Dr Rupy: Welcome to the Doctor's Kitchen podcast with me, Dr Rupy, where we discuss the most important topics and concepts in the medicinal qualities of food and lifestyle. Today, we are talking about eating for PCOS, or eating for women's hormones as well, actually, with none other than Dr Anita Mitra. She's a really good friend of mine. She's been on the first series of the podcast. She was one of the most popular people, and she is an amazing source of information. Even though we're talking about women's health, this is a podcast that is relevant for everybody. So if you're a guy listening to this, make sure you continue listening because you'll find some really good tips. Hi Anita, how are you?
Dr Anita Mitra: Hi, very well, thanks. Thanks for having me again.
Dr Rupy: Again, I know, this is round two. Well, the first one was super, super popular, and I think it's only right that we invited you back on to have a more in-depth discussion about your chosen topic. Why don't we just remind listeners of what your story is and what your background is?
Dr Anita Mitra: Yeah, so I'm Gynae Geek on social media and I am a gynaecologist, and basically I just love to share kind of digestible information about women's health. It wasn't something that I always wanted to do. I originally started off doing a science degree. And then so I went to medical school and again, wasn't really that interested in obstetrics and gynaecology, and then did it at the end of my degree, fell in love with it. And at the same time also started to really become super interested in having a healthy lifestyle, quite obsessed with diet and exercise, which actually started to have some negative effects on my life. And I didn't have a period for three years.
Dr Rupy: Not a lot of people know about this, right?
Dr Anita Mitra: No, so this is something that I've actually just started to talk about. Because I just think that it's actually really important that people realise that if something like that can happen, and it's quite easy for it to happen, you're not even realise. So I didn't realise that it had happened because I was so busy until I was moving house and I found a box of tampons and I thought, wow, I haven't used you for a while. And a lightbulb realised, yeah, exactly, ding ding. And then I thought, okay, actually, I probably haven't had a period for about maybe seven or eight months. And then this continued, but I didn't really at the time have any insight at all into the fact that it was because I was HIIT training maybe six or seven times a week sometimes, definitely not eating enough, and also very obsessed with making sure that what I was eating was the trendy food, you know, it had to have quinoa and avocado. It was all about what other people were doing on social media and I just completely got sucked into this really what was trying to be a healthy lifestyle but became very, very unhealthy. And that really to me is when I first started to realise the true impact of what lifestyle can do to your women's health.
Dr Rupy: Absolutely, just immediately there, the three things that you talked about, I mean, HIIT training, increasing your cortisol levels, increasing inflammation, stress as well of comparing yourself to others, and then also calorific deficit that you probably put yourself in and maybe even a nutrient deficit if you weren't eating right. So, yeah, it's a trio of things that no wonder.
Dr Anita Mitra: Well, not just that, but also, you know, sleeping about five hours a night, really poor quality of sleep and also being really, really stressed because this all happened at a time when I was just moving to London, I was starting my PhD, just so many things and you know, you've just got really a recipe for chaos there.
Dr Rupy: So should we dive into this? Let's talk about eating for PCOS. And why don't we talk about exactly what PCOS is?
Dr Anita Mitra: So PCOS stands for polycystic ovarian syndrome. Okay, so it's a syndrome, so it's a collection of symptoms and it's different in everybody. They decided that you needed to have two out of the following three. So firstly, irregular periods, signs of having too many androgens, so that would be things like excess hair on your face, having lots of acne. So this isn't just spots, this is, you know, really cystic acne, something that's really problematic, and also, you know, things with mood. And then the third thing is having polycystic ovaries on an ultrasound scan. So they are the three things, but if you have two of them, then you fit the criteria for a diagnosis of PCOS. Another thing that's quite common in PCOS is insulin resistance. You might wonder how insulin, so the hormone that regulates your blood sugar, has anything to do with hormones. Between 50 and 80% of women who have PCOS have insulin resistance and this contributes to why they actually have this problem. And that's because insulin actually stimulates your ovaries, so the theca cells of the ovary, it stimulates them to make lots of testosterone. So then you're adding to the problem. So you've got lots of sugar, not enough insulin to sort it out, you're making lots of testosterone. And then what happens is you don't ovulate. That's one of the really big problems in PCOS. Your ovaries are not able to produce an egg every month as you should in a normal menstrual cycle. And that's why you get that polycystic appearance. It's called a string of pearls on an ultrasound scan. I'm sure lots of people have been for an ultrasound scan and the sonographer tries to show them. I mean, to be honest with you, when I first looked at an ultrasound scan, I was like, what is that? I'm never going to be able to learn.
Dr Rupy: I think we have like a level of assumed knowledge as well when we're in clinic. Exactly. Look at this and can you see this? And I'm like, it just looks like black and white dots.
Dr Anita Mitra: I know. Quite often I'll show patients if I'm scanning them and I say, it's really okay to just say you cannot see what I see right now because it's all pattern recognition. But basically, your ovary is trying so hard to pop out an egg every month and it is not able and that's why you get this polycystic appearance. So your ovary is trying so hard. If you're not ovulating, then you're not able to regulate the rest of the hormones. Your most of your progesterone comes from the corpus luteum, which is the sac that the egg ovulates out of. So your progesterone is not going to be very high if you haven't ovulated and that will cause problems with your periods. So you don't have to ovulate to have a period. That's a common misconception. But if you don't ovulate, you probably tend to have quite a long cycle. So that's why you get infrequent periods with PCOS. And also they can be quite heavy and quite painful. The reason is that the longer you have without a period, the lining of your womb will tend to build up. It gets thicker and thicker and then it comes away and it can be quite clotty sometimes, quite thick with little bits in sometimes, little clots. And also it will be painful often because your womb has to try and contract to get all of that lining away.
Dr Rupy: And I am at the moment doing my womb dance with my hands. Yeah, I think you quite eloquently described the mechanisms behind a lot of the symptoms that women experience and that, you know, we see in general practice and obviously in gynaecology. So that's infertility, irregular periods, heavy bleeding, and pain as well, particularly worsening pain.
Dr Anita Mitra: Yeah, exactly. And I think that the infertility thing is really the thing that scares a lot of women because a lot of people are diagnosed quite, they're quite young and, you know, maybe in their late teens, early 20s. And for them, you know, the idea of having a child sounds completely abstract. But for a lot of women, you know, they think that this is a life sentence that is going to completely ruin all the plans. You know, and we do see a lot of people coming to fertility clinic who have PCOS as the reason for why they're not getting pregnant. But one thing I would say is that the two don't necessarily go hand in hand. It's not, you have PCOS, therefore you will have problems getting pregnant. And actually, the other week I had a student midwife sitting in clinic with me and we were just talking about PCOS before I called the patient in. And she said, oh, I've got PCOS. My GP told me I'd never get pregnant, so I didn't use any contraception and the next month I was pregnant. So if you have PCOS, please use contraception because you, you know, it's not necessary that you will not get pregnant. But we do obviously see a higher prevalence of fertility problems in people who have PCOS. And there are lots of things that you can do about it. And a lot of the lifestyle factors that we're going to discuss today are actually much more effective than any kind of medication that you can have.
Dr Rupy: Absolutely. And I think that's key and that's something that we can actually stand by that this is very effective. And certainly when you think about the risks of PCOS, not only does it pertain to things like lack of fertility, I should have said earlier, but risk of diabetes, risk of blood pressure, risk of gestational diabetes, so that's the type of blood sugar dysregulation, the diabetes when you're pregnant. All these different lifestyle factors will be protecting you against these risks when you have PCOS as well.
Dr Anita Mitra: Exactly. I also sometimes think that actually finding out that you've got PCOS when you're young can actually, you can give it a positive spin. You can say, okay, I have this risk factor for these very common diseases, like as you mentioned, diabetes, heart disease. And it's a great opportunity to just turn it around and do something good for your health that's going to have a massive positive outcome, not just for fertility, but later in life as well.
Dr Rupy: Absolutely. I think I had a 16-year-old come into clinic a couple of months ago with her mother who was understandably worried. She'd done a lot of Google searching and fertility certainly came up. It was certainly not on the mind of the 16-year-old at the time. But yeah, there were lots of questions and I think flipping the diagnosis on its head and saying, you know, this is something that we can manage actually and this is an opportunity to not only lead the healthiest, happiest life, but also prevent these complications from occurring later on in life as well. There's a lot of talk of particular dietary strategies to improve the risks or improve the symptoms immediately of PCOS. Low carbing, that's one thing that I've certainly heard a lot about.
Dr Anita Mitra: I have to say that I don't think that there's one particular way. It's what's going to work for you as an individual and it's trial and error. But I have a few suggestions, of course.
Dr Rupy: Yeah.
Dr Anita Mitra: So I think, you know, I get really disheartened when I have young women coming to me and they say, my GP told me to lose weight.
Dr Rupy: Yes, I think that is a bugbear of a lot of us in this, yeah.
Dr Anita Mitra: And I find it really hard because obviously, you know, I'm quite small. I'm five foot one and three quarters on a good day.
Dr Rupy: That three quarters is very important.
Dr Anita Mitra: Don't rob me of that. And I'm a size eight, but I didn't always used to be. And that's another thing that I always tell patients, you know, I've worked hard to maintain a healthy lifestyle and they can do it too. I like to give my little motivational spiel. But when I say to them, I always start by saying, look, we need to talk about how you can improve your health through the way that you eat and the way that you move. But the first thing I will say is I'm not going to tell you to lose weight. And they all suddenly, like, you know, they look at me and think, oh, okay. And I feel that they suddenly become a lot more engaged. And that's the most important thing. First of all, you've got to engage your audience. I'd like to think it's music to their ears because it's just so destroying to be told you need to lose weight.
Dr Rupy: And it doesn't, I don't think it's very helpful either because I think everyone across the country, everyone says to themselves, I need to lose weight, I need to lose weight. It doesn't give them any idea about how or what an ideal weight for them is. And actually, when you focus the conversation around being well, that's actually when you get a lot more engagement and that's actually where you can have a lot more benefit.
Dr Anita Mitra: Absolutely. And so, you know, if you go online, there's something called the PCOS diet and it just irritates me because it's not, it's about eating for a healthy lifestyle, which as a side effect will help your PCOS. So there is a lot of talk about low carb diets and for me, I don't like the term low carb. I think it just ultimately to me says food fad. And I think a lot of girls that I see these days are scared of carbohydrates. I have girls coming to see me in clinic and as soon as I start talking about the diet, they immediately think I'm going to say no carbs. A lot of patients ask me as well, what do you eat for lunch, for example? And when I say, you know, I'll have chicken with some vegetables and then rice, they're like, oh, she eats carbohydrates. And honestly, they're shocked because there is such a fear of carbs these days. And I've been through that too from looking at social media. A few years ago, I was completely terrified of carbs. Social media told me I was not supposed to eat carbohydrates if I wanted to be lean. So, you know, it's all about the quality of your carbohydrates though. That's something I always talk to patients about. There's some awful diets online where they say eat 20 grams of carbohydrates. Well, you could have 20 grams of carbohydrates that's actually, you know, a bowl of porridge oats and that's much better than having a piece of cake, for example, that is your 20 grams of carbohydrates.
Dr Rupy: Exactly, yeah, yeah. I think there's a lot of miscommunication there. And I think also, it's not just the social media generation. I have patients in general practice who are in their 50s, 60s, and they've suggested to me that they're going on a healthier lifestyle by cutting out all the carbohydrates. So it's really filtering across the board that cutting out carbohydrates somehow equates to a healthier lifestyle, which is not necessarily the case for a lot of people.
Dr Anita Mitra: That's what we've been told over the last few years. So there is actually a little bit of evidence to suggest that the ketogenic diet is actually good for people with PCOS. So the ketogenic diet is where you put yourself in this slightly unnatural state of ketosis. Well, it's it's not an unnatural state. It's something that your body does go through, but it's not something that you're supposed to be in all the time.
Dr Rupy: 24/7, yeah, like a lot of people.
Dr Anita Mitra: Exactly. So it's based on having a lot of protein, a lot of fat, and then it's quite restrictive in terms of what you can have in terms of carbohydrates.
Dr Rupy: It's basically where you flip your body's main energy consumption from carbohydrate sources to fat.
Dr Anita Mitra: There is evidence to suggest that it can help insulin resistance. So as I mentioned at the start, that's something that's a problem for a lot of women with PCOS. But is it something that's sustainable? Because if you're on a ketogenic diet, are you going to stick to that? If you can, that's absolutely fine. But for a lot of people, that's going to be very, very restrictive. For me, it's not something that I would like to do because, I mean, you and I have a shared love of colourful vegetables, don't we? And you won't be able to eat all those things. And for me, the ketogenic diet misses out a lot of things that I really enjoy in my diet. And I worry slightly about the fact that it's quite a low residue diet. You're not getting a lot of fibre as well.
Dr Rupy: I yeah, I think that's probably the prime concern for me certainly is when people go on ketogenic diets, I don't mind, you know, if you want to try something and you find that it's been beneficial for you, do it safely and do it with the supervision of a health professional. Long-term strategy, as a long-term strategy rather, when you're removing that much fibre and from what we know about the importance of the microbiome, the population of microbes living around our body, largely centred in our gut, you know, it's not going to be a good thing reducing their food source essentially. And also there's the side effects of going on a ketogenic diet, which include bad breath, nausea, constipation, and the fact that it's pretty difficult to live a normal way of living if you're constantly searching for fat and protein sources and trying to eliminate sources of carbohydrates, which include most vegetables.
Dr Anita Mitra: Exactly. And that just kind of makes your life much more restrictive and it means you have to think a lot more about food, which I think just generally kind of increases anxiety for me at least. And the thing also I would say about fibre and women's health is that having a good poo is the way that your body gets rid of excess oestrogen. And it's a massive problem. So most people in this country don't eat enough fibre, but we think we do because we have caffeine. So a lot of people when they actually look at how much they're eating, they're not having enough fibre, but they're still going for a poo every day because they're having their coffee in the morning or lots of tea and things. But if you get constipated, you can actually get a build up of oestrogen in the body. And if you have PCOS, you naturally will be more oestrogen dominant because of the fact you're not ovulating, not making progesterone. But this also applies to lots of gynaecological disorders. So fibroids tend to be oestrogen driven, endometriosis, and also can contribute to just things like PMS, so premenstrual syndrome. So it's really important to be helping your body to eliminate all the waste products by making sure that you're having a healthy poo every day.
Dr Rupy: Lots of fibre in your diet. Absolutely.
Dr Anita Mitra: Exactly. But then so then there's the Mediterranean diet, which we're both huge fans of. And that also equally has been shown in a lot of populations to be very useful at preventing diabetes. So again, it can be helpful for insulin resistance and for people with PCOS. And there's actually been studies to show that the Mediterranean diet is much easier to stick to. And it's just, you know, it's a much more applicable principle to life. It's something easier to do. You don't have to shun any particular food types.
Dr Rupy: Yeah, and I think like as a starting point for a lot of people, a Mediterranean way of eating is very appropriate and it's very achievable as well. Really, what a Mediterranean way of eating is is colours, lots of different sources of fibre like beans, legumes, good sources of quality fats.
Dr Anita Mitra: Fats are so important though as well, as you touched on it, because that's what our female hormones are made of. And lots of hormones in our body. So they're steroid hormones. They're made from cholesterol, which you get from good fats. So that's why it's really important for women to eat things like avocado, nuts, good healthy oils. And that's something that a lot of women are still quite scared of. I remember when I was tracking my diet all the time, I was terrified to eat avocados at that point because they're full of fat. But again, it's all about when you get a bit too obsessed with the details. Exactly, yes, yeah. You know, it can all become a bit too much, but you need to eat healthy fats. And also, I think that the low fat diet that used to be quite popular a few years ago is also really not that healthy, particularly for people with PCOS, because if you're buying a low fat alternative, it will tend to have much more sugar. You think that you're being healthy because you're not having fat, but then you're actually giving yourself tons of sugar, which you're then spiking your insulin, you're making testosterone, and you're not going to ovulate and all of that.
Dr Rupy: Exactly. You can see these downstream effects, right? And I think that's where we have an unhealthy obsession with particular elements of a diet, whether that be fat, whether it be calories. We really lose the grander picture, which is whether our diet is wholesome. Are you having whole sources of fats? Are you having whole sources of fibre and colourful fruits and vegetables with the skins on and, you know, largely processed to a minimum, etc. All these different things. So from a Mediterranean perspective, there are different sorts of phytonutrients that we find in these sorts of diets, right? So reds, the oranges, the purples. These are going to have a direct impact on the symptoms of PCOS as well, as well as the risk factors for things like diabetes and cardiovascular disease, right?
Dr Anita Mitra: Exactly. So they're all helpful for, you know, the whole spectrum of complications that can be associated with PCOS. So you're going to be able to reduce your blood pressure, you're going to be able to keep your sugar levels under control. And all these are really important. And also another thing that a lot of people worry about is endometrial cancer. It's known to be associated with PCOS. There's about two and a half to three times the risk for women with PCOS. The reason that PCOS is associated with this may be to do with insulin resistance, but also if you're not actually shedding your endometrial lining every month well, we want to be getting people to the point where they are having a regular cycle. So by making all these little changes in your diet, you'll start to find that you will start to ovulate, you'll start to have more regular periods, and that's when you know that you're actually doing something positive for your health.
Dr Rupy: Exactly, yes, you're reducing that unfortunate cancer risk. Also, I think a lot of the things that people miss out on when it comes to choosing a particular way of eating is when you do a lot of the things that are similar across all diet spectrums, and that is removing refined carbohydrates, removing the things that are highly calorific and nutrient poor, like fizzy drinks, and improving the amount of vegetables that you have in your diet, you're doing pretty much some of the best things that you can do overall. So it's no wonder there are successes of individual diets because the core of what they're doing is very, very similar.
Dr Anita Mitra: Yeah, so I think the main thing is, I just think find something that works for you that you're going to be able to stick to. And is not too restrictive because the problem is that, you know, these are all young women often that are diagnosed with PCOS. And I don't want to be giving anybody anxiety regarding food. I don't want people to become faddy eaters because of the fact that they are worried about their PCOS. I want somebody to adopt a way of eating that makes them feel good and has a positive impact on their gynaecological health, but also on their health in general.
Dr Rupy: Absolutely. So that's diet. Exercise. Now, this is like your favourite subject, I think. Yeah.
Dr Anita Mitra: This is my absolute favourite and I will go to town on this. It's something that I get asked about a lot. And this again is not just applicable to women with PCOS. This is for any woman who has hormones. So, that's everyone.
Dr Rupy: That's everyone. Yeah, that is, yeah.
Dr Anita Mitra: As I said at the start, I was really obsessed with HIIT training and a few years ago, it really became the thing to do.
Dr Rupy: Yeah, it just blew up, didn't it? Yeah.
Dr Anita Mitra: Exactly. So that's high intensity interval training. And so what that means is it's an exercise that you'll pick a couple of exercises and you'll go like balls to the wall for 20 seconds, 30 seconds, you know, for a short period of time.
Dr Rupy: That's what my coach Adam calls it.
Dr Anita Mitra: You know, you'll really go for it for a short period of time and then you'll rest and then you'll do it all again. And so there's lots of workouts online or lots of classes where you can go and do that and you're doing that for maybe half an hour, 45 minutes, even an hour sometimes.
Dr Rupy: An hour, that's a lot.
Dr Anita Mitra: Yeah. And so when I was doing that kind of thing, I was always on fire. Like temperature wise, I was sweating all the time. I always felt like, you know, my metabolism was on fire, so I thought this is amazing. I'm doing something really good for myself.
Dr Rupy: Yeah, yeah.
Dr Anita Mitra: But it's not good to be like that all the time. Because basically when you're doing that kind of thing, HIIT training has been shown to increase your insulin sensitivity. So I can see why it would make sense in PCOS. But it also is not something that you need to be doing all the time. So if you are chronically doing HIIT training, if you're doing it, you know, more than three, four, five times a week, and that's your predominant form of exercise, that's too much for most people because you're going to be massively spiking your cortisol levels. So cortisol is your stress hormone. When you make cortisol, you do so at the expense of progesterone because they're made in the same pathway. So your body preferentially makes cortisol because you need cortisol to survive. You'd like to make some progesterone, but you don't need it to survive. You need the cortisol. So your body does that. So if you're using up all the ingredients, you can't make progesterone. So that's going to have an impact on your women's health.
Dr Rupy: And this particular pathway that we're actually talking about right now is also the same pathway we talk about when we talk about stress as well. So it's really interesting to see how exercise is having this essentially, we're taking away the raw ingredients from producing progesterone and putting it towards cortisol. So we're creating an imbalance there.
Dr Anita Mitra: But HIIT training is very interesting because I think as a mode of exercise, the research is pretty old. It's come out like at least 20, 25 years ago now. There were some Japanese researchers and they certainly weren't doing HIIT training for an hour straight. It was usually less than 45, 30 minutes.
Dr Rupy: Exactly. All the studies I found actually do HIIT training for quite a short period of time, but we've kind of like taken it that step too far, I think. And I get asked a lot via social media, particularly people say, you know, how many times a week should I be exercising? How many times a week should I be doing HIIT? And all this kind of thing. There's not one rule for all. And I always say to people as well, it depends what else is going on in your life. So for some people, you know, if you're quite a chilled out person and you're eating well and sleeping well, then maybe you can do five HIIT sessions a week and it's not going to affect you. But if you are somebody who maybe sleeps five or six hours a night, goes out three evenings a week, has a very stressful job and is always eating on the run, for example, then HIIT training probably isn't great for you. So I'm much more of a fan of strength training for women. And when people say, you know, hear the term strength training, they think, oh, she's going to tell me to go to the gym and lift weights. And yeah, okay, that's what I do. And if you look on my social media, you'll see that yes, I do go to the gym, I lift weights and I have an amazing strength coach called Adam Willis.
Dr Anita Mitra: I thought you were about to say I have amazing guns. Well, let people decide what they think about my guns. But I like weight training and that's my kind of strength training that I do. And that's my time to go and just be quiet. I don't have any phones or emails. I go at 6 o'clock in the morning. That's what works for me and there's no one in the gym. I don't have to talk to anyone. And that's almost like for me, my kind of like mindfulness time as well.
Dr Rupy: I was just thinking that as well. I think a lot of people find gym work, whether it's strength training or otherwise, a form of mindfulness, which is very important.
Dr Anita Mitra: Yeah, absolutely. But then there are other kinds of strength training that you can do. And there's lots of great workouts online and lots of people putting great videos out on Instagram and on YouTube of things that you can do. And you can be so creative. I mean, there's all these people who do all these great home workouts just using sofas and chairs. So many things you can do. And strength training compared to just pure cardio is much better in my opinion for women's health because women are more likely to have thin bones, you know, later in life, osteoporosis. And so when you load your bones, they become stronger. So you want to be building bone strength when you are young. So it's really important for that. But also, strength training tends to build lean muscle. So particularly weight training has a bad reputation amongst women because they think they're going to get really bulky and they're going to end up, you know, looking like the incredible Hulk. Well, that doesn't happen to women unless you're really, you know, trying to achieve that. But the reason that strength training is good is because you build lean muscle, so you actually lose a bit of adipose tissue. So you might not find that your weight changes. In fact, some people's weight will go up. I'm my heaviest when I'm strongest and leanest actually, because I have more muscle at that point. Lean muscle is much more insulin sensitive compared to adipose tissue, so fat tissue. And also fat is the source of testosterone in women. So about 50% of your testosterone is made by your fat tissue. So if you've got more fat tissue, you're going to make more testosterone, which again, will have an impact on your PCOS symptoms. Exactly. So if you're doing something that is beneficial in that respect, then that will have a positive impact on the outcome. So lots of people who've started strength training have actually found their periods are coming back because of the, you know, complete different impact it has on your hormones and on your body.
Dr Rupy: That's brilliant. And I think that is going to be revolutionary for a lot of people to hear that actually strength training can have that impact, or at least the variety of exercise that we should be introducing our patients to. Certainly, I have a lot of people doing HIIT training and that kind of stuff. And it's been great for their fat stores and their energy levels and the post-exercise metabolism, the one that made you like a heater 24/7. But certainly, like, you know, adding things like yoga and stretch and flow and mobility, adding that quiet time. And I suppose that leads us quite nicely onto the next sort of topic, which is stress reduction and PCOS.
Dr Anita Mitra: So that's so important. So first thing I would say is there's a really interesting study that I was reading recently, looking at some girls in India. So there's 90 girls in India and they all had PCOS. And what they did was they got them to do an hour of yoga every day for 12 weeks. And they found a massive improvement in all of their biochemical markers, so lots of blood tests that they did, and also in their PCOS symptoms.
Dr Rupy: So it's both subjectively their symptoms improved as well as objectively when we look on a blood panel, they had improvements.
Dr Anita Mitra: Exactly. And so you might think, okay, well, that's not really achievable for me. I can't do an hour of yoga every day. And I mean, I completely agree for most people, it's not achievable. As I mentioned before, the message is all about what is achievable and what are you going to stick to. But even if you just say start by doing it once a week, that's going to help because when you do yoga, it's been shown that it improves your stress levels, so you're going to make less cortisol. Another thing to mention actually as well with regards to PCOS is that your adrenal glands make testosterone. So that's another source of if you're very, very stressed, you're going to be increasing your testosterone there as well. So you're making more testosterone, you're making lots of cortisol and it's expensive progesterone. Also, stress can actually turn off the production signals for your female hormones in your brain. A lot of people don't realise this. So a lot of people think that their brain is completely disconnected from their ovaries and their womb. It's just not true. So it's called the hypothalamic pituitary ovarian axis. So the HPO axis, and this also integrates with the HPA axis, so that's with the adrenal glands as well.
Dr Rupy: Yeah, because I think a lot of people have heard of HPA axis and yeah, but HPO.
Dr Anita Mitra: Yeah, and the reason is it's completely an evolutionary phenomenon. So, for example, your body thinks that there's a lion chasing you, which is what you're doing when you're running around all day at work and then running all around all day in the evening and then doing your HIIT workout. You know, from an evolutionary point of view, your body thinks you're being chased by a lion. So it says, danger, got to switch off the signals. And that's what it does. It switches them off centrally in the brain. So you won't be making all of these hormones because it doesn't want you to get pregnant.
Dr Rupy: Yeah, and you can see how this is having impact on all normal hormonal issues, right? With women, it's not just PCOS that we're referring to.
Dr Anita Mitra: Exactly. And and again, yoga's been shown to be associated with better outcomes in terms of diabetes, heart disease, also brain function. So I think that we really underestimate the impact that psychological health and mental health can have on our on our menstrual cycle. I mean, lots of people will be nodding now thinking, yeah, okay, I've been really stressed and I didn't get my period that month or my period was late. It's all due to the stress that's happening around you. It's a real thing.
Dr Rupy: Yeah, totally, yeah. I'm glad we can say for definite, this is a real thing. And even if you can't achieve, you know, an hour of yoga or, you know, 20 minutes of meditation per day, any amount of that particular activity that creates inner calm, that's good for your physical ability as well, is going to have some benefit. And you may even decide to prioritise a bit more time per day to this activity when you actually see the benefits that can be achieved.
Dr Anita Mitra: Yeah, absolutely. And I had a patient the other week and I was talking to her about exercise. And she was like, yeah, I've got a gym membership, but I don't go. And I said, look, you don't need to go to the gym to exercise. Because this is what society tells us. It tells us that we have to go, we have to wear the best lycra, we have to, you know, be sweating and, I mean, it's all about the lycra, isn't it? No, but it tells us that exercise is something that's done in the gym, but exercise is something that you can do anywhere. And then so I had a discussion with this lady trying to work out how she could fit it in with her day. And I said, how much time do you get for lunch at work? And she said, oh, I get an hour. So I thought, okay, that's great. That's really lucky. If I had an hour for lunch, I'd be living the dream. But yeah, so she said she had an hour. So I said, great, why don't you go for a 20-minute walk? Then you've still got 40 minutes, you can eat your lunch. And I said, can you go and walk somewhere to go and get your lunch, for example, if you haven't brought it with you? And then I said, just go for a walk, don't take headphones, just go in your own thoughts. And so then she would be doing two things. She would be getting some exercise, but also having that mindful time to just relax. We have constant stimulation all the time. You know, you've got amazing podcasts that you could listen to. You can get the radio on your phone these days, you can listen to music. We're always being stimulated. And then so you don't have that time to just let your brain just, you know, process all the things that it wants to process. And I think that really contributes to poor sleep in a lot of people. Because sleep is something that I really talk to my patients about a lot. And it's something that I'm working on in myself, I have to admit.
Dr Rupy: Yeah, yeah. We all are really when it comes to sleep.
Dr Anita Mitra: I think me and you are quite bad actually. We don't really practice what we preach, do we? I've seen the time that you're posting your Insta stories at night.
Dr Rupy: I know, yeah. And everyone's like, everyone's texting me like, you should be in bed by now. You shouldn't be using your phone. I know, I know. Do as I say.
Dr Anita Mitra: But it is so important. And I think that if you're very stressed, I mean, I personally like clench my jaw when I'm really stressed and I know that I haven't had a good quality of sleep. So these are things that you can look out for in order to actually see if the things that you are doing are having an impact. Because you need positive reinforcement from somewhere. So if you feel that you're waking up more refreshed, you haven't been clenching your jaw, you haven't been having funny dreams and things, you know, that's a little bit of positive reinforcement that these little things that you're chipping away at every day are actually having an impact on your health.
Dr Rupy: Absolutely. And I think it's that positive reinforcement that people lack and that constant engagement and, you know, testing the waters, trying out different things, trying different mindfulness techniques. I had a patient that, basically said that, you know, she'd been meditating for 15 minutes twice a day. And I was like, wow, that's amazing. Do you feel more relaxed? She was like, absolutely no. And it's because she was using an app that she didn't really like using, but she wanted to stick with it because she'd been told that it was beneficial for her. I think there are lots of different mindfulness strategies that we can find. And I think your sneaky way of doing a walk and a mindfulness strategy is something that I'm going to, I'm going to borrow. That was a good one, yeah. Anita, it was an absolute pleasure. Thank you so much for coming back for a second time. I think we've got lots more things to talk about as well, and I'm sure we'll be doing this again and there's going to be lots of comments and stuff like that. But just to sign off, where can people find you and what are you up to next?
Dr Anita Mitra: So you can find me at gynaekeek.com or at Gynae Geek on Instagram and Twitter. And keep an eye on what I'm up to. That's all I'll say.
Dr Rupy: Dr Mitra is one of my closest friends in this. I can't tell you how much of a pleasure it was having her again on the podcast for a second time. You can find her at Gynae Geek on Instagram and her website, again, is brilliant. You should definitely go check it out and follow her. I'm going to summarise some of the key points that we had from our conversation here. So we talked about fibre. Now, fibre is particularly important for women's hormones. As Dr Anita said, it actually helps clear excess of the women's hormone oestrogen from the body. So it's really important when it comes to reducing your risk for a number of different conditions. Nutrient density in the form of colourful vegetables. I mean, if you remember to series one, we talked about phytochemicals and what those actually mean. Nutrient density is things that we get from a Mediterranean style diet. So that's colourful fruits and vegetables, the greens, the yellows, the purples, very, very important, and all the different anti-inflammatory effects that they have as well. Refined carbohydrates. So excess sugars in the diet, excess processed foods. By just simply eliminating some of those or the majority of those in your diet can have an effect on women's hormones. Exercise and variety of exercise can be really important. And actually as a form of exercise, which is almost a form of mindfulness as well, is yoga. Anita is a really big fan of that. And I think given that there are some small studies looking at how it could be effective for some women's health issues, it's something that you may want to try as well. If I was to suggest a recipe that sums up exactly what we were talking about today, it would be the butternut massaman curry from my cookbook. It is fantastic. It's got lots of different vegetables in and it is very easy to make. So make sure you get to the kitchen and start cooking that up and subscribe and comment on this podcast. It really helps spread the message and get this information to more people.
