The Truth About Plant-Based Diets And Women's Health

If you're a woman struggling with issues like menopause, Polycystic Ovary Syndrome (PCOS), hot flashes, or any other health concerns, you may want to consider a plant-based diet. That's according to Dr. Nitu Bajekal, a gynecologist with over 35 years of experience in women's health. Dr. Bajekal is the author of "Living PCOS Free", and she says that a whole food plant-based diet can offer a number of benefits for women's health. For example, it can help to regulate hormones, reduce inflammation, and promote weight loss. During the interview, Dr. Bajekal provides tips for transitioning to a plant-based diet, and she also shares her own personal story of how this way of eating has helped her. If you're interested in learning more about how a plant-based diet can improve your health, be sure to check out the podcast interview with Dr. Bajekal. Trust me, it's worth a listen!
Hosted by
Laurie Marbas
Last updated
September 2, 2022


00:01:36 Introduction
00:02:31 Why Dr. Bajekal first got into medicine
00:11:00 When Dr. Bajekal became vegan
00:16:18 Benefits of a plant-based diet for women
00:17:36 Dr. Bajekal's book
00:23:42 What is PCSO and why plant-based lifestyle medicine is effective at treating it
00:41:11 How a plant-based diet helps with menopause

Podcast Transcript

Dr. Laurie Marbas: Welcome to the podcast. I'm Dr. Laurie Marbas. And today I'm very excited to welcome someone across the pond in I'm really interested in seeing just all the amazing differences between the UK system and the American system, but welcome Dr. Nitu Bajekal. How are you today?

Dr. Nitu Bajekal: Thank you, Laurie. Thank you so much for inviting me. I'm so excited actually, to continue our chat and, and hopefully the, the people who listen to your podcast will benefit from what we have to discuss.

Dr. Laurie Marbas: Thank you. Yeah, I, I agree. There's, there's many things because of your specialty being OB gen, and there's some, so many things that women struggle with, but before we get there, I always like to kind of make this a little bit more personal and learn about your background. So can you tell us a little bit about, first of all, you know, where you came, you held from originally, and honestly what made you decide to go into medicine?

Dr. Nitu Bajekal: Okay. That's a longish story, but I shall try and make it a bit short <laugh>. So I was born in India. I'm south Indian, if you know, India the, the geography I'm south India, south Indian by by birth, but actually grew up in Calta or Karta as it is known. So I'm a Bengali at heart. So I had to listen, just hear word spoken in Bengali and my heart sings. And, you know, it's, it's something that is very close to me. And I was meant to go to medical school in Karta. My father was an engineer. My, my mother was a teacher but she actually held down four jobs. And what happened, my father was a very hands-on father in those days. And it was really, I was very blessed in, in many ways because I didn't really consider myself as a girl.

Dr. Nitu Bajekal: I have a brother in between and older sister and me and all three of us were always treated exactly the same. It was only when I went to medical school at the age of 18, I suddenly realized, wow, I'm actually a girl. There are differences here. <Laugh>. And so it was quite refreshing for me now, looking back as to how advanced my grandparents and my parents were but we were isolated nuclear family in cold QTA, and we were vegetarian by by caste, if you, if you know what the Indian system is, however, my mother was an atheist and my father was an agnostic because we came from the so-called upper cast or the oppressor cast as I, I like to call them. So basically we were not eating any meat or eggs or fish. But my mother was doing that from the ethical point of view.

Dr. Nitu Bajekal: And so she was occasionally I would go to my friend's house Bengal or called ware is, is the capital of Bengal is a, quite a heavy fish, eating, meat, eating state, and a contrary to what people think most Indians actually do eat meat rather than not. It's because of the cost factor that they don't eat. And so this idea that India's largely a vegetarian country comes from the fact that mostly the privilege come out into the Western world. And so you think that they are predominantly vegetarian. So I would occasionally go and taste some goat or and my mother would be quite horrified and she would say, oh, why are you doing that? Don't you realize what's happening to the the goats that are being tied up because in India, the, the butcher shops are often quite next to your home and you can see them crying because of the fact that they know they're going to follow their brother or sister.

Dr. Nitu Bajekal: And I said, ah, they're actually already dead. And so I did eat some meat a couple of times a year, probably. But predominantly I was, I would say actually whole food blonde based with some, a bit of dairy and a bit of oil, because they were very expensive in those days. And so we really couldn't afford to have a lot of that. So it was a very I was very sporty as well. And my father was particularly happy because I had had polio before the polio vaccine had come in and I had a mild attack now looking back because obviously I wasn't left with anything other than very mild you know, weakness in one of the legs. And polio is a very dangerous virus. And now I'm so pleased that it's eliminated because of the vaccine and you know, hundreds and thousands of children would die from respiratory problems and then all be left disabled from with paralysis.

Dr. Nitu Bajekal: And so my father was always very proud because I was very good on track and field events, but in India, you didn't have that option of going getting a scholarship to do sports. So my brother, my sister first became a doctor and then my brother became a doctor. And so I thought, you know what, can't do anything else. Let me follow what they're doing. So I didn't have any reason to go into medicine when you were asking me a lot of people know from the beginning. I didn't. I just thought if you're good in studies in India, you either became a doctor lawyer or an engineer. And so I chose medicine because my sister and brother were there and thank God I did Laurie, because it was the best thing I ever did in my life. It was absolutely spot on the profession that has never failed to thrill me and excite me.

Dr. Nitu Bajekal: And I joined medical school 42 years ago. And I was very fortunate. I went to a wonderful medical school, one of the top medical schools on the seaside, a French town called pondi cherry deep in the south. And I met my wonderful husband now you know, all that, those years ago, we were in the same year. And within a few years when it came to choosing the subjects, I knew very quickly that OB GYN was the, the subject for me because it had that perfect mix of surgery. I knew I wanted to do surgery. It had the perfect mix of medicine, but it also had a lot of psychology. And I just loved the fact that I was able to combine all these three and actually, you know, train in a specialty that ticked all those boxes. And so for me, I have never felt at any point, any regret, except this joy that I, I chose such a wonderful specialty, highly intense though.

Dr. Nitu Bajekal: There were very few women because of the long hours. And so that was tough. And so we moved to Delhi to do our residency. And in again, it was one of the, the top medical schools in all Institute. And we were 29. We'd sat every possible exam in India. And we, we, I just, we had just had our first daughter and we thought there must be more, you know, we can't settle down to becoming consultants at 29 in a big teaching hospital. I, I just didn't feel that was right. We said, let's go and see the world. And we didn't want to go to the us cause we heard people don't come back to India. So we went to the UK and of course we are here 30 years later, no regrets. And that's to do with the NHS you know, the national health service in India in the UK for me was epitomized the way I wanted to practice medicine free at cost, without having to ask the person who has walked in through the door pregnant, or with HIV or with cancer, what is your financial status?

Dr. Nitu Bajekal: None of that has ever needed to be asked. And I just loved the way I could practice medicine. And so we took a decision to stay and we both became consultants about 22 years ago. So that was over the time. And then when I came to the UK, I was pregnant with my second daughter and I saw a couple of programs on the television. And those couple of times that it was eating chicken and things like that without realizing cuz in India, you often don't see meat on the bone. You often see it in little pieces. So once a month we would go into town and splurge and we would have some dairy called pane and some chicken because it, we were vegetarian hosp hosts and I never much thought much about it. And I saw these couple of programs and I was pregnant.

Dr. Nitu Bajekal: And for me, this was like a little switch and I became completely vegetarian. I didn't know the connection between dairy and meet at that time. And my brother then came shortly after that from the us and he was vegan and I still didn't get it. I didn't understand it. Maybe I wasn't willing to listen. And so fast forward. And my younger daughter who currently lives in New York she was about nine or 10 and she came home having grown up eating sausages and things outside said I'm going vegan. And I said, what do you mean? Why can't you be vegetarian? And she said, mom, don't you understand that red equals white or white equals red? And I said, what do you, I don't understand that. So she said, mom, the white milk that you're drinking, are you making me drink? Becomes the cow has to go to the slaughterhouse in two of three years because she can't produce anymore milk.

Dr. Nitu Bajekal: So, you know, just because you're eating dairy, don't think you're not eating meat or contributing to the, the, the carnage. So for me it was like a light bulb and I became vegan. You know, this is about 22 years ago. Wow. And it was really hard because obviously there was nobody else that we knew who was vegan. My brother was in the states, my parents and my sister became a vegan, but my immediate family and in the UK, all my friends were not vegan. So they looked at me completely AGAs because suddenly I was this person who was not, who looked like them, but wasn't behaving like them. Mm. And so it was tough for me and my two daughters, you know, we would go for these fancy medical dinners and we would be given an apple. I would be given an apple at the end of the thing.

Dr. Nitu Bajekal: And I would've paid a, a ton or a stuff pepper with some very sad looking rice <laugh> oh, often, often nothing, actually just some white lettuce. And so it was very tough, but I became very quickly, very good at cooking and at at baking. So, you know I'm here, but the real change came about five years ago when my husband, I came back from work and my husband said, I'm going plant based. And I said, wow, what did I say? 18 years later? And he said, no, I actually watched forks over knives. <Laugh> because he'd been trying every single diet, keto, paleo, everything. He never ate meat. He stopped eating meat in 94 or something like that, but he ate fish and eggs because he didn't want to make a fuss when he went out, he ate vegan at home, but also he didn't see, didn't think he thought it was good for him.

Dr. Nitu Bajekal: And of course he was getting progressively more diabetic, progressively overweight. And so he decided after seeing folks over nice, you go plant based and then became vegan pretty quickly after that. And now tells me, I wish you had forced me. And I said, now everybody has their own journey. <Laugh> everybody has their own journey, but it was the best thing that happened. People often say having children is the best thing that happened in your life. And I love my daughters, but I think the best thing was a gift that was given to me was when Raji turned around and said he was going plant based for me, it was a big load of my shoulders. It meant I could start writing my books. I could just be even more myself than than before. So that's my story a bit long as I said,

Dr. Laurie Marbas: <Laugh> no, I love it. So your daughter really was the catalyst for you just to kind of put all that together. And I love that it comes from innocent children. They're just so intuitive and just say it the way it is. It's like, you know, the truth just falls outta their mouths. Like it's just amazing.

Dr. Nitu Bajekal: <Laugh> and the other thing that also happened, Laurie was just before I turned vegan, I actually thought I was very stressed. I was just applying for consultant jobs and my period stopped. And I thought, oh, I'm very stressed. But what actually was happening is I went through premature over in an insufficiency. And your listers may not know what that means. There's basically premature menopause and anybody under the age of 40 you know, that's not common. So only one in hundred women will go through a situation that I went through and, you know, menopausal hormone therapy is really important, but that was the time when the w H I study came out and I was really struggling. And I didn't know where to turn for help because there was just no information. And interestingly, when I turned vegan, because I was not vegan in the traditional sense, I was really whole food plant based because there wasn't anything <laugh> right.

Dr. Nitu Bajekal: I was a whole food plant based vegan, you know, wearing non leather and non-sale, but also eating, you know, food that was completely cooked at home because there wasn't any choices, you know, these wonderful pizzas and burgers and things that we see now that in the UK, in London, where I live, there is so much of choice, which I think is great. Doesn't necessarily always be best for your health, but, you know, that is always a place for those foods. Mm-Hmm <affirmative>. And so for me, a lot of my symptoms improved hugely, but the skeptic that I was the scientist in me, never believed that anything that I had to do, because I was always active. I was always slim. I didn't know that I was healthy. So I didn't realize that what I was eating was actually making the difference because my parents also were very healthy and I didn't realize it was their diet that, you know, I just thought it's genetics, right?

Dr. Nitu Bajekal: And it took me another 10 years to understand the science. And I got very upset and angry because all this information was there. And I was seeing 4,000 patients. I was operating on them. I was delivering babies. I was doing complex surgery. Mm-Hmm <affirmative> and there was something always missing in my toolbox. And that really was lifestyle medicine. And so when I found that out, I started putting it into practice to, with my patients, but I just felt I had so much of lost time to catch up on and to tell my patients I was vegan and they would try and understand a bit, but I didn't want my patients to go vegan. I wanted my patients to understand it from the health point of view, because the evidence was so staggering that I just felt, oh my God, I have really not helped my patients because every aspect of women's health, there is not a single aspect of women's health reproductive health.

Dr. Nitu Bajekal: You know, when I say women, I, I mean, I want to include those assigned female at birth. So that's very important for people to understand mm-hmm <affirmative>, but there's no aspect of reproductive health that does not benefit where there's painful periods, where there's heavy periods, whether it is optimizing fertility, whether it is optimizing your menopausal symptoms, whether it is preventing dementia or heart disease, more women die of heart disease than men do you know, preventing or reducing the risk of cancers, bowel cancer, breast, breast cancer, ovarian cancer, wound cancer. You know, one in eighth of women in the us and one in seven in the UK will get a lifetime diagnosis of breast cancer. And we know a large part of that can be reduced by changing the way one eats and lives. So I've been really throwing myself into this, and I felt that the time had come for me to start, cuz I was talking to, I go to schools, I, I talk to the public and I felt I needed to pin some words down. So hopefully we'll be to be able to help people who may not be able to, you know, experience or benefit my 35 years of experience.

Dr. Laurie Marbas: Mm, absolutely. Which is a beautiful segue to tell us about your book and your work and, and specifically the P C O S

Dr. Nitu Bajekal: Yeah. So about eight years ago, I want, so I set up a organization, a voluntary organization, not charity because I didn't want to be bossed around by others. I just wanted to use my private practice money into doing some good. And so I set up an organization which allowed me to go into schools where we would do half day or full day workshops, where we would teach six formers you know, yoga for painful periods meditation or breathing breath work before an exam to relieve stress dancing, to improve their mood and Pilates for core strength and nutrition, we would make them try a new food that they have never touched before and teach them about the basics. Cause a lot of children in the UK would come to schools in the inner cities, especially with a packet of chips and things like that.

Dr. Nitu Bajekal: So I really wanted to do that and I was doing a talk to about 200 GPS and I was following on after a breast surgeon and the topic was how to prevent breast cancer. And this person went up and started talking about breast cancer. But what, the words that came out was really about early diagnosis, it was about mammograms, about fine needle aspiration. It was about ultrasound diagnosis. There was not a word about prevention. So I, I had just started writing my book. This was about eight or 10 years ago, eight years ago. And I said, you know what, there's no point writing a book. I need to go out. And that's when I set up my organization and what anyway, then that continued and I didn't get a chance to write. And then COVID the pandemic happened. And I started writing a book on general women's health.

Dr. Nitu Bajekal: When my daughter came along last February, I just literally started penning it down in October, 2020. I had put a few thoughts down and in, in Fey, my daughter who's, co-written the book with me. She said, mom, why are you writing a woman's general women's health book? You are writing three pages on menopause, three pages on P C O S three pages on endometriosis. And that's really doesn't reflect the experience that you have had for 35 years. You've not going to be able to tell people how to change things. It's a book that doesn't do your experience. Justice. You should really be doing a deep dive into conditions that you always talk about how patients have made such dramatic changes. And why don't we write about polycystic ovary syndrome is the most common endocrine condition is the most common hormonal condition to affect women.

Dr. Nitu Bajekal: And those assigned female at birth in the reproductive age group and she herself. And she said, I have P C O S and I've been able to put it into control. So why don't we write about this? It's such a stigmatized condition because of the science and symptoms that really prevent people from coming up and talking about it. One in 10 women suffer from this condition. We think one in four women who belong to, you know, Hispanic and Asian and, and subgroups, including those who are trying to struggle to get pregnant. And those who are carrying excess weight, for example. So, you know, it's, it's the most common condition for fertility infer cause of infertility as well in women. So it was, it's just not spoken about because the stigma of having acne in your adulthood, living in a larger body, having excess facial hair or body hair, losing your hair from the top of your head not being able to conceive.

Dr. Nitu Bajekal: These are all very stigmatizing conditions because the society tells us that we've gotta be smooth like dolphins. We've got to, you know, pop out children whenever we want to. And you know, so that sort of expectation means that people don't come forward. And 75% of women never get a diagnosis of their P C O S never wow, in their entire lifetime, because they may come and see a gynecologist for missed periods or irregular periods. They may go and see a dermatologist for acne. They may go and see a therapist for anxiety and depression, which is also a features of polycystic ovary syndrome. They may go see a fertility specialist. They may go and see a psychiatrist. They may go and see somebody, a therapist, again for bingeing eating disorders or an endocrinologist for insulin resistance, which is the, so what happens is nobody's joining these dots.

Dr. Nitu Bajekal: They may go and see a beauty therapist for laser hair removal. So you can imagine all these variety of symptoms and nobody's joining the dots. So what I want is to empower the person who has the condition and hopefully health professionals who read it because we are getting such good feedback that, you know, you should learn to join the dots and perhaps tell your health provider, listen, I think I have this condition. Can you help me by doing these particular tests? Or do you think you can reassure me that I actually don't have this condition? That was the driving force of the book is to empower people, whether you have tic overview syndrome or not is to actually understand your body, understand how lifestyle plays an important role alongside or instead of Western medicine. So it's not one or the other, you may need to have medication.

Dr. Nitu Bajekal: And often medications are very useful in many women's health conditions. So this book is actually not just for those with polycystic over syndrome. It's for some, I have had now so many men write to me saying that they're learning so much from the book, not just about the female reproductive health, but also just generally, because part two and part four are applicable to everybody. And then the it's a deep dive into polycystic syndrome, but we talk about periods and why understanding your periods is so important. We talk about all the symptoms and individually dive into acne and excess weight, all the things that affect other people as well.

Dr. Laurie Marbas: Mm that's wonderful. So just to back up a little, can you explain exactly for the audience, what P C O S is and why lifestyle intervention is so effective?

Dr. Nitu Bajekal: Yeah, so PCOS is a, a short form, but basically it's polycystic ovary syndrome. It is a misnomer really, which I, I bust a lot of myths in my book, including case studies, but what one has to understand is there are no true cysts in the ovaries. You are born with a number of eggs at, at birth. And over time they get you know, shed. And so what happens is that by the time you reach menopause, the number of eggs drop below critical level, and then your period stop. So that is what menopause is. So what happens in P C O S is that you can have a lot of immature egg follicles, and none of which actually race to the front and ovulate monthly, because it's ovulation regular ovulation that gives you a monthly cycle. So one of the hallmarks of this polycystic ovary syndrome is irregular or missed periods.

Dr. Nitu Bajekal: So PCOS is a metabolic condition. Think of it as a closed cousin of type two diabetes, that is the best way to describe it is the most common endocrine or hormonal condition. Basically endocrine means that you have organs that produce these chemical messengers called hormones, which are produced in a, in, in a distant organ, say in your brain FSH and LH are hormones that will work on your ovaries, which will then release estrogen and Tron and testosterone, and what I try and explain to people. So this is the most common condition, the most common hormonal condition. And it's a close cousin of type two diabetes. That is the easiest way. And the, there is it, the ovaries are not diseased. It just affects the function of the ovaries. And we know this from a very big study from the UK, which looked at 175,000 men, and they found that they also have characteristics of polycystic ovaries syndrome.

Dr. Nitu Bajekal: So if you have a brother or a or a father or an uncle, they may have symptoms of type two diabetes, excess waste measurement. They may have high triglycerides metabolic syndrome frontal balding of hair. These are clues as to whether you may have PCOS or whether they may have characteristics of metabolic syndrome and PCOS. So we know that polycystic ovary syndrome is not a disease of the ovaries. There's nothing wrong with the ovaries. So although it's the commonest cause of not being able to conceive, there is a lot of hope because it's easy, easier to fix than a lot of other conditions that can affect fertility, because we know that lifestyle and behavioral changes are the first line of managing this condition of PCOS. And this is not me saying this is the international guidelines all over the world.

Dr. Nitu Bajekal: All the experts agree that behavioral changes and lifestyle changes are the key. The problem arises. However that there is no consensus as to so the patient is left. Wondering what lifestyle changes, what should I be doing? How much exercise should I do is sleep important? What should I eat? And so if you don't be spell it all out, and because we know from the all the in information and evidence, we know that type two diabetes response beautifully to a whole food plant based way of eating. We also can see those magical differences. I have patients that have not had periods for two years, and then they go on whole food plant based diet, and a lot of them will start having periods regularly. Wow. And then I have, you know, five patients currently who are pregnant. So it's so, so important. It doesn't mean to say that you may not need medication.

Dr. Nitu Bajekal: You might need medication for fertility for managing your acne or your excess hair growth. So the symptoms of P C O S are wide and wearing, like we discussed the hallmarks are those of androgen excess. So you may have signs of androgen, excess cystic acne that persists after the age of 25 or painful cystic acne, even younger, that is on your chin on your back on your, on the, on your chest. That may be a feature of androgen. Excess androgens are hormones, the most famous of which art is testosterone, and it's not a male hormone. You cannot have estrogen without testosterone because the pathway is cholesterol, progesterone, testosterone, estrogen. So without testosterone, there is no estrogen. So all the people who are listening don't ever for a minute thing that tested on is a male hormone. Yes, men may produce it more and we produce testosterone in different amounts.

Dr. Nitu Bajekal: So we have almost three times am higher levels of testosterone than estrogen in our reproductive age. You know, the east, the ovaries produce that much more and then it gets converted into estrogen. So it's really important to understand that. So P C O S will have symptoms of irregular or missed periods because you're not releasing eggs. That is the first hallmark. And the second hallmark is science of androgen, excess losing the hair from the top of your scalp acne or excess hair growth. Or you may have lab tests that actually show that you have higher levels of certain hormones. And so an ultrasound can also help to diagnose these little Pearl like immature egg follicles that I set. They're not CYS, they don't cause pain. And so two out of these three criteria were decided by experts to say, yes, this person has polycystic OV syndrome.

Dr. Nitu Bajekal: Some people will have all the three criteria. So irregular periods, signs of androgen excess, as well as an ultrasound diagnosis, but P C O S often starts in, in teenage years. And for teenagers, we should not be using ultrasound to diagnose P C OS because teenage ovaries can also have these little empty egg follicles, which look very similar to P C O S. So you have to use the clinical science and symptoms. So you have to use the acne and the excess hair growth as well as the irregular or missed periods. So normal periods are between 24 and 35 days. So if, if you're regularly having periods that are, you know, 40 days apart, 60 days apart, 50 days apart, that is not acceptable, that is not normal. You know, so except maybe in the first year, as soon as you start your periods and in the first, in the year, leading up to your menopause, otherwise periods should be between 24 and 35 days.

Dr. Nitu Bajekal: If you're not on hormonal medication. So it's so important to track your cycle because periods are a vital sign because it may be a sign of an eating disorder. It might be a sign of exercising too much. It might be a sign of a brain tumor and PCOS is a diagnosis of exclusion. So that's why when you miss periods, especially for more than 90 days, I would always recommend that you should seek the help of a specialist or of, of your family doctor first, so that, you know, diagnosis can be ruled out and a diagnosis of polycystic over syndrome made so, so important that you track your cycles because I see so many women who think it's normal, do not have periods, and it may be just stress and things, but you need to see somebody first to get that diagnosis and just don't assume it's, it's a normal thing.

Dr. Laurie Marbas: Mm. So that was fabulous. Thank you. I'm curious. So how would you describe to someone what actually causes P C O S cuz you're mentioning it in, in youth, in our teen. So is it lifestyle that causes it or lifestyle that, so

Dr. Nitu Bajekal: It's a very, very complex genetic condition, like type two diabetes. And there's also epigenetics that come into role how your grandmother lived, how your, your mother lived, because all these things influence the, the baby inside. And so it's never too early to make changes and it's never too late. And but P C O S we think has got some drivers, insulin resistance is one of them. So if you have the genetic background where you, as I said, you have a family member with type two diabetes or a sister or a mother with polycystic ovary syndrome, you may be more likely to develop the condition. So then you have the right setting like George bra said, and then later on Calwell Stein said, you know, that genetics loads, the gun and lifestyle pulls the trigger. That's what happens. So we think genetics plays a huge role because of there are gene receptor defect, insulin receptor defect.

Dr. Nitu Bajekal: There are all kinds of genetic issues that can be linked in with polycystic OV syndrome. And then when you then add on the lifestyle where you have a sedentary life, you are stressed, you are eating highly processed foods, ultra processed foods. Remember 60% of our diet in the Western world is made of ultra processed foods and saturated fat. So we know that incident resistance then comes into play. And when one is living in a larger body or carrying excess weight, that makes the condition even worse. So losing some amount of weight can actually make a big difference in normalizing your hormones, but losing weight is easier said than done. So we always say, and throughout the book, we explain that always focus on health goals. I want to be to get pregnant, or I want my periods to come back.

Dr. Nitu Bajekal: I want my acne to get better. Those are better goals because when you try and focus on weight, almost always, people will put all the weight back, genetics, insulin resistance, excess weight. Those are the drivers. Those are the possible causes of P C O S whether polycystic ovary syndrome causes people to put on more weight. We have evidence to suggest that as well. And whether weight itself worsens your PCO OS or makes you get PCOS. We have evidence for that as well, but remember two outta three women actually do not have excess weight. And so when we do CT scans and MRIs, we may find some of them will have increased abdominal fat. And that may be triggering the insulin resistance. I don't know whether you are, you've discussed enough about insulin resistance in the past, but essentially a hormone produced by the pancreas which is a tail shaped organ and is responsible for driving the glucose that is produced by breaking down the food that we eat in through the cells into the cells so that they can be used because it's the major source of energy.

Dr. Nitu Bajekal: So when the cells in your body get blocked by fat, whether it's saturated fat or your own body fat, what happens is this insulin cannot do its job. So the insulin levels start rising. And when the insulin levels start rising, when the blood sugar start rising. And so you can imagine that you then start having problems like gestational diabetes and pregnancy induced diabetes and type two diabetes by the time you're 40 and even earlier. So it's so important to understand that insulin resistance is not just causing that shift in harder shift, but insulin itself starts stimulating insulin like growth factors, which then make your ovaries produce even more testosterone and actually make the condition of P C O S even worse. And that is why losing about five to 10% of your body. Weight reduces melts that fat around yourselves helps to bring the testosterone levels down, improves the acne improves the hair growth, improves your ovation.

Dr. Nitu Bajekal: So it's very, very intertwined. So incident has got many actions, not just on blood sugar. And that's, again, something that we discuss in great detail about how, and of course there are other things like endocrine disruptors and, you know stuff that we eat especially red meat and things. They often have organic pollutants and endocrine disruptors and mammalian, estrogen, all these things really matter. That's why a fiber rich diet, a whole food plant based diet that focuses on colorful fruits, lots of vegetables, lots of home, grains potatoes with skin sweet potatoes with the skin beans and legumes and lentils and green peas and soya and herbs and nuts and seeds. All these things are so important. The colorful varied diet that feeds your gut bacteria feeds you with fiber and then normalizes your hormone because this is a endocrine driven hormonal condition.

Dr. Nitu Bajekal: That is why lifestyle makes such a role. And of course you have to bring in exercise and sleep and stress and avoid smoking and alcohol. So there's a lot of stuff that is going on very complex, but there is so much hope available. There's no cure for it, but there is a lot of hope. So I don't like the use the word reversal that are couple of studies that have shown reversal. But what I would suggest is always think of it as remission, because if you go back to getting stressed, if you go back to sleeping poorly, if you go back to an eating standard American diet, then you're going to be back again in Theros of the condition.

Dr. Laurie Marbas: That's exactly right. So there's so many things there, you, it affects heart disease, hypertension, diabetes, all of these things that you're

Dr. Nitu Bajekal: Describing. Yes. And wound cancer actually is the commonest cause of wound cancer in women under the age of 35. Oh, so yes, because you're not having periods, so there's unposed estrogen. And so if you're not missing periods, the lining starts thickening. And if you don't shed that regularly with the help of medication or by changing your lifestyle, then that can make you at a higher risk, especially if you're carrying excess weight. So type two diabetes heart disease, wound cancer. These are all risks. And actually $8 billion was spent last year in the us Laurie for healthcare related to polycystic ovary syndrome. It should be a public health issue. Wow. You know, because of pregnancy related complications and type two diabetes, but nobody's talking about it. And that really upsets me. So, which is why we wrote the book. We wanted people to, you know, and the book is a bright pink color.

Dr. Nitu Bajekal: It is very, very sort of accessible. It looks like a fiction book. It is thick because we've got lots of references, hundreds and hundreds of references, but more importantly recipes. Cause there's no point in me discussing that P C O S is a hormonal condition. There's no point in me discussing about the acne and the excess hair growth and the infertility or the excess weight or the incident resistance, because you need to know what to do with that information. That is why part for written by Rahini. My daughter, who's nutritionist basically tells people how to take charge of their own lives and actually meeting them where they are. So nobody's expecting you to suddenly change your diet overnight is making these small steps, whether it is going for a walk, it's a domino effect. When you go for a walk in the outdoors with a friend, your laughing, when you come home, you want to make better choices of eating. When you eat better, you tend to sleep better when you sleep better, you don't want to have that drink and you don't need you know, all that risky substances. And so then you want to exercise. And so you can see there's like a, a beautiful effect one way or the other. When you sleep early, you stress more. When you stress more, you reach out for the wrong foods and you reach out for the wrong foods, you have negative body image. And so it goes on. So it works both ways.

Dr. Laurie Marbas: Yeah, absolutely. And they can get your book where if they live in the us

Dr. Nitu Bajekal: In Barnes and noble, as well as amazon.com or great if you are or any of different you know bookstores, but basically online and you, you can just look up, it's called living P C O S free. Which basically means it's a pneumonic actually, you know, P stands for plants. See for community over optimism. I'm sorry about my dogs.

Dr. Laurie Marbas: That's okay. That's okay. There's one <laugh> <laugh>

Dr. Nitu Bajekal: So, so P C O S free stands for P for plant C for community or for being optimism S for self care and F for fun. Fun is so important to have fun and not think things life too seriously, because it's so easy to sort of go down a rabbit hole. And then E is for empowering and E is for exercise. So it's really, or exercise comes before empowering. So empowering oneself allows you to ask the right questions so that you can advocate for yourself for your own health. Because as I say, in one of my chapters, nobody loves your body better than you.

Dr. Laurie Marbas: Mm. That that's true. I, I wish more people did love their bodies more. There's so many women struggle with body image and oppositions.

Dr. Nitu Bajekal: Yes. Because we've been told that for, for generations, for centuries, isn't it? Mm-Hmm <affirmative>. So that's why, if there's one thing that people want to take away from the book or from this podcast, I want people to talk to themselves as if they would be talking to their best friend to the one who they really love. So, because we often feed ourselves such negative words that any of the good that we want to do through diet or exercise, we undo because we are being harsh on ourselves. And so just stop and think, would I say this to somebody I love and care for the most? If the answer is no, don't say it to yourself.

Dr. Laurie Marbas: That's absolutely true. Well, I do have another question. If you don't mind, it's kind of off from the P CS, but in this, but because you're a specialist and I get a lot of questions regarding it is how can less, so intervention help around menopause? I feel like that's another topic you should write your second book about, but I

Dr. Nitu Bajekal: Am, I've only started writing my second book on menopause.

Dr. Laurie Marbas: <Laugh> fantastic because it's such an such a difficult stage, right? You're not only going through these physical changes, but your children have left home and you're, you're like, yes, you're not. It's just a lot of things going on. You know,

Dr. Nitu Bajekal: It's a lot of things going on.

Dr. Laurie Marbas: <Laugh>

Dr. Nitu Bajekal: And we are in an unusual situation because don't forget life expectancy was, I dunno, 32 years, 35 years, about a hundred, hundred 50 years ago. Probably 50 years for the privileged or 55 years, you know, queen Victoria lived till late, but generally speaking, women died in childbirth. So, you know, it was not normal to have periods. If you think about it people would start their periods at 14 or 15, they would get pregnant. They would be nursing. They would die in childbirth. And if they did have 10 or 12 children then they would probably have about a handful of periods by the time they were menopausal. Mm. And, and so menopause is basically, as I explained, when the particular level of the eggs in your ovaries drop, and you stop your periods for 12 months, but there's a whole period before that, that is just as important called per menopause. And that can last anywhere between two to eight years. And the average age of menopause is 51, but the range is 45 to 55. So do your calculations, petty menopause can start in your late thirties.

Dr. Laurie Marbas: Wow.

Dr. Nitu Bajekal: Okay. And you can have symptoms where suddenly you are having hot flushes and mood swings and night sweats and, and all these early menopausal type symptoms that about 34 of them described and they can start and then they suddenly become better. And then they get worse. Again, there's crowding of your periods, your periods that were coming, maybe every 28 or 30 days are now coming every 24 days, you may notice that the people are getting bit heavier. So you shouldn't be really ignoring those things. And you think you're starting to forget a few things. So those that per menopausal time is really super, super important. That's why I say it's never too early or never too late to bring in lifestyle changes. And all these lifestyle changes, Laurie, that I described for P C O S is, is the same. Whether you want to avoid dementia, whether you want to manage your menopausal symptoms, about two out of three women out of 10, come forward with their symptoms.

Dr. Nitu Bajekal: 85% of women in the Western world suffer from hot flushes, the most common known symptoms, and those who that carry excess weight suffer even more with hot flashes, paradoxically, even though they have higher levels of estrogen. I mean, know that estrogen is the most effective therapy for menopause you know, to manage menopausal symptoms, especially in the early stage. So the question I would tell pose to people is understand about menopause. I have a lot of free fact sheets on my website that you know, basically go through every single, whether there's menopause, whether there's per menopause, whether it's menopausal hormone therapy, whether there's endometriosis, whether there's heavy periods or painful periods or painful sex, I have about 50 different fact sheets on my website. And it's very simple. Just put my name in.com. You can download it, you can read it. You know, it is, it won't cost you anything.

Dr. Nitu Bajekal: You don't even have to buy the, the living P C OS free book. You can get it all for free <laugh>, you know, on my website, right? So menopause is a time where you never become, people say, oh, I've been through the menopause. You don't actually, you're always in the post-menopausal place. And it's a very important time of life. So if you imagine the average age is 51, and the average life expectancy is 81 years, I think in the us is 82 point something in the UK. It's 80, even higher in Hong Kong. So there's a good 30 years of a life that you can actually celebrate. And so it's so, so important to empower yourself and not look at it as a negative with aging and things like that. So making those changes, those lifestyle changes are really important, but also knowing that there is help available, whether it's in the form of menopausal hormone therapy, which is very safe for the worst majority, and you need estrogen and pone, and perhaps testosterone, if you have an intact URIs.

Dr. Nitu Bajekal: And if you don't, if you had a hysterectomy, you just need estrogen because estrogen is the one that manages all the sub symptoms, PGE is needed to protect the lining of your wound from cancer. If you just took estrogen on its own. So, you know, all this information should be available to women right from school age, so that you know how to deal with these clinical symptoms. And you don't, you're suddenly not faced with thet nest syndrome. You're caring for older parents. You know, you are the sandwich in the middle, you know, you're the, the filling in the middle, the homeless in the middle <laugh>, as I would say, mm-hmm, you know, so it's so, so important to self care should have been built in right from, because women always put themselves last, you know, it's everything, isn't it. It's your children. Then it's your partner.

Dr. Nitu Bajekal: Then it's your work, then it's your pet or whichever order you wanted in our house. The dogs are the top dogs. <Laugh>. So, you know, you basically are always putting ourselves. We put ourselves last. And I think I want women to whether you have P C O S whether you have endometriosis, whether you have no medical conditions, whether you're approaching menopause, it doesn't matter. It is not a selfish act to look after yourself because only when you start looking after yourself, can you start spreading happiness and looking after people outside mm-hmm <affirmative> outside of your own world. So it's so, so important to do that. And so I hope that people will realize that menopause, like in many societies elsewhere in the world, they look at it as a positive thing. And maybe we should also start doing that. It doesn't mean to say that, you know, you should neglect yourself.

Dr. Nitu Bajekal: If you want to, you know, have, I don't know, laser or Botox, or, you know, color your hair or whatever, it doesn't matter. Nobody should be judging you, but also look after your health, you know, Absolut bring in those fruits, those vegetables, if you're somebody who doesn't eat any fruit, start with one fruit. If you're somebody who eats one fruit today, make it two and slowly build it up. Same thing with vegetables, same thing with whole grains. Don't be scared of carbohydrates. Those who don't eat carbohydrates complex and simple carbohydrates that are, you are not talking about white rice and, and cakes and biscuits and cookies. We are talking about fruits and vegetables and legumes and whole grains, the global the, the Lancet, the global burden of disease study that looked at 175 countries basically found that this 11 million deaths would be prevented if we ate our vegetables and our whole grains and, you know, wow.

Dr. Nitu Bajekal: Our beans. So it's so, so important. It doesn't matter what else you eat. Don't focus on what you're not eating. Right? Right. Always focus on what you're bringing in. So crowd out those other foods, don't think I'm not eating my chicken or my meat or my cake or my donut and the other thing I find, which really helps my patients and helps me is instead of saying, I can't always say, I don't want to. So somebody says, have a piece of cake. Then you say, actually, you know what? I don't want it. Not that I can't have it. I'm on a diet. The moment you say I can't is deprivation. The moment you say don't, you are in control

Dr. Laurie Marbas: Mm-Hmm <affirmative>

Dr. Nitu Bajekal: Or somebody says, come on, go on, have a glass of wine. We know that even having three units of alcohol in, especially in the menopause increases, our breast cancer is between 12 and 15%. So it's so, so important to say today, I've chosen not to drink or today I'm not drinking. So then that pressure is taken off. Or I don't want to, you know, those are more empowering words than I can't. I shouldn't I'm being naughty. It's I'm is guilty. I'm feeling guilty or that's a bad food. This is a good food. That's a super food. I don't like any of those words. I just think they tend to make us feel very confused and want things more rather than actually, you know, taking it in a stride. I was very naughty. I made my daughters think that salad was dessert. So <laugh> please. Mommy, can we have salad for dessert only if you are very, very good. <Laugh>

Dr. Laurie Marbas: That's wonderful. Oh, goodness. Well, that's fabulous. I mean, it's so very key to understand that all of these factors in women's health can be addressed with lifestyle interventions, everything that you've discussed, everything that's on your website. So thank you for those free resources. We'll put a link of course, to your website in the course of the book living P C O S free, which is fabulous. Is there any final advice you'd like to give someone I know I've kept you almost an hour already that for someone who's maybe suffering or struggling and confused or considering in, you know, employing these type of lifestyle changes,

Dr. Nitu Bajekal: I would say, first of all, you know, don't forget everybody's different. And you know, many of us are in positions of privilege. So don't think that eating a plant based diet involves having cheer seeds and blueberries and things that are expensive. So I always tell my students, I tell my, the public, I speak to, I, we often I do cooking classes for community organization where people don't have access to a blender or anything other than a knife in a small stub. So I always say, go to the ethnic supermarket or the markets or the open markets go to your local supermarket at the end of the day, when all the produce has been really slashed, because a lot of people in the us, I know, live in food deserts. So, you know, buy things in bulk. So beans and things, which are dry, they shouldn't cost you a lot of money.

Dr. Nitu Bajekal: Sadly, the government doesn't subsidize the real foods that would change our health. And, you know, there's a vested interest with all this. So I really would say, think of where you are in your life and bring one little change every single week, maybe, you know, just switching a few things here and there can actually make a big difference. And then you will start seeing that you'll actually save money because your health will feel better. You'll feel more energetic and you'll make those choices that will allow you to you know, learn how to cook at home. These are simple ti tips that cuz you may be a busy mom with, you know, lots of young children and it's easier sometimes to feed them you know, ready, made stuff. But you will actually, once you see how much money you will save, when you make some big potatoes with some big beans and you know, make homeless at home or whatever, you can decide what foods you like. You know, everybody has cultural preferences and all those preferences can be made plant based and they can be made plant based. So we have over 30 or 40 recipes in our book that really are from pantry ingredients where you don't always have to have lots of fresh produce. So I hope that people realize that instead of being hard on oneself, just starting where you can and being kind to yourself, if you take a few steps back, that's okay, you know, take, get up and make the next step

Dr. Laurie Marbas: For what absolutely that's perfect address so many different things and just keeping it simple and absolutely they call it the diet of poppers for a reason it's cause that's cheaper and, and healthier. Yes. So wonderful. Well thank you so much for your time today. It was wonderful. I'm so glad. This is such an important topic that we need to address and I'm, I'm looking forward to success in your book.

Dr. Nitu Bajekal: Thank you. Thank you Laurie, for inviting me. I know it's a lot of information to pack in. And I hope I've been able to get that across to your listeners, but all this information, as I said is on my website, which people can read in their own time because sometimes it can get overwhelming. When you have to say so much of medical information, you know, you and I can understand it sometimes because we have that background. So I always say, you know, spend time to listen to the podcast couple of times, maybe go on to the part to the website because I try and again, talk as simply as possible. Hopefully helping people.

Dr. Laurie Marbas: Absolutely. Well, it was, it's refreshing to see someone so joyous about their career in medicine because it's loves many places, not the case. And so I, I do appreciate that so much. And thank you again. Thanks for watching. And I hope you enjoyed that video before you go though, please hit the subscribe and alert buttons. So you don't miss out on any of the amazing content we're working so hard to provide you. We upload a new episode of health and Mora with Dr. Laurie Marbas every Friday. Now, if you read the listen to the podcast, you can find us in all the major platforms such as iTunes, Google play SoundCloud, and even Spotify. If you're looking for amazing resources to help you start and sustain a plant-based diet, exercise recipes or anything wellness, we got you covered there

Laurie Marbas
Laurie is our Chief Medical Officer, double board certified family and lifestyle medicine physician, licensed in all 50 states and DC.

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