1 00:00:00,000 --> 00:00:20,960 Hey hey and welcome to the Forties Formula, your go-to place for insightful discussions 2 00:00:20,960 --> 00:00:25,160 on navigating the forties and thriving in this transformative decade. 3 00:00:25,160 --> 00:00:29,120 We're your hosts, Jasmine and Amanda, two women that are passionate about exploring 4 00:00:29,120 --> 00:00:41,720 the challenges and adventures that come with turning 40 and what lies ahead. 5 00:00:41,720 --> 00:00:46,560 Our guest today, Dr Tash Mirandu, is a British-trained family doctor with experience in both the 6 00:00:46,560 --> 00:00:48,800 UK and here in Singapore. 7 00:00:48,800 --> 00:00:52,680 She's a member of both the British Society of Lifestyle Medicine and the British Menopause 8 00:00:52,680 --> 00:00:57,400 Society and she's developed a well-deserved reputation as the go-to doctor for women navigating 9 00:00:57,400 --> 00:01:00,320 the challenges and changes of menopause. 10 00:01:00,320 --> 00:01:04,040 Menopause is a transformative phase for many women and is a topic that isn't often discussed 11 00:01:04,040 --> 00:01:05,040 openly. 12 00:01:05,040 --> 00:01:08,880 So whether you're approaching this stage in the midst of it or simply curious about what 13 00:01:08,880 --> 00:01:14,520 it entails, we invite you to listen to this conversation with Dr Tash Mirandu. 14 00:01:14,520 --> 00:01:15,520 Menopause. 15 00:01:15,520 --> 00:01:19,160 Now I was trying to think of an analogy as to how I can describe it because I started 16 00:01:19,160 --> 00:01:23,320 going through it when I was 36 years old and the one thing that popped to mind was that 17 00:01:23,320 --> 00:01:27,720 ride in Universal Studios, the Jurassic Park one, you know you're on there and it's going 18 00:01:27,720 --> 00:01:31,320 around quite smoothly and everything's fine and you think you know what I've got the hang 19 00:01:31,320 --> 00:01:35,040 of life I know exactly what I'm doing but you know something's coming you don't know 20 00:01:35,040 --> 00:01:39,040 when it's gonna come and you don't know how bad it's gonna be and I feel like that's what 21 00:01:39,040 --> 00:01:40,040 menopause is like. 22 00:01:40,040 --> 00:01:41,040 What would you say? 23 00:01:41,040 --> 00:01:44,040 I couldn't agree more. 24 00:01:44,040 --> 00:01:48,560 I think this is one of the, I won't even say issues, but one of the things we sort of have 25 00:01:48,560 --> 00:01:55,880 to really battle is each person's different and each woman's experience is different. 26 00:01:55,880 --> 00:02:00,720 Most will be fine, mild to moderate symptoms, if at all there'll be some who just go through 27 00:02:00,720 --> 00:02:03,940 it, breeze through it, don't even realize they've been through the menopause until one 28 00:02:03,940 --> 00:02:08,600 day they go oh I haven't had a period in 12 months oh I guess I've been through it and 29 00:02:08,600 --> 00:02:13,320 for those patients I usually say let's not talk too much about that. 30 00:02:13,320 --> 00:02:17,920 Maybe we say right what have you done right in order to, it's not just about your genes 31 00:02:17,920 --> 00:02:22,280 but you're right it's very individualized and this is why it's so important to talk 32 00:02:22,280 --> 00:02:29,720 about it and for women, for people in general to know more so that we can deal with it and 33 00:02:29,720 --> 00:02:31,440 look at best ways of managing. 34 00:02:31,440 --> 00:02:36,520 Quality of life is what I go for and that's the meaning with managing perimenopause and 35 00:02:36,520 --> 00:02:37,520 menopause. 36 00:02:37,520 --> 00:02:44,560 I remember I was watching TV, I was 36 years old, the twins were babies and I felt like 37 00:02:44,560 --> 00:02:50,320 this hot wave just come over me and I was like Jesus what is going on? 38 00:02:50,320 --> 00:02:54,400 I remember putting on the aircon and then probably within about 30 seconds I was cold 39 00:02:54,400 --> 00:02:58,600 I was like oh that was weird I felt like I was having a hot flush and I joked to my husband 40 00:02:58,600 --> 00:03:02,960 I think I'm going through menopause and then it was like oh shit so I booked a doctor's 41 00:03:02,960 --> 00:03:06,360 appointment and lo and behold I was. 42 00:03:06,360 --> 00:03:10,020 So obviously I experienced the hot flushes and I also got the night sweats. 43 00:03:10,020 --> 00:03:16,640 What other symptoms do women tend to get or can get during the perimenopausal phase? 44 00:03:16,640 --> 00:03:21,720 It's such a vast list I mean we're probably at over 70 plus symptoms now so it's very 45 00:03:21,720 --> 00:03:28,800 hard to I know and it can be you know it can be as subtle as oh I've got some joint pain 46 00:03:28,800 --> 00:03:33,800 or my hearing's changing or I've got some tinnitus which is ringing in the ears. 47 00:03:33,800 --> 00:03:39,240 Generally speaking what we tend to do is broadly categorized if we say physical symptoms so 48 00:03:39,240 --> 00:03:44,480 these are your vasomotor symptoms so the hot flushes, night sweats, things like palpitations, 49 00:03:44,480 --> 00:03:47,720 your joint pains, headaches, breast tenderness. 50 00:03:47,720 --> 00:03:52,040 Also estrogen plays an important role with your hair, your nail and your skin so just 51 00:03:52,040 --> 00:03:54,160 subtle changes there. 52 00:03:54,160 --> 00:03:59,200 Sleep issues and unfortunately weight gain and in all the wrong places. 53 00:03:59,200 --> 00:04:05,680 Looking at it from a cognition point of view so this is your brain health, brain fog, forgetfulness, 54 00:04:05,680 --> 00:04:08,160 inability to focus or concentrate. 55 00:04:08,160 --> 00:04:13,400 You're in working, you're managing life, a family, trying to tackle all of that. 56 00:04:13,400 --> 00:04:18,440 You're looking at short term memory recall which can get affected as well. 57 00:04:18,440 --> 00:04:25,000 Your mood changes, anxiety, impatience, irritability, tough dealing with day to day life as it is 58 00:04:25,000 --> 00:04:29,520 sometimes and then when you add to that tearfulness as well. 59 00:04:29,520 --> 00:04:34,960 And then something that we as women really ignore are sort of urinary, sexual and vaginal 60 00:04:34,960 --> 00:04:35,960 symptoms. 61 00:04:35,960 --> 00:04:40,520 There's a condition called gentorurinary symptoms of the menopause and that's something that 62 00:04:40,520 --> 00:04:45,400 really affects women so you're looking at recurrent urinary tract infections, vaginal 63 00:04:45,400 --> 00:04:53,920 dryness, discharge, incontinence, not forgetting low sex drive, poor libido which we just go 64 00:04:53,920 --> 00:04:57,720 oh you know what it's part and parcel of life so we're just going to deal with it. 65 00:04:57,720 --> 00:04:58,720 Nobody should deal with that. 66 00:04:58,720 --> 00:05:02,280 Yeah I think you get to this point you know you're in your forties, you're busy, you're 67 00:05:02,280 --> 00:05:06,400 a mum, you've either got teenagers who are going through puberty or you've got little 68 00:05:06,400 --> 00:05:11,480 kids and you know they're just driving you nuts and you're kind of and you're just like 69 00:05:11,480 --> 00:05:16,480 I'm so busy I just don't have the time to think about sex but how you know how can they 70 00:05:16,480 --> 00:05:20,080 tell whether it's hormones or just their lifestyle? 71 00:05:20,080 --> 00:05:26,000 It's very difficult because they're very good as women at making excuses so we'll always 72 00:05:26,000 --> 00:05:30,440 find a reason or to come up with a reason as to why we can't do something or why we 73 00:05:30,440 --> 00:05:32,280 feel in a certain way. 74 00:05:32,280 --> 00:05:39,280 I think it's specifically a very significant drop in sexual desire, sexual function, inability 75 00:05:39,280 --> 00:05:46,200 to have sex in a sense as well and I think it's again really thinking back on things, 76 00:05:46,200 --> 00:05:51,360 looking at how things were versus what has changed and getting the help you need early. 77 00:05:51,360 --> 00:05:56,280 Do you get clients to say it's almost like it's an overnight thing or does it come in 78 00:05:56,280 --> 00:05:57,280 gradually? 79 00:05:57,280 --> 00:06:01,320 It's usually a gradual process, there are some symptoms that can just hit you like a 80 00:06:01,320 --> 00:06:07,840 ton of bricks so your hot flashes, your night sweats as Jasmine you were mentioning but 81 00:06:07,840 --> 00:06:12,160 there are other symptoms which can be very subtle so change in your memory, your ability 82 00:06:12,160 --> 00:06:18,960 to focus or concentrate, your sleep, you're not going to gain 15 kilos overnight so from 83 00:06:18,960 --> 00:06:24,400 a weight gain point of view as well that's something really to keep an eye on. 84 00:06:24,400 --> 00:06:31,080 So I've been told that perimenopause symptoms can last anywhere between 5 and 15 years, 85 00:06:31,080 --> 00:06:37,280 that's a scary number, a scary time frame to sort of go through. 86 00:06:37,280 --> 00:06:41,680 What can we do to help manage all of this? 87 00:06:41,680 --> 00:06:46,880 With the perimenopause yes, the average timeline is about 7 years but it can be anywhere between 88 00:06:46,880 --> 00:06:54,040 5 to 10, sometimes 5 to 15 years and it's not that the symptoms are disastrous from 89 00:06:54,040 --> 00:06:55,040 the get go. 90 00:06:55,040 --> 00:07:00,520 It can start very subtly and then build up or it could just be very subtle and people 91 00:07:00,520 --> 00:07:01,760 manage. 92 00:07:01,760 --> 00:07:06,280 For me the main stage is that prevention side and what we can do about it and I think the 93 00:07:06,280 --> 00:07:12,600 two of you would know more really in a sense from a nutrition point of view and the lifestyle 94 00:07:12,600 --> 00:07:13,600 medicine side. 95 00:07:13,600 --> 00:07:17,540 Yeah, and I'll tell you, you know that 5 to 15 years timeline when you were listing off 96 00:07:17,540 --> 00:07:21,600 some of those symptoms I was like gosh a lot of that sounds like pregnancy, you know I'm 97 00:07:21,600 --> 00:07:25,560 22 weeks pregnant right now, a lot of that sounds like the brain fog and sweating in 98 00:07:25,560 --> 00:07:27,360 general sounds familiar. 99 00:07:27,360 --> 00:07:28,560 But I know it's going to end, right? 100 00:07:28,560 --> 00:07:30,900 I know that I'm going to deliver that baby and there's the end. 101 00:07:30,900 --> 00:07:35,960 But I do think in a way, and tell me if you think I'm crazy, that pregnancy is almost 102 00:07:35,960 --> 00:07:41,520 like your first preparation for the impact of what hormones can do to your body. 103 00:07:41,520 --> 00:07:45,040 Of course, I mean PMS and periods are the very first. 104 00:07:45,040 --> 00:07:50,020 Pregnancy though is that I feel this preparation of a time when hormones affect you in a way 105 00:07:50,020 --> 00:07:52,760 that you absolutely cannot control. 106 00:07:52,760 --> 00:07:56,600 And it changes your body and it changes your mind and it does all of these things to you 107 00:07:56,600 --> 00:08:01,840 in a way that preparation and prevention can only go so far. 108 00:08:01,840 --> 00:08:06,280 But that being said, I think that there needs to be better awareness of the role, and this 109 00:08:06,280 --> 00:08:11,000 is what I do right, of fitness and nutrition in preventing some of these symptoms, right? 110 00:08:11,000 --> 00:08:14,740 We know that a higher protein intake can help prevent some of the vasomotor symptoms. 111 00:08:14,740 --> 00:08:19,860 We know that having more muscle mass can help you have an easier time through your paramedic 112 00:08:19,860 --> 00:08:21,040 and impausal period. 113 00:08:21,040 --> 00:08:26,240 How do you work with patients to encourage those lifestyle changes before you jump into 114 00:08:26,240 --> 00:08:27,600 different types of treatments? 115 00:08:27,600 --> 00:08:30,840 Oh, I love that you mentioned my favorite word protein. 116 00:08:30,840 --> 00:08:33,520 Hey, Amanda, picture this. 117 00:08:33,520 --> 00:08:34,520 You're in your forties. 118 00:08:34,520 --> 00:08:35,520 I am. 119 00:08:35,520 --> 00:08:36,520 You are. 120 00:08:36,520 --> 00:08:39,400 You're working, you're raising kids, you're heavily pregnant and you're hungry. 121 00:08:39,400 --> 00:08:40,400 Yep, that's my every day. 122 00:08:40,400 --> 00:08:43,520 But you're not going to feed yourself and your family any old crap. 123 00:08:43,520 --> 00:08:46,200 No, and that's exactly why I use the Meat Club. 124 00:08:46,200 --> 00:08:50,920 Basically, the Meat Club is your premier online source for top quality Australian and New 125 00:08:50,920 --> 00:08:53,300 Zealand produce right here in Singapore. 126 00:08:53,300 --> 00:08:56,720 And if you're tired of the endless struggle of family meal planning, guess what? 127 00:08:56,720 --> 00:09:01,120 The Meat Club subscription service delivers high quality meats direct to your door. 128 00:09:01,120 --> 00:09:03,320 And we have a little treat for our listeners. 129 00:09:03,320 --> 00:09:09,780 As a new customer, you can get $12 off by using the discount code TFF12, and there's 130 00:09:09,780 --> 00:09:11,640 no minimum spend. 131 00:09:11,640 --> 00:09:16,640 Prices are only valid through the website, themeatclub.com.sg. 132 00:09:16,640 --> 00:09:21,680 For more updates, recipes and special offers, don't forget to follow the Meat Club on Instagram 133 00:09:21,680 --> 00:09:23,960 at the Meat Club SG. 134 00:09:23,960 --> 00:09:28,680 That's the meat M-E-A-T-C-L-U-B-S-G. 135 00:09:28,680 --> 00:09:37,680 Now back to the show. 136 00:09:37,680 --> 00:09:41,800 We made a very good point there about pregnancy, but not forgetting menaki, which is when you 137 00:09:41,800 --> 00:09:43,600 first start your period. 138 00:09:43,600 --> 00:09:45,200 So these are the main stages. 139 00:09:45,200 --> 00:09:49,620 We're in a way good at talking about, oh, when your period first starts, here's what 140 00:09:49,620 --> 00:09:50,620 you look out for. 141 00:09:50,620 --> 00:09:53,680 It's also the teenage hormones going up and down. 142 00:09:53,680 --> 00:09:56,040 Or pregnancy. 143 00:09:56,040 --> 00:09:58,200 Roughly here's what you can expect. 144 00:09:58,200 --> 00:10:00,040 Here's a lot of support. 145 00:10:00,040 --> 00:10:01,040 But then what? 146 00:10:01,040 --> 00:10:02,760 It just stops there. 147 00:10:02,760 --> 00:10:06,480 So this has been the issue is we have those two big stages in life, and then everyone 148 00:10:06,480 --> 00:10:11,160 forgets about what comes after, and especially with pregnancy. 149 00:10:11,160 --> 00:10:14,160 And as women, we're getting pregnant later on in life. 150 00:10:14,160 --> 00:10:18,520 So that surge in hormones sometimes can almost trigger things off. 151 00:10:18,520 --> 00:10:23,320 So it's looking at that surge in hormones, and it suddenly drops post-pregnancy. 152 00:10:23,320 --> 00:10:25,280 And then depending, are you breastfeeding? 153 00:10:25,280 --> 00:10:26,280 All of that. 154 00:10:26,280 --> 00:10:28,080 It plays a huge role. 155 00:10:28,080 --> 00:10:32,020 From a lifestyle point of view, it's never too late to start. 156 00:10:32,020 --> 00:10:35,200 So it's something that I'm a firm believer in. 157 00:10:35,200 --> 00:10:38,640 I'm doing a lot of extra work for it as well. 158 00:10:38,640 --> 00:10:41,280 And it's really looking at the six pillars of lifestyle medicine. 159 00:10:41,280 --> 00:10:43,560 So for me, sleep is number one. 160 00:10:43,560 --> 00:10:51,160 Because if we're not sleeping, so quality, quantity, and consistency, that's automatically 161 00:10:51,160 --> 00:10:53,000 going to make us feel more tired the next day. 162 00:10:53,000 --> 00:10:54,240 We're going to consume more calories. 163 00:10:54,240 --> 00:10:56,800 We're not going to want to exercise, et cetera. 164 00:10:56,800 --> 00:10:58,400 It's this vicious cycle. 165 00:10:58,400 --> 00:10:59,400 Nutrition. 166 00:10:59,400 --> 00:11:00,400 Looking at things. 167 00:11:00,400 --> 00:11:06,160 So with hormonal surges, it's looking at how nutritionally can we improve our phytoestrogens, 168 00:11:06,160 --> 00:11:08,120 our progesterones, our testosterone. 169 00:11:08,120 --> 00:11:09,880 A lot of it is protein-based. 170 00:11:09,880 --> 00:11:15,280 So your soy, your edamame, your lean meats, your fish. 171 00:11:15,280 --> 00:11:18,480 Looking at flax seeds, a little bit of dark chocolate. 172 00:11:18,480 --> 00:11:19,480 Not a bad thing. 173 00:11:19,480 --> 00:11:20,480 I am all about that intervention. 174 00:11:20,480 --> 00:11:23,480 All about the chocolate, definitely. 175 00:11:23,480 --> 00:11:25,600 But also the exercise. 176 00:11:25,600 --> 00:11:29,400 It's not about going for runs and doing massive HIIT workouts. 177 00:11:29,400 --> 00:11:31,120 You need to lift weights. 178 00:11:31,120 --> 00:11:32,760 Girl, preach it. 179 00:11:32,760 --> 00:11:33,760 Say it again. 180 00:11:33,760 --> 00:11:36,680 You have to lift weights and safely. 181 00:11:36,680 --> 00:11:42,120 It's not about suddenly showing up at a gym and trying to deadlift 80 kilos or 100 kilos. 182 00:11:42,120 --> 00:11:43,200 Gradually build it up. 183 00:11:43,200 --> 00:11:49,200 Because again, with the more muscle mass you have, increases your basal metabolic rate. 184 00:11:49,200 --> 00:11:54,120 That unfortunately the fact that things can slow down a little bit as we get older with 185 00:11:54,120 --> 00:11:56,240 the hormones going up and down. 186 00:11:56,240 --> 00:12:01,120 All of this can just help to counteract that and give us the best chance to have as good 187 00:12:01,120 --> 00:12:03,680 a quality of life as possible. 188 00:12:03,680 --> 00:12:06,960 I recently wrote a blog and it's called Why HIIT is Shit. 189 00:12:06,960 --> 00:12:09,760 For women over 40. 190 00:12:09,760 --> 00:12:14,360 I don't think there's that big of a role for that style of workout. 191 00:12:14,360 --> 00:12:16,800 But somehow that's the more popular workout these days. 192 00:12:16,800 --> 00:12:20,880 I'm confused as to how those two messages have gotten so crossed. 193 00:12:20,880 --> 00:12:23,560 I think it's there for the right person at the right time. 194 00:12:23,560 --> 00:12:25,480 And it's doing it correctly. 195 00:12:25,480 --> 00:12:27,520 All of this is very individualized. 196 00:12:27,520 --> 00:12:31,920 But getting that zone two training in, getting your walks in, getting your bike time in, 197 00:12:31,920 --> 00:12:34,600 cross trainer and really looking at. 198 00:12:34,600 --> 00:12:39,160 And I'm not saying everyone needs to be paying to get a personal trainer or join a fancy 199 00:12:39,160 --> 00:12:40,160 gym. 200 00:12:40,160 --> 00:12:42,520 There are lots of resources online. 201 00:12:42,520 --> 00:12:45,280 Go on YouTube, lots of exercise programs. 202 00:12:45,280 --> 00:12:47,440 Just start with body weight exercises at home. 203 00:12:47,440 --> 00:12:50,080 Five, ten minutes and then build it up. 204 00:12:50,080 --> 00:12:54,360 And as you start to enjoy it more and you start to see the benefits, automatically that 205 00:12:54,360 --> 00:12:57,720 behavior change comes in and you want to do more and more. 206 00:12:57,720 --> 00:13:00,440 Which means then you're going to look at your nutrition even more. 207 00:13:00,440 --> 00:13:02,280 You're going to sleep better. 208 00:13:02,280 --> 00:13:03,880 Your mental health is going to be better. 209 00:13:03,880 --> 00:13:05,480 You're going to want to do things socially. 210 00:13:05,480 --> 00:13:07,960 I mean, Singapore has lots of places to walk. 211 00:13:07,960 --> 00:13:10,640 Oh yeah, we are in a walking city. 212 00:13:10,640 --> 00:13:11,640 Absolutely. 213 00:13:11,640 --> 00:13:12,640 Spore for choice. 214 00:13:12,640 --> 00:13:14,440 And also if you smoke, stop smoking. 215 00:13:14,440 --> 00:13:16,720 If you drink, look at how much you're drinking. 216 00:13:16,720 --> 00:13:17,720 Cut back. 217 00:13:17,720 --> 00:13:20,600 Today is World Temperance Day. 218 00:13:20,600 --> 00:13:26,280 Which is basically about moderation and looking at cutting back and stopping alcohol. 219 00:13:26,280 --> 00:13:29,440 So I just thought I'd mention it since it's the third of October. 220 00:13:29,440 --> 00:13:30,440 Amanda's already there, aren't you? 221 00:13:30,440 --> 00:13:31,440 Yeah, it was a trick. 222 00:13:31,440 --> 00:13:32,440 You know, here's my halo. 223 00:13:32,440 --> 00:13:37,440 I stopped alcohol entirely for 22 weeks. 224 00:13:37,440 --> 00:13:42,440 I actually feel like I have cut back loads and I don't know if it has coincided with 225 00:13:42,440 --> 00:13:44,120 the whole paramentapausal thing. 226 00:13:44,120 --> 00:13:46,720 But for me, I know how alcohol affects my sleep. 227 00:13:46,720 --> 00:13:49,400 And like you, sleep is number one for me. 228 00:13:49,400 --> 00:13:53,080 And I know that if I have more than one drink, I'm not sleeping. 229 00:13:53,080 --> 00:13:56,200 So I'd rather just not have a poor night's sleep. 230 00:13:56,200 --> 00:13:57,800 Plus then I've got to deal with the kids as well. 231 00:13:57,800 --> 00:14:00,400 So it's kind of balancing everything out. 232 00:14:00,400 --> 00:14:04,560 And I think it's important to make, so for example, you said that you know alcohol interferes 233 00:14:04,560 --> 00:14:05,560 with your sleep. 234 00:14:05,560 --> 00:14:08,240 I know that alcohol interferes with my muscle protein synthesis. 235 00:14:08,240 --> 00:14:10,720 So that's something for me that's non-negotiable, right? 236 00:14:10,720 --> 00:14:14,140 It's like I know that if I'm in a phase where I'm trying to be anabolic, there's no way 237 00:14:14,140 --> 00:14:16,080 that alcohol is going to have a role in that. 238 00:14:16,080 --> 00:14:21,180 And I think that sometimes the symptoms of paramentapausal are confused with the symptoms 239 00:14:21,180 --> 00:14:23,280 of lifestyle choices. 240 00:14:23,280 --> 00:14:26,800 And how do you help women kind of parse that out? 241 00:14:26,800 --> 00:14:31,040 I think this is where the conversation piece, and it's finding somebody who actually is 242 00:14:31,040 --> 00:14:34,400 there to listen and look at things holistically. 243 00:14:34,400 --> 00:14:38,120 It's not about a symptom-based approach and going, oh, you have this symptom, we'll do 244 00:14:38,120 --> 00:14:40,520 this test, we'll fix it. 245 00:14:40,520 --> 00:14:44,400 It's looking at that sort of overall holistic viewpoint. 246 00:14:44,400 --> 00:14:50,320 And a lot of the times, I spend most of my time just sat listening and just letting people 247 00:14:50,320 --> 00:14:55,600 talk because the more information you get, the more you get to know your patient, you 248 00:14:55,600 --> 00:14:59,880 get to know the person, you actually go, hold on, now this makes sense. 249 00:14:59,880 --> 00:15:02,200 Have you thought about it? 250 00:15:02,200 --> 00:15:07,160 So it's then bringing that into light and looking at the behavior changes that can be 251 00:15:07,160 --> 00:15:08,160 made. 252 00:15:08,160 --> 00:15:09,600 And it's not easy. 253 00:15:09,600 --> 00:15:12,160 This is not about fixing everything overnight. 254 00:15:12,160 --> 00:15:14,060 These things take time. 255 00:15:14,060 --> 00:15:19,840 Somebody has been overweight or obese, it's been 5, 10, 15, 20 years. 256 00:15:19,840 --> 00:15:24,360 I don't want anyone to lose that over three months because it's going to come back with 257 00:15:24,360 --> 00:15:25,820 a vengeance. 258 00:15:25,820 --> 00:15:31,800 It's doing it in a sustainable way where you look at things in the long term so that once 259 00:15:31,800 --> 00:15:36,640 you get to where you need to get to, you are in the best place possible to deal with any 260 00:15:36,640 --> 00:15:38,480 stress that comes your way. 261 00:15:38,480 --> 00:15:43,820 And this again comes into play with the perimenopause, menopause, and also as women getting older 262 00:15:43,820 --> 00:15:50,400 risk of heart disease, chronic conditions, born health, all of that. 263 00:15:50,400 --> 00:15:55,240 So when I went to see the doctor, HRT was mentioned to me and my immediate thought was 264 00:15:55,240 --> 00:15:56,800 cancer risk. 265 00:15:56,800 --> 00:15:57,800 Is there a risk? 266 00:15:57,800 --> 00:15:59,520 Is there a link between the two? 267 00:15:59,520 --> 00:16:02,320 What would you say to your patients? 268 00:16:02,320 --> 00:16:06,720 That is a very good question and that is what is always making the news and that's what's 269 00:16:06,720 --> 00:16:11,280 been in the studies and this is one of the reasons sort of in the early 2000s with the 270 00:16:11,280 --> 00:16:17,000 Women's Health Initiative where sort of the data was represented in a certain way and 271 00:16:17,000 --> 00:16:18,760 then it just spiraled from there. 272 00:16:18,760 --> 00:16:21,280 Since then, a lot of extra data. 273 00:16:21,280 --> 00:16:25,760 Most women, 90% of the female population have a low lifetime risk of breast cancer. 274 00:16:25,760 --> 00:16:28,600 Okay, so I want to start with that. 275 00:16:28,600 --> 00:16:36,200 HRT and estrogen alone is not associated with increasing breast cancer and may even lower 276 00:16:36,200 --> 00:16:37,200 it. 277 00:16:37,200 --> 00:16:41,880 This is for women who have had a hysterectomy, for example, so you don't need that progesterone 278 00:16:41,880 --> 00:16:45,280 component to protect the lining of the womb. 279 00:16:45,280 --> 00:16:51,240 Also we've got much newer hormone therapy, so the body identical treatments, so our gels, 280 00:16:51,240 --> 00:16:56,400 patches, eutrogestin, which is a micronized progesterone, there's no increased risk of 281 00:16:56,400 --> 00:17:00,000 breast cancer for the first five years of taking it. 282 00:17:00,000 --> 00:17:02,500 Also under the age of 60. 283 00:17:02,500 --> 00:17:10,440 If I put it into context, the risk is so low that it's actually, the risk is lower than 284 00:17:10,440 --> 00:17:16,480 if you're overweight or drinking a couple of glasses of wine each night or being sedentary, 285 00:17:16,480 --> 00:17:19,480 meaning doing no exercise. 286 00:17:19,480 --> 00:17:21,880 So that is just putting it into context. 287 00:17:21,880 --> 00:17:26,520 So it's always worth the conversation, but it's not about going, oh gosh, I could never 288 00:17:26,520 --> 00:17:30,480 go on it because I don't want to get breast cancer. 289 00:17:30,480 --> 00:17:32,600 And I think that's how people tend to look at it, don't they? 290 00:17:32,600 --> 00:17:36,520 They've just heard something, and I think it was a flawed study. 291 00:17:36,520 --> 00:17:41,960 Not even flawed, it was just that the study was done for a particular reason, and it was 292 00:17:41,960 --> 00:17:44,120 also done in older women. 293 00:17:44,120 --> 00:17:48,960 Once upon a time, hormone therapy was used more from a prevention point of view, so preventing 294 00:17:48,960 --> 00:17:55,240 heart disease, preventing bone health, and it was also much older synthetic hormone therapies. 295 00:17:55,240 --> 00:18:01,400 You know, technology is passed, pharmaceuticals have improved, and what we have now is way 296 00:18:01,400 --> 00:18:05,880 superior and in a sense safer, more natural as well. 297 00:18:05,880 --> 00:18:10,320 So we have to take all of this into context, and it's very individualized. 298 00:18:10,320 --> 00:18:15,480 I have some women who come and say, listen, I'm pretty sure I'll go through the perimenopause 299 00:18:15,480 --> 00:18:16,480 soon. 300 00:18:16,480 --> 00:18:19,840 I'd like to go on HRT because I don't want to get XYZ. 301 00:18:19,840 --> 00:18:20,840 That's not what it's there for. 302 00:18:20,840 --> 00:18:22,800 So it needs to be used correctly. 303 00:18:22,800 --> 00:18:26,920 Yeah, and that's something, you know, at the Lyft Clinic, what we always say is know your 304 00:18:26,920 --> 00:18:31,600 numbers, and this refers to know your, you know, we do exercise testing, know your VO2 305 00:18:31,600 --> 00:18:33,440 max and your resting metabolic rate. 306 00:18:33,440 --> 00:18:35,020 This applies to your iron, right? 307 00:18:35,020 --> 00:18:38,960 Know your ferritin level, and this applies to your hormone profile. 308 00:18:38,960 --> 00:18:44,720 I always say, you know, if you are a woman that is 40 and over, get a baseline, get a 309 00:18:44,720 --> 00:18:48,120 baseline, get your hormones tested, see where your estrogen, progesterone, testosterone 310 00:18:48,120 --> 00:18:49,160 are falling. 311 00:18:49,160 --> 00:18:53,560 That way, in the future, if and when you're experiencing symptoms, you have a baseline 312 00:18:53,560 --> 00:18:58,440 against which you can test, and then you can have a sense of what you might need in terms 313 00:18:58,440 --> 00:19:00,980 of BHRT or HRT or estrogen replacement. 314 00:19:00,980 --> 00:19:02,360 Then you have an idea. 315 00:19:02,360 --> 00:19:06,200 But if you have no idea what your numbers were to begin with, then you're really just 316 00:19:06,200 --> 00:19:10,120 kind of shooting in the dark for where you have progressed. 317 00:19:10,120 --> 00:19:13,480 So this is a bit of a gray area with testing. 318 00:19:13,480 --> 00:19:19,560 Simply speaking, the consensus is that only specific instances to test hormones. 319 00:19:19,560 --> 00:19:26,000 If someone's having symptoms under the age of 40 or in their early 40s, now less than 320 00:19:26,000 --> 00:19:30,360 sort of one in 100 women will have symptoms under the age of 40, one in a thousand under 321 00:19:30,360 --> 00:19:32,200 the age of 30. 322 00:19:32,200 --> 00:19:36,480 So you know, these are, yes, they sound like bigish numbers, but they're not. 323 00:19:36,480 --> 00:19:39,800 So it's always taking that into consideration. 324 00:19:39,800 --> 00:19:45,360 If you're in your, you know, depending on where you are, so mid-40s, late 40s, you're 325 00:19:45,360 --> 00:19:48,840 symptomatic, it's a clinical diagnosis. 326 00:19:48,840 --> 00:19:51,940 We don't need to do hormone testing at that point. 327 00:19:51,940 --> 00:19:56,760 Another time we do hormone testing is actually if somebody has a marina coil in as part of, 328 00:19:56,760 --> 00:20:01,040 yes, contraception once upon a time, but also as part of protecting the lining of the womb 329 00:20:01,040 --> 00:20:06,720 if they're on hormone therapy and to help reduce that sort of up and down in your periods, 330 00:20:06,720 --> 00:20:08,440 your heavier periods. 331 00:20:08,440 --> 00:20:13,120 Then before we remove it, sort of 55, 56, we do a blood test just to make sure you've 332 00:20:13,120 --> 00:20:15,080 been through the menopause. 333 00:20:15,080 --> 00:20:16,700 And then again, it's a choice. 334 00:20:16,700 --> 00:20:21,040 You know, we do therapeutic trials on HRT, on hormone therapy. 335 00:20:21,040 --> 00:20:24,120 We can do therapeutic trials off hormone therapy. 336 00:20:24,120 --> 00:20:27,720 You're on it one day, you come off it the next day, the hormone's out of your body. 337 00:20:27,720 --> 00:20:30,040 So this is not a magic medicine. 338 00:20:30,040 --> 00:20:33,000 This is just giving back what the body needs. 339 00:20:33,000 --> 00:20:34,000 I love that. 340 00:20:34,000 --> 00:20:37,040 So full disclosure, I am on BHRT. 341 00:20:37,040 --> 00:20:42,960 So I take estrogen, progesterone, micronized progesterone, the eugestrone that you mentioned, 342 00:20:42,960 --> 00:20:43,960 and testosterone. 343 00:20:43,960 --> 00:20:48,640 And I've noticed that any time I feel my symptoms coming back, and it's usually the sleep, that's 344 00:20:48,640 --> 00:20:52,240 the one that I can tell straight away whether something is not right. 345 00:20:52,240 --> 00:20:55,160 You know, I will have to sort of go and figure out how to tweak it. 346 00:20:55,160 --> 00:20:57,320 I'll speak to my doctor and I'll say, look, this is coming back. 347 00:20:57,320 --> 00:20:58,960 I don't feel great. 348 00:20:58,960 --> 00:21:00,760 And I can just feel it in my body. 349 00:21:00,760 --> 00:21:03,680 And I think straight away, you know, you kind of know, I think I've gotten to the point where 350 00:21:03,680 --> 00:21:06,720 I'm very, what's the word? 351 00:21:06,720 --> 00:21:07,720 I'm very self-aware. 352 00:21:07,720 --> 00:21:08,720 Self-aware, yeah. 353 00:21:08,720 --> 00:21:09,720 Very self-aware. 354 00:21:09,720 --> 00:21:15,720 So, you know, straight away, the night is the one that gives it away the most. 355 00:21:15,720 --> 00:21:20,120 And that's very, very common because at one point in your life, you may need a certain 356 00:21:20,120 --> 00:21:24,080 amount of hormone therapy and then that could change. 357 00:21:24,080 --> 00:21:28,380 So this is why it's not about starting somebody on something and then saying, okay, go away 358 00:21:28,380 --> 00:21:30,520 and just carry on. 359 00:21:30,520 --> 00:21:34,760 You know, I would do an initial follow-up in a month, then three months until we've 360 00:21:34,760 --> 00:21:37,480 got the person in a nice steady state. 361 00:21:37,480 --> 00:21:38,480 After that, every six months. 362 00:21:38,480 --> 00:21:43,560 And this is why actually being on something like hormone therapy, if somebody needs it, 363 00:21:43,560 --> 00:21:46,400 you're actually monitored much closer. 364 00:21:46,400 --> 00:21:47,720 The screening is up to date. 365 00:21:47,720 --> 00:21:52,200 So your breast screening, cervical screening, if you need a pelvic scan, for example, your 366 00:21:52,200 --> 00:21:53,800 examinations. 367 00:21:53,800 --> 00:21:57,680 So if we're going to pick something up, we're going to pick it up much earlier than somebody 368 00:21:57,680 --> 00:22:01,240 who is not having this level of monitoring and screening. 369 00:22:01,240 --> 00:22:02,240 Yeah. 370 00:22:02,240 --> 00:22:06,400 And what's really different in what you're doing, Dr. Tosh, is that you're actually spending 371 00:22:06,400 --> 00:22:11,580 time with your patients and you're monitoring them on several markers, not just one. 372 00:22:11,580 --> 00:22:14,840 And you're also looking at what is optimal versus what is normal. 373 00:22:14,840 --> 00:22:19,660 And I think functional medicine allows you a different paradigm than traditional medicine 374 00:22:19,660 --> 00:22:22,080 in that you can get deeper with your patients. 375 00:22:22,080 --> 00:22:23,160 And you mentioned the word holistic. 376 00:22:23,160 --> 00:22:26,600 I think that is so far describing your approach beautifully. 377 00:22:26,600 --> 00:22:30,740 And this is, you know, for us as a clinic, this is what we do. 378 00:22:30,740 --> 00:22:31,840 It's not just about... 379 00:22:31,840 --> 00:22:34,640 And I think the privilege we have is time. 380 00:22:34,640 --> 00:22:36,420 I still do my NHS work. 381 00:22:36,420 --> 00:22:37,420 Do I have time? 382 00:22:37,420 --> 00:22:38,420 No, I don't. 383 00:22:38,420 --> 00:22:43,400 And it's very unfortunate because I would love to do more for 40 patients, 50 patients 384 00:22:43,400 --> 00:22:44,400 a day. 385 00:22:44,400 --> 00:22:46,400 But I'd be there constantly. 386 00:22:46,400 --> 00:22:47,400 That's not going to happen. 387 00:22:47,400 --> 00:22:48,400 Yeah. 388 00:22:48,400 --> 00:22:53,000 Whereas having that privilege of time and being able to listen and have that conversation 389 00:22:53,000 --> 00:22:57,360 and be able to really look at things holistically, looking at the lifestyle measures. 390 00:22:57,360 --> 00:23:02,580 So you know, medicine 3.0, we're going for the prevention rather than waiting for something 391 00:23:02,580 --> 00:23:06,860 to happen and then trying to fix it. 392 00:23:06,860 --> 00:23:12,680 So I understand that as you age or after menopause, post menopause, your risk factors for certain 393 00:23:12,680 --> 00:23:14,440 conditions increase. 394 00:23:14,440 --> 00:23:20,880 Can you tell us what these risks are and how we can minimise the risks? 395 00:23:20,880 --> 00:23:23,780 Lifestyle medicine. 396 00:23:23,780 --> 00:23:26,040 It's really looking at that prevention piece. 397 00:23:26,040 --> 00:23:30,180 So looking at your nutrition, your sleep, your exercise, your mental health and wellbeing. 398 00:23:30,180 --> 00:23:35,980 These are things that we can do sometimes more easily than other times, but we have 399 00:23:35,980 --> 00:23:38,740 to take that responsibility and that's on us. 400 00:23:38,740 --> 00:23:44,640 From a risk profile point of view, two of the main things are heart disease plus strokes 401 00:23:44,640 --> 00:23:50,440 and osteoporosis, which is where the bones start to thin, which is osteopenia, and then 402 00:23:50,440 --> 00:23:52,380 start to break down. 403 00:23:52,380 --> 00:23:57,480 So both of these factors, looking at your exercise, your nutrition, your sleep, you 404 00:23:57,480 --> 00:24:00,360 could automatically reduce it. 405 00:24:00,360 --> 00:24:04,440 For women after the menopause, the risk of heart disease is higher than men if they haven't 406 00:24:04,440 --> 00:24:07,200 had any heart disease by the age of 50. 407 00:24:07,200 --> 00:24:11,600 Other things to look at is urinary symptoms, so recurrent infections, incontinence, especially 408 00:24:11,600 --> 00:24:13,880 after childbirth as well. 409 00:24:13,880 --> 00:24:15,000 Sexual dysfunction. 410 00:24:15,000 --> 00:24:19,840 Just because somebody goes through the menopause doesn't mean you stop having sex. 411 00:24:19,840 --> 00:24:21,920 Weight gain. 412 00:24:21,920 --> 00:24:26,880 So this is where looking at sleep, generally speaking for an adult, and you may laugh at 413 00:24:26,880 --> 00:24:30,400 this, but the average should be 8.5 hours of sleep every night. 414 00:24:30,400 --> 00:24:31,400 Who gets exactly? 415 00:24:31,400 --> 00:24:32,400 I got eight hours last night. 416 00:24:32,400 --> 00:24:33,400 I took seven hours and 59 minutes. 417 00:24:33,400 --> 00:24:34,400 Go ahead. 418 00:24:34,400 --> 00:24:35,400 Yeah. 419 00:24:35,400 --> 00:24:43,200 Well, I was just, you mentioned osteopenia and osteoporosis, and I think that's something 420 00:24:43,200 --> 00:24:47,320 that by this point in 2023, most women are aware of. 421 00:24:47,320 --> 00:24:53,320 But in Asia specifically, we have this other issue of sarcopenia and muscle loss. 422 00:24:53,320 --> 00:24:58,680 And I don't know that women yet are connecting how important their muscle loss is to their 423 00:24:58,680 --> 00:25:05,160 bone loss, meaning if they had more, a higher ALMI, higher skeletal muscle index versus 424 00:25:05,160 --> 00:25:08,000 just looking at bone density every time, how those two interact. 425 00:25:08,000 --> 00:25:11,560 How do you educate your patients about this issue, and how do you encourage more women 426 00:25:11,560 --> 00:25:15,160 to think about their muscle mass in addition to their bone mass? 427 00:25:15,160 --> 00:25:20,080 I think this is something where everyone's striving for this perfect BMI. 428 00:25:20,080 --> 00:25:21,720 Am I the biggest fan of BMI? 429 00:25:21,720 --> 00:25:25,440 No, because it doesn't take into account quite a few things. 430 00:25:25,440 --> 00:25:26,680 It's about being healthy. 431 00:25:26,680 --> 00:25:30,800 So really looking at your in-body scan, looking at the breakdown of things. 432 00:25:30,800 --> 00:25:34,600 So you're looking at your bone mass, your muscle mass. 433 00:25:34,600 --> 00:25:38,400 With women, so we do after the age of 50, we say it's recommended to get a bone density 434 00:25:38,400 --> 00:25:43,360 scan done, and that's important to look at a baseline. 435 00:25:43,360 --> 00:25:49,440 Getting a little bit more weight within the right range will help with your bone mass, 436 00:25:49,440 --> 00:25:53,440 and this is where that strength training and your protein plays a big part. 437 00:25:53,440 --> 00:25:57,440 So it's having that conversation and almost educating women to say, you know, it's not 438 00:25:57,440 --> 00:25:58,440 this or that. 439 00:25:58,440 --> 00:26:01,280 You put it together, it's two for the price of one. 440 00:26:01,280 --> 00:26:05,600 You know, you're building your muscle mass, you're reducing your chance of sarcopenia, 441 00:26:05,600 --> 00:26:07,360 which is loss of muscle mass. 442 00:26:07,360 --> 00:26:09,240 And muscle mass can go like this. 443 00:26:09,240 --> 00:26:12,960 You fracture your wrist, you fracture your lower limb. 444 00:26:12,960 --> 00:26:15,440 You notice your calf just go down like this. 445 00:26:15,440 --> 00:26:19,860 You'll notice your forearm and your muscles just drop. 446 00:26:19,860 --> 00:26:23,320 So that's why it's important to be consistent with that. 447 00:26:23,320 --> 00:26:25,120 So it's that education piece once again. 448 00:26:25,120 --> 00:26:26,120 Yeah. 449 00:26:26,120 --> 00:26:30,400 And as an aging athlete, right, my concern has shifted so far away from performance and 450 00:26:30,400 --> 00:26:35,280 so far into injury prevention, because exactly what you said, I cannot suffer a lower limb 451 00:26:35,280 --> 00:26:39,080 injury because I cannot afford that muscle loss at this age. 452 00:26:39,080 --> 00:26:44,000 And also from, you know, whether you were an athlete at a higher level or you're still 453 00:26:44,000 --> 00:26:48,620 competing, you're doing things socially, it's about that injury prevention. 454 00:26:48,620 --> 00:26:52,400 And that's one of the reasons for me is I play a lot of tennis and I want to be able 455 00:26:52,400 --> 00:26:57,440 to be on that court for however long I need to be on and put that work in in the gym with 456 00:26:57,440 --> 00:27:03,460 the nutrition, et cetera, to make sure that it helps from a quality of life point of view. 457 00:27:03,460 --> 00:27:08,920 You mentioned risk of cardiovascular risk and stroke. 458 00:27:08,920 --> 00:27:14,120 My grandmother actually had a stroke when I think she must have been over 50, definitely 459 00:27:14,120 --> 00:27:15,120 under 60. 460 00:27:15,120 --> 00:27:21,600 And I wonder had she had been given some form of HRT, whether that may have helped prevent 461 00:27:21,600 --> 00:27:22,600 that. 462 00:27:22,600 --> 00:27:26,280 And it's crazy because I feel like, you know, there was a whole generation of women who 463 00:27:26,280 --> 00:27:34,200 were sort of not given the opportunity to, I guess, manage symptoms, manage other risks 464 00:27:34,200 --> 00:27:35,920 in their life. 465 00:27:35,920 --> 00:27:37,440 I'm sorry to hear that. 466 00:27:37,440 --> 00:27:41,920 It's tough because these are things that can be severely debilitating. 467 00:27:41,920 --> 00:27:46,960 And also at that time, it's a conversation piece around not just medication, but what 468 00:27:46,960 --> 00:27:54,720 can you do to rebuild yourself, which unfortunately even now is a struggle, you know, trying to 469 00:27:54,720 --> 00:28:01,460 get the older generation to do the work that needs to be done to make sure that sarcopenia 470 00:28:01,460 --> 00:28:02,960 doesn't play a role. 471 00:28:02,960 --> 00:28:04,320 It's huge. 472 00:28:04,320 --> 00:28:10,120 Now tough question because again, hormone therapy is there not to prevent heart disease, but 473 00:28:10,120 --> 00:28:12,240 it's for the symptomatic management. 474 00:28:12,240 --> 00:28:20,000 Yes, it does help to reduce the risk of heart disease, again, with osteoporosis as well, 475 00:28:20,000 --> 00:28:21,640 because it's the estrogen component. 476 00:28:21,640 --> 00:28:27,380 So we need estrogen for our bones, for our muscles, our ligaments. 477 00:28:27,380 --> 00:28:28,600 In the heart, what is a heart? 478 00:28:28,600 --> 00:28:29,600 It's a muscle. 479 00:28:29,600 --> 00:28:31,400 What are the blood vessels? 480 00:28:31,400 --> 00:28:33,560 So again, yes, there is a role to play. 481 00:28:33,560 --> 00:28:38,360 It's very hard to look back in retrospect, but again, it's looking at your grandmother 482 00:28:38,360 --> 00:28:44,080 as an individual and looking at, okay, what happened at that time and what may have helped 483 00:28:44,080 --> 00:28:48,240 her, but here's the situation now and how can we move forward with it. 484 00:28:48,240 --> 00:28:52,160 And this is where that sort of lifestyle piece plays a huge role. 485 00:28:52,160 --> 00:28:56,440 What can husbands and partners do to help support their wives during this period? 486 00:28:56,440 --> 00:28:59,200 Because obviously we can become psycho bitches, right? 487 00:28:59,200 --> 00:29:02,040 So much shit going on. 488 00:29:02,040 --> 00:29:08,240 And some men may not understand what is happening, obviously psychologically, emotionally. 489 00:29:08,240 --> 00:29:12,560 How can they support their wives during this crazy period of our life? 490 00:29:12,560 --> 00:29:17,280 I think this is where the conversation piece comes in, starting conversations early. 491 00:29:17,280 --> 00:29:23,720 And also as, you know, with families, if you have sons, daughters, it's starting that early 492 00:29:23,720 --> 00:29:29,600 because it's looking at it from a period point of view, going through those teenage years. 493 00:29:29,600 --> 00:29:34,160 Most moms going through perimenopause are likely to have teenagers at home. 494 00:29:34,160 --> 00:29:36,800 So can you imagine the hormones surging in that household? 495 00:29:36,800 --> 00:29:39,760 I mean, to be fair, I had newborn babies. 496 00:29:39,760 --> 00:29:42,360 I was just like, I don't know what's worse. 497 00:29:42,360 --> 00:29:46,040 Newborn twins as well. 498 00:29:46,040 --> 00:29:52,960 So for me, that conversation piece, and sometimes it's hard as a couple to start that conversation. 499 00:29:52,960 --> 00:29:57,040 So you know, use a healthcare provider, use online resources. 500 00:29:57,040 --> 00:30:03,840 There are, you know, there are videos done by husbands about how they helped manage sort 501 00:30:03,840 --> 00:30:06,180 of symptoms with their wives. 502 00:30:06,180 --> 00:30:13,520 Also for partners and in the workplace to know and understand people working with them, 503 00:30:13,520 --> 00:30:14,840 for them, above them. 504 00:30:14,840 --> 00:30:19,080 When you start to notice changes, to be able to offer that support. 505 00:30:19,080 --> 00:30:23,240 It's not always easy because you have to, there's a lot of compromise. 506 00:30:23,240 --> 00:30:25,880 But again, it's looking at, right, how can we work together? 507 00:30:25,880 --> 00:30:27,380 Can we look at our sleep together? 508 00:30:27,380 --> 00:30:32,480 So let's make sure, you know, we're both sleeping at the same time, waking up at the same time. 509 00:30:32,480 --> 00:30:36,640 Because even a slight shift in that, if someone's sleeping a bit earlier, waking up a bit earlier, 510 00:30:36,640 --> 00:30:39,520 a little bit of light that comes on. 511 00:30:39,520 --> 00:30:45,040 Yeah, it advances your, you know, sort of circadian rhythm and changes things. 512 00:30:45,040 --> 00:30:50,000 So that's a good piece, looking at exercising together and looking at nutrition together 513 00:30:50,000 --> 00:30:51,400 at home. 514 00:30:51,400 --> 00:30:56,360 Because if you do it as a family, you're also teaching your young children, your teenagers, 515 00:30:56,360 --> 00:30:58,760 how to eat better. 516 00:30:58,760 --> 00:31:01,660 So that as they grow up, this is the norm. 517 00:31:01,660 --> 00:31:05,320 So it's not, you know, you've already learned what the norm is. 518 00:31:05,320 --> 00:31:07,520 So as you grow up, you know exactly what to do. 519 00:31:07,520 --> 00:31:10,360 Yes, there'll be times you go have your kebab after a night out. 520 00:31:10,360 --> 00:31:11,360 Still has protein. 521 00:31:11,360 --> 00:31:12,360 Thank you. 522 00:31:12,360 --> 00:31:13,360 That's my favorite word. 523 00:31:13,360 --> 00:31:16,440 Get a bit of salad in there, you know. 524 00:31:16,440 --> 00:31:20,440 But all I'm saying is it's about making good things the normal so that you're not having 525 00:31:20,440 --> 00:31:22,680 to make that effort. 526 00:31:22,680 --> 00:31:25,640 So exercising shouldn't be an effort. 527 00:31:25,640 --> 00:31:29,760 You know, go for a cycle together as a family, go for a walk together as a family. 528 00:31:29,760 --> 00:31:33,720 Do a Joe Wicks online program as a family. 529 00:31:33,720 --> 00:31:35,720 But it's just making things as normal as possible. 530 00:31:35,720 --> 00:31:38,320 And doing it together makes a big difference. 531 00:31:38,320 --> 00:31:42,360 It's funny you say that to do it as a family, because my boys know now that I always prioritize 532 00:31:42,360 --> 00:31:43,360 their protein. 533 00:31:43,360 --> 00:31:47,200 And they'll say to me, mommy, I'm full, but if I eat all my protein, can I finish? 534 00:31:47,200 --> 00:31:48,200 Can I be done? 535 00:31:48,200 --> 00:31:49,200 I'm like, yes, okay, fine. 536 00:31:49,200 --> 00:31:54,440 Technically, yes, you can. 537 00:31:54,440 --> 00:32:05,280 So one of the things that I realized is that when you are going through all of this, sometimes 538 00:32:05,280 --> 00:32:09,020 and other people are not going through it at the same time you are. 539 00:32:09,020 --> 00:32:14,200 How can you, how can you better sort of find the support that you need? 540 00:32:14,200 --> 00:32:15,240 Because people don't talk about it. 541 00:32:15,240 --> 00:32:18,920 And I think whenever I used to say, oh, I'm going through menopause, I'd be like, they'll 542 00:32:18,920 --> 00:32:19,920 get the response, what, already? 543 00:32:19,920 --> 00:32:20,920 Really? 544 00:32:20,920 --> 00:32:23,800 And I'm like, well, yeah, it can happen at any time. 545 00:32:23,800 --> 00:32:29,920 And that's actually a common misconception that menopause happens when you're older. 546 00:32:29,920 --> 00:32:34,160 And this is why a lot of women, a lot of people will not think about it or talk about it because 547 00:32:34,160 --> 00:32:35,600 the assumption is, oh, I'm fine. 548 00:32:35,600 --> 00:32:37,100 I'm not old enough. 549 00:32:37,100 --> 00:32:41,720 But as I mentioned earlier, you know, less than one in a hundred under the age of 40, 550 00:32:41,720 --> 00:32:44,680 less than one in a thousand under the age of 30. 551 00:32:44,680 --> 00:32:48,160 And this is where I have to say with, and this is the beauty of where social media has 552 00:32:48,160 --> 00:32:53,040 played a big part over the last year to 18 months, is getting that message out, getting 553 00:32:53,040 --> 00:32:54,960 people talking about it. 554 00:32:54,960 --> 00:32:58,520 It's actually to a certain extent a bit of a problem in the UK because you can't cope 555 00:32:58,520 --> 00:33:00,720 with the demand. 556 00:33:00,720 --> 00:33:04,920 And that is because from a time point of view, you don't have the luxury of time. 557 00:33:04,920 --> 00:33:10,920 But I think with access to pharmacies, with access to pharmacists who can have that conversation, 558 00:33:10,920 --> 00:33:17,160 so using that multidisciplinary team, nurse practitioners, general practitioners, specialists 559 00:33:17,160 --> 00:33:20,400 in hospital, it's we have to work as a team. 560 00:33:20,400 --> 00:33:23,840 And I think for women, just keep talking. 561 00:33:23,840 --> 00:33:28,440 You know, if your own friends shut you down, you keep talking. 562 00:33:28,440 --> 00:33:33,560 If you have, you see a healthcare provider who shuts you down, you keep going, you find 563 00:33:33,560 --> 00:33:35,880 the person who will listen. 564 00:33:35,880 --> 00:33:37,920 And that can take time. 565 00:33:37,920 --> 00:33:44,320 Yeah, I think the keep talking part is so important and so different from our parents' 566 00:33:44,320 --> 00:33:45,320 generation. 567 00:33:45,320 --> 00:33:49,200 You mentioned that your grandmother had had a stroke and maybe if HRT could have helped 568 00:33:49,200 --> 00:33:50,200 her. 569 00:33:50,200 --> 00:33:51,200 I think about my own mother. 570 00:33:51,200 --> 00:33:55,880 You know, she went through postpartum depression and was told, not real, not a thing, you don't 571 00:33:55,880 --> 00:33:57,080 need anything. 572 00:33:57,080 --> 00:34:03,720 She went through a very long, almost decade long menopause and was told again the same, 573 00:34:03,720 --> 00:34:06,440 you just white knuckle it, you don't need anything, this is normal. 574 00:34:06,440 --> 00:34:10,400 And I think, you know, had she just been born a little bit later, you know, and been in 575 00:34:10,400 --> 00:34:15,320 my generation with access to information and professionals that are reassuring her, you 576 00:34:15,320 --> 00:34:18,960 know, it's definitely one thing to talk about it with a friend, but it's something to be 577 00:34:18,960 --> 00:34:22,640 told by your healthcare professional, you are not crazy. 578 00:34:22,640 --> 00:34:25,320 This and this are things you can try. 579 00:34:25,320 --> 00:34:27,760 Here's some actionable tools I can put in your hands. 580 00:34:27,760 --> 00:34:29,400 And my mom never had that. 581 00:34:29,400 --> 00:34:33,800 And I think that the talk is the first step and health professionals that are supportive 582 00:34:33,800 --> 00:34:37,320 and willing to give actionable tools is that second step. 583 00:34:37,320 --> 00:34:38,320 Thank you. 584 00:34:38,320 --> 00:34:42,160 And I think that's one of the reasons I'm even, you know, here I do all these talks, 585 00:34:42,160 --> 00:34:48,360 we as a practice will do all these education pieces is because we want people to be empowered. 586 00:34:48,360 --> 00:34:51,400 We want them to have the right information. 587 00:34:51,400 --> 00:34:55,720 And also it's about looking at other causes to things, you know. 588 00:34:55,720 --> 00:35:01,280 Yes, a lot of the times it's a perimenopause, menopause, but we've ruled other things out. 589 00:35:01,280 --> 00:35:04,160 You know, we need to make sure that is there something else going on? 590 00:35:04,160 --> 00:35:05,320 Could this be your thyroid? 591 00:35:05,320 --> 00:35:07,200 Could you be diabetic? 592 00:35:07,200 --> 00:35:08,200 Could it be your kidneys? 593 00:35:08,200 --> 00:35:09,200 Could it be your liver? 594 00:35:09,200 --> 00:35:12,360 So we look at all of that and also look at the screening side of things. 595 00:35:12,360 --> 00:35:14,800 So this is where health screening plays a big part. 596 00:35:14,800 --> 00:35:17,520 And actually Singapore is very good with health screening. 597 00:35:17,520 --> 00:35:22,200 It's just making sure you get the explanation rather than just going to get the test done. 598 00:35:22,200 --> 00:35:28,960 So would you say then that if you feel any different in your normal self, you know, whether 599 00:35:28,960 --> 00:35:33,000 you are feeling a little bit more anxious or, you know, you are getting that little 600 00:35:33,000 --> 00:35:38,080 bit of joint pain, you should go and see somebody and then question further, why is this happening 601 00:35:38,080 --> 00:35:40,200 now and could it be perimenopause? 602 00:35:40,200 --> 00:35:41,280 Absolutely. 603 00:35:41,280 --> 00:35:43,680 It's always worth the conversation. 604 00:35:43,680 --> 00:35:47,240 It's not going and saying, I am going through the perimenopause. 605 00:35:47,240 --> 00:35:52,000 You know, yeah, you could be, but it's also looking at your symptoms overall and saying, 606 00:35:52,000 --> 00:35:54,600 actually, could it also be X, Y, Z? 607 00:35:54,600 --> 00:35:57,000 We need to rule out those organic causes. 608 00:35:57,000 --> 00:36:01,040 And it's a really good time then to just get the health screen done. 609 00:36:01,040 --> 00:36:02,560 Just make sure you're on top of things. 610 00:36:02,560 --> 00:36:07,160 Make sure your breast screening is up to date, your cervical screening, all of that, to chat 611 00:36:07,160 --> 00:36:08,760 about other things. 612 00:36:08,760 --> 00:36:12,800 And also look at the preventative side of things and starting at any point. 613 00:36:12,800 --> 00:36:13,800 It's never too late. 614 00:36:13,800 --> 00:36:15,900 You're 70 or 80. 615 00:36:15,900 --> 00:36:16,900 Get going. 616 00:36:16,900 --> 00:36:18,800 Start, you know, lifting a bag of peas. 617 00:36:18,800 --> 00:36:19,800 That's right. 618 00:36:19,800 --> 00:36:21,280 Fill up your water bottle. 619 00:36:21,280 --> 00:36:22,600 Fill up your water bottle. 620 00:36:22,600 --> 00:36:23,600 Go for a walk. 621 00:36:23,600 --> 00:36:28,640 See how, you know, even if it's up and down in your living room, time it. 622 00:36:28,640 --> 00:36:29,640 Can you do it faster? 623 00:36:29,640 --> 00:36:32,680 Oh, I like, oh, you're speaking to the athlete in me, girl. 624 00:36:32,680 --> 00:36:33,680 There you go. 625 00:36:33,680 --> 00:36:34,680 You know, it's funny. 626 00:36:34,680 --> 00:36:35,680 You just said about that. 627 00:36:35,680 --> 00:36:40,940 So my parents are visiting, they're 74, and I was reading one of my favorite weekly news 628 00:36:40,940 --> 00:36:45,840 letters from Arnold Schwarzenegger, health guru and, you know, life advisor to me personally. 629 00:36:45,840 --> 00:36:47,560 And he was talking about the sit to stand test. 630 00:36:47,560 --> 00:36:50,240 And I thought, you know what, my parents are over 65. 631 00:36:50,240 --> 00:36:52,220 Let's hit up the sit to stand test. 632 00:36:52,220 --> 00:36:53,940 And they loved it. 633 00:36:53,940 --> 00:36:57,160 They took it on like it was me taking on high rocks this weekend. 634 00:36:57,160 --> 00:36:58,960 You know, they were like, let's do this. 635 00:36:58,960 --> 00:37:01,840 And then when I didn't tell them the norms to begin with, you know, so they hit their 636 00:37:01,840 --> 00:37:03,680 number and then I was like, well, this is the average. 637 00:37:03,680 --> 00:37:04,680 And they're like, oh, let me do it again. 638 00:37:04,680 --> 00:37:05,680 Let me do it again. 639 00:37:05,680 --> 00:37:06,680 I love that. 640 00:37:06,680 --> 00:37:09,880 You know, don't, I guess the message there, right, is don't underestimate older people 641 00:37:09,880 --> 00:37:14,760 for having the vim and vigor to take on physical challenges and to make lifestyle changes. 642 00:37:14,760 --> 00:37:18,040 You know, don't assume that they're just heading out to pasture. 643 00:37:18,040 --> 00:37:22,680 They want to be vibrant and in control of their health as much as we do. 644 00:37:22,680 --> 00:37:23,680 Couldn't agree more. 645 00:37:23,680 --> 00:37:27,760 This is looking at it from not a lifespan point of view, which is how long you live, 646 00:37:27,760 --> 00:37:32,440 but your health span, your quality of life, that marginal decade, which is your last 10 647 00:37:32,440 --> 00:37:36,080 years of life, you need to be living it to the full. 648 00:37:36,080 --> 00:37:37,080 But you start early. 649 00:37:37,080 --> 00:37:39,200 But again, it's never too late. 650 00:37:39,200 --> 00:37:42,560 It's always looking at that quality of life. 651 00:37:42,560 --> 00:37:45,960 When I found out that I was going through perimenopause, I think it was a couple of 652 00:37:45,960 --> 00:37:47,880 nights later, I had a dream. 653 00:37:47,880 --> 00:37:52,400 And in that dream, I felt like I'd fast forwarded my life by 10 years, which I kind of probably 654 00:37:52,400 --> 00:37:54,080 felt like it had happened. 655 00:37:54,080 --> 00:37:56,280 And I was trying to work out, did I do this? 656 00:37:56,280 --> 00:38:01,040 I used to be a serial yo-yo dieter, always trying out different things. 657 00:38:01,040 --> 00:38:04,080 I have had different hormonal issues. 658 00:38:04,080 --> 00:38:07,320 And so I'm looking back and thinking, did I do this to myself? 659 00:38:07,320 --> 00:38:09,160 Was this my fault? 660 00:38:09,160 --> 00:38:13,200 And then after that point, I thought to myself, right, it doesn't matter now where I've got 661 00:38:13,200 --> 00:38:15,520 to, I'm now going to make a change. 662 00:38:15,520 --> 00:38:19,660 And it was almost like a switch in my head, a mindset shift. 663 00:38:19,660 --> 00:38:23,560 And I thought, from this point onwards, it's not going to be about how I look or how much 664 00:38:23,560 --> 00:38:24,680 weight I gain. 665 00:38:24,680 --> 00:38:28,840 It's going to be about making sure that I'm strong and I'm healthy, especially for my 666 00:38:28,840 --> 00:38:31,520 boys, because like I said, they were babies at the time. 667 00:38:31,520 --> 00:38:34,320 And I wanted to be able to be there for them and do things. 668 00:38:34,320 --> 00:38:37,920 I didn't want to be that mom who couldn't keep up with the boys. 669 00:38:37,920 --> 00:38:43,960 And so I felt like for me, that was the driving force on making a change in my lifestyle. 670 00:38:43,960 --> 00:38:47,600 And you need that where it needs to come from you. 671 00:38:47,600 --> 00:38:51,600 As a healthcare professional, I can tell you till I'm blue in the face, till you're blue 672 00:38:51,600 --> 00:38:53,720 in the face, here's what you need to do. 673 00:38:53,720 --> 00:39:01,880 But until that behavior change, that switch flips, it has to come from the person. 674 00:39:01,880 --> 00:39:05,800 And then that's where that constant conversation, we keep addressing it, we keep addressing 675 00:39:05,800 --> 00:39:06,800 it. 676 00:39:06,800 --> 00:39:09,520 And there'll be something where, in your case, it was the boys. 677 00:39:09,520 --> 00:39:12,040 And it's not just about being able to be there for them. 678 00:39:12,040 --> 00:39:16,240 It's also looking at as you get older, from a travel point of view, from quality of life 679 00:39:16,240 --> 00:39:20,080 point of view, grandchildren, you want to be able to pick up your grandchildren. 680 00:39:20,080 --> 00:39:24,000 You want to be able to, when you're on a flight or on a bus, anything, to be able to pick 681 00:39:24,000 --> 00:39:28,120 up your own little hand carry on and put it up instead of somebody else doing that for 682 00:39:28,120 --> 00:39:29,120 you. 683 00:39:29,120 --> 00:39:34,720 If you have a fall at home, you want to be able to get up with your one hand, rather 684 00:39:34,720 --> 00:39:38,000 than being on the floor for three days until somebody finds you. 685 00:39:38,000 --> 00:39:44,600 So it's about day to day practical things and how you can start early to reduce the 686 00:39:44,600 --> 00:39:47,160 risks for you as you get older. 687 00:39:47,160 --> 00:39:51,060 And I think that, again, is a way, one of the recurrent themes that we've been talking 688 00:39:51,060 --> 00:39:56,760 about here is like women needing to take charge of their own health and women needing to own 689 00:39:56,760 --> 00:39:58,120 their own identities. 690 00:39:58,120 --> 00:40:02,920 And I think that exactly that by encouraging them to make these better lifestyle choices 691 00:40:02,920 --> 00:40:08,880 as an act of empowerment and an act of self-reliance for your eventual future, I think that is 692 00:40:08,880 --> 00:40:11,760 a complete reframing from what our parents were told. 693 00:40:11,760 --> 00:40:13,480 Yeah, absolutely. 694 00:40:13,480 --> 00:40:18,960 It's that reframing and also what we have access to now compared to once upon a time, 695 00:40:18,960 --> 00:40:20,920 the amount of data we have. 696 00:40:20,920 --> 00:40:25,440 Love data, love research, because that's what we base our advice on. 697 00:40:25,440 --> 00:40:27,920 And yes, sometimes we don't always get it right. 698 00:40:27,920 --> 00:40:31,240 And then we say, listen, we're sorry, we didn't get it right, but here's the new data. 699 00:40:31,240 --> 00:40:33,160 Here's how we move forward. 700 00:40:33,160 --> 00:40:34,160 But that's the whole point. 701 00:40:34,160 --> 00:40:38,300 And it's that constant learning experience as well. 702 00:40:38,300 --> 00:40:39,300 Thank you, Dr. Tashi. 703 00:40:39,300 --> 00:40:41,000 It has been absolutely wonderful. 704 00:40:41,000 --> 00:40:43,800 And before we finish off, we do have one more question to ask you. 705 00:40:43,800 --> 00:40:47,240 And we want to know what is your prescribed 40s formula? 706 00:40:47,240 --> 00:40:51,800 What piece of advice or wisdom would you like to share with our listeners about navigating 707 00:40:51,800 --> 00:40:53,760 this next phase of their life? 708 00:40:53,760 --> 00:40:58,960 I think this is such a brilliant question and a great way to end a fantastic conversation, 709 00:40:58,960 --> 00:41:01,720 really, a chat. 710 00:41:01,720 --> 00:41:03,400 You're going to hear the same things from me. 711 00:41:03,400 --> 00:41:08,880 Prioritize your sleep, protein up, lift some weights and manage your stress early. 712 00:41:08,880 --> 00:41:13,160 In your 40s, you're likely to be juggling a lot, you know, career, family, the good 713 00:41:13,160 --> 00:41:16,360 and not so good stress that comes with it. 714 00:41:16,360 --> 00:41:18,960 So be a little bit selfish. 715 00:41:18,960 --> 00:41:23,320 Prioritize self care and emotional well-being so that you can thrive. 716 00:41:23,320 --> 00:41:24,320 Love that. 717 00:41:24,320 --> 00:41:25,320 Incredible. 718 00:41:25,320 --> 00:41:28,880 Take that one to the bank. 719 00:41:28,880 --> 00:41:30,160 Thank you so much, Dr. Tashi. 720 00:41:30,160 --> 00:41:31,240 It was amazing. 721 00:41:31,240 --> 00:41:32,240 Thank you so much for having me. 722 00:41:32,240 --> 00:41:33,240 Thank you. 723 00:41:33,240 --> 00:41:36,280 This is Paul, our editor. 724 00:41:36,280 --> 00:41:41,240 He's a 25 year old unmarried Singaporean guy listening to the ramblings of 12 older women 725 00:41:41,240 --> 00:41:44,440 on everything from menopause to weightlifting to sex. 726 00:41:44,440 --> 00:41:46,920 Paul, what's your thoughts on today's conversation? 727 00:41:46,920 --> 00:41:50,000 Hey, hello there again. 728 00:41:50,000 --> 00:41:56,000 So for me, I'll be honest, this isn't exactly my area of interest or expertise as well. 729 00:41:56,000 --> 00:42:01,560 I mean, let's be real, I'm a guy in my 20s and menopause is just not something that I'll 730 00:42:01,560 --> 00:42:04,240 ever go through, I guess. 731 00:42:04,240 --> 00:42:09,640 But well, for me, I guess I do have a partner and it is interesting to better understand 732 00:42:09,640 --> 00:42:15,080 what menopause is from the perspective, at least like when she gets to the station live 733 00:42:15,080 --> 00:42:16,080 further down the road. 734 00:42:16,080 --> 00:42:17,080 So great topic. 735 00:42:17,080 --> 00:42:18,080 All right. 736 00:42:18,080 --> 00:42:19,080 Catch you guys soon. 737 00:42:19,080 --> 00:42:20,080 See y'all. 738 00:42:20,080 --> 00:42:25,400 Hey guys, did you know that you can leave us questions and comments on FanList? 739 00:42:25,400 --> 00:42:26,400 That's right. 740 00:42:26,400 --> 00:42:29,920 On fanlist.com slash the forties formula, you can leave us a voice note where you can 741 00:42:29,920 --> 00:42:33,640 ask us anything, leave us your feedback or just say hi. 742 00:42:33,640 --> 00:42:36,240 And now a word from listener Balwant09. 743 00:42:36,240 --> 00:42:37,240 Wow. 744 00:42:37,240 --> 00:42:39,160 Episode one was so empowering. 745 00:42:39,160 --> 00:42:40,680 I fucking love it. 746 00:42:40,680 --> 00:42:43,280 Balwant, we fucking love you too. 747 00:42:43,280 --> 00:42:44,640 Thank you. 748 00:42:44,640 --> 00:42:49,360 Before we go, please remember to hit subscribe and take a moment to support the forties formula 749 00:42:49,360 --> 00:42:52,800 by leaving a review on your favorite podcast platform. 750 00:42:52,800 --> 00:42:56,600 Your reviews will help us to reach more people and allow us to continue to bring valuable 751 00:42:56,600 --> 00:42:57,600 content. 752 00:42:57,600 --> 00:43:00,680 It should only take a moment and it's a free way for you to support the show. 753 00:43:00,680 --> 00:43:05,240 You can also stay updated with the forties formula by following us on Instagram at the 754 00:43:05,240 --> 00:43:06,440 forties formula. 755 00:43:06,440 --> 00:43:07,680 All one word. 756 00:43:07,680 --> 00:43:11,220 We share behind the scenes insights, episode updates and much more. 757 00:43:11,220 --> 00:43:13,920 So please be sure to hit that follow button. 758 00:43:13,920 --> 00:43:15,540 We appreciate your time and support. 759 00:43:15,540 --> 00:43:18,720 Thank you for being part of this community and we'll be back next week for more empowering 760 00:43:18,720 --> 00:43:21,080 conversations with inspiring guests. 761 00:43:21,080 --> 00:43:42,240 Bye. 762 00:43:51,080 --> 00:44:08,560 It's being confident enough to say yes, I'll come for brunch, but no, I'm not having that 763 00:44:08,560 --> 00:44:10,160 bruise brunch. 764 00:44:10,160 --> 00:44:11,160 I'm still there. 765 00:44:11,160 --> 00:44:14,280 I'm still, you know, I don't need to be drunk to have a conversation with you. 766 00:44:14,280 --> 00:44:18,240 I probably remember a lot more if I wasn't. 767 00:44:18,240 --> 00:44:21,720 Because we were just saying like this first season, right, is all about just establishing 768 00:44:21,720 --> 00:44:24,460 experts in these areas of relevance to the forties, right? 769 00:44:24,460 --> 00:44:25,840 And then we can get into like little things. 770 00:44:25,840 --> 00:44:27,760 I said we could do a whole episode on alcohol. 771 00:44:27,760 --> 00:44:28,760 I think so. 772 00:44:28,760 --> 00:44:33,860 A whole episode on how women in their forties are using alcohol and being honest, like you're 773 00:44:33,860 --> 00:44:36,880 using it as a crutch to get through what is a difficult time. 774 00:44:36,880 --> 00:44:40,440 And we've established all the reasons why and man, you touched upon that in your talk 775 00:44:40,440 --> 00:44:41,440 as well, didn't you? 776 00:44:41,440 --> 00:44:44,040 I do remember you talking about, you know, like just having that glass of wine because 777 00:44:44,040 --> 00:44:46,840 you just want to, but it's not actually helping. 778 00:44:46,840 --> 00:44:48,440 It's just putting a plaster over. 779 00:44:48,440 --> 00:44:51,760 It's all, and this is what, the more plasters you get, what happens, it just stops. 780 00:44:51,760 --> 00:45:19,120 So you're not getting to the root cause of things.