a placenta cracks in the icing, which I can to look like that.

Dr Ron Ehrlich: So part of this issue is the definition of, well, part of this issue is not that deep rest of the mother, honouring the mother, giving them four to six weeks to recover, given this incredible hormonal change which has occurred. But it’s also the fact that we’ve restricted this to a six-month thing. And after that it comes under a different category. What do we do? What can people do when they’re faced with these issues? Because the issues are all of the things you’ve mentioned putting on weight, mental health issues, poor sleep, how should we approach this? What is the postnatal depletion cure?

Dr Oscar Serrallach: Well, I mean, the idea is if this, we need to have a broader definition, obviously it will have, well in this book I’ve said maybe the definition for postnatal should be seven years, not six month, and theres quite a lot of research showing that the postnatal period or the effects of the postnatal period, with depression peaking at four to five years after the birth of the child. The Danish [inaudible] studies showing that the incidence of thyroiditis related to the birth of a child peaks at about a year after.

Dr Ron Ehrlich: Wow. So, so after the birth, people are more susceptible to thyroid problems and that’s epidemic in our, you know, I mean thyroid.

Dr Oscar Serrallach: It is, and I believe that autoimmune diseases can be very much kicked off by especially a stressful pregnancy and stressful labour, very little actual epidemiological research that’s done on autoimmune disease. The thyroiditis study from Denmark is the only one that I can find that’s actually followed up nearly half a million woman over many years.

They are looking not only at autoimmune disease and also thyroiditis and other thyroid conditions. And that’s just looking into the room through a keyhole, just going, wow, there’s something big going on. Yet. Now suddenly my mother’s who had an autoimmune disease you know, when they come back from immunologists or rheumatologists, I ask them. Did they actually ask you whether you had any children? And, and nine times out of 10, it’s like, no they didn’t, it’s such a short appointment, we didn’t even get there.

Dr Oscar Serrallach: I said, did you actually tell them that this started pretty quickly after the birth of a child? And they’re like, Whoa, no, they didn’t ask me. And so the specialist who should be known isn’t asking the question. And, and so it’s a blind spot. So I’ve come up with a term, called matriarchstrics to kind of go, look, maybe we should be having a separate field of medicine to not only to acknowledge fact that mothers, but they’re pretty much lumped into main studies and issues.

Listen, it has to do with the reproductive system. And medicine doesn’t have a very clean origin and that most studies up until the 1970s and eighties were done purely on men unless it had to do with all contraceptive pill or reproductive carcinomas or those kinds of things, and reluctantly woman were added into research in the seventies and eighties, and I look at that and it’s ridiculous. It’s 50% of the population. We all know we’re not the same and also mothers aren’t the same…

Dr Ron Ehrlich: And we certainly know that men are much simpler physiologically than than women. Not to mention mentally. And one could go into this. We won’t, we won’t go down that path. But, but I guess the women, you know, God, they run, they have their periods, every, you know, it doesn’t even come every month. It could be variable. So how could you include them in a study? No, no, well, we’ll remove that lot.

Dr Oscar Serrallach: Well, what’s happening is we joke at medical school about the mythical 70 kg white middle class, Caucasian male. That was kind of galloping out there in society somewhere because that’s where most of the research that we’re looking at when based on this kind of mythical creature and now it wasn’t a lot of research, wasn’t taking into fact that even cultural diversity and those kind of things and all of the research from American now showing that Afro Americans are very different in a lot of their risk factors and outcomes and those kinds of things.

And a lot of research now it’s showing cardiovascular issues and woman present very differently. They probably need different treatments and that’s not even looking whether they’re mothers or not. So it’s,  I’m kind of fascinated by that. So matriarchstrics, it’s one of those pediatrics and geriatrics to have a different sort of focus. And hopefully, I see that in my lifetime we get that.

Dr Ron Ehrlich:  I mean, you know, women choose not to have children or to have children or sometimes they don’t choose, but the fact is some women do have children and some women don’t have children. And that experience physiologically apart from anything else is very different. Puts them into a very different women’s health guiding up, you know, gynecological experience. Is that what, that’s what you’re really saying here, isn’t it?

Dr Oscar Serrallach: Well, yeah and it can really affect, you know, the menstrual cycle after its origin can really affect how menopause is going to be, it affects autoimmune disease, inflammatory disorders. Now osteoporosis I speak might be put on there, but again, the studies call it being a mother is pretty common and possibly more common than not being a mother. It’s almost considered to be a normal part of womanhood if you like. Whereas it needs its own sort of filter and acknowledgement and why I’m kind of looking at things.

Dr Ron Ehrlich: Now another thing, Oscar, that you mentioned and I want a task you a bit about is this hormone leptin, because we hear an awful lot about insulin and we are very preoccupied with quite rightly so I guess,  but leptin’s one that we don’t hear a lot about or as much as we should. I wondered if you might share with us, give us a little bit of leptin 101 and why it’s so significant.

Dr Oscar Serrallach: Yeah, so I’m fascinated with leptin and a lot of what I know about leptin actually came from doing research in chronic fatigue, and then kind of realizing in my mother’s a separate issue going on around something called leptin resistance that causes a neuroinflammatory issue and this kind of inflammation within a very specific part of the brain.

The brain is obviously the air traffic controller of the body. And so if you have inflammation, very specific parts of the brain, they have downstream effects, exaggerated responses, and so the body can get locked into inflammatory states. And so what’s exciting about leptin, is it was only discovered in 1994 so fairly recent, the first 10 years, researchers had it all upside down and there was billions of dollars thrown at trying to find a leptin analog because they found in these mice that they had no leptin were obese.

Dr Oscar Serrallach: And so they were like, okay, well if we can maybe give them leptin into the mice and they became normal weight and said, great, this is like insulin, you know, and when insulin was first discovered was mainly around type one diabetes where there’s no insulin and you had diabetes, but that’s the less common issue with insulin. And it actually types two diabetes, which is a bigger issue, which is actually insurance resistance. So actually too much insulin is produced in the body, become resistant to the signal.

And so when they came to do human studies, nearly two thousand, they realized that hang on, most humans have too much leptin. And so I discovered this thing called leptin resistance, the pharmaceutical industry dropped it like a hot potato, just going, well, you know, that’s that

Dr Ron Ehrlich: There’s nothing here.

Dr Oscar Serrallach: Well, it’s not an instant money-making drug to be had with this leptin, but what’s interesting with when,   if you have a condition like postnatal depletion, so in your inflammatory disorder, it can really affect the leptin signal. Leptin is produced by the fat cells to tell the brain how much weight is the body carrying. I mean, how does the brain actually know?

The brain doesn’t just look at you as your wife and go, Oh, I know I’m overweight or I’m normal weight or I’m skinny. That’s not how the brain perceives it. Signals sort of visual, similar to biochemicals. And leptin is that signal to tell the brain how much weight are your carrying. When we eat fatty meal leptin is produced by the fat cells and it’s part of the, with grehlin is another hormone that gives us the feeling of being full.

Dr Oscar Serrallach: So we don’t overeat and we don’t sort of under eat but what happens with leptin resistance. You know, leptin, I’m totally fascinated with leptin, because you know there’s still so much we don’t know about it and there are six different receptor types in the body. So it’s like, for me, leptin is almost like a, a vowel in the alphabet that just because you’ve got the letter a, doesn’t mean A works the same in every work.  And leptin has a different picture in the liver than it does in the gut than it does in the brain. The brain is a very unique way of processing leptin, but if you have sleep deprivation as an example, or if you’ve got some sort of toxicity, they might be coming from the environment, the environment and that stuff sitting up in your inflammatory disorder.

Dr Oscar Serrallach: You know, mold is probably very common. Your inflammatory disorder, when you see leptin resistance, the brain starts to become insensitive to the leptin signals. So the fat cells start to produce more leptin. You develop with resistance. And it’s a little bit more complicated than this, but what I say to my clients is leptin resistance is like your brain thinking you are super skinny and you’re overweight and your brain is thinking that you’re super skinny. You have to kind of go past the irony.

Every decision that your body makes thereafter is with that decision in mind. So exercise, and I’m counting calories. If your brain is thinking that you’re super skinny it isn’t going to work. And this is part of the paradox that a lot of, especially female with leptin resistance. And I mean you can get it as well, that the brain gets tricked into thinking that they’re already skinny and when they exercise they become stronger. Now they might, they’ll burn muscle before they’ll burn fat.

So it’s a very tricky world of mathematics to go. And when you’re looking at that sort of 20th century and calories in, calories out, burn off your calories for exercise, and that’s the end of the conversation, that’s certainly what I learned in medical school, and we know that it’s not right, I have many clients tell me, look, I’ve done the calorie counting, I’ve done the exercise, I actually gained weight and my GP tells me I’m crazy or I’m cheating and so we often will look in leptin. Is that the explanation of what’s going on? And then what do you do about with the resistance? Because it’s not like, Oh, here’s a tablet or a pharmaceutical that’s gonna correct that. Leptin resistance is lifestyle. So two most powerful things in lifting resistance, correction of the circadian rhythm because that’s one of the causes of leptin resistance.

Dr Oscar Serrallach: So getting up at the same time every day, I go to bed at the same time every day, getting enough sleep, making sleep a priority, eating at exact times of the day. Nothing that can be profound for reversing leptin resistance is restricted eating. So this whole thing around the 16:8, so fast in 16 hours a day and eating 8 hours a day, I think a lot of the benefits, and there are other things done that it does, which are also very important. So, and we’re not designed to be eating from dusk till Dawn necessarily.

Dr Ron Ehrlich: Mm Hmm. It’s, look, you’ve mentioned two things there that are just a recurring theme on so many discussions I’m having recently and that is the circadian rhythm and this time-restricted eating. And you know, you can only reflect back on, the advice that we’ve been given via the food pyramid or the food plate or the Australian healthy eating guidelines, which suggest three meals a day and two snacks to keep our blood sugar levels up is a beautiful economic model. It’s great.

It keeps the food industry and pharmaceutical industry busy for yonks, but it’s just not happening. It’s not having very good effects on our health and the influence on our circadian rhythms of our lifestyle. There’s another big one that that’s, and the other thing that strikes me is we very rarely test for leptin on blood tests. I can’t recall ever having being tested. Is there value in blood tests for leptin resistant? How do you determine leptin resistance?

Dr Oscar Serrallach: Well, technically you need to do fasting leptin liberal with leptin recept a byproduct sort of ratio, but it’s almost impossible to do. I’ve never done it. I wouldn’t know where you’d get that done. That’s kind of research only. But all the researchers who do this say fasting leptin is a good enough test. It’s not a cheap test, are not paid for by medi-care you know, there’s one lab in Sydney that does it, and in Australia and is often a 4-6 week wait time for that.

So sometimes I’ll make the assumption that someone may have leptin resistance, or order the test, and start treating awaiting the result becoming somebody will need, I think just the confirmation. I think it’s, if we’re useful from that point of view at the moment, you know, for me, it’s about $160.

I don’t go there lightly when I’m sort of ticking boxes for pathology, but I definitely walk someone through that and how necessary it is. But it’s a 10, so that’s enough. I’m quite familiar with doing sort of the passing leptin test and its utility.

But I think even if it’s just an explanation of what’s going on or, or to help someone commit to doing one of this circadian rhythm and restricted eating hours amongst other things, you know, I think there’s great utility in that engaging someone in their health journey doing. So the explanation part of that is actually really important rather than just, Oh, I’ve got this idea and let’s stop treating it. So, the idea in the testing, confirming a new hypothesis and then go with to start doing these sort of corrective behaviours.

Dr Ron Ehrlich: Now another the thing that I heard you speak of and I was fascinated by, and I may not get the pronunciation of this correct either. Microchimerism.

Dr Oscar Serrallach: Yeah. So fetal microchimerism.

Dr Ron Ehrlich: Fetal microchimerisms. Okay. Is that correct? That’s the baby side charm, isn’t it? Yeah. Tell us, tell us about it.

Dr Oscar Serrallach: So Chirmera is a Greek God that is part human? I think so. This idea of being half-half, and so what happens, during a pregnancy, is part of the child’s or the fetal cells or the cells from the baby make it into the mother’s circulation. And that’s called microchimerism. And a small amount is considered to be normal and some researchers even think that it may be a benefit from that, somehow tunes the mother’s body. These cells can stay in a mother’s system using the bone marrow for up to 20 years beyond the birth of the child. And sometimes a child will have some of the mother’s cells in their bone marrow. So it’s possible for a mother to has been mothers cells in the system and the child cells.

Now when the machinery becomes too inflamed, we talked about inflammation and becomes slightly leakier than it should do. You get more cells getting into the circulation. And this actually might be a unhealthy stress on her immune system. And there are quite a few researchers who are saying that they think this date may be a contributing cause to autoimmune disease.

For example, post a nightly, number of researchers looking at no finding male DNA in the thyroid’s of mothers who have thyroid problems. And where does that mild DNA come from? So either come from a male child, that might come from a blood transfusion, and I don’t think it can come from intercourse. , but now there’s that Y DNA. , the one she had wrote Mike’s Mike’s myo and it’s come from somewhere.

And I’m amazed that this isn’t talk more widely about is that because everything is kind of more in the research building, nothing I’ll say is in the medical sort of field. It’s a very interesting idea if nothing else. And it’s a very profound idea going, well, this is meant to happen. And nature obviously not stupid is a positive aspect to it, but like many things, when it becomes exaggerated, then this can be a negative aspect to it. , and I don’t even know what you’re doing around trying to reduce mothers, you know, fetal cells in the circulation. But we should and we should just try to provide an environment where that’s not at the procedure isn’t to stress and, and, and is behaving appropriately.

Dr Ron Ehrlich: Mmm. Amazing. Amazing. What an interesting thought. You know, one of the things also that I find I’m very interested in, and we touched on it earlier, is, that cultures prepare for, for pregnancy, et cetera. What, what are some of the things that in your research we can learn from our traditional cultures?

Dr Oscar Serrallach: Yeah. And then this goes from North American cultures to Asian cultures, to African cultures, to old European cultures.  , and so, you know, for me, in a nutshell, it’s about, , really preparing the mother for the postnatal period now that the birth of a child is not the finish line. Why I was kind of sitting through my parental journey. It’s the start line.

Dr Ron Ehrlich: Yeah. Just once we have the child loud, lots can get back to normal. Oh, wow. What a lesson that’s learned for all parents. Yeah. Yeah.

Dr Oscar Serrallach: Which I hadn’t had that kind of a idea with having children. This guy here, he then at Charles is going to become part of outlaw style and yeah, that’s a very harsh lesson to sort of go through, especially in the middle of the night. Sleep deprivation and struggle. And so I really encourage people to you’ve got a birth plan, fantastic, that’s great.

Put it away, let’s get a really good postnatal plan and listen to Pao and not just a mater but ideally the father or another caregiver to innit to initiate that plan and beat the mother shouldn’t be running around making sure people are doing the food Rosta and doing washing rosters and those kind of things. That should be the caregivers, other caregivers that role and food turn out people kind of doing cleaning in the house and and and so the mother and ideally the father or other caregiver can really be in that deep space, that four to six weeks.

So, you know, postnatal plan is around providing the cocoon, if you like, around the baby bubble and trying to get the father and or other kid give it as much involved as possible rather than having them busy running around doing stuff. We’re at back at work. So that’s one thing. I’m pretty barred from old cultures in that personnel plan. , interestingly, all universally, all old cultures have only cooked food, often fatty food.

And there’s facial prepare for the flu to the mothers. And that often happens to be high in fish fat. There’s no raw food, typically lots of broths, slow cooked foods, regardless of the time of year and just things that have very easy to digest it a nutrient dense. So that’s kind of, and so if you’re doing a food Rosta, and I love the idea with weed Russell, when you get people kind of engage and bring food to your house, I could say I loaded the baby and then they can take the garbage out.

Dr Oscar Serrallach: I wouldn’t be doing, I was saying, you know, we had a joke in my clinic that in the first six weeks, no visitors, only staff. And the idea is that if anyone’s coming to have a nose yet the baby, you know, you’re not, you’re not being entertained, you know, they’re there to do a job as well as visit the family. So and just to give permission in our culture, people need permission to do things along the time.

Part of that permission is gone. You can take six weeks off from your busy life and just dive into this and switch off social media and not really engage society. And that’s okay. And that’s actually kind of the biological design rather than just getting this idea of trying to get back to your made in itself, back to work as soon as possible.

Dr Oscar Serrallach: Pretend like you’re not a mother. I mean, this is part of the mantra of the 21st century workplace which everyone loses when that’s the common conversation. Pretend you’re not a mother. It’s like, that’s just crazy. And so breastfeeding at work is kind of part of that, not, not really engaging or engaging in very different way to afterschool activities, those kinds of things.

Now in Denmark, they have, if you’re a parent, you get six extra days of paid holiday by your employer and it called parent days that you can do something with your child. Like if there could a school performance, school performance isn’t going to typically happen outside of work hours or they may be a school exertion excursion that you want to go on or that may be a camp that they’re doing.

You can actually go do that, be paid and not pretend that you still have work if you sneak away to do these sort of things. And it’s, it’s a very interesting conversation that when I talk to people about them, they’re just like, wow, I have no, I have nowhere to put that.

Dr Ron Ehrlich: What about, what do we also learn from traditional cultures about timing between children cause given this enormous impact on the woman’s body hormonally, physically, mentally, emotionally. I’m guessing that a recovery, and we’re talking about postnatal period being seven years, well, very few women would leave seven years between what do we know about from traditional cultures, about timing of other children?

Dr Oscar Serrallach: Well, what we know about traditional culture, do they have children much younger, often their late teens, you know, between, so then they’re more immune to the effects of sleep deprivation. For example. This is why we can look in body in our twenties and go to work the next day. No problem much how to do that in your forties so there’s that financial aspect to it.

I haven’t seen a whole lot of research around the time between children, but they tend to leave two to three years, typically are the apes three to five years between offspring is what the researchers are saying. And for me that’s a very common question that I get at my sort of public talks probably the most common question I get actually is what’s the perfect time between children and for me it’s not a number, it’s the fact that you have to had your sleep re-established and reestablished for more than just a couple of months.

Dr Oscar Serrallach: So if you actually deprivation, sleep debt, sleep disturbance, going into your next pregnancy, you’re setting yourself up for much Pata the next round of pregnancy and postnatal but now I’m really interested to have a, a conversation around that. , cause I don’t know, the answer isn’t clear, but what I’ve worked out is that the sleep is a really crucial part of going into your next pregnancy. Healthy. We’re having twins more often.

So I think the of twins is about one and it into a pre IVF times and now rates probably double, maybe more. And so that has a huge biological impact. And then we have this kind of very cerebral kind of idea around [inaudible] I want my children pretty close together and now we’re going to be moving into this world of design and babies very soon have all one boy, girl, boy or no.

Dr Ron Ehrlich: Scary. Scary.

Dr Oscar Serrallach: Yeah. None of that’s really born out of bio. Why don’t you Google,  , planning, really it’s, it’s more out of this cultural conversation that we’re having.

Dr Ron Ehrlich: Yeah. Well Oscar you know, your book, The Postnatal Depletion Cure covers a huge range of these issues and more in, in much more depth obviously. And so we’re going to have links obviously to that. Well, I just want to finish up and ask you this. Taking a step back from your role as a doctor,  cause we’re all on this health journey through life in our modern world. What do you think the biggest challenge is for people, for us on our journey through life in this, in this world we live in?

The Biggest Health Challenge

Dr Oscar Serrallach: It’s a great question, Ron. I’ve got a couple of things that are coming up from me around that. So, no, I think one of it is permission to do things that are good for us that may not necessarily be part of the two-dimensional life goal, money earning house building, that now I certainly grew up with and it’s very common, Todd, of this hollow capitalistic drive that we sort of have. And a lot of people really struggle to give themselves permission to relax or get a massage or do nothing. And the lion of Hemet can do nothing.

I mean, I look at the, the new generation of teenagers and young adults and they’re now, they’ve grown up with technology. You know, the idea of that is, is quite foreign to them. And if they have a spare moment, they’re on social media or on their phone or playing a video game or watching YouTube.

And so there’s, there’s not even the permission to do this isn’t there or the idea that that should be done.  , and part of that is we need to give ourselves permission and also the priority to really engage in healthy practices and this idea of a practice, talk to all my moms and all my clients around it.

That practice is something that we do ideally every day or quite regularly if not necessarily outcome driven. So, you know, I’m in charge of trying to do a training for a marathon and you’re trying to get some kilometer on the five minutes or whatever your goal is. That’s not a great example of a practice and has to help reset the nervous system. And when you look at what the booze owns, you know, these are the always lived peoples in the world.

Dr Oscar Serrallach: When you have a look at people who report happiness are the people who are happiest in the world. Now there are people who do have a practice who are in a flow state frequently who are really kind of engaged in the society outside of themselves. And we live in such me kind of world that we just don’t really think in we and doing things that you don’t necessarily want to do a bit of good for our local community. And we were just, we’ve lost connecting with those kind of things.

So practices can sometimes be around those sorts of things and looking at something bigger than ourselves and sort of those, it’s quite a long winded way to get round to your question, but essentially we’ve lost know when you believe that you are the biggest thing on the planet, you’re going to run into a lot of problems and we need to really believe in something bigger than ourselves.

And it doesn’t have to be a religious idea of the name. It can just be an idea. Maybe mother nature or community wellbeing something bigger than me. We actually a lot happier when we do that all the research is kind of showing them that when you’re the biggest thing in the room, you’re gonna suffer eventually. And we live in a world where we aspire to that.

So I think the biggest challenge is around giving permission to be able to relax and healthy wise stress on stress off and then to aspire to follow along to something that’s kind of bigger than ourselves. And that, that’s a really hard challenge if you’re not familiar with that. I talked to my kids, I took my kids friends. It’s not part of the conversation and they’re going to have to learn this probably the hard way. I intend to just experiencing crisis, asking big questions and then going through a transformative experience.

Dr Ron Ehrlich: Hmm. Oscar, what a note to finish on.  , thank you so much for joining me today and sharing your wisdom and your experience. I’ve really enjoyed the conversation. We’ll obviously have links to the book but also know the health lodge as well, which is just such a wonderful enterprise. Thank you so much.

Dr Oscar Serrallach: Well, thank you, Ron. Thank you for the opportunity and thank you for everything that you do. You’re a leading light in the wellness community, so thanks again. Going back to you.

Dr Ron Ehrlich: Well, we’ll have links to Oscar’s practice website, the health lodge and his book, the postnatal depletion cure. It’s fabulous. It’s really worth a read. Don’t forget to download the Unstress app at the app store or Google Play and keep up to date with the episodes, the blogs, the courses and events as they happen. 2020 is shaping up to be a very exciting year for us and we want to share it with you. And of course, don’t forget, leave a review on iTunes. So 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.