Jacqui Fahey (0:06):
Welcome to Common Ground, a podcast series discussing new research and interesting projects in the field of complementary medicine. Hello, my name is Jacqui Fahey, head of education at vital.ly.
vital.ly is a digital platform, a health professional resource, and a distribution service all in one.
Firstly, I'd like to begin by acknowledging the Gadigal people of the Eora nation as the traditional custodians on the land on which we gather here. I would also like to pay my respect to their elders both past present and emerging.
In this episode today, we're going to be hearing about nutritional psychology, what it is, key nutrients that support the journey through fertility and IVF, plus going beyond prescriptions, what are the other aspects that impact the mental health of our fertility patients.
Katey Weekes is an accomplished clinical naturopath and nutritionist specialising in hormonal health and fertility, IVF support, pregnancy and postnatal care with post-graduate studies in natural fertility education.
In addition to her clinical work, Katey's also the senior clinical consultant and team leader for Bioconcepts technical support team in Brisbane. Katey as the founder of Peachy Natural Health and Fertility in Brisbane, Queensland, love that name. Katey consults both nationally and internationally and is both passionate about supporting fertility and ART assisted reproductive technology patients, as well as working with multiple pregnancies and other high-risk presentations. Katey is frequently invited to present and mentor large practitioner audiences in the areas of male and female reproductive health, mental health, and pathology.
We're very pleased to have Katie share with us today on Common Ground and welcome Katey.
Katey Weekes (01:54):
Thank you so much, Jacqui. I'm happy to be here. I'm very excited to chat to you about everything today.
Jacqui Fahey (02:00):
Katey, we'd love to hear a little bit about yourself. What firstly led you into practicing naturopathic medicine?
Katey Weekes (02:08):
Well, I think like most people in our industry, I had a really awesome experience with a naturopath when I was younger. So I think at the time I had undiagnosed coeliac disease and I was getting a really severe form of eczema which we now know is dermatitis herpetiformis and that's really associated with coeliac. So it kind of led to my diagnosis, but my practitioner was just phenomenal and so helpful. And I had so much change compared to the standard medical care that I was receiving, you know, topical steroids and things like that. So I was just really amazed at the power of herbal medicines, then pretty much from that time on when is I started out in practice, I was actually into bodywork as a remedial and sports massage therapist. I worked really heavily with people like elite sports people, cyclists, triathletes as well as professional dancers and performers.
But I really felt the restrictions of not having, you know, that oral ingestive therapy as part of my arsenal. It started to feel very limiting. And that's really what led me down the path into nutritional and naturopathic medicine. And then I guess as far as how I got into fertility as a specialty as well, I was brought up by this powerhouse midwife of a mother. And she also went into IVF after midwifery. I've been surrounded by pregnancy, birth and had the time to also spend and the privilege to spend some time in IVF clinics and embryology labs and things like that. So that's what kind of got me to this area that I'm in today.
Jacqui Fahey (03:42):
Very interesting. Question for you. I've heard this term nutritional psychology. What is it and how might that help in fertility?
Katey Weekes (03:53):
Well, nutritional psychology really just looks at that connection of diet and nutrition and its relationship with behaviour and mental health or mental wellbeing. So really things like our nutritional choices can directly influence our headspace. And then that has both a direct and indirect on things like fertility, as well as other parts of health. So for example, macronutrients even, so protein it's essential for mental health and amino acids provided by protein makeup the building blocks required for everything, including the production and function of neurotransmitters and without sufficient protein, it's really an uphill battle to support things like depression and anxiety, and even just simple stress, particularly in the conception pregnancy and postnatal period. If people, you know, end up conceiving, it's a bit of a chasing a tail situation because there's so much nutritional demand during that time, so much growth. So it's something that really needs to be addressed early on.
And then also knowing that simple micronutrient deficiencies, things like vitamin D, which I think about up to 60% of Australians currently, from a large population study showed that 60% of Australians were actually insufficient in vitamin D which is amazing with the sun that we have access to. I think we don't know how to moderate that sun exposure very easily. Also B vitamins, magnesium, zinc. These will underpin the pathology associated with both subfertility and fertility, but also mental health disorders. So all these factors really greatly affect fertility. And that's just even from the ability to conceive, but all the way through to things like intergenerational mental health experiences as well.
Jacqui Fahey (05:38):
Wow. Gosh that's a journey, isn't it?
Katey Weekes (05:42):
Yeah. It can be quite heavy, but there's a lot that we can do. And that's the positive aspect.
Jacqui Fahey ()5:47):
Absolutely. So what's involved with supporting mental health in fertility and IVF and what's the importance of this?
Katey Weekes (05:55):
Well, I guess first and foremost, the lovely thing about nutritional medicine is that it's really suitable alongside things like fertility treatments. It doesn't seem to ruffle too many feathers. You know, doctors are quite happy for you to be using nutritional medicine. It doesn't have to be so much of a strong negotiation period. But we also see little to no side effects or interactions with nutritional medicine and IVF medications, if that's how they do end up going through their fertility journey, these patients. But we also see these nutritional prescriptions working really successfully to support the headspace of mental health as well as their patients and as well as the patient's fertility itself. So just to give you an idea of the mental health picture in Australia as far as the reproductive space goes, around 30 to 55% of assisted reproductive technology patients, so that could be IVF patients, report significant depression, and about 60 to 75% suffer from significant anxiety. So that's quite alarming numbers. When I saw those, I was like, well, it feels a little bit blown out, but you can see the tenacity that you need to go through. You know, the preconception period into conception, even if you're not in IVF care, you know, if it doesn't happen quickly, you start to realise how much anxiety and other mood shifts can happen in people. So it's quite prominent.
So there's also a lot of negative language unfortunately as part of this process, particularly in the IVF world. So you hear things like recurrent miscarriage, failed cycles, chemical pregnancies, incompetent cervix, it feels very personal, even though they're just medical terms, it really contributes to these patients' experiences. Yeah, it's really full on.
Katey Weekes (7:50):
So we also say things like a strong pattern where ART patients in particular naturally isolate away from their support networks even more and more over time. So every time they have a, a new cycle, if they need one, they seem to withdraw more and more. And that, can you imagine it's not always a couple of going into these processes either, what if you're single during this process, it's quite common for women or men or other forms of couples to be going through this process and not always the same support networks work for everyone. So that withdrawal is kind of hard. And it looks like around in Australia at the moment that 80% of those people are really showing that they turned to social media platforms in this community, and that's where they connect. And as you know, the information in this space isn't always vetted, you know, so it's good that they're with their community and they can bounce off each other and download. But the information that's, that's crossed in these platforms, isn't always solid and that can kind of contribute a lot to that, to their, to their experiences as well. So I've got a few other things, but I don't want to, I don't want to stop you if you want to go on.
Jacqui Fahey (09:02):
Yeah, no, no, thank you for sharing. I'm just, you know, as you're sharing, I could just imagine, you know, you mentioned the language that can be often used just how disheartening it would be if you unsuccessful and to, you know, to try again.
Katey Weekes (09:21):
Yeah. The tenacity of these people is just quite amazing. I am amazed at these people that do cycle on and off and have the energy and the head space to be able to do that. And so you see really commonly antidepressants and anxiolytic prescriptions during this time as well, to help people cope with that ongoing process. And then simple things in our world, like magnesium can really augment that medication and make it work better. So things like SSRI’s actually rely on magnesium because what they're trying to do is raise brain magnesium levels and inhibit that NMDA receptor. So it's okay to put the medication in. SSRI’s can be lifesaving in some circumstances but they only work 25 to 30% of the time and it's usually because of things like insufficient magnesium in the system.
Katey Weekes (10:11):
They deplete magnesium faster because that's how they work as well. So we need to be aware that we can work alongside these medications and actually help them work better and therefore improve things for the patient. Yeah. Serotonin as well, we need sufficient serotonin for SSRI’s don't we, you know, like it's not enough to just expose the synapse a bit more for a longer period of time to serotonin. You need a pool of serotonin and therefore you need that protein and amino acids and B6. So you can see how much our world really plays into even the success of standard prescriptions.
Jacqui Fahey (10:48):
So are there any key nutrients that are a must have in this space?
Katey Weekes (10:54):
We always tailor treatment to that individual, but there are some common choices that I guess, straddle both the fertility and mental health space. So things like magnesium we've touched on that as far as how it can help without prescriptions or people that are on prescriptions for SSRI’s and things like that. But it's also its synergy with a B complex and B5 in particular, we know is required for a healthy stress response. So even simple stress needs support, and those B’s really work together. So a B complex and magnesium have a beautiful synergistic effect. You have also other synergy happening between minerals and vitamins like the combination of zinc, magnesium and B6 is just beautiful because they happen to be the right limiting factors for ovulation, but also serotonin production. So that's a lovely trio. And we're talking around 25 to 30 milligrams of zinc a day, magnesium, we want at least 300 milligrams.
Sometimes we go upward of that as long as bowel tolerance is okay and B6 somewhere around 50 milligrams and that needs to include some P5P, not just straight pyridoxine hydrochloride. And if you can get straight P5P even better because we then minimize the potential for anything like our peripheral neuropathy, but basically having minerals like the zinc and magnesium in there in alkalizing forms as well. So citrate form, it's very, very alkalizing for the system, so that can help counteract the effects of things like high cortisol. High cortisol equals high glutamate essentially and so having that alkalizing state, whether it be from diet or whether it be from alkalizing minerals is a really beautiful way to kind of counteract that chronically high cortisol level that we see in stressed individuals. So that's just one kind of synergy moment of nutrients that I definitely use a lot of.
Katey Weekes (12:45):
I also use a lot of GABA support. So I might use more precursors and GABA mimetics. So thing like things like glycine as a direct precursor for GABA, it's really beautiful for supporting sleep, but it also supports the liver and detoxification, and it's very easy to give because it's naturally sweet, so people are very compliant on glycine and love it. Taurine is a GABA mimetic directly and that's again lovely for supporting detoxification, but obviously it has beautiful implications as well in in male reproductive health and sperm health. So taurine is good for both men and women, as well as the glycine. And then things like L-theanine. They kind of sit directly on those glutamate receptors and allow the glycine and GABA levels to naturally increase. And that works straight away, you know, that crosses the blood brain barrier I think within 20 to 30 minutes.
Katey Weekes (13:41):
So you have an immediate effect with things like L-theanine, and you can just take it on the days that you're feeling particularly anxious. So I use L-theanine a lot around embryo transfers or they're having collections done. Men are going to go give semen samples. It's all very anxiety producing, very situational anxiety. So think L-theanine when you think situational anxiety, cause you can use it as you need it. It's really beautiful. And then people say to me why not straight GABA? I certainly do sometimes, but there is this kind of small population group that seemed to get more anxious on GABA. And some of that is genetic. And some of that is the fact that when you take GABA orally, you've got to remember that it's still dissociates into molecules. And one of those is glutamate. The glycine, the taurine, the L-theanine don't do that. So there's no risk of creating anxiety with those kinds of precursors. Although, you know, GABA works in majority of people, it's that little bit of a backwards turn in some individuals. So I don't use it as frequently as I would the others. So yeah.
Jacqui Fahey (14:51): That's a beautiful symphony of nutrients you have shared. Thank you. And really good tip for the situational anxiety.
And so beyond our prescriptions, what other aspects of practice impact mental health of our fertility patients?
Katey Weekes (15:06):
I think, you know, some simple things that we can't underestimate are our availability and time that we afford these patients particularly IVF patients can feel very rushed through their processes onto the nurse. Like it's very system driven you know, seeing the doctor for this, seeing the nurse for that thing, you know, here's the medications off you go, like it's very rushed.
So we often are quite a good sounding board and a more nourished and relaxed and time forgiving environment for them to just take a breath and kind of download a bit more. The other thing that we're really great at beyond our prescriptions is working cohesively with other people. I find that naturopaths are actually quite wonderful at this. Because patients can feel very stuck between practitioners and we don't want to contribute to poor mental health.
We don't want them to feel more anxious about ‘oh, I've been to my naturopath and I'm now taking this’. You want to do that communication for them, you know. So to be able to say, here's a letter just to take to your physician, to let them know what you're on with my rationale and to let them know I'm fully available for them to speak to if they have any concerns.
You know, and even saying out loud, ‘I don't want you to feel like you're the go-between between me and your doctor. I'm quite happy to communicate for them, with them, for you’ but also finding people to refer to. I know we might talk about that in a bit, but we're really good at taking those people out and we'll talk to each other in the community. So we quite often have quite a few referrals to pick from to match our patients to so that's quite lovely.
I guess I can't go past a mental health discussion without pointing out the importance of the way we manage our language as part of our patient care. Like you pointed out. So we can have all these beautiful prescriptions that can be fabulous and sexy but they can have far less impact if we don't deliver that information with care and nurture. And most of the time I think we do. But I think in the fertility space, particularly when you start to see more and more patients, it's easy to be flippant about the way you deliver things and that each individual person sitting in front of you will need a slightly modified delivery. Some people can take ‘just give it to me straight, just tell me what's going on, tell me what you found’ and other people need that softened a little.
Katey Weekes (17:25):
So we need to be aware that it doesn't matter how great our prescription is, how scientifically we deliver that information to them. If we don't deliver it in a nice nurturing way, it can have less of an effect. So you can't underestimate that the power of that placebo effect and that has people and just like reflecting back on positive aspects of their case to kind of counterbalance all that negative language, you know, so where you can pull positives, and it's possible in every case to, to just say, these are the things that are going really well, you’re great, you're ovulating like a champion, you know, just pulling out some positive aspects, you know, it makes, it makes all the difference. Yeah.
Jacqui Fahey (18:04):
I could imagine. I mean, it's delicate, isn't it? It's such a critical point that you raise here. It's the language that we speak apart from, it's the part of the holistic approach, isn't it, you know, mentally, nutritionally, emotionally, spiritually how we're handling and looking after such a delicate, you know, journey.
Katey Weekes (18:25):
Yeah, absolutely. I think we know we want to match and meet the medical world as far as the technical terminology and understanding and interpretation of testing as we can, but then not just, you know, oocytes and sperm cells sitting in front of us, they’re people, and they're a result of their entire environment, you know, and quite often they have a lot of intuitive insight. We're not with them all day, every day. So we don't know what all those experiences are. So quite often checking in and asking them what they think about things can be so insightful. So yeah, they are a whole person, as you said, they're not just those reproductive organs and cells.
Jacqui Fahey (19:01):
Absolutely. And so in your clinical experience when is the timing right for mental health support that you might refer to a counsellor or whomever that you think your patient needs referring on for support?
Katey Weekes (19:17):
I guess the time is as soon as possible if that's what the patient needs, you know, so yeah, so like the preconception experience is directly reflective of things like perinatal and postnatal experiences. So achieving a pregnancy doesn't always mean that mental health experiences are all fine and just melt into a state of elation. But I think most of us actually think that's what's going to happen. But over time, those mental health issues start to re-emerge because things just normalise, ‘oh I'm pregnant’. Those things have melted away or maybe things come up in their pregnancy, you know, as far as their health goes or their baby's health goes. Not everything's ideal and perfect, certainly in most circumstances. So things like IBS systems, they already have, you know, these services or mental health support as part of their package.
But I think that from my witnessing so far in clinic is that that is highly underutilized. It tends to just flip straight into the crisis mode when that happens. So no matter the preconception situation, whether it's IVF or not, I think it's about checking in at each consult and asking about their headspace really thoroughly as part of a normal line of questioning. Let's just normalize it a bit more and not just, ‘how are you?’ maybe have that broken down into a few probing questions if it's appropriate, because this is how we appropriately provide our support and stay in tune with our scope of practice. We're really good at continuing to support their emotional health and encourage them to download with us. Because even carrying that energy around is really hard for them and sometimes a download can be a huge length. They walk out with like, ‘oh I just left that with someone else, I don't have to carry it’.
It's so nice for them, but we help patients identify their support options really well as well. So what's the best support for them, you know, are they aware that there's Medicare subsidised mental health support? as well as specific specialists. You don't have to go straight to a counsellor or a psychologist and pay for that. If you're under a lot of financial pressure from IVF processes, there's a lot of Medicare subsidised care to tap into. And then, like I mentioned before, we have a lot of vetted practitioners that we typically know other professionals can recommend for us in our networks. And that takes quite a bit of stress off patients as well having that that pool of people ready to kind of refer to might be acupuncture. It might be a counsellor.
It might be a specific grief counselor, you know, matching the type of counsellor is also important and matching the energy of the practitioner to the patient as well. You need a different range of people that will help click because not everyone suits everyone and that's completely fine. So we really also offer that patient centred care and we’re the gatherers of information, and we help them to make decisions when it's needed to. And we optimally we'd like to do that with our prescriptions, but also before those prescriptions aren't cutting the mustard. We don't do it when the prescriptions stopped working, we try and identify it earlier than that. Cause crisis can happen super quickly that can shift overnight in some people. And that's where psychotherapy has its absolute place and it can be lifesaving in circumstances, but let's try and catch it before it gets to there. Then our prescriptions, like we talked about before, augment psychiatric prescriptions, if that's what needs to happen, simple things like magnesium and fish oil.
Jacqui Fahey (22:51):
Yes. Well said. And a great point that you mentioned there with the Medicare subsidised support, if that's also needed. Thanks for sharing that. And so soon you'll be sharing and exploring or rather expanding further on nutritional psychology at the ATMS symposium coming up soon?
Katey Weekes (23:12):
Absolutely. Yeah. It'll be a big dive into how managing the mental health of fertility patients whether they be IVF patients or, you know, preconception patients not in that kind of care, how much of a difference it can make to one, their experiences, but also the ability to conceive. And I think that's something that we do really beautifully, as I said, there's you know, prescriptions kind of coming and just try and do one mechanism, but that's what part of the ATMS symposium discussion will involve.
Jacqui Fahey (23:50):
Oh, that sounds very interesting. Well, thank you Katey for your time today. We loved having you on Common Ground. Thank you for the little pearls of wisdom that you shared.
Katey Weekes (24:00):
My absolute pleasure. Thank you for having me.
Jacqui Fahey (24:01):
Thanks for tuning into this episode today. We appreciate your support and feel free to leave us a review. We'd love to hear from you. Thank you.