The Ultimate Guide to Women’s Nutrition: Hormones, Exercise, PMOS & Endo with Dr Hazel Wallace

Almost 80% of active women have never

received advice on how to properly fuel

their bodies for exercise. And so much

of the nutrition advice we're given

still isn't designed with women in mind.

So today I'm sitting down with Dr. Hazel

Wallace, former NHS doctor and

registered associate nutritionist to

understand how to eat as a woman, not a

man.

>> Most of the medical research we have is

based on male bodies.

>> We're talking about iron deficiency,

nutrition for POS or endometriosis, body

image, and so much more. After this

episode, you'll never fall for another

hormone balancing nutrition trend again.

But before we get into the episode, if

you could do one small thing that takes

two minutes, subscribe to the YouTube

channel or follow us on Spotify. It

allows us to keep bringing you episodes

for free to help you live a happier,

healthier life. Thank you, Dr. Hazel. I

am very, very, very excited to have you

on the podcast. And before we get into

nutrition for women, iron deficiency,

conditions like endometriosis, what I do

love to do before that is go into your

reasons behind where you are now. Do you

remember the moment you realized that

nutrition could have such an impact?

Yeah, I so my backstory is when I was

14, I lost my father to a stroke and

that was obviously a very pivotal part

of my life and despite being that young

I knew then that I wanted to go into

healthcare. I never thought about it

before. My dad was an accountant. So the

thought process was I would do something

similar and I think the experience you

know being in and out of the hospital

although it happened over quite a quick

period I thought this is something I

want to do and as I was doing placements

I was doing that during school to learn

more about cardiovascular disease and

really maybe got a bit obsessed with it

and started to understand that our

lifestyle really impacts the risk of

that. So, nutrition, exercise, stress,

all of these things. And so, I went into

med school thinking, I'm going to learn

about all these things. I'm going to

learn everything about nutrition. I'm

going to prevent so many deaths. And as

you know, I learned not very much, if at

all, at med school. So, in my first year

of med school, I set up a blog called

The Food Medic over 14 maybe 15 years

ago now. And I was basically trying to

take the research about how nutrition

impacts health, not just cardiovascular

disease, but other aspects of health and

share it in a really digestible way. And

Instagram was very new. Then I set up an

Instagram account. There was no

intention behind it. Like I didn't

influencers didn't exist or anything. I

just wanted to share what I was

learning. And it just grew really

quickly because I think

then there was a big boom in the

wellness industry with like lots of

wellness bloggers who were saying very

bizarre things. So I think the desire

for someone who was maybe grounded in

science was big. And so by my final year

of university I had two book deals and I

was just like wow this is huge.

Alongside working as a doctor, I then

did my master's in nutrition and worked

as a nutrition doctor for a little

while, which was interesting, but it was

a lot more clinical in terms of like

working with patients oncology, patients

going through surgery who required

parental nutrition and then co happened

and that was everything really

>> took its toll. Yeah.

>> Yeah. I think I was deployed from the

nutrition team onto a COVID team and

I

did that for a really long time. I would

say 18 months I was in some kind of

COVID specialty be that ward based

intensive care and then I did longco

follow-up. It was so intense and

intensive care follow-up. So I was

unable to escape it. Even when the

pandemic was kind of ending, I was still

within it. And it was actually during

COVID that I wrote my first women's

health book, The Female Factor, because

I had the plans to do it. And I think I

was living alone. So if I wasn't at

work, I needed something to do. And more

and more research was coming out around

that time about how most of the medical

research we have is based on male

bodies. And that was news for me because

I was like, we weren't told this at

medical school. That was quite enraging.

And even as a woman, I was thinking this

makes so much sense for how I was being

treated. And I was thinking checking my

own biases of how we treat women in the

hospital, especially during co and yeah,

so that was kind of like the pivot into

women's health and I guess now I merge

both of them. I practice as a

nutritionist, work exclusively with

women, and I write about women's health.

And I've somehow ebbed and flowed to get

to where I am, but it feels like a

really nice place. Yeah, it's

interesting you say it explains some of

what you were experiencing in healthcare

because whenever

I speak about injustices that may be

happen in women's health, there's always

some doctors who get enraged by a lot of

those post and see it as a bit of an

attack. It's always important to

recognize that two things can be true at

once. You can be critical of the

injustices that happen without

criticizing those individual

practitioners themselves. they have been

educated in a system that is broken, you

know,

>> and also recognizing that so many

>> female doctors have experienced these

injustices themselves. You know, we're

going to come on to your journey with

POS previously, PCOS, a little bit later

on.

>> But first, we've got a little game on

the podcast called Bye or bye-bye. There

is only one rule is that we love nuance

because there's not enough nuance on

social media. But I'm going to say

something and I would like to know

whether you would buy this thing or say

bye-bye. I do it. First on buy or

bye-bye is cycle tracking apps. By Yeah,

I'm a big fan of them. I think any way

you want to track your cycle is great if

it's a pen and paper. That works fine,

but I just think apps have made it so

much simpler for women to track their

cycles. And I think being cycle aware is

so important as a woman.

>> Cortisol cocktail.

>> I had to look this one up. And

[laughter] it's like a combination of

it's like orange juice, coconut water,

and what was the other one? Salt maybe.

>> Yeah.

>> Yeah.

>> And so, I mean, there's nothing there's

no evidence to back this up. I'm like,

who came up with this? It's an example

of how of course that's going to go

viral on social media and cortisol is

such a buzzword right now. Of course,

people are going to want to think that

this is going to solve their problems.

Like yes, there's a kernel of truth to

say that food can impact cortisol and

our eating habits in general. This

particular cocktail absolutely not. So

bye-bye from me.

>> It's difficult because the whole

cortisol conversation, I think it

creates a dichotomy of cortisol is bad,

which

>> isn't the case. Cortisol is is is bad.

It's what gets us out of bed every

morning. But

>> cortisol at high levels for an extended

period of time is associated with, you

know, negative outcomes. I think when

people say cortisol, they tend to mean

they tend to use it as synonymous with

stress.

>> If a woman is listening right now and

she's worried about her cortisol, what

would your advice be?

>> We don't want to get to a point where we

have low or no cortisol because it's

really important for so many processes,

including getting you up in the morning,

getting things done, and also driving

other important processes within your

body. But I understand that if you're

feeling like your cortisol is high and I

think to take what you've said there,

you're feeling stressed in your body.

Your lifestyle is a great place to look

at, but not just your nutrition. So

thinking about your sleep, thinking

about your phone habits, thinking about

your work boundaries. When it comes to

nutrition, like the most important thing

is the fact that you're eating enough

and eating regularly. if you're doing a

ton of exercise and you're not making

time for recovery, potentially impacting

your cortisol. So, it's really the load

of things within our lifestyle that

could impact our cortisol levels. And I

think also like it depends on what your

job is. We both worked as as doctors in

the NHS and it's almost impossible to

drive the cortisol away when that's your

job. if you're doing night shifts and

you're surviving off Red Bull. So,

within your control, think about those

things, you know, like it's it's the

same principles of a healthy lifestyle

and I think most of us know that it's

just about actually implementing them.

There's a trend at the moment where

you're sold a supplement to reduce your

cortisol,

>> but the conversation is rarely if your

boss is a prick and your partner doesn't

do anything around the house, that's

probably having more of an impact than

any supplement will, you know. Um, so I

think it's really important. Yeah.

Considering other factors in your

lifestyle, cortisol's become like a

scapegoat or like this catch all that

people are latching to or even companies

like are saying, you know, there's

something wrong with your cortisol. And

I see more and more people, not just

women, having their cortisol tested. And

you know, really, we should be testing

that first thing in the morning. I

remember going in as a junior doctor at

6:00 a.m. to have to do the cortisol

tests, but there'll be random cortisol

testing throughout the day that these

people are having done. It's just there.

It's not the right time to have it done.

It doesn't really mean very much. Also,

to have problems or issues with your

adrenals and cortisol is quite rare and

it's very specific and it should be

diagnosed by doctors. I think we're

probably just misusing the term and like

yeah, your lifestyle is probably

stressing you out and probably impacting

you on so many different physiological

levels, but maybe it's not cortisol.

>> Yeah. Yeah. Reducing stress is is never

a bad conversation, I think. Yeah. Next

on Bio Bye-Bye is cycle syncing. I'm

going to say bye-bye.

I always use the term cycle aare because

I don't want to disregard that there's

some impact of the menstrual cycle on

how you perform and recover and

exercise. But with the current evidence

pool that we have, it's very small. It's

very inconsistent. And I just don't

think we have enough to h like be giving

women prescriptive exercise programs

based on the week they're in in their

cycle.

You know, for most women and for most

programs, they also are very

conservative and they suggest that you

should be doing low intensity exercise

really most weeks apart from like around

ovulation where they say you do high

intensity. As women, we need to be

exercising more, especially doing

strength training. And I worry that if

we all fall into these patterns and we

start training in this way, we're going

to have this epidemic of osteoporosis

and lack of independence and all of the

risk factors that come with that. So I

think too often we're telling women what

they should do with their bodies, how

they should train, how they should eat,

blah blah blah. This is just another

example. And I think where there's a

lack of support, it's usually some form

of marketing will just wedge itself in

there and say, "You need to buy this

program and this will solve your

issues." And I think that's just what's

happening because the people who are

selling these programs are not

qualified. They are maybe listening to

some of the research and saying or

hearing that like kaching in their head

and then deciding this is a great

opportunity. For some women, they really

love training in a way that is in

keeping with their cycle. I feel my

worst in my leutil phase the week before

my period. And if I'm in a say a

training block for running, I might like

shift some of my runs to like later in

the week. I might turn down the

intensity, I might not do my speed work,

but then some months I actually feel

great. So, I'm not going to dictate what

I should do based on someone else's

program. I think it's important to know

your body, but I'm not a big fan of

these prescriptive programs.

>> You hit the nail on the head there with

know your body because I think more than

ever, we're looking for external sources

to tell us how we should feel. We're

more distracted than ever before. We're

losing touch with, okay, waking up and

thinking,

how do I feel right now? Like, I love my

wearables a lot, you know? I I love

looking at my data. However, there's

something to be said about that score

that you see on your phone shouldn't

mean more than how you feel when you

wake up one morning.

>> Yeah. Yeah. I agree with you. I think

for some people they can just take that

with a pinch of salt. For some people,

they need to take that as gospel, as

Bible, and they will live their life

like that. And I think when it comes to,

you know, training around your cycle,

it's not going to cause you any harm if

you exercise hard during your period or

in your lutil phase. It's not going to

do anything like that. And you know,

there's evidence to say that exercise is

beneficial for PMS and painful periods.

So, if anything, we want to encourage

exercising throughout the cycle, not

just, you know, in that one week. Celery

juice. Bye-bye. The caveat or kind of

exception to that is like if you enjoy

it, by all means. But if you're drinking

it thinking it's going to detox your

body, which is like probably the biggest

claim in the celery juice space, it's

not going to do that. like your your

liver, your kidneys, your body is doing

that in the background all the time. If

you need support with detoxification,

like you need to go to hospital.

>> Celery juice space is a [laughter]

is a group of words I didn't think I'd

ever hear.

>> Trust me, there is a space where of

celery juice fanatics. I find that um

sometimes my friends will show me like a

trend on social media and I'll think,

"Oh my god, my algorithm obviously

doesn't serve that stuff to me." Yes.

Because that's not the type of content

that I consume. But do you ever find

yourself on weird like wellness

>> Yeah.

>> spaces?

>> I would say it was probably 6 years ago

with the medical medium. He like

basically is the celery juice guru and

he just said like it cures everything.

And so I feel like at that time there

was a lot of like myth busting around

celery juice. But yeah, I think it's so

interesting when you like kind of find

these areas of the internet and you're

just like, "Wow, this is so interesting

to me." I feel like the celery juice

trend has kind of died down now. It's um

carrot juice, which is like on the rise

for skin health.

>> Yay. Final bye-bye. Hormone balancing.

>> Bye-bye. You can't balance your

hormones, unfortunately. like yes they

can be too high or too low but they're

constantly fluctuating. So I know that

terminology can be really accessible for

people but I think it's misleading and I

just really don't like how brands use it

in their marketing. So we are going to

come on to nutrition advice specifically

for women. First of all a big big topic

of conversation is iron deficiency and

you've recently done some brilliant

videos on iron boosting um meal

prepping. If anyone doesn't see Dr.

Hazel's meal prepping videos are

absolutely brilliant. Iron deficiency

may affect one in three women of

childbearing age worldwide. So, from a

nutritional perspective, what are the

best foods to eat if you're iron

deficient?

>> Yeah, I think it's this conversation is

so big on social right now and I I think

it's so important because

>> it is really robustly backed in

evidence.

>> It really is. And I think the other side

of the conversation is like if a woman

of tribe baron age is iron deficient in

the UK and I assume across most

healthare systems in the in the world we

don't panic because we're like oh you're

having periods that's why you're losing

your blood. If it's a man we're like

what is going on? Order every

investigation. We need to find out what

this is. We often like neglect women in

that regard. And even if it is heavy

periods what are we doing to sort out

the heavy periods? We're not just like

giving them supplement after supplement

after supplement. Like we need to look

into why they're having heavy periods

and if we don't have a reason, we can

still support that. So I love this

conversation and I think when it comes

to foods, obviously the the ones that

people know quite well will be your

animal based products. So like your red

meat, your poultry, your fish, but you

can get it from plant-based foods. So

your beans, legumes, green leafy veg, um

certain dried fruits like figs and

apricots.

>> Oh, really? Yeah.

>> Oh, that's a nice one. Actually, I do

like a dried um a dried fig. So, I'll be

adding that one

>> with kind of the kind of conversation

around animal versus plant-based. If you

don't want to consume animal-based

products, that's fine.

>> But if you're consuming a plantonly

diet, we want to consider the

absorption. So, the type of iron that is

in plant-based foods is less absorbable

compared to the iron that's in

animal-based foods. And we can support

that by adding animal-based products to

the meal. But if you're not doing that,

you can also add vitamin C to the meal

and it just helps with that absorption

process. Also things like if you're

having grains, making sure that they're

like soaked and cooked, that can also

help having teas and coffees and matcha

away from your meal because they have

things called tannins which can impact

absorption.

And um another thing for like active

people, if you're doing a lot of

highintensity exercise, your absorption

of iron can be reduced shortly after

exercise because basically the

inflammatory process. So what we want to

do is if you're taking iron supplements,

take them away from exercise. Uh I don't

think you really need to change your

meals too much in that regard. And the

final thing to say is calcium can impact

iron absorption. So if you're taking

those supplements, try take them apart.

So they're the main things. There are so

many foods that have iron in it. It's

just about getting enough in the diet

and you really need quite a varied diet

to get enough, especially if you're not

eating those animalbased products that

are quite high in hem iron. It's good

you spoke about active women. Is that

because they're hepsidoning or Yes. So,

another stat that I read about active

women was almost 80% of active women

have never received specific advice on

how to properly fuel their bodies for

exercise. And I was surprised it wasn't

higher, to be honest. You're a qualified

personal trainer yourself, but

>> I see a lot of personal trainers online

who

are advocating for 1,200

calorie meal plans. So, I was actually

really surprised it wasn't a higher

figure. What should women who are active

know about how to fuel themselves?

>> Yeah, I'm also surprised that it's not

higher. The most important thing is what

you've said is like having enough

energy, having enough calories. And I do

think that we very much underestimate as

women how many calories that we need,

especially if we're doing exercise. And

I think also what's not made clear to a

lot of people is that you're also just

using energy to live and to like have a

conversation, to think, to like turn the

page of a book and exercise is on top of

that. So on top of your daily needs, we

need to be accounting for that. So

making sure you're fueling enough. And

if you're someone who, I don't know,

goes to the gym three times a week and

then you suddenly decide, I'm going to

train for a half marathon, that's going

to increase your energy so much more.

And I think one of the biggest things I

see in practice is I see a woman come in

who's training for her first half

marathon or marathon and her periods

disappeared because she didn't realize

how much extra energy she needed, not

just during her training runs, but also

around and across the day. And I think

that that's really the biggest thing.

We're like under fueling and it's so

important because

not only will that impact your

performance and you'll see a plateau or

you'll drop off there. It might impact

things like your bone health and

fracture risk, your mood, your gut

health, and then more importantly your

menstrual cycle. So that's a really good

like report card to know if you're

feeling well. So, if your cycles are

regular and they're coming every month

and you're bleeding for 3 to 5 days and

they're not getting lighter and more

irregular, generally a good sign that

you're on track, it doesn't it's not a

perfect measure to say you're definitely

feeling well, but it's a really good

sign to look out for. Whereas, if you're

someone who is finding that your cycles

are all over the place or they've

disappeared because you've been

exercising more, that's like the number

one red flag that we want to look at.

But in addition to calories, like we

want to include all the macronutrients.

And I think when it comes to exercise,

like carbs are king and carbs are the

ones that are demonized so much. I think

like if you're someone trying to eat

healthy or maybe lose weight, like carbs

come out first. Even if you are those

people, like keep carbs in. They're so

important. You need carbs for most forms

of exercise, especially high intensity,

moderate to high intensity exercise. But

you also need like carbohydrates are

involved in thyroid hormone formation.

So we need to keep them in. And then

your protein so important for muscle

building and like h and even like your

hair, your skin and nails. So all of

those things and your healthy fats. So

we want to have all those nutrients. And

then as you've mentioned, iron is a

micronutrient that active women are most

at risk of because of all the things

that we spoke about before. So having

regular periods and bleeding that way.

But women in general tend to have lower

iron in their diets. And then if you are

exercising there are a few different

processes where you can lose iron.

There's something called like foot

strike hemolysis. So runners tend to

have low iron levels for that reason men

and women. A few things there. And then

calcium and vitamin D to protect bone

health. And again what I'm seeing is

like you know having dairy in your

diet's not super trendy. I think I feel

like it's kind of coming back, but if

you're not having dairy in your diet,

that's a really big contributor to

calcium in your diet. And so, we want to

make sure that you're having uh plant

fortified alternatives. Now, if you're

having oat or dair or soya or coconut,

whatever it might be, not all those

alternatives are fortified, so check the

label. Usually, the organic versions

aren't. And I think that that's what

catches people out. Thinking about those

micronutrients and even small

deficiencies can really impact your

performance, especially when it comes to

iron levels and feritin. So if you are

an active woman and you're feeling like

you're super lethargic, you're not

really doing very well in your workouts,

you're not sleeping well, go get your

iron levels checked. Yeah. and check

what reference ranges they're using as

well because there's still so many

doctors who will say if it's less than

30 but some doctors still we will only

recognize it if it's a less than 15.

>> Wow. Cuz it's in it's in our guidance

for 30.

>> Yeah.

>> But Yeah. Wow. There was a lot of

comments I posted about it recently with

people saying that even still they

weren't recognizing it and because I

guess if their systems aren't aren't

being update like the IT systems aren't

being updated with the guidance and it's

still only flagging up as red if it's

less than 15 then yes very important

point about the fortified milks because

obviously there's a big rise in

conversations around ultressed foods.

You've done many marathons,

>> brilliant cracking times on your

marathons. And when you train, you'll

show a a white bagel with jam on.

>> Yeah.

>> Now, that might be surprising to some

people why you as a nutritionist would

post about a white bagel with jam on.

>> Could you explain why that is a decision

that you make as a as a nutritionist?

>> I get that question and also the fact

that I have PMOS. People are like, "Oh

my god, you're having white carbs." It's

like, "Why?" And I think the the thing

is like healthy eating advice is a

little bit different to sports nutrition

advice. So, when we're exercising, as

I've mentioned, we need carbohydrates.

And if you're about to go out on a run

or you're during your run, you want fast

acting carbs. So, you don't want any

fiber in there. And that's why I'm

having the white version versus a whole

grain version. And also, I'm adding more

sugar to it by having jam on there as

well because that's what's going to fuel

my runs, protect my health, protect my

hormones while I'm running. And also,

that energy is going to be used up in

exercise. I'm not just kind of sitting

down at my desk. The kind of process

side of things is I could probably go

and make that bagel myself. Can I be

bothered? No. And so I'm willing to

accept that there are some processed

foods in my diet. Understanding the fact

that 80% of my diet is not processed and

I'm cooking from scratch. Cuz I think

when it comes to nutrition, we need to

think about like what's practical,

what's within our budget, what's

actually realistic and what's necessary.

Like is it necessary that I cook

everything from scratch and I go

completely zero unprocessed? Probably

not. Like not for me. And if you want to

do that and you have the time and you

enjoy doing that, like amazing because

you'll get lots of great nutrition in

it. For me, that would probably cause me

more stress. I wouldn't stick to it and

then I'd probably go swing the other way

and eat more processed foods. So, I

think like when it comes to that

conversation, sometimes it can be very

privileged and just completely forget

about like the nuance in the situation.

If you asked me this maybe 10 years ago

when I first like came into the

nutrition space, I probably would have

been the person that was like, "No, no

processed foods at all." But I think

with time, with like clinical

experience, you realize that's just not

practical. And also, it's just not

necessary.

>> Yeah. And with say the milks, if if

they're falsified, then they would be

classed as ultrarocessed. In that

situation, they are healthier as

ultrarocessed. So the emerging evidence

on ultrarocessed foods is it's an

important conversation to have. It

really swings from one one end of the

spectrum to the next quite quickly and

it's very important to hold that that

middle ground and it's we're living real

lives as well.

>> Yeah, that's it. And I think you always

always need to see the context. Like if

I was doing a what I eat in a day in a

in like a standard working day, I

wouldn't be having a bagel and jam.

Maybe I'll be having a bagel, but

probably with eggs and avocados, so it

keeps me full for the day. And I think

people forget that context. And around

the ultrarocessed conversation there, I

do feel like we we miss that. And like

I've had, you know, type 1 diabetics say

like, I have to have Haribo if I'm

having like a low. And so now I feel bad

that I'm doing that. Like I think so

many people have different needs. And

yes, we know that consuming a lot of

ultrarocessed foods in your diet is

going to be harmful for health over

time. Having the small amount every now

and then in a diet that is otherwise

healthy, in a lifestyle that's otherwise

healthy, is not going to do any harm. If

you're feeling the winter skin scaries,

then here's a reminder of my dry skin

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Slast repair balm which I'm sure you've

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ultra repairing thick smoothing cream

that helps repair the skin barrier and

is enriched with 5% vitamin B5 or

panthanol. It speeds up the natural

recovery process of damaged skin. I use

it for two main things. One to help with

dry and irritated skin and two any

scarring on the skin. I'll pop some

links in the notes so you can try it out

for yourself. Before we come on to your

journey with POS and how you eat for POS

or how you advise your clients to eat

for POS, we're going to come on to a

very topical conversation that can be

quite controversial and that is GRP

ones. And I I am by no means anti-GP1s.

I think they're a miracle for so many

people, but they've undoubtedly

contributed to the rise in skinny

culture coming back. What impact have

you personally seen on GRP1's impacting

the way that women fuel their bodies?

>> I agree with you. I think um for certain

clinical populations, people who are

living with obesity and people with type

2 diabetes, GLP1s have been absolutely

revolutionary for most people in that

who have tried it, not for all people.

But the issue is like you can now get it

on a private prescription. You don't

need to meet that criteria. You can get

it on the black market. you can fake

what your BMI is, what your weight is.

And so it's now available to people who

do not need it, who maybe are using it

to lose a few pounds for a wedding or

just be a smaller dress size or whatever

it might be pressure from online. And

we're seeing people who don't need to

take it dropping to very low body

weights. with that you have, you know,

risks of your bone health, your muscle

health, hair loss, iron deficiencies,

other nutrient deficiencies because what

it's causing essentially is suppressing

your appetite. So you take, you know,

you consume less calories, but you also

consume less nutrients.

And with these people, they just don't

really feel that hungry that their

desire to eat is so low that it's very

hard to motivate them to get the

nutrients in. And even if you're someone

who's very well educated on nutrition,

you'd have to work very hard to meet

your nutritional needs. So I think the

biggest issue is the nutrient

deficiencies, potential risk to bone

health, muscle health, and also we're

seeing like in certain people like a

drive in eating disorder behaviors or it

respsparking those tendencies if you've

had it before.

We can't like forget that these are like

injectable medications. Yes, you can get

some oral versions now, but any

medication comes with a a risk. And it

just feels like so many people are

taking it without being fully

counseledled or followed up. 95% of

prescriptions in the UK are private. So

only 5% come from the NHS. We don't know

how many people are taking it on the

black market, but in the UK, to our

knowledge, 2 million people are taking a

GLP1. that's just going to grow. You

know, in this skinny epidemic, pandemic,

whatever you want to call it, we already

have these girls um and women who are

consuming very low amount of calories.

In 10 years time, we are going to have

osteoporosis as a huge issue. But also,

you know, lack of independence, falls,

hip fractures, and then you know what

that comes with that like hospital

stays, hospital acquired pneumonia, blah

blah blah. I think the pursuit of

thinness is going to mean that people

are sacrificing their health.

>> I went to the gym with um one of my

friends who's an orthopedic reg last

night and we were having this

conversation because the data for GLP1s

on groups where it's not indicated. So

I'm not like what you said not not those

with obesity not with those with type

two diabetes but on those who are in

normal body weight. We don't have enough

data on those populations. We don't have

data for what happens in 10 years time.

But she was saying that she has seen an

alarming amount of young women who have

come in with fractured hips. And that

is, you know, stereotypically as

doctors, a fractured hip is the

condition you see in an elderly woman,

not someone you see in a a premenopausal

woman.

>> Yeah.

>> Just really remember to fuel yourselves.

Really, really, really remember to fuel

yourself. So many of us have seen an

elderly relative go through that, a

grandma, an older aunt, a auntie

fracture a hip, and then they might have

carers. Then they might go into a care

home and it starts that steady, you

know, decline. Around your 20s is when

you hit your peak bone density. You

can't add more, but you can slow down

how quickly that declines.

>> Yeah. Strength training, eating your

calcium, eating enough food. Actually,

the most impactful thing you can do to

protect your bones is to eat enough.

>> I think that's a really, really, really

important important message. Coming on

to your journey with PMOS, what were the

signs that you had and what was getting

a diagnosis like for you?

>> It was 2018 when I got my diagnosis. So,

I was like 2 years into working as a

doctor at that point and I had 2 years

of symptoms. So, I'd been to my GP

because my cycles were a regular and I

was told that it was stress from working

night shifts

and I had acne, really bad acne for the

first time. I didn't really have it as a

teenager. Maybe like a bit of back acne,

but nothing terrible. Hair loss. All of

this was attributed to the stress that I

was experiencing. I spoke to a friend

from another hospital who is now an

Obsson consultant and she was just like,

"You need to push for this diagnosis

because like this is absolutely what's

happening." And the reason the GP didn't

do any of the screening tests was

because I didn't fit the picture of POS.

And I think I don't know how you were

taught about POS when you were in med

school, but I was told that all the

women are fat and hairy. And they're the

words that they use as well, which is

just so terrible. There's a really bad

slang name. It's a horrible way to

describe women with POS. It's like fat.

>> Is it fat? Something in 40.

>> Oh, that's another one. That's for

kolistasis as well. It's like Bratz and

for ops and gs and gy. There's

some awful ones.

>> Um, so you didn't fit the stereotypical

picture. Yeah,

>> that's it. That my GP did a blood test

then and I had high testosterone. So I

was referred to gynecology and I had an

ultrasound and I had polycystic ovaries

on the scan and it was a male

gynecologist and he just said, "Well,

you're not overweight so you don't need

to lose weight, but just cut the carbs

and come back when you want to get

pregnant." like literal words burned

into my brain. He never asked me about

my diet and I just felt so

well what am I supposed to do myself?

It's so so so wild how that response is

so copy and paste. How many other women

experience that the comeback when you

want to get pregnant? I don't know why

every single person seems to get that

when they get a POS diagnosis is wild

and either lose weight or you don't have

to lose weight. It's it's just always

focused on weight and focused on

fertility, which is why it's so great, I

guess, that we've renamed it from PCOS

to PMOS because we're now looking at

other things. And like it's in our

guidance that women like prior to the

change that women with POS should be

having regular annual screens or well on

diagnosis, you should be having your

risk factors for type 2 diabetes and

cardiovascular disease assessed. So,

we're doing like HBA1C, we're checking

your cholesterol, blood pressure, asking

about family history, all of that. That

should happen at diagnosis. That never

happens. Now, you know, there's new

guidance coming in. I think it should

come out in later this year. It's in

draft guidance right now to say that

should happen every year. If it's not

happening at all, like I'm interested to

see how this is going going to happen

and change, but I think like for me that

never happened. My father died from

cardiovascular disease. He has type two

diabetes. It's in my family. Like I

could be walking around with that. I've

gone and had mine checked and I'm really

on it with my GP. I'm like every year we

need to check and I'm always on it with

my clients as well. But it's so

interesting how that's kind of hidden in

the guidance and no one's really doing

that. I'm a bit of a cynic if I'm being

completely honest with a lot of the the

attention women's health gets at the

moment, especially from the government

because I think it's one thing putting

it in guidance, it's another thing.

>> Yeah. and getting the buy in from

clinicians like if you're not starting

at the route where medical school where

you're making sure that women's health

is being taught correctly. There's a

stat I'm going to have to fact check um

we'll cite it we'll site in in the

episode anyway but uh a review of all

the papers all the main women's health

journals I think it was 60% of the

articles if not more were just relating

to reproduction.

It wasn't looking as women, you know,

how many how many years of our life do

we spend reproducing? Obviously,

reproduction is a huge part of women's

health,

>> but it's not everything. Women have to

live their lives. And that is reflected

in the way that women with

endometriosis, women with PMOS are told

to come back

>> when they want a kid. Okay. What about

all the other years that I am living

with this condition and all the other

years that my lining isn't being shed?

Yeah. And you know, so this gynecologist

>> told you to cut the carbs.

>> Yeah.

>> How does that differ from the advice

that you give your clients?

>> So I will say that there is like some

research around a very low carb diet or

a ketogenic diet. And now we have like,

you know, a modest amount of research

looking at different amounts of

carbohydrates in the diet and how that

impacts POS. It doesn't seem to be

superior if you have like low versus

moderate carb in your diet. And actually

when you look at the amount of

carbohydrates in the diet for a low carb

study, it's actually not too low. So

it's not like ketogenic where it's like

completely out. So the reason why that

recommendation exists is because a huge

percentage,

we think about 80% of women with PMOS,

regardless of body size, have an element

of insulin resistance. And so if

insulin, you know, is driven by having

carbohydrates, it makes sense that we'd

reduce that in the diet. And it seems

that the amount of carbohydrates matters

less to the type of carbohydrates. So

the glycemic index of carbohydrates. And

glycemic index just means how much a

carbohydrate will increase or spike your

glucose to use lack of a better word.

And so low glycemic carbs don't cause

that high spike or they don't cause that

prolonged spike. They give you kind of

slowreleasing energy. Whereas like a

high glycemic carbohydrate, think Haribo

for example,

>> or your bagel in your jam,

>> or your bagel in your jam, give you a

fast releasing in carbohydrates or

energy, which is great if you're about

to do a run, but if you're doing that

across the day many, many times, you're

getting big energy spikes, big energy

crashes. So by having high fiber carbs,

so things like oats, quinoa, beans,

barley, your whole grains, you're having

a slower release of energy. But if we

also pair them with protein, fat, and

fiber from veg, and things like that, we

slow that down even further. So that's

really the principles of like what I

speak to women about. And then we're

just looking at overall nutrient quality

because POS, endometriosis, they're both

very inflammatory conditions. So, we

just try to get as much color in there,

as much like vegetables, nuts and seeds,

herbs and spices, oily fish, because

it's rich in omega-3s, and less of the

processed foods. But, you know, I think

with myself and with women I'm working

with, there's no demonization of like

you can't have a white carb or you can't

have a glass of wine. I think again,

we're looking at 80% of the time versus

what we're doing 20% of the time. And

food's not the only thing. Like exercise

is incredibly important. supplementation

in the right people with you know clear

guidance from from someone who is

personalized sleep stress all of those

come into the picture of POS and it can

be so transformational like now this is

what I do all the time because I'm like

it's amazing the impact of nutrition on

your symptoms

especially for POS I can't say that for

all women's health conditions but

because it's so tied to our nutrition

and nutrition respon responses. They can

really impact things.

>> You mentioned supplements. What sort of

supplements do you recommend for your

PMSOS goalies?

>> I am a big fan of anositol. I know that

it's like rinsed and repeated, but it

does have good research behind it. The

caveat to this is all of the supplement

brands have caught on to this and

they're just bringing out like

run-of-the-mill inositol, not at the

right dose, not always at the right

formulation. What you want to look for

is either myionositol on its own or

myionositol in combination with

dyroinositol

and the dose is two 2 to four grams a

day and generally I recommend four grams

a day which is a lot of supplements so

they are hefty pills to swallow and it's

split two in the morning two in the

evening I often see women who have maybe

picked it up online from like you know a

popular women's health supplement brand

or something and it will have like tiny

tiny amounts of anositol and I'm like

you're just wasting your time because

that's not what the research is based on

and we don't really see meaningful

results. Now not everyone gets great

results with anositol give it 3 months

if it doesn't work it doesn't impact you

in any way then get rid of it. The

biggest changes I see in people is their

cycle length begins to get shorter.

That's the big one. And then the rest

really depends on what your diet is.

Vitamin D and omega-3 are like two that

I generally will consider it for people.

vitamin D in all people at this time of

the year because we're we live in the

UK, we just don't get enough sunlight

and most of us are vitamin D deficient

anyway. So, get on that from October

onwards and I will make sure everyone's

taking that. And then omega-3,

depending on how much oily fish you have

in your diet. I like you for people to

be having two portions a week. It's

really tricky because if you're, you

know, a a woman, we say like have two

portions but no more, but have exactly

two [laughter]

to get like the amount of omega-3, but

if you're having lots of oily fish, you

could increase the amount of mercury

you're taking in. So, an omega-3

supplement. And then everything else

really depends on, you know, your goals.

So, if someone's like trying to

conceive, we'll add in folic acid. If

someone is vegan, we'll be looking at,

you know, vitamin B12, iron, other

nutrients. So, it is very specific,

which is why like I'm not, you know, a

huge fan of these like multi-formulation

powders that people sell because you're

likely going to be taking ingredients

you don't need. And supplements aren't

regulated like medicines. They're

regulated like food and no one's really

checking how safe and effective they

are.

>> Very thorough answer. And I was going to

mention the mercury thing because

whenever we we mention oily fish, it's

always

>> people mention that.

>> Yeah. They're like, "What about the

mercury?" Yeah. So that's a a nice clear

clear clear one.

>> Now what about endometriosis? You did a

brilliant video for an endometriosis

meal prep. What what sort of advice are

we giving for for those Gayies?

>> Yeah. So I think with endometriosis

um it's a little bit different to PMOS

and I would say it's probably less

transformational when it comes to food,

but food can impact your symptoms. And

so we know for example like a

Mediterranean style diet has been shown

to reduce endometriosis related pain

which is really great. Again like

Mediterranean diet we talk about all the

time but for context it's like a diet

that is minimally processed. So largely

whole foods your oily fish your fruit

and vegetables your nuts and seeds

moderate amounts of dairy and poultry

and less red and processed meats. And so

while we talk about it as like

Mediterranean diet, you can adapt it to

other cultures. Just like keeping those

principles in mind and a few other

things when it comes to endometriosis, I

do like to check vitamin D levels for

that as well because often times vitamin

D levels are low in endometriosis.

Again, chicken and egg scenario, but

it's something that we want to make sure

you're getting enough in. The other

thing that comes up is low FODMAP diet

and IBS. So there's a big overlap with

IBS and endometriosis

and a lot of women with endometriosis

have IBS but also oftentimes you can be

misdiagnosed with IBS when really you

have endometriosis. So it's something

that we really need to be careful on. So

in those people a low FODMAP diet which

is used in IBS can be helpful for

managing symptoms. Even if you don't

have IBS, sometimes a low FODMAP diet

will be trled for if you have bowel

related endometriosis symptoms because

when we think about it like your womb

and your bowel are like so close

together. So if one thing's happening in

one of the organs, it can impact the

other. And there are dietitians who work

especially with women in those

situations. So I definitely think if

you're struggling, you know, get support

because nutrition can really help. So

that's kind of one of the main things

there. And with any of these conditions

like we just want to make sure that you

don't have any nutrient deficiencies

that could potentially be impacting your

symptoms. So iron again if you have

endometriosis and you've got heavy

periods iron something we want to be

checking or adnomiiosis which is

similar. We've got a couple of community

questions before we come on to the

section real or real where I'm going to

show you a social media clip and then

ask for your opinion on it. First

community question is what are the best

foods to incorporate for necessary

nutrition on a budget?

So, I think I'm a big fan of frozen

fruit and veg. A big misconception is

that like if it's in the frozen section,

it's not as healthy, but actually it can

be more nutritionally beneficial because

it's picked and frozen at source. So,

lean on that. Also a big fan of like

tinned beans and legumes and lentils cuz

they're so cheap. You can buy them dry

as well, but they require a bit more

work and they're high in protein and

great. Eggs are really versatile,

relatively cheap, although they've gone

up a little bit. And you know, like nut

butter is a great way to get in healthy

fat. You know, enjoyment to a meal as

well. Enjoy.

>> Yeah, enjoyment. Next community question

is, "How much should I be eating before

working out?"

>> Uh, it depends. So, I'm a big fan of

eating something before you work out. I

think if it's 30 to 60 minutes before,

no one's expecting you to have a big

meal. But have a carb based snack. As we

talked about, carbs are king. So, like a

crumpet and honey is like my go-to or

like a banana, a little flapjack bar, a

piece of malt loaf, a handful of dried

fruit, like dates, all really good

examples. Even a glass of orange juice

is, you know, a great carbohydrate to

have before you go out. If you have a

bit more time and you're doing a bigger

workout, so I'm thinking about like

girls on longer runs, high rocks

workouts, going to a class, maybe not

having breakfast for a bit, then we want

like something like a bagel and banana

or bagel and jam, toast and peanut

butter, a small bowl of porridge or

overnight oats. making carbs the focus,

less fat and fiber because that will

slow down your digestion and that will

make you feel sick when you're

exercising and you just don't need those

nutrients before you're exercising but

afterwards get them in. Side note, the

way you say banana is just absolutely

brilliant. I could listen to you say

banana all day. Banana. Banana. Like

it's just oh it sounds so musical. It's

beautiful. Before I forget, we need to

talk about high intensity workouts

because they get a lot of demonization

and you're going to have to myth myth

bust this for me. But my initial

reaction to that is I just don't like

any fearongering around exercise. I

think we all most of us spend our days

at desks. A lot of us have busy busy

busy stressful lives. If you have kids,

if the exercise you can get in is a

20-minute hit, I don't think that we

should be demonizing that 20 minute hit

workout. What's your perspective as a

woman with POS where it is often

demonized?

>> Yeah, I think highintensity exercise for

all women's demonized, but especially in

the POS space. And what we know from the

research is actually there's good

evidence to say that highintensity

exercise is beneficial for PMOS. And

people don't believe me when I say that,

but that is what the research says.

Well, the the research says there's no

superior form of exercise for POS, but

actually there's lots of benefits to

highintensity exercise. Now, the caveat

to that is if you're doing a ton of

highintensity exercise, you're not

taking rest days, you're not fueling

your workouts, you have a really

stressful job, you're not really

sleeping, your kind of load of stress in

your body is going to be high, and you

could run the risk of like impacting

your hormones and your cycle. In that

regard, I think, yeah, we don't want to

be doing high intensity every day. It's

also not necessary, but

>> or enjoyable.

>> Hit every day. It can be a bit

>> it can be a bit intense. So, I think no,

you don't need to cut it out. You don't

need to just do low intensity because

you need to protect your hormones. It's

fine to do high intensity, but it's just

that like recovery piece and the fueling

piece that's really important. So, it's

a myth that needs to die, but it's also

weird that it hasn't died when there's

so much

>> other research to the contrary. Like,

let's stop blaming exercise and start

blaming the pressure on women to starve

themselves while doing it. Because I

think like what you said over exercising

and under fueling it's probably why a

lot of women who've done high intensity

exercise have felt potentially felt

worse afterwards and that's where this

myth has come from.

>> Yeah.

>> But I think it's important to ask Yeah.

were you doing a hit every day and were

you fueling yourself adequately for that

that hit?

>> When I was diagnosed with POS I was

doing a I would you go to CrossFit

before work which was wild. It was like

a 5:30 class and then go on a surgical

ward round. But I would do that fasted

and I would take a noco, which is like a

really high caffeinated drink and then

I'd probably not eat until lunchtime. So

like I don't think it was the exercise

that I was doing and then I'd be like so

stressed going be in a stressful job all

day. Whereas like now I'm still doing

high intensity exercise. I'm running but

I also go to the gym and do low

intensity weights. I sometimes go to

Pilates. I sometimes take a rest day or

walk my dog. It's like the balance and I

see that even with my own clients of

some who have POS and really great

results and they do loads of

highintensity exercise. I have some

women who just don't want to do that cuz

they feel like my job in my life's

already stressful enough and like I

don't want to do workouts that don't

make me feel good and I'm like well

that's a perfect reason not to do it but

like if it's coming from a place of like

the internet told me not to then like we

need to question that 100%. Just before

the final question that we ask all the

guests, I'm going to show you a video

because this is the section called real

or not real and I would like to know

your opinions on this.

>> How can we stop our periods from being

so heavy? Seed cycling is a really great

old naturopathic remedy of way of

balancing hormones. It's in the first

half your cycle. So hopefully everyone

>> has got the flow app or or they know

where they are in their cycle. So for

the first half of your cycle, you're

going to eat pumpkin seeds and flax

seeds. They need to be ground. So a

tablespoon of each.

>> So get yourself a little coffee grinder

if you can or or buy them preggroundown,

but do keep them in the freezer because

freshly ground because ground seeds can

go rancid. Flax seeds and pumpkin seeds

first half of your cycle. And then

sesame seeds and sunflower seeds, a

tablespoon of each ground in the second

half of your cycle. What this can do,

it's really powerful actually. It can

help regulate cycles, help with heavy

periods, help detox that estrogen,

particularly the ground flax seeds can

do that. And you just keep doing it like

that around your cycle. It's called seed

cycling.

>> That's genius.

>> I It is genius.

>> That is like what a wonderful tip for

girls to have that like why is no one

talking about this?

>> I don't know. I am

>> real or not real thoughts and feelings.

Oh, I hate offending. I don't want to

offend anyone. I will say not real in

terms of there's not enough evidence to

say that seed cycling is going to impact

the things that this lady has said in

terms of like balancing your hormones

and reducing heavy periods I think was

one of the claims. Now we know that

seeds have lots of healthy

micronutrients in them. So things like

magnesium and selenium and zinc that do

impact our cycles and our hormones. So

absolutely keep them in your diet. But

the rotation of seeds through specific

weeks, no, we don't have enough evidence

to say that that's going to impact

things. And for a lot of people, that is

again not very practical. It's quite

stressful. And I just think that's the

reason why we're not talking about it

because actually we we don't have

evidence to say that. Now, the reason

I'm like I don't want to insult anyone.

If you're doing it and you enjoy it,

like by all means, you're not going to

harm anyone by doing it. And I have

women sometimes come to me when I speak

about this and say, "Well, I've done it

and it's worked for me." And if that's

worked for you, amazing. But I'm not

going to sit here as someone who claims

to be evidence-based and say, "This is

something all women should do." When

actually I'm really not convinced. Seeds

are absolutely brilliant. So consider

they were demonized a lot by skinny

culture, calorie counting maybe like 10,

15 years ago. It took me personally a

long time to undo my fear of seeds.

Really?

>> Yeah. I remember I vividly remember I

think when I was doing Sikthorm personal

trainers would come on Instagram and

they would do they would say this is a

Mars bar. This is a handful of seeds.

This handful of seeds has more calories.

And then um or they'd go this is um

Nutella on white bread and this is

peanut butter on whole grain bread. The

real calories in versus calories out

movement.

>> So toxic. It was only through doing this

podcast when every single nutritionist

that comes on seeds, nuts, seeds, nuts.

There are much worse trends for women's

health on on social media than seed

cycling. But the added burden, I can't

imagine waking up going, "Oh, no, I

can't have pumpkin seeds today." You

know?

>> Yeah. No, I completely agree with you.

And I think I feel like we're over

complicating women's health there. And

it's great to be having these

conversations, but we just need to make

sure we're giving women the right

information and not like going down a

rabbit hole and like not speaking to

your doctor because someone told you in

the internet that if you seed cycle,

it's going to solve your bad periods.

Like yeah, I think that's where I kind

of like get a little bit fed up and

think not great advice.

>> Damage can be done through added stress,

added mental load as well as if

something isn't evidence-based. I'm very

sad because that brings us to the final

question of the podcast.

>> Amazing.

>> Dr. Hazel, what do you wish every woman

knew by the time she was 25?

>> That your menstrual cycle is a monthly

report card. So like start paying

attention to it and understanding your

own kind of like patterns, what's good

for you, what's normal for you, so that

you know when something goes wrong.

>> Gorgeous. Well, thank you so so so much

for coming on and we will leave the link

for your most recent book, Not Just

Period, in the description if anyone

would like to have a look. Thank you.