Hannah Swan was doing everything right when it came to weight loss. She ate a clean diet consisting largely of fruit and veg, understood her macronutrients, took collagen and other supplements and was working out four times a week.

And yet every day, for years, the 45-year-old author and writer from Dorset faced the same problem: severe bloating that left her in agonising pain by the end of the day.

‘Sometimes I would wake up and I could see my abs and think I was finally making progress,’ she says. ‘But by the end of the day, I was extremely bloated and in so much pain. I can only describe the feeling as being suffocated inside my own body.’

The swelling was so extreme, friends and family assumed she was pregnant. ‘My boyfriend said: “Are you sure you’re not pregnant? You look like you could be six months along.“’

And appearances aside, Hannah’s social life was on hold. ‘I didn’t accept a dinner invitation for a good few years, because I understood I would be in pain. It’s just constant anxiety about feeling so awful.’

Looking for answers

Hannah’s confusion was largely down to the fact she was proactively living a ‘healthy’ life. She trained nearly every day, focused on healthy eating and had long left behind the party lifestyle of her younger years.

But when she started seeking answers, she was fobbed off with the same ‘diagnosis’ many women receive. ‘As soon as you hit 40, everything is put down to perimenopause,’ she says. ‘I went to the doctor and it was confirmed I was perimenopausal, and everyone said that would be the cause of my pain and bloating.’

‘I started to think: “Is this just what happens? Am I going to have to accept this is how I look and feel?” People were telling me it’s cortisol belly, related to your hormones, and you just need to get on with it.’

Hannah Swan suffered severe bloating, to the extent that her friends and family thought she was pregnant, which left her in agonising pain

Hannah says she remembers thinking: ‘Is this just what happens? Am I going to have to accept this is how I look and feel?’

She tried calorie restriction, intermittent fasting, smoothies for breakfast instead of meals and a range of health supplements. At one point she even began questioning her workouts. ‘You get to the point where you’re like, should I switch out weight training for Pilates? Or should I just do my 10,000 steps instead?’

But nothing made a meaningful difference to the persistent pattern of swelling and pain around her stomach.

‘A lot of my friends who were struggling with perimenopausal weight gain started taking Ozempic, and they got amazing results. But then they were having side-effects such as hair loss, not to mention spending £200 a month.

‘I knew there must be another way, and kept thinking about my symptoms. When I woke up, I realised there were drastic differences in my bloating and pain depending on what I’d eaten the day before. And I started to think: “Maybe this is down to something I’m eating?“’

Identifying the issue

Eventually, searching for a clearer explanation for her symptoms, Hannah decided to try a YorkTest food intolerance test. She hoped it might reveal whether certain foods were triggering the bloating and discomfort she had been living with for years.

The results highlighted a number of specific foods her body appeared to react poorly to, including wheat, dairy, sugar and certain processed foods.

At first, she was sceptical. ‘I didn’t eat a lot of dairy anyway and wheat-wise it was really just sourdough.’ But when she looked more closely at the full list, the picture became more nuanced.

She says: ‘I realised there were drastic differences in my bloating and pain depending on what I’d eaten the day before’ 

Hannah saw a huge improvement once she tweaked her diet to combat the bloating

It wasn’t simply about cutting out obvious culprits such as gluten or sugar. Instead, the results suggested that several smaller, more specific triggers might be contributing to her symptoms. ‘I can’t eat egg whites, but I can eat egg yolks,’ she explains. ‘I can’t eat tomatoes, because I struggle to digest them.

‘People will assume I’ll just cut out gluten, sugar and dairy. But it’s so much more nuanced than that.’

She also discovered that some cooking oils were causing problems. ‘I’m allergic to rapeseed oil and swapped it out for olive or avocado oil instead,’ she says.

Instant results

One of the most surprising aspects of the change was how quickly her body began to respond.

‘The moment that you take out anything nasty from the body, the body stops becoming inflamed,‘ she says. ‘So the moment that you take away anything that’s causing inflammation and pain, you’re going to start to feel relief.’

Within weeks, the difference was clear. ‘I lost 5kg, primarily from water weight and some fat,’ she says. ‘I also experienced significantly less bloating and noticed a marked improvement in my energy levels.’

For Hannah, the biggest lesson was how individual nutrition can be. Rather than following generic diet rules, she believes understanding your body’s specific triggers can make a significant difference.

‘You don’t imagine a tiny bit of sourdough or tomatoes can be doing this,’ she says. ‘But your body is a fine-tuned machine. It’s like driving a Ferrari: you need to know what fuel to put in it so it can perform.’

Instead of restricting food, she says she now focuses on nourishing her body properly. ‘It’s not about elimination; it’s about replacement,’ she explains. These days her diet includes more whole foods (especially fruits and vegetables) and far fewer processed ingredients.

The result? Hannah says she feels healthier and more energised than she has in years – and more confident in how her body looks.

Looking back, she only wishes she had discovered the cause of her symptoms sooner.

‘Knowledge is power,’ she says. ‘And now I’m just so relieved I have answers. And after all this time, I finally have the abs I’ve worked for and can show them off!’

Standing in front of the mirror before my son’s wedding in March 2023, I felt crushed. At a size 18, my expensive dress was bigger than any I’d worn in my life – and I’d had it taken out another two inches at the last minute. At 13 and a half stone, I was so much bigger than I’d been just a year before.

I’d been a confident size 12 for years, maintaining a healthy weight of around 10st. I swam three times a week and enjoyed long dog walks. I ate normally and knew I could lose a few pounds by being sensible and cutting out treats if I’d overindulged.

But when I turned 50 in 2020, I went into full menopause. In just a month, I put on a stone. I was still cooking fresh meals, I was still active and, as the weight piled on, I cut down on portion sizes. But the extra weight just wouldn’t shift. Within a year, I’d gained two stone.

So I started trying different diets and I’d shed a few pounds – but they always piled back on, with interest. My husband Amin tried to reassure me that he still found me attractive – but it wasn’t about how he felt, it was about how I felt.

I’m only 5ft 3in, meaning my BMI was in the obese category, and I hated the way I looked. It was so frustrating – I felt I couldn’t wear the bright, fashionable clothes I loved and my confidence nosedived.

After months of lockdown, when everyone was thrilled to get back together, I stopped accepting social invitations – no meals out, parties or even coffee with friends. I felt too embarrassed to see them.

In summer 2021, Amin and I celebrated our 30th wedding anniversary with a wonderful trip to Barbados. I wore a swimsuit but I’d always cover up with sarongs. Even in paradise, I felt like a prisoner in my own body.

My eldest son Adam announced his engagement the following year. I was overjoyed for him. But privately, I was filled with dread about how I’d look at the wedding.

Shazia with her eldest son Adam at his wedding. When I saw the photographs a few weeks later, I was devastated, she says

In summer 2021, Amin and I celebrated our 30th wedding anniversary with a wonderful trip to Barbados, says Shazia. I wore a swimsuit but I’d always cover up with sarongs…

… even in paradise, I felt like a prisoner in my own body, she adds

For the big day in 2023, I had my hair and make-up done professionally. I wore a beautiful Indian dress and tried to smile for the cameras. But mostly, I avoided everyone, feeling self-conscious and uncomfortable.

When I saw the photographs a few weeks later, I was devastated. It had been such a lovely day, celebrating Adam and his beautiful bride, and all I could think was, ‘How did I let myself get to this stage?’

Those photos were my breaking point. I’d wasted our 30th anniversary hiding under sarongs, I’d avoided socialising for two years – and now I’d hidden at my own son’s wedding.

Thankfully, I had another lovely occasion coming up. In September 2024 Zayn, our younger son, announced he was getting married too – and this time, I was determined to overcome my weight issues. I’d tried the food replacement system LighterLife back in October 2007, to shift the weight I was still carrying after Zayn was born.

I lost three and a half stone in three months and kept it off. I knew it was time for something radical again – so in June 2024, I went on to an intense programme to give me a kick start. The 12-week programme involves four meal replacement packs a day, about 600 calories in total, and cost around £2 per pack. 

Needless to say, the first ten days were brutal – I felt so hungry and exhausted and was ready to quit, but my mentor Lisa was key to my success. She was available for daily support, and we had weekly group sessions online. Lisa regularly reminded me that the process was designed to rewire my brain around food, by giving it a break from the usual craving and bingeing cycle.

I also liked the ‘mindfulness’ and cognitive behavioural elements.

In our weekly sessions, we often delved into uncomfortable territory – examining the core reasons for our eating habits, our relationship with food and our emotional triggers. For me, being in the right headspace was the key to keeping it up.

Shazia with Amin at their younger son Zayn’s wedding

Shazia now… I don’t see a woman hiding from anyone any more, she says. I’m free to be fully myself

The first two weeks were so difficult, I really needed the online support. But quickly, I learned I wasn’t always as hungry as I thought. Often, my body needed water, not food.

I learned to distract myself when triggers came up, too, which led to a newfound love of pampering myself with face masks and hair oils.

Within weeks, I felt lighter and more energetic. I could jog up stairs without getting breathless and carry my grandson Gabriel without wanting to hand him over after a few minutes. My morning walks with friends became enjoyable again, not embarrassing struggles where I had to constantly slow down.

By the time of my dress fitting, just one week before Zayn’s wedding, I’d lost so much weight that the dress had to be taken in by four inches.

The difference between Adam’s wedding photos and Zayn’s is like night and day. In Adam’s photos, I’m tense, hiding, barely there. In Zayn’s photos, I’m radiant with happiness and confidence.

My blood pressure, which had been diagnosed as high back in July 2022, is now stable. My health has improved dramatically. I swim regularly again and take Gabriel to swimming lessons on Saturday mornings. Before, I would never have worn a swimming costume in front of other parents.

I even dress differently when I go to work at our care home. I stand straighter. I carry myself with confidence I haven’t felt in years.

My relationship with food has completely changed. I’ve learned to take time to enjoy my meals, to think about mealtimes as a positive experience rather than an emotional crutch or a source of shame. I learned to focus on one meal at a time, one day at a time. I was nervous when I slowly began to introduce ‘real’ food, so I included the packs until I felt I had a routine.

Before, I’d have toast and jam for breakfast, a chicken mayo wrap for lunch, biscuits at teatime and a big curry for dinner. Now, I’ll have a banana or apple, a salad and chicken with peppers or stir-fried salmon fillets. If I crave an ice cream, I’ll have one – but I won’t have another the next day.

In June 2024, I weighed 13.5 stone. Now, I keep my weight at a steady 8st 13lbs – and eating well has become second nature. I’m healthier, more confident, more present in my own life and I have my joy back.

Looking at those wedding photos from Zayn’s big day, I don’t see a woman hiding from anyone any more. I’m free to be fully myself.

As told to Flic Everett

Sitting opposite me, looking me dead in the eye, my patient swore blind that he had stopped drinking. Very convincing he was, too, as he detailed how he hadn’t touched a drop of alcohol in months.

The only problem was that his blood tests told a rather different story. His liver function was through the roof. When I gently pointed this out, he paused, before saying: ‘Well, maybe the odd glass of wine with dinner.’

After further probing, it transpired that the ‘odd glass’ was a bottle and a half. Every night.

I wasn’t shocked. Not because I’m cynical but because I know, from experience, that patients lie to their doctors all the time.

Research by online pharmacy MedExpress in 2024 revealed that 73 per cent of Britons said they had lied to medical professionals. 

It’s a staggering figure, especially once you consider that 45 per cent of those surveyed believed that their dishonesty had delayed their diagnosis or treatment. .

And it’s not just alcohol people lie about, although that’s certainly the big one.

People also mislead about taking their medication, how much they exercise (or rather, don’t), what they eat, whether they smoke and about their sex lives and sexual health.

Doctors nearly always know, or at least have our suspicions that our patients are not being entirely honest. We are trained to pick up on inconsistencies 

Bowel habits are another topic people often gloss over. Although I don’t condone it, I understand why. These are personal, sometimes embarrassing subjects.

Nobody wants to confess that they haven’t been to the gym since 2019, that they’ve been skipping their blood pressure tablets or suffer frequent bouts of constipation.

The reality is that we doctors nearly always know, or at least have our suspicions that our patients are not being entirely honest. We are trained to pick up on inconsistencies.

If someone tells me they barely drink but their blood results suggest otherwise, that’s a red flag. If someone claims to be taking their medication religiously but their condition isn’t improving in the way it should, I have questions. 

I see diabetic patients who swear they never touch anything sweet, then their HbA1c blood test comes back revealing that can’t possibly be true.

Some then admit they only followed the diet in the week before the blood test, not realising that HbA1c measures the damage done to red blood cells by sugar over the previous three months. 

If a patient tells me they exercise regularly but they’re breathless walking from the waiting room to my consulting room, something doesn’t add up.

Sometimes it’s body language. A slight hesitation, a glance away, a vague answer where a specific one was needed. We are not interrogators, but years of clinical experience teach you to read people.

What concerns me far more than the lying itself, though, is why people do it and how damaging it can be.

I might attribute symptoms to one cause when the real culprit is something the patient hasn’t told me about. I might prescribe a medication that interacts badly with something they’re secretly taking, or fail to screen for a condition because I’ve been given false reassurances.

In the worst cases, a lie can delay a diagnosis.

So why do people do it? Fear of judgment is a big factor. Many patients assume their doctor will think less of them, lecture them or write them off if they admit to bad habits, especially if they’ve been warned about them in the past. I promise you, we won’t.

We genuinely do not have the time or inclination to judge. We’ve seen and heard it all before and very little surprises us.

There’s something deeper going on, too. As a psychiatrist, I recognise that much of this dishonesty is driven by denial, one of the most powerful and primitive defence mechanisms we have. 

Denial isn’t simply about deceiving your doctor, it’s about deceiving yourself, too. If you don’t say something out loud, if you avoid it altogether, then on some level it feels less real.

The obese patient who insists they eat healthily and never snack isn’t just lying to me, they’ve told themselves that story so many times they half believe it. The heavy drinker who says it’s ‘only a couple’ has re-framed reality to make it tolerable. This is entirely human and we all do versions of this in our daily lives.

But in a medical setting, it can be dangerous. Denial keeps people from confronting problems that need confronting. It delays treatment. It can, in extreme situations, even cost lives.

So, next time you see your doctor, I implore you to be honest. Not because lying is wrong but because your health will depend on it. We are on your side and we want to help. But we can only do that if we know what we’re actually dealing with.

The consulting room should be the one place where you don’t have to put on an act. So please take advantage of that and tell us the truth.

My fears for Bea and Eugenie

I can’t help feeling sorry for the Princesses Beatrice and Eugenie as the Epstein files continue to reveal the true extent of their parents’ appalling behaviour. The sisters are said to be ‘aghast’ and ‘mortified’

I can’t help feeling sorry for the Princesses Beatrice and Eugenie as the Epstein files continue to reveal the true extent of their parents’ appalling behaviour.

The sisters are said to be ‘aghast’ and ‘mortified’. Beyond the shock, there is the shame. And shame is one of the most corrosive emotions there is.

It is not the same as guilt. Guilt says ‘I did something bad’. Shame says ‘I am bad’. 

What makes this so psychologically cruel is that Beatrice and Eugenie have done nothing wrong, yet they are carrying the shame of their parents.

This is something I see regularly at work: Children absorbing a sense of disgrace that belongs to a parent. 

It can be damaging to identity and self-worth. 

But nobody should maintain a relationship purely because of a blood tie, especially if doing so causes real pain. Loyalty has its limits. 

Sometimes the bravest thing you can do is walk away.

Have we been failing to spot autism in girls? A landmark study suggests we have. 

By tracking 2.7million people born between 1985 and 2022, the Karolinska Institute in Sweden found that while boys were far more likely to be diagnosed with autism in childhood, girls caught up during adolescence. 

By the age of 20, the diagnostic rate between the sexes was almost equal. 

Girls tend to be better at ‘masking’, mimicking their peers in social situations to fit in, which can conceal the very traits clinicians look for. 

As a result, many girls and women are misdiagnosed with anxiety, depression or personality disorders. 

I have seen women in their 20s, 30s, sometimes older, finally getting an autism diagnosis after years of feeling that something was different about them. 

A new study analysing 19million cancer cases in nearly 200 countries has found that 38 per cent of cancers are attributable to 30 lifestyle factors. 

Smoking is the biggest preventable cause but infections, such as HPV, account for one in ten. 

Dr Max Prescribes… The Examined Life by Stephen Grosz 

Through case studies, psychoanalyst Stephen Grosz reveals how self-deception shapes our lives in ways we rarely acknowledge

This beautifully written book by psychoanalyst Stephen Grosz draws on his 25 years of clinical practice to explore the stories we tell ourselves and, crucially, the ones we hide from. 

Through short case studies, he reveals how self-deception shapes our lives in ways we rarely acknowledge. It’s very relevant to my main piece: the lies we tell our doctors are often the same lies we tell ourselves. This will make you consider your own blind spots.