Paradigm Shifts in Women’s Health and PCOS with Dr. Jim Parker

SHOW NOTES

• Learn more about Dr. Parker’s work: Visit the University of Wollongong Research Portal.
• Mentioned Studies: 109 Studies on PCOS and Pregnancy Outcomes, Kuhn’s Structure of Scientific Revolutions (1970).

Paradigm Shifts in Women’s Health and PCOS with Dr. Jim Parker

00:03 – Introduction of Dr. Jim Parker and the topic of PCOS.

04:39 – The keyhole surgery revolution and Thomas Kuhn’s cycle of paradigm shifts.

09:29 – Why mainstream medicine gives lip service to lifestyle guidelines without executing them.

14:59 – Understanding PCOS as an ancestral evolutionary survival mechanism.

19:24 – The diagnostic criteria of PCOS and the movement to change its name.

22:00 – The “Seed and Soil” paradigm in pregnancy complications and pre-eclampsia.

32:00 – Historic data on how whole-food diets radically lower eclampsia rates.

35:30 – The structural failure of the traditional glucose-centric model of health.

41:36 – 5 ways listeners can measure their own metabolic syndrome markers at home.

46:57 – The clinical value of tracking high-sensitivity CRP and fasting insulin.

51:13 – The role of the oral and gut microbiome in driving systemic inflammation.

1:02:38 – The importance of translational medicine over repetitive molecular studies.

Dr Ron Ehrlich (00:05)

Hello and welcome to Unstress Health. My name is Dr. Ron Ehrlich.

Well, today we are exploring women’s health and inviting back Professor, Associate Professor, Dr. Jim Parker. Had Jim on before. We’re talking about polycystic ovarian syndrome. 

Now, before you say I don’t have that condition, I think it is an interesting condition to consider in terms of how it is approached in healthcare. Like so many other health conditions.

There are many commonalities to it. Jim is an obstetrician and a gynecologist with over thirty or maybe even forty years of clinical experience. He’s delivered thousands of babies and performing thousands of gynecological procedures. 

So he has a great deal of experience. And after stepping away from clinical practice, he’s continued his work as an academic and as a researcher at the University of Wollongong.

Contributing extensively to research and medical education. I find that quite reassuring considering I first met Jim at the Australasian College of Nutritional and Environmental Medicine where he was a lecturer. 

So for him to be lecturing medical students is great, is wonderful, reassuring and very optimistic note. His recent work explores a new paradigm, emerging paradigm shifts in women’s health, including new perspectives on

Polystic ovarian syndrome, PCOS, insulin resistance, which affects many of us, pregnancy complications, and the role of lifestyle and preventive medicine in improving women’s, and dare I say, men’s health outcomes. I hope you enjoy this conversation I had with Dr. Jim Parker. Welcome back, Jim.

Dr Jim Parker (01:50)

Thanks a lot, Ron. It’s nice to be speaking with you again.

Dr Ron Ehrlich (01:56)

Jim, I always like to touch base with some of my guests and get updates on where they are professionally. You’ve had a very long career and now focusing almost exclusively on education and research. 

You started your career studying science and chiropractic and then transitioned into medicine and eventually obstetrics and gynecology. Now, reflecting on that journey over many years, what what was some of the experiences or questions initially that drew you?

Firstly into women’s health and then particularly focused on PCOS, pol polycystic ovarian syndrome.

Dr Jim Parker (02:35)

Yeah, well a as you said, I started this journey a long time ago, over fifty years ago now. And what initially I was just I was interested in all all aspects of human biology and health. And I was interested in lifestyle and all the things that go with that at the time.

And basically I just followed my nose. One thing led to another. I studied human biology. That led me into physiology and anatomy and like the helping sciences with chiropractic. We’ve talked about all this before. And then eventually into medicine. 

And of course medicine is i is just an open book of what where you can go and what you can do with that. So I I worked in general practice. I trained as a generalist and then I I studied and worked in obstetrics in the country at Maitland. 

And that’s where I got particularly interested in obstetrics and I was getting more and more involved and and thinking of moving further out into the country to work as a a GP type specialist and realized that I’d just need more training if I wanted to be in an independent environment.

And I was getting interested in the surgery and the gynecology. And anyway, one thing led to the other. And I eventually ended up at the Royal Women’s Hospital in Melbourne. I got into the training program there, which was the best one of the best decisions of my life because of the quality of the training and how big a teaching center it was. And then I I immediately got involved in the endoscopic surgery revolution that was happening in the early nineties.

Dr Ron Ehrlich (04:27)

Yeah, remind our listener what end what distinguishes they’ll have heard of colonoscopy, perhaps, but endoscopy. Well tell us about endoscopy just briefly, one one.

Dr Jim Parker (04:39)

That was really the beginnings of this of this revolution in this change from open surgery, laparotomy, to keyhole surgery. And in gynecology, we were pretty well one of the first specialties to to move into that area. 

And then after that, most other specialties got hold of it. But on the theme of what we’re talking today about paradigm shifts, that was a major paradigm shift that came around pretty quickly. 

And all of the things, all of the research that I’m hoping to talk to you about today follows that same, it’s somewhere in this process of paradigm shift, which really, you know, when you get a new paradigm, this is what’s called Kuhn’s cycle, it’s based on his book from nineteen seventy,

The Structure of Scientific Revolutions it’s how science changes over time. It it just doesn’t gradually evolve slowly. There’s a there’s a s a process and a cycle, and that’s what he called tomb cycle. And it seems to be happening over and over again. 

And it’s what I’ve witnessed in my lifetime as well. So a new paradigm comes in, and and as I said, we’ll be talking about some of these today that I’ve been involved in research and then everyone seems to fall in line with that paradigm. 

The science and the research is all based around that paradigm and it just reinforces this new model that everyone’s very happy with. And then then there’s a bit of paradigm drift. People notice a few chinks. 

There’s a few things that come up in the research that that don’t quite fit with with that model.

And this is the process of science evolving over time. It’s got to evolve and change. But you know, we we tend to get stuck on a paradigm for a while. So that that that re that model shift brings a bit of doubt into it. 

And then sort of leaders and innovators start to research those areas a bit more and look into it a bit more. And then they find some mig major changes. And and then you

Then you’re you’ve really got a model crisis because here you are you’ve had this model going for could be years, could be decades. In in the case of the glucocentric model of insulin resistance that we’ll be talking about today, it’s been going for a hundred years. 

So something comes up along the way, it then then it becomes more major ⁓ and then there becomes a model revolution. People develop new models and new ways of thinking about it instead of the old paradigm. 

And and the and that that’s being termed the paradigm clash, a clash between the new and the old model. So it’s a really nice this cycle, this Kuhn cycle. Then you get to paradigm change and it all starts again. 

And that’s how science progresses and we should expect that. And we shouldn’t resist it. We shouldn’t expect it.

Dr Ron Ehrlich (07:53)

It’s so interesting to hear you say that, remind us about science that just using the words trust the science doesn’t really cut it in the real world of science. It does in media and in tropes or memes that designed to get compliance. 

But trust the science is so unscientific, just that term alone, trust the science. Well, actually.

Let’s challenge the science. And I think it’s also interesting you talking about a paradigm shift because your background came from science, basic the basic sciences and chiropractic, which tends to take a very holistic approach, 

and then to be dropped into medicine and reassuringly learning about some basic sciences, but then really not getting into it properly until pharmacology, where you can start not only diagnosing and prescribing.

That’s when you’re really a doctor and you pick up a scalpel. But you you didn’t do, I mean, you because of your background, that paradigm shift of traditional medicine, the way 

traditionally medicine is practiced, and the way you were brought up to practice science would have been a real challenge at that time. 

Would you not? You you must have gone through medicine and thought, hang on, why aren’t they thinking about, why aren’t they talking about, why aren’t they doing, you know?

When are we going to get that paradigm shift, Jim, back to ⁓ what your the the Jim Parker integrative approach, paradigm shift?

Dr Jim Parker (09:29)

I think we’re well and truly into that. It depends on where you where you think we are in this cycle. I I I think we’re already at the major crisis centre looking at looking at that model. 

Every single international guideline in every area of medicine, whether it’s endocrinology, neurology, polycystic ovary syndrome, that’s my area, every guideline recommendation, the number one recommendation is for lifestyle.

So diabetes, obesity, you go to the guidelines on any of these things, heart disease, and you’ll find on the first page, the first recommendation is to implement lifestyle. So the the knowledge and the understanding’s there now in traditional medicine. 

What’s missing is the translation of that of the evidence and that thinking into practice. So that’s that’s the where we’re up to in this paradigm shift.

So for instance, the old paradigm is in traditional medicine is health is the absence of disease. So you come along with symptoms, we do some tests, we diagnose the disease, and then retrospectively we quite we try and look back and find some causes. 

Whereas the new paradigm and the functional medicine paradigm is that health is the maintenance of optimal physiology before you get to disease.

Dr Ron Ehrlich (10:55)

Interesting.

Dr Jim Parker (10:58)

And that paradigm is being taken on by mainstream now and it’s in all of those guidelines, but it’s not quite hit the desk of the people practicing because of a whole variety of reasons. 

But maintaining optimal physiology really means coordinating all of the networks that control physiology in the body. The old paradigm was looking at systems.

Cardiovascular, metabolic, immune, reproductive. The new paradigm is looking at networks of these systems that cooperate and work together, all coordinated by the brain, which is the central processing unit of the whole human body. 

It gets all the feedback from everywhere, integrates that, and then changes these systems to to maintain homeostasis and proper physiology and and health.

Dr Ron Ehrlich (11:56)

I mean, we’re gonna we’re gonna go into a little more detail that, but I just want to stay with that bigger picture because we have done many programs on an integrative approach in various areas. 

And my experience is that unless a practitioner has themselves experienced some ⁓ crisis, be it themselves or a family member close to them, the discussion about lifestyle and nutrition is

Largely lip service, like I you know, I have to say that before I tell you what we’re really gonna do. You need to go off. It’s not until they actually believe I mean, if a practitioner doesn’t believe the power of lifestyle, nutritional and environmental medicine, they essentially just pay lip service to it, don’t they? Has that changed in education? I mean, nutrition, how much is it studied? Lifestyle, how much how big a part of the course is it?

Dr Jim Parker (12:54)

No, it’s not a big part and it never has been. But as you say, it’s been increasingly recognized. But if you think about it, if you go back to where we started today with the revolution in laparoscopic surgery, 

if you didn’t do this surgery through a telescope and you just did open surgery and you never saw those patients as as you’ve suggested, you might not realise how radically the difference is between a patient.

That’s been operated on through a telescope the next day and and a patient who’s got a a very large hole in their abdomen. So once you see a few of these patients and they’re out of hospital within a couple of days instead of a week and and their recovery trajectories, you s you s you rapidly get converted. So there’s nothing there’s you can’t be seeing and experiencing things for yourself. The problem with lifestyle is

Often it’s harder to implement and slower to give results, if especially if you only take it up in a sort of piecemeal fashion, you know, so people aren’t necessarily going to see

quick. They’re there to be seen and and for a whole lot of reason reasons it it it ⁓ you know it will become it is becoming mainstream. My my my position is I see a big overlap between functional medicine and there’s a lot in common and that’s what I like about moving between these two worlds. I like bringing one to the other.

And in all my research papers, you’ll notice that I’ve got people from both from all disciplines and all walks of life on those papers involved in developing the ideas and supporting these new paradigms and concepts that are coming through. And that’s because there is so much overlap.

Dr Ron Ehrlich (14:59)

So Jim, you’ve written a lot about P PCOS and and you’ve even described it as an evolutionary adaption. I wonder if we might just remind our listener about what PCOS is and what you mean by it being an evolutionary adaptation, how that changes the way we think about it.

Dr Jim Parker (15:19)

Yeah, well that’s something I’ve been interested in for many years. And we’ve put together a a unified theory ⁓ based on evolutionary principles about why and how PCOS develops. And that’s based people started putting that talking about paradigm shifts, people started putting those ideas forward in the nineteen nineties, but without the word evolution, but still getting

Towards the the idea. And then we’ve built on the work of Shaw and Aziz and Dan Dumeric and put together, like, you know, taken bits and pieces of everyone’s ideas and put together a unified theory. But basically the principle of that is that women with PCOS have got the genes, ancestral genes, that were very well adapted to an ancient environment.

And so in times of starv starvation and hunger, stress, infection, there was a set of genes that allowed women with PCOS to have a particular survival advantage. Fast forward to now, and those genes are impacted by all the modern lifestyle influences: high highly processed diets, environmental chemicals, endocrine disruptors.

excessive stress, circadian disruption, and all of the other lifestyle things. And though they those genes therefore are are maladapted to this current environment, even though they’re very good survival genes in in an ancient environment. And and what’s important to realize about PCOS is it’s not actually a disease. It’s it’s not anything abnormal. All of the 25 or so genes that we know

provide a survival advantage are good to have. And so I look at PCOS and I tell women with PCOS that they’re the metabolically elite. They can store energy easily and 80% of women with PCOS are overweight or obese. But so is 50% of the world’s population. Anyone can become overweight and obese. Women with PCOS are just a bit better at doing it. They’re better adapted.

They’ve got slightly better gene variants that allow them to do that. They can implement insulin resistance easier. And therefore, that allows them to maintain higher blood sugar levels for better brain function to look for food when they’re starving and things like that from an evolutionary point of view. And similarly with fertility, women with PCOS have fertility problems. They can down-regulate fertility when there are metabolic problems in the body. And therefore, you know, why would you want to get pregnant if if you’ve got problems? 

If you’re starving and hungry, for instance, in an ancestral v environment, you’d want to turn fertility off until times are better. But every woman can turn down fertility very easily. If you start running marathons or have a very high stressful life with the the death of a spouse or whatever,

Or you suddenly lose a lot of weight, your menstrual cycle will stop. And that’s what commonly happens, and it’s called functional hypothalamic amenorrhea. The brain turns off the menstrual cycle. Well, women with PCOS can do that even under less extreme conditions. So they have a metabolic advantage. It’s not an abnormality, it’s just a problem in today’s environment. And that’s the whole basis of the evolutionary model of PCOS.

Dr Ron Ehrlich (19:12)

But Jim, there are the you I think you mentioned once to me that there were three criteria for diagnosing and that that’s actually thinking about a name change. Can you just share with us that?

Dr Jim Parker (19:24)

Yeah, well, the three criteria are irregular periods, increased male hormones or androgens, and polycystic ovaries on ultrasound. But you don’t actually need you only need two of those things to be diagnosed with PCLS. So you don’t need to have polycystic ovaries. So and hence the impetus to change the name.

Because people have realized in this paradigm shift that it’s really a metabolic and an endocrine or hormonal problem, not so much a problem just with the ovary itself. And that opens up a whole lot of possibilities because once you realize that PCOS is a normal variant, it’s not a disease.

It’s just women that were better adapted to one environment in an in another environment. And of course adapting that evolutionary approach potentially gives women control. Because once you’ve got a a potential reason, then you then you may have just a little bit more incentive to do the lifestyle changes that are necessary.

To get some of the symptoms and problems under control. And it’s been well demonstrated, for instance, our second papers that followed on from that evolutionary model. When when we were doing that, we realized that there was a very under recognized problem of pregnancy complications. 

Women with PCOS have double the risk of pregnancy complications everything from miscarriage to infertility to real pregnancy complications like pre eclampsia, preterm labor, and growth problems in the baby and even stillbirth. And that problem has not been well recognized or publicized in in either clinical practice or the literature in in any area of medicine. And so we I then got together a group of people and spent the next two years after that evolutionary paper researching that pregnancy type issue. 

And of course all the same things apply. The paradigm shift had already started in pregnancy research because for years, or thirty years, the the main body of research was done looking at the placenta and the fetal side of pregnancy.

And what was going wrong there? It was presumed to be in the genetics of the f of the fetus. Remembering that when fertilization happens, the sperm and the egg come together, and you’ve got half the chromosomes of the mother and half the chromosomes of the father. And then the embryo develops from that, and by the time the embryo implants in the uterus, which is about day seven,

Some of those cells they they divide into two groups, one that’s going to develop into the embryo and the baby, and the other develops into the placenta. So those cells have got to attach to the lining layer of the uterus, the endometrium, and then burrow into the uterus and cause a whole lot of changes there, one of which is to not get rejected by the mother, because essentially fifty percent of the genes of that baby are from the father.

And if you took anything from the father with fifty percent of the genes and put it into any adult, it would like a kidney or a liver, it would be immediately rejected without very strong immunosuppressant drugs. But there’s a communication going on between the fetal cells that are developing the placenta and the underlying mother cells or maternal cells to down regulate that inflammatory immune response.

Anyway, the old paradigm was that all of these placental problems, preoclampsia and growth problems and stillbirth, were originating from the fetus and what was happening in the fetal tissues and the way they were developing the placenta. And over the last five to ten years it’s been realised that since the problem or n none of those problems have been solved, that maybe it’s the mother’s side.

So this is the seed in the soil thinking, the seed being the fetal side of it, the soil being the maternal or mother side. Maybe there’s a problem with the soil. Maybe there’s something going on in the mother, in the endometrium, in the lining layer of the uterus, with the lymphocytes, the macrophages and all of the other cells that are in there. 

Maybe there’s something wrong with the way they’re responding as well that’s contributing to these pregnancy complications. And we then thought, well, what is the evidence that there’s an increased risk of pregnancy complications in women with PCOS? We know they have all these metabolic problems and insulin resistance and inflammation and how is that potentially affecting the placental development and the soil, if you like?

And what’s the evidence? So we s we did big research projects and published two papers on that. And what we found is that when obstetricians look at pregnant patients, we ask them about their history. If you’ve got a history of pre-eclampsia or blood pressure or other problems, then we will say that person’s at high risk and we might want to do more closely monitor them with ultrasound or even treat them, say for instance with aspirin but and and all of the major pregnancy groups around the world have got lists of risk factors that they consider major and minor. And PCOS wasn’t on any of those. 

And in fact when you look at those risk factors, seventy-eight different risk factors have been identified. The number one risk factor, clearly above everything else, is obesity. Overweight and obesity increases your risk of pregnancy problems multiple fold. And when we looked at PCOS, eight eighty percent of women with PCOS are obese, this is all lifestyle. 

So suddenly it clicked that lifestyle is affecting the mother’s systemic environment which is affecting the ovaries and the uterus, which is affecting the development of the placenta, and contributing to all these pregnancy complications. 

So we sort of extended this the soil paradigm to go right back to not just what’s happening in the endometrium, but what’s happening in the mother and looking at all of those things. And we found 109 studies that have looked at PCOS and the risks of pregnancy complications. And it’s there’s a massive amount of data showing that that should be right up the top of the list. There’s a two to fourfold clearly increased risk of p pregnancy complications.

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Dr Jim Parker (28:05)

While we were researching the evolutionary paper and putting that together, we realized that there was quite a big gap in the understanding of pregnancy complications related to PCOS. And that stimulated me to put together a group of people after we finished that paper to research that issue. And what the the problem was.

Is that we knew that women with PCOS were at increased risk of getting pregnancy complications. That’s things like miscarriage, pre-eclampsia, preterm labor, delivering early, and preterm growth problems in in babies, and even things like stillbirth. But we didn’t know the extent of that problem. And we didn’t we didn’t really know how important it was, but when we started researching it.

We realized that there was a large amount of data, 109 studies we found, and six systematic reviews that had looked at what was the increased risk of pregnancy complications in women with PCOS. And there was a two to fourfold increased risk. Wow. But when you look at pregnancy complications, 78 different risk factors have been identified, and PCOS was way down the list.

And in fact, the number one risk factor was obesity, clearly contributing to pregnancy complications and clearly implicating lifestyle and changes in the mother’s metabolism and systemic features, things like insulin resistance, hormonal changes and inflammation that were affecting the ovaries and the endometrium and contributing to pregnancy complications.

So anyway, we started to look at that and dissect it apart and published information on that.

Dr Ron Ehrlich (30:10)

Jim, I think you will have noticed it’s interesting that you know, two out of three symptoms, and one of those being even not having polycysts in your ovaries, you don’t even need that for a diagnosis and and this idea of rebranding the the does the syndrome as a metabolic one. Every c every conference, every course, didn’t matter whether you were doing it on cancer, heart disease, autoimmune conditions.

Everything is now being seen through the lens of metabolic health, isn’t it? So it’s hard hardly surprising. We’re starting to get to how dare I dare I say root cause issues.

Dr Jim Parker (30:51)

Yeah, well something’s got to cause the metabolic problems. You know, when you think of well, what is metabolism? Metabolism metabolism is the way the body makes, stores, and uses energy. So there’s roughly about thirty trillion cells in the human body all undergoing chemical reactions and biochemical reactions, breaking down like parts of the food we eat, the proteins, the fats and the carbohydrates and building up other molecules and allowing cells to to function. 

And what we want to do is get metabolism working optimally so that all those systems are working together. So we figured that given that PCOS is characterized by problems with insulin resistance, which is a metabolic problem, and chronic systemic inflammation, which also is a metabolic problem.

And generated from excess energy storage in fat tissue, excess stress in the body from various reasons, and that these things were having an impact on both the ovaries, which then produce and release the hormones that affect the endometrium, and on the endometrium itself. So what we did is we we looked at what was going on there, and then we said, well.

If these things are happening in the mother, we know they’re caused by lifestyle. What evidence is there that lifestyle makes any difference in preeclampsia, for instance? We chose preeclampsia because it’s a sort of model pregnancy complication. And what we found is a hundred years of evidence and studies. 

People had been implicating diet and lifestyle as a causative factor or contributing factor pre-eclampsia for a hundred years. And in the first half of the 20th century, 1900 to 1950, the first thing that people noticed is during World War One and World War II, rates of eclampsia, that’s fitting, caused as a progression of pre-eclampsia, which does kill 70,000 women a year now on the planet and 500,000 babies, rates of eclampsia dropped dramatically during the first and second world war.

Then a whole lot of researchers in that fifth first fifty years of last century went out into indigenous populations. And what they found is that in indigenous populations eating a whole filled food diet, the rates of a calamcia were dramatically less than urban city dwellers in European countries.

So there was a lot of circumstantial evidence. And of course, they looked at the dietary differences between the two. And nothing has changed from a hundred years ago to now, to what we’re saying. And in the second half of that 20th century, 1950 to 2000s, big epidemiological studies were done looking at the dietary profiles of women with PCOS and preeclampsia and pregnancy complications.

And big meta analyses of those studies showed that women eating a healthy diet, defined in specific ways that you’ll know, had a twenty two percent reduction in preoclamsium, and women eating a high ultra processed food diet had a twenty eight percent increase. So very good solid evidence.

Dr Ron Ehrlich (34:32)

Wouldn’t they also you know, that is interesting because so much of it relates to, well, glucose as one marker, but let’s say insulin as the main marker. And yet, and yet the health messages over the last fifty or sixty years have which has just changed recently, but we haven’t heard much about it, is to make the food pyramid the foundation of the food pyramid.

Carbohydrates, which are very quickly broken down into glucose, which affect insulin levels, shooting them up, and causing metabolic imbalances and an epidemic of chronic diseases. So arguably people following the food pyramid would have predisposed themselves to obesity and any one of a number of preventable diseases. What do you say to that?

Dr Jim Parker (35:30)

Thing I’d say is I should have invited you to be involved in our paper that we wrote after the pregnancy papers on insulin resistance, because that’s exactly what we said and researched in those papers. So from our pregnancy papers, we identified that diet was a factor, that by improving diet before pregnancy, you could improve pregnancy outcomes. And that is a big paradigm shift because and then and it’s way down, it’s still way down the circle.

Of paradigm shifting. That’s in the initial stages. It’s a long way from coming into clinical practice yet. But it it will go through that cycle and it will get there. But the evidence is there and and the evidence is clear. But anyway, that’s just part of the scientific process of paradigm shifting. But as you said, what we identified in that research.

Which we’d already identified in our evolutionary papers and many papers before that. The problem is a problem with insulin resistance. And the paradigm with insulin resistance developed from the discovery of insulin in nineteen twenty-seven. And that is we’ve always looked at insulin resistance as a glucose problem. We’ve had a glucose-centric model of insulin resistance for a hundred years.

And the we were looking at this cycle of change, we’ve gone through the minor things wrong with that to the major things wrong with that. And now we’re in the revolution stage where we’ve got this clash of paradigms between the glucose and the insulin-centric models. And our paper was looking at all the evidence and the history behind why we do have a glucose-centric model and why we should have an insulin-centric.

Centric model and why we haven’t. And of course, the problem with the glucose-centric model is that we measure glucose. And glucose stays normal because insulin goes up and keeps it normal for a decade or two before it gets to that magic number of seven millimoles per liter where we diagnose diabetes. So long before diabetes develops.

We’ve got a massive problem with metabolic dysfunction and insulin resistance. And that we see that I in the people we diagnose with diabetes. Because a third of people diagnosed with diabetes already have complications. Loss of sight, kidney problems, peripheral vascular disease, neurological problems. 

One-third of people with this low level just past the diagnostic criteria of seven, already had those complications. So we’ve missed the boat there. So our insulin-centric model presents all the evidence and rationale and the history behind why the glucocentric paradigm was good for about 50 years, but the last amount of decades, whatever that is, we should have been moving into the insulin-centric model. 

And pretty well everyone knows that now. So we’re in that we’re in that real clash of paradigm stage, the last stage before a paradigm shift of getting people to actually measure insulin instead of glucose and pick up and diagnose the problem earlier. And

The real tragedy is, of course, that insulin resistance is the most common disease on the planet. It is a disease. It causes problems. So if you think about it, there’s eight hundred million diabetics on the planet. They all have insulin resistance. There’s another billion pre diabetics. Pre diabetes is insulin resistance. They’re the same. So you nearly got two million two billion.

Dr Ron Ehrlich (39:34)

Well well Jim Jim, I I’m gonna put my hand up here for another ⁓ you know, you should have included me in the com in the in the article because guess what? WHO did a study on oral diseases which are charac which are characterized by chronic inflammation.

Which I think we can agree, and they estimate that three and a half billion people globally suffer from oral diseases. And I would say that is without a doubt a gross underestimation because half the population haven’t been to the dentist in the last twelve months, and probably eighty or ninety percent of the population have never had what I would consider a comprehensive oral exam. So so there there’s a lot of

A lot of failings going on here, but I think it’s fair to say that the lower the insulin level, the healthier you will be, whether your diagnosis is PCOS, cancer, ⁓ autoimmune, whatever, the lower it is, the better. Is that a fair statement?

Dr Jim Parker (40:39)

It is a fair statement. And then the next question is how can you assess it? And your viewers today can all assess their level of insulin resistance. And they can all work out today where they are in this metabolic paradigm. Okay. Because one of the ways that you can assess insulin resistance is by looking at the characteristics of metabolic syndrome.

So there’s there’s a million complicated ways of working out and measuring insulin resistance. But don’t forget that insulin resistance, you’ve got to measure the action of insulin in every cell in the body. It’s going to be an inherently difficult thing to do. So you’ve got to work out strategies for doing that. Anyway, one thing that would be of interest to your listeners today is how they can assess themselves for

Dr Ron Ehrlich (41:34)

Yes.

Dr Jim Parker (41:36)

How much insulin resistance they might have. And one way of doing it, and it’s very well accepted in traditional medicine as well, is to look at the parameters of metabolic syndrome. And that is five different things that you look at as in human health and physiology that characterizes metabolic syndrome. The number one thing is abdominal circumference.

An abdominal circumference less than eighty centimeters in women and less than ninety-four centimeters in men. So anyone can do this right in a minute by grabbing a tape measure and measuring at the level of their umbolicus all the way around. It’s less than eighty in women, less than ninety-four in men, then that’s a sign of metabolic health. And the simple reason is because metabolic abnormalities.

Come from visceral adipose tissue that’s deposited in the abdomen, deep in the abdomen, but it increases the abdominal circumference. So it’s just a surrogate measure of visceral adiposity, which is a the site that chronic inflammation and insulin resistance are generated from in the body, due to all of the lifestyle things impacting various pathways in that area.

So abdominal circumference, number one, blood pressure, number two. So obviously blood pressure is one of the most common problems on the planet, and funnily enough, so is insulin resistance. And we used to say that fifty percent of people with blood pressure had essential hypertension, and we essentially didn’t know that’s the old paradigm. But now we essentially know it’s due to diet and lifestyle. That’s the new paradigm.

So anyone can take their blood pressure. You buy a cheap blood pressure device from the chemist and you take it over numerous times a day for five days and look at what the profile is and work out a rough average. If your blood pressure is under 120 over 80, you are likely to have a healthy metabolic profile. Now, 110 over 70 is better.

Up to 140 over 90 is accepted as normal. But once you get over 120 over 80, your risk of cardiometabolic disease, in other words, heart attacks, diabetes, strokes, and all those things just progressively goes up. So everyone can measure their abdominal circumference, everyone can measure their blood pressure, and that’s two of the criteria. Then the third, the the other three things need to be done by your doctor.

But pretty well everyone listening to this today will have had them done. And they are fasting blood sugar level, which we said is a late marker for insulin resistance. You don’t want it at six point eight or seven, that’s diabetes. But if it’s under five point five fasting, then you’re more less likely to have insulin resistance. And there’s other things you can do then to look into it in more detail if you want to.

We can talk about these if we if you want to. But the other blood things that people do, everyone gets a cholesterol profile done. But metabolic syndrome, which is used by all doctors all around the world, does not include cholesterol. And it does not include LDL. And the simple reason is because cholesterol, absolute cholesterol and LDL levels are not predictive for cardiovascular disease and metabolic disease.

Half of the people that have heart attacks have normal cholesterol levels. But what is predictive, which is always done in that lipid profile, is triglycerides and HDL. So if your triglycerides, which everyone that’s had a cholesterol panel done, if they look at their results, they’ll find they’ve got triglycerides there. If they’re over 1.7, that’s indicative of insulin resistance and metabolic dysfunction. And ideally they should be under one.

So if your blood pressure, abdominal circumference, fasting blood sugar level and fasting triglycerides are normal, you’re very unlikely to have significant metabolic problems and you’re likely to be healthy. And the last one is your high density lipoprotein, HDL. If that’s high, this is supposed to be the good cholesterol, HDL, over one point five, then that goes with a a good and normal metabolic profile.

Then if you next time you go to your GP, you ask them to do a couple more tests and do a bit of negotiation and maybe stretch their paradigm a little bit, they might do a high sensitive CRP, which is a measure of inflammation. That’s now coming into traditional medical practice. If you look at the American Heart Association guidelines,

They’ll they’ll recommend that everyone has a high sensitive CRP now and other organisations around the world and authority bodies are taking it up.

Dr Ron Ehrlich (46:57)

So Jim, the higher that number, the worse it is. The more indicative of inflammation.

Dr Jim Parker (47:03)

It’s that’s right. It should be less than one. One to three is borderline. And over three is clearly abnormal and associated with a significantly increased risk of cardiometabolic problems. So it’s not too much of a stretch to ask your GP to do that now because it is coming in. And if they don’t know about it, do a quick search on any of your AI interfaces and take a summary of it to them because it it’ll it’ll just be there standing out. 

So in those people that have a normal cholesterol and have a heart attack, a lot of those people will have an increased chronic inflammation, high sensitive CRP, because it’s inflammation that’s initiating the changes in the blood vessel walls and the deposition of the various cholesterol fragments that are found there once someone has a heart attack.

And the other thing that you can ask for on top of a HSCRP is a fasting insulin. And if you’re as well as getting your fasting blood sugar level, you do a fasting insulin. If your fasting insulin is less than seven, then you’re unlikely to have metabolic problems. Seven to seventeen is borderline, and above seventeen is abnormal. 

Now the reason that Traditional medicine hasn’t gone to measuring insulin is because the levels can go up and down. There’s a bit of variability. But the information research we’ve got on insulin is much better than the level of evidence that we had when we introduced testing for glucose, the oral glucose tolerance test and hemoglobin A1C, which are all worth doing as well. 

But if you do your blood fasting blood sugar level and it’s up a little bit and you do your fasting insulin and it’s up massively, you know that your blood ins sugar level is only in the normal range because of that high insulin.

Dr Ron Ehrlich (49:11)

Insulin is the insulin is regulating the glucose level, keeping it abnormally normal in inverted commas, whereas it itself is overworking and eventually could become insulin resistant.

Dr Jim Parker (49:25)

And your insulin is regulating your blood pressure through nitric oxide in in blood vessels. Yeah. And it and through sodium reabsorption, which is the function of insulin in the kidney to increase blood volume. So your insulin is regulating all those parameters that we just talked about. It’s regulating blood pressure, abdominal circumference, because when you’ve got insulin resistance, you get visceral adiposity and your abdominal circumference increases.

It’s regulating your triglyceride levels. That’s its job is to get glucose in and convert it to dry triglycerides and store it as fat and save it up for a rainy day or when you’re fasting overnight and release it then. So insulin resistance is the driving force or the what we call the core pathological, pathophysiological process behind all of those metabolic parameters that you measure.

Dr Ron Ehrlich (50:23)

Yeah, and and Jim, Jim, most people will have had just that fasting glucose done. Don’t eat anything for twelve hours before you we want to do a fasting glucose level. So we’ve got abdominal circumference, blood pressure, fasting blood sugar. Yes, okay we’ve also got triglycerides, HDL, and and we’ve got the fasting insulin levels as well as CRP.

Another area that I think you are folk you’ve focused on and we’ve heard a lot about in terms of mental health is microbiome. The microbiome being a significant driver of health in general and your s your research explores all those things. What are we beginning to understand about the role of the microbiome in women’s reproductive health?

Dr Jim Parker (51:13)

Shaping up to have a role in virtually every women’s health problem, just like lifestyle is now. And and different women’s health problems are in different parts of that circle, that paradigm shift. Some are right at the beginning, like for instance heavy menstrual bleeding, and some are right at the end, like the insulin-centric paradigm. 

And the microbiome, I’ve scene ship because when I used to lecture to medical students in the early 2010 to 2015, every time I did a tutorial with them and I had a group of eight or nine students, I out of interest, I used to ask them, put your hand up if you’ve heard of the microbiome. And for those five years I never saw a hand go up. Fast forward to 2020, and when I do similar lectures, half of the lecture hall

Put their hand up. Everyone knows about the microbiome. So we’ve seen that paradigm shift in medical education and in medical practitioners to understanding the role of the microbiome. And it ties in the whole theory of what’s happening there ties in with your comments on oral health. The original model of the microbiome in PCOS was put forward by 

Professor Kelton Trumelton, who we just finished it publishing a paper together with as well, not necessarily on that aspect, on on another topic, which I’ll just briefly tell you about in a minute. But he put forward a very comprehensive theory back in 2012, in the early days of the microbiome’s role in chronic disease, that a high glycemic, high fat, low fiber diet caused changes in the microbiome, which caused a breakdown in the barrier, this leaky gut which activated chronic systemic inflammation 

I by a whole lot of mechanisms that are well described, which then cause this low-grade inflammatory response throughout the body. And in our first papers, we put that in ⁓ as a mechanism. But in the last five or six years a lot of other mechanisms to do with the microbiome, not just the release of the lipopolysaccharide, which is the component that was put forward that caused the damage to the the the epithelium and the lining layer. 

Now there’s a whole lot of other mechanisms like bile acids and choline and other molecules as well. So that whole concept has been extended. And we’ve extended it also to talk about the whole mucosal immune system, because the microbiome influencing inflammation in the gut

That process of activating inflammation can be done anywhere in any mucosal immune system, including the oral immune system. So if you’ve got an imbalanced microbiome or infection in the gums and in the mouth, that can initiate chronic systemic inflammation, which then impacts insulin function and contributes to insulin resistance. So and and similarly the endometrium.

Which hasn’t been really well studied, but any microbiome can initiate inflammation in the body. And then the downstream effects on chronic disease are the same. It doesn’t matter to the body where that inflammation starts. So the the microbiome model has been extended quite considerably in terms of mechanisms and in terms of initiating things. 

So we know that air pollution and microplastics can initiate chronic inflammation in the lungs and then that can impact insulin resistance and metabolic function in the body.

Dr Ron Ehrlich (55:13)

So Jim, we’ve we’ve spoken about a lot of things here today. I wonder if we might just wrap this all up, sort of give us a summary of what we’ve what we’ve discussed. ‘Cause it’s it is there’s quite a lot here.

Dr Jim Parker (55:24)

Yes, true, Ron. We have covered a lot of ground. I mean, the theme of today’s talk being emerging new paradigms in women’s health. we have covered a lot of these potential new paradigms that are, you know, part the way through or almost all the way through. But from our research in the last few years, the evolution is is provides quite a a good framework. 

It’s a unifying framework that we’ve put forward that it that provides a good basis to explain what’s going on in PCOS and in fact in most of the chronic diseases that we’re dealing with these days. And that i in in looking at that circle of how emerging paradigms come into in into play, that’s right just under the radar. It’s at the model crisis. There’s a real paradigm shift happening there. So hopefully that that that concept of the evolutionary model is getting a lot of international attention. 

And and that paper of ours has been cited over 160 times already, just to give you some idea. Yeah. And of course our our pregnancy complications model, our model for preventing pregnancy complications using a combination of lifestyle intervention before pregnancy, the endometrium gets primed and is in an optimal state for when pregnancy occurs and and obviously limiting the risk of complications in pregnancy. 

We’ve tied that lifestyle intervention in with the current existing biomedical screening tests, which have been very well researched over the last 20 years.

And the starting to come into practice in some of the tertiary centres in Australia and s and some of it’s still a way off. So that’s quite a forward-thinking model as well. And we talked about today the our insulin-centric model of looking at insulin resistance to replace the hundred-year-old glucose-centric model. 

And we also talked about how everyone listening be able to assess their own metabolic health and determine whether they have those underlying risks for insulin resistance in terms of blood pressure, abdominal circumference, fasting blood sugar, and their lipid panels, particularly triglycerides and HDL. 

But one thing that your listeners are probably picked up on throughout all of this discussion is that a lot of these complications and problems focus on the endometrium, which is the lining layer of the uterus. And the endometrium is an end organ. It gets blood supply from the rest of the body, so that everything that’s going on in the mother, like inflammation, insulin resistance, all of these hormonal changes and and everything else, actually has an impact on the endometrium.

And that’s why we see all these complications in women’s health sort of converging on this area. We’ve got abnormal uterine bleeding, which happens in a third of all women, heavy menstrual bleeding, quarter of all women, and iron deficiency anemia in sixty percent of those women. Iron deficiency anemia is the most common nutrient deficiency on the planet. And

Twenty-five percent of those women with heavy menstrual bleeding have got anemia, iron deficiency anemia. It’s a massive problem. And our that’s that was the focus of our last paper because the old paradigm looks at what’s going on in the endometrium, the endometrial events. What’s what are the hormone interactions that are happening there and the cellular changes and and the molecular changes within cells? 

And it it really looks at that as a cause. But of course, the new paradigm, which we support as well, is that, well, what about the influence on what’s happening in the mother, which we’ve talked about many times throughout this talk today? How does insulin resistance, inflammation, and all these hormonal changes affect what’s happening in the endometrium, which increases the risk of miscarriage, abnormal bleeding, pregnancy complications, and even pre cancer and cancer later in life in women post menopausal.

Dr Ron Ehrlich (1:00:25)

Jim, it’s an interesting focus to to mention at this point the endometrium so much because of course endometriosis is a huge and undiagnosed problem. You mentioned a third of women have heavy bleeding, which is often dismissed as, well, that’s just normal, isn’t it? I mean, don’t worry about it, go off. 

And we did a program on endometriosis many years ago where I was given this shocking statistic that it the average diagnosis it takes between seven to fourteen years for a woman to be diagnosed accurately with endometriosis. I mean, that’s quite a shocking indictment on what is normal.

Dr Jim Parker (1:01:08)

Yeah, that’s true. And that’s had your attention lately. And endometriosis, of course, is when the endometrium that we’re talking about today grows outside the uterus. But our last paper focused on all of the things that are happening inside the uterus in the endometrium that are influenced by what’s happening in the mother. And of course, by default, they are influenced by lifestyle.

Yeah. And that is in that is one of the things that is just not on the radar or not considered in the conventional approach to endometrial bleeding problems at the moment. And that’s why we’ve tried to introduce this as part of an another new paradigm in our recent paper.

Dr Ron Ehrlich (1:01:58)

I mean, Jim, I know that we’ve known each other for many years through the Australasian College of Nutritional and Environmental Medicine, ACDEM, and you were lecturing there for many years. 

So that’s why I was very excited to hear that you joined the teaching staff at Wollongong University and because I knew what your focus would be in obstructrics and gynecology. I mean, is I know we’re saying it’s a new paradigm and I know you are doing research on this.

Are you optimistic about the profession in general embracing this more, dare I say, holistic approach?

Dr Jim Parker (1:02:38)

Here I am actually as we spoke about before, all of the current guidelines have lifestyle first. So what what the the big gap is at the moment is called translational medicine, translating the research and knowledge into clinical practice. And you probably know that on the eighth of March, just two days ago, was International Women’s Day.

So this is a very appropriate time for you and I to be talking about paradigm shifts in women’s health and bringing all these things up for discussion and to for awareness to people. But what we really need to see now, and what I’m passionate about, is getting the existing research base into clinical practice. 

And there’s so much repetition of existing data and studies. We do this, you know, like I mentioned, for instance, with polycystic ovary syndrome, 109 studies looking at pregnancy risks in women with PCOS, six systematic reviews. We do not need another systematic review, but there’d be someone doing it right now. 

So we need and the International Guidelines Group published a paper outlining 150 areas that need to f be researched in PCOS. And they’ve said in that paper, which I agree with, the move should be towards translational medicine now and away from all these molecular studies and big systematic reviews that are just repeating the same thing and coming up with the same results, or saying we need more evidence. 

We have so much evidence now and so much knowledge. It’s now the time to move that into clinical practice. And and that’s that’s what I’d like to see ⁓ happening now. We’re bringing all this holistic approach, if you like, with lifestyle. It’s already there, the research is there, there’s more than enough evidence. Obviously you can always have more evidence, but there’s more than enough evidence for us to take public health actions.

Sugar taxes on sugar drinks and ⁓ labeling, black labels on ultrapressous food. You know, there’s lots and lots of public health interventions that we could do. We need governments to take action, we need health authorities to take action, we need food pyramid changed, like it has recently been that you mentioned earlier in the US. 

So we need to to to get the evidence that we’ve got and take action on that to intervene and get people’s hells ⁓ in now. And it doesn’t mean stopping all research, it just means changing direction.

Dr Ron Ehrlich (1:05:38)

Well, Jim, that’s a good note for us to finish on because it’s one of the reasons I got you back on to talk about that and to give us an update. And I’m also optimistic when I see people like you teaching medical students. So thank you so much for everything you’re doing, have done, and will continue to do in sharing your knowledge and wisdom with us today. Thank you.

Dr Jim Parker (1:05:58)

Thanks for having me on, Ron. It’s been great. And happy International Women’s Day.

Dr Ron Ehrlich (1:06:05)

That’s a good note too. Well, emerging new paradigm, paradigm shift in how healthcare is approached. What a wonderful idea, because if the evidence is anything to go by, ⁓ we have some serious health problems that require paradigm shifts. And to see Jim involved in medical education is something to be truly optimistic about. We’ll have the links to some of those articles that Jim mentioned.

I would refer you back to some of the many other articles or rather programs we’ve done on women’s health. We did one on endometriosis a couple of years back and we need to revisit that. That’s often a a very undiagnosed, takes a long time to diagnose those kind of conditions. And again, so many health conditions being seen in the framework of metabolic health.

I hope this finds you well. Until next time, this is Dr. Ron Ehrlich.

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