Dr Louise Newson: Dr Hussain is back on my podcast by popular demand. You might have seen him on my Balance app. You might've listened to our podcast before. We talk about lifestyle medicine. So how we can improve all those pillars that are so important with movement, sleep, relationships, reducing addiction, nutrition, just being better versions of ourselves. But the most important thing that comes through is being honest to ourselves, being really true what we can do to improve our future health and be happy as well. So enjoy it. So Hussain you're back, but you're back in real life. Last time we did a podcast, it was remotely, wasn't it?

Dr Hussain Al-Zubaidi: It was, and it's a lot better face-to-face. It's great to be here.

Dr Louise Newson: It is, it's really nice studios, you've come down. I've kept you waiting late, but you're still smiling. So that's great. And we're still being connected. I still see you because you're part of Balance+. You're one of our Balance+ people. So today I was, we've just refreshed it actually, and we've had a great update. So it's all got different colours and everything. And you're there with your open water swimming, your smiley face, which is, which is great. So for those people that don't know you. You are a GP extraordinaire, really, and just explain a bit about what you do.

Dr Hussain Al-Zubaidi: Yeah, so a portfolio GP that specialises in lifestyle medicine. So as well as working part time as a GP, I work at the Royal College of GPs as the lifestyle and physical activity lead. Also work at Parkrun, which is a health and wellbeing charity. People may know about the event they put on on a Saturday and Sunday morning as the health partnerships lead. Also have roles with Red Whale for medical education and Swim England as a medical advisor supporting people with long term conditions to access aquatic activities. So Lots of things, there's probably something I've missed, but it's a smogasbord.

Dr Louise Newson: Well you have missed that you are a supreme athlete as well.

Dr Hussain Al-Zubaidi: I try. This year, I haven't been as good as previous years.

Dr Louise Newson: Well you had an injury.

Dr Hussain Al-Zubaidi: I did. Yeah, I decided to fall off my bike. But apart from that, I'm hoping next year I can get back to form. But yeah, no, represented my country yes.

Dr Louise Newson: And I don't want to big you up, but you are an inspiration because you've not always been this lean, you've not always been in this fit and it's so easy, I think, to look at people and go, well, he's got it. He's look at him. He's really slim. Look at him, but actually I was saying to Jack before you came in, but years ago, when you said to your partners at work, I'm going to take up running. They laughed at you, didn't they? Because you were quite overweight and...

Dr Hussain Al-Zubaidi: I'd been diagnosed with MASLD, which is metabolically associated steatotic liver disease, which is essentially fat infiltration in the liver. Diagnosed with high blood pressure and...

Dr Louise Newson: And you were young, weren't you?

Yeah, I was in mid-20s, and it was just... and it was just, and to be honest, until I got diagnosed with the fatty liver disease, I didn't even realise that I'd gained weight, like I never weighed myself.

Dr Louise Newson: Yeah.

Dr Hussain Al-Zubaidi: I avoided taking photos, I avoided looking in the mirror and obviously clearly, clearly I knew on some level but I hadn't consciously made the realisation that I'd gained weight and it was just that real... I went home after having that ultrasound scan and I went on the scales and I'd gain 26, 27 kilos from when I last checked.

Dr Hussain Al-Zubaidi: That's huge amounts!

Dr Hussain Al-Zubaidi: Yes, and I asked my wife, I was like, I've gained a lot of weight, and she's like... Duh, have you not thought about all the new clothes that I've been buying you and the fact that, you know, you've got a new belt and all that. And I just hadn't accepted it. I think I didn't want to because I didn't want to accept it. And I sort of slept-walked into it. I was leading a lifestyle that was actually helping me at the time because I was overworking, I was overstressed and the kind of foods that I was eating helped me feel better on the day.

Dr Louise Newson: Yeah.

Dr Hussain Al-Zubaidi: I often use like a reward thing. I don't know if you've ever done that, but let's say you do a duty doctor and you go, do you know what? I've worked so hard today. I deserve.

Dr Louise Newson: Well, I used to, I mean, as you know, I don't drink alcohol, but years ago, well, 25 years ago and I just was full-time GP, I would deserve that half bottle. My husband and I would open a bottle of wine and we'd share it. Not every night, but quite a few nights. But if it's been an especially hard day, yeah, I deserve that. And it's, you know. It's whereas yeah, you can get rewards in different ways, but it's that slippery slope. And, you know, I've never put on that sort of weight. But when I was pregnant three times, you know, I've put on 10 kilogrammes and it's very gradual. And because it's a very gradual, you almost think, well, I'm not really that big. I mean, I have had big babies, you, know, nine pound babies, and obviously I'm tall. And I look at my pregnancy photos, of course, I had this massive bump, but you sort of get used to a different size when it's a slow thing.

Dr Hussain Al-Zubaidi: Definitely.

Dr Louise Newson: And I can see that, how easy it is to just adjust and kid yourself.

Dr Hussain Al-Zubaidi: 100%. And I think often, you know, back then when I wanted to lose the weight, like the focus is all around losing the kilos. I'd want to see the numbers come off. But what I've learned now from that journey was actually the weight loss was really a tiny, tiny part of the health gained.

Dr Louise Newson: Yeah. See, that's really important because I just like to highlight to those listeners, you lost weight without GLP-1s. You did it with your lifestyle, but I'd like to, I'd to sort of focus a bit on lifestyle because I don't think people know what lifestyle means. It's, it's one of those words that is brandished around a bit. Lifestyle, style your life? What does it really mean?

Dr Hussain Al-Zubaidi: It's a really good point. And I think when I talk about lifestyle, I specifically mean lifestyle medicine, which is an evidence-based way of utilising various behaviours and actions to improve health. So we've got six pillars of lifestyle medicine. We've got physical activity, nutrition, sleep. Then we have mental wellbeing, healthy relationships. And minimising harmful substances and behaviours. So when we think of that, also like gambling, if that's a problematic gambling use or things like social media use, if it's problematic and overuse.

Dr Louise Newson: And that's important and I like the way you didn't use the word exercise actually.

Dr Hussain Al-Zubaidi: Yes, I never used the word exercise. I never use, because when I started my own personal journey, I viewed exercise, like many do, as a chore, as something that's good for me.

Dr Louise Newson: Yeah.

Dr Hussain Al-Zubaidi: But was effort and was time consuming and was painful. And that's not what real physical activity is. Physical activity should be movement that you enjoy. And I often see on social media people saying, oh, you have to sprint and do this, or you have to start running marathons to do that, or, you must go into the gym. And look, there's lots of benefits to all those things. But the best movement is the one that you enjoy. And sometimes you don't even realise you're doing.

Dr Louise Newson: Yeah.

Dr Hussain Al-Zubaidi: Let's say if you go to a dance class and you don't even realise and you don't log that as exercise, then that's the perfect form of physical activity.

Dr Louise Newson: Well, you know what? Angela Rippon has sat in that chair.

Dr Hussain Al-Zubaidi: Yeah.

Dr Louise Newson: Talking about dance and you know you can't dance and not smile so the two go together and I think you're absolutely right, people's relationship with exercise can be really complicated actually and you know and I think finding some sort of movement that you enjoy means that you will do it regularly because that's part of the battle isn't it?

Dr Hussain Al-Zubaidi: 100%. You know, I viewed physical activity before when I viewed it as exercise in the frame of competition.

Dr Louise Newson: Yeah.

Dr Hussain Al-Zubaidi: And I was always last in school. You know, my parents always focused on academia. So I never had the opportunity to really practise or get good at it. And so therefore whenever I did it in PE, I was obviously rubbish. And it's funny because now I compete regularly and I enjoy it and I love it. And it is such a, you know, pleasurable experience for me. But when I used to always think of exercise and always think about comparing to other people and me not being as good as other people. And as soon as I broke that away and I started to just go, how can I find a way to move my body where I feel adventurous, where I can feel like I can spend time in nature because I always loved being outside. And suddenly these things start to develop and I can get to a point where, yes, if I took up running from the get-go, I don't think I'd ever have engaged with it, never. Couch to 5K for me, never worked because I'd do it for a few weeks and then I get bored. But when I just found a way of, let's go outside, let's spend some time with friends, with family, move my body and see where this takes me. Slowly, I would start to find and I discovered running later on. And after a long time, I'd spent time walking and hiking, and then I'd go, okay, what's it like to just run little bits? And I found my own way because Couch the 5K can work with lots of people. Great. But if you find that those kinds of programmes work and then you quit, look to discover it in your own way. Do your own journey that you've designed rather than it being three sessions a week for nine weeks. That's not going to work for everyone.

Dr Louise Newson: No, and I think all these pillars are so important and they are the foundation of so much. They're almost the non-negotiable things, I think, and, you know, I think, you, know, people are quite surprised when I say I don't drink alcohol, I don't eat chocolate, I don't have caffeine, I don't need processed foods. And I have to be like this because I have such bad migraines. If I didn't, it would trigger migraine. So I'm almost blessed and cursed, but I'm lucky. Because I can't cheat. You know, if I was hungry and I just went and bought a packet of crisps, I would get a migraine later, so I have to hunt out the nuts and the fruits, which is quite hard sometimes, I always have to have something in my bag. But it's so easy to do it wrong and it has such an impact. And all these pillars work very closely together, but you have to work at it, but then it becomes part of routine. And I think getting to that stage can be quite hard for a lot of people can't it?

Dr Hussain Al-Zubaidi: For sure. And I love what you've done there, because it's something that I try to encourage patients to do, which is, you know, you have a barrier, for example, migraine or a condition, you could see that negatively, or you can see it as that drive. Like for me, it was the MASLD. It was the liver disease that because I got that with a BMI of 28. And there's lots of reasons why that happened. And we know that there's ethnic and genetic variations, which means that your complications from increased weight varies. It's not equal across society and instead of thinking, oh my god, I'm so unlucky, I got high blood pressure and metabolically associated liver disease at only a BMI of 28. I said, think of it oh, that's a blessing. That means that I'm going to target lower, you know, I know, I'm gonna really focus on making sure that I don't get to that because I don't want those implications. So no, you're right. Like if we can switch that narrative can help. But the interconnection of those pillars are so important. You know, let's just take for example, going to Parkrun, okay, whatever form that may be. Let's say you want to walk at Parkrun. Yes, you get the physical activity, but you also get the healthy relationships and building a community when you go regularly, you go to your local one, you'll get to know people. You also get the green social prescribing of being around natural spaces. You also get that regularity of seeing light in the morning and waking at nine o'clock, starting your weekend right. So these things, they rarely just have one benefit. You see compound benefits when we talk about lifestyle.

Dr Louise Newson: Yeah, and that's so important. And the other thing is, I know it sounds a bit weird as us as doctors, but I don't actually like prescribing drugs other than hormones, which I think are probably the seventh pillar actually for men and women. Hormones are so important because they're natural, but we don't want to be prescribed, every medication has side effects and risks and, you know, they can interact with each other as well. And, you know if I didn't exercise, if I didn't eat healthily, I mean, I'm 55 now, I probably would have hypertension. I know that my, I'm sure I've got ADHD. It's been formally diagnosed, but it's just the way I am. And I know if I didn't do yoga most mornings ending in a headstand, that would really affect my mental health, because I would be so fragmented. I just know the way that I am, I would probably be lower in my mood. I wouldn't sleep well. I probably would be overweight, you know? And so it catches up with us, all these things. And any ways that we can de-medicalise and de-prescribe, but actually not even start those prescriptions is actually really important, isn't it?

Dr Hussain Al-Zubaidi: 100% because people are suffering, you know, when it's not just a label of getting a long term condition, it's all the symptoms and the impact on people's quality of life that those things bring. And we know from sort of estimates that the WHO has done in terms of long term condition rates, that 60 to 70% would be eradicated if people were supported to live a lifestyle which included healthy food and regular movement. You know, that is astonishing.

Dr Louise Newson: It's massive, isn't it? I mean if you could prescribe a pill of exercise. I mean, it must really frustrate you, but I feel as healthcare professionals, we have a responsibility. And I know like you and me, we're out in the public more than a lot of doctors, but I've always tried really hard as a doctor to be an example for my patients. And I'm not perfect. I could always do more exercise. I could do a lot better in all sorts of things. But I do think it's important and I think it's a shame when I see doctors like you were many years ago, you know, because it's not a good example, is it? But it's so easy in medicine, especially in hospitals, because you can't access good food often, you're working long hours, it's very stressful. So I'm not criticising medical professionals here. But I do feel we have to have a bit more maybe responsibility for our patients.

Dr Hussain Al-Zubaidi: Definitely. And the thing is the challenge is we're just living within an environment where there's various social determinants, which means it's really challenging. It's challenging for everyone, but it's even more challenging for certain groups often underserved in lots of other areas. And it makes gaining weight actually kind of the default. Like you have to do so much. And as you just said, you know, so many elements in our own lifestyles to do it. So I kind of think of it as, do you know what, it's not your fault, but it is your problem.

Dr Louise Newson:Yeah.

Dr Hussain Al-Zubaidi: So until we can look for real policy change to support more people to access healthy lifestyles that are affordable, that are achievable, an environment that promotes health, brilliant. But until that point, we do need to take some personal responsibility because no-one else is coming, unfortunately, to help us out. I wish it could. And clinicians, yes, we need to lead by example, because we are better placed. Often, let's say, if we think about our fellow doctors, but we are well placed to understand the information. And to not just communicate to our patients, but communicate it by living it. Active healthcare professionals are more likely to encourage patients to be physically active. So it's really important that we make sure that as a workforce, we are enabled to support that. Because for many, as you know, it can be really challenging even to get a toilet break, let alone have time to stretch and to keep our bodies moving and to eat well.

Dr Louise Newson: Yeah. And sometimes when someone who works in our practise teaches yoga, so we've got her to just teach some of our, and it's very basic, 15 minutes, that's all people come away from their desk, they're moving and they're laughing because they're watching everyone else. And it's just a really lovely uniting thing and it doesn't cost me much money owning the company. It doesn't take much time away from people's duties or work and little things can make a really big difference, can't they?

Dr Hussain Al-Zubaidi: Exactly. And if you guys are doing it, you know, you're private and you're doing that for your staff, it shows that there's a good reason to do it. So, you know, the argument often is that we have no funding, etc. But I think the reason we have limited funding is why we should be doing these things. Yes, we need to get the most out of our staff and our staff will only deliver the best if they're at their healthiest.

Dr Louise Newson: I've got something really exciting to share with you. Every Thursday, I'm going to be releasing an extra episode for those of you that sign up. It's an opportunity that I can have more guests share more information, dig deeper into the research that I can share with you. And when you subscribe, this money is going to used to help with research, much-needed research that's away from pharmaceutical companies. So information is down in the show notes. So have a look and subscribe and enjoy. Because of migraines, I'm always taking my food to work and it's a bit of a constant, you know, if I have a lunchtime meeting, I will eat in front of people because if I don't, I just don't want the consequences. And having fridges at work is really interesting. So when people first start, they are bringing in their ready-made sandwiches, their low-fat yoghurt, thinking they're doing really well. And over time, it's, I don't actually say anything, but you can see how people change. We have fruit delivered at work as well on a Monday. And we just have a local supermarket to deliver some fruit. Um, so there's less crisps around and when people, when I'm walking around and people have a can of whatever on, on their desk, they're hiding it from me. And it's just quite funny, but I, what I have noticed also is a lot of my work colleagues have lost weight, they are exercising more. And, um, now I've been talking more about Vivo Barefoot, which I know you're an ambassador for as well. We've both got our Vivo Barefoot on. And people initially, because I've worn them for quite a few years. They're like, what are those, Louise? You know, but now, like, in fact, one of my colleagues has just gone and bought one. And he's like, oh, feels a bit weird, but I can get into this. And I, I love that sort of passive influence. I'm not going around lecturing people, but they're sort of watching and they're like oh, okay.

Dr Hussain Al-Zubaidi: The zero-minute consultation, I call it. And I do it, let's say, with the footwear I've got or I leave my cycling helmet on the back of the door or I'll leave my trainers, because I often do a run after work, I'll leave the trainers just visible in the corner of the room. And I don't mention it, but patients will often mention it. Oh, you like to run or oh, you've cycled into work. Things like that helps to open the conversation because I never want to just be telling people what to do.

Dr Louise Newson: No, because it's also, you know, I've got three children. If you tell them what to do, they'll do the opposite. So it's, um, it is funny. And, and I think I told you this story before, but before I left general practice, one of my fave, I have got quite a few favourite patients, but one of my real favourite patients was in her 70s and she'd recently lost her husband, who again, was a lovely patient of mine, but about 10 years before I had pancreatitis and was really ill and she used to come in morbidly overweight. And she'd say, ha Dr Newson, all these seeds that you eat, look at you. It hasn't done you any favours. You've been really ill, because I was off work, and even afterwards...

Dr Hussain Al-Zubaidi: A little harsh.

Dr Louise Newson: And it was a bit harsh. And I was like, hang on a minute, you know, because I'd spent a long time trying to help her to lose weight really, talking about her lifestyle and everything else. And then obviously when her husband died, things went and she was comfort eating a lot. But then the last two years, she quietly, she didn't tell me she was doing it. She just changed her, her eating. And all the little things I'd said to her over the years before had sort of just fallen into place. And she lost about five stone. And this was just with her lifestyle. It wasn't with any medication. And she was so happy and so proud to show me what she'd done. And I thought, wow, because it's so easy to think, well, I'm too old now. My metabolism's changed. I'm not going to be able to lose weight. But the whole thing really for her was she had to admit to herself. And I think honesty to yourself is quite a hard thing to do often.

Dr Hussain Al-Zubaidi: Yeah, it is so important to do. And it is the biggest barrier that often people aren't even visualising because they're focusing on all the other, yes, important barriers, whether it be various long-term condition symptoms, financial barriers, time barriers. Yes, they are all genuine, but it's so important. Like for me, I had to realise that I was addicted to certain types of food. Do you know what I mean? Like I used to...

Dr Louise Newson: Are you talking about the crisps? You used to have...

Dr Hussain Al-Zubaidi: Man, don't get me started on those. Louise, I could, on days, easily have consumed more than 13, 14 packets of crisps.

Dr Louise Newson: I can't even imagine you holding it a packet of crips now.

Dr Hussain Al-Zubaidi: Oh yeah, I haven't had a crisp for, I don't know how long, like maybe three, four years, you know. And before, like even just looking at them, like I would just be driven to just consume them. And I would always go with the intention of having one packet, don't get me wrong.

Dr Louise Newson: Yeah.

Dr Hussain Al-Zubaidi: I never used to start a day going I'm gonna have like 13 packs in one good I used to have to hide it Louise because if I put it in the bin my wife would see and she'd get upset with me so I used take it to the outside wheelie bin and like lift up a bag and put the packets there because otherwise she'd see and then...

Dr Louise Newson: Awful isn't it?

Dr Hussain Al-Zubaidi: It's crazy.

Dr Louise Newson: But that's, you weren't honest with yourself, you see.

Dr Hussain Al-Zubaidi: I wasn't honest. I used to say that I had no time, that work was too stressful. Reality, I was using food as a way to make me feel better and it did. And it did a great job at that, but it was having unwanted side effects. And so until I realised that I needed to work on my relationship with food and what I was actually using it for, what were the wounds that I was trying to heal with it? Only then did I start to actually see some benefits and to start to make shifts towards a healthier lifestyle.

Dr Louise Newson: It's so important. And the one of the other pillars, if you like, you were talking about was addictions. And I've recently done a survey looking how addictions change in perimenopause and menopause and with any hormonal change, because a lot of people, as you know, these hormones, progesterone, estradiol, testosterone have effects on dopamine, especially. So if your levels are low or fluctuating, you don't get that dopamine hit. So a lot of people are trying to get pleasure elsewhere. And I see it a lot in patients. They drink more to numb their symptoms, try and help them sleep. But I also see patients who take harder drugs. And one lady who's very posh told me recently how she'd been using a local dealer to get some cocaine. And I thought, Oh my gosh, what about hormones? Well, her GP refused to prescribe them. She wanted to feel better. And a lot people actually, certainly in our survey that we did, in the free text comments, they were taking them to try and improve their confidence because they felt being perimenopausal, menopausal, their confidence had gone, their self-esteem had gone. They wanted confidence, or they wanted to help sleep as well. So some of them were smoking cannabis to help them sleep. Some of them are taking class A drugs. Some of them, one lady just said, I want to escape this cage of doom. And we had over 1,300 responses in a very short space of time. And it made me weep literally reading these comments. We're letting down people. But think, and also, you know, 5% of them had increased gambling as well. So, and it's so easy now to gamble on your phone. It's, you don't have to go and make an effort.

Dr Hussain Al-Zubaidi: Do you know there's 33 million active online gambling users?

Dr Louise Newson: Doesn't surprise me. It's huge. It is so shocking. So we're doing some more research with the charity Gordon Moody Association about the role of hormones and hormone changes with gambling. But that's a bit that people almost just think, oh, that's just for down and out people. That's just a small proportion. But I think it's a big hidden epidemic actually, the gambling, the addiction.

Dr Hussain Al-Zubaidi: Because it doesn't just affect the individual. Like it really affects the nuclear family and also workplace and the community. So it ripples through. So you have to look beyond just purely the gambler. I think I saw one stat which showed that 7% of the UK population is either directly or indirectly affected by someone who's gambling or they are themselves have problematic gambling use. So it is an area that needs to be explored. And it's just one of those other ways of looking for that dopamine hit, as you say, trying to either manage or treat in some way, if you can use that word, an other underlying issue which isn't being addressed.

Dr Louise Newson: Absolutely. And I think that goes into one of your other pillars is about relationships with people because people I think are lonelier probably than they have been before. And partners, relationships can really change. And, I think if you haven't got that, it's so important, you know, that oxytocin, just from having a hug, the social connections. And you know I'm quite socially awkward. I don't really enjoy going out, the thought of going to a pub and talking to people just, I can't stand, because I'd much prefer to go home and read and, you know. But I'm very lucky. I meet lots of people with my job and my work and I have a very social job. Like you do.

Dr Hussain Al-Zubaidi: Yeah, I was gonna say, I'm quite surprised that you get awkward in social situations.

Dr Louise Newson: Yeah. No, I am very socially awkward. Oh, wow, okay. It's really interesting. I'm a quite complicated person. But we have a very people job. Whereas if I was sitting behind a screen working from home all the time and didn't have good social connection. And I have a very solid relationship with my lovely husband and I'm very fortunate with my family. But you can see how it's different to maybe it was 20, 30 years ago for a lot of people.

Dr Hussain Al-Zubaidi: Because it's more than just being connected to people and having friends, because it is deeper than that. Because actually, if you look at the highest rates of loneliness, it's in young people.

Dr Louise Newson: It is, yeah.

Dr Hussain Al-Zubaidi: And they have lots of technically social connections, like if you add it up, you can draw out a really nice map, but they report highest levels of loneliness.

Dr Louise Newson: Yeah.

Dr Hussain Al-Zubaidi: And so we're talking about quality of relationships. And for me, actually, I have all the pillars in my own lifestyle journey. I know we've talked about physical activities, etc. It was the healthy relationship one that was the first one I did because in order to really combat that addiction to food that I had, I really leaned in on my relationship with my wife, my relationship close friends. I needed people to help me to see things I couldn't see, I was clouded. And they really supported me on that and kind of gave me advice and helped to sort of shift my decision-making and realise other things. And so I think healthy relationships gets ignored.

Dr Louise Newson: It does and I think relationships are very different, you know, I even, I apologised to you before we came on air, because this is about social media, you know, I see that you had an awful injury, you fell off your bike, and I was like, oh, poor thing, that's really awful. And I, did I reach out to you the first few weeks? No, I didn't, because I just, no, but it just, it just shows that we're very, it's very different. Like in years gone by, you probably would have phoned me or written me a letter and said, oh I've been, you know, had this awful injury. And I would have gone, oh my goodness, are you okay? Can I do anything? But it's that sort of thing. And then when you get so many likes on your social media, it's like, Oh, I'm really popular. Like it means nothing really. I mean, of course, don't get me wrong. My social media is very important way of educating people, but I don't have friends, I don't know these people. And I know when I do a public facing event and afterwards, if I do book signing and I can feel the energy of those people, it is the most amazing feeling ever to have real people. And that's where change happens as well. And I can see you when you're running with other people, it's this camaraderie, it is changing together and I think that's what we need to focus on a lot as healthcare professionals as well.

Dr Hussain Al-Zubaidi: Like generally, when you do things together, the perceived effort drops. If we just talk about physical activity, we know from the evidence that group exercise really improves motivation, improves the longevity that you do the particular activity and also reduces the perception of effort. That's brilliant. You can do that. And that's one of the reasons why the practice that I'm based at, we do community physical activity sessions. Where we don't even call it exercise, we frame it as a support group, as a place for people to come and chat and to move outside.

Dr Louise Newson: Yeah.

Dr Hussain Al-Zubaidi: We're very lucky in Leamington. We've got beautiful parks, beautiful places to move. And it just it just makes it so much more effortless. The number one thing that patients tell me, they go, firstly, I've never walked all around five kilometres before my life. And I did that. And I didn't even find it that difficult. I didn't even realise till the end when when I showed them on my watch that we'd done this distance, like, really? We've done that because they were just chatting and having fun and and just enjoying people's company. And so like, look to see how can you develop more of those closer relationships, maybe work on some of the relationships you already have. It's also the inverse. There may be toxic relationships going on in your life that you need to manage. Some of them you can't cut off for various reasons, but you can look to manage and control to limit the impact that it has on you as well.

Dr Louise Newson: I think so. And I think, you know, we learned that quite early on in general practice. It's how you feel with other people. And, I was very lucky when I was trained as a GP. My trainer was really good at the consultation modules and everything else. But, you know, if you're with someone and you're feeling a bit nervous, it's taken me a while to realise it's actually because they're nervous. And the same if someone's sad, you feel that sadness, and happy is great, isn't it? You know, but the same with negativity. It can really affect you. And I feel very strongly that you've got to be positive. And this sounds a bit cheesy, I think, but it's true. And I have an affirmation diary that I write in every day and my husband goes through for my birthday. And every morning I have to write three things that I'm grateful for. Three things that are going to make my day good. And one thing that I just need to remind myself about. And then in the evening, I write three things that have made my day good. And it's really like, I'm quite an over thinker. So I was like, oh, I've got to get this right. And actually, yesterday I was in a bit of a hurry and I thought, so I was just happy to be alive. I'm happy to, you know, live in a peaceful country and I'm to not have a migraine. You know, because I've just come out of having a really awful spell. It's quite, and I am happy to have love and kindness. And You know, it becomes very, very simple. It's not that I've got a new dress or I've got this or I've got that. It's material things. Often it is friends and family and having a job.

Dr Hussain Al-Zubaidi: And we have to be intentional about identifying those positive things because we're naturally geared to want to look for negative things because it's going to help us survive, you know, yeah, you know, those that survived were those that picked out the dangers in their environment. But in how we live at the moment luckily, our environment isn't filled with that many direct dangers. Yes, lots of lifestyle elements that means long term. But we need to sometimes be able to be intentional to go, do you know what? Actually, what are the positive things happening? I had to do that big time in the accident because my brain went straight into negative mode. Oh, my God. The whole 48 hours afterwards, I was just telling my wife all the negative things and why this was the worst time that it could happen. And she told me a very important thing. She goes, OK, when would be the best time for this to happen? And I was struggling to find the best time and  it took me a bit of time and I don't write it down, but for me, like I often will start, if I'm gonna be sort of starting the day, I'll just think of, okay, what was I most proud of yesterday and what am I most looking forward to today? And so it can mean, it's different things to different people, but just be intentional in trying to pick out the positive elements. Because no matter who you are, there are always positive things going on. And I love to speak to those that have gone through some incredible adversity. And often when you hear them they still speak about the positive elements and the things that they're grateful for. And I'm thinking, goodness, like how can you pick that out in an experience like that?

Dr Louise Newson: It's so important. So gosh, we've covered a lot. There's so much, but you will come back I'm sure. Three things like it's a new year now, a new beginning. We all have these great new intentions, what we're going to do. And they often don't last beyond January. And I'm really keen for this conversation to be continued, to be thinking positive, to be thinking about your six pillars plus one, hormones, and to be thinking about being true to yourself, to really being completely honest and thinking, what else can I do to improve my lifestyle, my movements, my sleep, my nutrition, everything else as well. So what three tips for people, I don't want to say New Year's resolutions, I don't want to save things for the New Year, three things that you think should be able to last throughout the year and beyond that people could do.

Dr Hussain Al-Zubaidi: Tip number one, that is measure your goals correctly. So what I mean by that is don't always measure your changes in lifestyle from weight lost. I actually hate that as a measure because it doesn't give you a good picture of the work that you've put in. So many people will say, I do so many things and I don't lose the weight. And they get demotivated, they stop doing those things. But then I go, well, all those things were helping your cardiovascular health. They were improving your longevity. They were helping your mental health, etc, etc. So find various different ways of assessing the thing that you're going to do. Maybe you're gonna measure on how it makes you feel or your anxiety levels, or maybe it's you're gonna measure how many people you're gonna spend time with each week that you enjoy. So find measurements that are personal to you that you can use to track whatever it is that you want to do. Number two is I want you to draw a circle on a piece of paper, I want you to split up into those pillars that we've spoken about. And I want you to fill in amount of that particular slice that you feel confident that is a strong pillar. So if you feel it's really strong, colour it all in. And then I want me to look at that pie chart and see which ones are currently deficient in. And then target what you wanna do to the pillar that you feel, one, has progress to make, but two, you can feel it's low-hanging fruit. You go, do you know what, I can make some changes here that's gonna make a difference early on. Start there, before you tackle some of the bigger things that you're gonna need to, eventually, start with small wins, build up that confidence, because as we talked about, it's interconnected. So if you can improve the other areas of the pie chart, it will make improving the other slice that maybe is really low down easier to do. If you focus on where the fire is, then unless you have the whole systems in place elsewhere, you're gonna find it really hard to control a difficult area. Third and finally, and I really, really mean this, look to just bring more fun into your life. Because when I look back, yes, I was overweight. Yes, I had high blood pressure. Yes, my liver was a mess. But I just wasn't enjoying life. I just, wasn't having fun. I was constantly tired. I was constantly anxious. I had, like, self-esteem that was non-existent. I just moved to go, let me just enjoy my life more. Let me have things in my day that made me laugh, things in that day that may be smile or made me feel shocked with surprise. Do that because that, I promise you, whatever activity you find that makes you feel like that, I can nearly always guarantee it's gonna be healthy for you, okay? So just have more fun because often people are struggling. They then take on a lifestyle change that's quite difficult and that causes even more struggle. And yes, it maybe brings some health benefits but you're finding it really challenging and boring and difficult. Start with the fun, okay? If you're having loads of fun already, good for you. Then maybe take on some of the more difficult things but start with fun.

Dr Louise Newson: Love it. Thank you so much. It's been brilliant. Thanks.

Dr Hussain Al-Zubaidi: Thank you.