Latest / The Dr Louise Newson Podcast / 26 - How hormones and lifestyle shape healthy ageing

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26 - How hormones and lifestyle shape healthy ageing · The Dr Louise Newson Podcast

0:00
So for World Menopause Month in October, I'm going to be coming
0:03
to three theatres, the 5th of October in Glasgow with Kay
0:07
Adams, the 12th of October in Birmingham with Liz Earl and the
0:11
19th of October in Kingston near London with Emma Barnett.
0:16
I'm going to be doing AQ and A so these women will be
0:19
questioning me, asking me about my background, my work and also
0:25
about hormones. And the second-half will be
0:28
audience asking questions. So there'll be lots of
0:30
opportunity to put your questions across.
0:33
You can ask me anything, of course.
0:35
And I really look forward to meeting some of you there.
0:40
So today my podcast guest is Doctor Tash Morando.
0:43
She's auk trained GP, but she now works in Singapore.
0:47
We talk a lot about preventing diseases.
0:50
We talk about the foundation, so which is really lifestyle.
0:55
We talk about aging, is it a disease or not, what we can do
1:00
to be healthy as we age, and talking about health span versus
1:04
lifespan. It's a really great conversation
1:07
with lots of really good practical tips as well, so I
1:11
hope you enjoy it. So Tash, it's great you're over
1:18
here. Last time I saw you in fact, was
1:21
over here in London, and before that I was over in Singapore.
1:25
Like, it's just amazing because you're an NHSGP very, very, very
1:30
part time over in the UK, aren't you?
1:32
But you mainly work out Singapore.
1:35
But you're really interested in me about keeping people healthy.
1:39
I am. Thanks, Louise.
1:40
Thanks. It's really nice to actually be
1:42
here in person doing this because the first one we ran was
1:45
was virtual. And I never met you?
1:46
Then no. We hadn't.
1:47
No, and now I feel like I'm really close to you.
1:50
We what's up with each other a lot, but lots of people think
1:53
it's really weird when I talk about wanting to prevent disease
1:57
rather than treat disease. And I know you're the same as
2:00
me, but I'm very reflective. And I think about when I trained
2:03
as a doctor, I learned and we learned a lot about diseases and
2:08
how to treat them. And obviously that's really
2:11
important. But the older I've got, the more
2:14
I'm trying to prevent disease in people.
2:17
I say people rather than patients because they won't be
2:20
patients if we reduce diseases. And it's so important, isn't it?
2:24
Couldn't agree more to be honest.
2:26
We really need to start moving away from the sick care model.
2:30
I really don't want to be looking after sick people.
2:33
I want to look after, well people and get them optimised
2:37
and feeling better, yeah, Because that means I know for my
2:41
own longevity that I can keep going a lot longer doing what I
2:47
love doing, just getting people feeling well and optimised,
2:52
which is great. It's so important.
2:54
I mean, I'm very fortunate, like a lot of people know who my
2:57
mother is because she's been on the podcast, but mentally she's
2:59
really good and physically she's not bad.
3:02
And I've always been really inspired just expecting other
3:05
people to be like that when I was younger and watching her.
3:09
But then as AGP, and I know you've done the same, you go to
3:12
nursing homes, residential homes, care homes, sheltered
3:15
homes, and it's usually women who are sitting there staring
3:19
into space. And I've always been petrified
3:21
thinking I don't want to turn into that woman.
3:23
I want to be the woman like my mother.
3:25
And there are so many ways that we could probably reduce that.
3:29
Some of it is genetics. And we can't really change our
3:32
chromosomes, but we can change our genetic makeup by what we do
3:36
and how we eat and how we exercise, what we put into our
3:39
bodies. We're not really thinking about
3:41
it so much. Sometimes as doctors, we're not
3:44
thinking about the end game, are we?
3:46
And I think we have to be to save healthcare systems, not
3:49
just in the UK, but Gloverly as well.
3:51
Yeah. We have to think of it at a
3:53
population level as well at this point in time.
3:56
So I'm a lifestyle medicine physician as well.
3:59
And for me that's a non negotiable right, because
4:02
lifestyle is what we are in control of and the way we do
4:07
things in a sustainable way means we keep going for as long
4:11
as we keep going. So the term longevity, we're
4:13
trying to move away from that because it seemed to be used in
4:17
different ways and forms. So part of the healthy longevity
4:20
medicine society. And I've just come back from
4:22
Copenhagen, which was very lucky to be a part of the aging
4:27
research and drugs development conference.
4:30
And really what we're looking at is how do we make this just like
4:34
lifestyle medicine is a specialized within medicine, how
4:38
do we get Jairoscience, Jairo medicine?
4:41
So the science of aging and how we do it well, but it's also
4:46
about living that best quality of life.
4:49
So it's not about lifespan, which is the age we live until
4:54
it's about health span, which is the age we are healthy until.
4:57
Yeah, right now that gap between the two is about 10 years.
5:00
Especially for women, it's worse for women, isn't it?
5:03
So I often say to people that it's not the age we die, it's
5:05
the journey to that age. And that's completely what
5:08
health span is about, isn't it? And I was reading a paper last
5:13
night recently in the late 1970s about ageing, and it was a
5:19
philosophical paper about is ageing a disease or not?
5:23
And I can argue it both ways actually.
5:26
I don't know what your thoughts are about ageing being a
5:28
disease. And that's a tough one because
5:31
as soon as you start labeling something that is inevitable.
5:35
So ageing is inevitable. However, doesn't mean you have
5:39
to get older, right? I'll take a solid 85 and be
5:45
happy on a tennis court and be done right, but do you really
5:48
want to be diseased and not be able to have that quality of
5:52
life? So I think that's a tricky one.
5:54
It's hard. It is really hard and that's
5:56
something you know, probably need hours to debate over.
5:59
That's his and the whole definition of disease in itself.
6:02
And I often play mind games, you know, Is menopause a disease or
6:06
not? Is being in labour and being
6:09
pain in pain when you're in childbirth, is that a disease or
6:12
not? And of course people will have
6:14
different opinions, but I think with ageing, it's something like
6:17
you say, we can't avoid, but we can reduce the negative impact
6:22
on our bodies. And I think that's what's really
6:25
important, isn't it? And that is, and again, this is
6:27
where I'll go back to that lifestyle piece because I, you
6:31
know, when I explain it to my patients, I say, think of it as
6:33
a pyramid, that foundation, that's your lifestyle.
6:37
You solidify that foundation with no cracks in it, which
6:41
means in everything we do to optimize on top of that actually
6:45
makes sense and it works. It's very hard to treat and
6:50
supplement someone who hasn't really optimized that
6:55
foundation. So prioritizing sleep,
6:59
nutrition, especially protein and fibre, strength training.
7:03
We had a little strength competition before coming here
7:07
today. And then that in turn means your
7:11
mental health should be so much better.
7:14
You get that social connectedness in because we were
7:17
also talking about group classes and attending classes and
7:20
meeting different people, especially if you are moving
7:23
countries, living in different places and then also avoiding
7:26
those risky substances. So these are things that, yes,
7:30
make sound easy, but that behaviour change is really hard.
7:35
Yeah, it is really difficult. And especially when people are
7:38
busy, and especially as it's so easy to not do that, to not eat
7:42
healthily, to not exercise frequently, to not think about
7:45
our sleep. And you know, you're one of the
7:47
few doctors that actually practices what they preach.
7:52
I hope you don't mind me staying there.
7:53
Thank you. It's taken me a while, I'm being
7:56
through my own journey and I see what works now and I don't want
7:59
to go back. No.
8:01
So when did you really change? I'm going to say sort of pre
8:05
COVID, I'm being fit and healthy, you know, with a lot of
8:08
sport, but it's different to really being optimized and
8:12
feeling that difference, especially with competitive
8:16
sport and also being able to keep up with, you know,
8:20
teenagers. Well, your tennis.
8:21
Tennis is your main. I mean, because that's what I
8:24
sort of hold there in the middle and what I do is around that to
8:28
make sure I'm strong enough. I've got that endurance.
8:31
So my muscle mass, my strength, my endurance and my recovery
8:34
after. Because at the end of the day, I
8:36
don't want to be playing a three hour tennis match at 2:00 PM,
8:39
which is what usually happens in Singapore for the matches and
8:43
then have to spend the rest of the weekend playing catch up.
8:47
So it's about how do I, what do I need to do for me as an
8:50
individual? And this is where precision
8:51
medicine comes into play because it is very individual and it's
8:55
how do you create that environment for you in a way
8:59
that is sustainable in the long term.
9:01
It's sustainable is really, really important because, you
9:05
know, my lifestyle's changed a lot and I feel very strongly
9:09
that I can't practice and preach something differently.
9:14
I can't be saying to patients, come on, you need to exercise.
9:16
If I'd never exercise, it just doesn't work.
9:19
But you know, nobody feels worse if they eat better.
9:22
No one feels worse if they exercise.
9:24
But I was having this, this, this discussion with my daughter
9:27
actually last night, because like I said to you earlier, she
9:30
took me to an exercise class last night in London and it was
9:33
quite hard. And I think most of the people
9:36
in the class were between like 20 and 25.
9:39
So I was definitely more than double every age in the class.
9:44
And it's inside Louis what it is.
9:46
And I thought, Oh my God, I've really, I've got a show, I've
9:48
got a show and I, but it was great and I really enjoyed it.
9:53
But then she was saying, oh, let's go to a spin class next.
9:55
Now I can't like I, I used to cycle up, but it often triggers
9:59
migraine for me if I do a really high intensity work out.
10:03
So I said CVI, I'll do other classes, but I just really
10:05
careful. I have to make sure my head's
10:07
completely clear and I've just come out of having a three day
10:09
migraine. So the minute I'm still a bit
10:11
careful, but it's very, very individualized.
10:14
Whereas other people like my husband can go for a cycle and
10:17
he won't have had anything to eat.
10:19
He'll be absolutely fine and, and really go for it.
10:22
And I think that's where like we've got privilege of knowing
10:25
our patients and know what works for them.
10:28
And also to just do it in stages.
10:31
Because if if people heard like the weights that you lift and
10:35
the exercise you do, they would be so intimidated.
10:38
They probably would do nothing. But you are so wonderful the way
10:41
you educate and bring your patients on their journey.
10:45
Thank you. That for me is what I really
10:48
enjoy. And I know, OK, I, I'm a family
10:51
physician, I'm AGP. And I think that's the beauty of
10:54
this is you can have somebody sit in your consult room for two
10:59
years on and off and then one day show up and go, I think I've
11:04
finally heard what you've said. I'm ready and then you're ready
11:06
to go. And that's the beauty of it is
11:09
building those relationships and also working through the changes
11:14
that can happen. There's no one-size-fits-all.
11:16
Things change. Similar with perimenopause and
11:19
all the hormonal shifts and changes.
11:21
We can get it right And then six months later it's off again.
11:26
And then we've got to tweak and change.
11:27
And this is where it's more often art than a science as
11:30
well. And getting to know the patient
11:32
sat in front of you makes such a big.
11:34
Difference, absolutely. And, and I think it is really
11:36
important when we think about hormones, cause I've had
11:38
patients who are really sporty, really fit.
11:41
And then they say to me, gosh, I, my stamina is reduced.
11:44
My post recovery is taking a lot longer.
11:47
I just feel absolutely exhausted doing very little training.
11:51
What's going on? And then you realise they've got
11:53
no testosterone and, and, or they're not eating enough
11:57
protein. You know, there's lots of
11:58
things. And I think there's general
12:00
physicians. We're not just looking at one
12:03
thing, we're looking at everything.
12:04
And that's sometimes missed in medicine, isn't it?
12:07
It is. And it's also assuming that it's
12:10
one thing or another. Absolutely.
12:12
I have patients where they've been stable on their hormone
12:15
therapy for years and then present one day going, I think
12:19
my hormones off and you said they're going hold on.
12:21
It doesn't quite make sense. And then you dig and you dig and
12:24
you dig. I'm a bit of A and it's finding,
12:29
you know, a thyroiditis and hold on, let's manage this because I
12:33
could very easily just throw more and more hormones at this
12:36
person, at my patient. It's not going to change
12:38
anything, but it's finding that underlying.
12:42
And this is where, yes, the buzzwords at the moment, it's
12:45
menopause, it's hormone therapy, it's longevity, but at the end
12:50
of the day, it's about your overall health and well-being.
12:54
And how to? Get on top of that with your
12:58
health screening, ruling things out, finding you know, knowing
13:02
what your biomarkers are. Is there inflammation?
13:05
Are you pre diabetic? So, you know, non diabetic
13:08
hypoglycemia, what's your fasted insulin like?
13:12
These are things and then looking at cardiovascular risk
13:15
and we have so many extra parameters we can utilise now,
13:19
but it's tailoring it to that person rather than just doing
13:22
again every test under the sun. It's really important, even
13:24
though I've got a patient at the moment who's perimenopausal, so
13:28
it's always difficult to get there and she's had a lot of
13:31
mental health issues. It's been really scary for her
13:33
but really difficult to get the right dose.
13:35
And recently after about 5 months, I think I just got
13:38
there, but she's still been not right.
13:41
But then her iron, her ferrity level is really low and she's
13:44
tried iron supplements and she can't tolerate them at all.
13:48
But she's also got endometriosis.
13:50
And so often when people have active anything that's
13:53
inflammatory, but especially endometriosis, their iron will
13:56
be falsely raised. So her low iron is probably even
13:59
lower. So I'm trying to get her an iron
14:01
infusion at the minute and there's so much pushback because
14:04
it's not quite the level. It's like too higher than it
14:08
could be for the guidelines of the iron.
14:11
And anyway, they've just finally agreed to do it.
14:13
And I'm, I'm just thinking, I don't think her mental health
14:17
and her physical health will be optimized without.
14:20
I can give all the hormones I like, but she just needs iron
14:23
and she eats meat and you know, so but again, it's looking at
14:27
everything. So when people say don't do
14:29
blood tests, well, actually we don't just do hormone blood
14:32
tests. We look at everything.
14:34
Overview. Yeah, it's so important.
14:36
Iron, I mean iron, vitamin D, these are.
14:38
Really crucial fixes. Right, looking at B complexes,
14:44
why not? Yeah, right.
14:45
First thing is do no harm. Yeah, right.
14:48
It's. Shared decision making, it's
14:50
education, it's conversation and it's monitoring.
14:53
And yes, in Singapore, I'm in a very privileged position to be
14:57
in private practice where I can do all of that, compared to NHS
15:00
work where, you know, it's a lot more demanding.
15:03
And trying to stay on top of 3040 patients you're seeing
15:07
every day is not always easy. But again, it's how do you just
15:11
keep that relationship, sort of keep building on those
15:15
relationships and trust and that education.
15:18
Piece. But I look back at some of my
15:19
patients in general practice and I know I gave them a disservice
15:23
because I wasn't thinking long term.
15:27
I wasn't thinking how to prevent their next urinary tract
15:29
infection, for example. I was very reactive.
15:32
I was do I need to dipstick? Do I need to send it for urine
15:35
culture? Do I need to give them
15:36
antibiotics? Do I give them three days or
15:38
seven days? Do I need to give them
15:39
prophylaxis? But I didn't think about why
15:42
were they getting the infection? Why is a 62 year old lady coming
15:45
for the third time with a urinary tract infection?
15:47
I didn't even ask if she had any vaginal dryness or soreness,
15:50
didn't even ask when her period stopped.
15:53
And of course if I'd given her some vaginal hormones, I
15:55
probably would have never seen her again in the clinic.
15:57
But I didn't think. And I think that's the problem.
16:01
Often it's very knee jerk. Whereas when you've got time,
16:04
and I think that's when you say your privilege, working
16:07
practice, my privilege I think, and I think you'll agree as well
16:11
is that we've got time. So yes, you've got access
16:13
probably to more tests, but you've actually got time to work
16:17
with your patients, which it's. That, for me is a privilege.
16:22
It is, isn't it? It's having an hour for a
16:24
patient, A new patient. Yeah.
16:26
Just sit back and listen. I spend most of my time
16:28
listening. But you get to really understand
16:31
what the how to prioritise, how to work with them, how they can
16:35
work with you. And every patient is really
16:38
different. And at different stages of
16:41
making decisions as well. I have some women who come in
16:44
going, yeah, I'm ready, let's go.
16:45
And I'm like, oh, OK, hold on a second.
16:47
We still need to make sure you're not up to date with your
16:49
screening. Let's get all of that done.
16:51
And there are things we need to work on.
16:53
But it's it's that those building blocks, right?
16:56
As I said, you can't really out exercise a poor nutrition.
17:01
And if you're not? Sleeping enough, it's very hard
17:05
to then be able to function and do what you need to do.
17:08
It's like waiting through treacle rather than just walking
17:11
outside. Yeah.
17:12
And it's, it's interesting because you gave the most
17:14
amazing presentation and in March at our conference that we
17:18
did, and it was about lifestyle medicine for healthcare
17:21
professionals, wasn't it? And lots of people came up to me
17:24
afterwards and they said, wow, like this is incredible.
17:28
And I was like, obviously it was the most amazing talk, but
17:31
actually a lot of it was stuff that.
17:33
You made. I've known for ages, but it
17:36
actually when I was looking at the audience and seeing people's
17:39
responses, I thought, gosh, people don't know like basics
17:43
because in medical school we're not taught basics about
17:45
nutrition and exercise, are we? And then if if you're not
17:48
personally interested or you've not read, you can see that, you
17:53
know, you think that a ready made sauce is going to be fine.
17:57
You think that low fat yogurt is going to be healthy because no
18:01
one's they told you the obvious people don't understand the gut
18:05
microbiome and how that has affected your mental health.
18:08
And it makes you realise actually that it's not just
18:12
people and our patients we need to educate, but other healthcare
18:15
professionals because this is very basic.
18:18
Like it's not sexy medicine. It's not, it's not cutting
18:21
people open. And but it, it is.
18:23
I love the way you say it's the foundation.
18:25
It's the foundation. And, and I think like sometimes
18:28
with my work, people think what I do is prescribe hormones and
18:32
it's like, hang on. And do you not think that
18:34
hormones will start, We know, work better if you've got less
18:37
inflammation in your body, if you've got that foundation.
18:40
But also, you know, if someone had diabetes, they had raised
18:43
blood pressure, they had any condition or they were really
18:47
fit and well, that that sort of foundation has got to be there,
18:50
hasn't it? It does.
18:51
And this is where actually different people at different
18:54
stages and then behaviour change.
18:57
And as doctors, I'm going to say we're natural health coaches,
19:01
right? And yes, there are extra sort of
19:03
exams etcetera you can do in a lot of learning.
19:06
But it's part and parcel of what we do is we are coaching our
19:11
patients through their own health Chin.
19:13
And OK, on the NHS you have to switch every 7 to 8 minutes.
19:19
Private practice, you've got more time, but it's still, it's
19:23
how do you actually tailor something?
19:26
You know, I'll have one patient go, right, I'm ready.
19:29
Tell me everything I need to do, I'm going to do it.
19:31
And you know, that you can actually come up with a plan.
19:34
And we do written plans and we follow through on it and others
19:38
where if I give them more than one thing, it's not going to
19:41
happen. And they're going to come back a
19:43
few weeks later not having done that and feeling even worse for
19:46
wear because you're going to feel that guilt of, oh, I only
19:49
had one thing to do and I couldn't do it.
19:51
But it's how do you, in a stepwise approach, build it?
19:54
And then when you get it right, boys, it's satisfying.
19:56
Yeah. Because you're going through the
19:58
journey with your patient, which is great fun.
20:00
But do you think we're making progress, do you think?
20:03
I have to say, we are, I know, I know, I know, I've, you know,
20:07
for me, I want to make sure that the glass is always half full,
20:10
right? And this is part of all the
20:12
education work we do, the writing, you know, with the
20:16
Healthy Longevity Medicine Society, we've got a Women's
20:20
Health and hormone therapy group that we're writing about how
20:25
hormone therapy needs to be utilized moving forward.
20:28
And there are so many papers, so much research out there putting
20:32
it together and basing it on the 12 hallmarks of aging, thinking
20:36
about how it can be a Gerra therapeutic, a Gerra protector.
20:40
So how do we protect ourselves as we age is key, right?
20:46
And it's from an education point of view, it's also giving all
20:50
our colleagues the right information.
20:54
And yes, different, you know, different doctors will practice
20:56
at different levels because we all have different interests.
20:59
But it's how do you get everyone thinking in a way of going
21:02
right? How do I get the person sat in
21:04
front of me feeling as good as possible?
21:08
Because you've got, I mean, it's going for gold when it comes to
21:11
quality of life. Yeah, and I think I was.
21:13
I was with my daughter last night and she's 21 and her
21:17
generation and lots of them don't drink nearly as much as
21:21
when I was 21 and not smoking the same way.
21:23
But she's buying avocados, She's got pomegranate.
21:27
She's thinking about her food in ways that I certainly didn't
21:30
think about when I was 21. And I think, well, if she and
21:33
she's learned it herself, really, because there's only so
21:36
much you can tell your children and you know she's watching it,
21:40
but also she knows she feels better when she eats better.
21:42
And that's, I think that's the most magical thing if you learn
21:46
that as an individual because he'll carry it with you.
21:49
But when we think about preventing diseases, it we
21:53
always know about, like you say, those foundations.
21:56
But when we're talking about hormones, that's still being
21:59
forgotten. And you know, people have this
22:02
accelerated ageing when they become menopausal.
22:05
And we've known it for many, especially when you look at the
22:07
data, like Water Rockers data, when women who have a surgical
22:11
menopause at a young age, so women in their 30s have their
22:15
ovaries removed, their hormone levels decline overnight, and
22:18
then they have this increased risk of diseases.
22:21
And we know sort of metabolically, there's increased
22:26
inflammation, there's worsening of very basic biological
22:29
processes because these hormones are biologically active.
22:33
And that's been forgotten. But we've known about it for
22:36
decades. So this isn't new science.
22:39
No, I think it's also just historically what's been done
22:44
and the way it's been done and comparing now to then.
22:47
I think we need to move on from the Women's Health initiatives.
22:51
We need to move on and we need to go right.
22:53
What do we have access to now? We've got modern hormone
22:57
therapy. We've got transdermal Easter
23:01
dyne, right? We've got micronized
23:03
progesterone, we've got testosterone.
23:07
So how do we utilize modern, I'm going to keep saying this,
23:11
modern hormone therapy for the person sat in front and there's
23:15
no one-size-fits-all. But we need to start thinking
23:19
about that prevention piece and the precision medicine piece,
23:23
tailoring it to that person. And where we can do this at a
23:26
population level is again, that foundation of lifestyle
23:30
medicine, plus the education work that goes with it.
23:34
So each and every person has choice.
23:37
And you were talking about your daughter and how she is eating
23:41
and exercising. And I'm seeing that so much more
23:43
because we do a lot of work in adolescent health as well.
23:46
And from a sports and performance point of view, with
23:50
access to social media, AI platforms, and lots more
23:55
conversations taking place, adolescents, teenagers have a
23:58
lot more information than I ever did.
24:01
For sure. Right?
24:02
And they're utilizing that because they're seeing the
24:04
benefits. They want to be optimized.
24:05
They want to feel well. So even when I talk to families,
24:10
it's going right what you do as a parent, if your teenager's
24:17
tweens see you eating in a certain way, doing things in a
24:21
certain way, that's their normal.
24:23
Which means when they're going through exams or life stresses
24:27
or whatever happens, they're not reaching for ultra processed
24:31
food, they're reaching for good whole food, predominantly plant
24:35
based, prioritizing things that really make them feel better
24:39
because they know the impact and that behaviour change then is
24:44
there normal? So you're not having to force it
24:49
later on in life, which is what we've had to go.
24:51
Through yeah, it's so important, I think, you know, accepting
24:55
things, normalizing conversations, normalizing
24:58
behaviours is, is so important with our patients.
25:02
But it's, it's just a shame that it's sort of been lost and, and
25:07
even thinking about the health preventative or the disease
25:10
preventive effects of hormones. I was reading, there's a
25:13
conference that was in the 1970's, the 1974, it's a big
25:17
conference. And it was, it was about healthy
25:20
ageing and the role of hormones. And, and they've really well
25:23
written notes. I, I had to get the, the book
25:27
from the Royal Society of Medicine because it's impossible
25:29
to, to get online. And, and anyway, it's, it was
25:33
talking about the disease, preventative effects for
25:37
osteoporosis, for heart disease, for cognitive decline,
25:40
Alzheimer's, dementia and probably cancers for hormones.
25:47
And these, this was a really pivotal because before that time
25:50
in 1941, as you know, Professor Albright announced about the
25:56
osteoporosis and the bone strengthening of effects of
25:59
hormones. And people were like a bit, not
26:01
sure, but this was really like, actually guys, hormones can
26:06
reduce disease. And then it sort of seemed to
26:10
have been lost again and it's such a shame.
26:13
And we need to bring that. Back which is.
26:15
Part of the work. That's happening, absolutely.
26:18
Is to bring that back and also remembering that 50% of the
26:21
world's doctors are primary care physicians and thereabouts.
26:26
And it's about things written in a logical way and with the
26:32
science that we have. And there's so much research.
26:35
As I said, the 1st paper we wrote, we had to to actually cut
26:38
down. And then we had to cut down in
26:40
the number of references as well.
26:41
But there's so much science. There's so much basic science as
26:45
well, which is really important. And, and, and The thing is, I
26:49
think, you know, often I feel very sad because menopause is
26:51
denigrated to bad symptoms. And there's all this discussion
26:55
is how bad are your hot flushes or how many night sweats do you
26:59
have? How many times do you have
27:00
broken sleep? Whereas actually as the
27:02
physician who wants to prevent disease, we need to be thinking
27:06
about right, why do we give HRT and the British national
27:11
formula, the BNF, which is our sort of Bible, if you like, go
27:14
to is very clear that there are two license indications for
27:18
estradiol. For example, the patches 1 is
27:21
for treatment of menopausal symptoms.
27:23
So actually not perimenopause and we do give it like
27:26
perimenopause, but just to add, it's fine to give drugs out of
27:30
license. But the second indic is for
27:32
prevention of osteoporosis. And so when we're thinking about
27:37
this discussion about what symptoms do you have and if
27:40
you've got living in different countries or different
27:42
ethnicities, do you experience different symptoms?
27:45
I think that's an interesting discussion.
27:47
But the most important thing is think about the diseases that
27:50
are affecting people. And so I'm sort of thinking
27:53
about in Singapore, osteoporosis rates are really increasing, but
27:59
we've got a treatment that's licensed for prevention of
28:02
osteoporosis, yet most people in Singapore, but also in the UK
28:06
and globally and not being prescribed hormones for that
28:08
reason, are they? But that licensing is in the UK,
28:11
Yeah, right. So it's also looking at regional
28:15
guidelines because at the end of the day, it's going right.
28:18
What does my regional society say?
28:22
Right. What does my local society say?
28:24
And that's something that's really changing because the Asia
28:28
Pacific Menopause Society as well, looking at the federation
28:32
guidelines, which have just been updated, and then being utilized
28:36
for the region in AIPAC is huge and having a lot more education
28:41
events. So there's going to be an event
28:43
run by the Singapore Menopause Research Society next March and
28:48
just a lot more education work happening.
28:50
And I think that's key because it's getting the doctors on
28:56
board. Absolutely it's.
28:58
Getting the clinicians on board, it's also looking at the next
29:01
generation, right? So medical school, having
29:04
conversations is part of the communication teaching that we
29:07
do as well. And similar here, even with the
29:12
British Society of Lifestyle Medicine, really looking at how
29:17
we get lifestyle medicine taught at medical school as part of
29:21
curriculum, as part of GP training.
29:24
And I'm going to say everyone needs to that this is basic
29:28
knowledge and you can delve into it in more detail, but at least
29:33
knowings you can pick things up. But it's also the collaboration
29:36
effort, right? It's working together.
29:40
And I think the more we can work together within the
29:43
specialities, within group practices, wherever in the world
29:48
they can. I love the fact that I can pick
29:50
up the phone and call somebody in the US or hear, you know, the
29:54
conversations we have then in Australia.
29:57
It's just having that network. And it's not about fault.
30:02
It's just going right, here's what I'm thinking.
30:06
What do you think? Can I and how do I improve my
30:10
practice? And I think that is changing
30:13
even over the last couple of years.
30:14
You know, there's there's a lot of us in lots of different
30:17
countries that are really working often behind the scenes
30:20
together. And we're, you know, joining the
30:24
dots that often haven't been there.
30:26
We're realizing that we're not working alone.
30:29
And then it just helps our patients as well because you
30:32
know, you never get something 100% right.
30:35
And it's a journey with our patients that you say.
30:37
So there's there's loads that we're doing, there's loads more
30:39
we can do. And I and I think bringing those
30:41
people that want to learn is part of it as well.
30:44
The people that don't want to learn, it doesn't matter.
30:46
They can do other things, but there's some really keen people
30:49
to be joined up in this space. So I so I'm very grateful for
30:53
you being here, Tash, but I just need to end for three take home
30:57
tips. You know they're going.
30:58
To I know, I know it was coming. What are the three things that
31:01
you would say if I was coming to you as a patient that said, you
31:04
know what? I don't exercise.
31:06
I know I don't eat well. Like what are the three things
31:09
that I should do that's going to help my future health span?
31:13
It's choose one thing, start somewhere, right?
31:17
And that could be nutrition for one person.
31:20
It could be I'm going to have one drink less when I go out.
31:24
But one thing has a hugely beneficial ripple effect.
31:29
And then it's, it's, it's once you pop, you can't stop, right?
31:34
So you, you, you do one thing and you go, oh, actually I feel
31:36
I've slept better. Let me try this next thing.
31:40
And it's working with that clinician who, you know, can
31:43
guide you on that. Secondly, ageing is inevitable.
31:49
However, what can you do to optimize your quality of life?
31:54
And that's going to be different for different people.
31:57
And I don't, you know, expect everyone to be lifting really,
32:00
really heavy weights. If you've never done it, please
32:02
don't just go to a gym and start trying to deadlift and squat and
32:06
do pull ups. Start somewhere.
32:08
Start with some home exercises, start with a wall, sit for 30
32:13
seconds whilst your kettle is boiling.
32:15
You know, these are things that it just keeps building up.
32:19
And also, I really want not just women, I want people to advocate
32:24
for themselves, right? We need to push for up to date
32:29
guidelines and to stay on top of that and think of a guideline as
32:33
a guideline, right? Look at the latest research,
32:36
look at the latest evidence and collaborate, have conversations
32:40
because we as clinicians need to make sure that our patients are
32:44
getting the best care available to them and we can't do that
32:47
alone. Yeah, I really like that.
32:49
So it's not just patients being advocates, it's doctors being
32:52
advocates for their patients. Great way to end.
32:54
Thank you so much. Thanks, Louise.
32:56
Thanks for having me again.