Dr Louise Newson [00.00.00] So for World Menopause Month in October I’m going to be coming to three theatres. The 5^th of October in Glasgow with Kaye Adams, the 12^th of October in Birmingham with Liz Earle and the 19^th of October in Kingston near London with Emma Barnett. I’m going to be doing a Q&A. So these women will be questioning me, asking me about my background, my work and also about hormones. And the second half will be audience asking questions. So there’ll be lots of opportunity to put your questions across. You can ask me anything of course and I really look forward to meeting some of you there.

Dr Louise Newson [00.00.40] So, today, my podcast guest is Dr Tash Mirando. She's a UK trained GP, but she now works in Singapore. We talk a lot about preventing diseases. We talk about the foundation, which is really lifestyle. We talk about ageing. Is it a disease or not? What we can do to be healthy as we age, and talking about health span versus lifespan, it's a really great conversation with lots of really good practical tips as well. So, I hope you enjoy it. So Tash, it's great you're over here. Last time I saw you, in fact, was over here in London, and before that, I was over in Singapore. Like, it's just amazing, because you're an NHS GP, very, very, very part time over in the UK, aren't you, but you mainly workout Singapore. But you're really interested in me about keeping people healthy.

Dr Tash Mirando [00.01.39] I am. Thanks, Louise, thanks. It's really nice to actually be here in person doing this, because the first one we ran was, was virtual……

Dr Louise Newson [00.01.46] And I'd never met you then.

Dr Tash Mirando [00.01.47] No, we hadn't…

Dr Louise Newson [00.01.48] No, and now I feel like I'm really close to you. We WhatsApp each other a lot, but lots of people think it's really weird when I talk about wanting to prevent disease rather than treat disease. And I know you're the same as me, but I'm very reflective, and I think about when I trained as a doctor, I learned, and we learned a lot about diseases and how to treat them, and obviously that's really important, but the older I've got, the more I'm trying to prevent disease in people. I say people, rather than patients,because they won't be patients if we reduce diseases. And it's so important,isn't it?

Dr Tash Mirando [00.02.25] Couldn't agree more, to be honest, we really need to start moving away from the sick care model. I really don't want to be looking after sick people. I want to look after well people and get them optimised and feeling better. Yeah, because that means I know for my own longevity that I can keep going a lot longer, doing what I love doing, just getting people feeling well and optimised,which is great.

Dr Louise Newson [00.02.53] It's so important. I mean, I'm very fortunate,like lot of people know who my mother is because she's been on the podcast. But mentally, she's really good, and physically, she's not bad. And I've always been really inspired just expecting other people to be like that when I was younger and watching her. But then as a GP, and I know you've done the same.You go to nursing homes, residential homes, care homes, sheltered homes, and it's usually women who are sitting there staring into space. And I've always been petrified thinking I don't want to turn into that woman. I want to be the womanlike my mother. And there are so many ways that we could probably reduce that some of it is genetics, and we can't really change our chromosomes, but we can change our genetic makeup by what we do and how we eat, how we exercise, what we put into our bodies. We're not really thinking about this so much.Sometimes, as doctors, we're not thinking about the end game, are we? And I think we have to be to save healthcare systems, not just in the UK, but globally as well.

Dr Tash Mirando [00.03.52] Yeah, we have to think of it at a population level as well, at this point in time. So I'm a lifestyle medicine physician as well, and for me, that's a non-negotiable right, because lifestyle is what we are in control of, and the way we do things in a sustainable way means we keep going for as long as we keep going. So, the term longevity, we're trying to move away from that, because it seemed to be used in different ways and forms.So part of the healthy longevity medicine society. And I've just come back from Copenhagen, which was very lucky to be a part of the Ageing Research and Drugs Development Conference. And really what we're looking at is, how do we make this just like lifestyle medicine is a specialised arm within medicine. How do we get general science/general medicine, so the science of ageing and how we do it, but it's also about living that best quality of life. So, it's not about lifespan, which is the age we live until, it's about health span, which is the age we are healthy until. Right now, that gap between the two is about 10 years.

Dr Louise Newson [00.05.00] Especially for women, it's worse for women,isn't it? So, I often say to people, it's not the age we die, it's the journey to that age, and that's completely what health span is about, isn't it? And I was reading a paper last night written in the late 1970's about ageing, and it was a philosophical paper about is ageing a disease or not, and I can argue it both ways. Actually, I don't know what your thoughts are about ageing being a disease?

Dr Tash Mirando [00.05.29] And that's a tough one, because as soon as you start labelling something that is inevitable, ageing is inevitable, however,doesn't mean you have to get older right? I'll take a solid 85 and be happy on a teddy squat and be done, right? But do you really want to be diseased and not be able to have that quality of life? So, I think that's a tricky one.

Dr Louise Newson [00.05.54] It's hard.

Dr Tash Mirando [00.05.55] It is really hard, and that's something you know probably need hours to debate over.

Dr Louise Newson [00.05.59] And the whole definition of disease in itself,and I often play mind games, you know, is menopause a disease or not? Is being in labor and being pain in pain when you're in childbirth? Is that a disease or not? And of course, people will have different opinions, but I think with ageing,it's something that you say we can't avoid, but we can reduce the negative impact on our bodies. And I think that's what's really important, isn't it?

Dr Tash Mirando [00.06.26] And that is, and again, this is where I'll go back to that lifestyle piece, because I, when I explain it to my patients, I say, think of it as a pyramid. Yeah, that foundation, that's your lifestyle piece. You solidify that foundation with no cracks in it, which means that everything we do to optimise on top of that actually makes sense and it works.It's very hard to treat and supplement someone who hasn't really optimised that foundation. So prioritising sleep nutrition, especially protein and fibre strength training, we had a little strength competition before coming here today, and then that, in turn, means your mental health should be so much better you get that social connectedness in because we were also talking about group classes and attending classes and meeting different people, especially if you are moving countries, living in different places, and then also avoiding those risky substances. So, these are things that, yes, may sound easy, but that behavior change is really hard.

Dr Louise Newson [00.07.35] Yeah, it is really difficult, and especially when people are busy, and especially as it's so easy to not do that, to not eat healthily, to not exercise frequently, to not think about our sleep. And you know, you're one of the few doctors that actually practices what they preach. I hope you don't mind me saying that.

Dr Tash Mirando [00.07.53] Oh thank you! It's taken me a while. I'm using my own journey. Yeah, I see what works and I don't want to go back.

Dr Louise Newson [00.08.01] No. So when did you really change?

Dr Tash Mirando [00.08.03] I'm gonna say sort of pre covid, I mean fit and healthy you know, with a lot of sport, but it's different to really being optimised and feeling that difference, especially with competitive sport, and also being able to keep up with, you know teenagers.

Dr Louise Newson [00.08.21] Well your tennis, tennis is your main……

Dr Tash Mirando [00.08.23] Tennis is my main because that's what I sort of hold there in the middle. And what I do is around that to make sure I'm strong enough I've got that endurance so my muscle mass, my strength, my endurance and my recovery after because at the end of the day, I don't want to be playing a three hour tennis match at 2pm which is what usually happens in Singapore for the matches, and then have to spend the rest of the weekend playing catch up. So, it's about, how do I what do I need to do for me as an individual? And this is where precision medicine comes into play, because it is very individual. And it's, how do you create that environment for you in a way that is sustainable in the long term.

Dr Louise Newson [00.09.01] Sustainable is really, really important.Because, you know, my lifestyle has changed a lot, and I feel very strongly that I can't practice and preach something differently. I can't be saying to patients, come on. You need to exercise. If I never exercise, it just doesn't work. But you know, nobody feels worse if they eat better. No one feels worse if they exercise. But I was having this, this discussion with my daughter,actually, last night, because, like I said to you earlier, she took me to an exercise class last night in London, and it was quite hard, and I think most of the people in the class were between like 20 and 25 so I was definitely more than double average age in the class…

Dr Tash Mirando [00.09.44] It’s what’s on the inside Louise…

Dr Louise Newson [00.09.45] Well it is. And I thought, oh, my God, I've really I got a show. I've got a show, and I but it was great, and I really enjoyed it. But then she was saying, oh, let's go to a spin class next now, I can't, like I used to cycle a lot, but it often triggers migraine for me if I do a really high intensity workout. So, I said, Sophie, I'll do other classes.But I just really careful. I have to make sure my head's completely clear, and I've just come out of having a three-day migraine, so the minute, I'm still a bit careful, but it's very, very individualised. Whereas other people, like my husband can go for a cycle and he won't have had anything to eat, he'll be absolutely fine and really go for it. And I think that's where, like, we've got privilege of knowing our patients and knowing what works for them, and also to just do it in stages. Because if, if people heard like the weights that you lift and the exercise you do, they would be so intimidated they probably would do nothing. Bu you are so wonderful the way you educate and bring your patients on their journey.

Dr Louise Newson [00.10.45] Thank you. That for me is what I really enjoy.And I know, okay, I am a family physician. I'm a GP and I think that's the beauty of yes, is you can have somebody sit in your consult room for two years,on and off, and then one day, show up and go, I think I've finally heard what you've said. I'm ready, and then you're ready to go. And that's the beauty of it, is building those relationships and also working through the changes that can happen. There’s no one size fits all. Things change. Similar with perimenopause and all the hormonal shifts and changes, we can get it right, and then six months later, it's off again. And then we've got to tweak and change. And this is where it's more of an art than a science as well. And getting to know the patient sat in front of you makes such a big difference.

Dr Louise Newson [00.11.34] Absolutely. And I think it is really important when we think about hormones, because I've had patients who are really sporty, really fit, and then they say to me, gosh, my stamina is reduced. My post recovery is taking a lot longer. I just feel absolutely exhausted doing very little training. What's going on? And then you realise they've got no testosterone and, or they're not eating enough protein. You know, there's lots of things. And I think as general physicians, we're not just looking at one thing, we're looking at everything. And that's sometimes missed in medicine,isn't it?

Dr Tash Mirando [00.12.07] It is, and it's also assuming that it's one thing or another. Absolutely. I have patients where they've been stable on their hormone therapy for years, and then present one day going, I think my hormones off. Yes, that they're going, hold on. It doesn't quite make sense.And then you dig and you dig and you dig. I'm a bit of a dog with a bone, and it's finding, you know, thyroiditis, Yeah, hold on. Let's manage this. Because I could very easily just throw more and more hormones at this person, at my patient. It's not going to change anything, yeah. But it's finding that underlying and this is where, yes, the buzzwords at the moment, it's menopause,it's hormone therapy, it's longevity, but at the end of the day, it's about your overall health and wellbeing, and how get on top of that with your health screening, ruling things out, finding you know, knowing what your biomarkers are, is there inflammation? Are you pre diabetic? So, you know, non-diabetic,hyperglycemia, what's your fasted insulin like? These are things and then looking at cardiovascular risk. And we have so many extra parameters we can utilise now, but it's tailoring it to that person, rather than just doing again every test under the sun.

Dr Louise Newson [00.13.24] It's really important. You know, I've got a patient at the moment who's, um, perimenopausal, so it's always difficult to get there, and she's had a lot of mental health issues, so it's been really scary for her, but really difficult to get the right dose. And recently, after about five months, I think I've just got there, but she's still been not right,but then her iron, her ferritin level, is really low, and she's tried iron supplements, and she can't tolerate them at all. But she's also got endometriosis,and so often when people have active anything that's inflammatory, but especially endometriosis, their iron will be falsely raised. So, her low iron is probably even lower. So, I'm trying to get her an iron infusion at the minute, and there's so much push back because it's not quite at the level. It's like two higher than it could be for the guidelines of the iron and anyway,they've just finally agreed to do it. And I'm, I'm just thinking, I don't think her mental health and her physical health will be optimised without I can give all the hormones I like, but she just needs iron, and she eats meat and, you know, so but again, it's looking at everything. So, when people say, don't do blood tests, well, actually, we don't just do hormone blood tests. We look at everything.

Dr Tash Mirando [00.14.33] Exactly – it’s an overview.

Dr Louise Newson [00.14.34] Yeah, it's so important

Dr Tash Mirando [00.14.36] You mentioned iron. I mean iron, vitamin D,these are…..

Dr Louise Newson [00.14.38] Oh really crucial fixes.

Dr Tash Mirando [00.14.40] Right, looking at B complexes. Why not? First thing is, do no harm. It's shared decision making, it's education, it's conversation, and it's monitoring. And yes, in Singapore, I'm in a very privileged position to be in private practice where I can do all of that,compared to NHS work where, you know, it's a lot more demanding, and trying to stay on top of 30/40 patients you're seeing every day is not always easy, but again, it's how do you just keep that relationship? Sort of keep building on those relationships and trust? That education piece.

Dr Louise Newson [00.15.18] But I look back at some of my patients in general practice, and I know I gave them a disservice, because I wasn't thinking long term. I wasn't thinking how to prevent their next urinary tract infection. For example, I was very reactive. I was do I need to dipstick? Do I need to send it for urine culture? Do I need to give them antibiotics? Do I give them three days or seven days? Do I need to give them prophylaxis? But I didn't think about, why were they getting the infection? Why is this 62-year-old lady coming for the third time with a urinary tract infection? I didn't even ask if she had any vaginal dryness or soreness. Didn't even ask when her period stopped. And of course, if I'd given her some vaginal hormones, I probably would have never seen her again in the clinic. But I didn't think, and I think that's the problem. Often, it's very knee jerk, whereas when you've got time,and I think that's when you say, your privilege working in private practice, my privilege, I think, and I think you'll agree as well, is that we've got time.So yes, you've got access, probably to more tests, but you've actually got time to work with your patients, which is….

Dr Tash Mirando [00.16.20] And that for me, is a privilege.

Dr Louise Newson [00.16.22] It is, isn't it?

Dr Tash Mirando [00.16.23] It's having an hour for a patient, a new patient, yeah, just sit back and listen. I spend most of my time listening.

Dr Louise Newson [00.16.29] But you get to really understand what the howto prioritise, how to work with them, how they can work with you and every patient is really different.

Dr Tash Mirando [00.16.41] And every patient is really different at different stages of making decisions as well. I have some women who come in going, yep, I'm ready. Let's go. And I'm like, oh, okay, hold on a second. We still need to make sure you're not up to date with your screening. Let's get all of that done. And there are things we need to work on, but it's, it's that those building blocks, right? As I said, you can't really out exercise poor nutrition. And if you're not sleeping enough, yeah, it's very hard to then be able to function and do what you need to do. It's like wading through treacle rather than just walking outside.

Dr Louise Newson [00.17.12] And it's interesting because you gave the most amazing presentation and in March at our conference that we did, and it was about lifestyle medicine for healthcare professionals, wasn't it? And lots of people came up to me afterwards and they said, wow, like, this is incredible.And I was like, obviously, it was the most amazing talk. But actually, a lot of it was stuff that I've known for ages.

Dr Tash Mirando [00.17.33] It's nothing new right

Dr Louise Newson [00.17.35] I’ve known for ages, but it actually, when I was looking at the audience and seeing people's responses, I thought, gosh,people don't know like basics, because in medical school, we're not taught basics about nutrition and exercise, are we? And then if, if you're not personally interested, or you've not read, you can see that, you know, you think that a ready-made sauce is going to be fine. You think that your low-fat yogurt is going to be healthy, because no one's like told you the obvious,people don't understand the gut microbiome and how that has affected our mental health. And it makes you realise actually, that it's not just people and our patients we need to educate, but other healthcare professionals. Because this is very basic, like, it's not sexy medicine, it's not, it's not cutting people open and, but it is. I love the way you say it's the foundation. It's foundation and, and I think, like sometimes with my work, people think all I do is prescribe hormones, and it's like, hang on. Do you not think that hormones restart? We know work better if you've got less inflammation in your body, if you've got that foundation. But also, you know, if someone had diabetes, they had raised blood pressure, they had any condition, or they were really fit, and well, that that sort of foundation has got to be there, hasn't it?

Dr Tash Mirando [00.18.51] It does. And this is where actually different people at different stages and that behavior change. And as doctors, I'm going to say we're natural health coaches, right. And yes, there are extra sort of exams, etc. You can do in a lot of learning, but it's part and parcel of what we do is we are coaching our patients through their own health journey. And okay, on the NHS, you have to switch every seven to eight minutes. Private practice you've got more time, but it's still, it's, how do you actually tailor something? You know, I'll have one patient go, right? I'm ready tell me everything I need to do. I'm going to do it. And you know that you can actually come up with a plan, and we do written plans, and we follow through on it, and others where, if I give them more than one thing, it's not going to happen, and they're going to come back a few weeks later, not having done that, and feeling even worse for wear, because you're going to feel that guilt of, oh, I only had one thing to do, and I couldn't do it, but it's, how do you, in a stepwise approach, build it and then when you get it right, boy, is it satisfying.

Dr Louise Newson [00.19.57] Yeah, yeah.

Dr Tash Mirando [00.19.59] Because you're going through the journey with your patient, which is great fun.

Dr Louise Newson [00.20.01] But do you think we're making progress?

Dr Tash Mirando [00.20.02] Yes

Dr Louise Newson [00.20.02] Do you think?

Dr Tash Mirando [00.20.03] I have to say we are. I know, I know, I know. You know, for me, I want to make sure that the glass is always half full. Right.And this is part of all the education work we do, the writing. You know, with the Healthy Longevity Medicine Society, we've got a women's health and hormone therapy group that we're writing about how hormone therapy needs to be utilised moving forward, and there are so many papers, so much research out there,putting it together and basing it on the twelve hallmarks of aging, thinking about how it can be a gerotherapeutic, a geroprotector. So how do we protect ourselves as we age is key, right? And it's from an education point of view.It's also giving all our colleagues the right information. And yes, different,you know, different doctors will practice at different levels, because we all have different interests, but it's, how do you get everyone thinking in a way of going, right, how do I get the person sat in front of me feeling as good as possible? Because you've got, I mean, it's going for gold when it comes to quality of life.

Dr Louise Newson [00.21.12] Yeah, and I think I was with my daughter last night, and she's 21 and her generation, and lots of them, don't drink nearly as much as when I was 21, they're not smoking the same way, but she's buying avocados, she's got pomegranate. She's thinking about her food in ways that I certainly didn't think about when I was 21 and I think, wow, she she's learned it herself, really, because there's only so much you can tell your children.And you know she's watching that, but also she knows she feels better when she eats better. And that's, I think that's the most magical thing, if you learn that as an individual, because you'll carry it with you. But when we think about preventing diseases, it we always know about, like you say, those foundations, but when we're talking about hormones, that's still being forgotten. And, you know, people have this accelerated ageing when they become menopausal, and we've known it for many especially when you look at the data,like Walter Rocca’s data, when women who have a surgical menopause at a young age, so women in their 30s have their ovaries removed, their hormone levels decline overnight, and then they have this increased risk of diseases. And we know sort of metabolically, there's increased inflammation, there's worsening of very basic biological processes, because these hormones are biologically active, and that's been forgotten, but we've known about it for decades. So,this isn't new science.

Dr Tash Mirando [00.22.39] No, I think it's also just historically what's been done and the way it's been done, and comparing now to then, I think we need to move on from the Women's Health Initiative.

Dr Louise Newson [00.22.51] Of course we do

Dr Tash Mirando [00.22.51] We need to move on, and we need to go right.What do we have access to now? We've got modern hormone therapy. We've got transdermal estrogen, right? We've got micronized progesterone, we've got testosterone. So how do we utilise modern…I'm going to keep saying this modern hormone therapy, yeah, for the person sat in front and there's no one size fits all, but we need to start thinking about that prevention piece and the precision medicine piece, tailoring it to that person. And where we can do this at a population level is, again, that foundation of lifestyle medicine, plus the education work that goes with it. So, each and every person has choice. And you were talking about your daughter and how she is eating and exercising, and I'm seeing that so much more because we do a lot of work in adolescent health as well, and from a sports and performance point of view, with access to social media, AI platforms and lots more conversations taking place adolescents,teenagers have a lot more information than I ever did for sure, right? And they're utilising that because they're seeing the benefits. They want to be optimised. They want to feel well. So even when I talk to families, it's going right - what you do as a parent, if your teenagers, tweens see you eating in a certain way, doing things in a certain way that's their normal, which means when they're going through exams or life stresses or whatever happens, they're not reaching for ultra processed food. They're reaching for good whole food,predominantly plant based, prioritising things that really make them feel better because they know the impact and that behavior change then is their normal. So, you're not having to force it later on in life, which is what we've had to go through.

Dr Louise Newson [00.24.53] Yeah. It's so important. I think, you know,accepting things, normalising conversations, normalising behaviors, is so important with our patients, but it's, it's just a shame that it's sort of been lost and, and even thinking about the health preventative or the disease preventive effects of hormones, I was reading, there's a conference that was in the 1970s the 1974 it was a big conference, and it was, it was about healthy ageing and the role of hormones, and they've really well written notes. I had to get the book from the Royal Society of Medicine because it's impossible to get online. And anyway, it was talking about the disease preventative effects for osteoporosis, for heart disease, for cognitive decline, Alzheimer's, dementia,and probably cancers for hormones and these this was really pivotal, because before that time, in 1941 as you know, Professor Albright announced about the osteoporosis and the bone strengthening of effects of hormones and people were like, a bit, not sure, but this was really, like, actually, guys, hormones can reduce disease, and then it sort of seems to have been lost again. And it's such a shame.

Dr Tash Mirando [00.26.13] And we need to bring that back. Yeah. And part of the work that's happening

Dr Louise Newson [00.26.17] Absolutely….

Dr Tash Mirando [00.26.18] Is to bring that back. And also remembering that 50% of the world's doctors are primary care physicians, or thereabouts,and it's about things written in a logical way.

And with the science that we have, and there's so much research, as I said, the first paper we wrote, we had to actually cut down, and then we had to cut down in the number of references as well. But there's so much science…

Dr Louise Newson [00.26.44] So much basic science as well, which is really important and and the thing is, I think, you know, often I feel very sad because menopause is denigrated to that symptoms, and there's all this discussion is, how bad are your hot flushes, or how many night sweats do you have? How many times you have broken sleep? Whereas, actually, as a physician who wants to prevent disease, we need to be thinking about, right? Why do we give HRT and the British National Formula, namely the BNF, which is our sort of Bible, if you like, our go to is very clear that there are two license indications for estradiol, for example, the patches. One is for treatment of menopausal symptoms, so actually not perimenopause, and we do give it like perimenopause, but just to add it's fine to give drugs out of license, but the second indication is for prevention of osteoporosis. And so, when we'rethinking about this discussion about what symptoms do you have, and if you've got it, living in different countries or different ethnicities, do you experience different symptoms? I think that's an interesting discussion, but the most important thing is thinking about the diseases that are affecting people. And so I'm sort of thinking about in Singapore, osteoporosis rates are really increasing, but we've got a treatment that's licensed for prevention of osteoporosis, yet most people in Singapore, but also in the UK and globally,are not being prescribed hormones for that reason are they?

Dr Tash Mirando [00.28.10] But that licensing is in the UK.

Dr Louise Newson [00.28.11] Yeah.

Dr Tash Mirando [00.28.13] So it's also looking at regional guidelines,because at the end of the day, it's going right - what does my regional society say, right? What does my local society say? And that's something that's really changing, because the Asia Pacific Menopause Society as well, looking at the federation guidelines, which have just been updated and then being utilised for the region in APAC, is huge, yeah, and having a lot more education events. So, there's going to be an event run by the Singapore Menopause Research Society next March, and just a lot more education work happening. And I think that's key,because it's getting the doctors on board.

Dr Louise Newson [00.28.57] Absolutely.

Dr Tash Mirando [00.28.58] t's getting the clinicians on board. It's also looking at the next generation, right? So medical school having conversations is part of the communication teaching that we do as well, and similar here,even with the British Society of Lifestyle Medicine, really looking at, how do we get lifestyle medicine taught at medical school as part of curriculum, as part of GP training. And I'm going to say everyone needs to have that, this is basic knowledge, and you can delve into it in more detail, but at least knowing so you can pick things up. But it's also the collaboration effort, right? It's working together. And I think the more we can work together within the specialties, within group practices, wherever in the world, you know, I love the fact that I can pick up the phone and call somebody in the US, or here, you know, the conversations we have then in Australia, it's just having that network. And it's not about fault, it's just going, right. Here's what I'm thinking. What do you think? Can I and how do I improve my practice?

Dr Louise Newson [00.30.11] And I think that is changing even over the last couple of years. You know, there's, there's a lot of us in lots of different countries that are really working, often behind the scenes together,and we're, you know, joining the dots that often haven't been there. We're realising that we're not working alone, and then it just helps our patients as well, because, you know, you never get something 100% right, and it's a journey with our patients, like you say. So, there's, there's loads that we're doing,there's loads more we can. And I think bringing these people that want to learn is part of that as well the people that don't want to learn, it doesn't matter.They can do other things. But there's some really keen people to be joined up in this space. So, so I'm very grateful for you being here Tash, but I just need to end for three take home tips. You know?

Dr Tash Mirando [00.30.57] Absolutely - I know, I knew it was coming.

Dr Louise Newson [00.31.00] What are the three things that you would say,if I was coming to you as a patient, said, you know what? I don't exercise. I know I don't eat well, like, what are the three things that I should do that's going to help my future health span?

Dr Tash Mirando [00.31.13] It's choose one thing start somewhere, right?And that could be nutrition for one person. It could be, I'm going to have one drink less when I go out. But one thing has a hugely beneficial ripple effect.And then it's, it's, it's once you pop, you can't stop, right? So, you you do one thing, and you go, oh, actually, I feel I've slept better. Let me try this next thing. And it's working with that clinician who you know can guide you on that. Secondly, ageing is inevitable. However, what can you do to optimise your quality of life? And that's going to be different for different people. And I don't you know, expect everyone to be lifting really, really heavy weights. If you've never done it, please don't just go to a gym and start trying to deadlift and squat and do pull ups. Start somewhere. Start with some home exercises. Start with a wall sit for 30 seconds whilst your kettle is boiling.Yeah, you know, these are things that it just keeps building up. And also, I really want not just women. I want people to advocate for themselves, right? We need to push for up-to-date guidelines and to stay on top of that and think of a guideline as a guideline, right? Look at the latest research, look at the latest evidence, and collaborate. Have conversations, because we as clinicians need to make sure that our patients are getting the best care available to them, and we can't do that alone.

Dr Louise Newson [00.32.48] Yeah, I really like that. So, it's not just patients being advocates, it's doctors being advocates for their patients.Great way to end. Thank you so much.

Dr Tash Mirando [00.32.55] Thanks Louise -thanks for having me again.

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