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Period Story Podcast, Episode 12: Toral Shah, We Need More Diversity In Healthcare

For the 12th episode of Period Story Podcast, I was honoured to speak with Toral Shah. Toral is a nutritional scientist, functional medicine practitioner, food & health writer & consultant and the founder of The Urban Kitchen.

Toral shared how a family holiday to Egypt ended in a surprise from her first period and how supportive her mum was. She says her mum had made sure to educate her about menstruation beforehand, so when it arrived, it wasn’t a complete shock. 

She said her mum’s openness helped her see her period and menstrual health in a matter of fact way, which was quite different to her friends.

Toral shared her experience of medical menopause after her breast cancer treatment. She shared the side effects she experienced and how she believes more needs to be done to help women with the side effects of breast cancer drugs.

Toral says that more women need proper education on what menopause and perimenopause actually is and how it can affect them. She says that many doctors aren’t educated in menopause, unless they have specialist menopause certification and believes this needs to change.

We also had a great discussion about the lack of diversity in healthcare, health and wellbeing. Toral talked through research by Dr. Adrienne Milner that shows that BAME community isn’t being represented effectively at consultant levels, which means that they aren’t necessarily being reflected in policies and structures. 

Toral says that we need to listen to ourselves, our bodies and give ourselves what we need and I completely agree! 

Get in touch with Toral:

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Toral’s Bio

Toral Shah is a Nutritional Scientist (MSc Nutr Med), Functional Medicine Practioner, Food and  Health writer and Consultant, as well as the Founder of The Urban Kitchen. She originally went to medical school with a view to becoming an oncolgist but when her mother was diagnosed with breast cancer, she realised that this was not the career for her. After completing her BSc in Cell Biology, specialising  in cancer, she worked in research, winning a presitigious Royal Society internship where she worked on SRC oncogenes. Toral then went on to do an MSc in Nutritional Medicine at University of Surrey.

She specialises in optimising health and disease prevention through  improving food, diet and lifestyle. She uses evidence based science knowledge along with lifestyle medicine and cooking skills  to help support others to lead a healthier life by eating delicious and nutritious food. She is particularly passionate about cancer prevention and completed her MSc thesis researching the foods that prevent recurrence of breast cancer. As a breast cancer patient and survivor, she understand how patients might want to change their diet and lifestyle post diagnosis.

She also works with a large portfolio of brands, press and individuals within the food and wellness industry from hosting supper clubs, speaking at large health and corporate wellness events, festivals and private events, developing recipes and creating nutritional content for brands sharing her knowledge of nutrition and science.

Toral is also passionate about combatting the lack of diversity in healthcare and ensuring both doctors and patients from BAME groups are equally represented within the NHS and healthcare systems. Currently, BAME  people have poorer health outcomes, even when you take into account socioeconomic factors, and are often diagnosed with cancer later and at later stages. Toral is working with several charities and organisations to ensure that they are creating more inclusive health promotion campaigns with more diversity and inclusivity so that all communities know that cancer can affect them.

She is currently  the process of writing her first book which explores the latest science behind foods that optimise health and illustrates them with some of her favourite recipes. 

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SHOW TRANSCRIPT

Le’Nise: On today’s episode, we have Toral Shah. Toral is a nutritional scientist, functional medicine practitioner, food and health writer and consultant, as well as the founder of The Urban Kitchen. Toral specialises in optimizing health and disease prevention through improving food, diet, and lifestyle. She uses evidence-based science knowledge, along with lifestyle medicine and cooking skills to help support others to lead a healthier life by eating delicious and nutritious food.

Le’Nise: Toral is particularly passionate about cancer prevention, and completed her MSc thesis in researching the foods that prevent recurrence of breast cancer. As a breast cancer patient and survivor, she understands how patients might want to change their diet and lifestyle, post-diagnosis. Toral is also passionate about combating the lack of diversity in healthcare, and ensuring both doctors and patients from BAME groups are equally represented within the NHS and healthcare systems. Welcome to the show.

Toral: Lovely to be here. Thanks for having me.

Le’Nise: We’re going to talk about your very impressive resume later on in the show. But first, I want to ask you about the story of your very first period. Can you tell us what happened?

Toral: I was actually one of the lucky ones. My mom had shared with me what exactly happens before you have a period. So I wasn’t completely surprised. But I was actually in Egypt on holiday with my family, so I wasn’t quite expecting it then. I had just had tummy cramps, and I hadn’t felt great for a couple days. I actually attributed that to some fish we had eaten. So I was like, “No, the fish has made me really ill.” And then obviously, I started my period.

I think the thing that was difficult about that was, we weren’t back in London. We were in Egypt where it’s a slightly different country, where you don’t know where you need to buy what you need to buy, like sanitary products and things. It’s also an Islamic country, so it’s harder to ask someone for help to where to go buy that. I felt sorry for my mum in hindsight, now that I’m older. She had to magic some things up to help me. I know I was really lucky, it was a light early period. But I was only 11, so it was probably a little bit earlier than I had probably anticipated having that happening to me.

Le’Nise: So how did you feel when you got it?

Toral: Surprised, but not… I didn’t know what it was. I didn’t realize that I had to have stomach cramps. No one had actually mentioned that part to me. I understood what it was from a biological perspective. But I didn’t realize that I was going to have it like I thought I’d get. I wasn’t going to feel very happy, and I was going to feel slightly miserable, a bit grumpy. And also, just not being at home. Being in a hotel was a little bit challenging for me. But having my mum there with me all day made it so much easier than if I had been at school or somewhere else.

Le’Nise: You said that your mum talked to you about it beforehand. So you weren’t completely surprised about what you saw.

Toral: No.

Le’Nise: What sort of things did she teach you about it?

Toral: So I think for my mum, it was really important that someone told me… Well, she told me about what a period was and why you had it, and what was going to happen. Because she had such a terrible experience, herself. My mum’s actually one of five sisters. And despite being number four, no one had really explained periods to her. She knew something happened. She knew there’s something mysterious. She knew that there were times of the month where her sisters were a bit grumpy, and things were happening. But she didn’t really know.

So when she started her period, she was actually the same age as me, she was 11. She was at school and she started bleeding, and just literally thought she was dying and didn’t know what to do, and just ended up using loads of tissues and things like that. Then obviously… This in the times before we had all the amazing sanitary products that we have now. So they used to use towels and rags. They used to buy these pads where you used to have to put them in some sort of special contraption so they could stick to your pants, and things like that.

My mum said she just didn’t want me to have that experience, and not know. And also, I was quite precocious. I had already had a really high reading level, and knew a lot about biology. So it made it a little bit easier for my mum. Just to be able to understand what was happening to me biologically, made a difference.

Le’Nise: And then when you got back from holiday and you went back to school, what was it like with the conversations with your friends?

Toral: Interesting. I was one of the youngest ones to start her period. And it was a bit like, “Oh my God. I am so grown up. I’m better than you guys. I already started my period.” It was that kind of conversation. In those days, that was like who grew boobs first and who had their period. That made you just sort of a grown up girl, as opposed to a little girl.

Le’Nise: When you were talking to your friends, you said that your mum had already talked to you about it beforehand. Were you kind of the educator amongst your friends?

Toral: We had already had some sort of sex education and talk about periods at school by then. So whilst I may have talked… I don’t remember talking. I do remember talking to my friends about it, but I don’t remember getting into detail. I think we were already all… Whether our parents had done it or whether it was the school, we had had some information at least. So it wasn’t completely… Actually, I didn’t have a terrible experience. It wasn’t something we talked about a load. It was just more, “Oh, I had it.”, rather than anything else.

No, no, no. It was only I think a little bit older, that we started talking a little bit more about it. I think at that first couple years, it wasn’t something that we maybe talked about.

Le’Nise: So as you got older, you started to talk about it more. Was it starting to be in a context more of sex and relationships with boys, or was it quite more still on the biological functional level?

Toral: I think it was more on the biological functional level. I think it depends on who everyone is friends with. Most of my friends were not the people having sex at 14 or 15, and things like that. There were some in my school. But it was more about like, what can you use? Does it feel great? Does it dirty? What about swimming? What about the gym? This is when there wasn’t much choice of products then. They were very thick. There were tampons with applicators. So it was before the smaller… Shows my age, this does. It was before the kind of smaller little tampons came out without applicators.

I remember when Always came out with the pads with wings. So that was a revolutionary new thing, when I was maybe about 14 or 15. So that was something new, and we were all a little bit, “Oh, this makes it so much better.” It doesn’t fall off, and things like that. We would talk more about the practicalities of it in that way. And obviously as I got older, I think the sex and relationship part didn’t actually come into conversation with the periods part. They were two quite separate conversations. Even though they’re obviously inextricably linked, we didn’t talk about it together that way.

Le’Nise: You said that when you got your first period, you said that you had a stomach ache. Was period pain a part of you having a period?

Toral: Yes, period pain has continued to be a part of me having a period. It is something that I have lots of conversations about, because it’s something that we didn’t talk about. I’m on day five, so I’m going to be very honest about that. I was going to meet a friend on Friday, which was day two, and I messaged him. I said, “I’ve got period pains, and I’m not feeling great. Let’s not meet for a coffee.” Well, I probably wouldn’t have done that with boys before. Ironically, it’s a very good friend. But even then, I think how much more open, just because we as a society, we’re talking a bit more about it. We’re talking more about it being a normal bodily function. Before, we just hid it. It wasn’t something you would ever tell. I think my brother was aware of these things, but he’s definitely much more aware now.

Le’Nise: Why do you say that?

Toral: Because he has a wife. Yeah, he has a sister. He doesn’t have any daughters, he’s got sons. I think we’re much more open to talking about it. Whereas it wasn’t something I would necessarily have said to him when we were 13, “Oh, this is what’s happening.” He must have known, but he didn’t… And again, it was a bit confusing for him too. So again, we need to educate the boys just as much as we educate the women.

Le’Nise: Why do you think society is more open about periods and talking about periods now than it used to be?

Toral: I don’t know, actually. I don’t know if it’s just because we’ve become more open about talking about so many thing. We talk about relationships more. We talk about sexuality more. We talk about sex more. We talk about… I think the world has changed so much. I think particularly in the U.K., where we are a very kind of closed, stiff upper lip society. I think things are changed. The society’s just changed. I think we also understand things a bit more from a biological perspective. There’s a lot more science and understanding all sorts of things around the period. Whether it’s the hormonal and the emotional aspects, or the physical aspects, and what we can do to support ourselves.

I think it’s also having a whole society of women, like my mum, who wanted their daughters to have different experiences, and talked about it. But yeah, I was out with my sister-in-law the other day, and she’s from a different culture. She’s from Kyrgyzstan, and they didn’t… Her mum didn’t explain anything. Her mum gave her a book. So I think it really depends on the other things. From my mum, my mum’s hugely, hugely open. My mum’s also quite scientific, and she works in the healthcare industry. For me, I think that was because of her passion, she wanted it. I’d be really interested to speak to my cousins to see whether they had the same experience, even though their mums were all brought up with my mum. I feel like my mum’s slightly different. I will actually ask them this next time I speak to them, because I think it would be an interesting conversation.

Le’Nise: Do you think your mum being so open about periods and menstrual health in general, changed the relationship that you had with your period?

Toral: I can’t say it did or didn’t, because obviously, she was always like that. For me, it was a part of biological life, and that was what happened to girls. And we always talked about it. I didn’t have to hide it, and I didn’t have to hide buying products. I think it only made it easier. When I hear about some of my friends’ stories, then I think that at least I had someone who was actively engaged in the process, and explaining and buying the products and doing things, and making sure I had everything I need. Obviously, I can’t imagine what it would be like if I had not known. And I do know from friends and family members, that they didn’t really know what was going on. They had to try and find tissues and towels and rags, even in those days. Even now, I feel like when you think about people from different countries, they still don’t really know. So for me, I’m just grateful that I had my mum explain what it was before it happened.

Le’Nise: Yeah, I think that’s very… It’s very different to a lot of the other guests that I’ve had on the show, where shame and secrecy is a big theme. It then translates into the relationship they have with their period. A lot of them have said as they get older, it’s only now where people are more open, that they actually feel like, “Why am I so ashamed of this?” It’s nothing to be ashamed of. I think it’s amazing that your mum’s openness and not having to hide it, has just made you… It sounds like you have a very matter-of-fact relationship with your period.

Toral: I do now. But I do think there was shame and secrecy. I would have told my female friends. I would never have told any male friends. My brother and my dad knew, just because our family is quite open. That’s the way it is. But I wouldn’t have told maybe even boyfriends and male friends, and other family members. Because they’d say, “Why don’t you want to go swimming?” And things like that. You’d sort of make something up. I think that society has changed now. So we are able to talk about it more. The fact that you’re even doing this, I love that you have a whole podcast dedicated to getting your period, because this happens to half the world. Literally, half the world. We’ve shrouded it in secrecy and shame for so long. I still think for me when I think about it, culturally, there are so many aspects of that.

I’m Indian. One of the things about when you have your period is, you can’t pray and go to a temple. You’re not supposed to cook for people. You’re not supposed to use certain things. Yeah, and there are so many things you’re not supposed to do. I can understand why. In some aspects it’s to give people rest, so they can actually rest. And then it became something dirty and something secret. Actually, the whole point of why these rules are created, to give people some time to rest and recuperate while these things happen to their body. It had become something nasty and dirty and secret.

I think it’s partly the whole patriarchal nature of culture and religion. I could go on about that. That’s been forgotten. I think for me, when I hear these stories still in the news of places like Nepal and India, where people are made to sleep outside and are not given food… People are dying. I’m thinking, it’s 2020. This is ridiculous that we are… Well, society and patriarchy is punishing women for having a natural bodily function. It’s ridiculous. It still happens in so many countries and cultures, where you’re not supposed to go to wherever your area of prayer is. Or eat with other people or touch other people, and things like that. I find that horrible.

Le’Nise: Even in yoga actually, they’re still talking about culture. There is this kind of old school mentality where you hear male practitioners say, “You shouldn’t do yoga on your period.” I actually find that quite frustrating, because it’s basically saying that you’re not allowed to listen to how you feel and what your body is telling you. And actually, yoga is amazing when you have your period, especially have things like period pain and cramps because it can ease a lot of that. What you’re saying about patriarchy and cultural experiences drifting into how people talk about periods, goes into loads of different areas.

Toral: Well, I think you have to remember that yoga comes from India and the Hindu culture. That’s part of why male practitioners say that, because they do not want to have people essentially making their yoga place dirty. They don’t want anyone not to be purified. It’s ridiculous, because… You’re absolutely right. Yoga is amazing for period pains. For me, I’m really conscious about how I look after my body and what I do. So yoga is one of the things I’ll do. I will go and do some cycling, but maybe I won’t go and lift really heavy weights the last couple of days, just because it makes me feel really tired. But I think we have to look back at why did this happen. Men made rules about women’s bodies for so many years, and still do. I mean, think about it.

What’s been seminal in the last couple of weeks is that certainly in the U.K., Scotland is going to provide free period products to school, and that England’s following suit. But we pay a tax on these things. Why are we paying tax on sanitary wear, which is an essential item? We’re paying tax as if it was a luxury item. I find this incredibly patriarchal and kind of ridiculous, because it’s not a luxury item. We need it. And actually, we haven’t educated people to understand that. There are still so many things around period pains and work and stuff. People just don’t talk about it. Some women are debilitated with these pains, or whatever’s happening around that. So for them to go to work, they can’t even say anything. It’s not built into our structure.

Le’Nise: There are lots of signs that this is changing, but not as fast as it should. I’d say that it’s certainly when I speak to younger people, people in their teens and 20s, they are much more open, men and women… about periods, menstrual health, sexuality and all of that. I think that’s forcing older people from 30-plus, to start to change their attitudes. I want to talk a little bit about your cancer diagnosis, and how that changed your period. Because I know some cancer patients, they go into medical menopause. I wondered, was that your experience?

Toral: I have had a bit of both. It depends on your cancer. Firstly, I had breast cancer, which was very hormone related. So basically, it grows in response to estrogen and progesterone. What happens in those cases, which is a lot of women, is they want to give you something that will reduce the amount of estrogen in your body or stop your ovaries from producing estrogen. So they’re two different kinds of things. One is by taking Zoladex, which is an injection. The other one is taking a tablet like Tamoxifen. I have avoided Zoladex for a long time. I have an appointment on Friday, where I’m sure we’re going to have the conversation yet again. But I have had Tamoxifen. It has stopped my period, because it’s an estrogen blocker.

It is interesting, because it’s such a part of being a woman. It feels very different. So part of me is like, great. I can just do whatever I want to do. I could swim all the time. But actually, blocking your estrogen and not having estrogen changes your mood, changes how your body works, changes how your brain works. It also increases your risk of certain diseases and things like that. So whilst it does help you when you’re on medical menopause to reduce your risk of having breast cancer again or certainly any hormone-dependent cancers, it does change so much of your body. I think this leads us back to menopause where again, this happens to half the world. We haven’t been talking about it until the last year or so, which I find amazing. Because women are such an integral part of our society and our workforce now. And we’re not actually allowing them the space to understand the menopause, and work through it and make allowances for some of the really big changes that happen in your body.

Again, as a cancer patient, when you go through medical menopause, people just think you’re being a little bit difficult or you’re being hard or something like that. It’s so debilitating, some of the side effects. For me, the hot flushes were one thing. But I had some of the rarer side effects, including… You just seem to have a very, very, very sore and dry vagina. And other parts, the vulva. It’s something that we’re starting to talk about. It happens in normal menopause, too. But because this happens really suddenly, I was in absolute agony. I literally couldn’t walk or do anything, to the point where I can’t take this job anymore.

Not only does your period stop which is a small thing, but it’s actually, why do they stop? It affects all your hormones, because it’s blocking the estrogen. For me, it just ends up being… Both times I tried it, because I had breast cancer twice, it hasn’t been something I could actually tolerate for more than a few weeks at a time because it’s so painful. And we’ve still not really researched or found a cure to help women with these side effects. It’s something I talk about. I’m sure if it had been for men, like Viagra, we’d have discovered it quite quickly. But because it’s for women, the research just hasn’t been there.

Lots of women have to go through medical menopause with different types of cancer, because the chemotherapy can just also stop your ovaries from working and things like that. But there are so many other reasons. And we’re not really still researching what we could do to help. Every time I go to a conference… I went to a conference for young women with breast cancer last year. They were talking about how women, there was such a reoccurrence in younger women because they’ve stopped the hormone treatment. I kept putting my hand up after every single lecture I spoke, and said, “But you’re not helping us with the side effects.” I mean, I know I can do for myself and I work in nutrition and lifestyle medicine. But then there’s very little, and they’re insisting that we keep on these drugs, and I totally understand why. But actually, it’s much, much harder for younger women. And you’re not helping us and we’re finding it really difficult, both emotionally and physically.

Le’Nise: What was the response of your doctor when you went to them and talked about the side effects you were experiencing?

Toral: My own GP this time around, I have a female GP who’s absolutely phenomenal, who used to actually work in AIDS research, also has had some experience of women who’ve had AIDS treatment with exactly the same side effects, because they suddenly go into menopause too. So she had loads of ideas and things to help me, including taking some vaginal estrogen suppositories and cream, and all sort. And just the conversations, and just actually listening to me. That was amazing. The previous time, they just all seemed to be really baffled that this was a side effect. I did end up seeing a gynecologist at Chelsea and Westminster. But again, we kind of agreed that let’s just stop it, and we didn’t know what to do. I think I’m very knowledgeable about hormones and how our body works, so I have a little bit more say in my own treatment with my cancer. So it has been a little bit easier to have those conversations. I’m also quite strong. So in fact, I’m not taking something because it’s making me feel horrible, then I’m not doing it and I can explain why I’m not doing it. But I think a lot of women suffer in silence.

I was at an event on Tuesday about medical menopause and the side effects for younger women, with a charity called Trekstock. So many women had no idea there were things that could help them. They could take some forms of HRT, or they could take some of these creams or patches and things like that. I think again, we need to start educating women. We need to talk about these things. If it’s shrouded in secrecy and again, don’t talk about how it impacts our society and our workforce and women, then we’re not going to help them.

Le’Nise: What do you think your experience of being in medical menopause would do for your eventual journey into perimenopause and menopause?

Toral: I think a little bit of understanding about how difficult it might be, and preempting that I’m going to need some support around this. I’m also conscious that a lot of things that can help people through perimenopause and menopause may not be suitable for me, just because I’ve had an estrogen dependent type of cancer. But I’m also conscious there are people who are interested in this and talking about it. There are things that we can do from a nutritional lifestyle medicine perspective. So at the moment, I am spending a lot of time researching and understanding the estrogen system, we have an estrogen detoxification system in our bodies. So perhaps it’s for me and my body, it’s not all about removing estrogen from my body, but it’s about helping my body and supporting my body to naturally detoxify that estrogen and go through that system.

What’s really interesting about the perimenopause and menopause is that we’ve not talked about this to women. We’ve never ever talked about this in school. We’ve obviously talked about periods and stuff, but we’ve never educated girls to talk and understand what menopause is. We sort of just say, “You have menopause, and you’re period’s stopped.” But we’ve never really educated. So maybe that’s an area where we are… I know that’s on the curriculum now. That will make a difference to women. My own personal journey, I’m just conscious from now on. Being in my 40s, perimenopause may happen soon-ish. I don’t know when I would go through natural menopause. Because my mum had breast cancer too, and she had chemotherapy and suddenly went into menopause, from having her period and being actually quite normal. So we don’t actually know what the natural age of my mum having menopause is, and that’s really the biggest indication for when you would have menopause. So I’m really interested to see what happens in the next 10 years.

Le’Nise: It’s interesting that you’re talking about a mix of HRT and also nutrition and lifestyle intervention. I think that’s actually really positive to hear. Because in the conversations about menopause, they are very dominated right now of HRT, HRT, HRT. I do find it frustrating, and that’s not just because I am a holistic nutritionist. It’s because I just know that HRT, it’s a solution, but it’s not the only solution.

Toral: As long as there is a solution. But from my perspective, when I think about the side effects of the body not having estrogen, how it increases your risk of cardiovascular disease. It affects your brain, so you’re not working as well and have brain fog. And all the other different risks. And osteoporosis, things like that. I do think I kind of want HRT, to continue for my own health. But, agree. I think there are so many things. One of the things I wrote about last year is that there’s been some research on the Mediterranean Diet. It’s a diet full of vegetables and fruits, legumes, a little bit of dairy, lots of fish. It can actually help to delay our menopause by up to three years.

Delaying our menopause is actually healthy, because it means our body has estrogen for longer and will reduce these risks of having cardiovascular disease and osteoporosis. But also, when we’ve reduced our estrogen, we also become a little bit more insulin resistant. We’re already becoming more insulin resistant as we get older, particularly if we’re putting weight around our midriff area, which often happens as our estrogen levels decrease. So if we can help people by eating a little bit more differently, then that will make a difference to their long-term health. So it will help because hopefully, they’ll help not put on so much weight by putting on that fat in the midriff area by having… Because if we’re insulin resistant, then we’re going to process our food in a slightly different way. So insulin is not going to work as well, so we are more likely to store extra fat. By understanding that, that helps hopefully for us to understand how to eat.

Also, we need lots of fiber to help detoxify estrogen from our body, and it helps our gut health and everything anyway. And having these kind of legumes and things, we know that there’s so many good things for heart health, for our… There’s lots of good protein in them, there’s lots of really good fiber. So maybe it’s about doing a little bit more research to understand how that’s going to help our bodies. I think that having a slightly lower carb diet can help some women. And again, we’re looking… I think it again, that works again, without insulin resistance. I wrote about this a couple of days ago. So maybe it’s just understanding this a bit more.

Doctors aren’t really educated in menopause, that’s the other thing. Unless you’ve got a specialist menopause certificate, your GP won’t know that much about menopause and what the different options are.

I find it quite scary that lots of GPs aren’t trained in menopause. Unless your GP has a specialist menopause certification, they may not know that much, even if they’re women. Given that half of the population are women and will go through menopause, I find that quite terrifying. So why isn’t nutrition, why isn’t menopause part of the general GP training given that it’s important to everybody, and menopause is going to affect half their patients.

Le’Nise: It’s actually quite frightening sometimes, what you hear secondhand about what GPs have said about menopause. I was working with someone last year, and her GP said to her perimenopause isn’t real. It’s not a real thing.

Toral: Oh my God.

Le’Nise: And that’s actually not the first time I had heard that. It was only when I got her to do some tests, and then she went to her GP with the test results and said, “Well actually, this is what my tests are showing.” And the GP was like, “Oh. Actually, this might be perimenopause.” But then it started being a conversation about HRT. HRT is fine as I said. But I think there are other things, because this client was so young, that could have been done first. That education piece is so important. I know that you’re involved in a lot of campaigning. Have you done any campaigning around more education for GPs within this area?

Toral: Not in the menopause areas yet. It’s something I am constantly talking about, though. You have to pick and choose the campaigns that you do. But one of the things I have talked about is, why are… I would love doctors learn more about nutrition. So I’m really supportive of an organization called Nutritank. They’re trying to get nutrition onto their curriculum for medical school. Obviously, it’s the same with Culinary Kitchen and Dr. Rupy. There’s definitely that.

As far as menopause, for me, it was really getting my head around… I didn’t really realize that doctors weren’t educated until I investigated it for myself. I try to help women with a particular medical menopause. I work with a lot of cancer patients. But also, some of my cancer patients are post or during menopause. And they’re not getting any support. So I think it’s not even the difference between male GPs and female GPs. It’s just that people aren’t understanding. I do think I need to start campaigning for this, because it’s such a simple and natural bodily function and part of life. If it affects our workforce, then we need to support that. I think that’s the interesting… Anyway. I think that’s what will make a difference.

Understanding that people who are most productive, whether they’re male or female, are between 45 and 64. They’re the ones that make the most money. So understand that women who go through menopause are normally within that age frame, and that’s going to impact our economy and our workforce. That is what I think will actually push people into looking and helping people through menopause more, because it affects our workforce. I don’t think the actual fact that women just having menopause, it being difficult, is something that’s encouraging people to necessarily research or learn more. And it’s a shame. Because why must it have to always have to be about the economy?

Le’Nise: I want to just talk a little bit about one of your other passions, which is about the lack of diversity in healthcare. And I wondered if you could speak a little bit about your experience as an Asian woman in having dealt with the NHS with your cancer treatment. Did you feel that your ethnicity affected the treatment you got?

Toral: Actually, I’m going to say no. I am very lucky. I have a really amazing team, they’re quite mixed. I’m also very understanding about my own body, and what wasn’t working. So when I was diagnosed with breast cancer, it actually took me quite long to be diagnosed. Not because of my ethnicity, because I was young. I was 29, and no one really believed me. So I was very lucky that my mum believed me. My own GP at the time didn’t believe me. So I have a new GP who did take into account my history, and then I was diagnosed and looked after. I think why I’m involved with this, is just understanding the statistics. For me, I come from… I went to medical school, my mum worked in healthcare. I understood how the system worked, so I knew… We knew that when my GP wasn’t taking it seriously, what we needed to do to be taken seriously so that my mum would help me to be diagnosed. And actually, I have to be all credit to my mum. It’s because my mum worked in a hospital and she asked her radiologist friends to help get me diagnosed. That wasn’t a problem.

But going forward and working with cancer patients and having lots of friends who have had cancer or have cancer, there is a real discrepancy. So many other women that I meet, are diagnosed much, much later. Because the statistics show that women on average, have to go at least two to three times more to their GP if they are from a Black Asian Ethnic Minority to be taken for their symptoms, to be taken seriously, til they have tests done to be diagnosed with cancer. This means that women are often diagnosed later. Men, too. BAME men, too. The BAME community is generally diagnosed later, at a fairly later stage, which means that they may not respond to treatment because it may have spread. For me, that’s a problem. That’s really scary.

When we come back to the actual research, there’s been some really interesting research that came out in the last couple of weeks in the BMJ. A friend of mine, Adrienne Milner, did some of the work. She looked at representation in the NHS. And despite there being so many doctors who have British Indian, or Chinese or other BAME populations, white men are still over represented at consultant level. Which means they’re the ones forming the policies and the structures around what’s happening in and around different things. So if women aren’t being represented and the BAME community isn’t being represented, then our needs aren’t being looked after. So Chinese people, there are more Chinese people working in NHS, ethnicity wise, than any other group. And yet, they’re not represented at the top, which is really sad.

As far as cancer in particular, I’m lucky. Don’t get me wrong. I have an amazing team, and I have a very mixed team. My main doctor is of Chinese descent, my breast cancer nurse is of African descent. That’s not really a problem for me. My main problem is for other people who are not getting diagnosed, or are being diagnosed very, very late and at a point where it’s not actually able to help them. And they’re not being taken seriously. And the provision of care is less. I was reading something about transplants in the Muslim community yesterday, and over 38% of the people waiting for transplants are of the BAME community, and they’re way less likely to get a transplant. And organ or whatever, partly because of matching. But partly, they’re just lower down the list. So it’s really interesting that we still have this really inherent racism in the medical part of healthcare.

Now I’m going to flip it on its head and talk about the other part. The other part of health and wellbeing is the people like the fitness trainers and the yoga teachers and the nutritionists, the holistic carers. Again, that’s very dominated by white females, despite people having the knowledge. If you look at social media, it’s massively over represented… If you’re Caucasian, female, of a certain age, particularly if you’re blonde. It’s ridiculous, because this doesn’t mean you know more. In fact, a lot of the time you know a lot less, I would say. Not because you’re not educated, but because people are listening to you because you look a certain way. You’re slim and you look healthy. That doesn’t mean you’re healthy.

I find that terrifying that we’re taking… The society is taking advice just from the way people look rather than what they understand and what they know. And actually, how you look. Just because you’re slim, doesn’t mean you’re healthy. For example, how often you get a cold or infections. That’s a good sign on whether your immune system or you’re healthy. How much energy you have, that you’re not feeling tired, that you’re not feeling very moody and depressed. All of these things are much better indication of where your health is… your mental health, your physical health, your social health, than how your body looks in a bikini. So that’s a big thing for me.

Why don’t we have more representation? Because I know so many amazing women and men who are of the BAME groups. Again, they’re not promoted in all these events like Live Well events and all these shows. It’s still very much run by white women for white women, and so are magazines. Health is for everybody. It’s an integral part of society. It’s an integral part of balance. It’s an integral part in equality, equanimity. So why don’t we have that?

Le’Nise: What do you think can be done to change that?

Toral: That’s such a big question. I think firstly, to us talking about it. I’m really privileged that I’m talking to you about this. I’ve talked to Vicky Shilling, who runs a podcast. So many people who have picked up on this aspect of there is not equality between all the different groups. Remember, London is a… And I’m talking about London, in particular. It’s a very mixed group. You know, 52% of people identify as BAME in London. So we should have that kind of representation. Whether it’s in the medical healthcare or whether it’s in the holistic space, we don’t have that.

What’s the answer? I think education, talking about things. I am actually talking to a lot of cancer organizations, because their campaigns are very much using white Caucasian men and women. But cancer doesn’t discriminate. It affects all of us. So one of those things that I’m doing is requesting that they have campaigns which are very inclusive and diverse, of different people of different races, different body shapes, different ages. Some people do it better than others. Also, the information and the literature that’s produced should be inclusive too, because that’s not at the moment. And certainly, I’m thinking about more of the diet and the nutrition literature for both cancer and diabetes is very much based on white Caucasian people and their diets. And remember that different ethnicities have very different diets. If you look at diabetes, we have a much higher proportion of ethnic groups who have… BAME groups rather, that have diabetes. The dieticians aren’t providing them with advice that’s appropriate to their ethnicity and their culture, and the food they eat. I think that’s really important.

So I’ve been doing a project with South Asians since 2004 with a friend of mine, Dr. Natasha Patel, who’s a consultant endocrinologist at Guys. We’ve been working at that. We’ve been changing the food so it reflects the ethnicity and the culture of people and what they like to eat. And how things are very much in the Asian and Indian community. Yeah, celebrations are all about food. So how do you tailor it to help people, given that there seems to be something every single day? How do we then help people? So these are the kind of things where we need to really start asking for things, making a difference, talking to organizations. And there is some white fragility in there, I’m not going to lie. I had a meeting recently with an organization, and they kept insisting that they were doing things. But I’ve asked for examples, they haven’t been able to provide me with examples. I find that ridiculous. I do keep saying, “What’s happening?” They said, “We’re looking at our organization.” If nothing happens in the next few weeks, I’m going to take it to their CEO.

I realize I’ve grown in my own confidence that I know enough about this. I know enough about the stats. I know enough to help people. Before, I felt like I’d often get pushback because I felt like I was bullied back. And there was a lot of pushback, because people didn’t want to do it. Now I’ve just become stronger within myself with my own self development. So I’m able to have those conversations. I’m not saying that I don’t go and have those conversations and then go home and cry. I will. I’m not going to lie, because it’s very emotional. But having groups where… I’m in an amazing group called Yogis of Color, and I know you’re in that group too. For me, just to be able to talk about these things and ask for support, has made a huge difference. Because I think energetically, I have this massive group of people backing me and who have got my back all the time. That makes a difference. I think we need to… There’s a long way to go.

I mean, even right now, we’re at the midst of coronavirus. I’m absolutely disgusted with some of the racism we’re hearing towards Chinese and other Asian people with the coronavirus, because some of the things I’ve heard are absolutely horrific. They’re telling them to go back to their own country. They don’t want to be treated by Chinese doctors. It just shows that we’re actually in a world at the moment where the governments… and I’m going to blame the governments, people are really just trying to divide us. Because they don’t know what they’re doing, they’re trying to divide us and separate us, and make it about us than them. And it’s not. We’re all the same. If you take our skin away, we’re all exactly the same underneath. We’re exactly the same. We’re made of blood. We’re made of muscle. We’re ourselves, we have nerves. And it’s terrifying that we still see the outside skin differences as being so important.

You know, we all have this. I had someone who tried to collect something the other day, and they were really late. I looked at the name, and I was like… You know, culture. I was like, “That person’s just going to be late.” Because I knew that it was about the person. I was like, “Ah.” And I caught myself. I just thought, “Toral, you can’t think like that. This is really part of the problem.” That person was really late. But I was thinking it, not because before they were late. So I think we all have to be conscious where we’re discriminating in our head, and just acknowledging that means it goes away. Just being open about it, being brave to it, being vulnerable. I think Brené Brown has some fantastic things she talks about racism and differences between people in her book, Braving the Wilderness. I highlighted some bits, I’ll be sharing bits and pieces. Because we’ve got a world where we’re trying to be in a tribe. It doesn’t matter. We’re almost believing what the tribe… If we come up with veganism, if it were a vegan tribe, and people were saying things that make sense and not sense, and you just want to fit so badly in that tribe, you’re basically then trying to distance yourself from other people.

But actually, we’re all the same. The person next door who’s your best friend, who’s not vegan, is still going to be the person that’s going to be sitting at your bedside if you happen to be in the hospital or anything like that. I think we’ve forgotten the basic humanity of people, and that’s so important. Does that make sense?

Le’Nise: No, that was brilliant. There are so many amazing things that you said there. I think that one of the main things is supporting other people, having your network, knowing that there are people who have your back. But also, I think what’s really interesting is… and I’ve seen this a lot, is knowing if you have a big platform, being able to lift up other people. So talking about in social media, how it’s a very white space in terms of health and wellbeing, being able to lift up if you have a big platform, lifting up others. But I just want to as we round off the podcast, I want to just take it back to your experience and the way you feel about your body now, your period. What do you know now that you wish you knew back in the beginning, when you were an 11-year-old girl in Egypt, having your first period?

Toral: That’s a difficult one. I think how normal it is. It’s okay to give yourself a bit of space and time on those days, to rest and relax on the day, and listen to your own body. What’s amazing to me is, I’ve had my period for 30 years now, over 30 years. How I feel about it each month, hasn’t really changed that much. But understanding that it’s not dirty, and that you can talk about it, and you’re allowed to say, “I’m not doing that today because I’ve got my period.” It’s okay.

Le’Nise: Brilliant. Where can podcast listeners find out more about you?

Toral: I do a lot of work… I’m going to start again. Thank you so much for asking me. I’m on social media. I’m on @theurbankitchen. I’m on Twitter, but not so much. I also have a Facebook page. Most of the time, I’m sharing ways of how people can eat healthy, nutritious but tasty food, that will make a difference to their health and wellbeing. I am doing some research at the moment. I’m actually putting together a proposal for a PhD, which is very exciting. I’m also talking at lots of events around cancer and the BAME community, and on nutrition and how we can make a difference to our health.

So I’m all over the place at the moment, which is really exciting. I’m working a lot with cancer organizations to create not only this element of inclusivity and diversity, but also it’s talking more about the nutritional lifestyle aspects of what we can do to help prevent any type of cancer, but also particularly, with breast cancer and things like that. So I am working with the Royal Cancer Research. I work with Breast Cancer Now. I work with Trekstock. I work with lots of charities to look at how we could help educate people, and actually support them through that journey if they’ve already got cancer, and to help prevent. So for me, that’s a really big part of my life. So yeah, that’s all that I do.

Le’Nise: Brilliant. If listeners take one thing away from everything, all the amazing things that you have said on this podcast, what would you want that to be?

Toral: In relation to what aspect?

Le’Nise: Any of it. Anything, any nuggets that you feel like you just want to stick in their minds.

Toral: As a woman, and I’m assuming most people listening to the podcast are women, remember that our bodies are so much more than our bodies. And we are so much more than our bodies. But do listen to yourself, do listen to your body, and give yourself what you need.

Le’Nise: Amazing. I think that’s such valuable advice. Thank you so much for coming on the show, Toral. It’s been amazing. You’ve certainly given me a lot of food for thought.

Toral: Thank you so much for having me. It’s been an absolute delight that we’ve finally got to connect after knowing each other for a while.


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