Ep.38 All The Things They Never Told Us About Female Bodies With Dr Hazel Wallace

0:00This is costing women's lives. In health and healthcare, women are not being served and treated in the same way as men are. At puberty, you learn about your period, but you don't learn about the entire other part of the menstrual cycle. Across the menstrual cycle, we also have different nutrient requirements. So much happens when we're asleep. It's not something you can skip out on. We can tie it to basically every health outcome. It's when we release most of our growth hormones and anabolic hormones. So it's the biggest low-hanging fruit that we can have for our health. We do have different nutritional requirements to men and that is vitamins and minerals.

0:39Around pregnancy we need folic acid, through the menopause we need vitamin D and calcium. It's one of those issues that I cannot believe isn't talked about more. How are we getting away with this?

1:00What is up guys and welcome to a new episode of Working Hard Hardly Working. I'm so excited for this one. This was a great chat. It was all about the differences in medicine between male and female and the fact that like the differentiation between like what we're taught in terms of nutrition and everything about our bodies and what the actual reality of that is when looking at male versus female bodies there is so much to learn here and so much actionable stuff from hazel who is dual qualified as a doctor and also in nutrition and i think you're going to find it incredibly interesting if not like completely enraging when you hear about the realities of the medical space when it comes to female research and the inclusion of anyone other than men in clinical studies so I hope you really enjoy this episode I think you're gonna learn a lot let me know how you find it and as always please rate and subscribe to the podcast it really helps other people discover us and helps us to be able to get more amazing guests like Hazel so thank you so much for listening and as always have a lovely day thank you so much for joining me thank you for having me I'm very excited to be here we actually recorded an episode on Hazel's podcast a few weeks ago weeks ago months ago no it was weeks it's quite recently I genuinely get told off a lot for saying like the other day because I'm always like the other day and it will be like seven months ago which apparently is not like appropriate to do the other day but I have like no concept of time at all I just get up do my day and move on so I want to get straight into your kind of background and giving some context on your expertise and your job and everything like that so that people can understand what we're going to talk about in this episode and how it kind of affects them, why they should know about it.

2:56So let's get back to way back when, early life. Could you give like a whistle stop tour of essentially how you got to where you are now, career wise, who you are, etc, etc? For sure. I will give you the elevator 60 second I love it if I can um so way back when when I was 14 I lost my father to a stroke and that was the reason I decided I wanted to study medicine and become a doctor yeah I didn't get the results I needed to study in Dublin if people haven't picked up from the accent I'm Irish so I went to Wales did a undergrad in biomedical sciences or medical sciences in South Wales for three years then went into graduate entry medicine for another four years.

3:45Oh that's so interesting so there are obviously multiple different routes into medicine obviously the more traditional one is studying medicine at university is that right do most people do that? Yeah. I love that I love the fact that you kind of saw it as something you wanted to do and took a different route to go there was there any anything during that point that made you think or maybe I won't do medicine or were you pretty? No I was pretty dead set and the course that I joined was like fast track into Cardiff University med school and so they would select the top I can't remember 10 I think you for interview anyway okay and so I just worked my ass off for that degree I actually came top of my year and then went into med school but slightly older at this point like which I think benefited me because I got out all the uni kind of party lifestyle in the first degree and that I was really serious for med school and then I qualified in 2016 moved to London which was my first choice and started working in a busy London hospital here and throughout this time whilst I was at med school I started the food medic which is my brand and that also I guess stems from my interest in how our lifestyles impact our health which is related to how my dad passed away because he died from stroke which is like largely preventable in terms of the risk factors and we talked about this at med school but it was just like pain lip service really yeah I've heard there's like a because I remember kind of when I was originally starting in the fitness industry my general interest in fitness how the I don't know if it was from you or if it was general kind of because I remember you know I followed you for a long time and I remember there was there's something about the fact that like as a doctor you're essentially people can come to you about you know it might be a kind of dietitian type thing but actually in med school you get kind of like one lecture on nutrition which seems insane yeah that's it like I can tell you how the gut functions but in terms of like learning how to apply nutritional knowledge is it's like not something that doctors are trained to do so I actually did return and do a master's in nutrition in clinical nutrition at UCL and then worked as a nutrition doctor for a while.

6:01So I'm like dual qualified as a nutritionist. Then the pandemic hit and I started writing The Female Factor, which is my third book. My first two were largely nutrition and recipe books. And The Female Factor was like a completely different book with the same publishers. So I had to really like convince them to trust me, not to do another like healthy blogger sitting on the counter holding a solid type of book but like something I can imagine is a lot more commercial in a way like I I mean I'm this is totally up my street like the female factor is like exactly the type of stuff I want to be reading about but I know especially when it comes to I mean when I originally had conversations about my book having even having moved out the fitness industry and having no fitness quality I don't have any fitness qualifications I've always hired people with fitness qualifications in order to be able to you know be in the positions in the companies that for example at shreddy so you know obviously everything's kind of qualified in terms of the advice but I remember the amount of publishers that I essentially had to rule out because they would be like and where's the fitness part of the book yeah and I was like oh you literally like as in I've talked about fitness online as someone engaging in fitness and someone who owns a company within the fitness space I'm not going to be writing like a 28 day you know this to this for this kind of published book it's like that's very different from like the direction I want to go to but I know that within the health and fitness space they want to have a kind of like 14 days to a happy gut or whatever which is very like valuable in its own right but I can imagine once you've done two of those and you're kind of being like actually my background is more like the you know this kind of research-based stuff that I want to be able to talk about I can imagine that took a bit of persuasion it took a bit of persuasion and there's nothing wrong with the other books like I really enjoyed writing them but like this felt like a really significant piece of work that I needed to do and when I said I would write the book I didn't actually know what it would look like I was only like stepping into the space of research but I was noticing as like a woman but also as a doctor to many women that like in health and health care women are not being served and treated in the same way as men are and then they're not having the same outcomes and yes they're living longer but with poor health and so I really wanted to understand why this was and I was noticing like little biases and how we treat male and female patients in the hospital as well so I like stepped into the research and just opened this minefield of of how much disparity there is in health care isn't it the sexes something like there's until like the 1990s or something you didn't have to have women in clinical trials or something yeah it was most of the medical research we have is based on a male body and just extrapolated to a female with these which is wild like as in like how could even just like knowing about like probably like one main difference between the sexes in terms of like carrying children and like the menstrual cycle and stuff like that like how an entirely different hormonal profile like how are we expecting the like to be like this is an entire study we did on like all men and maybe like one woman and like we're we wouldn't you'd never be able to do that with like sample size extracting it from like one person to a million people so why would you do it from like literally missing out half of the population well this is it and this is why it's so ironic because they historically excluded women for three main reasons the first is because of our fluctuating hormones and that's right a nuisance for them to control for so we'll just pretend they don't exist yeah the second is the risk of pregnancy so there's like an ethical issues and the third is the fact that women have historically been primary caregivers so they just can't like come to the trials but researchers haven't made it like accessible that they would do evening trials or like or like the fact that okay sure sure women are still very much um primary caregivers but the thought that like we expect women to be able to go to work but we couldn't possibly do like a or like to be able to attend a doctor's appointment or to be able to like do anything but we couldn't possibly do like a clinical trial to actually determine like what this species is in terms of like how it is like that is it's like laughable it is insane and like it's one of those issues that like I cannot believe isn't talked about more I remember hearing like some of the stats on it a few months ago and this is why I so wanted to do this episode because I was kind of just like we can't seriously still think like that in my mind someone completely like separate to the field absolutely no like knowledge in anything that you kind of specialize in it's like they're almost surely should be like a body put together to be like how can we rework all of these main clinical trials trials that are like the backings of everything we know about medical conditions and redo them essentially like including a 50 50 female to male split like to me that would make sense in terms of being like I'd assume people in the field as well would be like let's get more accurate yeah but the fact that it's kind of just like even edging more towards that way rather than there being like a task force put together to literally be like let's redo these main things like where it's going to be quite expensive but you know we've managed to pull task force together for all of these different things as well like to me that's insane yeah yeah and it's definitely you know now you do have to include sex disaggregate disaggregated data but it's happening so slowly and by the time research happens that changes clinical practice takes years and in the UK they released the women's health strategy last year um which is basically outlining all the changes that they're going to do in terms of restructuring of the NHS and research okay and that's a really positive step but it's just it is just paper at the moment so everyone's always like asking me to go on the radio and talk about it and I'm like until I see any movements in this I'm not willing to talk about it because we bring out papers all the time and change nothing yes no I mean I think it's absolutely crazy I want to go on to talk about women as small men and all of that kind of like what that really means to someone from who might not have heard of that kind of at all as a concept but before I want to do that I want to get really clear on the differentiation between sex and gender so that we're referring correctly in this episode to that differentiation yeah absolutely and it's it is tricky because a lot of the research does use sex and gender interchangeably and incorrectly and I found that like quite shocking when going through like research that actually specifically looks at differences between the sexes but then they'll use gender terms.

12:41So when we talk about sex we talk about what's assigned at birth so male female and then gender is like how you identify so it does not have to be the same as sex. The thing is when it comes to research and I'm like clearing the book because it's not being so clearly separated when I refer to woman I'm referring to someone who's been assigned female at birth and identifies as a woman because whilst we have like very little research on on actual female people we have very much less research into trans people and so it is not perfect and I really like recognize that when I'm talking because I don't want anyone to feel like they're being excluded and so hopefully that makes it of course and I can understand that the other I think that's incredibly important and I think it's not it's not always going to be got right especially coming from a perspective of both as people who identify as the sex that we were identify gender wise as the sex that we were assigned at birth um so there are going to be nuances that we probably like don't quite understand but I also think that like the alternative to that is steering clear of it completely in order not to I think when you're approaching it in a way of being like this is how I'm talking about it there are some conflations in the research of the two terms which makes it really hard to kind of differentiate what is like actual findings versus what they're conflating etc etc but I think it's incredibly important as well not to kind of just be like I'm going to steer clear of this completely because I don't want to you know whereas actually realistically the sooner we're able to talk about this in a way that's kind of really open we're able to move also more towards recognizing differences where it might come to you know non-binary identifications or whatever that might be yeah absolutely and that's why I use the term female in the title of the book to make it really clear but whilst we're on the topic both sex and gender influence our health and our health outcomes and I do talk about that in the book because as we'll like go into an episode it's not just our biology it's also like these biases we have about women sure and like that acts as a barrier to our access to healthcare okay that's incredibly interesting let's dive into the concept of the female factor women's health and kind of why should women care about looking at their health in a different way than they maybe have been taught throughout their life or the way they've maybe kind of perceived their health care service like what led to you writing this book in terms of the way that people should kind of care about that well if we think about the term women's health it just means reproductive and gynecological health right sure when actually like our total body health matters and we have historically been reduced to just that just like our ability to conceive and that is our main difference when really compared to male a female and a male body is different on a very on every cellular level because of these hormones and because of our life experiences as well but because we've excluded women from research historically and we've just assumed that we are smaller men it means that women are assumed to present the same way when it comes to certain conditions be respond to the same treatment and have the same outcomes when in matter of fact that's not correct so if I use heart disease for an example like typically if people think of any adverts they've seen it will be a white older man clutching his chest that is like classic heart attack picture um when women are just as likely to die from heart disease and in fact they twice as many women die of heart disease in the UK than they do breast cancer but it's less there's less awareness around it okay um and women are also 1.5 times more likely to be misdiagnosed when having a heart attack compared to a man and so from onset of symptoms to discharge from hospital at every stage of that process if you look into the research women aren't being served so for example when they first experience symptoms women will typically well chest pain is the most obvious symptom and both sexes experience that most commonly women may also experience nausea shortness of breath symptoms that in the research we say atypical but it's just because it's different sure women are also more likely to put off going to hospital and try self-medicate and put others first so there's a delay and when they get to hospital then if they're not presenting with a classic picture then they're less likely to be correctly diagnosed and when it comes to heart disease we say time is muscle because you want to get the heart perfused as quickly as possible right so all these little delays lead to really devastating effects even when it comes to diagnostic tests like we do blood tests and they measure enzyme levels they may they're based on a man's heart which is bigger and so the the kind of cutoffs may be too high and this is something that like we know now the british heart foundation have done research on it we know that women's levels are slightly lower and yet it's not yet been integrated into our clinical guidance so we're still using universal cut-offs and then when it comes to to discharge again women are less likely to be recruited into rehab which is really important to prevent a second heart attack so it's it's mixed up in because they're not willing to attend it it's not being presented to them so it's kind of tied up in multiple reasons the fact of the matter is the fact that we know this we should be driving more awareness and women we should have a stronger follow-up yeah and so if you add all these pieces to the puzzle like a swiss cheese model it means that women are just falling through the gaps and so they're more likely to die after a heart attack than a man would that poses I mean I'm not the first person to say this maybe like to me this poses a moral issue but like I feel like hearing all of that so black and white and so kind of straightforward and so even the fact that like the blood test what you would look at against what might be healthy or and not healthy or what might be presenting in a way or not presenting in a way the fact that we don't have the results for what a woman's equivalent would be other than extrapolating from men's that is absolutely unbelievable is that not a huge priority to overturn just for the like purely not even from a moral standpoint but from the standpoint of like getting more accurate science and treatment yeah absolutely like this is costing women's lives and I you know I've been kind of following this research ever since writing the book and also work closely with the British Heart Foundation as their ambassador and they do lots of research into women's health and released a report like biology and bias and how women are underserved in cardiology care but this isn't just cardiology it's like all of the different disciplines in medicine that were like not treating women the same like even when it comes down to pain management women are less likely to be prescribed painkillers will get them later are more likely to be given antidepressants for their pain and it's just like shocking yeah like to read it as as a woman it makes me feel like so much anger and to think like it makes me think back on like treating patients do I hold these biases like how are we getting away with this yeah no I mean I think it is absolutely kind of unbelievable and I want to talk about what women can do in order to be able to I mean it's not the onus absolutely shouldn't be on women but like say in this specific case of heart disease for example what can women do to kind of advocate for themselves in order to be able to or kind of we'll get on to the kind of preventative stuff in terms of like actual lifestyle and the you know what you spend a lot of kind of time talking about hearing this it's obviously kind of terrifying and then you want to be able to go to the doctor and you want to be able to be believed and then but you also don't want to be a kind of hypochondriac or you don't want to be wasting people's time especially kind of in the UK when it's you know you're kind of costing the NHS etc etc what can people do in order to be able to improve their chances of you know being correctly diagnosed etc I would say like don't first of all don't feel like you are being a burden because that's something that women often feel like they are and the fact that women are more likely to be given a psychiatric diagnosis than a physical one for a physical problem compared to a man just really illustrates how we often see women as hysterical um so like a lot of there's like research around um a condition which causes a very high heart rate and lots of women are misdiagnosed with anxiety when they present with it because they'll say like i've got flutters in my chest and then the doctor will be like oh it's just anxiety like you're just an anxious woman so don't dismiss your feelings i hope no one goes away from this podcast after having like a coffee and thinking oh my god I'm having a heart attack but if you are having like severe chest pain that isn't going away after resting that is you know reason to call an ambulance but if you are experiencing any health condition regardless of whether it's like you know related to your heart or any part of your body never feel like you're a burden advocate for yourself if you feel like your GP isn't listening to you you're very much in your right to ask to speak to someone else you can bring someone with you you can take notes Like, I think the most powerful thing for me when I've seen patients who felt like they haven't been listened to is when they come in and they've had a diary of symptoms and they're like, look, this isn't in my head.

22:32I've been experiencing this for three months. And yeah, people might say they shouldn't have to do all of that research. I should just believe them straight up. But sometimes it's like really powerful for you to like bring the facts. And also it makes you feel a bit more like confident in what you're saying. Yeah. Because the patterns are on the paper. Yeah. No, for sure. let's talk about um vitamins minerals nutrition are certain vitamin and mineral requirements particularly important at certain points of women's lives yeah yeah so the book um one of the chapters is nutrition uh obviously it's my main thing but I found it the hardest chapter to write because when it comes to food and nutrition between the sexes like the biggest point of difference you'll come across is that women need less calories than men and like it's all wrapped up in like you know this this whole narrative that we should eat less be smaller like even when it comes to like fitness classes it's always you know tone and sculpt and be smaller versions of ourself but really nutrition we do have different nutritional requirements to men not just calorie requirements and that is vitamins and minerals and it will change across a woman's life cycle so for example the obvious one like you know our iron requirements increase after we go through puberty around pregnancy we need folic acid through the menopause we need vitamin d and calcium across the menstrual cycle we also have different nutrient requirements right yes which i find the most interesting because like for example in the second phase of the cycle which is the luteal phase after ovulation just before the next period um progesterone and estrogen is quite high and we burn up to 300 calories extra per day so our metabolism is higher because our body is doing all this extra work we break down more protein during that time we also use other specific nutrients in excess and what we find is that women typically will have like a response that you can really correlate to that increase in progesterone which will be increased cravings for food increased food intake and I don't know about you but a lot of women come to me and they're always like I can't deal with those cravings around my period and I find it's really helpful to explain that to women this is what's happening it's not all in your head you're not going crazy and actually there's just like you can make some smart nutritional fixes around this time to help control those cravings like adding in more kind of high fiber complex carbs increase your protein healthy fats and yeah if you crave chocolate it's fine to have chocolate it's not going to do anything harmful to you the most interesting part i think is that like when you split people up at school in terms of like having the kind of PSHE classes and talking about um you know talking about sex talking about a kind of periods like all of these things it's like it is that whole kind of cliche that like the male students like learn about like sex but not really anything other than like use a condom yeah and like we're being taught kind of like you're gonna have a period and also like never have sex and like nothing about kind of like consent or any of these important things like nothing about like the fact that like I would consider myself quite like a curious person who like I read a lot I listen to a lot of things I you know spend a lot of time consuming information because I'm you know find things very interesting the fact that I kind of didn't hear about the fact that I might be training differently or consuming differently or feeling different because of these specific things that aren't just like oh women get really weak and moody around their periods like imagine changing your entire hormonal profile for like a period of time like of course it's going to change the way that you're like even you saying like you're burning 300 calories extra like that's probably the only thing that like a like someone will hear and be able to kind of like justify like then cravings rather than just being like you know we we know when we're pregnant for example that there's going to be a difference in terms of the amount you might need to eat sure it might not be double but it's gonna be like there's gonna be a significant difference the fact that it's like pretty much nowhere in like normal you know you'd have to go really out of your way to find out these things to me is just insane yeah yeah that's it and I think like you quite rightly said at puberty you learn about like your period but you don't learn about the entire other part of the menstrual cycle the period is typically the first five days of an average 28 to 29 day cycle yes but there's so much else that happens during those weeks always in the cycle at some point you're always in it and so if you if we were teaching people from an early age like this is what's happening in the different phases you might feel like this you might feel great here you might feel stronger here at this point of the cycle you might want to have some more magnesium like telling people how to do this would help them have a much better experience of the mental cycle and like dare I say even enjoy it but we're just told it's terrible and like yeah to just it's just a period and everything else is a roller coaster that you just have to ride that whole point about like the concentration being like the days where you're bleeding and it's actually like you know that's like this like such a small part of the pie if you're looking at like the actual way that we're kind of operating throughout an entire month or however your cycle might fall like it's just I mean it's ridiculous that we're literally taught like you're gonna bleed and you're gonna need a tampon and then they're like bye yeah like good luck yeah like have fun for the rest of your life and like we also normalize how painful it should be which is why like you know I think like a lot of women put off going to the their GP with like really heavy really painful periods because they're like oh it's normal yeah I mean I don't know we kind of I think we briefly talked about this but I know you know I've been on birth control since I was like 13 because it happened because of having like such painful periods to the point that like you know I would get I would not be able to see because I'd have such bad aura from migraines my sister gets it too she'll be like vomiting on the bathroom floor and like lying on the cold tiles for like her entire period and like kind of just being like we'll stick you on this pill or like will see like I was even put on a combined pill when my family literally has thrombosis and it was kind of just like little girl in pain like give her this pill in order to be able to like essentially change my hormonal profile completely when like actually you know if more questions were asked it would have been seen that I'm literally the worst candidate for you to be like even giving that kind of at all I just think that I mean the the normalization of that kind of type of pain and then you know it's seen as such like a trivial topic like if you look at comments on anything where it's like menstrual leave yeah menstrual leave and then it's kind of like the trivialization of that because it like wipes out the concentration from like I mean I don't think that's trivial but I think like you you'll it only takes you to look at some like Facebook comments on that and be like oh boohoo and like all of this and it's like also we could get like great treatment on like PCOS and endometriosis that would actually like help women know if they have like a like a serious condition that means that they're actually going to be, they're going to find it pretty hard to function for a lot of their life.

29:44That's it. I remember watching this, like, I can't remember what it was. It was a documentary that I watched a few months ago and it was women with endometriosis. Was it below the belt? Yeah, I think it was. And it was like trying alternative treatments. Yeah. And I remember just like one of the women being like, oh yeah, I'd like strongly considered suicide multiple times because of like, and doctors being like, periods are painful and it's like this is to the point that someone's experiencing pain that they believe that it might be better for them not to live in order to be able to like and you're telling them it's normal physiological pain because women bleed like we're not in the tudor times like you don't need to be like actually on the like verge of like not being able to like live anymore or actually like passing out from pain in order to be able to take be taken seriously yeah i completely agree with you I think like in my gynae rotation when I was a med student one of the clinics I was assigned to was an endometriosis clinic and it was the most profound experience because I've never seen women so distraught and like it was a male consultant and he was fantastic like he made me want to be like going to obstin gynae because he was just like whatever you do do not dismiss a woman in pain like these women did not just have really heavy painful periods they were unable to have sex because it was so painful even going to the bathroom was extremely painful they were having difficulty conceiving like it's it's not just heavy periods it's like quite like a full body syndrome and it's so it's it takes on average eight years to be diagnosed eight like eight years and like looking at the fact that you know young teenagers will be getting their periods that kind of like I mean I think I was like 11 or something and then just going like your first experience of like actual severe pain and like going to a doctor and then being like oh welcome to womanhood and you're like oh no I'm literally like vomiting on the bathroom floor like this doesn't seem like something that should be normal and then but the fact that like even like endometriosis for example like that eight year diagnosis time is shocking but then on top of that like the fact that you can only really properly diagnose it through opening up someone's body like you cannot tell me that if that was a male condition we wouldn't have like significant improvements in research in order to be able to diagnose that like outside of literally cutting someone open yeah yeah it's i mean it's just shocking and i think we could talk about it for years um in terms of like actionable advice for vitamins and minerals and what people should be kind of prioritizing is there anything that would kind of be like i know it's obviously very specific to the person but i know you said for example like increasing iron intake like after going through puberty like increasing protein intake in your luteal phase are there any kind of real tips that you'd give in terms of like the types of vitamins that women should be making sure they're getting when there's so much kind of conflicting advice yeah it complete completely depends on where you're at in your lifespan like pre-menopausal pregnant post-menopausal but in general like take the menstrual cycle as an example um across the fluctuating kind of 28 day i always say 28 day because it's like general guide what people know but if you're not textbook 28 day it's fine um so across the month we'll see fluctuations and hormones which influence like what nutrients we need um our energy requirements and so at the very start of the cycle during the period or menstruation there's actually like a huge amount of inflammation going on in the body and that's why we feel like cramps and bloating and headachy and one way you can kind of help offset that at least a little bit is with like an anti-inflammatory diet so thinking about like colorful fruits and vegetables like lots of fruits and spices whole grains um a lot of women also report that they got like quite loose stools around their period because of that drop in progesterone but also because of all the inflammation so you may want to steer clear of like fried and fatty foods caffeine sugar-free foods those foods that can like really stimulate your gut and make things worse oh interesting so I the thought of me staying away from fried and fatty foods during my period is like ambitious to say the least um but I yeah that's so interesting I can so see why I remember once seeing this like animation of how your if your body's like well when your uterus I think is inflamed and like the way it like shifts the other organs around it kind of like when you're pregnant but like if it's obviously like swelling because of your period and I remember like seeing this animation and like it's showing kind of how like it can also say like hit against something which will mean that you you know you'll get worse cramps or whatever it might be and I remember being like oh my god I've never actually like thought of the fact because I get really bad um like it wouldn't be bloating it would be like inflammation around my period but it literally looks like I'm about like five six months pregnant and like it's it's like quite hilarious because it literally looks like the perfect shape for as if I was actually having a baby I've had multiple times where I'd be like oh my god if someone sees me right now I'm actually there's gonna be like rumors leaked um but but yeah and like then when you think about it you're like of course like if that's gonna change size and you're thinking of a circumference that's not actually like that big then something else something else has like got to give and it's likely going to be squished well that's it so yeah you can help yourself in that way um obviously like iron rich foods are really important then but really across like your 28 day cycle for a woman um and then in the next phase just like after your period in that like late follicular phase estrogen like comes back up and progesterone remains low and this week is when people typically feel their best your mood is better your energy is higher your appetite's probably less um and that's because of the estrogen as well estrogen is like literally wonder drug um like my friend adrian calls like calls that week like her power week because she feels like stronger and like better and and typically you're more attractive too you're more so you get like your skin as well changes oh interesting um so we call that like the ovulation glow yeah um and it's like just the right balance of estrogen is very like anti-aging and it makes your skin look a lot more plump and firmer and um progesterone can cause like that causes more like sebaceous like um oil and like oily skin so later in the cycle you'll find you get like oily skin spots and that kind of thing so we love estrogen um such a shame i can't go on the combined pill i remember one of my friends um when she first went on one of the combined pills when we were like 14 she just came on in one day and she was like guys look at my boobs and she was like she was like my boobs have got so big and my skin has got so clear and we're all like what's the pill like yeah that that particular pill is very good for acne um and then into your luteal phase so after ovulation around that time when progesterone is high your temperature is going to be higher you're going to retain more water um and like i said earlier you're burning more calories at rest you break down more protein um and you'll have higher hunger and cravings so like make sure and typically people experience constipation so you're getting in what you want to get in is like lots of high fiber foods um higher protein healthy fats are still really important and like omega-3 fatty acids to help reduce that inflammation before your next period and would you generally say to eat more during that time yeah I would say be intuitive about it like um because it will vary from person to person like how much calories we're using but what I try to like really hammer home with a lot of women is that like don't feel like because you've got cravings you need to avoid them and just drink coffee and have gum because you're like afraid of it like listen to your body if it needs more energy it needs more energy yeah and just focus on like getting in as much of the good stuff as you can um and like also we're like less hydrated so making sure you're just like drinking more water and then later in that phase like a lot of women will experience pms so 90 % of women experience at least some form of premenstrual symptom and then premenstrual syndrome then is like a smaller subset of women so that means like it's clinically significant and that's causing like an effect on your day-to-day life so it's really impacting you and then an even smaller subset of women experience pmdd which is like pms but a lot more like mental disturbance so mental health issues and that's really tied to your cycle so if you're someone who experiences pms and there are certain nutrients that like could be helpful magnesium supplementation and calcium and vitamin d they would be like the top ones and omega-3 is really important as well um we know that like omeg um magnesium can help with like period bloat and can help with um migraine as well if you get it around your period and then calcium and vitamin d typically are lower in women with pms and when we supplement it in trials it seems to improve symptoms so again like we're talking about like very little research in this space but more and more is coming out and i think like hopefully in the future we'll be able to be a little bit more detailed and like what to eat for your cycle but right now it's been it's really more intuitive and I'm a huge advocate of like tracking your cycle tracking your cravings like really learn what your body needs at those different phases what types of tools would you recommend for people to track their cycle I use clue I think it is yeah I use clue as well I mean you can be as like basic as pen and paper or like just write it in your notes like when your period's coming when it ends when you think you're ovulating and any other symptoms across the month but now that we've got apps that are so accessible and easy to use like I think flow clue there's one called like fitter woman which is more catered towards like kind of female athletes or very active women yeah um but there's so many and I think like just start tracking it for at least three months and that will give you a good snapshot of of like kind of what's happening and things and it helps inform i remember i used to think that my period was irregular but i think what happened was that it actually just wasn't a textbook 28 day cycle and so in my head i was like i there's no nothing's going to be able to predict it because it's crazy yeah and then i remember putting it in i've like tracked my period for years now one thing that's really so anecdotal so strange and actually like just not useful to the conversation but my body seems to work on a 12 month cycle just just like the world yeah just like the world goes around the sun because in august i have my period for three weeks every time really yeah three a three-week period three-week period i don't feel like it's normal grace that it's something that you should know i'm well aware i have like as in like pcos and stuff but like as in yeah no there's some strange things going on but i thought that was quite a fun fact for everyone i think like it's that's an an important point in that like your period will change across you're like years and like what my experience of my menstrual cycle is when I was a teenager is completely different to now right yeah yeah and it evolves all the time so I think and it will change but like your lifestyle and like how stressed you are like working in the pandemic I just lost my period and then it just came back that's so interesting and I often think like I want to talk about stress a little bit and um kind of women and stress related conditions but in that on that kind of front I always think that like when talking about women and stress in particular it's like often on a patch in a patronizing sense like it's often been like oh you're a little bit stressed like as you said in terms of like diagnosing anxiety when someone has a heart condition etc etc like the idea of us seeing stress as something that is um to do with our like mental resilience rather than also like a literal hormonal like impact like if you're the effect that stress can actually have on your body is obviously like insane or like the you know I had a physiologist on the podcast and he was kind of saying how your body can't really differentiate between like literally going to war yeah and having like you know going through a divorce or like whatever it might be which I'm not saying that you know like they're obviously very different like um life moments but in terms of like actually the effect on your body in terms of kind of like hormones and as you say like losing your period and all of that is just like the fact that we think of it is something that we just need to kind of like push through and get more resilient at rather than actual like lifestyle changes to I mean I'm number one culprit for that I'm like any medical consultation I have and they're like so how stressful is your life and I'm like I'm in a very high stress job and they're like is there any bandwidth to change that and I'm like nope like I'm afraid not I'll see you in a few years that's the thing um it's like probably the the most difficult thing for people to manage um but when it comes to stress and like our menstrual cycle because like all of our hormonal axes in the body don't just like work in isolation they like work from like a master regulator in your brain that like feed down to like tell your ovaries produce um these hormones stress also comes and works in that feedback loop so like cortisol will like cortisol will down regulate those hormones which is why if you're really stressed especially over a long period of time it will just tell your hormones uh your ovaries to just stop producing hormones and so typically people will skip a period or miss it for a few weeks if they've gone through like trauma like grief or the pandemic and the longer that goes on forward the longer it can disrupt it like we're all very different but what i say is like your menstrual cycle should be a vital sign like it should it tells you how healthy your body is and so if it just disappears don't just ignore it like that's reason to go speak to a doctor yeah no absolutely and why are women more likely to experience stress-related conditions yeah I found this chapter really interesting to write for the book because it goes back to what we said in the beginning in that like especially when it comes to mental health it's not just our biology so male female it's also our gender and our social norms and how society views us as like man and woman and so to like tease that apart's really difficult so the stats are that like women are twice as likely to experience anxiety and depression in their lifetime be diagnosed with it and that's true of all the anxiety disorders even like phobias and things like that the reason why that is we're not entirely sure it seems to be both biology and and kind of social and gender and kind of norms and how we deal with stress so on a kind of biological level there seems to be something to do with hormones and how we respond different differently in terms of that like fight or flight response so men typically will fight in a kind of stressful scenario whereas women they use this term in the research called tend and befriend where they'll look after or they'll look out for their offspring or the people closest to them first and then they'll deal with themselves and we are more dependent on other people for our mental health and our mental well-being than men are there more men are more independent um in terms of their emotion but also like we have kind of gender norms of like men should be stoic and like kind of keep their feelings in whereas like women are hysterical and they cry all the time and they're emotional and it's down to our hormones and that's the thing that can get really sinister because for both men and women because then men you know don't deal with their feelings and then they'll externalize it and go to drinking or gambling or suicide whereas women will ruminate and they will experience depression anxiety and other phobias and like i said earlier in the episode women are more likely to be given a psychiatric diagnosis for a physical problem even in research where both men and male and female patients will present with the same symptoms with the same condition and yet doctors will be more likely to give the man um kind of more formal investigations like x-rays and they're more likely to give women lifestyle advice and send them home with anti-anxiety medication well thank you i will go to the gym rather than getting this mri scan thank you that is crazy it's crazy and women are even when we account for rates of anxiety women are more likely to be on antidepressants and anti-anxiety meds so there's like this huge discrepancy in who we're prescribing to it also kind of feels like the fact that and this might be a bit of a reach but like the fact that when I've kind of you know might be sat in might be like a PCOS consultation whatever it might be and they're kind of talking about stress and the effect of it and I completely understand like I should probably live a less stressful life but like I also feel like I am quite good at dealing with stress in terms of the way that I um kind of perform and it's always you know I feel more comfortable in a little bit of chaos and kind of all of that and the fact that my I do sometimes question whether women it's seen as less necessary for a woman to live a stressful life so it's kind of like when asking someone like oh are you in a stressful job and almost being able to assume that they might be able to change their lifestyle to stop that stressful job like I'm not sure you'd listen to a man being like and then when they're like oh what what makes your job so stressful and kind of being like oh well you know I have a VC backed startup and it's you know it's quite a lot of work and it's pretty chaotic and it changes all the time and all of this I'm not sure you'd ever assume that a man would kind of have an option to like chill that out a bit it's kind of like the are ingrained kind of well women of the caregivers and men are working like even the suggestion of being like oh could you just like chill that out a bit seems like it's almost like a little bit of playtime because it's a woman's job rather than being that yeah yeah it's um that's it and it's I think like all these things like contribute to that narrative we have around women and like I'm not completely dismissing the fact that women do experience anxiety and I don't want to yeah of course um anyone to think that like I myself have a a diagnosis of anxiety but I think it shouldn't be the diagnosis of default it should be the diagnosis of exclusion things can still exist and not be that's it you know the default of course And I think when it comes to kind of female biology, we also see like this massive divergence in depression and diagnoses after puberty between females and males.

48:57So there's definitely like some kind of hormonal workings going on there. But the other thing that I think is really important to think about is at puberty as well. It's not just these like new hormones that you're experiencing, but you're also probably at a new school. you've probably just discovered boys you've just like discovered mean girls so there's like lots of things that could be contributing to your mood yeah um so yes hormones are at play but we should all also like think about what else is going on in someone else's life yeah so I want to talk about sleep and its kind of overall effect on your health can you talk a little bit to that yeah absolutely I actually seen uh tiktok recently of another doctor who's like a crossfit doctor and she was like sleep is the number one performance drug and i was like that's so true because it is it's like when we release most of our like growth hormones and anabolic hormones and when we do all our recovery and like when our body basically just presses a reset but it's not like a passive process so much happens when we're asleep so it's not something you can like kind of skip out on um like we can tie it to basically every kind of health outcome whether it's like cardiovascular disease whether it's stress related diseases or anxiety disorders whether it's like gut health issues like stress is so incredibly important for everything but also like like you know it helps us perform better it helps us like maintain attention and focus like contribute to our relationships be less irritable so it's one of the most kind of the biggest low-hanging fruit that we can have for our health um like even one night of poor sleep and i know you don't want to hear this right now can like impair your immune system and make you more susceptible to catching a cold.

50:39I mean I am sleep's biggest fan. I think that like there is this assumption that like especially in the type of work I do there's this whole like obviously there's all the 5am club stuff but there's also the kind of like sleep when you're dead like you can just like sleep four hours and then you get like x amount more hours work and it's like I will be the first person to say that first of all I must get eight hours every night like I really I am weak I like I it is what I need I can't make decisions on it otherwise I mean obviously I can make decisions but like I am a completely different person and that is my threshold and I know some people are happy on less some people are happy on more to me it actually hugely changes like everything and like I can so believe like all of the science around sleep I'm like yes I see it it changes me completely it changes my like how I get ill it changes like absolutely everything but even like my overthinking reflex is like completely different when I haven't had sleep so like last night for example when I was up from like three or whatever it was I was thinking about this and actually the night before as well I was thinking about this thing and I know I can't trust myself like I can't trust myself at that time in the night when I've had that much sleep because I'll think about it and I catastrophize to such an extent and it's like I it's like I'm possessed because I'm like in that moment I'm like I know I this isn't actually yeah what I'm thinking and it's almost like I'll explode if I don't do something about it but I'm also like you don't you're not thinking about this like as in like you're not thinking about this in like a rational sense and your responses and you're like catastrophizing of it is like not normal and then I think that like it took me so long to realize like actually how important it was and actually how when you think about getting enough hours sleep a night versus like okay it might be working in those hours instead like when people are like get you know four hours sleep and like work until 11 or whatever it might be I realized for me personally that was actually like less good self-control because it's you trusting the process less and having to spend more time working that's not actually like productive because you're thinking like oh it's all about hours rather than about actual like substance and what you can bring to those hours but like I am the biggest believer in like I mean I'm a whole different person when I haven't slept properly and I just know it's not something I can compromise like it's just yeah I will do anything to make sure I get my sleep and otherwise I will not be making decisions yeah I agree with you I agree with you I think like as I've gotten older I've definitely appreciated it more and now that I know what I know I'm like why did I pull all nighters when I was like probably sabotaging yeah my chances are doing well in these exams yeah when like the most like that's when we consolidate our brain actually wasn't going to work yeah exactly like your brain actually wasn't going to work well the next day when you were revising through the night obviously there's a limit like when you actually don't know anything about something then it's probably best to you know be doing some revising but no I completely agree I think that's one of the biggest things um again just fun facts from grace that's one of the biggest things that terrifies me about having children is just not being able to control your sleep like I think about it a lot like I think that will change the entire timeline of like when I like hopefully think about having children yeah it's like the fact that like I just I just know I won't be able to perform anywhere near as much because I am so weak when it comes to like my like sleep disturbance and like how it affects my day that's it you're just gonna have to accept it I'm not sure I just never will um but no I think that that is all like incredibly important and I think that we often it feels again like this kind of like weak thing that we need to be doing and just like it's our like body's um downfall that it needs to kind of have this sleep whereas actually it's like oh no it's like it can be like your superpower like actually getting that much yeah it's why we're such an advanced species because we have to recover and like your experience of like kind of being awake and ruminating in the middle of the night is like very universal for women yeah like it's it's women will typically get more hours in bed but less good quality sleep okay because we do have more awakenings in the night and like I know I'm the exact same as you yeah and my boyfriend's like like how does this happen to you so regularly like you've had no caffeine you've like gone to bed at a good time I'm like it just happened it's just a thing yeah no I completely get that and what what steps can people take in order to be able first of all actually what thresholds can people be like aiming for in terms of like what they you know general rules around sleep yeah I mean the like magic number is really like seven to eight hours of sleep um and I think anything below six definitely anything below five is when you start to see like poor health outcomes especially if it's like consistent like I don't mean that like you know you have a night out and you get five hours sleep fair enough but if you're doing it like quite regularly five to six hours like and if there's nothing else you change in your life that would be the one thing I'd like say can you increase that like can you get into bed half an hour early if you can't can you nap in the day like just try to make up as much sleep as you can like some people argue that you can't make up your sleep debt but I think like if that's your only option that's what I do because it can be quite refreshing um but other than that like I think sleep hygiene like sleep's gotten quite big recently maybe with the Matthew Walker book yeah um but what I'd say is like you're a good night's sleep starts first thing in the morning and so what you should be doing is viewing early morning early morning light at least 30 minutes on waking which is really hard because not much of us not many of us will like wake up and be at the door in 30 minutes and also the UK doesn't sponsor light like it's just like afraid not until now like it's only starting to get light in the mornings but what I do in the winter months is like I will sit in front of my sad lamp which um when I'm like writing my to-do list and just like getting ready so 30 minutes of that can like replicate kind of 10 minutes outside um and that the benefits of that is that it basically shifts your circadian rhythm and makes you feel sleepy earlier um it helps you have a more restful sleep then like across the day thinking about like what you're doing like definitely try to move your body at some point which can help with sleep I would cut off like caffeine consumption at midday at least I do that and people think I'm crazy but I remember just hearing I think it was on the Matthew Walker um in the Matthew Walker book or he talked about it on a podcast um but it was the it was like the half-life of caffeine yeah it can be up to 10 hours in some people so like if you have your last coffee at 12 you could still be metabolizing it at 10 p.m right which is not what you want to be no you want um but also thinking about like your last meal time and try to have that like three hours before bed which is tricky yeah so I have a new heart rate monitor um and it always tells me when I've like it knows when I've had a late meal it's like it's like oh you had a late meal last night and therefore your your heart rate was higher like throughout the night and didn't settle until like 6 a.m which means that you're feeling like less stressful today and I'm like you're so smart like yeah like you know me so well honey but it's so true and I didn't realize because I think my I operate on such a routine and that routine is based entirely around like my work performance that it's kind of and also like wanting to fit social life in there that it's like this is the only option so it's like this is how we're gonna do it but actually looking at that and being like could I maybe even like if I'm gonna stay late at work could I and I know this is really bad but like could I maybe have my dinner at work before I go home and then just relax when I go home rather than being like well I'm I want to be in front of the tv relaxing having dinner so I'm gonna like shift that later um but like it always I have like a much worse score on like my readiness and everything when I've like had a later meal which I think is I mean it's like I didn't trust the science well that's it you know your body has to if it's like focusing on digesting food it's diverting its energy away from like important restorative processes um so yeah I would say like try to have your last meal three hours before bed but it's not always possible especially like when you're socializing three hours yeah there is yeah no way I'm afraid but thank you and then the other thing like that people often use to help them fall asleep is alcohol and it can help you fall asleep quicker but it will mean that like the quality of your sleep just for clarifying I just said yes like I have like a like shot of vodka before bed I'm like I just like to clarify that that's what I was like ah yes my like hot toddy my nightcap me just sitting there with my bottle by the bed yeah which is not the case but I do agree like when I have a glass of red wine I'm like oh perfect yeah because it makes you feel sleepy and for some people like yeah maybe one drink won't affect you but the research suggests otherwise I know for me that like if it's anything over one glass of wine like even just like one in a smidge like my sleep will be completely disrupted and like I also track my sleep and my recovery will be like red line and I'm like you it just the impact alcohol has on your body and like I'm you know I'm not like an anti-alcohol person but I do think once you start to really realize the effects on your body you're like this cannot be good for me yeah god it's just no fun it's no fun it's really rude and then like last kind of thing before night I think everyone knows this like not to be looking at blue light emitting devices devices and like turning down overhead lights and like use lamps or candles instead and like have your room dim dark and quiet yeah like and I do I believe so strongly in sleep hygiene in terms of like the subliminal messages you give your body in order for it to know like that you're going to sleep like there's this one I think it's called like deep sleep on Spotify it's just like this playlist that I turn on it's like if I'm there's there's two playlists there's like essentially but I'm it's like my body knows that in that moment and it's just like these like kind of stimulating it from these different areas and just being like I don't know it's like I suddenly feel like I'm in like this cocoon and I'm like okay it's sleep time and it really really does work it's just like these cues that actually kind of whether you know it or not or whether you find it stupid or not like having that kind of routine that makes your body think oh no I know what time it is now yeah that's so important like a sleep routine and one of my friends Michael says like the sun doesn't just like set like it's slowly set so like don't expect yourself to just like get into bed like yeah exactly it takes time so like regardless of what your routine is if it's like spraying lavender spray on your pillow or your favorite pajamas or having a bath like or having a herbal regardless of what it is if that's what you do every night it will send a signal to your head it's like why reading kids books before bed works because they're like oh it's bedtime I know this like this is familiar it's time to go to sleep yeah no I could no no I see that it's like when your dog knows like what time of the day it is like when your dog knows it's like walk time or like when you're like as in it's specific like as in it's based on your movements that you probably don't even know you do but it like gives you that cue so you're welcome I could work in science just like yeah sure you're all done yeah your little pooches going for a poo um but honestly this has been such an interesting podcast so actionable um i will be prescribing myself more sleep tonight um although i will be having alcohol so probably all can't sweep each other out um but no thank you so much for coming on you're welcome you've been um great and i've learned so much and i'm sure people will find it incredibly helpful i hope so thank you for having me Thank you.