Coming up on The 40s Formula. Our hormones go
beyond reproduction. They protect our heart,
they protect our bones, our cognition, our brain
health and our metabolic health. And so when
they decline, we see other consequences and often
they're silent. Women are twice as likely as
men to get Alzheimer's dementia and their lifetime
risk of dementia is much greater than men. There's
a risk of 20 % mortality within a year of having
an osteoporosis. fracture you think of menopause
and you think right oh i'm getting old i'm gonna
stop my period i'm gonna get fat and then that's
it end of yes but there's so much more stuff
that is actually a hell of a lot more serious
more important what is the one tip for women
for how to approach movement in their 40s if
there's just one thing i would say it's BMI as
a reliable indicator of my health. Hot or hype?
It is a hype. Big time. It does not reflect your
lean body masses, what your fat mass is. We should
be doing body composition. Dr. Sundas Hussain
Morgan is a physician and lifestyle medicine
advocate who believes prevention is the most
powerful medicine we have. She uses the six pillars
of lifestyle medicine from food and movement
to sleep, stress and connection. to help women
reduce risk and build resilience for decades
to come. The 40s Formula. The 40s Formula. The
40s Formula. Hosted by Jasmine Dillon, integrated
health strategist specializing in gut health,
hormones, and midlife well -being. And Amanda
Lim, director of Lift Clinic and a leading expert
in female strength and metabolism. Named one
of CNA's top podcasts. and winner of the 2025
Asia Podcast Awards in the Best Health and Wellness
Podcast category. The 40s Formula is your no
-fluff, science meets real -life guide to thriving
in your 40s. Menopause isn't just about hot flashes
and mood swings. It's the moment when your risk
for heart disease, osteoporosis, diabetes, even
dementia begins to rise. But here's the good
news. What you do now in your 40s can radically
change the trajectory of your health. In this
episode, we're breaking down exactly what you
can do now to protect your future health. Let's
get into it. But before we do, don't forget to
like and subscribe and share this with a loved
one, especially someone who needs to hear this
today. Dr. Sendis, thank you so much for being
with us today. We're so excited for this conversation.
Thank you for having me, Amanda and Jasmine.
Really, thank you. I am so encouraged that there's
so much awareness about menopause and that women
are getting the help they need to manage the
symptoms and their quality of life. But one thing
we're not telling women enough about is the long
-term health risks of menopause. Menopause comes
with certain risks. Our hormones go beyond reproduction.
They protect our heart. They protect our bones,
our cognition, our brain health and our metabolic
health. And so when they decline, we see other
consequences. And often they're silent. Women
aren't aware of them until it's... unfortunately
too late or it's picked up on a blood test. And
what I'm here to say is to look at your health
risks, get tested for it and become aware of
them. So what are they? Cardiovascularly, our
heart health. We know that cardiovascular disease
is the number one cause of death in women after
menopause. Our blood pressure rises, cholesterol
goes up, there's more inflammation and that puts
women at risk. Bone health, we lose 10 -20 %
of our bone mass during the menopause transition
and that puts us at risk of osteopenia or a more
serious condition called called osteoporosis.
The risks of fractures in your wrist, in your
spine, in your hips increases, and that has dire
consequences. Then we've got the metabolic health.
We see a change in body composition together
with muscle mass loss as we age and increased
visceral fat, so that fat around the midsection.
There's insulin resistance, which if left unchecked
can become diabetes. And then brain health, you
know, women are twice as likely as men to get
Alzheimer's dementia and their lifetime risk
of dementia is much greater than men. The thing
is, these things are preventable. There are things
we can do today, if we're aware of it, to prevent
these, to treat these, to reduce the risk and
live a long, healthy life. Women live a third
of their life in menopause. We want those years
to be healthy and in good health. It's crazy,
isn't it? Because I feel like you think of menopause
and you think, right, I'm getting old. I'm going
to stop my period. I'm going to get fat. And
then that's it. End of. Yes. But there's so much
more stuff that is actually a hell of a lot more
serious. More important. And these are the things
we need to be thinking about. So what should
we do? Well, what I like to use is the pillars
of health. So lifestyle medicine, the six pillars
of health. And lifestyle medicine is an evidence
-based medical discipline that looks at lifestyle
interventions and behavior change so that we
can treat, prevent, and even reverse disease.
The six pillars are nutrition. Physical activity,
sleep, stress management and mental health, social
connections and reducing harmful substances.
So together with other medical modalities and
using lifestyle interventions, we can really
help minimize those risks and even manage menopause
symptoms. Yeah. And let's talk about those one
by one, if you don't mind, because I think that's
such a helpful framework. Anyone can understand
what those six words mean. Nutrition, movements.
sleep, stress management, social connection,
and the reducing of risky substances, which is
always the one that goes last, right? It's like,
wah, wah, no one wants to hear about it. But
can we unpack the first two? And they're not
hierarchical, right? But can we unpack the ones
that I think are the first that we think about
when we think about taking control of our health?
And that's nutrition and movement. What are the
big points in nutrition and movement that you
want women to understand about health in their
40s? So these six pillars do work synergistically,
but let's look at those two first of all. So
nutrition is a big one. There's so much to unpack
about nutrition. There's so many stories we've
heard about nutrition, a lot of myths and misinformation.
But with lifestyle medicine, what we believe
in is a whole food. a diet that is predominantly
plant -based, low in ultra -processed foods,
refined sugars and carbs. Is there a special
menopause diet? Not really. There are certain
foods that I do encourage my patients to make
sure they have in their diet. Like what? Give
us some hot foods. So looking first of all, you
know, for your bone health, for example, we want
to be having enough calcium in our diet and vitamin
D, although mostly we get our vitamin D from
sunlight, but there is some in food, but calcium
particularly. And it doesn't have to be from
dairy. Oh man, I was going to be like, right.
So that daily flat white back. Every day. It's
for my bone health. This is why. I'm doing it.
For my health. Yeah. So calcium and vitamin D.
Next, I like to look at fiber. Fiber is so important.
As you know, Jasmine, you know, gut health is
good health. And we're feeding not just ourselves,
we're feeding those trillions of microorganisms
in our gut that help us keep our health in check.
So fiber comes from plant -based foods. So that
could be vegetables, fruits, nuts, seeds, herbs,
beans, legumes. So including that in. your diet
and most of us are not getting enough fiber in
our diet. Then there's the protein. So we want
to be looking at a protein that's either meat
or animal based, sorry, animal or plant based.
So lean cuts of meat, chicken. We want to be
looking at fish. We want to be looking at legumes,
tofu, tempeh, and particularly tofu, tempeh,
edamame. These have phytoestrogens in them and
these help stimulate some of the estrogen. receptors
to modulate the menopause symptoms in some women.
Flax seeds is another one as well. Yeah. And
can you talk about phytoestrogens for women in
menopause and perimenopause and moving through
the menopause transition? Because I just had
a client come in two days ago, confused about
the inclusion of phytoestrogens in the diet.
She said that her doctor said they are bad for
menopause. Could you elaborate a bit more on
that? Right. So there is this misconception that
phytoestrogens, because they stimulate estrogen
receptors, that they may have a harmful effect.
There's still, unfortunately, a lot of myth about
stimulating estrogen receptors in terms of breast
cancer risk, cardiovascular risk and so forth.
But phytoestrogens stimulate a different type
of receptor. There are two types of estrogen
receptor and they stimulate the beta receptors.
And by doing... so they can help modulate the
symptoms without causing that increased risk.
And what are phytoestrogens? These include tofu,
tempeh, soy, so anything from soy -based products,
but you can also find them in other plant -based
products like flax seeds, for example. Including
these has been shown, studies have shown that
for some women can really help, particularly
with hot flushes, night sweats and can minimize
their symptoms. What about if a woman is on HRT
and then she is also eating a lot of phytoestrogen
type food, soy based food? Can there be maybe,
I don't know, an overproduction of estrogen?
And is there any risk if that happens? What could
a woman expect? to feel or, you know, what would
happen in that situation? It's a great question.
I must say, I'm not aware of any study that shows
that, you know, you can over consume these foods
or that it would overstimulate them. I think,
you know, our body is complex, but it's also
quite smart as well. I think it knows when you
don't need certain foods or... receptors may
not be necessarily upregulated if you eat more
of these foods. So I can't give you a precise
answer, but I will go back and look at that.
I was just wondering, because, you know, it's
kind of like we understand if you aren't taking
it and it can help with, you know, the hot flashes.
But if you are taking it, does it have the same
effect? But, you know, that's just something
that was popped into my head and I thought I'd
ask. Very good question. And that actually reads
really well into one of our tastiest features
here on the show, which is called Fuel Your 40s,
sponsored by The Meat Club. And they've submitted
a question for you to answer as an expert in
this field about how food fuels your life and
your work. And this one is for you. So thinking
about your work with family medicine and your
work with families in general and your own family.
Protein feels like such a big demand, right?
You mentioned that you want to have diverse protein
and you want to have fiber and some different
types of foods on the plate. What is one tip
that you can give to families for preparing a
balanced meal that everyone can enjoy? So protein
definitely is important, even for young children,
adolescents, and of course women going through
hormonal changes. I would say... include a variety
of proteins. And the earlier you can include
these in a child's diet particularly, the more
they get used to it. You know, try throwing in
some lentils into a pasta sauce. Try fish as
nuggets or, you know, maybe as goujons, you know,
something that they enjoy, something that's easy
to dip. Use yogurt as a dipping sauce for vegetables
or fruits. Even chickpeas. you know, boiled chickpeas,
sprinkle some or squeeze some lemon on it, use
that as a snack, add it in here and there and
try a variety of different proteins. Yeah, I
know that works in my family. Like, you know,
it's almost like they get bored of stuff. You
know, it's not that they don't like it, it's
that they don't want to see it again. So I think
that that's a very helpful tip for families.
Novelty and curiosity. And it's such an easy
way then to get that variety in, you know, because
if your microbiome needs diversity, whether it's
coming from, you know, plants, based, animal
based, whatever it is, the best way to do it
is just changing it up and not having the same
thing day in, day out. Because once that sort
of, you know, fatigue kicks in, like diet fatigue
kicks in, you're going to be like, all right,
okay, I'm just going to have pizza. Yeah, because
I don't want to look at this again. Yeah, exactly.
Exactly. And so we've covered a little bit about
the nutrition piece, right? I would love to talk
about the movement piece. So what is the one
tip, the main tip you can give for women for
how to approach movement in their 40s? If there's
just one thing I would say. If there was one
thing. But I'll let you say other things. But
for now, just one thing. I would say it's strength
training. Yes. Strength training, strength training,
and again, strength training. Not enough women
are doing that. It's not something that women,
certainly of my age, have grown up with. We're
not familiar with it. And we'd walk into the
gym and go straight for the cardiovascular machines
and the aerobic classes. Zumba. Yeah, Zumba.
Which is still wonderful. And if you love it,
please continue to do that. In the category cardio,
it is great. In the category cardio. Exactly.
But when we're in our 40s, as we age, we begin
to lose our muscle mass. We lose 3 % to 8 % of
muscle mass every decade. And by the time you're
70, 80 years old, you've lost 30 % to 50 % of
your muscle mass. Medicine is recognizing that
muscle is more than just an organ to help us
move and live independently. And to look good.
To get that boobish. But aesthetic aside, muscle
is actually its own endocrine organ. It helps
us. It releases chemicals that are messengers
to our brain, that helps with blood flow in our
brain, helps with cognition, memory, mood. It
bolsters our mood as well. Muscle mass also helps
to keep our bones healthy. And that is so important
for women in their 40s. So when we strength train,
when we move those muscles and load them, we
also load the bones. And that mechanical loading
on the bones, that pulling on the bones helps
to build bone mass and counteract that menopause
effect. effect of the bone loss and it keeps
our bones strong. And there's several studies
showing how incorporating strength training can
actually improve osteopenia and possibly even
reverse it and treat osteoporosis as well if
it's done safely and supervised. And of course,
metabolic health, you know, our muscle is the
biggest organ that uses glucose and stores it.
So it's like a sponge, you know, it just soaks
that up. Yes, it does. It increases our basic
metabolic rate so that we're burning energy even
when we're sitting still. And so helps lower
risks of diabetes, insulin resistance, helps
with and also changing that body composition
that I talked about that changes in your 40s.
Yeah, I'm reminded of it. agree with this as
well you know like if you don't have enough muscle
mass you're more likely to be insulin resistant
yes and that's probably why you're struggling
with your weight loss is not because you you
know you've got too much fat which you might
have but it's the fact that the the proportion
of muscle to fat in your body is off that's it
that's it and that's why what we do at lift clinic
with metabolic health we talk about body composition
as one of our three markers of metabolic health
and it's not how lean you are and it's not how
muscular you are. It's the composition of those
two things. Do you have enough muscle at an adequate
level of body fat? Do you have enough leanness
with enough functional muscle? Like it's the
combination of those two things, the interplay.
And under muscling is something that I see much
more. much more problematic as uh as opposed
to being over fat but unfortunately in the popular
opinion the over fat the the overweight is typically
what people see as the problem so you know we
always joke at our clinic it's like we get them
in for the weight loss but we keep them for the
muscle you know the bait and swish um because
and i and i think you you touched on a few really
important factors that muscle is the gateway
to bone. So if there is no muscle to protect
your bone, then your bone is exposed and vulnerable.
And I don't think there's enough impact there.
And I really love that you mentioned strength
training. So the category is physical activity,
right, of lifestyle medicine. And of course,
cardio is important. We all agree on that. But
it cannot be the only thing. Mobility is important.
It cannot be the only thing. You know, there
has to be that third element, which is strength
training. So I love that you singled that out
very specifically. You mentioned bone. I'm a
woman in my 40s. Why should I care about my bone
health? I mean, like, what is it doing for me?
Like, why is this important? So bone is obviously
the structure of our body. And not many people
know, but our bones turn over every 12 years.
They're constantly building and breaking down.
We've got like a bone zodiac every 12 years.
All right. What bone here am I hearing? They're
a living organ. They're not just hard. I know
we see a dog bone. Yeah, you think that's that.
They are living organs. If you cut a bone, it
bleeds. Oh, I did not know that. So bones are...
an extremely important part of our body. They
don't just keep our structure upright and moving.
They are actually a living organ themselves.
There's bone turnover. Every 12 years, we turn
over our bones. We build them and we break them
down. And estrogen plays a really important part
of this. It helps to continue that cell turnover
in a positive way. However, when estrogen drops,
what happens is there's more bone breakdown than
there is. bone making and the bones become thinner.
And particularly it's the bones that we call
the trabecular bones. Those are the ones in the
spine, in the wrist, in the hip joint as well.
And for some women, what can happen is it thins
so much that... Even a simple trip or a little
tumble is enough to fracture their bones. And
once a fracture happens, it's really not just
painful, but you become less mobile. The incidence
of being dependent on others, ending up in...
nursing homes is so much higher. And there's
a risk of, unfortunately, a 20 % risk of mortality
within a year of having an osteoporotic fracture.
And this is preventable. The problem is it's
a silent disease. You have no symptoms until
you do. Yes. Until that fracture. Then that's
sadly too late for many. Okay, Amanda, I've got
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Yeah. And, you know, what you mentioned about
a silent disease, right? It's one of those things
where you can't, you as a woman in your 40s,
me the same, you can't imagine being frail enough
to fall down. It's like, it almost seems fun.
Yeah, exactly. What do you mean by fall? Like,
how am I going to fall? You absolutely ask anyone
who's had an elderly relative that's taken a
fall and it becomes very real in that immediate
moment for that person. And that is your future
if you don't take care of it. And I saw too many
of these. I worked in the elderly care for many
years. It was almost daily we had a patient coming
in with what we call a fragility fracture. It
was a simple tumble and they fractured their
hip or they fractured their spine. Fragility.
I hope, may that never be written on my chart.
This is the other thing, you know, like you said,
you become immobile, right? You have to rest
if you, you know, are okay enough to rest it
off. Then when you become immobile, then you're
going to lose that muscle mass because you can't
use it. And then you're becoming, you know, then
you're going to be, you know, having issues with
your metabolic health and all the other stuff
that cascades out from it. Yes. The stuff that
you didn't have previously. Yeah. You have it.
Yeah. I can't move. And it's scary how quickly
muscle mass shrinks. I had an ACL tear after
skiing injury. And, you know, I work out. I do
a lot of strength training. But the amount of
muscle mass I lost within a few weeks was scary.
And it really made me emphasize strength training
even more. patients. So yes, immobility. Very
important. And even if we can't sell bones, because
bones are tough, like you said, it's hard to
sell. Like, hey, your bones might be brittle.
I don't care. Yeah. Still want to be skinny,
right? That's what we care about. So let's take
bones aside. How about brain? You mentioned cognitive
decline. Can you at least sell us on how muscles
can help your brain age healthier? The other
important thing about muscles is they release
something called myokines. These are chemical
messengers that help stimulate the brain, help
improve our blood flow in our brain, help with
the... new transmitters in our brain. And this,
in return, improves our memory, it improves our
brain function, and protects us against cognitive
decline, which we know is increased in women
after menopause as the hormones decline. I was
at the gym yesterday and they've got this new
machine up there. It's like only there for a
week. And it was part of, I'm going to give a
free shout out now. So Techno Gym, you've got
to support us. And it was a Techno Gym one. And
they're basically looking at, you know, how healthy
are you and how you're aging. And they had different
metrics. Like they had the grip strength one,
which you couldn't do because they didn't have
the grip strength thing. There's a cardio test
you can do. Then there's a cognition test on
there, like a balance and mobility. So they're
checking all of this stuff. And I did the cognition
test. enough, my memory was great. 100 % but
my attention was not so good and I don't think
we can blame muscles for that one that's the
condition of modern life sadly so it's really
interesting you know I was like okay the memory
is working fine I'd just done my strength training
session but you know the attention thing I mean
I would say I couldn't keep focused on the two
things they needed me to focus on I remember
years ago when Spartan Race was a thing do you
remember when Spartan Race was very big and I
was doing the long version ones and I remember
one of the like obstacles was they would give
you a word and you had to remember it. At the
end of the race. No. Yes, yes. And everyone had
a different, or was it a word or a series of
numbers? Anyway. That would be hard. Claudia,
if you're listening, you were with me there.
It's something difficult to remember. It would
be too easy. Yeah. I think it was a series of
numbers. And it's like you had to remember them
in the order they were in. And then there was
just a guy at, you know, let's say kilometer
20 or something. Oh, my God. With your race number
and your thing. And he would just have you recite
it. And if you couldn't do it, drop and give
me 35 burpees. Because they were trying to incorporate
memory. as part of it. And especially memory
under demand, right? Like, you know, with exertion
and stuff like that. You know, when you're younger,
okay, now we've all got mobile phones, we don't
actually remember numbers. But, you know, we
have to remember. I remember my parents' phone
number. I say, do I? Yeah. I remember my auntie's
phone number because, I mean... That's your call
to complain about your friends. My emergency
number. Yeah, but that stuff you don't do. It's
true. We don't exercise that muscle as much anymore.
We don't exercise that muscle anymore, no. And
it's important to, you know, do that as well
as... muscle training as well i actually use
old mobile phone numbers as you know like pin
codes yeah because i'm like well no one else
is gonna know this no one's gonna use it we don't
use it anymore but i still remember i remember
yeah i know i'll find it yeah well so so speaking
of muscles that we need to exercise Another one
of the pillars of lifestyle medicine that I think
gets kind of overlooked in the glamour of the
others is stress management. And I cannot tell
you enough when I'm working with patients or
clients and I say, you know, hey, we really do
need to work on your stress management. Your
coping mechanisms are directly related to food
and alcohol. We got to work on this. And I get
the eye roll. Oh, yeah. Like when my kids grow
up and I quit my job, maybe I'll work on stress
management. Or like, what, do you want me to
meditate? You know, I mean, there's definitely
I feel like that one kind of gets. swept under
the rug as least important. Can you talk about
how that is important and some strategies that
women can use to manage their stress? Absolutely.
I mean, modern life is full of stresses. It's
not something we can just, you know, unless we
move to a desert island. Defense, what are you
going to take with you? Yeah, not the kids. But
as women, you know, most of the women that I
see, you know, they're at the peak of their career
if they're working or they're working towards
a big project. They are looking after their children.
They are looking after parents who are elderly.
They often can't last. You know, women are the
caregivers and they're constantly giving, giving.
And when your bucket is empty, when you are dealing
with a lot of stress, it has an impact on your
health. So for me, I have the luxury of time
with patients. I actively listen and allow them
to reflect and allow them to see how, despite
all the good things they're doing, how stress
is. actually sabotaging a lot of their good efforts.
And we try and work on their why, what's important
to them. What is in their circle of control?
If leaving your job right now is not possible,
what else can you do to minimize that stress?
What are some of the actions you can take? For
some women, that might look like saying no, setting
up boundaries to certain things. For others,
it might be how they respond to stress, using
things like mindfulness -based stress reduction
mechanisms, strategies, mindfulness, meditations.
might be a walk in nature to build up that resilience
to cope with stress. So it's very personalized,
but it is highlighting to people that stress
isn't just an inert thing. It does affect your
health and it can be sabotaging some of the good
work that you're doing. And if you don't deal
with it. It's not going to go away. I love my
walk with my dog. You know, in the evening we
go out, I put a podcast on, usually the 40s formula,
sometimes Huberman or, you know. But, you know,
I feel like it's my time to sort of get out there
and just feel. at ease and get away from the
chaos that's my house with the three boys. I
mean, I take one little boy with me as in the
dog. But one of the other things that I love
and I feel like is a bit underrated is I, when
I'm doing like the school drop off, it is so
intense because I'm like, kids, we've got to
get out of the house. We've got your shoes. Like
seriously, we've forgotten shoes before because
they'll just jump in the car and they haven't
got their shoes on. And my kids are, you know,
old enough to know that they need your shoes.
And once I drop them off, like I don't even get
out of the car now. I'm like, get out, you know,
just leave the boot open. I'll close it myself.
Just get out. I love to get in the car, play
my music and sing. Not that I can sing, but sing,
you know. And can you demonstrate? We want to
lose money. But, you know, it's just. It's my
way of just releasing it. And I'm like, you don't
have to, you know, go through a whole meditation
technique. It's whatever you find calming and
a great way to sort of just feel at ease and,
you know, get those buggers off to school. And
you're a sit and scream it out type gal, and
I like that. I'm a sit in silence person. So
when I'm experiencing oversimulation, which is
with my three kids always, by the way, I just
need to be in silence. Just no one touching me,
no one talking to me. And I mean, five minutes,
it's not even like a whole big deal. And I don't,
sometimes I would meditate, but often I don't.
Like I just, you know, I consider it like my
DNS time. Like I just lay on my back, put my
feet against the wall and I just. luxuriate in
silence. I don't know if I could do that. I've
tried, but I just, I can't, I can't do it. It's
wonderful. Set a timer. I'll try it. I always
set a timer, which is how, you know, I don't
really relax. But yeah, I mean, again, whatever
it may be. It's very difficult. You know, it's
finding something. Sometimes I find people overstimulate
themselves without realizing. And then wonder
why they're freaking out. Exactly. Exactly. So
sometimes you really do need to just take a step
back and say. is what I'm doing serving me well
or is it not? Do I need to just change things
up a little bit? Yes. What you're describing,
the school drop -off and the chaos, and then
I know so many women who go straight from that
into high -intensity interval training class.
And they're rushing into class because they're
barely going to make it. They show up all frustrated,
flustered. Then they have to go do 45 seconds
of 90 % heart rate activity. It's like, have
you considered? not doing that at that time,
you know, and maybe like do your HIT on a Saturday
morning when things be chill. Yeah. And maybe
a husband. Some slow and steady strength training
in that pocket of time. But, you know, it's like
even the things that are correct, like I don't
want to take that HIT away from you if that's
something you love, but like maybe that's not
the slot for it if it's affecting another pillar.
And I think you said it really well. They're
synergistic. pillars one feeds into the next
they are not isolated pillars with space in between
you know it's more like a i feel like we need
a new word for pillars it's got to be like like
mary go round of health or something reaction
of lifestyle medicine yeah because you're right
when you think of pillars you're like Yeah, they're
just steeped in subway. And if one falls, the
other will hold it up. And it's like, but you
can't let one fall. Like this in this case. Okay,
so let's talk about one that falls. Let's talk
about the wine coping strategy that I alluded
to earlier. So again, this is interrelated with
stress and also with nutrition is alcohol. And
girl, we've had Dr. Fung on from Oslo Health
talking about alcohol at length. So I'm not looking
for a whole metabolic dissertation on alcohol.
But how bad is it really? You mentioned reducing
exposure to risky substances. Talk to us about
alcohol as that substance. What are we looking
at? What are the tradeoffs? WHO say there is
no safe limit for alcohol. Here in Singapore,
the guidelines are two drinks for men per day,
one drink for women per day. We all have different
alcohol tolerances. What I notice, especially
in the 40s, women notice that they just don't
metabolize alcohol as well. If you don't notice
that, I feel like you have to be lying, right?
No, I mean, honestly, honestly, like raging in
my 20s would put you in a coffin today. And although
alcohol may put you to sleep, it actually disrupts
your sleep. I had wine yesterday. I was up at
4 a .m. I was like, fuck me. Like they're kind
of like. I don't know, I was just wide awake
and I thought, oh man, I didn't even realise
how much I was drinking because I thought I was
having one glass. What I didn't realise was the
waiter kept coming and topping up my glass and
then would ask my husband, do you want more?
And I was like, hold on, why is my glass still
so full? And then I realised that he was just
pouring it in and my husband goes, well, it looks
like I'm drunk. Yeah, the 4 a .m. wake up, never
a good sign of quality sleep. So alcohol, you
know, when we're going through perimenopause,
it actually can make your symptoms much worse.
Your heart flushes, your mood changes, and it
increases your insulin resistance as well. So
it can have these metabolic consequences. Not
only is it extra calories, and depending what
you're drinking as well, often cocktails are
loaded. full of sugar as well. And that disruption
of sleep and the dampening of mood as well. So
many negative effects from alcohol, plus it is
a carcinogen, you know, it does increase your
risk of cancer as well. I had a client who was
like, right, okay, I've stopped drinking, but
then, you know, every time I go out, sometimes
I need a cigarette. And if that person wasn't
smoking, then wanted chocolate or something else.
It's like, I need advice. How does somebody who
needs something bad to do as a coping strategy,
how can they move forward? Like, do they really
need advice or can they pick up something that's
not so bad? I mean, this is really difficult.
This is, we're talking about. People using these
methods as a coping strategy. And it's stepping
back and saying, why do you need a coping strategy?
What is it that you're trying to cope with? And
looking at that first of all. And then working
with a practitioner to help them reduce. They're
smoking or drinking and finding other ways to
manage their coping. This takes a lot more work.
It's understanding why do you want to change
and what is it you need to change and then small
steps making those changes. For me, I feel like
my vice is coffee. Oh, not a vice. That's health
care. Mental health care. Okay, 101. At least
my vice is a good one. It's the timing of coffee.
Yeah, you're right. It's the timing and the amount.
I don't drink. I should 12. So, you know, I feel
like that's pretty good. That's great. Sometimes
I might sneak in a before one. Generally, it's
12. Yeah. And I was just listening to my buddy,
Dr. Mike Israel. Love him. Are you familiar with
Dr. Mike? Is his real name? Isriatel. So he's
a PhD, not a physician. Not a medical doctor.
Definitely not a medical doctor. This dude is
jacked on anabolic steroids. And that's kind
of part of his trope is like he talks about his
life on steroids and whatever. But he has a company
called RP Strength. Free shout out. And anywho,
he was just on Dr. Gabrielle Lai's podcast talking
about caffeine. Yes. And one of the things that
I think is important to hear, you're hearing
me defend my vice, by the way. So this is why
we're having this conversation. Yeah. Is because.
Just like there's differences in how we metabolize
alcohol, there's differences in how we metabolize
caffeine. And you kind of know it if you're being
honest with yourself. You know if you have that
first cup of coffee in the morning and it just
kind of gets you going on with the day. Or if
you get up and you're jittery and you're like,
okay, now we're ready. Probably you're not a
superb caffeine metabolizer. Probably you should
definitely limit to that amount or less and that
timing or less. And again, I'm not saying that
you should use caffeine if you're a great metabolizer.
But, you know, there are differences that if
you're tuned in, you can kind of tell if it's
moving you toward your goals. I've never gotten
the shakes. Actually, no, I said I think I've
gotten the shakes once. But generally, I'm like,
I'm OK with coffee. Oh, my dear husband. Oh,
my gosh. I mean, he's like. It's like it kills
him, that first cup. You know, let's put it out
there. He's in the restroom within a second.
And then he's like shaky the rest of the time.
I was like, maybe not that for you. Maybe not
breakfast fast. Oh, man. All right. So this is
the next section of our show where we love to
do this kind of fun, hotter hype. Meaning we're
going to give you a hot topic in health, and
you tell us if you think it's hot. Like, yeah,
there's data behind that. It rocks. Or if you
think it's hype. And then you can tell us why.
Okay. So you're not limited to a one -word answer
or anything like that. All right. Perimenopause
supplements. Hype. Why? I think there's been
too much marketing, I'm afraid, with perimenopause
supplements. Supplements are not governed by
any body. We don't know what's inside them. And
I just fear that women go for these supplements
without... actually getting the real help they
need. It's periwashing, is it? Is that what it's
called? What is periwashing? I like, is that
one of the new? I think there's a term, it's
like periwashing. You know how there's the pinkwashing?
Yeah, greenwashing. Pinkwashing. But yeah, no,
there's, I think there is a specific term for
it where they're just marketing everything. Menomarketing?
Yeah. Oh, I like that. I think it might be menomarketing.
I think you're right. But, you know, it's like,
oh, it says this is for perimenopause, but, you
know, actually it's just vitamin D. And I'm not,
you know, I'm not against supplements. I think
some women definitely need. them, but it's a
supplement to supplement everything else you're
doing and making sure you monitor, you know,
get a blood test first, find out what is deficient
and talk to a practitioner who is menopausal
aware and has the qualifications to guide you.
It may be those supplements are actually doing
more harm than good. There are some supplements
where we actually need to watch liver function.
They may interact with your medication. Of course,
when women are vulnerable, they will go and when
they're desperate to get some help, they will
go and purchase these products. So I just, you
know, a caveat, just be careful what you're buying.
Yes. And do talk to a practitioner first if you're
really unsure. There are some supplements that
do wonderful things, definitely, that I advocate
for. Yeah. See what you're into. I'm with you.
One of the things that drives me crazy about
the supplement industry is how much money it
takes from people, meaning they redirect resources
that they should be spending on other aspects
of their health care into these supplements that
don't do what they think it's doing. You know,
I won't call it out, but there's a very popular
greens -based supplement that people love. And
one of the things I always hear is like, oh,
before then, I can never get a good bowel movement.
Like, it really helps me go to the bathroom.
And I was like, it's fiber. So it's not that.
That greens powder is not magic. It's a fiber
supplement. And it's very expensive. You can
get a fiber supplement a lot cheaper. It's veggies.
Eat those. And people think, oh, it's a supplement.
It's not a medicine. So it's a good thing. It's
a good thing. Yeah, it's like, eh, anyway. All
right, next one. And this alludes to our previous
conversation. Red wine as heart healthy. Hot
or hype? Hype. Really? Yes. But the Respatrol.
But that's why, right? So Amanda, you know how
I've been on this journey about improving my
sleep? Oh, you have been obsessed about it lately.
Well, I have found something that has been incredible.
Cozy Earth bed sheets. That's saying a lot because
you are really picky about your sleep setup.
Exactly. These sheets are made from bamboo viscose.
They are naturally breathable and I get the perfect
night's sleep. They keep me cool all night. Oh,
and I've been eyeing the pajamas too. They are
so chic and super cozy. It's a total game changer
and so relaxing for the evenings. And what's
crazy is that Cozy Earth actually ships to Singapore,
orders over $560 ship free, and in the US orders
over $50 ship free. And did you know you can
get your biggest ever discount, 41 % if you use
code TFF today. So head over to CozyEarth .com
and use that code TFF today. So many other things
you could do for your heart health is what my
answer would be. I mean, if you choose to drink,
fine, just be mindful of it. But I wouldn't be
drinking red wine just for your heart health.
There's so many other things you can do for your
heart health that have amazing benefits. So,
yeah, for me, it's more a hype. Yes, there is
a ritual, but people say you can get that from
eating grapes. Yeah. Yeah, I mean, that's where
it comes from in the wine. You should have a
cup of the ethanol, by the way. So that's not
what's giving you the nutrients. All right, BMI
as a reliable indicator of my health. Hot or
hype? It is a hype. Big time. Thank God. You
know, we spoke about body composition, and I'm
afraid BMI doesn't take that into account. It
is what all the studies are based on. Because
it's easy. Because it's easy, quick to measure.
But it does not reflect, your weight does not
reflect what your lean body mass is, what your
fat mass is, and where that fat mass is as well.
So definitely we should be doing body composition.
Is it different here in Asia? I'm wondering,
is the BMI standard globally? No, there is an
Asian BMI. There is an Asian BMI. So the Asian
BMI scale is lower thresholds for overweight
and then for obesity as well. Yeah, damn, I'd
probably be, you know. Yeah, so overweight for
Asian is 23 .1. No. For Caucasian is 25. Okay.
Obese for Asian is 27 .1. For Caucasian is 30.
Where do I fall under? As in, am I Asian or am
I Caucasian? I mean, I'm not Caucasian, but you
know. Yeah. I don't know, like. That's a really.
That's a bit different. It's not Asian Asian.
Yeah, it's not East, traditional East Asian,
you know. That's a really great, that's a question
for Tyler. That is a good question. Do you feel
some BMI at all? Yeah. Okay, my kids are a perfect
example. Yeah, I think they split the difference,
right? So it's like somewhere around 24. I don't
know. But yeah, but again, this is why BMI is
not helpful for the majority of us. And just
for those listening that aren't familiar with
that term, it's body mass index. And it refers
simply to a ratio of your height to weight. So
I love when folks come in and they have some
weight loss with us and they say, my BMI went
down. And I was like, no, no, yes, because that's
what weight loss is. Less weight on your height.
Like your BMI will always track with your weight.
That's all it is. And you know, there are some
women and men that are skinny fat. Yeah. In the
Indian culture, that's a big thing. Like, you
know, they might look skinny, but where's the
muscle mass? And then what's going on? Yeah.
And here in Singapore, I think a study recently
released on Chinese ethnic women who are young,
who look slim, Their muscle mass is really huge.
We see it every day. It puts them at risk. Every
day. Yeah. And stunned to find out that that's
a risk. We had a patient earlier this week, came
in 47 .5 kgs on the scale, which for my American
listeners, it's very small. It's very, very small.
By any standard, whatever height, it's still
very small. And she was overjoyed by it. But
then we demonstrated to her that her... appendicular
lean mass index was 5 .1. And again, for doctors
listening, you're about to fall out your chair.
For lay people listening, it means that she's
severely under -muscled, almost at the threshold
of sarcopenia in her 40s. And body fat, 36 .7%.
You know, above what would be considered the
healthy range. And with that muscularity problem,
I mean, this is a really metabolically deficient
body composition. But we couldn't talk her through
it because she saw that 47 .5 on the scale. She
was like, but I'm doing great, right? I was like,
not, no. But yeah, I mean, that weight is not
an overweight weight, if that's what you're asking.
That's basically the sort of thing that leads
to... insulin resistance, prediabetes, and diabetes.
Yes, hugely. Yeah, and osteopenia and osteoporosis.
I mean, that's a recipe for it right there is
the light body weight with the under -muscling.
But yeah, so get your bones strong, get your
muscles up. All right, so another Hotter Hype.
And this one, Dr. Sundus, you might break our
hearts, okay? Stress scores, recovery scores,
body battery reads from our smart watches. Hotter
Hype, Hotter Hype. It's a tricky one. It depends
how you interpret data. Okay. Tell us more. I
would say hot, but only if you don't get obsessive
about your data. So for some, this is amazing
to have those scores because it can really help
you get in tune with your body and realize, okay,
today is a good day for training. Today, I need
some recovery time. But for some, it can be quite
an obsessive thing to look at your scores. be
very stressful it can add to your stress it would
be ideal if we can tune in and learn without
these devices how do I sleep today let me look
at my watch like not how am I feeling do I feel
rested what time do I go to bed so maybe that'll
help but yeah I totally get that because I mean
to be honest I do get a little bit obsessive
you know I do love to track my sleep and all
of that stuff I don't know you'll see that on
my stories every now and again But I do listen
to my body. Like sometimes I'll look at my watch
and it will say you had a shit sleep. I feel
great. You know, I'm going to ignore that and
just pretend it was, you know, maybe that late
dinner I had because I was out with some friends
or whatever it is. But generally, I will go by
how I'm feeling. But I do like to show to my
husband, look how I, yeah, look how recovered
I am. And back to that example about the mom
going from the school pickup to the HIT class.
So let's say you wake up with a recovery score
crap. Your sleep was crap. on your schedule today
is drop off the kids, go to this class. Maybe
you could pick a different class today because
it's not going to help your recovery to go into
another super high heart rate bout of exercise.
Perhaps today would be the day to kick back with
a walk in nature, maybe do some low intensity
zone two. So it would help you formulate a better
program, I think. But you're right. I think on
the flip side of that, you wake up, your sleep's
crap, your recovery's crap. You're like, well,
I'm skipping the gym. And that's the more honest
response, I think, for most people. It's like,
well, I'm not recovered, can't do anything. What's
more important then? Exactly using that example,
you know, you slept crap, but you've got a class
booked. You know, what's more important there?
What would you say to somebody who is like, right,
okay, we're looking at the lifestyle pillars,
even though they're not pillars, but, you know,
do I go with my movement, which obviously is
important? Do I go with my sleep, which is...
Also important, like how much weight do you give
to each thing, each pillar? Ideally equally.
But it really depends on the patient sitting
in front of me. You know, which pillar is important
to them? Which one is actually, are they ready
to make some changes in? I can easily say to
you, you need to strength train. But if you are
so stressed, you're sleep deprived. You can't
get to the gym. OK, we need to work on those
first. So it's where are people ready to start
making some changes? Of course, as a physician,
I can guide them and say, look, we're not going
to be able to do this if we don't do this. But
are you ready to make changes in this area? So
in this example, they're sleep deprived, but
they've got a class. Is that class actually going
to benefit them in that moment in time? Great
physical activity is wonderful, but is it just
going to add more to their stress? Is it going
to add more to their mood that's already down?
Exercise, on the other hand, is helpful if you
do it earlier in the morning than at night. So
maybe choose a class that's less intensive, as
we said. Maybe go for a walk instead. If it really
is your only chance to do that class, and it's
strength training. Skip the speed. Then go for
it. Maybe don't, you know, push yourself as much
as you normally would, but do push yourself and
then think about, okay, I'm going to have an
earlier bedtime. 9 p .m. New bedtime, everybody.
9 p .m. I wish. I hope that day is upon me soon.
It's always been upon me. I can't, like, 9 o
'clock, I'm yawning away. Our last hotter hype,
and this kind of circles us back to the first
question about supplements. Iron infusions if
you have demonstrated low ferritin. Hot. Definitely.
If you can take iron orally and it's absorbed
orally, then absolutely. But if there's issues
absorbing it orally or side effects absorbing
it orally, then an iron infusion can be really
helpful for women. We know a lot of women do
have heavier... bleeds during perimenopause and
that can really affect their iron level. And
so we need to top that up and then obviously
work on the root cause of why they're iron deficient.
Absolutely. And I think, you know, for the listener
out there right now in her 40s, you know, taking
diligent notes on this episode, but now she's
feeling completely overwhelmed. OK, there's six
pillars you got to think about. There's BMI stuff.
There's like something with my lean mass. I don't
even. What are the two things? that she can do
this week to start improving her health for perimenopause?
Yes, women do get overwhelmed. And when I see
them and go through a lifestyle medicine consultation,
it's like, oh, goodness, I've got to change this,
this, this, this. And I'm like, no, we're going
to do it one step at a time. As I said before,
what's important to you? What's your health goal?
Where are you in your health journey right now?
Let's pick one pillar, two pillars. Let's pick
one change or two changes. What are you ready
to make? And let's start making those changes.
Let's make sure they're sustainable, they're
consistent, so they become a daily habit. So
it's really hard for me to say two things. But
I would say in perimenopause, in your 40s. Definitely
strength training if you aren't doing already
and start small, you know, start by doing some
body weight exercises, use some resistance band,
carry your shopping, start small and then build
up. And the second one would be probably, I'd
say sleep, because most of us are not getting
enough sleep and not working on our sleep. That
will help build, improve your mood, improves
your weight as well. All our hormones, our appetite
and satiety hormones are released during that
time. It will improve our cognition and also
our stress management. We become more resilient
to stress as well if we can prioritize that.
I do think, though, you know, if you are strength
training and you get decent sleep, I feel like
you're naturally going to make better choices
with your food. You know, because you're going
to be thinking like, look, I'm waking up now.
I should probably do something better with my
food choices. And when it comes to sleep, you're
not going to just reach for, you know, the quick
and easy processed snack that's just, you know,
there. And, you know, you've actually got that.
that patience and that time to really sort of
think, right, okay, now I'm fully energized.
I will make a nice meal. I will go for the unprocessed
option and I will get my fiber in and I'll get
my protein in. And I think you're not thinking,
you know, like what's quick, what's easy. You've
actually got that capability to make the better
choice. Yeah, it really buffers you. And we know
people who are sleep deprived do. you know unconsciously
eat more calories absolutely and make wrong not
as healthy choices there's so many studies out
there you know you will choose more carbohydrate
heavy foods you will choose more sugar rich foods
you'll choose more processed foods like all the
things you said in that very first thing about
the type of diet that will help you is not what
you choose when you're sleep deprived and that's
a sad truth that's right Well, again, you've
given us so much to think about today and we
really appreciate your expertise in this area.
But I would love to know, you know, personally
from you, for women in their 40s, what's your
40s formula? How would you give women advice
to thrive in this decade? So what I would say
is while you're navigating perimenopause and
menopause, see it as an opportunity to look at
your health, your holistic health overall. Yes,
absolutely get some help with your symptoms and
improve your quality of life. But look at the
bigger picture. Think about those long -term
health risks that are silent, that you may not
feel. Educate yourself about them. Get tested.
Know what your risks are for them. And there
is plenty you can do out there to minimize those
risks. Look at those six pillars or six cogs
of health and see. What is important to you right
now? Where are you ready to make some changes
that will be sustainable? And think about what
kind of life would you like to have in your last
10 years of your life? You know, women are living
till into their 80s, 90s. We want to remain well
and healthy and do the things we enjoy and love
and be independent for as long as possible. That
would be my message to women. I love that. Think
about who you want to be in the future and work
toward that, right? Start today. Exactly. Perfect.
Thank you. Thank you so much. Thank you. with
me.