The Dr Louise Newson Podcast - 120 - You are what you eat, with the Healthy Eating Doctor

Episode Date: October 12, 2021

Healthy Eating Doctor, Dr Harriet Holme, joins Dr Louise Newson on the podcast couch this week to discuss the importance of nutrition for reducing long term risk of disease and improving your future health. Before becoming a registered nutritionist, Harriet worked for ten years as a doctor before her interest grew in the link between what we eat and our health. She is passionate about sharing evidence-based knowledge to help people understand more about their own diets and health, and offers nutritional consultancy as well as lecturing on culinary science and nutrition.   Harriet’s four key ingredients for eating in the peri/menopause: Calcium is key, try and get it from your diet as much as possible. Balance your diet with a wide variety of wholegrains (brown bread and brown pasta, for example) fermented food (such as kimchi or kefir), lots of fruit and vegetables, and avoid sweeteners and fizzy drinks. Top up your omega 3 by eating 2 portions of oily fish a week. And last but not least, vitamin D. Take this one as a supplement especially in autumn and winter in the UK. If you’re vegan, also take a B12 supplement, but otherwise it’s always best to get nutrients from your diet rather than relying on supplements.   Listen to Harriet on her own podcast, ‘Eating for Health’ or visit her website: healthyeatingdr.com   Find Harriet on social media at: Facebook = @healthyeatingdrcom Twitter = @healthyeatingdr Instagram = @healtheatingdr

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsome, a GP and menopause specialist, and I'm also the founder of the Menopause charity. In addition, I run the Newsome Health Menopause and Well-Being clinic here in Stratford-upon-Avon. So today with me I have Harriet Home, who is a registered nutritionist and used to work as a doctor. and I've just recently met her virtually in this weird world that we live in. But it's a real joy to have you today on my podcast. So thanks for agreeing to come, Harriet. Oh no, thank you so much.

It's a real pleasure to be here. So I just really wanted to confess, actually, that I've thought a lot about what would I do if I wasn't a menopause specialist and sort of dedicate my life when it seems to be thinking about hormones and the menopause. And I actually would be doing something about nutrition because it's so important and we'll talk about why. But when I think back about my training, I had obviously a really good, robust, solid undergraduate

and postgraduate training that I'm very grateful for and I learned a lot about various diseases and management of them. But I had no formal menopause training, but I also had no formal nutrition training. And every person, adult, child, men, female that I see, that everyone sees as clinicians, has to eat. We don't have a choice about that. but we do have a choice about what we eat.

And we also, I really strongly feel as healthcare professionals, we have a real power actually to help change what our patient's choices are regarding food. So I'm really interested to hear, because you've got chelial medical background, you would have had medical training. I'd really like to hear whether you had a different experience to me. Did you have any formal training, not just in nutrition, but in the menopause as well? So my training in the menopause world is extremely. extremely limited. Just think that it's a huge area of unmet need for medical students.

I'm much the same for nutrition. I did have quite a lot of lectures in sort of the biochemistry and probably the sort of metabolism because I went to Cambridge University and did medicine there. We shared a lot of our lectures with the natural scientists. So we did a lot of the biochemistry and physiology and a lot of that in really great detail. But certainly from a sort of practical level, learning about diet, learning about how important diet is for long-term health. We had very little training and I think that that was a huge area of unmet need. I know that there are other people out there now. So, for example, Rupy, the doctor's kitchen has set up the culinary medicine to try to get nutrition, really talk to medical students

and to GPs so that they can be going out there and really spreading the message about how important diet is. And as you say, it's one of those things that you really can control for yourself. You really can control what your long-term risk of cardiovascular disease and cancer and diabetes is by what you put in your body and you can choose to do that or not. And I think it's really empowering to be able to share evidence-based nutrition knowledge to help people really reduce their long-term risk of disease. And that's really what I'm passionate about, that sort of evidence-based nutrition and how it impacts on long-term health, not really from the sort of Cosmesis side, but more about that, you know, how important it is for health. And I think probably from a lot of my training in the

NHS, and I think probably the way it's funded and the way it's structured. And I think probably you may well find the same in the menopause that it's very difficult to actually put money in the root of the problem a lot of the time and in prevention because there's not much money, there's limited money and there's limited resources. And so it ends up, you know, fighting fires. And if your fire's not burning now, it just doesn't get the attention or the resources it needs. So it gets put, you know, extinguish those fires. Yeah. It's absolutely right. And I think also I've thought about us a lot, actually, and certainly when you're very busy in clinical practice, but any role, really, in the NHS, there's so many demands and you're very reactive and you just deal with a crisis and then you

move to another crisis and everything else. But actually, I've had the real luxury of having a portfolio career. So every day has been very different. So I've had quite a lot of time over the last 25 years of really being very reflective in the way that I work. So when I used to work as a GP, in the evening when I came from work, I had no time, no space in my brain to think or reflect about anything. My brain was dead because I gave so much of myself to my patients, and it is very mentally very demanding. But when you're writing an article and you're unpicking the evidence

and you're sitting with the luxury of being at home on your computer, writing some evidence-based training program or an article, you can't just take things from face value, can you? You have to reflect. You have to think. You have to work out what the source is, what the trial was, what was going on. And it's really good to have this analytical sort of tool. And then everything that you read, whether it's about medicals or nutrition or any disease,

you always go back to the basis. You go back to the basic pathophysiology. What's caused it? One of the risk factors. And then it's about disease prevention is really important because we're living so long. And I think also there's so much information now about. nutrition. There's so many fads as well out there. And it's really quite confusing because there's one extreme we know that obesity rates are escalating and so high. But then there's also people,

we see a lot of women who have had eating disorders, but we also see people who are telling themselves, they have to be vegan, they have to be gluten-free, and they have to be this, but they're not taking any sorts of supplements. They're not worrying that, you know, their blood count will be low, they have low iron, they'll be feeling tired. And then, you know, we see people with migraines, for example. But then you talk to them and they're having coffee, they're having chocolate, they're doing intermittent fasting because they think that's good, but then that's sort of their headaches are triggered.

And it's really difficult, isn't it, to know how to get the right information. Just as a mum of three children, how do I feed my children? It's quite hard, isn't it? No, I agree entirely. And I think there's an awful lot of noise around nutrition. I think part of that isn't helped by social media. in fact that anyone can sort of give nutrition advice. I'm a registered nutritionist and that means that I'm registered with the Association for Nutrition.

I think that's a really important distinction that not many people are aware of that anybody can be a nutritionist with zero training. But registered nutritionist is a protected title whereas nutritionist isn't. So if you're getting your information from a nutrition coach or a nutritionist, I think you need to be really quite wary that they've got the appropriate qualifications and they're giving you actually correct advice. And there are an awful lot of headlines such, I know there's a big myth going around in Australia at the moment, things like bone broth is better than breast milk. It's really, you know, shocking things like the celery juice fad as well. And I think so really trying to find that evidence-based nutrition is really important. And I find that from my training, certainly as a doctor, so after

medical school, I was a doctor for over 10 years and then did a PhD on the genetics of bone cancer, that it was only really during that time, actually during my PhD, that I really became able to understand a peer-reviewed publication and really what the science was. And although I had been an academic clinical fellow and I'd done research before that, it was only really doing the research and preparation for it that I understood the differences between animal models and cellular models and when you'd used them and how that science translated into medicine. So, you know, my career in medicine and medical schools spanned you to probably 20 years. And it's only through that experience that has enabled me to really be able to read those scientific papers and understand then how

the nutrition, the science and the medicine and the health all all integrate. And I think that that's not a usual skill set. It's quite an unusual skill set. And that really understanding the pathophysiology of something is actually really important in how we can prevent disease and prevent health issues in the future is really important. It's really hard and I also get very frustrated. There's a lot of talk obviously for medications and pharma being influenced and I'm sure hopefully all of you listening know that I do no paid work with any pharmaceutical company. But actually you're big. So when you think about drugs such as statins or the lower cholesterol or think about blood pressure lowering tablets, a lot of pharma, you know, in some ways quite rightly do fund some

trials because the NHS can't afford every trial, but there is the bias for that, what you obviously have to be prepared for. And people are aware of that, actually, with the drug industry, but actually with food industry, it's a massive market and it scares me more than a farmer actually. I don't know what your thoughts are about that. I agree, because I think it's very unregulated. The pharmaceutical industry is a very, very regulated industry. And there's safety profiles for drugs, the regulation, and the reporting afterwards, all of that is extremely, regulated and so it should be. But actually the supplement industry and the food industry are not. And there are all sorts of claimed supplements that are on really quite dodgy ground, I think,

a lot of the time. There's very little supportive evidence. And I think that generally, you know, the sort of people at their most vulnerable are targeted. And a lot of the time, that's just great marketing that actually, I don't think it's the right way forward. I personally think that we should be getting our nutrients from diet where possible and avoiding supplements that you just don't need. Absolutely. I expect someone to email me earlier this morning about a new company that set up some menopause supplements and they could be 3D engraved with your name or something. I don't even know what that means. You're right. Menopals and women are very vulnerable. They'll try anything I spoke to a lady this morning in my clinic who was really struggling to work because of our

brain fog and fatigue and she'd been trying a new supplement. And I think we have to be really careful, not just what the supplement is, but what it contains and what it's doing. And if the person needs it, there are some supplements, I think, like vitamin D that are really important. Some people choose other things. Magnesium can be very useful, but there are different types. It has to be considered with maybe vitamin Bs to help the absorption. It's a bit more complicated than just buying something off the shelf. But I think before anybody buys anything other than vitamin D, I would say, is looking at what nutrients are we getting from our diet. And also I think with the way some of the food industries are,

it's very corrupt actually out there. If you look at the big ones are the ones that are selling processed foods, that they're selling very cheap food, and the tax that they get is really important for our government. But this really is awful actually, because it's very easy to buy bad food, isn't it? I mean, it's very easy and it's everywhere. and I think that's a huge problem. But equally as a mum of two young children who works,

it's hard to cook fresh nutritious food every day. And that's not to be underestimated, the pace that we live in these days, you know, modern 24-hour society. I think it's a challenge, and I think we need to recognise that. And I also think for people on lower incomes, it's a real struggle.

Fresh fruit and veg are generally more expensive than fast food or a processed meal. And if you're a single mom or a single parent, and you're working all hours or you're trying to support your family, you can see why it's very attractive, you know, to pop a processed ready meal in the oven as opposed to, you know, starting from scratch. And I think that that's certainly a challenge of modern day life,

but it's having huge repercussions for society and with an ever-increasing obesity trend, that's going to be a substantial problem for society because we know that with obesity and, you know, increased risk of multiple other diseases, in type of diabetes, cardiobacid disease, cancer, are all linked with obesity. It is hard. I mean, I've got three children, and it's interesting also in that. So my oldest daughter's 18, so she's just left. She's going to study in London at the Royal Academy of Music.

And I feel very bad because she has migraines and I have migraines. So one of the bad things I've given her to be my genes is headaches and migraines, but they've been intractable. They've really crippled her life. And she's been on various treatments. and after about six months they're starting to really improve. But one of the things we've really looked at is her diet because I'm very obsessed about my diet because I also know that if I have processed food, if I have sugars, if I have caffeine, if I have alcohol, it will trigger my brain.

But I'm 51 and I can cope with making these changes. I also have to eat very routinely so I can't do a 5-2 diet because I'll get headaches. But she's 18. When I was 18, I could eat many bread for supper. that I could eat rubbish. And I did eat rubbish because I didn't know much about nutrition when I was 18. So she's gone off to university.

I went shopping last week for her. And we're putting things like chios seeds. We're putting things like oats. We're putting, you know, quinoa. We're putting all these things I never even heard of when I was 18. And, you know, I'm giving her recipe. She's just sent me a WhatsApp now. She's doing some pancakes she's made.

And she said, I've even added some child seeds and I've got some fresh herbs on it. And I'm thinking, goodness me, she's like my dream child. She does it because she knows if she goes and buys a McDonald's, she'll get a migraine. So it's actually, I think it's a very positive now with my brain because it makes me eat really well. As soon as you start to eat well, you feel amazing. You know, she's saying my skin's better, my weight's better,

my energy's better, my sleep's better. It sounds awful, but when you have something that's limiting, you do it, you have to do it. I don't want migraines because they're so awful. I'll do anything. But if I didn't have that, I would probably be thinking, So I'm really tired I just have a bit of chocolate. I just have a bit of toast or something, but I can't.

So it's hard, isn't it? It is hard, and I'm sorry to hear about your daughter, but it sounds like she's doing a fantastic job and you've given her those life skills. But I think it is hard, and that's partly because we're sort of evolutionary programmed to be that way, that when we're tired, you know, we're probably a bit more cortisol

that drives us to have those high fat, high sugar foods. And it generally is a lot quicker and easier to us to grab a biscuit or, you know, piece of toast or something carbohydrate-y than it is to go to your fridge and find some fruit and wash it. And it feels a lot more of a hassle doing that a lot of the time. And I think than just a quick biscuit. But certainly, you know, long term, you're much better off preparing your fruit when you buy it so that there's less of that inertia when you need that snack and try to snack on something other than there's processed food because we know they're not good for you.

Yeah, absolutely. And certainly, I don't know if you know Emma Ellis-Blint, who's nutritionist that works with us who used to be a chef as well. So she's been doing some Zoom classes with Jessica actually and making some sort of energy bars with lots of seeds and oats and nuts in that she can freeze. And then when she's hungry, she just gets it out. And it's very really efficient. And I think, gosh, I wish I was like that when I was 18.

That would have been amazing rather than having a white cheese sandwich for lunch because that was all that was in the canteen. So in some ways, you know, the world has sort of turned into sort of fast food and it's really readily available. but in other ways there are signs of change as well. So both my children had cows or protein allergy, so I gave up dairy while breastfeeding. And the difference between the first child,

the second child, the provision that was out there and, you know, everywhere's got, you know, oatly milk or their soil alternative now in all the cafes. Whereas I, you know, had to take a little thing of milk round the first time round. So I think that's great that the plant-based options are more available. You know, there is that sort of drive to sort of healthier eating in some ways.

And I think that is really great. And certainly, I think probably that your sort of daughter's generation are growing up, knowing much more and being much more informed, and that's great. I think there's two camps, isn't there? There's like my daughter, who's quite extreme, but then I says I'm quite extreme. And it is, like you say, readily, babe, but you can go to Tesco's, or same reason, buy some really healthy things.

But then there's the other camp that I didn't have in their 80s when I was her age, because there were green grocers everywhere. There were markets everywhere. There were the bushes. It was, Tescas were not big. It was quite small then. So you're just overwhelmed by jobs. giant-sized packets of crisps and ready-made food that we just didn't have before. So it's almost like,

I think, the two differences are more extreme than they used to be, which is a real concern, actually. They are. And also add to that, your smartphone, how, you know, a burger or whatever is only a few minutes away on your app, you know, I think that's, the temptation is always there. So yes, absolutely. It's more extreme in both directions. So I'm very interested in gut health, and I'm very interested in our gut microbes. And again, I knew nothing about that. I didn't even know we had bugs in our gut. I knew we had bugs in our mouth. But I didn't really think about it. No one taught me in medical school. And I think, I hope you agree, it's so important to feed these bugs and make them healthy. But can you just talk through a bit about what I'm talking about

and what it means and how we can help? So our gut health, as you say, is extremely important. And actually, it was the microbiota and the microbiome that sort of really got me interested in nutritional why I changed from medicine. So the microbiota are all of those bugs that live in your stomach, so the bacteria and viruses, and they are considered friendly. And they are really vital to health, and they play a role in all sorts of things from autoimmune disease and intolerance are how your body learns to recognize the difference between self and foreign, and even cancer and response to chemotherapy and drugs, and even your weight, are all really tied up with those gut bugs. And then when you sequence all the genetic material, that's called the

microbiome. And it's really only in the last sort of five is years that that sequencing has been available. And we're still really in our sort of infancy of understanding about it. Or if you sort of compare it with the sort of human genome, how we slowly did the first human genome. And then that was a huge milestone for genetics. It was extremely time consuming and costly. And now, so 20 years later, you can exome sequence someone pretty quickly and cheaply. And that because we've got thousands of thousands of thousands of thousands of those exome sequences and genome sequences, we can use those as a reference for normal and then understand much more about the sort of the function, the biology and all the sort of interplay of the genes and an environmental

interplay as well. And so it's really only now that as we build up a repository for microbiome sequencing that will be able to actually understand what differences in environment play, what difference is diet play, how has it formed? How can we modulate it? And there's still a huge amount left to understand. But as research continues, really only looks like it's more and more important the more we understand about it. So it's really fundamental for health. And what do you think about hormones of gut health? Because there's not a huge amount to research in it, but I'm sure they have an effect. Because hormones get everywhere, especially eustodial. I'm sure they do, but I don't think that anyone really knows enough about it. I don't think it's

been studied yet. I don't think we really know what normal is, let alone what, you know, the effects of hormones are, to be honest. I think we really need a greater bank of normal and then to see, you know, from all ages, all ethnicities and locations. I don't think we're able to see yet what a difference hormones would make, to be honest on it. I don't think we have enough information. No, and it's very interesting. So easteroid receptors, so the estrogen receptors are on every single cell in our body, including our bowels. And a lot of women actually come to see me and they've got obviously myriad of myrient, menopoles and symptoms, but they also complain of irritable bowel.

They've been diagnosed irritable bowel syndrome. They've had other tests, everything fine, great. And then I give them HRT because they've got other symptoms and health risks. And they say, gosh, it's so much easier to eat. It's really quite, and I'm sure it has a really important effect. And I've got health is so important just for the way that we function. Obviously, it can help improve mood. but there is some evidence as well that it can improve future health for gut health are

a good and lots of them in the right ones. Yeah, absolutely. And really that gut health has so many long-term effects, so cardiovascular disease, weight gains. So, for example, what you really want in a good, healthy microbiota is diversity, so lots of different species. And we think the way to get that is to eat a huge range of food, so not to be restricted, not to be cutting food groups out. And then eat lots of fruit and vegetables.

vegetables. So no limit to the amount of fruit and vegetables, really, whole grains as opposed to processed grains. So swap your white bread and white pasta for brown bread, brown pasta. Avoid sucrose and sweeteners, busy drinks because those impact gut health. And then fermented food, try to add in sourcrow, kimchi, kifir, all those fermented foods that have those bugs naturally in them to help repopulate your gut. Which is really important. But there are certain things that can really affect adversely. I've got how so, for example, antibiotics can be really bad, aren't they? They can. So antibiotics have obviously have a hugely important role to play in health, and the role of the drug obviously is to kill bacteria, and that's why we use them for infections.

But at the same time, the side effect of that is that they will kill off some of your gut bacteria. And also you have bacteria living on your skin, so that's why if you have antibiotics, you're more likely to get thrush just because those normal healthy bacteria that live happily there, they're killed off by the antibiotics. It means that the thrush can then dominate. There's more food available for it so it can thrive. And the same thing happens in your gut. So if you have antibiotics, the antibiotics can have quite a profound impact on your gut,

which is often why you can have diarrhea associated with antibiotics. And there's more and more evidence coming out about sort of long-term impact of some antibiotics. So for example, Cyprofoxysin has an impact for up to two years on your gut health. Two years. And that's after what sort of length of course. just a standard course of it provost. So this is an antibiotic that's often given for urine infections. Yeah, and also respiratory infections as well. So, and there's certainly there's evidence in

people with cystic fibrosis, for example, that the more antibiotics you have to treat the chest infections actually, because you're damaging that respiratory microbiota and the gut microbiota, that actually increases your risk of further invasive pathogens. So it actually increases your risk of chest infections. So it's a really difficult line, you know, obviously, need to treat the infection, but what about the future risk? And I think we really have a lot more research to be done to really understand how we can support that regrowth of that microbiota and how we can prevent then against future infections and return it to health after antibiotics. And in the same way that antibiotics, they do a fantastic role for infections, but more and more, bugs are becoming resistant

to them. So we really need to think about exactly when the indication, what are the risks of them, and when to prescribe them a bit more, I think. It's really important. So certainly for me, practically in menopause, there's lots of women who have recurrent urinary tract infections. And this is often because they have what we call genitia urinary syndrome with the menopause.

So associated with vaginal dryness, the tissue around the urethra, and the bladder supporting tissues becomes very thin. And the flora changes. So there's much more incidents of the current urinary tract infections. Best treatment is to treat the underlying cause with localised estrogen, but a lot of women have recurrential tract infections and are given antibiotics time and time and time again.

And this is a real concern. In fact, when my middle daughter was 12, she had sepsis. She had an infection in one of her joints and her hip, her sacriac joint. And so she had three months of really heavy-duty antibiotics. No one in hospital talked about any nutrition, actually. She had some horrible synthetic drinks. I obviously stayed or my husband stayed with her all the time she was in hospital for two weeks. and there was a vending machine which sold rubbish.

So one of our jobs was to bring in food, actually, and I'd make it for her, bring it in, sneak it in, felt a bit naughty, got some trouble a few times because she wasn't supposed to. And I'd make smoothies and things. But it's quite hard work doing that. And actually, no one switched me. And no one even suggests that she took any probiotics. And you can argue about probiotics.

I'm sure I'll be really interested in what you think about probiotics if someone's had antibiotics. Yeah, so I agree, actually. I think very little has changed in many regard, and that still, you know, I was in pediatrics until relatively recently, and there's very little discussion about actually how, you know, what you should be eating post-antibiotics and how you can improve your gut health. I think probiotics is actually a really interesting topic. So for me, there are very specific indications for probiotics where there have been clinical trials done, and they're normally very specific indications and outcomes and specific strains.

And I think that if you just buy a probiotic off the shelf, you don't know what strain it is unless you have a look and you don't know what study was done and what the research is. And certainly they're very strain specific that if the strain was studied to look at the sort of symptoms of irritable bowel syndrome, there's no point in taking it if you're looking for one to improve your mood, for example, you need the right strain. Otherwise there's not really evidence to support it. But there have been some really good quality evidence in a really high impact. journal called Cell that has shown that actually if you take a probiotic supplement after antibiotics,

that instead of replenishing those gut bugs, which I think most people thought it was doing, it might actually have a placeholder effect where it prevents regeneration. And so actually, that it might actually be doing you harm as opposed to helping. And I think that, again, we sort of come back to what we were talking about before about the supplement world, that I think most people think that because it's not a drug, there aren't any side effects. And I think it's really important to realize that supplements do have side effects as well. And a lot of them are promoted or, you know, when you sort of see the latest influencer drinking their probiotic or showing off, you know, I'm having my probiotic and my coffee now, that there are actually real risks with them. And that they really, I think, should be, you know, taken in the context of either, you know, someone who's trained and knows a bit more about them personally.

Absolutely. I totally agree because they come under the food supplement, don't they? So I could just make some here and just send it to you, couldn't I? Yeah, absolutely. And you could make some claims. You know, there are sort of regulation about the claims a bit, but, you know, you could get an influencer to promote it. And, you know, I mean, I get asked most weeks to have a quote behind or be a name behind some sort of menopal supplement.

I don't even see the emails anymore because everyone just knows that I'll say no. But there's a lot of money in that. And often they're packaged really beautifully. And it's the same actually for some of the supplements for menopause, people really get sucked into them. because they're desperate to improve and it's like they're desperate to feel better. And also maybe they think it's an easy way of not having to eat so healthy as well. I think that a lot of the time, I think it's an awful lot easier.

It sort of absolves some sort of guilt and responsibility. It's an awful lot easier just to pop your supplement in your probiotic. And then you think I'm doing great now. I don't need to bother actually eating well. But the best evidence for repopulating gut health post antibiotics is actually with something that's rather unpalatable. It's a fecal transplant. And yes, that is what it's a subject. it is. So that is taking some feces from either yourself, pre-antibiotics or from someone else,

popping that in your gut. So that's really the best way of doing it. Whether that will catch on, I'm not sure. I don't know how people sort of market that in quite the same way as a probiotic, but certainly for indications like C-diff, so that's a really nasty antibiotic associated colitis, inflammation of a gut. It's actually showing real promise. And I think there's sort of more research needs to be done and how we might be able to make that a bit more accessible to people in the future. Really interesting. And it's amazing.

There's so much to think about. And there's still a bit like menopause, so much uncertainty, so much more research that needs to be done. And I'm really grateful for your time today, how it's talked through everything. And I think the take-home message is just really think about everything that you eat and enjoy food is really important. And usually if it doesn't make you feel good, then it's not the right food for you. But certainly, doing more research then.

wouldn't it be wonderful if we could collaborate and do some research together, looking at perimenopause and menopause and gut health, it would really be very important. So thank you so much for your time. Before we finish, I just like always ask for three, take-home tips, but just three things that you think, a menopause or perimenopause a woman, could just do very easily that would improve,

not just their gut health, but their future health, by changing just three simple things to change the diet at the moment. Is that it possible? I might be cheek and ask for five. Oh, go on then. So calcium is your number one. Your calcium needs really increase in your perimenopausal. They go from sort of 700 milligrams to 1,200 milligrams.

So I would try to steer away from a calcium supplement, but try to get it from your diet instead. And, you know, that's things like dairy, tinned fish, are eating the bones and dried fruit, tofu. They're lots of different sources of calcium. And I think, you know, really calcium, really focus on that calcium for your long-term bone health as it's so important. And then I think just a sort of balanced diet. So eating lots of healthy food, eating those whole grains, the fruit and vegetables, because the fermented food, that will help not just your gut, it will help your bones, that vitamin K, the phosphorus,

the magnesium. They're all going to be in your diet if you're eating all of those different things and helping your gut health. So by having a healthy diet, you really are decreasing your long-term risk of disease. And we know how important that is, you know, in the menopause, the cardiovascular disease, the osteoporosis, dementia, all of those things. And then omega-3, you know,

have your two portions of oily fish a week or your plant-based sources. So that's, you know, nuts and seeds and things. But really, oily fish is probably the best place to get it. And then vitamin D. So I think, you know, supplements, most supplements really don't have a place. If you're vegan, you need to be,

B-12, but otherwise everyone should really be taking vitamin D. That's the NHS guidance. And it's just such an important vitamin. And if you live in the UK, you should really be taking it in the autumn and winter. So now's a great time to make sure you remember your vitamin D. Really good, really sensible advice. And actually quite cheap of price as well, which I'd really like, because it's all about trying to give the right advice to as many people as possible. So I really appreciate your time. It's been really good. And maybe we could invite you back to just do a bit well, talking because there's so much I want to ask you, but thanks for so much. It's been great. Oh, no, it's an absolute pleasure. Thanks so much. I'd love to come back.

For more information about the perimenopause and menopause, you can go to my website, menopausedoctor.com.uk, or you can download our free app called Balance, available through the App Store and Google Play.