Speaker A
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.
Dr Faye Bate interviews Dr Hazel Wallace on women's nutrition, hormones, iron deficiency, PCOS, endometriosis, and debunking wellness trends like the cortisol cocktail.
Key Takeaways
- Women's nutrition needs are underresearched and often ignored in standard advice; women should seek individualised guidance.
- Viral wellness trends like the cortisol cocktail lack scientific support; evidence-based, lifestyle-focused approaches are more reliable.
- Adequate energy intake and regular eating are foundational for hormonal health, recovery, and preventing iron deficiency.
- Dietary patterns like the Mediterranean diet can help manage conditions such as endometriosis, while PCOS management may involve specific supplements at evidence-based doses.
- Healthcare systems can be biased against women, and recognising systemic issues need not mean blaming individual clinicians.
What the video covers
- Most nutrition and medical research has historically been based on male bodies, leaving women's specific needs under-addressed.
- Dr Hazel Wallace's path: losing her father at 14 inspired a medical career; she later blogged and built an audience on evidence-based nutrition while training as a doctor and nutritionist.
- Her first women's health book, The Female Factor, was written during the COVID-19 pandemic, prompted by research showing medical trials are male-dominated.
- Cycle tracking apps are endorsed as a useful way to become cycle-aware, while the viral 'cortisol cocktail' is dismissed as lacking evidence.
- Cortisol is essential for daily function; concern should focus on chronic stress and lifestyle factors such as sleep, boundaries, and adequate eating rather than supplements.
- Iron deficiency is common among women of reproductive age, and women often underestimate the calories they need, especially when active.
- Calcium intake, including dairy, matters, and practical, budget-friendly nutrition is emphasised.
- For PCOS, myo-inositol (sometimes with D-chiro-inositol) at 2–4 g daily is discussed, with caution about product formulation and dosage.
- A Mediterranean-style, minimally processed diet has been shown to reduce endometriosis-related pain.
- Pre-workout fueling with easily digested carbohydrates, and attention to energy availability, are emphasised for active women; seed cycling lacks sufficient evidence.
Chapters
- 00:00Introduction: Women's Nutrition Gaps
- 01:18Dr Hazel's Journey into Nutrition and Women's Health
- 06:18Buy or Bye-Bye: Cycle Apps and Cortisol Trends
- 09:37Cortisol, Stress, and Lifestyle Factors
- 15:28Iron Deficiency and Energy Needs
- 20:29Calcium, Dairy, and Practical Nutrition
- 26:59GLP-1 Medications and Women's Health
- 33:29PCOS: Diet, Carbohydrates, and Inositol
- 42:57Endometriosis and the Mediterranean Diet
- 54:54Fueling Exercise and Seed Cycling
Full Transcript — Download SRT & Markdown
Speaker A
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.
Speaker A
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.
Speaker A
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,
Speaker A
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
Speaker A
reasons behind where you are now. Do you remember the moment you realized that nutrition could have such an impact?
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
going through surgery who required parental nutrition and then co happened and that was everything really took its toll. Yeah.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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,
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
such a buzzword right now. Of course, people are going to want to think that this is going to solve their problems.
Speaker A
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.
Speaker A
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.
Speaker A
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
Speaker A
stress. If a woman is listening right now and she's worried about her cortisol, what would your advice be?
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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.
Speaker A
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.
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker 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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
that you see on your phone shouldn't mean more than how you feel when you wake up one morning.
Speaker A
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,
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
that in the background all the time. If you need support with detoxification, like you need to go to hospital.
Speaker A
Celery juice space is a [laughter] is a group of words I didn't think I'd ever hear.
Speaker A
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.
Speaker A
Because that's not the type of content that I consume. But do you ever find yourself on weird like wellness Yeah.
Speaker A
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.
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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,
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
really surprised it wasn't a higher figure. What should women who are active know about how to fuel themselves?
Speaker A
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,
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
30 but some doctors still we will only recognize it if it's a less than 15.
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
Yeah. Now, that might be surprising to some people why you as a nutritionist would post about a white bagel with jam on.
Speaker A
Could you explain why that is a decision that you make as a as a nutritionist?
Speaker A
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
Speaker A
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
Speaker A
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,
Speaker A
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
Speaker A
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
Speaker A
think about like what's practical, what's within our budget, what's actually realistic and what's necessary.
Speaker A
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
Speaker A
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
Speaker A
conversation, sometimes it can be very privileged and just completely forget about like the nuance in the situation.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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 favorite that is probably one of the most recommended skincare products I have ever known. This is the Lash Pose
Speaker A
Slast repair balm which I'm sure you've probably seen recommended by the skincare goalies on Tik Tok. It is an 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
Speaker A
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
Speaker A
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
Speaker A
quite controversial and that is GRP ones. And I I am by no means anti-GP1s.
Speaker A
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?
Speaker A
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.
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
your appetite. So you take, you know, you consume less calories, but you also consume less nutrients.
Speaker A
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,
Speaker A
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
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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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
blah blah. I think the pursuit of thinness is going to mean that people are sacrificing their health.
Speaker A
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
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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.
Speaker A
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,
Speaker A
not someone you see in a a premenopausal woman. Yeah. Just really remember to fuel yourselves.
Speaker A
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
Speaker A
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.
Speaker A
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.
Speaker A
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?
Speaker A
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
Speaker A
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
Speaker A
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
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happening." And the reason the GP didn't do any of the screening tests was because I didn't fit the picture of POS.
Speaker A
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
Speaker A
just so terrible. There's a really bad slang name. It's a horrible way to describe women with POS. It's like fat.
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
into my brain. He never asked me about my diet and I just felt so well what am I supposed to do myself?
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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?
Speaker A
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?
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
glycemic index just means how much a carbohydrate will increase or spike your glucose to use lack of a better word.
Speaker A
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,
Speaker A
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
Speaker A
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
Speaker A
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,
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
really impact things. You mentioned supplements. What sort of supplements do you recommend for your PMSOS goalies?
Speaker A
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
Speaker A
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
Speaker 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
Speaker A
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
Speaker A
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
Speaker A
cycle length begins to get shorter. That's the big one. And then the rest really depends on what your diet is.
Speaker A
Vitamin D and omega-3 are like two that I generally will consider it for people.
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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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker 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
Speaker A
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.
Speaker A
Yeah. They're like, "What about the mercury?" Yeah. So that's a a nice clear clear clear one.
Speaker A
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?
Speaker A
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
Speaker 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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
ask for your opinion on it. First community question is what are the best foods to incorporate for necessary nutrition on a budget?
Speaker A
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,
Speaker A
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,
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker 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
Speaker A
people don't believe me when I say that, but that is what the research says.
Speaker A
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
Speaker A
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
Speaker A
regard, I think, yeah, we don't want to be doing high intensity every day. It's also not necessary, but or enjoyable.
Speaker A
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
Speaker A
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,
Speaker A
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
Speaker A
exercise have felt potentially felt worse afterwards and that's where this myth has come from.
Speaker A
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?
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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
Speaker A
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
Speaker A
do that. And you just keep doing it like that around your cycle. It's called seed cycling.
Speaker A
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?
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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
Speaker A
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.
Speaker A
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.
Speaker A
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.
Speaker A
So toxic. It was only through doing this podcast when every single nutritionist that comes on seeds, nuts, seeds, nuts.
Speaker A
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?
Speaker A
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
Speaker 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.
Speaker A
Like yeah, I think that's where I kind of like get a little bit fed up and think not great advice.
Speaker A
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.
Speaker A
Amazing. Dr. Hazel, what do you wish every woman knew by the time she was 25?
Speaker A
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.
Speaker A
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.
Topics:women's nutritionhormonesiron deficiencyPCOSendometriosiscortisolfemale healthsports nutritionMediterranean dietmyo-inositol
