PCOS Reframed: From Hormones to Metabolic Health
In this episode of Coffee with Dr Geoff, we challenge the outdated view of PCOS as purely a reproductive condition. Joined by nutritionist Claire, we explore the emerging science behind insulin resistance, lipotoxicity and metabolic dysfunction, and how a more personalised, data-led approach can finally offer clarity and control.
For the full transcript, see below:
Hello and welcome to Coffee with Dr Geoff. This is a space where we pull back the curtain on the latest medical science and we have a very honest, deep-dive conversation with experts in their fields. And we'll go into details that you're not going to hear in a standard 10-minute, um, doctor's consultation.
So, we're really trying to take the functional medicine approach here, the why behind any health issues, looking past the surface symptoms to understand the biology of how our bodies actually work. So whether we're discussing the latest breakthroughs in metabolic medicine or the nuances of hormone health, the goal's always the same: move away from one-size-fits-all advice and grab the data-driven tools you need to take control.
So grab your coffee, get comfortable, and let's dive into the science.
The topic we're going to cover today is one that affects a lot of women. And if you've been told you've got PCOS, you've likely been told the same two things for years: "Just lose weight. See me when you want to get pregnant." And it's an incredibly frustrating experience that leaves millions of women feeling like their bodies are a mystery, even to their own doctors.
But one of the reasons that the standard advice isn't working is because we've been looking at it in the wrong way. And so today, we really want to dive into a lot of the new research, the groundbreaking work that shows that PCOS is not just an ovarian problem, it's an energy crisis that physically changes the wiring of your muscles and the way your brain talks to your fat cells.
we're talking about a new discovery called lipotoxicity, where fat actually clogs your muscle engine, and how new high-tech medications and science-led nutrition are finally offering a way to possibly help clean that engine, reset your metabolism. So whether you're lean, PCOS, and feel ignored by the system, or you've struggled with your weight for a long time, this episode hopefully will give you some new information.
area.
So today I'm joined by an expert who truly sits at the cutting edge of women's health and metabolic medicine. Claire is a registered associate nutritionist with over five years clinical experience specialising in areas that many of us, myself included, find the most confusing: hormone health, complex obesity, and PCOS.
Claire doesn't work just in private practice, but she's also in the front lines at Guy's and St. Thomas' and Estates Trust. She helps patients there navigate a world of advanced weight loss, medications, and bariatric surgery. But what makes her truly unique and for this conversation is she's got a deep background in research, and she's been published in her work on how specific nutrients, like inositol, can help manage PCOS.
She's also collaborated on groundbreaking gut health work with Professor Tim Spector in the ZOE team, and she's known for her very science-led, human-centred approach using advanced data and diagnostics to stop the guesswork to help her patients get sustainable fixes working with their biology. So whether you're struggling with PCOS symptoms, looking to optimize your fertility, or trying to understand how the new wave of metabolic medications might fit into the show, Claire is the person who's going to help us dive into this in a little bit more depth.
So Claire, welcome to the show.
Thank you. Thank you for the introduction.
So Claire, PCOS is a really complex area. But before we jump into that, I know you've got your own story and background on how you found your passion for, for this area. Maybe you could tell us a little bit more
Yeah. So it's quiet, it's been quite a long journey, uh, to be honest. So in terms of my most recent position at Guy's and St. Thomas', I've been there just over a year, and I've moved around a little bit, but primarily working with patients in complex obesity and those awaiting bariatric surgery or post-bariatric surgery, which has been super interesting.
Fantastic. And you've got... Well, we were talking just before the show that you have got particular interest in PCOS as well. You've had your own frustrations, and I think for a lot of us, myself included, that when, you know, there's something that affects you, your family, you, you tend to really dive into the detail a little bit more.
Can you tell me a little bit more about your own story?
Yeah, sure. So I am a classic example of someone that went through that process. this must have been years ago. I think it was 2019 that I came off the contraceptive implant and noticed that my menstrual cycles were everywhere or nowhere to be seen. There was no consistency.
And the GP had told me to wait it out, but it got to around eight months post, coming off the contraceptive implant, and there was still no regularity. So I sort of pushed for blood tests and eventually got that PCOS diagnosis. But the advice I was given kind of left me feeling quite confused, because the, the sort of most common clinical advice is to lose weight.
However, I fall into the bracket of lean PCOS because I have a, uh, a a sort of lower BMI. So that kind of left me with nowhere to go. And when I pressed for more answers, I just got, "Well, it's genetic. There's nothing you can do." So that kind of led me down the path of my own sort of nutrition research working with dieticians, and eventually studying a master's degree in clinical nutrition to try to get some answers, and then finally did my own clinical trial.
Fantastic. And, and, you know, obviously we'd love to jump into insights on how you managed your own, so some of the listeners can actually hear a real-life story, as well. Before we kind of jump into that, PCOS, I think, is not well understood by a lot of people.
would be able to give us, a simple explanation in general terms what PCOS actually is?
Yeah. So I would say from a top level, PCOS is an endocrine and metabolic, uh, dysfunctional disorder, and it's multi-systemic. So, there really isn't one simple answer or explanation, which is really frustrating. And if you've ever looked through PCOS papers or research, every single paper will start with something along the lines of, "PCOS is a complex multifaceted condition that is still not fully understood." And then it will go into really complex science.
And by the end of it, you'll, you can sometimes feel left just as confused because it really is quite complicated. But to simplify it, there is a neuroendocrine element of sort of hypothalamus interacting with the ovaries, and there's a metabolic element. And these both, they don't exist independently. They feed into each other.
There are a lot of sort of vicious circles and vicious loops in, PCOS as well.
Yeah. So it's, you know, brain, hormones, and we talked about hormones. Obviously, it's a bit like the manager shouting out instructions. Sometimes they're right instructions, sometimes they're not, and then there is the fuel, energy, power bit. And I think what confuses us all is what causes which.
Yes. Yes.
that circle is kind of, you know, that classic chicken and egg story. So, so look, as we said at the start of the show, there has been some really significant papers published in the last few years with regard to
And one of them
by Steiner-Victorin, which caught my eye, because this link to fat inside muscles, so this kind of thinking
Mm-hmm.
steak versus filet steak, and the question that this might be lipotoxic and might be driving some of these bigger issues. so
where are your views on this?
So I think this paper is really interesting because it goes into more detail about the metabolic dysfunction. So essentially, at the top of the chain of the sort of dysfunction and, disturbances in PCOS, you've got the insulin resistance metabolic picture and the hyperandrogenism, which is excess androgens, and both of them fuel each other.
But what, like you said, what we don't know is chicken or the egg, which ones comes first to exacerbate the other. They, for me, they, they are both a cause and consequence of each other. This paper is interesting because it goes more into that sort of adipose tissue dysfunction and lipotoxicity, which that could be the sort of genetic defect or issue that we see in PCOS females in the first place that sort of triggers that, insulin resistant picture and those metabolic defects, which can then lead to the excess androgens.
So, in a way, the paper could explain where that insulin resistance comes from in the first place.
And one of the interesting things I find is that, my understanding is that the ovaries don't become insulin resistant, the other tissues do.
Yeah. That's exactly right. So, it's one of those really frustrating things where insulin resistance is present, and it's worth saying as well at this point that in overweight and obese uh, obese PCOS females, we see 95% prevalence rate of insulin resistance, but even in lean PCOS females with a lower BMI, we see around a 75% prevalence rate of insulin resistance.
So there's something going on at a tissue level independent of weight in females with PCOS. So going back to that sort of adipose tissue dysfunction or the, the lipotoxicity, from a more sort of overarching level, there's a dysfunction somewhere in how our body is responding to glucose and storing energy.
And like you said, what's really frustrating is our muscles and, and organs might become insulin resistant, but our ovaries stay insulin sensitive when they shouldn't be. So
take in a lot of this excess insulin that's traveling around the body because your pancreas is overcompensating when it shouldn't be. And that turns a lot of hormones or it sort of disrupts hormones and creates excess androgens, which feeds back into this picture of insulin resistance.
this loop that just seems to make
things worse and worse and worse.
Clare, one of the interesting things is and you've touched on this already, the different types of PCOS. Some people are lean, some people are overweight. And I've heard lots of people talking about this, and the two different conditions,
but yet, we treat them the same. Love to hear what your thoughts are on that.
Yeah. So, like, with all sort of common complex hormonal conditions, there's, there's lots of crossovers. So it's not quite black or white or lean versus overweight and obese PCOS. But what we do see in research and studies is that in lean PCOS, there tends to be, tends to be more of a neuroendocrine sort of disruption going on.
So from a really top level and without going too far into the science, what that looks like in all PCOS but particularly in lean PCOS is, in the brain, we have the hypothalamus, and the hypothalamus controls the, the sort of pulsation and the release of certain hormones. In lean PCOS, in particular, we see that the pulsation of gonadotropin-releasing hormone is quickened.
We're not sure why. Likely to do with insulin or excess androgens, but it's quickened, and this leads to an increase in luteinizing hormone. And then just like a domino effect, because luteinizing hormone is high, the ratio of luteinizing hormone to uh, follicular stimulating hormone is lower. The ratio's thrown off, and it needs to be a delicate balance.
Because that balance is thrown off, it throws off, how our eggs develop and go onto ovulation or the lack of being able to mature and go to, go on to ovulation. And then this can create excess androgens, and we see that this is much more prevalent in lean PCOS.
There's this sort of feedback, negative feedback loop from the brain, hormones coming down from the hypothalamus. Whereas in overweight and obese PCOS, there's much more of a metabolic issue. So even though insulin resistance can be present in both lean and overweight PCOS phenotypes, in the obese and overweight, types of PCOS, there is much more metabolic disturbance.
So higher rates of insulin resistance, uh, more impaired glucose, uh, tolerance. Things like more, visceral fat and low-grade chronic inflammation.
So the
metabolism, it's different, and the hormones are different. probably makes sense that we start, we look at treating them differently as well, so that generic advice we talked about at the start, just go and do some weight and... is obviously not appropriate. Um, and I just wanna touch on this very quickly.
in functional medicine, we're always thinking about why, why does something happen. And, I've seen some researchers talking about potentially it's an exposure to high levels of testosterone or androgens during pregnancy for these women. would love to know, without going in too much detail, what your thoughts are on that.
Yeah, I think this is a really interesting new area of research, and I, I've looked into it myself, and of course, it's quite complex, but I do think there's something to be said for that sort of fetal development, the, not just the exposure to, excess androgens as a fetus, but also environmental chemicals and toxins as well.
Yeah.
We're seeing huge links between environmental toxin exposure and things like PCOS and endometriosis. but I did always joke with my mom that she, uh, with her Scottish diet, must have caused my PCOS, and I always asked her when I first got diagnosed, I was like, "How many battered Mars Bars did you maybe eat?" "Is that why I have PCOS?" But of course, it's way more complicated than that.
Uh, but it's really interesting research, and it could even surpass the first generation and looking beyond
Yeah,
you know, your parents were, were eating or consuming in their lifestyle and even further up that chain of sort of grandparents and, and that knock-on effect.
Yeah, it's fascinating how we're starting to realize these epigenetic changes get passed on, through generations, which something
even 10, 15 years ago, we were rejecting, but there's, there's a lot of science backing up how that gets passed on. I'm talking about those kind of genetic changes because you can get genetic changes, but they don't necessarily turn into metabolic changes or protein changes. Um, in the Steiner Victorian paper, they actually measured all of those proteins, and that might be worth touching on one of those.
Perilipin was one of the, the hot ones that they thought was, was a big part of this.
Yeah, and I think how I explain it to patients when patients come to me or clients come to me saying, "Why me?" I always try to describe it as, "Lots of people might have the PCOS switch, but something in your genetics or diet or lifestyle might-" have been the thing that sort of switched the switch on." Um, in terms of that paper, it's really interesting looking at the different muscle fibers that are present in PCOS females versus non-PCOS females.
I think it maybe gives us a clue as to whether there is that strong genetic element and whether that is one of the sort of originators of the progression and mechanism behind why PCOS might develop in one female versus another, why one person might deal with more metabolic issues than another, and how that severity might change in terms of what's actually going on in the muscle and the adipose tissues and, and that sort of metabolic dysfunction.
Yeah, and I think that's, that's another good point to bring up because you could have gone, "Right, androgens are up, but so what? why is there..." mean, what does that mean? What's it affecting? And, you know, this muscle fiber analysis, where they did muscle biopsies of 10 people, gave us a little bit more insight into those muscle types.
And what it showed was that patients who had PCOS had a lower amount of type I fibers, so the marathon-type muscle fibers, and that was all pretty significant. And what we're trying to link this into is that, "Well, if I'm sitting here listening to this, what does it mean for me?" So, if I've got these muscle types, um, do I need to exercise more, do I need to exercise less?
what's, what's the type of exercise, therefore, knowing that this muscle fiber has been affected, that you would recommend for your patients?
Yeah, good question, and I think obviously, you know, in an ideal world, if we had access to all of these great scientific research techniques, it'd be great if you could walk into a doctor's office and find out exactly what your PCOS type was and what was going on. But in a world where we can't do that, I always advise that any exercise is good.
And, you know, regardless of whether you like HIT or strength training or resistance, anything is better than nothing. However, I do argue and, and strongly agree that resistance exercise and working that muscle, regardless of the fiber or what type of sort of exercise it is, by challenging a muscle group and working that muscle, you will increase insulin sensitivity, and that is one of the key mechanisms, um, you know, that can drive the severity or improvements that we see in PCOS symptoms.
So, I personally say, you know, any exercise and movement is good because that has that overall insulin-sensitizing effect. But if you can work a muscle, or, or challenge a muscle group, then I think that's a brilliant tool for managing symptoms and reducing the severity of that insulin-resistant picture.
when we exercise, our muscles use up 80% of our energy. they do need insulin to bring in that energy. They've got special receptors that bring it in. And so, if you think of it as a sink, so you're pulling out glucose. If you're pulling out glucose without the need of insulin, your insulin can come down, you become more insulin-sensitive.
So, that helps the, that whole bigger picture. Something we touched on before,
we started was, high-intensity interval training. So, I think you've, you've got your personal thoughts on this because there is conflicting advice out there, and I wonder if you could help clear that up.
Yeah, so the thing is with high-intensity, uh, interval training, we know that it can increase sort of acute cortisol response. And usually this is, this is a good response and your body becomes more resilient. Because we know that there's hormonal disruptions already in PCOS, and just to overcomplicate things, there, there is that sort of hypothalamus communication with the ovaries, and we've also got the adrenal access at play.
And cortisol can be heightened in PCOS females. And that has led some people to say avoid HIT at all costs because it will increase your cortisol, and that's gonna have this negative knock-on effect on the hormonal imbalances that we see. But actually, when you dive into the studies, we don't have any evidence that doing HIT workouts increases your cortisol enough to be sort of disrupting hormones unless you were chronically under-fueling and over-exercising.
But we know in PCOS that around 75 to 85% of females with PCOS do struggle with weight issues and are overweight or obese. So, I think to put a large group of females off any type of is not helpful at all, especially if people enjoy it. If, if people enjoy a spin class and that's something that they will regularly do, then that's what they should do.
If they ask me, "Is weight training better," I would say, "Yes," but if, you know, the spin ... or the HIT class is, is there to do and they enjoy doing it, then do that.
it's the exercise that you do is the most important. Uh, what I always say to my patients, and not, necessarily PCOS, but stress isn't a problem. Stress, we need stress in our lives. We need stress to do things. Not getting down to baseline from stress is the problem.
Mm-hmm.
do your HIT exercise, but, be mindful about having... even if it's only 15 minutes of whatever works for you. If it's sitting in a bath with candles without your phone
so we touched on exercise. The other big one that we haven't even mentioned yet is diet.
when you're speaking to patients, what's your absolute hard lines, red lines for them is like, "Look, if you're eating this way..." And, I presume, um, battered Mars bars are not, not in that advice.
Yeah, definitely not. so, just going back to the things we discussed at the start and just what my sort of interest area was and the research that I did was trying to point out and explore that even someone with a healthy BMI that has PCOS still has higher risk of, of metabolic disorders.
a lean PCOS female is still at higher risk of type 2 diabetes than, someone matched for BMI without PCOS. That insulin resistant is Even if it doesn't manifest externally as a, as a weight issue. So regardless of who comes to me with PCOS and which type they are, I'm always thinking about dietary habits and nutrition principles that will help with that insulin-resistant picture, even if it's you know, to a lesser extent, internally.
So I'm looking at lower glycemic index diets, steering away from, you know, ultra-processed foods, high sugar foods, high caloric foods, and, and those high fat foods, and just going with that Mediterranean approach. again, with the research in PCOS, it's always complex and very ... It's a very heterogeneous condition.
There's so many different factors at play. So you will never find any study that says, "This diet is proven to be the best." But we do see that Mediterranean, you know, it's high in antioxidants, it's anti-inflammatory, and it's lower GI. That is gonna be the best sort of normal pattern that people can adhere to that isn't as strict as like a keto diet.
So the standard things,
eating sugar or starches, as little as possible, or never eating them alone, always add protein in with them, helps bring those insulin spikes down. The rainbow diet, five colors in your plate,
no processed foods.
Yeah, yeah.
so one of the other studies ...
was the paper on lean versus obese phenotypes. I think we've covered that in quite a lot of detail. I think the other one, which we've been working on together, which is really interesting, is the use of glucagon-like peptides or GLPs like Wegovy, semaglutide, et cetera. And there was a really interesting paper, the SEMALEAN study done on patients with PCOS.
And I find some of the findings in this quite interesting, particularly the ones that it seemed to be protective for muscle for a lot these patients. They're measuring strength as well. So love to hear your thoughts on that paper and where these drugs might fit in the arsenal of treatments that we're looking to manage PCOS with.
Yeah. It's definitely an interesting, uh, topic area. And of course with the GLP-1 medications, the main mechanism is reduction of appetite, reduction of calories, and, and weight loss from there. I think what was interesting in the SEMALEAN study is it was a slightly lower dose. Uh, it was 2.4 milligrams, which is considered low, although in the paper I, I think they, they don't label it as low.
Yeah.
Um, so what they saw was significant weight loss, which would be expected, but also, um, maintenance of lean mass. I think at least by the end of it that the lean mass
Yeah.
um, and they didn't lose things like sort of strength and grip strength, which is great because what we're seeing with some sort of cohorts of people taking GLP-1s is, if they lose a uh, a lot of weight over a really short space of time and, and had that rapid weight loss, that some of that can come from muscle mass loss as well and not just excess fat.
So this study sort of goes against that in a sense that people were taking what I would consider a, a lower dose, but still managing to preserve that, that muscle mass as well, which can have a lot of metabolic effects.
Yeah. I think what was really interesting in this study was that they ... So they did DEXA scans. They're measuring muscle. One of the things that DEXA scan can't do is measure the fat inside the muscle. That's a very kind of detailed test where to do that you need radio-labeled isotopes, MRIs, et cetera.
So what they did do as a proxy was measure strength. And there was a very small reduction in the muscle bulk, but actually, for a lot of these patients, muscle strength was going up. And that kind of brings us back to that Steiner paper about lipotoxicity and, you know, my comparison of the sirloin steak to the filet steak in that, are we actually getting cleaner muscle?
And although it looks smaller, it's actually a healthier muscle, it's functioning better, and reducing the insulin resistance at the same time.
Yeah. And I think that's what's really interesting is, do GLP-1s have metabolic benefits beyond weight loss? Um, because obviously, we see that if you are overweight and lose a chunk of weight and, or lose a lot of weight and come to that healthy BMI, that you will naturally lower things like low-grade chronic
Yeah.
and this can have a positive effect on muscle tissue and adipose tissue. So, you know, are the main benefits from the GLP-1s coming from weight loss, or do they have metabolic benefits beyond weight loss? And I think what the studies are showing is they do have metabolic benefits beyond just the weight loss.
I think we're seeing increased insulin sensitivity, better glucose tolerance, uh, better muscle health, like you said, uh, maybe you know, better muscle, uh, fibers like we were talking about before. It's definitely a really interesting, sort of area to keep an eye out for.
Yeah.
if you're bringing down weight, you're bringing down insulin resistance, and you know, this all seems to help improve, the overall picture. But more and more we're seeing that tissues seem to react to these. So, you know, some of the studies have been doing on giving GLPs to patients post MI in a ...
it reduces the of damage done. We don't really understand the mechanism. So there's clearly interactions that are beyond the brain interactions. There are the gut interactions, with, with some of these.
uh, guys in St. Thomas', are you using, GLPs in some of your studies at the moment?
Yeah, so in the NHS generally, there is, there's a strict eligibility criteria. Um, so it's sort of those higher priority patients that are eligible for the GLP-1s, which I think is why the SEMALEAN study was interesting because obviously it wasn't necessarily just high priority,
Yeah.
sort of really, uh, overweight and obese patients. It was, you know, a sort of more general, uh, cohort of the public, I believe. I can't remember what the average BMI was. and I think that's why they used a lower dose and used that 2.4 milligrams and still saw really great effects from that.
Yep, yep. And, when we're working together, what we tend to do is, is really try to focus on that insulin resistance picture before any significant calorie deficit. turn on the fat burning mode before the calorie deficit, so, the body's able to access those fat stores. I find a lot of my patients then don't feel tired because they're actually still accessing energy.
So look, before we wrap up,
I'd love to, to ask you, over three years, what's the biggest insights that you've had? You've been treating a lot of patients, you've done a lot of research. Um, when you first went to your doctor, they didn't give you much advice. If someone's listening out there, what, what would you advise them, um, if they're looking to learn more about their PCOS?
Oh, that's, it's a big question. It's a really big question and I think one thing that I would like health professionals to take away is, if you do see patients with PCOS, just to understand that there are different presentations and different phenotypes of it depending on, you know, whether it is lean or overweight or obese.
And there is that sort of ticking the two out of three criteria of excess androgens, irregular cycles, and/or polycystic ovaries. Within those three, you can have all sorts of expressions of that. So some people might have all three of them, some people might just have, uh, two out of the three.
And then, you know, which ones they have might swap and it can
Yeah.
... lots of different presentations, lots of different, um, symptom severity and, and how patients present with PCOS. So rather than just having a sort of blanket lose a bit of weight and eat a Mediterranean diet, there needs to be a bit more nuance in the conversation and a, and a bit of a deeper dive.
And I know that a lot of healthcare professionals don't really have the time or the tools to do that. But I think even just acknowledgement that, you know, I, I have a lot of, um, clients that have had low BMI and PCOS and been put straight on metformin and told to lose weight and told to eat really low calorie diets, which just wasn't appropriate for them.
And then they lose their periods even more significantly and you're almost venturing into hypothalamic amenorrhea then. Is it the PCOS causing absent periods or is it chronically under-fueling because someone has told you to eat 1000 calories per day? So there's so much nuance, but I would say overarchingly, it is really helpful to follow a Mediterranean-style diet, increase the activity and movement, try challenge muscle groups and, you know, do that resistance exercise, get your muscles working because that's gonna have a really positive effect on insulin resistance.
And then also have a look into certain supplements. So, for me, myo-inositol is up
Yeah.
with one of the top effective supplements in PCOS. It's an insulin sensitizer, so it's great for lean and overweight PCOS. And then just the things you would already anticipate to be helpful, so like omega-3, whether it's through diet or supplement, because that's anti-inflammatory. And there's other sort of useful supplements like, uh, NAC, which is N-acetylcysteine that has anti-inflammatory effects, and vitamin D, which we see is often, um, deficient in PCOS, uh, females with PCOS.
Yeah. So, and those supplements that you mentioned are ones that I use a lot of as well.
N-A-C or NAC, is the precursor of glutathione. That's kind of the body's king antioxidant, so that's bringing inflammation down.
um, we also use chromium as well um, there's good evidence to show that can help insulin sensitivity as well. So anything to get the body functioning properly as opposed to medicating. Um, and vitamin D as well. Omega-3, we've done well over 1000 tests and I think 95% of people come back as deficient in in omega-3.
And a little tip on omega-3, it's one that you can't get from plant foods. So ALA, in chia and flax seeds, 10% of it best is converted. It just doesn't work very well. If you're a vegan, there are algal, um, omega-3s,
but look, Claire, as well as working, um, at Glasson Thomas, also work, um, privately as well. So, um, understand that you're also available for one-on-one consultations. And I think if people do have complex problems, working with a professional like yourself
takes away a lot of frustration. It's a complicated, condition. So we'll also put your contact um, in the show notes here. but I don't know if there's anything you want to say before we sign off
No, I think it's been a really interesting chat. Also, apologies that I'm sort of creeping away from the sun coming round, uh, from the sky. But yeah, I try to share a lot of the science on my, uh, Instagram page just to help people navigate. Well, I try to break it down in sort of non-scientific terms, but just to help people navigate and cut through the noise because there's so much misinformation online.
It's really, it's really confusing.
It is. So obviously we'll put that Instagram in show notes as well. What's your Instagram handle?
It's claire_womenshealthnutrition.
Fantastic. Claire, thank you so much for joining me today and helping me to try to understand this enormously complex, um, condition. And I think things are evolving in this space quite quickly. Um, and hopefully we'll get a, a better understanding and with that better understanding, have a more targeted approach to be able to help more women.
Yeah. I hope so. Fingers crossed.
