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Micro wisdom delivered to your ears every morning in voice notes ranging from 3 to 15 minutes long. Wisdom on how to live a healthier and more fulfilling life. Every podcast will ground you in the present moment to ensure you know what's important, the here and now.
How are you, Amalia?
Speaker 2:I'm good. Thanks. How are you?
Speaker 1:Not bad. It's a bit we have been inside when the sun is out in London, ain't it? You find
Speaker 3:it kinda weird.
Speaker 2:It's a very rare occasion. Although it's just setting now, it looks like it's got cloudy. Well, where I am, it is anyway.
Speaker 1:Yeah, whether you're getting educated instead, learning.
Speaker 2:Where exactly?
Speaker 1:Look at us, motivated individuals. But yeah, no, the time was meant to be seven. I mixed up on 07:30 also, so anyone who've seen different times, apologies. Next time, we'll do seven.
Speaker 2:Yeah? Okay. Fine. That's better
Speaker 3:for you? Yeah.
Speaker 2:Yeah. Yeah. I'm flexible. Ether's good. Yeah.
Speaker 1:We just wait for people to come in because they've known 07:30 now. Yeah. How have you been in? What's going on?
Speaker 2:Not bad. Not bad. I'm not I'm so untech savvy.
Speaker 4:I've got
Speaker 2:I've got some slides and I'm like, am I gonna be able to share Who knows?
Speaker 1:Easy. You see that big button in the middle of the share screen? Bam. The big button what? You see the big button in the middle, see this like a laptop icon.
Speaker 2:Yeah, yeah, yeah.
Speaker 1:Does that work for you?
Speaker 2:Yeah, let me try it.
Speaker 1:It should ask you to pick the screen you want to share.
Speaker 2:Google Chrome, but I would like to record this computer screen and audio. That's fine.
Speaker 3:That's what fine. It always does. It does some let me just click those. Because I know sometimes when I've tried to do it before, it's kind of probably my
Speaker 1:It can be a bit faffy.
Speaker 3:I think it's just the secure oh, for god's sake. See, privacy is who's trying to modify. Was it enter password?
Speaker 1:Yeah. You probably just need enter your password to share your screen or at least allow it to record or so.
Speaker 3:Okay. There we go. Allow. Good measure. Maybe I'll just call it on the run.
Speaker 3:Okay. Fine. Alright. That now should work. Let's try that.
Speaker 2:And then
Speaker 3:this is when Shall I do the entire screen? Yes, see, I'm so done with this.
Speaker 1:Don't say no.
Speaker 3:Good, Savi.
Speaker 2:Let me just
Speaker 1:You very slow on the computer and the GP is usually in there.
Speaker 2:I'm not that bad, but like am I using AI yet? So if I do entire screen.
Speaker 1:You you can do entire screen or browser. Can you see where where is your presentation on a slider on a browser, in a tab? It's on PowerPoint. It's on also, it's on a app on your computer. So it might be able to see window, like, just pick a window.
Speaker 1:It's present
Speaker 3:I see. Just it's some security thing. Window. There we go.
Speaker 1:Trying to find PowerPoint.
Speaker 3:It's more the access that it's
Speaker 2:I think let me quit and reopen because.
Speaker 1:Yeah, I might need to do that actually.
Speaker 3:Think that's what it's doing.
Speaker 1:Hello everyone. Hello hello. Got one video. Navel wooden, is that how you say it or no? Is it?
Speaker 4:I can't. Well, I think I said to you the last time.
Speaker 1:Yes.
Speaker 4:It's my joint email address. So I can't change it to my name. I don't know how to do it.
Speaker 1:That's your name now.
Speaker 4:Nave Wooders, it is.
Speaker 1:Wooders is your name now. That's your nickname.
Speaker 4:Definitely. Nave Wooders. Yeah. Wooders for short. Nave Wooders.
Speaker 1:How are you doing? You good?
Speaker 4:Yeah. Not too bad. Thank you. Been a busy day.
Speaker 1:Yeah. How's it been going last week or two?
Speaker 4:Yeah. Good. I've actually managed to up my protein intake. Some not really it has actually really helped.
Speaker 1:It
Speaker 4:does keep me full of for longer.
Speaker 1:What's your target? What's your target? Is it me breaking up or what? Am I breaking up?
Speaker 4:You might have done for a sec.
Speaker 1:Was I frozen? Yeah.
Speaker 4:Yeah. Were you speaking?
Speaker 1:I'm on listen. I'm on Starlink. I'm on the Elon Musk satellite. It's on my roof. It's meant to be unobstructed Internet, 300 megabytes.
Speaker 1:Honestly, it's terrible. But the good news is doctor Amalia here has got his screens working. He's got he's got the presentation working. Happy day.
Speaker 2:Log out of everything, and then security wise, to log back in, I had to do about 53 things just to get back into my email, so sorry.
Speaker 1:It's fine. It's fine. I'm looking forward to learning this topic. Everyone else, I hope you are ready to learn more. We've been on a learning streak, Amalia.
Speaker 1:We've been we've been last two weeks, we've been learning a lot, so we're excited.
Speaker 2:Good. So lots of talks. Well, I've tried to keep it enough so that there's plenty of time for questions because most of the time people have loads of questions at the end of things. So hopefully we'll have time for that.
Speaker 1:Yes.
Speaker 2:Let me know when you want me to start.
Speaker 1:That's fine. Everyone listening in, there'll be more people jumping in coming through the next few minutes, but if you have any questions, please, when you remember them, just post it in the chat and I'll be reading them and then I'll share the questions at the end, so I'll keep tabs on them for you so you don't have to catch up on your on yourself there. But, yeah, you can start now and people will start joining more as well, and it's recorded as well. Fine.
Speaker 2:So I'm just gonna let me get that up. Just tell me if you can see.
Speaker 1:We can see it. If you go to I can see it. If you go to I got PowerPoint. Type slideshow. Tap slideshow at the top there.
Speaker 2:Okay, from start. There we go. Done. Boom. Okay, perfect.
Speaker 2:Right, so I'll just give you a really brief background about me so you know what I do and I'm not a complete random person that's come to talk to you about hormones and aging and GLP1s. So I'm GP trained. So I trained as a normal kind of functional general practitioner and kind of over the years, I realised that we didn't really target health in terms of preventative ways. So I started looking at more preventative ways to kind of keep people healthy. That led me into hormones.
Speaker 2:So I started doing more natural hormones like bio identical, this was about fifteen years ago. And gradually over the years treating menopause, it's progressed into kind of healthy aging or age management medicine really. So trying to keep people healthier for longer because hormones are such a big part of that. So that's where my background is. And then I kind of am gonna cover slightly different things today.
Speaker 2:So we are doing another talk on hormones at some point. So I'm not gonna cover that predominantly today but we're really gonna talk about aging and how to age well and what to do. And we're gonna cover a little bit about GLP1s because it's such, which are the weight loss injections for people that don't know what GLP1s is just in relation to parrot pal and nutrition and health because there's such a big topic at the moment. And I think there's so much misinformation out there and scaremongering and people worrying about it. So we're gonna cover that and my experience of prescribing them with patients.
Speaker 2:So that's what we're gonna cover today. And hopefully I'm just gonna keep a check on the time so I know we've got plenty of time for questions because that's always the most important thing. So what I'm gonna talk about is the key drivers of aging. So why we age, what's behind us ageing and getting older. And then that leads to kind of metabolic health, muscle mass.
Speaker 2:So the key pillars of ageing and how to manage them, cognitive functions, so that's our brain decline. And then we're gonna cover a bit of hormones on there and the role of hormones in the concept of preventative medicine. So slowing down the ageing process and then cover a bit on GLP1s, what they do, the right way to use them and what the risks are of taking them and my experience. So there's quite a lot to get through. So I've tried to keep it brief.
Speaker 2:So we cover bits of everything. So what is aging? When people talk about aging, we think about, you know, older, getting wrinkly, going through menopause, nursing's high. All people have different ideas of what getting older is and what they worry about when they're aging. Hormonal decline, gaining weight for a lot of people is a worry as they get older.
Speaker 2:And a lot of the part of it, a lot of what we worry about tends to be more aesthetic, but also the inner side. So the biological aspects of aging and what's really happening in the body, what the aging process is. And what it is, is it's a loss of resilience in our body. So it's our body unable to process things the way it used to, not able to respond the same way, whether it's to do with weight or nutrition or recovery or our cognitive function. And there's a lot of talk moment about longevity.
Speaker 2:So if you follow doctors like Peter Attia and Huberman, they talk a lot about longevity and it's all over my Instagram. It floods my Instagram. There's face creams to do with longevity and everything's to do with longevity, supplements, this and that. And it's not about living longer. We don't all wanna live to 100 and live till 90 but what it's about is living well for longer.
Speaker 2:So we know that our life expectancy is getting more. So the average age for a woman and a Caucasian woman in this country is about 85. For men, it's a bit less, it's early eighties. And what we do know is we live in poorer health as the years go on in those last years of life. And that can even be from 65 onwards, people start getting, you know, loss of independence, inability to be able to really basic things like care for themselves, do their own shopping and 65 is not old.
Speaker 2:A lot of people are still working at that time. So the idea when we talk about longevity and how I focus with my patients is it's about aging well. So being able to stay independent, to stay healthy, being able to actually help our body to function in that time for as long as possible. And the key drivers of aging are, I put hormone decline at the top because obviously I'm a hormone specialist. That's kind of my bread and butter but that is a key driver in aging because as everyone will know and when you get to a certain point for women, it's quite obvious and I'll talk a bit later about menopause and things, but our hormones tend to drop off a cliff when we hit menopause.
Speaker 2:So around the age of 50, 51, our ovaries stopped producing hormones and the same with men, but it's a bit more gradual. The hormone decline is when you see the aging process speed up a little bit. And that's to do with not just our skin and how we look, but in terms of our body, our bones, our cardiovascular system, our brain function, it's all related. And then the second one, which is super important, which is the one I want to talk about next is muscle loss. So one of the key drivers of ageing is actually the loss of muscle and the loss of muscle is also related to the loss of hormones because for example, more obviously in men, as their testosterone declines, they tend to lose muscle.
Speaker 2:The same is for women. And when you lose muscle, you're not just losing muscle mass and how you look, you're losing your metabolic flexibility. So your muscle plays a big part in your metabolism to do with how you regulate sugar, how your insulin works and just how your body responds to food, to exercise and gaining weight. And when you don't have a good metabolism, so you're poorly functioning metabolically, that then leads to more inflammation and I'll talk a bit more in-depth about each of these but the more inflammation you have in your body, the less you're able to recover, the more likely you end up with age related diseases like Parkinson's and all the neurodegenerative diseases, the more you get, you know, cardiovascular problems, muscular problems. So it's all related and one of the key drivers really is muscle.
Speaker 2:I will use Ronaldo as an example, that's a good picture. I'm not looking about the muscle on what he looks like but he's a very good example of how we define chronological age versus biological age. For anyone that's got like trackers, if anyone uses a whoop or an oral ring or things, a lot of these health trackers now track your biological age. Now your chronological age is how old you are, so how many years you've been on the planet. So he's an example, he's 41, but his biological age is 29.
Speaker 2:Now you can have two people that are both 41. You can have a biological age of 29 like Ronaldo. You could have a biological age of 65 if you are not eating well, you're stressed, you're not sleeping, your body's aging on the inside. To be fair to him, to get his biological age that we're talking, continuous exercise. We all know he's quite famous for the lifestyle he leads, the amount of exercise he does, saunas, cold plunges, nobody's his friend because nobody wants to go for dinner with him because pretty much eats.
Speaker 2:I think one of the footballers like he has like, you get boiled chicken and salad and then you go training and then you do a cold plunge. So that's the kind of dedication. So he's like the extreme of somebody that's taking it but the general things to follow mean you can get your biological age down by doing quite simple things that we're gonna talk about today. And the reason we're aging poorly and if you only need to go into a nursing home or look at people's parents and grandparents and see people losing their independence is also part of modern day living. So there's lots of things that in our modern lifestyle that have exacerbated why we don't age so well.
Speaker 2:One of those commonly is sedentary behaviour. So our jobs generally are much more sedentary. Most of us have office jobs. I mean, involve sitting down, even in my clinic, I'm sitting for most of the day and what people now classify as exercise. And I mean to my patients, I will hold my hand up when I do my initial consult, you know, and I cover hormones, I cover nutrition.
Speaker 2:I'll say, okay, what exercise do you do? And some people say, well, I go to the gym three times a week. I cycle to work every day and everyone's kind of opinion on what exercise do is different. So some people classify exercise as walking to and from the tube station every day and that they classify as exercise. And for people that don't do any exercise, that is better than nothing.
Speaker 2:I'm not dissing walking or telling people they shouldn't but what we think is exercise now is actually just counteracting the fact that we sit at a desk most of the time. So it is really important to try and bring in exercise into our daily patterns as well. Ultra processed food is another one. So we live in a world of convenience where people eat on the go. I'm a big fan of meal prep.
Speaker 2:So I generally get my patients to try and meal prep as much as they can. I know it's not easy, but just, you know, trying to avoid picking stuff when you're out, especially things like ultra processed meats and things like that. So I try and recommend people eat, you know, the classic things, grass fed beef, wild salmon, try and eat as healthily as you can and what you're putting into your body is really important and loads of vegetables, loads of fibre, good fats and things like that. And then constant calorie intake. So we also, part of the not moving, not eating as well is we eat probably too much for what we're meant to be doing.
Speaker 2:And when we look later and I talk about GLP1s, it's interesting when people lose the weight because actually they don't think they eat much, but it stops the snacking. The amount of times actually, if you log what you eat, the amount of things people will add in a day that they don't count as food is really interesting when you log it. Chronic stress is another one. So people don't, I think emphasise the impact of stress on ageing enough and trying to get good sleep and doing some mindfulness and meditation and things is super important because when your brain is stressed, it puts your hormones out of balance, it puts your cortisol out of balance, you become more insulin resistant, it has a counter effect on everything and then sleep is also important one. Most people don't sleep enough or they don't have good enough quality sleep.
Speaker 2:So that's another really important one to address for aging. And so the four pillars I give people to try and slow the process down, again, I'm not a fan of anti aging, I don't call it anti aging, I think it's healthy aging because we're all gonna get older but ideally you wanna slow that process down for as long as possible so you stay independent for longer. And the four things we look at is muscle mass. So again, the main thing to do is strength training to maintain your muscle mass is really important. Metabolic health is the second one.
Speaker 2:I'm going to talk about these in a bit more detail. So making sure your metabolism stays on point, keeping visceral fat low. So visceral fat, for people that don't know, it's the fat you carry around your middle, which gets harder to lose as we get older. We all know as we get to 40, it's harder as you get to 50 and you hit menopause, it's even harder because as we age, we become more insulin resistant which is why we gain weight around the middle. And nutrition is really key to keep up metabolic health.
Speaker 2:So eating good foods, eating whole foods, focusing on protein and also movement. So movement, doing a bit of cardio, you know, walking, getting your steps in also helps with your metabolism. And then hormone balancing. So putting your hormones back is also essential because if you're trying to do all the other things without looking at your hormones as a whole, you're kind of missing, you can't finish a puzzle if you're missing like a quarter of it. And that's where hormones are really important because over and over, I see people who hit, and this is mainly once you've hit menopause and andropause for men is people saying, well, I'm eating well, I'm training, I'm doing this.
Speaker 2:But if they're not sleeping and they don't have the estrogen, progesterone and testosterone, then everything else you're doing just burns you out. And you're kind of going on an uphill treadmill continuously. And then another really important one that so many of my patients miss is recovery and sleep. And again, hormones do play an impact in that as well but it's actually letting your body rest. Trackers are good for that because they do track if your body's in a strained state, okay, we'll have an easier day today.
Speaker 2:And some people find that guidance really helpful and making sure your sleep is good quality so that you're sleeping enough hours that when you are asleep, you're in a deep sleep and you're getting your sleep targets so your brain recovers. And so we talk about muscle and there's so much chat on Instagram, on social media about muscle, about muscle mass strength training. And a lot of my patients ask me, well, why? Why do I have to strength train? What does having more muscle achieve for me?
Speaker 2:And it's not just about the aesthetics of how we look or having abs or having biceps or having, you know, nowadays the fashion, all the young people at my gym, all the girls are training their butt, everyone wants a big butt which actually serves you well later in life because it helps you get off a chair. But again, it's not about how we look, it's much deeper than that. So your muscle is basically what I call your longevity organ. So it's your organ that you really have to focus on training if you want to live well, not just because having good muscle mass helps you get up the stairs, prevents you tripping and falling. So as we age and we lose muscle, that's why people tend to trip over.
Speaker 2:Good muscle mass also equals good bone health. So bones are super important because as we get older, we get a risk of osteoporosis where our bones as we age become more brittle. So they're more prone to fractures and breaks. So the stronger muscle you have, the better your bones are. So it kind of comes hand in hand but your muscle is also your organ that helps with glucose disposal.
Speaker 2:So your muscle basically helps. You've got insulin receptors in your muscle. And what that does is when you eat, when your glucose rises, it helps remove glucose out of the blood vessels and puts it into the organs. So stores it as glycogen stores it in the liver, in the muscle. And what that then does is it helps to regulate your sugar levels.
Speaker 2:So the more muscle you have, the more insulin receptors you have as you age and we become more insulin resistant, the more muscle helps to control your blood glucose. Then that helps to then keep your inflammation levels down because the more we age, we get what's called insulin resistance. So our tissues, our body becomes more resistant to insulin. So the more muscle you have helps that. That helps decrease your visceral fat, which is the bad fat that also we carry around our organs and our liver and therefore helps to keep our muscle strength up.
Speaker 2:So the more reserve you have as well and the more glucose is stable, if you do get injuries, so if you are still able to be doing sport when you get into your sixties, seventies, if you do fall over when you're playing tennis and, you know, rupture your Achilles or break your leg while you're skiing, the more muscle mass you have before that means the better your recovery is gonna be because your body's in a better state. Metabolism is more balanced, your body's stronger. So it's able to then heal from that as opposed to if you're 70, you don't have much muscle mass, you fall over and break your hip. We can all see, and I see it in my patients, it sets you back like another five, ten years. It ages you very quickly.
Speaker 2:So that's also the part of having a good muscle mass before you injure yourself or fall over. And then your muscle actually also supports your cognition. So it's also to do with keeping your insulin levels down, decrease your inflammation. So a lot of the things we get when we're older, like Parkinson's disease and all the other neurodegenerative, so that means all the disorders of the brain we get like Alzheimer's and Parkinson's. All of it now is related to insulin resistance and inflammation.
Speaker 2:So the more you can control your insulin levels as we age, the less likely you are to get things like Parkinson's Alzheimer's and those things. And then you've got the basic things of being independent. So if it's all very well-being able to walk to the shops when you're 70 or 80 but if you can't carry your shopping bag when you get to the shop because you've got no grip strength or you've got no muscle mass is kind of a pointless exercise. You know, it's why you see a lot of people as they get older, they have those pulley bags, it's because they can't actually carry anything. So really simple things I get patients to do in the gym and this is even in my patients that are in their seventies and eighties is just things like walking with dumbbells and being able to carry as heavy as you can and build that really gradually is a really basic thing that even for older patients I get them to do.
Speaker 2:And so how you maintain it, the obvious thing is strength training. So that is really the non negotiable for people I tell them is out of everything. I mean, the arguments I have with my patients on a daily basis when they're like, oh, I do pilates like 10 times a week or, you know, I do yoga every day. And I'm like, that's good. They're all good things to do, don't get me wrong.
Speaker 2:But for me and to build muscle and keep your muscle mass up, you've gotta be lifting weights and lifting heavy. So you do your Pilates on the side, you can do your yoga but you really need to strength train and we actually start losing muscle in our thirties. The thing is we all start panicking because you notice it more in your body, in your fifties, especially when we hit menopause and andropause, but actually our muscle loss starts in our thirties. So trying to start strength training in your thirties and forties and fifties puts you in a really good space for when you actually do hit menopause or andropause. Balance exercises is another one because what we also do is we lose our proprioception as we get older, which is why people tend to trip and fall.
Speaker 2:You know, they'll trip over a pavement, they'll trip over their feet is because actually it's to do with balance. So even in the gym doing walking with dumbbells, one-sided exercise is really good. Working on your core because that's super important so you don't injure yourself and put your back out as your muscles get weaker. So that's where doing a bit of pilates and yoga and mixing everything out, it really helps. And then the key really with muscle, I tell people is adequate protein.
Speaker 2:And I bang on about this to patients and trying to measure out just making sure they get enough protein because ironically, we think we need less as we get older, but as we age, we actually need more protein to be able to reverse the sarcopenia that's happening and actually build muscle. So, you know, I try and get people to just track protein at least when they're starting because you don't know what you need to eat until you know how much protein you're getting in a day. And it still surprises me how much you need to eat in a day and that's where kind of food trackers and things and apps are really helpful because no one wants to sit and count how many grams of protein is in a fillet of salmon and a chicken breast and two eggs and things like that. So nutrition is key because I always tell patients it's like trying to build muscle and age well if you're not eating the right things is like trying to build a house when you've just got cement and no bricks, but it's just gonna fall down. You don't have the basics there.
Speaker 2:And the other thing is super important and we'll cover this kind of when we talk about GLP1s is crash dieting is probably one of the worst things you can do because when you do crash diets, you lose and you kind of put yourself in a massive calorie deficit to lose weight for a holiday wedding, whatever it is, you lose muscle. And we'll cover this when we come to GLP1. So that's a really not a great thing for aging because you're losing muscle. And as I said before, muscle is your longevity organs. That's the one that you really need to focus on to keep you kind of fit and well for longer.
Speaker 2:And so metabolic health as we age, when we lose muscle, as I talked about before, we lose our glucose disposal. So our blood sugar then tends to fluctuate more and we become what's called more insulin resistant. Now that happens anyway with age, as we all get older, we become more insulin resistant. If you have a family history of type two diabetes, so for example, if I'm South Asian, almost everyone in my family has type two diabetes, even, you know, my tall, slim fit uncle, it's genetically in us. And if you have a strong family history of type two diabetes, for example, you are more likely to be insulin resistant.
Speaker 2:You almost have to work doubly as hard to keep it at bay and delay it for longer. And then reducing your metabolic rate. So that's when you start to gain weight because when you become more insulin resistant, your metabolism starts to slow down. And that's why we call it, you know, around menopause, we call it the middle age spread, wherever it finds like they hit menopause and got the things I'm doing are not working anymore. Like they used to be, I'm gaining weight around the middle despite training, despite tracking my calories.
Speaker 2:And that's because your metabolism changes. And that all puts you at risk of type two diabetes. So we all know as we get older, two diabetes is one of the most common diseases, especially in The States, we're catching up pretty quickly with obesity and visceral fat. And then that all leads to inflammation. So the more metabolically unwell we are, the more we've got inflammation in our body because it's the glucose that's driving inflammation.
Speaker 2:And so that then also leads to injuries, it leads to joint aches and pains, all kinds of things, why our blood vessels build up with plaque and whatnot is all to do with inflammation. Arthritis, classic, that's classically as a result of inflammation in the joints. And the other thing is when you lose muscle, you lose what's called our mitochondria. So mitochondria are little cells in the body that are to do with their kind of energy. They produce energy for all the other cells, but they also clean out all the waste.
Speaker 2:So when you don't have enough muscle and they're all stored in the muscle, if you don't have enough muscle, you don't have enough mitochondria, you're not getting rid of all the toxins and everything and that's what increases inflammation. And that's also to do with age related Parkinson's and Alzheimer's as I said before, a lot of it now we know we used to think it was completely separate to metabolic health but a lot of these diseases we're seeing now are actually a result of having poor metabolic health and that's to do with our nutrition and exercise and aging. And that's kind of part of cognitive health. So when we think of cognitive health, it's about as we age and this even hits around fifties when our hormones change is being able to think clearly, remember things, learn new skills, focus, make decisions for ourselves. And loads of my patients come in and they're worried about dementia.
Speaker 2:Almost everyone worries and especially when women hit menopause and it's more common in women than men that they notice memory problems because our hormones have such a dramatic change. Everyone worries and everyone's got parents getting older and they're worried about dementia. And what I tell people over and over again, one percent of Alzheimer's, which is the most common kind of dementia is genetic, one percent. So when everyone worries about that, the most important things to focus on when we talk about cognitive health and how our brain's going to function is looking after your metabolic health, looking after your vascular health. So trying to avoid smoking, exercising regularly to keep your blood vessels strong, you know, don't drink too much, sleep well, nutrition.
Speaker 2:So make sure you get enough good fats because our brain uses fat our energy source. So omegas and having lots of good quality fats in your diet is really important for the brain. Exercising regularly, keep the inflammation low down and also with brain function. And we know when we look at all the blue programmes on blue zones and looking at the centurions who are the people that live to 100, also having a social connection is important. So I'm a big advocate of people when they retire whenever to play golf, tennis clubs, because actually having that social interaction is really helpful to keep your cognitive health intact.
Speaker 2:And so I'm gonna cover a bit on hormones. I'm not gonna go into this in massive detail because we're gonna do that separately but you can't really not cover it when you're talking about aging because hormones are basically chemical messengers in our body and they control just about everything in the body. I can't even go through the list because it is too long. The main ones we generally are gonna focus on are oestrogen, progesterone, testosterone, Insulin we've kind of covered a little bit in that it increases as we age. Melatonin is for our sleep hormone and then thyroid hormones because they're quite important as well.
Speaker 2:So estrogen is the main one everyone talks about in women. I've literally put three things here but I could list about 500 things that oestrogen does. But the common things that oestrogen is important for when it comes to ageing particularly is gra bones. So as we hit menopause, we get an increased risk of osteoporosis. So oestrogen is fundamental at bone building.
Speaker 2:So when our hormones drop off and we hit menopause, our bones become weaker and that's what predisposes us to fractures. The same thing with cognitive, with brain function and things we notice, oestrogen, there's loads of receptors, oestrogen receptors in the brain. So to keep your brain functioning, oestrogen super important. Again, joints, it's responsible for hot flushes, night sweats, skin, hair, nails, metabolism, everything in the body. It also when our oestrogen declines, our insulin resistance goes up.
Speaker 2:So that's often why women notice around menopause, they really struggle to keep their weight down because of the drop in hormones. Progesterone is the one that's really associated with sleep and mood. It's our calming hormone. It's our happy hormone. Again, it's relevant because it does help with bone building.
Speaker 2:So it works on your osteoblasts and osteoclasts to help bone remodeling. It helps with libido, it helps with cholesterol, it helps with everything. Testosterone, again, I talk about muscle mass because that's kind of key that we're talking about him. Testosterone is super important for muscle mass and that's for men and women. So women are predominantly made up of oestrogen, progesterone with a little bit of testosterone and men are made up of predominantly testosterone with a little bit of oestrogen and progesterone.
Speaker 2:So that's why, especially in men, they'll notice as their testosterone starts to decline, they struggle to keep muscle mass up. They get more visceral fat around the middle and it becomes harder to train. And the same thing for women. Testosterone, everyone assumes it with sex drive and erectile dysfunction and low libido, but actually it's a key hormone for the whole body, your energy, your brain function. Insulin's really related to metabolic health.
Speaker 2:So as we age, we become more insulin resistant. Genetics, as I said, play a role in that but it is key for inflammation and keeping your insulin levels down. And that also helps by putting the other hormone back then helps to keep you less insulin resistant. Then you've got your thyroid. So your thyroid, the gland that sits in your neck produces two hormones called T4 and T3.
Speaker 2:As we age, like everything starts to slow down, our thyroid can also start to slow down. So it's a key blood test I do in my patients at the beginning because if your thyroid's out sync, then that affects everything because it's to do with your metabolism, your mood, your energy, your cognitive function. So it is really important to look at someone's thyroid when you're looking at hormones and you could have an underactive or an overactive. And then the other key one is melatonin. So melatonin is our key sleep hormones.
Speaker 2:So as we age, our melatonin levels start to decrease, which is why sleep goes off. Obviously progesterone has a big impact in sleep as well, but melatonin is so sometimes I do give people melatonin if we've done everything else and their sleep still not impact. Again, stress has an impact on that. So that's where you have to look at the whole picture and, you know, drugging people up if actually they're stressed out and they've got other things going on, none of the hormones are gonna help. And then aging is such a big part because people always think, well, our hormones decline and that's why you know, that's why we get older.
Speaker 2:And we do age because of the decline in hormones. It's not the other way around. And so when we hit menopause, and this is around the average age of 50, 51, our ovaries stop producing the key hormones like estrogen, progesterone, testosterone. And that's why everything feels like for some people, it falls off a cliff suddenly. So, you know, they get flushes, night sweats, all the other symptoms of that.
Speaker 2:When we do the second talk, you know, in the run up to menopause, there's all changes that can happen with your hormones in the run up to menopause. So it's not just at 50. So it's important to look at it through the decades. And then men go through a similar thing. So men go through what's called the andropause which some people call the male menopause.
Speaker 2:But again, their testes don't suddenly stop working like our ovaries where the periods stop. For men, it's a gradual decline in testosterone. So often they don't notice it. You know, they start feeling a bit more irritable. They don't sleep as well.
Speaker 2:They're gaining weight, losing muscle, bit more grumpy and it's much more gradual. So people don't always recognise it. Interestingly in The States, they're far more focused on testosterone replacement therapy, so TRT, than they are on female hormone replacement therapy. Ironically here, it's the other way where we're very open and there's a lot of people talking about menopause and HRT and the pros and cons. But interestingly, I don't think guys get the same deal over here because no one really, you know, some people talk about TRT and testosterone but it's not plastered everywhere.
Speaker 2:So I think it is important that men also understand a similar thing happens to them and it is just as important to put hormones back in men. And the reason is also the diseases of aging we get, The common ones that I talk to people about are osteoporosis, which is brittle bones, cardiovascular disease where our blood vessels in our heart become clogged and you get heart attacks and strokes, dementia. So when you look, they did a study in New York on menopausal brain. So a woman pre menopausal, they did a brain scan and you could see it was all the colors you had blue and yellow and red. And then they did the same brain scan in a woman who was post menopausal, so not on HRT hormones have declined and it was basically black.
Speaker 2:It was quite scary looking at the difference because when your hormones decline and you don't put them back, the activity in the brain, the receptors are not being stimulated. So a common thing people talk about is brain fog and memory when their hormones are not quite right. And that is related to then puts you at risk of dementia and Alzheimer's because you need to keep your cognition and your brain functioning and your tissues healthy. So that's where important to put the hormones back. And then again, sarcopenia.
Speaker 2:So that's where we're losing muscle and we're losing bone loss because when you're not putting your hormones back and not doing the other things, you can strength train and do all of these things but you're kind of missing that bit of the puzzle. And insulin resistance again is the root cause of so many of these things because of the trigger it causes with inflammation. So hormone replacement therapy, I'm just going to cover this briefly. So now we've got much safer options. We've got what's called bio or body identical HRT.
Speaker 2:So they're the same hormones as you put in your body. They're not the old fashioned synthetic ones that increase your risk of blood clots and strokes and breast cancer and things now. So we've got much safer options for people. So you don't need to be scared of hormone replacement therapy when you're looking, you hit menopause and you want to explore, it's not necessarily for everybody. I'm obviously pro HRT because that's my job and that's what I believe in because I think it's a key part of ageing.
Speaker 2:And when we look at the studies now, we look at the long term studies and even the studies showed at the beginning when there was a slight increased risk of breast cancer and blood clots with the old fashioned stuff, when women were on it for a longer period of time, we saw the health protection benefits of osteoporosis. So keeping bones strong, less cardiovascular disease like heart attacks and strokes. So the women on HRT had fewer heart attacks and strokes. And again, brain function was much better in those women. Their muscle mass was more and the same with andropause with men, you put testosterone back.
Speaker 2:So whereas women, put all three in men, you just give testosterone because they'll convert enough to estrogen and progesterone if you get your levels high enough. So now I'm going to come on to GLP1s because probably what most people are interested in before we do questions. So GLP1s, for those people that don't know, are the weight loss, what we also know as weight loss injections. So that's what's marketed by all the weight loss companies and everyone's talking about, and there's Voy and Juniper and Boots everywhere does them at the moment. And what they actually are is in our body, we have something called glucagon like peptide one and it's a natural occurring peptide in the body.
Speaker 2:So what that means, it's made up of a chain of amino acids and it's made in the intestines a response to when we eat. And what GLP1 receptor agonists are is we've made a synthetic peptide, so a drug essentially, but it is exactly the same as a peptide and it's designed to mimic the natural hormone but it's designed to last longer because we all produce GLP1 but it's quite short acting. So you might feel full for a while and then it goes away. Whereas with the drugs, they're designed to last a longer period of time so that you feel fuller and that stays with you. And they're licensed in this country for type two diabetes.
Speaker 2:So they've really been trialed in type two diabetes but also in weight loss in people. And we're talking about weight loss in people with a high BMI. So you've gotta be obese or morbidly obese. That's who the studies were done on. And the ones you've probably heard of are Wegovy and Ozempic are the common ones.
Speaker 2:So that's semaglutide. So they just work on their GLP1s. Mounjaro is the other common one that everyone talks about at the moment and that's tisepatide and that actually works on two receptors. So for some people it's a bit more effective at weight loss because it's a dual receptor one. Again, the price of Mounjaro got hiked up massively recently.
Speaker 2:So there was a big hoo about that because we actually got it for very cheap in this country in Europe and then suddenly the price got hiked up and it's slightly unaffordable for some people. But interestingly, Wegovy and Ozempic are still affordable. So if people wanna start that may be the one to start on. And how do they actually work? So they work in a few different ways.
Speaker 2:So they can work by helping the body release insulin. So basically when you eat or you have sugars or your glucose goes up, your pancreas then produces insulin to take the glucose out of the body and store it in the liver or in muscle or wherever it's gonna store it and keep the blood sugar more regulated. So when I was talking earlier about insulin resistance and as we age, we become more insulin resistant or if you've got a genetic predisposition to type two diabetes and insulin resistance, then the GLP1s can work well for that because they help release insulin. So they regulate your blood glucose. But aside from that, the other way they work is they actually slow down what's called gastric emptying.
Speaker 2:So when you eat and the food goes into the stomach, it slows down the process at which it moves through the intestine, which is why people feel fuller. And then they also work, and we don't know how yet, they do work actually in the brain as decreasing appetite and decreasing cravings. So what a lot of patients describe is that continuous food noise that they tend to have, and that's what everyone calls it, tends to go away. So for some patients, it's a case of, you know, they're not trying to lose a lot of weight, but actually when they take GLP1s in a low dose, that kind of continuous, oh, what am I gonna have? What am gonna have?
Speaker 2:You know, I've got some patients that find they just make healthier choices because they don't have that insatiable hunger when they're going to make lunch or it stops them snacking and they find they're more likely to go for, you know, protein and veg and whole foods rather than walking into prep and buying a chicken Mayo baguette or something like that. And so they'll tend to make better choices. And there's also been studies looking at GLP1s in addiction. And what we found is it tends to switch off people's craving for alcohol or some kind of addictive behaviour, but we don't entirely know how that works at the moment, but people have found that they've stopped drinking and alcoholics, some people have been microdosing it and it seems to work well. Now the main side effects that you get, and this is what a few of my patients get, not all, they tend to be gastric.
Speaker 2:So things like diarrhoea, constipation, nausea is a common one and sometimes the nausea is normally at the beginning when they first start or at the beginning when they inject, because it's a weekly injectable. Normally for the first twenty four, forty eight hours, people are a bit nauseated or they can't eat as much And then that tends to wear off. Again, it can happen. It's not always dose dependent. Some people have it on the lowest dose and some people have it on a high dose but those are kind of the commonest ones that people get.
Speaker 2:The more serious ones that everyone talks about are pancreatitis. So that's your pancreas is what releases insulin and is to do with glucose control. So that can get inflamed and we think that's probably secondary to gallstones. So where you produce gallstones in your gallbladder. Now, the issue is around the side effects and the more serious ones is most of the studies done using the GLP1s were done in obese patients because that's what they're licensed for.
Speaker 2:And so if you lose weight suddenly, we think that could be what triggers the pancreatitis and the gallstones and gallbladder issues. So that's why it's better to do things slower and I'll go through the right way to do it in a moment. And a very rare thing is thyroid tumours, but I'm pretty sure they haven't actually had any humans with thyroid problems as yet. It was mainly in studies with rats, but there may have been a couple. But the main one is the pancreatitis to be aware of, that's the more common one.
Speaker 2:Right, I don't like saying right and wrong, but that was just easier to put on a slide. You you're never meant to say good, bad. Diet's meant to be a bad word because it's got the word die in it, but I'm old school. So just for simplicity sake, I have just written the wrong way to take GLP1s. And this is how so many people are doing it at the moment.
Speaker 2:And, you you only need to look at Hollywood and look at the BAFTAs and everything and all of these things and look at people as suddenly like the kind of slightly underweight look seems to have come back into fashion again, where your bones are showing through. And everyone's got friends that are taking it and being like, oh my God, it's amazing. I lost weight. I'm like, you know, back to the size I was before. And there's nothing bad about that, but it's doing it in the right way.
Speaker 2:And I'm incredibly strict with my patients. I don't even discuss it with them if they are not willing to do the weight training and address their nutrition because there's no quick fix. And my worry is with all the online companies now, and I've had some patients do it that way, I've had friends do it that way, they do not even discuss muscle loss or strength training or nutrition and what to eat and how to eat. It's just kind of about dishing out the pens. It's a brilliant money making scheme because they're not cheap.
Speaker 2:And the kind of the downside of it is although yes, you want some element of appetite suppression, but that's if you're overeating. So again, if you've got, you know, you're morbidly obese and you're overeating, it will work well for that. But you don't want your appetite to be so suppressed. And I've got patients, I had a patient a couple of weeks ago who bought it online or her private GP had given it to her. And she was like, Oh my God, Doctor.
Speaker 2:Maher, it's amazing. I had like a cup of tea and a biscuit yesterday and that's all I ate. And I've you know, three kilos in a week. And I literally just put my head in my hands and I was like, Oh God. Because when you don't eat enough and we know now that actually what you're losing is you don't just lose fat, but you lose muscle.
Speaker 2:And the other thing is if people are taking GLP1s and they're like, well, this is great because I just have like a bit of broccoli and a piece of salmon for lunch and that's all I need to eat in a day. Your body then gets used to just having that amount of nutrition. So your basal metabolic rate lowers because you're only getting this much food. So it changes your whole metabolism. And when you then start to wean off and your hunger comes back and you start to eat more and you start to eat normally again, you not only regain the weight, you'll probably gain more weight because your body's got used to having a lower metabolic rate.
Speaker 2:And that's the same for all the kinds of diets they advertised in like the eighties and nineties, like lighter life and things like that, where you just have a shake for lunch, shake for breakfast, and then you have a light meal for dinner. And inevitably when people stop doing that, they messed up their basal metabolic rate and therefore they gain all the weight back and some, and they were heavier than they were before. The second thing people don't do and they don't get told is you have to weight train. I mean, you have to strength train anyway as we age, but especially if you're going to do GLP1s and especially if you're going to do GLP1s in your 40s and 50s to try and help get your weight under control. If you don't weight train, you are a 100% going to lose muscle and more muscle than you would naturally anyway.
Speaker 2:And when they've done studies looking at it, twenty five to forty percent of the weight people lost was lean mass. It wasn't fat, it was muscle. And what lean mass is, it's related to your muscle, it's water, it's your glycogen stores and connective tissue. 25 to 40% of weight, that's a hell of a lot. And granted a lot of the studies, as I say, were not done in healthy people who are weight training and eating well.
Speaker 2:A lot of them were done looking at morbidly obese patients because generally most of the studies were for obesity or type two diabetes and they didn't do all of these things. It was case of they gave them the injections, they lost the weight, then we look at the outcome. And the second part of it is they didn't change behaviour. So the rebound weight gain, they looked at about fifty to seventy percent of people regain the weight after stopping within one to two years. So that's a majority of people that took them.
Speaker 2:And again, that's partly because people didn't change their behaviours. They didn't address their nutrition. They didn't eat right. So their metabolism was lower and the weight just piles back on because most people can't stay on them forever. So those are kind of the key things of how I see people doing it that is probably not the right way.
Speaker 2:And as a result of this, and it was interesting, there's a really good doctor I follow in The States called Doctor. Vonda Wright, she's an orthopedic consultant who talks about longevity and she's really into bone. She's written a very good book on bone health and bone health as we age. And she said exactly what I said on an interview the other day. She said, I don't know, we are gonna start seeing things, not now, but in ten, twenty years of people, you know, in their forties and fifties, who've been using GLP1s and they've lost muscle and the aging process, we're not gonna really see the repercussions for another ten, twenty years of people's bone health.
Speaker 2:Because I said before, if you don't have muscle, your bones are weak. So you're gonna get all these people walking around and they're gonna have a fracture when they fall over and they'll probably only be 65 and start fracturing their hips. And so this I say is the right way. This is how I recommend it to patients. This is how a lot of the doctors do.
Speaker 2:Try and maintain three meals a day. So try and eat at least three times because it will suppress your appetite, whether you like it or not, you will be less hungry most likely on them. So I try and get people to eat regularly three meals a day, even if they're not hungry to keep their blood sugar stable, keep their insulin levels regular and try and eat the right things. So try and focus on protein rich and nutrient dense food so that if you are gonna get full faster, you've eaten enough protein, you've eaten enough fibre, you've focused on the right nutrients. You may need smaller portions.
Speaker 2:So yes, that's where I've said it also. A lot of patients find actually, do you know what? I was snacking way more than I thought I was. So all of the things I didn't think I was eating actually stopped me having a couple of biscuits at 03:00, snacking on a piece of fruit. You know, people generally tend to eat three meals and that helps keep your blood sugar regular.
Speaker 2:Strength training is the non negotiable and at least three times a week if you can. And again, it depends on your age, depends it what your baseline is and how much other exercise you do, but in an ideal world, the worst thing you could do for patients is make them lose muscle when they're at their key years of 30 to 50 to 60, because it's gonna do them no good in the long term. Remember I said at the beginning, muscle is your longevity organ. That's the organ that's gonna keep you healthy at the end. I generally get people to do a weekly weight because you can then see, especially when you're dose titrating, not everybody needs a high dose.
Speaker 2:I've got loads of patients that I've used it on and, you know, I do use it in people that do not classify as having obesity because I also appreciate in menopause, we're looking at metabolic health. So for some people, you know, I do use metformin and medications like that to try and lower insulin levels if people are insulin resistant, but it can work if people are really struggling with their weight. And I've got plenty of patients that have had the lowest dose of Mounjaro two point five, they're strength training, they're eating regularly and they've lost just that bit of weight that they couldn't shift, they can now get back into their clothes, we keep things stable and we never need it to go up. Whereas with a lot of these companies where you buy it online, they go up and up and up and up on the dose and you just get sent it without actually them checking and see, not everybody needs to go up. Some people manage really well on two point five, they do that, some people take it for six months, that's all they need, then they maintain it with diet and exercise and some people take it for a bit longer.
Speaker 2:So it really varies and I've had success, I don't use them a lot but I do use them. I do prescribe them for patients again, as part of a holistic pattern. So I make sure they're putting their hormones back because if you're trying to lose weight and your hormones are out of sync, that's not gonna work. And also doing the weight training and making sure you're eating properly is so important because if you want success and you want a long term, you know, manage your metabolism, then, you know, there's a better way to do it. So my top tips, banged on about this, exercise, strength training, do what you enjoy as well.
Speaker 2:I know not everybody likes being in the gym. I try and tell people, look, it is just the best way if you're gonna build muscle and lift heavy. Not everyone can afford to have a home gym but you can do weights at home. So do what you can. Yoga's good for balance, it's good for the anxiety, for the meditation, helps with sleep.
Speaker 2:Golf and tennis are good ones as we get older. You know, there's a bit of cardio, bit of mobility in there, bit of cardio to help keep your metabolism up, pilates is good, but I say just try and do a mix of everything and do what you enjoy. Good nutrition is key. So protein focus, eat nutrient dense, unprocessed. I try and get people to eat good quality.
Speaker 2:So wild salmon, grass fed beef, what you put in your body is so important. Loads of fibre. So as we get older as well, our gut microbiome needs lots of fibre. Also it helps metabolise out our hormones, so loads of vegetables. Put your hormones back.
Speaker 2:So make sure you get your hormones checked, you know what your levels are doing, make sure they're balanced because that's the key to feeling good. Make sure you sleep well. So things like magnesium are really good for sleep, taking some supplements can help, doing some meditation before bed and that then leads to managing stress because stress, I think people underestimate the impact that has on how you age and how your body doesn't recover. So those are kind of the key things. That's just where to find me if you need.
Speaker 2:So my clinic's called the Hormones Wellness Clinic, but I work out of another clinic called Omnia. So I try and put lots of stuff on my Instagram as well because, you know, there's so much information out there now and I think it is really confusing as to, you know, almost we're too bombarded now with what we've given. So it's hard to make a decision. So I try and put just evidence based stuff on there. So there we go.
Speaker 2:I hope that was helpful. It was like a whistle stop of life.
Speaker 1:No, that was amazing. Like, I think Jess was saying up here who has to go on. Yeah. Jess Jessica Murray has to go, but she said you're a very good speaker as well. All good information.
Speaker 1:And I think said in such a clear way, super interesting. A few questions here coming in now so we can go through them and see how much we can get off in like five-ten minutes. Yeah. So the first one PCOS, myo andositol, it has insulin resistance benefits. Is it okay to take it long term?
Speaker 2:Yeah, it's fine. So myo inositol is good. It's, I mean, I, interestingly, we'll cover PCOS in the next talk as well, which interestingly has just been renamed PMOS.
Speaker 1:Rebrand.
Speaker 2:Yeah, so it's been rebranded, which is so much better because at least people will hopefully get diagnosed. Mynosotol's fine to take long term. I use metformin in a lot of patients because the root cause of PCOS is insulin resistance. So metformin's a good one to look at if you're being managed. But yes, there's a more natural supplement.
Speaker 2:Myanosotol is a good one to help with PCOS and you can take it long term. It doesn't really do any harm.
Speaker 1:Yeah. Wooders was saying there that she's been on the metformin, and it's just had symptoms a lot. Yeah. Are you out now then? Wooders, you're on the video.
Speaker 1:Do you wanna come and have a quick chat?
Speaker 4:Yeah. Yeah. I've I've been on metformin for years, so that's really helped with with symptoms over the years. And I was just replying to the lady who was talking about myoincetone I can't say it. My acetol.
Speaker 1:I
Speaker 4:took that when I would, to help with fertility when I was trying for a baby and that, I guess it helped because we ended up with one. I haven't taken that since, I've just stuck with the metformin. Yeah.
Speaker 2:I think if you're on metformin, you probably don't need the myosotol because the metformin does what the myosotol does. It's just myosotol is a supplement which tries to get your body to do it, if that makes sense. So a lot of people use it for fertility, but again, you can use metformin for fertility. So I use that a lot in in every patient with PCOS, they will get metformin when they walk in my door.
Speaker 1:What percentage of women have PCOS or like endometriosis as I figure? Or is it much higher than you think as well because of the
Speaker 2:Oh god, I think it's a hell of a lot higher than we think, Scott, mainly because both of those things are massively, I can stop sharing my screen here, massively underdiagnosed. So endometriosis, everyone knows is massively underdiagnosed because the only way they diagnose it is doing a laparoscopy. You know, I can diagnose it based on symptoms. You know, you can ask a woman about her periods and if somebody's crawling to the bathroom every month or they've got rectal pain or they're getting diarrhoea before their period, they've got endo. You don't need to do a laparoscopy to figure that out, but unfortunately that's how it's diagnosed.
Speaker 2:And with our health service the way it is, you barely get an appointment with your GP nowadays, let alone getting an appointment with a GP, getting diagnosed and then getting referred to a gynaecologist for a laparoscopy. So we know that endometriosis is massively diagnosed. Interesting, PMOS or PCOS is really linked with endo. So a lot of my patients with endometriosis also have PCOS and vice versa, but not always the dominant one. And again, PCOS massively under diagnosed because for the reason that it's been called polycystic ovary syndrome all these years and they've just renamed it poly endocrine metabolic ovarian syndrome because what we know now it's a metabolic disorder.
Speaker 2:The cysts on the ovaries are like, you know, just part, it was always looked at as a gynecological condition and it's not, it's a metabolic condition. So the lady that was talking about being on Metformin, good deal because that's the root cause of PMOS is the metabolic syndrome. It's not to do with having cysts on your ovaries. So hopefully with the renaming, more women will get diagnosed because we understand it as a metabolic problem. And what happens is you get sent to the doctor, you know, and not everybody has all of the symptoms.
Speaker 2:You know, those days you used to have to have no periods, acne, balding, you know, bed, hair falling out, overweight and all those classic things. Now I see, I think it's become a spectrum disorder. So I have patients coming in and I'm seeing more and more young girls with PCOS in clinic. A lot of them are daughters of my female patients that are going through menopause. They're like, do you know what?
Speaker 2:You were talking about this on your Instagram and I think my daughter's got it. So I think it's very common because insulin resistance is increasing and to do with our nutrition lifestyle and being more sedentary in what we eat, I do think it's becoming more common. But again, not everyone presents with the classic symptoms. I've got some patients that, you know, they're slim, they're a size eight, but they've got a face full of acne and they have PCOS when I do a proper blood test, you know, so they've got regular periods, but they've got one or two of the symptoms that they're manifesting in their phenotype. And so the GP doesn't pick it up.
Speaker 2:They get put on Racutane for their skin, lo and behold, six months after coming off, their skin gets worse because we've not dealt with the root cause. So I think it's way more common with both of those conditions than we even think. I think it's.
Speaker 1:And when it comes to the solution to them, I do see a lot of content coming on my feed. Don't know why because, you know, my algorithm shouldn't be showing me the endometriosis content, but it does. Endometriosis diet, so endometriosis specific things. Is that a thing as well or not?
Speaker 2:I think definitely, I mean, they've done studies on, well, we know it's an inflammatory disorder. Again, endometriosis, I don't think it's as simple as, you know, you've got tissue growing outside your womb and it's just a gynecological condition. Things I generally recommend people do are generally avoid gluten. So you want to decrease the inflammatory load in your body. So gluten we know is quite inflammatory for a lot of people.
Speaker 2:So I try and say, and there've been some studies saying people going gluten free actually helps symptoms. So I generally get people to avoid gluten, try and limit sugars, process food. Again, it's kind of the same advice I give all my patients, Scott, if I'm honest, it's eat whole foods, eat protein rich vegetables, loads of fibre, all of those things. I give endo patients progesterone. So natural progesterone is really good because it helps, it's generally oestrogen driven endometriosis.
Speaker 2:So I give people progesterone because that helps calm the inflammation down, it opposes the oestrogen and helps symptoms, but trying to have a cleaner diet, avoid exogenous hormones, so eating, especially meat and fish and stuff like that, organic and wild and good quality is really key if you can, because you want to avoid exogenous hormones.
Speaker 1:Makes sense, it makes sense. Joey, do you want to come on and ask you a question there? Because I think there'll probably be more detail you can get over done on
Speaker 5:Yeah. I can't put my camera on. I look like rubbish. Been at
Speaker 1:the hospital today.
Speaker 5:I've been podded and poked. So I've got fibroids, quite large fibroids, and an enlarged bulky uterus is what the diagnosis of that is as well. And they've been offering me a hysterectomy, but I worry because my mom's got osteoporosis and she has broken so many bones. She's got metal in her legs, her neck, you name it. She's the bionic woman.
Speaker 5:So I kind of just worry that if I didn't go into menopause naturally and all that sort of stuff that perhaps I would end up like her because it's quite genetic, isn't it? Something like that.
Speaker 2:It can be. I mean, you know, it's hard to give exact medical advice, Jo, without knowing you, so I don't want to misinform you of stuff. Yeah. Again, it depends when you have, if you have a hysterectomy, it will depend, I don't want to ask how old you are in front of everybody, but put it this way, it depends whether they're going to take your ovaries out or not because in terms of the fibroids, often what they'll do, if it's just limited to the uterus, they'll do a hysterectomy but leave your ovaries in, in which case you won't get periods obviously but you won't be in menopause. Your ovaries will still function as normal.
Speaker 2:Now, if you're post menopause and your periods have stopped already, then your ovaries have stopped. They might take out, in which case hormones are super important. If they keep your ovaries in and you go through natural menopause, it's worth just having blood tests every year because without the periods, you might not necessarily know when your ovaries are stopped. The basic thing when you're worried about osteoporosis, the key with osteoporosis is put your hormones back because yes, you'll probably, you might have a small genetic predisposition there, but again, things like muscle mass. So that's where I talk about muscle mass because the more muscle mass you have, the better function your bones are.
Speaker 2:Hormone replacement therapy is key. You know, if I have a patient whose mom had osteoporosis, one hundred percent they're going to get estrogen, progesterone and testosterone when they hit menopause because that's the biggest thing that helps stop you getting osteoporosis. Don't smoke, don't drink, you know, have an occasional drink. I say, drink, avoid as much alcohol as you can, but weight training because the more muscle you have, the stronger your bones are. So I wouldn't worry just because your mom's gone one way, you know, our genetics I always say are not our destiny.
Speaker 2:You know, genes are a small part of how we are, but I guess you've got to deal with what the issue is at the moment and it's if the fibroids are causing a problem, you need to deal with that.
Speaker 5:I'm just always iron deficient and I can't store iron, so they end up sticking me on something like, I think I take three hundred and twenty three milligram tablets of iron. Wow. And then that just causes me to have all sorts of stomach issues and things like that. So and that's so yeah. So I'm just trying to weigh it all up because Yeah.
Speaker 5:In my head
Speaker 1:Yeah.
Speaker 5:I'm like, when I go into menopause, surely that will all just shrink and this is not driven by.
Speaker 2:It depends whether they take your ovaries out when they do the hysterectomy or not. Most of the time, if you're not menopausal yet, they leave the ovaries in and they get through a natural menopause, which is probably better. But when you do hit menopause, you want to put your hormones back because that's what's going to protect your bones.
Speaker 5:Yeah. Yeah. Okay. Thank you for that.
Speaker 1:That's all right. Awesome. And one more, if you don't mind, and it's from Victor. So Victor, no audio and camera's fine. So, basically, he's saying he strength trains three times a week.
Speaker 1:His diet includes two meal meal replacements. He's eating a 130 grams of protein a day. He's got very low appetite, but he's struggling to lose weight. He's a 46 year old, ninety kgs, hundred and seventy four centimeter. Doctor is recommending Mounjaro, but he thinks, how can I help him if he already has a low appetite?
Speaker 1:Do have any cases you've dealt with this, Amalia, or people come in?
Speaker 2:Could be a couple of things. I mean, it's always worth if you I mean, there's two things that could be happening. One, and I'm not a nutritionist to know exactly how many calories and things people need. That is not my strong point when people need that. Sometimes people can undereat and you know, and actually you're not, if you don't have a big appetite, you're not eating enough and that's part of the problem because you're lowering your basal metabolic rate and your body's then stressed.
Speaker 2:Cortisol, because there's lots of hormones that can cause weight gain. So cortisol is one of them, which is your stress hormone. So sometimes if you're not eating enough, you produce more cortisol and that's why you don't lose weight. I think it's important to rule out the obvious things like an underactive thyroid, to look at hormones as well, because if your testosterone's low and really that can start declining from mid forties, if your testosterone's low, then that can cause you to gain weight around the middle and things. And I agree, I think you probably need to rule out those things, make sure you're working with a nutritionist to, you're strength training and you're doing all the right things that actually you're not in a calorie deficit and you're eating enough.
Speaker 2:Mounjaro could help because again, you need to look at, like when I said, look at the hormones, look at your thyroid, look at your testosterone, look at your insulin levels. So my baseline blood test on people, do a fasting insulin because if you've got a genetic predisposition to insulin resistance, you're gonna struggle to lose the weight. And I see this a lot in women, especially when they hit menopause, the only way they can lose weight, and this is very common with PCOS as well, is they put themselves in such a calorie deficit that their body can barely function but that's the only way they see any difference on the scales and what that's doing long term is then stressing your body out more. So looking at insulin resistance, you know, before going down the Mounjaro route, I'd make sure, you know, you're working with a nutritionist to make sure you're getting enough for the amount of exercise you're doing. Look at your thyroid has to be optimum, your testosterone has to be optimum, your insulin resistance has to be optimum and if all of those are perfect in nutrition, then Mounjaro could work because as I said, if there's any genetic predisposition to insulin resistance, it may not affect your appetite and for you, you don't want it to affect your appetite because you don't wanna be eating any less, but it could make your body more sensitive to insulin and glucose and it could try and help you lose that when probably just a tiny dose so that you're not under eating.
Speaker 2:But I think looking at all of the other things and making sure they're optimum because as I always say, normal is an optimum. You know, a normal thyroid function, a normal thyroid level is 12 to 22. Well, I tell people, where do you want to be? Do you want to be at twelve or do you want to be at twenty two? Cause I know where I want to be and it's not at the bottom for all my readings.
Speaker 2:So, you know, and that's where sometimes seeing your NHS GP and things like that, conventional medicine, you know, I'm not stating this has nothing to do with GPs, this is just our health system. We don't look at health prevention, we don't look at optimisation for anything. It's kind of, you know, the bare minimum that we can do to keep the population alive basically is how the NHS works now. So seeing, you know, either sometimes you do have to fork a bit of money and see someone privately to make sure you get proper blood tests. There's really good companies like Randox and Medicheks and stuff that do a good screen.
Speaker 2:But I always say try and do that under the supervision of a doctor because it's a bit pointless to go and get hormones done if you don't know when to do them or what time or things like that. But I'd rule all of those things out before going down the Mounjaro route, but it could help.
Speaker 1:Brilliant answer, very in-depth. And Victor, hopefully you've got a few things to go on next there. Victor does say he has a gen genetic predisposition for diabetes and low testosterone. So now we've now now under controlled by hormonal replacement. Victor, how long have you been on the TRT?
Speaker 1:Maybe we just need some time as well.
Speaker 2:Need a bit of time and again that's where metformin, so I use metformin a lot in people who've got a genetic predisposition to diabetes. Like you could use Mounjaro for that, but again, metformin's probably got better long term studies in the prevention of diabetes because almost genetically, you know, as I said, like I'm South Asian, it's like, I'm gonna be diabetic at some point, no matter how much I train, it is gonna come, but I just want it to come later. But like, you know, disclaimer, I take Metformin now because I'm trying to, I know my insulin levels are decreasing as I'm in, increasing as I'm in my forties. So why am I gonna wait to be diabetic? There's a lot of evidence for using diabetes, using metformin pre diabetes to prevent it coming.
Speaker 2:So there's lots of studies. So if I had a genetic predisposition to type two diabetes, a hundred percent, at least in my forties, I would be on metformin.
Speaker 1:Amazing. Amazing. Well, thank you so much for tonight. We've learned so much, and it'll go it'll go out to people on the podcast and replay. So hopefully, guys, you can check out the Instagram to follow someone who's gonna share legit information added to your algorithm.
Speaker 1:And we'll be I don't know when the next can remember the next talk is? I
Speaker 2:think June. June. Yeah. Yeah.
Speaker 1:In the meantime, if anyone has more things that you want questions asked because you need maybe some time to digest everything, let me know and I'll pass it on.
Speaker 2:Yeah, if people could send me a message and I'll put it, because people often suddenly think, Oh my God, forgot about it, wanted to ask that. So anything you could always just get in touch, either Scott, message Scott and then pass it on to me and then we'll do, yeah, then we'll cover hormones in-depth next time.
Speaker 1:Happy days, happy days. Well, Carmen's coming in saying thank you. So yeah, appreciate the time this evening.
Speaker 2:Thank you very much for giving us your Thursday night, Thursday night.
Speaker 1:Yeah, Thursday night. Alright everyone, nice run, see you all soon.
Speaker 2:Thanks Scott, thank you.