The Dr Louise Newson Podcast - 155 - Weight loss, diabetes and menopause with Dr Clare Bailey and Dr Michael Mosley

Episode Date: June 7, 2022

Dr Clare Bailey is a GP and health columnist with extensive experience in helping people lose weight and improve their health. Dr Michael Mosley is a science presenter, journalist and executive television producer. Together, they have authored several bestselling books on weight loss, diet and diabetes and created the popular 5:2 and fast 800 diets. In this episode, the guests describe the evidence showing the positive effects of incorporating principles such as the Mediterranean style diet and time-restricted eating into your lifestyle and how the fast 800 diet can dramatically improve your health outcomes, particularly in reversing type 2 diabetes. The ‘metabolic car crash’ of poor sleep, low hormones, poor diet and weight gain for women during the perimenopause and menopause are also discussed. Clare and Michel’s top tips: Enjoy olive oil. You don’t have to be stingy with it – it’s good for you! Eat oily fish – remember SMASH: Sardines, Mackerel, Anchovies, Salmon, Herring. Avoid snacks (especially in the evenings) or if you have to, reach for a few nuts. For more information on Clare and Michael’s diet books and the fast 800 diet, visit thefast800.com Follow Clare’s recipes on Instagram @drclarebailey

Hello, I'm Dr Louise Newsome and welcome to my podcast. I'm a GP and menopause specialist and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-Bron-Avon. I'm also the founder of the Menopause charity and the menopause support app called Balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based, information and advice about both the perimenopause and the menopause. So today on the podcast, I have two people with me in the studio, which is doubly exciting. So I have two people that I hold in very high respect actually as well. So I'm actually a bit nervous here. So I've got in front of me

Michael Mosley, who I have known and respected for many years and his good wife, Claire, who works very closely with him. I think a lot of people maybe, and I didn't till recently, quite how closely she works and helps. So thank you ever so much for joining me today. Pleasure. Great to be here. Oh, thank you. So I don't know whether you both know, but if I wasn't doing menopause, which takes up 100 plus percent of my time, I would actually be doing something in nutrition because it's one of the, well, one of the many things actually that we're not taught at medical school that would be very useful to know. And I don't know about you both, but I certainly didn't know what I do now about nutrition and I thought fats were bad. I went to medical school in the 80s, so there was

lots about do not eat fat and how wrong we were really. So things have changed, but there's so much confusion, isn't there, out there? And it's really worrying for everyone, but obviously I particularly worry about menopausal and perimenopausal women who are often really, really struggling with their diet because of the metabolic changes that occur. And then they find that this overwhelming information that often isn't right is very scary. So you've done some great work. But before we talk about all the work you're doing now, can I just unpick a bit and just find out how you got into what you're doing now? Sure. So Claire and I also graduated from medical school in the mid-80s. And in fact, we met at medical school in 1980, which would be

42 years ago. Quite a few years ago, yeah. So was that beginning of medical school? school. Yes, very early on. In fact, on the first day, we're at Royal Free, and it was about 50, 50 male and female, and we're about 100 of us in the year, and the Dean said that statistically four people in the room who had never met each other would marry. And so there you go. Yeah, because I met my husband in Freshers Week, actually, in the 80s, so not realizing that I would still be with him many years later. So that was kind of when we met and rather like you, neither of us were taught anything or frankly was that interested in nutrition and I think probably the precipitating event in a funny way in both our lives was in 2012 when I got diagnosed with type

two diabetes and my GP understandably said let's start you on medication and I said I'm not sure I want to go to that road because my dad had had diabetes around this image and had then died of complications, things like heart failure and also early signs of cognitive decline at the age of 74, which is pretty young. So I thought this is not good. And that's when I made a Horizon program with myself as a subject called Eat, Fast, Live Longer. Yeah, it was amazing program. I remember sending Claire an email from the States where I'd been talking to some of the academics there. And I said, I think this is going to be huge. That was kind of when, if you like, I invented, the 5-2 diet, but I was also fascinated by the link between diabetes and weight, which people

were not talking about. And so, yeah, I sent Claire an email saying this is going to be huge. And I think it has been, isn't it? It has been. And it's amazing. And it's amazing. So let's just spend a second talking about diabetes, because there might be people who don't know, I speak to a lot of people who have hypos, they feel a bit lightheaded, and they say, I want to be tested for diabetes. and we know that diabetes is raised sugar, isn't it?

If you're untreated, you're going to have raised. But there's type 1 and type 2. So do you mind just explaining the difference to people? I'm sure. In fact, there are lots of other variants, including, you know, linked to pregnancy. But the primary ones are type 1, type 2, type 1 tends to be more what used to be known as a sort of young person's disease, as a genetic element, although type 2, which is more closely, linked with central obesity is also seen in younger and younger people. In fact, I was talking to a

pediatrician recently who said she'd seen it in a four-year-old because we have increasingly obese kids. And what is very clear now is that type 2 diabetes, which is like 90 to 95% of all cases of diabetes in the UK, is primarily caused by too much fat around the tummy, visceral fat, goes into your liver, goes into your pancreas, clogs them up. And conversational, losing that fat through a rapid weight loss diet, which has been pioneered largely by Professor Roy Taylor up in Newcastle, has been shown to rapidly reverse that. And in my case, I lost about nine kilos in eight weeks. So that's... Because that's very rapid, isn't it?

It is. And my blood sugar went back to normal where they have stayed ever since. Though Claire has been obviously keeping an eye on me, just make sure I stay on the diet. Your sweet tooth to contend with. Yeah, so I don't think either Claire I had the slightest clue. really about the fact that type of two diabetes could be reverse put in permission or indeed I would have said been that interested in nutrition but Claire got very engaged after that and with her patients as a GP yes I mean it was at a time when we just said eat less and move more and that went on for years and years and years and it wasn't until I saw what happened

with Michael that I realized quite how powerful the impact could be but it's still you know I've been working with patients eight years. And initially, the really, people just thought every person who managed to get their blood sugars down, reverse their diabetes, was an exception. Yes. But eventually, I think over the last five years, it's now become very much pushing at an open door. People get it. They know much more about it. They are much better informed, I think, about diet and the impact it can have. And I'm going to say there's a very clear link with the menopause in the sense that as women go through the menopause, it doubles their risk of developing metabolic syndrome, which is a combination of the large waste, high blood pressure, high blood sugars, as you know,

and high blood fats. Whereas type two diabetes is relatively rarer in women before the menopause, it becomes increasingly common. And that seems to be largely to do with the fact that as women go through the menopause, there are greater risk of laying down visceral fat. The fat shifts, if you like, towards the abdominal. area and that's the high risk fat. Yeah and it's so interesting, isn't it? Because a lot of women, myself included actually, when I was perimenenopausal, I'd look down on my waist and I'd be driving a car and think, oh gosh, where's that come from? And this sort of midline change is often

because the body needs estrogen, doesn't it? So the fat cells produce not really a nice type of estrogen eustrone that can be quite pro-inflammatory, but it's all it's got. And then, as you quite rightly say, Michael, the metabolic change is occurring not only increase our risk of type 2 diabetes, but also cardiovascular disease, dementia, osteoporosis, and even clinical depression are thought to be inflammatory diseases now. So it's really crucial that we not just wait until we've got type 2 diabetes and then look at our weight, but it's trying to reduce metabolic syndrome and everything else as well. And certainly one of the first line treatments for type 2 diabetes is lifestyle. And I don't know about you both, but I've certainly had patients in front

for me, diagnosed a type two diabetes. And it's really difficult in a 10-minute consultation as a GP to talk to them about how they need to stop smoking, that they've smoked for the last 30 years, how they've got to reduce their alcohol, but more importantly, to really change their diet. And in three months, it's not much time for a lot of people when they've had 20 years of eating, you know, takeaways and goodness knows what? So what's your advice? How do you start? Because it's the hardest thing is starting a change, isn't it? I think in terms of starting a change, it's asking people what difference it's going to make to them.

How are their life change? How would they see it in three months' time? Really, the kind of issue is how much of a difference it can make to how they feel, to their mental health. And it's often recommended to tell people that they're going to be doing it and making those changes. But it's with rapid weight loss, It's incredibly rewarding for people because they see the change very quickly.

They feel better. Their mood improves. And it becomes a sort of self-fulfilling thing. You know, for most people, it sounds making, you know, dietary changes. It sounds challenging, putting people on a sort of lower calorie diet. But when they see the impact, it really does, you know, motivate them. We have written a number of books together, including the Fast 800 and, We have a website called The Fast 800.com.

So if you go there, then you can get some pretty detailed information. Because I think success with any weight loss regime is largely about the planning. It's about the understanding as well. Why am I doing this? What are the benefits? What are the pitfalls? And really getting to grips with it before you begin, rather than sort of dashing madly into some crazy diet.

So it's about getting everyone else on board, you know, your family on board, your partners, your friends. So they're going to support you because these can be quite. tough. And in the books, we detail a lot of the scientific research as well, so you kind of know that there's something behind it. But it is about things like, as Claire saying, why are you doing it, listing the reasons, having good, compelling reasons for wanting to do it, and also, as I said, recruiting as many friends and neighbours or whatever to take part, clearing the junk out of the cupboards, and then getting, if you like, almost a bit of practice in doing some recipes, some menus,

some stuff like that. And the thing distresses me is there are so many clinical trials that have been done over recent years. Oxford University has done a number, as has Roy Taylor up in Manchester, I'm so up in Newcastle. And they've all consistently shown that compared to standard advice, a sort of rapid weight loss, lowish carb, med train-style diet, always scores better. And indeed, the Oxford Group recently put the NHS weight loss app to the test. where they randomly allocated people to either following that advice or just, you know, carrying on as normal. And at the end of eight weeks, there was no difference between the two groups,

no significant difference at all. Using the app had made no difference. And when you look at it, I've looked at the menus on it. I can understand why. Because they are low in protein, low in fat. They seem to have a lot of sort of not what I would call terribly good quality carbs in it. And so it's kind of weird. They spent a lot of money doing this thing, but not evaluating it.

And so it's down to the Oxford group to evaluate it. So what a missed opportunity then, actually, isn't it? For a lot of people. So you said low fat. A lot of people might think, well, how can you lose weight if you eat fat? So can you explain what that is? And also what the Mediterranean diet is, because as much as we all want to live in the Mediterranean, we can't. So just can you talk us through both of those?

Because that would be really interesting. I mean, you know, the last 40 years we've all been kind of told to spritz olive oil, you know, even not eat eggs. And it's, you know, a generation has grown up on that. And people find it, you know, terrifying that, you know, they buy some decent olive oil and they're scared that they're going to have a heart attack. By the time they've finished the bottle, you know, there's so much myths out there. I mean, for example, with olive oil, we know it has anti-inflammatory properties.

It reduces certain cancers, lots and lots of benefits. And it makes food taste fantastic. It makes huge difference. In terms of the Mediterranean diet, it's, you know, very much bringing in fatty fish, nuts seeds, pulses. And it's very much about whole food. And dairy, bring back in dairy as long as it's not highly processed and hasn't got a lot of, a lot of the dairy we've been eating has all sorts of thickeners and sweetness in it.

And it's going back to eating real food. Some Spanish researchers put together an index. and you can score yourself. So, for example, you get one point if your primary fat is olive oil. You also get points if you eat at least three portions of legumes, that's beans and things like that, a week. The same is true of oily fish. Again, three times a week seems to be a good number, whole grains. They also, you get a point if you eat at least two portions of fruit and veg a day. And things like sitting at the kitchen table or the dining room table, if you see, down to eat at least three times a week, you get a point for that, and you get a point if you

eat sugary, junky, you know, cakes and biscuits less than three times a week. So that's how they kind of score it. You get a score out of 14. And using that index, they're then able to, you know, do all sorts of trials. So, for example, we know that with perimenopausal and menopausal women, those who score highly on the index have much better bones, better strength, less weight, risk of heart disease, lower risk of breast cancer, lower risk of cognitive decline. So you can kind of score yourself. And if you're seven and above, you're doing pretty well. Similarly, with depression, there's been some wonderful research out of Australia, the Food and Mood Center there showing that people who score well on the Medtrainian diet are around half as great

risk of developing depression and anxiety as those who eat more sort of junk food diet. So we're beginning to understand as well just how fundamental food is for your brain as well as your body. And the first proper trials of this were not done until 2017, which makes you kind of weak. It's shocking, isn't it really? It really is shocking because I think we've spent the last, I don't know, 20, 30 years using food as a comfort and the food, the way it's advertised, the way how easy it is, it can have short, fixed comfort, maybe eating a Mars bar or a bag of chips or whatever, but it's not going to help longer term. And it's not until you change your diet or eat healthy,

you realize how good you can feel. But it's quite hard for a lot of people I completely understand. And so it's interesting about what we eat and certainly what you're saying is very clear. And I always think about what we ate in the 70s growing up. We didn't have any fancy foreign stuff. My granddad used to say it's not even foreign. It's sort of packaged stuff, isn't it?

If you know what it is you eat, we just used to eat plain meat and two veg really when I grew up and full fat milk and it all fight over the cream at the top, really, and butter we didn't have. So all these low-fat labelled foods are actually not the things we should be reaching for, are they? No. And as I said, there are other things which have come in since the 70s like garlic, which I'm a fan of yogurt. I think I probably had my first yoghurt when I was about 13.

Plain yogurt again seems to be a necessary ingredient of Mediterranean diet. Yeah, so important. Yeah, my mother used to have a yogurt maker actually. in the 70s and we hated it. I have one in the cupboard, or rather we have one in the cupboard. Yeah, I use one now, but we used to just hate it. We used to put so much sugar in it and then it was all right. But actually, that was still probably better than having a sort of low fat fruit yogurt or whatever. So it's interesting how things are changed. Obviously, olive oil was something I don't think we ever had in our cupboard in the 70s, 80s, or 90s probably. So there are things that

are changing, which is great. But the other thing you mentioned at the beginning was the 5-2 diet, which some people might not have heard, you know, the sort of all the time restriction. Do you mind talking with about that? So the 5-2 diet essentially is a rapid weight loss diet. And about 40,000 to 50,000 people have so far signed up at the website fast 800.com and done it. And we've had the data analysed from that and average weight loss for just under 10 kilos at a year. So we're in one-year data because obviously you can lose stuff in the short term, but it's kind of how do you do in the long-term. and we're also very interested there in looking at the health benefits. So, for example, with the people who came in and were classified as pre-diabetic or type 2 diabetic,

around half of them were able to come off medication and are now in remission. And as long as they keep the weight off, they should be well. So these are significant improvements. I'd love to, and we haven't looked at it, try and break it down in terms of menopausal benefits as well, because we haven't looked at that. But certainly anecdotally, really good for snoring. I used to snore like crazy. But essentially, you start off with rapid weight loss,

around 800 to 1,000 calories a day, mainly sort of low-ish-carb, mid-rain-style diet, and then you graduate doing it two or three times a week and then as a way of life. And I think the main thing is that the French have a saying that hunger is the best source. So if in the initial stage when you're down 800 to 1,000 calories, you're going to be a bit hungry.

And it generally passes pretty quickly. but if you're learning to enjoy these foods while you are hungry, then this will translate to later. And even if you hate vegetables now, you will discover you love vegetables when you've been eating them on a low-calorie diet. I think one of the other things that is very often people go into ketosis and that's healthy nutritional ketosis. And with that, people often find that they actually have grace of clarity

and they don't feel so hungry. So I very often had patients saying, you know, I'm just amazed that I'm not feeling hungry all the time. Because one of the problems is when people have metabolic syndrome and they're not getting the feedback, telling them that they're full after meals. And it's not that they're greedy. It's the hormones are out of kilter. And once you start losing the weight and eating better, people find actually they're not constantly craving. And that makes a huge difference to them. And you also sleep better, obviously, once you begin to lose weight.

And clearly, again, perimenopausal, menopausal, its sleep is going dreadfully badly. That's why I went on, duevay on, duvet off. Yeah, and we know that poor sleep is associated with all these inflammatory diseases, don't we? And so, you know, poor sleep, low hormones, poor diet, obesity. It is a real metabolic car crash, actually, for people. And it's looking at what we can change. and what we can't. None of us can reverse our age, but we can reverse our biological age by being more anti-inflammatory. And as you say, Claire, quite rightly, taking HRT, especially

with body identical hormones, does reduce that inflammation, reduce risk of all these diseases. But diet is absolutely key whether people take HRT or not. We all have to eat, we all have to sleep, and we can make a few choices, certainly about eating. But a lot of feedback I get from from friends actually as well as patients about your diets and all the recipes is that they're just so easy and I know that's thanks to you mainly Claire isn't it? Yes, well we have a system now of testing and retesting and making sure as much as possible that the ingredients are accessible, they're easy, they're tasty because if you're going to be doing a diet you don't want to spend ages cooking and having around.

You want something, I'm busy, I'm impatient, I want to have easy, tasty food that doesn't take long to prepare. And they're not expensive either because I think that's really important. No, absolutely. Yes, we've kind of broken down the cost of it. And it works out at less than what the average Britain spends on a diet because, firstly, you're obviously eating less, but also the ingredients are all incredibly accessible. And things like fish, which forms quite a big basis of it. It doesn't have to be fresh, although that's nice. It can be frozen.

a lot of things like legumes, beans are very cheap. Olive oral, extra virginie is more expensive, but to be honest, you're not going to be gathering gallons of the stuff. So a part of it is just making it incredibly doable. So if you have the ingredients, tinned food, it's fresh, it's incredibly fresh when it's tinned, it's healthy. As Michael said, filling freezer, frozen prawns, frozen spinach, just make like easy for yourself,

and then you're more likely to stick to it. And the other thing is that because you can start with, say, this is a sort of 8 or 900 calorie a day dish. But you can, if other members of your family, you can just add more stuff, you pile on the potatoes for the price or whatever it might be. And you also can even squeeze in a few desserts. Not a bad thing, is it? It is important because, I mean, I don't eat meat and my children do, so I'm always cooking twice. I've just always done it. But to have meals that you can chop and change and add, And also you can vary so you can make double and then you've got two or three meals, you know, because everyone's busy. And I think people forget, actually, I quite enjoy cooking because it's a time that I can't have my phone on because I can't chop and use my phone. I use it. It's quite a meditative process, actually. And so even if someone said to me, look, I can deliver food for you every day that's fresh, I think I would turn it down because I quite like the ritualistic behaviour. I don't like going food shopping, but I have food.

delivered. It's so easy, isn't it, three supermarkets? And actually, that way, I used to go shopping when I was hungry, and then I'd always buy the wrong food. So ordering it online, like you say, and I think that's really clear, Michael, that we have to clear out our cupboards, you know. I know, when I was a student, I just used to have cups of tea and biscuits all the time when I was hungry. And, you know, if you don't have biscuits in your cupboards, it's more of an effort, isn't it, to go and buy them? Absolutely, and you need perhaps some walnuts or some almonds or something like that. Small handful of nuts I find satisfying other sort of snack things, Claire.

A bit of cheese. Yes. That's surprisingly filling and you don't need very much. I'm a big fan of herbal teas again, kind of, you know, quite often when you think you're hungry, you're just a bit bored or you're a bit thirsty or something like that. So you have a cup of herbal tea and the craving for something in your mouth, if you like, goes away and that's sufficient. It doesn't have to be a chocolate bar. Fortunately, we live at least a mile away from the nearest shop. So if I'm really desperate, I know I'm going to have to cycle down the hill, cycle up the hill again.

The crazy is often passed by the time that's passed. And then with time restricted eating, so the 5-2 is great for the more rapid weight loss, as you say, and the 800 calories. But what about sort of trying to get all the time you eat into a shorter time in the 24-hour period? Absolutely. So as part of the Fast 800 program, we also recommend you have a go at time-restricted eating. and I first came across this in 2012. It's the brainchild of a professor at the Salk Institute, Professor Panda. And sometimes people call it 12, 12, 14, 10, 16, 8.

But essentially all it means is you try to stop eating earlier in the evening and delay your breakfast by a bit. So, for example, if you were to stop eating at 8 o'clock at night and then not eat again until 8 o'clock the next morning, that would be 12. hours of time restricted eating. And I chat regularly with Professor Panda. He reckons probably 1410 is optimal. He also thinks the best benefits or the most benefits come from stopping eating earlier in the evening. So he actually stops eating about 6pm and doesn't eat again until 8 a.m. That's 1410. And that's the protocol for much of his research. But there are multiple reasons why this is beneficial, not least of which is that having that late night snack is often the undoing of a lot of people, you know, a bit of this, bit of that, I might have a biscuit, I might do that,

and you suddenly, you know, knocked back 400 calories without even think yet. And you're doing it at a time of day or other night, which is biologically not good, because you are sticking food in your face at a time when your body is trying to close down for the night. And that also seems to be the circadian rhythm seems to be important. There was a study which he told me about where they looked at women with breast cancer recurrence risk, and they found that those who were eating late at night, they had a greater risk of breast cancer recurrence. Interesting, isn't it?

And again, I wonder how much is related to this inflammation, but also about there is something about resting the pancreas, isn't it? You know, the pancreas shouldn't be churning out insulin all the time, and there's more spikes, isn't there, with certain types of food? Absolutely. Also, you want to rest your gut, because your gut takes a tremendous pounding. And I sometimes compare it to like a motorway. You can't repair the motorway if you've got to,

got the traffic churning down it. But you're absolutely right. Constantly just getting the big blood sugar spikes will ultimately lead you probably to prediabetes and ultimately perhaps to diabetes. So once upon the time you're referring to the 70s, you know, kids would basically go out and play and they didn't have snacks all the time. Now, the eating opportunities are so much greater. The people just eat all the time. And it's incredibly frustrating. There's so much confusing information out there about diets. So, you know, still people are being recommended to eat three meals and then to snack in between, you know, around 11 in the afternoon and then before they go to bed.

And that's six, you know, they're never, it's never recovering. And you're always in a pool of rising sugar. Yeah, which obviously the trick is, really, I think, is to eat food that once you eat and enjoy it, you're not thinking about it till your next. meal. Satiating. And that's when you need particularly the protein and some healthy fats, because then you don't feel hungry. Well, that's exactly right, isn't it? And I mean, I get migraines. So if I don't eat, it will always trigger a migraine or if I eat the wrong things. You know, if I ate a marsbar and a packet of crisp now, I can guarantee I'll get

a migraine later. So it's great for me, because I know I can't eat those foods. But for other people, it's not so easy. But actually, if you think about what it's doing to your body, that you say to your gut, to your pancreas, to your future health, then it is worth. There should be more sort of health warnings, I think, on some of these foods. I was on the train coming back from London yesterday, and there was a really healthy looking lady. The train was going up to Edinburgh. She had all her hiking stuff.

She sat down, she was just in front of me, and then she had her diet Pepsi. And it was a big packet of crisps that even said larger, something on it, and have bought sandwich. And I thought, oh, that's a shame. She's lovely and young. She looks really fit. And she's getting away with it now. but maybe, you know, like, no disrespect, Michael, you know, time catches up, doesn't it?

It has. Well, caught up. No, it's got caught. Absolutely. And unfortunately, we can't blame our metabolism because we all say, oh, it's because of my metabolism is slowing down. There's actually very little evidence that between the ages of 16 and 65, your metabolism genuinely slows down. What happens if you become less active, and unfortunately, you eat a lot of more junk. And tragically, because I recently made a series for Channel 4 on this. Apps and things like that are make it so much easier to just order up junk food. And we know that on average when you get a takeaway,

you consume twice as many calories as when you cook it yourself. So that's something bearing in mind when you order up the next pizza. And I do think that it's basically the industrialized junk food, which is largely responsible for the fact that we Brits are the second fattest in Europe after Malta. Maltese blame it on fiction. and chips, which they say they've got on us. And I think we are the fifth fattest in the world, highest rates of obesity. And we love our, you know, takeaways and our junk food. That's something

you kind of have to battle with. And like you, we're huge fans of cooking stuff yourself. And yeah, I'm fortunate that I have somebody sitting right beside me here who is just lovely at kind of conjuring up different. I have to use recipe books. Claire just invent stuff. Yeah, which is a great, but I think we can all learn. And I think, yeah, ending on that very awful statistic, thinking about how fat we are as a nation and how individually we can all make a difference, but not just to ourselves, I think, to our friends and our relatives and our family and anyone that we can cook for and preach to a bit. All these things have a little effect. So I'm really hoping the podcast today has just made people stop and think about little ways that

they can change. So just before we end, I'd really like three take-home tips. I don't know how you're going to do two and one maybe about just easy ways. People are going to be feeling a bit overwhelmed and but maybe guilty because their diet won't be as good as we've been talking. So what three things would be good for them to make a start to continue in a way they want to go? I'm not sure whether this is the sort of tip you're looking for, but what I would say is enjoy olive oil. It makes food taste fantastic. It keeps you full. It's anti-inflammatory.

Don't spritzy oil to lug it. Great. That's a great number one tip. I'm oily fish. I never was a fan of fish, but there's so much good evidence for the benefits of, they call it smash. So that salmon, mackerel, anchovies. I can't remember what the other ones are, but herring. So essentially the oily fish, lots of recipes. Claire also has an Instagram account where you can follow her recipes, but lots of wonderful things you can do with fish. And fish is more sustainable. It has a lower, invariable. It has a lower, environmental impact on meat as well. So if you're not a vegetarian, yeah, oily fish, pile it on. Great. And number three, I don't know who's going to do that.

Number three, what would we say? I think one thing is probably don't snack. That really does help make a difference. If you're eating Mediterranean style, you won't need to snack anyway. Or if you do snack, go for, you know, nuts, almonds and things like that. Yeah, and so don't... I think it's hard not a snack, I have to say. No, that's really hard.

But don't snack at night time in the evening. I think is a really key message from what you're saying. So if we are going to snack, just preload ourselves, do it in the day. So I'm so grateful for your time. It's been really energetic, lovely podcast and lots of nuggets of really useful information. So thanks so much for your time today. It's been great. Thank you.

Thank you. For more information about the perimenopause and menopause, please visit my website, balance, hyphen, menopause.com, or you can download the free balance app, which is available to download from the App Store or from Google Play.