The Dr Louise Newson Podcast - 157 - Science based weight reduction that lasts with Dr Saira Hameed

Episode Date: June 21, 2022

Dr Saira Hameed is a consultant endocrinologist working at the Imperial Weight Centre and at Imperial College London. Her work focusses on researching the drivers for appetite, obesity, and regulation of body weight to develop science-based interventions that help people manage their weight and lead healthier lives. In this episode the experts discuss the impact of obesity on individuals’ health, on the NHS and wider society, and the science behind sugar, fats, and processed foods. Dr Hameed’s book, ‘The Full Diet’, explains the weight loss programme that is used in the NHS by clinicians and patients and was developed and trialled at Imperial College. Saira’s 3 tips: Short term – do everything you can to remove ultra-processed foods from your environment Medium term – look at all the factors that contribute to your weight such as your stress levels, sleep, activity levels and seek to address those too Longer term – be your own biggest fan. Feeling good about yourself will have a positive ripple effect on other areas of your life. ‘The Full Diet’ book is available now and published by Michael Joseph. Find her on her social channels on Instagram https://www.instagram.com/drsairahameed/ and Facebook https://www.facebook.com/thefulldietbook 

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 with me in the podcast, I've got Saira Hamid, who I recently got to know, who has been doing some very important work for many years, and her work has become more

public since the publication of her book, which we will discuss. So before we start, do you mind just introducing yourself, really, and say what you do and how you've got to do what you do, if that's okay, Sire? Hi, Louise. Thank you for inviting me on. So of course, so I'm Dr. Saira Hamid. I'm a consultant endocrinologist, so that means I'm a hormone specialist. I work in two places. I work at the Imperial Weight Center, which is a nationally, in fact, internationally known center of excellence for weight management. So it's where people with some of the most important and complicated weight problems in the country will come for specialist and expert advice. And I also work at Imperial College London. And my background is in researching, the drivers for appetite and obesity and the regulation of bully weight and how we can come up with scientific evidence-based interventions to help people to manage their weight and lead healthier lives that feel good. So that's what I do. That's what gets me out of bed in the morning. And as you say, I've recently summarised all of this in my book. So thank you for having me on to

discuss all of this. So endocrinology is study of hormones. Now, how many hormones do we have in our body? There's lots, isn't that? That's such a good question. I mean, there's so many hormones. The thing I love about hormones is you're not based in a specific organ. What do I mean by that? I mean, cardiologists look after hearts and pulmonologists look after lungs and neurologist brains and so on. Hormones affect every single cell of the body. So you are looking at diverse systems, diverse processes. Hormones are like the body's text messages. So it's a way of the body communicating information from one part of the body to another to say either usually sort of start doing this or stop doing that. And the way that hormones kind of impact our everyday

lives is absolutely kind of viscerally felt. So everything from appetite to thirst to fertility to sleep, you know, you name it, hormones are involved. What's really fascinating, deeply rewarding about this profession is when your hormones aren't working, you really feel it. And so as an endocrinologist, bit of a detective working out. Firstly, you're working out, is this pathology? Is this an illness? When somebody comes and says, I'm, let's say, I'm tired. I'm tired so much of the time. Is this an illness or is it life? And that's part of the interest is sort of dissecting the two. And sometimes you find it's actually both of those things. So it's endlessly fascinating. Yeah. And it's so interesting because all our hormones work together, don't they? They don't just work in

isolation. And I think, you know, I've seen many women who have thyroid disorders and they often become worse during the perimenopause and menopause or type two diabetes and type one diabetes metabolic processes occur so that people find it harder to regulate their sugar when they have low hormone levels due to the perimenopause or menopause. And often people just look at or think about hormones in isolation, but our bodies are incredibly clever, aren't they? And they all work together. Yeah. So the body's really, really clever and it's really one dimensional to think about dysfunction or a problem in one part of the body or one hormone system acting in isolation. I mean, you know, as a physician, of course it doesn't work that way. And so the body is not only massively

interconnected, but it's also, I think the brilliance of it is it's really very resilient. So that if one thing isn't working too well, another thing, we'll do its very best to kick in and compensate, which is why sometimes we're not feeling well, there's something wrong, but we can try and and push on and push on and push on until really everything is just too much. And we're really poorly. But the flip side is that when we get treatment, our ability to heal and get better is also there. I always say to my patients that if you drop your phone and the screen cracks, that's it. No amount of brilliant engineering by Apple can suddenly miraculously repair that.

Whereas the body, given the right kind of conditions, will heal and get better. And so Tesla or Apple or NASA, they could never come up with something quite as clever and brilliant, which makes it endlessly rewarding being a doctor. I'm sure you agree. Absolutely, yeah. And why have you been interested? Because there's so many avenues of endocrinology, obviously. So what led you to be more interested in to weight

and the hormones associated with weight gain and weight reduction? I felt it was an area that wasn't perhaps well described as far as the public were concerned. So there is some fantastic science that goes on. And I had the privilege of doing a PhD at Imperial College. For three years, I was learning all about that science. You know, it was reading the journals. I was doing my own original research. It was really exciting.

And I was looking at how the body controls weight and appetite. Fantastic. And then I finished my PhD. I went back into clinical practice. And it surprised me that all of this fantastic science, hormones, endocrinology, was not routinely being shared with patients who were struggling with their weight. And I wondered why that was. And that became the sort of premise of my program.

I wondered if you can explain to people, kind of this is how you work. This is how your body gains weight. This is how you lose weight. This is why you're hungry. This is the psychology of why you eat when you're not hungry. Could that knowledge and the support lead to clinical benefit? Could it lead to weight loss and other? health improvements. And it does because I'm sure you find in your practice, people really want

to follow advice. You know, this idea of a non-compliant patient is not something we need to kind of consign to history. I know, you're absolutely right. I think, you know, the older maybe in the wiser I get, the more I realise that patients often have had a lot, and this is a generalisation, of course, but there's a lot of patients that have had a misservice because we've always been told, of course it's easy to lose weight, therefore don't listen to your patient when they tell you that they're not eating or, you know, a lot of patients who've got type two diabetes, you know, a lot of people think, oh, these aren't motivated people. They don't really want to feel better. And of course, they're going to carry on having poor lifestyle. Well, it's because they're not given the right

information or the right incentives or the right knowledge and tools. And I feel that you're absolutely right. No one goes to see a doctor unless they want help. But it's often it's giving them the right information and I think if it's not come from any reasoning then you will just take the path of least resistance with just that's what humans will do and I think this is so apparent isn't it with the food industry because a lot of people when they sit there and say I put on weight I'm not eating much they're actually not lying but then you ask them what they're eating and it's just completely wrong but they're eating it in good faith they're buying things saying low fat or you know the diabetic foods, for example, all this stuff and they just have no understanding because

no one sat down and told them. And they're also, kind of for me, against the tide, in terms of the food industry and the marketing messages and the fact that a lot, this food really plays on our pleasure and our reward. And we've also been, I would say, rather gone down the wrong path in terms of this obsessionality with calories. I always tell my patients, let's eat food, not calories because you can have two, you can have a Mars bar and avocado, they can have the same calorie content. We instinctively know they're going to have a completely different effect in the body in terms of metabolism, weight gain, pleasure centre, epigenetics, all that kind of thing. But this idea that I'm kind of eating to this calorie limit really has meant that we have

sacrificed kind of quality over this sort of arbitrary quantity that we're very faithfully recording in apps and notebooks and so on. It doesn't work and it just makes eating far too complicated. Yeah and there's even more isn't there about putting calories onto foods in menus and meals and restaurants and I really really worry about that because I think people will take the path of well they'll just take the easy option weren't they and they'll maybe have a pudding and miss out on some vegetables or something else and you're absolutely right Calorie is not a calorie despite what people try and say. But there's some horrific figures, aren't there, that have just recently come out

about obesity and overweight in the UK. It's just horrendous, isn't it? I know. I mean, we're really, we are not in a good place as a nation. I think the best way for your listeners to really visualize this is as follows. That if we have about 28% of the country living with obesity and then a further, third of us are living with overweight. And these are medically defined terms. These are to do with the BMI criteria. So now you've got roughly two-thirds of the population who have a weight issue

today in the UK, which means it's more normal in the UK today to live with a weight issue than to be living in a normal, healthy body weight. That has changed in a generation. So in the 1980s, when the figures were first compiled, about 7% of the country were living with obesity as per BMI criteria, 7%. And that's now quadrupled within a generation. And I don't know of any other illness that we can say that about across specialties. I don't know of any illness in any chronology. I don't know of any other illness across specialties that we can say this about. So something is going terribly wrong. And it's increasing, isn't it, more and more. It's not. It's slowing down. And it's horrific, actually, because the whole narrative as to whether obesity is a

disease or not can be argued either way. But if we look at one of the biggest risk factors for cancer, it's actually obesity, isn't it? And a lot of people just think about obesity associated with heart disease, which of course it is diabetes, of course, type two diabetes. It can be. But cancer is quite scary, isn't it? Because a lot of people don't realise that obesity is associated with other diseases. Yeah, so there are cancers which have very, very clear link with obesity. And you're right that mostly people think of obesity and then they'll think of type two diabetes or heart disease. But I always say when I give talks, you know, to many, many specialties, there is not a specialty in medicine that does not see the impact of obesity.

If you're a respiratory physician, you're looking after sleep apnea. Orthopaedics, rheumatology are looking after joints, that too much excess weight is going through those joints. The joints aren't working well. If you're a gastroenterologist, you'll be dealing with reflux and so on and so forth. So you can go through every specialty in medicine, and they are looking after people suffering with the consequences of excess weight. And of course, the system as a whole,

can't cope. We know the NHS is in a very difficult point in its history, post the pandemic. Pre-pandemic, we were spending 10% of the entire NHS budget on diabetes alone. So I'm not talking about now the sleep apnea and the cancer and the heart disease, just on diabetes. It's not sustainable. So we urgently need solutions that people can do and do for the long term. and understand, supported by the wider landscape. So that would be bold moves, bold measures from government, but also from other stakeholders, town planning, for example. But this has to be considered to be kind of societal problem high up,

maybe number one. Because if we want an NHS future and if we want a population who are healthy, who can work, who can live healthy, happy, happy lives like all of us would want, we need to tackle this. And we've been talking about the numbers and how they're not only not getting better, they're getting worse. And so I think we can conclude that what we've done up to this point hasn't worked. So we just need to stop and take a deep breath and say, okay, that didn't work before.

We're not going to blame the patients for that because I don't know of any other treatment in medicine where we blame the patients when it doesn't work. What can we do now? And what can we do in partnership with our patients? It's not about you and me sitting behind a desk and hectareing people and going on at them. We need to be in partnership. And to me, that means I have been very lucky on a taxpayer dollar to be put through medical school, put through my PhD. And I have so, so much knowledge, as to you, as to many of our colleagues.

And that needs to be democratised. People need to understand the body works, how their weight works, appetite, behaviour change. We need to hold their hand and we need to get those changes widen. It's so important. You know, it's interesting you're talking about obesity and I say the same things about menopause. So if menopause could be sorted and obesity could be sorted, I really wonder what the world would look like. And UK in particular, it would be very, very different. So obviously, I can't see every menopaus or woman. You can't see every obese person. And one of the ways of reaching people is through books and podcasts and, you know, apps, there's all sorts. But there's, there's all sorts. But there's, there's. an overwhelming amount of information for people about diet and nutrition and everything else. And so your book has come out and I saw it in our local Sainsbury's. We've got quite small Sainsbury's near me. It was there on the shelf. So I felt really proud actually to know you. But what is it about your book that would make people want to buy it compared to some of the other books?

Can you just summarize what it is in there and why it would be so important for people to consider either buying or getting from their local library? So I think the point you raise is really important that there is just so much information out there. What on earth do you listen to? And that's where my two jobs come into play. I think the first thing that should feel very reassuring about the program that I describe in my book is that it was developed in the NHS and that it's used in the NHS in our NHS Weight Loss Clinic and it is used by real NHS patients. Why I think that's important is one of the things I love about the NHS is that there is no commerciality, meaning you give your patients the advice based on your best knowledge and the best information you have

at the time. There is no other incentive to do otherwise. And therefore, the information that the patients are being given in this NHS program is just the very best evidence-based advice, gone through a lot of peer review and internal checks and balances, as people would expect in a program running the NHS. And I hope that feels different and reassuring. I think the second important point is that the programme was developed, researched and trialled through Imperial College London. So people I think have really heard of Imperial College, particularly in the pandemic when it's done a lot of work on COVID and modelling and so on. And I think why that's important, is that, and I know you say this a lot about the menopause, Louise, is we must only give advice

that can be backed up by the evidence. Not something I thought or I wonder if it's a good idea or, you know, I did this myself and now I feel really good, so maybe I'm going to advise all if you used to it. There has to be a published peer review evidence base, I think, in order for you to make a program or to give advice to patients, and that was done to the letter when this program was being developed. And of course, it's not just a buzzword to say evidence-based. If it's evidence-based, it's far more likely to work than if it's just something, you know,

I thought up one day and I wondered if I might have a go. And so I think those things, I hope, really reassure your list is that it's quite... Well, it is so important because I think no disrespect to your age, but I'm sure you remember, and I certainly remember time without the internet. And it was so much harder then to access information. And now it's easy, which is great, but it's a double-edged sword. And I think it's so easy, as you say, to put my own experience, you know. And we can all do that, can't we?

And I know when I had my first daughter, everyone was telling me how they put their child to sleep, how they winded them, how they fed them, how they're this, how that. And initially, I was taking every single bit of advice because I wanted to look after my baby as well as possible. And after a few days, it's just, no, forget. it. Actually, this feels right to me as a mother. This is how it is very intuitive, which is clearly not evidence-based, but it's very different bringing up a baby to something that needs evidence behind it. And I think this is so important because there are so many stories. And

also, you know, what you're trying to do is not just a quick weight loss and then carry on because we've all seen people who yo-yo with their weight. And what you're really keen, quite rightly to do is to maintain weight loss as well, isn't it? To have to have. have the best future outcomes. Yeah, I think that's right. I think the real challenge, which all my patients say to me, is maintenance. And I don't think it matters necessarily how you lose weight. You can even have weight loss surgery, but it's the maintenance that is the holy grail in this field. The pattern that we most commonly see is everything is going along nicely with your lifestyle change or after your weight loss operation. And you hit a bun. And you hit a bunch of

in the road in your personal life. You made redundant, get divorced, have a bereavement on a massive life event. And people who have not onboarded ways to navigate this in a practical sense in terms of eating and so on, but also have not learned ways to manage emotions that don't involve food are at very high risk weight regain. And ongoing support, ongoing dialogue is very important. I say to my patients who ease, and I'm not a pessimist at all. I am actually a passive optimist, but I say to them that weight is long-term chronic condition, even if you're at your target and even if you've been maintaining your target for years, that if you view every day as a work in progress, you'll do great.

I just can't afford to take our eye off the ball for any of us. It's really important. You always have a system, always thinking ahead, and then it will do. will do well. Yeah, which is so important. So tell me some of the sort of nuggets of information that people might not be aware of that are in your book, which is obviously packed with information and so well written. So that's so kind. And it really means a lot to hear that from you in particular. So what would I say? I'd say let's think about the what, what are you eating? And I think it's very important to have a good look at how much sugar you're eating. Now when I say that to my

patients, a lot of people say, I don't eat any sugar. I don't put sugar in my tea. I've given up having a biscuit mid-morning. Firstly, it's the hidden sugars. As you were saying, the ultra-process food, the hallmark of an ultra-process food is sugar. And sugar comes under many, many, many different names. So really important to be vigilant. But the second issue is that carbohydrate breaks down into our body, into sugar very, very quickly. So if you eat a couple pieces of toast for breakfast, you will get the equivalent of probably about sort of four or five teaspoons of sugar in your blood about an hour later because your body will break that carbohydrate down into sugar. And you then produce a hormone called insulin to clear the sugar from

your blood, a lot of the sugar will end up in fat storage. Unless you're planning to go for a run or be very active, the sugar has to go into storage. It can't just stay in your blood. So it's really important to consider that it's sugar that drives weight gain, and it can be obvious sugar, hidden sugar, or sugar sort of built up into a sort of carbohydrate like bread, rice, potatoes, pasta and so on. The flip side is, if you choose to reduce your consumption of those and eat other foods, great, delicious, natural whole foods, you'll lower your sugar level and you'll stop fat storing. Great, you lose weight. I think the other things to point out are that Fat does not make us fat. If we eat good natural fats, let's not make this sound like a biochemistry

lecture. Let's keep it simple. You know, fats that nature put on this planet for us, they won't make you fat. They'll just make your food taste delicious. They contain essential fatty acids. They're good for you. A lot of health benefits. The next thing is ultra-processed food. And you mentioned this. We sort of come back to it a few times in our conversation. It is devastating for help. Ultra-processed food, just so everyone listening, we're all on the same page, is really stuff that a home cook couldn't make themselves. So either the ingredients are not accessible because they're odd or production technique you just simply couldn't do in a domestic kitchen. And they are manufactured in such a way.

So they're very, very long life usually. Usually contain a lot of sugar. Usually contain a lot of weird ingredients. One of the reasons for the weird ingredients is often the food would taste awful unless you had a lot of colouring. and flavors and things to sort of make it not smell too bad and so on. So if you ever look at ingredients list and you think, I've got no idea what this stuff is. I've never cooked with this stuff.

And I wouldn't even know where to begin. How do I even pronounce this stuff? You just put that straight back on the shelf. If your brain doesn't understand about stuff, your body doesn't know what to do with it. So that's the food stuff. Then I ask my patients to think about the when, when are you eating?

And put sort of very plainly, the body was not designed to be eating, digesting, metabolising food for every waking moment of the day. That's just not the circadian rhythm. And so I advise people choose a period of time during the day when you eat and choose a period of time when you don't eat. Just keep it really simple. And people say, well, when should I start and when should I stop? And the thing is, I can't prescribe that.

You've got to know when am I most likely to be hungry. Some people say, I was never hungry for breakfast, but I was told it was the most important meal in the day. So I made myself eat it. No, no, no, no, listen to your body. If you're hungry by 11, 12, eat then. And then decide to stop eating by 7, 8. So maybe it's, you know, like a kind of 8 hour eating period, not eating for 8 hours, we're just eating during that period if you're hungry. What fits in with your schedule, your family, your work and so on. Only you can decide that. So the when is also important. Look after your gut bacteria, 100 trillion microbes that live in your gut. And when you keep them, well-fed with things like fiber, they will love you right back by keeping you full and helping with your blood sugar control, your weight control and so on. So really important to keep

them in mind. Sleep is very important. Sleep is very important to weight regulation, appetite regulation. Exercise. I don't really like the word exercise because for many people it fills them with a sort of slight sense of dread, but actually if you consider exercise just simply to be movement and to reframe it to think that humans were designed to move more. more than to be still, so that if you're moving every day in some way, and that can just mean gardening, taking the stairs, walking a few extra bus stops and so on, that will pay dividends. That's really super important. I think the other really big element of my program is the way you relate to yourself, the way you talk to yourself. None of these changes will last and none of

these changes will speak to you if you don't think you're worth it. Why should I look after myself? Why should I bother with myself? Everyone else, even the family pets more important. I try to change that in the book. I try to change those internal conversations, develop a way that you're kinder to yourself, more compassionate to yourself. And then I look at ways that can address emotion-driven eating or comfort eating, because why do we eat when we're not hungry? It's odd. We're not responding to, you know, biological hunger there, managing feelings with food super common. So why do we do that? And how can we stop doing that? So sorry, Louise, that was not at all succinct. That was my best attempt.

And it's also important. Every single one of those areas is really, really key and important. And I think if you try one in isolation, it's just not going to work. And I think so many diets are set up to fail. And the cynical side of me is says, well, that's because these people want them to keep buying their books or doing their programs or eating their food or whatever. But I think it is so important. And I think also to touch on the psychological side, it's really important. Just literally before we finish, though, looking at hormones, obviously I can't do a podcast without mentioning the word, menopause or perimenopause. And the more I see people in my clinic, the more I realize if you've got low estrogen and also low testosterone as a woman, it can be

very, very hard to keep your weight maintained or to not put on weight. And so I think, as you said, right at the beginning, actually, it's really important to look at the whole thing. And you're and sometimes it is a combination of hormones and weight. So certainly those of you who are perimenopausal and menopausal and have read Cyrus book and still struggling, then actually think about balancing your hormones as well. And sometimes we do get surprises and see people and we find that they have got diabetes or they have got hypothyroidism. And so you are allowed to have more than one metabolic problem or more than one endocrinology problem.

But it is really important. And another thing is really important is not to do this alone. I think having people that you can talk to and share is so important. And I know myself, I'm the only person that cooks in my family. So it's really important that, you know, others share that journey. Because otherwise it's very lonely, actually, trying to lose weight, isn't it? Yeah. And it becomes very fixated.

I think if you're told never to talk about Paris, all you can do is think about the eyeful town. and sort of, it's that whole thing, isn't it? People will get very fixated, whereas actually talking to someone might share that load and free your brain. And, you know, we're allowed to be thinking about our diets and thinking about our food intake, but in a positive rather than a negative, self-critical way. I completely agree with you. I think, you know, looking after yourself is not about being egotistical or arrogant or self-nation. Sometimes that's the way we might think of it, you know, that, oh, no, no, no, I should prioritise my family or my job or my community or whatever it is,

but actually you can do all those things so much better when you feel good. And absolutely, looking after your diet and your sleep and making sure you move enough and making sure that every conversation you have with yourself isn't always negative and, you know, putting yourself down and you'll reap the rewards. I agree with you, Louise, talk to people, speak to your GP who, as you say, might want to run some additional blood work or talk to you about other conditions you might have, might want to help you with your medications, speak to supportive family and friends.

As you say, Louise, if there's somebody who does the cooking in the house, you've got to let them know what's happening. What my patients find is when they share with people, they are bowled over by how much people want to help. If there's an office party and someone say, well, but I've brought this for you, or I've made sure the spread is good, or you go out to someone's house for dinner

and they say, you know, thank you so much for letting me know about the way you're eating and you look great and you're clearly so energetic. And so not only we're all going to have a good time together, because it's no fun if you've just sit there not eating, but actually tell me more about what you're doing. So people are really, really enthusiastic. So just let them know. Conversely, if you have anyone in your life who's trying to derail you in some way, and that does happen, you lose weight, your confidence improves, you know, things are working out for you. and then people say, oh, you know, fun anymore and why do you never want to have dessert with me or whatever? I always say to my patients, this is about them. It's not about you. Maybe they're worried their own choices. Maybe they're worried about their weight or their health or have some of the issue.

And you changing can be very destabilizing. But just keep breath if you can, look at the bigger situation. And almost always this is about them. People who are at ease in themselves will be very supportive of what you're doing. Yeah, that's a really, really good point. Thank you ever so much. So for those of you that want to buy the book, it's called the full diet and it's available, well, even in my local Sainsbury's, but it's available in Amazon and most good bookshops. But so before we finish, could you just say three tips? So people that have been listening to this and think, right, I really want to make a difference. So one quick tip that can make a quick difference, one in the media term and one longer term as well, because, you know, we have to eat as long as we're, alive so we have to think about not just what we're eating today but for decades ahead so if you wouldn't mind giving three tips that would be great okay so number one tip if i was world king for the day world queen it would be do everything in your power to shun abstain from remove ultra-processed food from your world and just for you you will it will be so important and helpful for the health of other people in your network, be that your family or other people that you live or eat with.

So if you can get ultra-processed food out of your diet, your health will already be on a massive optic. So that would be my first really strong sort of, not strong, because that sounds a bit much, but I would be enthusiastic about that piece of advice. I think medium term, it's really important to understand that weight is not just about what you eat. It's a component. It's a part of the jigsaw. But if you simply change the food that you're eating, you'll get some progress and that's good. But I would definitely encourage people to look this in a much more holistic way. So also ask questions about what's my stress like, what's my sleep like, how much am I moving during the day and so on? because we don't gain weight for just one reason, like we just eat the wrong food.

And therefore, addressing weight is about addressing all those other reasons that have contributed, trying to put them right, or at least making some changes that make you feel better day-to-day of quality of life improves. My third tip, and this is a longer process, not going to happen overnight, is be your own biggest fan. And that might sound a bit like, you're right, how do I do that? but actually the way that I coach my patients is all in the book. You know, firstly, you're going to go from potentially some people being your own biggest enemy, that's a bit strong, but, you know, going from being quite negative,

can be a phase of being quite neutral. But if you can begin to feel kind of good about yourself, I do tend to find that that then permeates into so many other areas of life. And people kind of pick up on that sense of ease that you have and then kind of other opportunities, friendships and so on, kind of come your way. So if you can develop a way of beginning to be your own biggest fan, being you will feel like a kind of good place to live. Really important. And thank you so much for sharing your wise words, backed on research as well, which is always a delight to hear. So thank you ever so much for spending your time.

And I look forward to speaking more and maybe even collaborating with some research. So we can hopefully come back and talk about that in time to come. So thanks ever so much for today. It's been my pleasure. Thank you ever so much for inviting me. Really enjoyed talking to 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.