The Dr Louise Newson Podcast - 279: Heart health, hormones and menopause: what you need to know, with Dr Jeremy London

Episode Date: October 22, 2024

Cardiovascular disease is the leading cause of death in women and this risk increases after the menopause, and a woman’s risk of heart attack is around five times higher after the menopause than before*. Joining Louise on this week’s podcast is Dr Jeremy London, a board-certified cardiothoracic surgeon based in the US, to discuss heart health, hormones and menopause. They discuss the role of oestrogen in reducing inflammation in the body, why women typically present with different heart attack symptoms compared to men – and the signs to look out for – and the crucial role of nutrition and exercise in maintaining good heart health. Finally, Dr London shares his top three tips on what women (and men!) can do to help their future cardiac health: Don't smoke: it is the single worst thing you can do for your health in general. From a cardiac standpoint, from a blood vessel standpoint, for the risk of lung cancer. Nutrition: avoid processed foods and eat real, whole foods. Exercise and recovery: look to incorporate resistance training and some aerobic training, and don’t forget about recovery and prioritising sleep. *El Khoudary, S.R. et al. (2020), Boardman, H. et al. (2015). Follow Dr London on Instagram @drjeremylondon For more information on Newson Health, click here. Dr Louise Newson’s first-ever live theatre tour, Hormones and Menopause – The Great Debate, runs until 12 November. For more information and tickets, click here.

Hello, I'm Dr Louise Newsom. I'm a GP and menopause specialist and I'm also the founder of the Newsom Health Menopause and Wellbeing Centre here in Stratford-Pon-Avon. I'm also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research,

bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newsome Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on the podcast, I am really excited because I have managed to entice a cardiothoracic surgeon, no less, from America to come onto my podcast. and I've been stalking him like I do lots of people on his social media, which is really very, well, you'll all be following it when you've listened to this podcast, but it's very informative and lots of information, not just about cardiothoracic surgery, but about health in general.

So I'm very delighted to introduce to you, Jeremy, London, who is not from London, I guess, I don't know, are you, Jeremy? I am not. I am not. Thank you so much. I'm so excited and honored. to be invited and to be here today. I really am. Thank you. Oh, no. Well, thank you. So I was saying to you, actually, before we started recording, when I was a medical student, you have an eight-week elective period, and I decided to go to Canada, and I worked with a cardiothoracic surgeon, but he was a transplant surgeon, so I enjoyed flying across different places in Canada at two in the morning to retrieve organs. But what was very interesting is the cardiothoracic surgeon was very lean. he was very fit, but he smoked.

And I kept saying to him that how can you smoke and do cardiothoracic surgery when people have atheroma, the fairing of the arteries, have heart disease. And he said, because Louise, I tell my patients, if they're as lean as me and as fit as me, then they can smoke. But until that time, they must not smoke. And I was like, okay, I mean, don't forget, this was in the early 90s. It was a long time ago. Yes.

And one of the things I noticed from stalking you is that, you know, you are really good with your lifestyle, which this is a generalization, but not many doctors are, especially somebody who works as hard and long hours as you. It can be really easy to not look after ourselves when we're clinicians, can't it? For sure. And there are certain aspects of my life that I definitely give a lot of attention to. and I utilize fitness as my escape. So that's a nice win-win, I think, from that standpoint. And, you know, dietary choices and food choices have been a big part of our family for about the last 10 to 15 years. Interestingly, in the same time course, I worked with cardiothoracic surgeons that would smoke on the way into the operating room and place their cigarette on the scrub sink. Come in.

No way. More portion of the case and go back out and smoke in the, yeah, and this was, you know, this is in 93, you know, it was crazy. Just a different time, you know, a totally different time. I don't think you can support that argument irrespective of how lean or how fit you, you know, you are. You know, it's like if I had to give one piece of advice, it's don't smoke. Yeah. Or vape, actually. Who knows what's happening with Veifah, but that's a real problem, isn't it?

Oh, yes. Yeah. I mean, it's dramatic. You know, vaping, first of all, we don't really know. It's such uncertain headwinds. We really don't know where we're going. But in the short term, and I deal with the endgame of vaping too often with young kids that come in that we end up having to put on an external lung machine, an ECMO machine because they have such intense acute lung injury. And it's been really a mission of mine to really work. at getting a lot of information about vaping out through social media because it's so convenient and it's socially acceptable and it's totally unmetered by any industry at this point. So the nicotine levels are very high. The most dangerous portion of it is actually the flavorings, the diacet oil that we think causes the popcorn lung or the damage to the lung sacs themselves.

but I've just seen some devastating, absolutely devastating situations from vaping. I think it's really, we have not seen the carnage yet. No, it's kind of going to come, and it's so sad because they're so, they just look like sweets. They're bright colors, their flavors, they're so easy to get. I don't know whether I'm allowed to tell you, whether my daughter would tell you off, but my middle daughter stopped vaping. And she's had a really horrible chest infection over the summer.

Maybe COVID, I don't know, but it really scared her, which was good. and actually her boyfriend threw her vape away for her, which was wonderful. But it's been really difficult for her because I'm sure she was addicted to the nicotine and goodness only knows what. And I guess it's similar to a smoker. They often feel worse before they feel better. So she had this disgusting cough, sometimes vomiting because she was coughing so much. But she's stuck with it unless she won't go back. She absolutely won't.

And she's young. So I'm hoping she'll, I didn't even know about this type of lung disease, of popcorn lung that she was. I'm not about. Yes. But it's too late and it's really worrying. It's really real. And a lot of people I know listening to this podcast will have children. I'm not unique with a child that's vaped because it's so easy.

And actually what was scary, she fractured a pelvis not that long ago. And I could see her vaping in the morning because it's just there next to her. Whereas if she has a cigarette, she'd have to go out of the house. That's the key. She'd get cold. She'd come back in. Well, with a fractured pelvis, she couldn't move anyway. So I would have had to wheel her, which I wouldn't have done.

outside the house. So you can see the convenient doesn't smell. You know, it's very easy to smoke at school or to vape at school, to vape at work or wherever. And that's the problem. It's so convenient to get these chemicals into your lungs, isn't that? No, absolutely. It's socially acceptable because it's not offensive. And so as a result, the amount of exposure time, because you don't have to get up, go outside, be away from everyone else, you can be in your office, at school, in your home, sitting at the dinner table in a restaurant, and it's this constant, constant exposure. You just see the little blue light, you know, when you look around the room, the little blue, right.

It's, it has become an absolute epidemic in this country. And young. And it's the same. Same for us. And young people starting really young as well. Yes. So we weren't going to talk about vaping, but I do think it's relevant, actually. and I do think it's important that us as older adults really look out for younger people

and try and educate them as well. But you're interested in, well, obviously the heart, because you are a heart surgeon. I'm actually very interested in the heart and every organ in our body. And I did quite a lot of cardiology as a junior doctor. And one of the only thing actually that I learned about menopause indirectly as a medical student was that women have a higher rate of heart disease. disease over the age of 50. And I remember being told that and thinking, well, what happens on their 50th birthday?

Like, really? What? It took me about, I'm not joking, about five years to realize that that is because of this accelerated atherosclerosis, this burying of the arteries, if you like, because we don't have estrogen in our body. And in general, it's over the age of 50. But as you know, for many women, it's a lot younger than that. And I'm very interested in the role of inflammation.

in our bodies, but in our endothelium, the lining of our blood vessels, there are lots of good things that happen in our body to reduce inflammation, and then there's a balance, because if those things aren't there, you get more inflammation, bearing of the arteries, increase incidence of heart disease, and heart disease and dementia are number one killers of women globally, aren't they? Yes, absolutely. And I worry because women are living longer, which is great, but we're actually living longer, but the last 10 years of our life is in poor house. And this increased incidence of heart

disease is contributing to that. And also hypertension. Most women who are menopausal who don't take hormones will have hypertension at some stage as well, wouldn't they? Yes. And I think you make a very interesting, very general point, too, about balance. I think our bodies are a wonderful organism because they strive for balance. And really, even at the cellular level, this idea of homeostasis at the cellular level. And so I think treating chronic diseases is all based on that concept. How do we help, number one, figure out how the bodies are out of balance and either adding things that help us nudge back to center or what are we doing? to our bodies to throw ourselves out of balance and tip the scales towards disease processes.

And I think you're right. I think that inflammation is really the universal engine for all chronic diseases, you know, diabetes, cancer, heart disease, autoimmune diseases, irritable bowel syndrome, and gut issues. And I think that it is absolutely underrecognized in typical alopathic medical education. It's becoming more in the forefront these days because there's been so much discussion. But as far as how we approach these problems, you know, you and I were trained to define the what. What does someone have? We were applauded for making a diagnosis, for giving a medication, for performing an operation. But we, I, unless your experience was different, we never talked about the why. You know, why does this individual have diabetes? Why does that 50 and a half

year old woman suddenly start to develop these issues? And, you know, I think you're right. You know, the estrogen in particular, you know, not only is it protective of the vessel walls itself, but it's a very powerful anti-inflammatory in a woman's body. As again, we look at this balance, you know, to say, okay, well, how do we support? the next 10 years, next decades, as a woman deals with these pari and postmenopausal changes. And so the fact that there has been really absolutely no emphasis placed on this amazes me. It absolutely amazes it. It's so interesting, isn't it?

Because this balance with our immune cells, so the cells that fight infection are really crucially important because they fight infection but inflammation as well. And I learned when I was doing a pathology degree that our immune cells can turn against us so they can become pro-inflammatory. So it's not just reducing inflammation, they increase inflammation. And then about six or seven years ago, I was reading some very old papers from the 80s looking at the role of estrogen as an immune regulator, so regulating our cells at fight infection. And I learned that when there's low concentrations of estrogen in the body, i.e. menopause, our cells become pro-inflammatory. So that's why you get this accelerated, aging, if you like, this increased incidence of all these diseases that you mention. And it's all connected. And then you look at real world clinical evidence. And we know the longer a woman is without their hormones, the greater the risk of those diseases.

But a lot of people still think heart attacks happen in men and you get this central crushing chest pain that might go to the door, might go down the left arm. And it doesn't always present like that in women, does it, a heart attack? Absolutely not. And that's information that we try to get out actually repeatedly because there's so much misinformation, you know. What we call the TV heart attack, the television heart attack, the crushing chest pain. down the left arm into the jaw. Women can present that. Yeah, of course. Absolutely. But when women present with chest pain, it's usually a very different character of pain. It's usually a burning type pain. It may not be nearly as focused as the pain is in a male patient. And more importantly,

the symptoms could be more soft type symptoms that are not directly related to what we would consider a heart attack situation, shortness of breath, easy fatigability, abdominal pain, nausea and vomiting. And so what happens is it's on both sides. From the patient and the family side, the awareness is not there to say, we need to go to the hospital because every time I go up the stairs, I get nauseated, that there's no association with the exertional component. And women many times have the pain entirely at rest or even are woken from sleep. So that's not unusual. So there's a delay. There's a delay getting to the hospital. And then when they show up, there's the, well, this isn't exactly cardiac in nature. We need to do a CT scan of the abdomen. Maybe it's your gallbladder.

There's this kind of immediate shift that it's not cardiac. And so there's now a delay on the other side. And obviously when you're having an event that involves the heart muscle and a lack of blood flow to the heart muscle, time equals heart muscle saved. So the faster you recognize that and the faster that that blood flow is reestablished, the better the outcomes, the better the recovery and the better the survivability. Now, there's a lot of theories, and maybe you know some of the data better than I do about why these symptoms are different in women. I think part of it is, you know, we have the larger arteries on the surface of the heart and then the smaller arteries as they branch. And women tend to have more what we call macrobascular disease processes in the heart than men do. So the presentation there can certainly be very different.

But I have read, and it would be interesting to know your thoughts, that just the changes in the estrogen levels actually can change the way that those symptoms, present themselves. And I don't know if that evidence has borne itself out. I haven't looked at it in depth. No, I think it's really interesting because you can get basoconstriction, so you can get the narrowing of those blood vessels. And if those small blood vessels are slightly diseased,

without estrogen, estrogen, it works as a basodilator. So it opens up the blood vessels, as you know, it relaxes it, helps with nitric oxide production, which again relaxes, making everything just quite calm and chilled, but it doesn't happen without. So I think there is something to do with that. There is also something called Syndrome X, or it's got different labels, if you like. There's lots of labels for women where people get chest pain, but they don't have cardiovascular disease.

So they do an angiogram, and it all looks fine, but the women still have chest pain. And I'm sure that's related to some of this basospasm that occurs. But there's also something called SCAD, this spontaneous carotid artery dissection. And there are a lot of women who are just labelled as having a heart attack, but it's a very different ideology, of course. And I think a lot of the, well, it's not rocket science, it's not rocket scientist, the commonest type of person that has this SCAD are women in the late 40s. So in my mind, that's related to hormones.

And actually, we're just starting to do a study looking at women who've had SCAD, giving them HRT or placebo to see how their cardiac form. physiology improves because a lot of these women are told, oh, you can't have hormones because you've had a heart attack, whatever the cause may be, because of the hangover from the WHOHI study. Yeah. Which, as you know, some of those women had heart disease in the past and were given HRT, but they were given synthetic HRT. They were given the pregnant horses urine, conjugated equine oestrogens, with a synthetic

progestogen, which actually we know is associated. with a cardiovascular risk as well. But move forward 20 years or so, we wouldn't give that type of hormone to people who've had a heart attack. We give the transdemol ethyl, which is a basodilator, it's very anti-inflammatory, and the natural progesterone,

which is either neutral or beneficial for cardiovascular disease. So we know that there are benefits, and actually in the 80s, they used to give intravenous or sublingual Easter dial to people that were having heart attacks. I don't know if you've read any of those papers. And it's brilliant because they cause that, you know, you've got that spasm that's stopping the blood getting into their heart, so causing a heart attack, whatever the cause is.

You can open up in a nice physiological way with a natural hormone. Of course, that makes a lot of sense, doesn't it? That's amazing. I tell you, I had a very extreme example this last week of exactly this. And just to show you how the mindset is so similar, I saw a patient with Turner syndrome. So she has been essentially without estrogen all of her life. This is someone who's born with one X, essentially. And they're known from birth to be hormone deficient. And she's had all of the sequelae, all, I mean, hip fractures, knees, ankles, everything. And she has a bicuspid, aortic valve and needs a valve replacement. And I said, well, you know, your bone is in terrible shape. I said, the fact that you haven't been on estrogens is a crime. And she said that her gynecologist

told her that her risk of thromboemabolic event was too high with someone with Turner Centra. I mean, I was like, the endocrinologist was all for it for the same reasons that you have put forth that obviously the newer formulations are totally, we're talking about a totally different situation. But I was like, this isn't even a nebulous case. She has documented Turner Center and we can't do her in a minimally invasive way. You know, sometimes we can replace the aortic valve just through the groin through a small catheter and do it that way. She's not a candidate for that unfortunately. So now, you know, her rehabilitation is going to be, and she's got a typical Turner syndrome habitus where she's short and very heavy and is going to have a very, very fragile

bone as a result of a misunderstanding of the importance in somebody like this. So it was really, it was a habit. It's such a shame. And, you know, I'm very interested, like you are, as preventing disease. It's all very well you operating on people that have heart disease or me giving treatment to people that have disease. But actually, isn't it nice in medicine if we can prevent disease? And I'm very keen to prevent cardiovascular disease because it's so common. And one of the ways we know, we've got good evidence that taking HRT, especially when we're young, when we're perimenopausal, will reduce incidence of cardiovascular disease. And it makes sense the way that especially estradiol, but also progesterine and testosterone work in our body, not just on the endothelium,

but our whole, our RAS system, our renal angiotensin system, with our blood pressure, everything else as well, all that inflammation. So I often talk to women about reducing their heart disease risk with HRT, natural hormones, but a lot of people are told, oh no, you've got to go on a statin, go on a statin, that's going to help. And I'm not convinced there's good evidence. for primary prevention, which means giving it to women who've never had heart disease, by the way, just to clear for listeners there. So for primary prevention for women, giving statins, any evidence that's there is usually been done in men, but there isn't as good evidence as there is for HRT. And I know you've done a little Instagram thing about statins, but what's your take on giving statins

for primary prevention to women? Well, what I'll say is there is going to be and is in process a huge pivot in this country and it's undergoing and it's happened what I call in a secondary manner. Because what's occurred is the risk stratification calculator for cardiac disease has been retooled in the last 18 months. So immediately what's happened with that is when we're looking at the high and medium risk categories, which is where we should be using technically statins for primary prevention, if that's the case. It looks like between 40 and 50% of the patients that have been on statins would no longer even qualify to be on statins for primary prevention. Now, I do say as a cardiac surgeon and as someone who takes care of these patients, statins work.

Statins have saved a lot of lives. And I don't think that that's really an arguable point. for secondary prevention and impatience that clearly are at significant risk. So I don't want to demonify, you know, to a point that I would say that statins are not good. They're good for the right patients, but they are not the answer as a primary prevention for patients at all. I think for all the reasons that we've been talking about that, you know, it's a response to a perceived risk. not looking at, well, how do you change your lifestyle at these different points to keep yourself in that low risk category and not require them at all? It was really interesting because when Staten's first came out, obviously there was, and

like you say, they have a real role. And like everything in medicine, it's a balance and it's looking at what benefits versus what risks you might get from taking any medication or anything we do in life. But I find the whole thing very interesting. When you think about how our hormones are made in our body, they are actually made from cholesterol. And cholesterol forms our cell membranes. So I sort of sometimes play quite a few mind games. I've got quite an inquisitive mind. So I think, well, actually, if we're blocking cholesterol and the enzyme that stops,

is that going to stop some of our hormones? And I've been trying to read papers, and there's some not brilliant papers, especially in men, actually, who have had lower testosterone, who've been on statins. And then I think about one of the commonest side effects of statins can be sort of brain fog people explain and describe, but also some muscle and joint pains. Now, what are the commonest symptoms I see in my menopause clinic, brain fog, muscle and joint pains? Is the etiology the same? How are they, are hormones affected? And I don't know the, I mean, do you know the answer?

Because I don't know the answer because the studies haven't been done. No, but I agree with you. I've had that exact same thought with hormones as well as with neurotransmitters. And when we look at things like depression and you look at just overall mental health, you know, that we're actually changing in that balance of the backbone of many of these molecules in hopes of preventing something that may not even require that prevention. And so I've had that exact same, even for myself, and for me, It's actually secondary prevention because I actually had a stem place about two years ago.

So I really know what it means to go through all this, but I really have that same thought process about like, okay, what are we actually doing to the balance here? And I think it's really, really important, you know, as we move forward that we are maintaining that in the forefront. I totally agree. And we see lots of women who have raised cholesterol, they have raised LDL cholesterol, the so-called bad cholesterol, but they're also perimenopausal or menopausal, and they've got no real risk factors for heart disease. So it really would be thinking about primary prevention. But I'll often say to them, let's start your hormones first. We can repeat your cholesterol in six months or a year. And I tell you what, nine times, or 99 times out of 100, rather than 9 out of 10, their cholesterol comes down.

also their HDL cholesterol comes up, so their good cholesterol comes up as well, which is no surprise the way our hormones work. But I'm also not just thinking about women, I do think about men as well, and the way testosterone can have an effect too. And if we can treat ourselves with a natural hormone instead of anything synthetic, whether it's a statin or whether it's a blood pressure-lowering drug, it's got to be better for us, doesn't it in the longer turn? I like to believe so.

Anytime we're maintaining physiology and it becomes supportive, I think you're always headed in the right direction. I do have a question for you about the cholesterol after the estrogen as well. When we look at it in men with testosterone, a lot of times we see that they're able to be much more active because the energy level is different and they're able to keep their weight down and all those kinds of things, you think that that's also a common. component. Absolutely. There's so much in medicine that's multifactorial and obviously the way Eustodal works in our liver as well, of course it's going to help cholesterol. But you're absolutely

right. And we spend a lot of time in the clinic talking about nutrition and exercise once women are on HRT because I tell you what, if I'd met you eight years ago before I started hormones and you'd tried to tell me I've got to keep going with my yoga, I've got to eat better, I've got to sleep better, I probably would have been very rude to you because I was exhausted. Like I had muscle and joint pain. I had migraines. I just couldn't do it. I mean, I've done yoga for many years.

I loved doing yoga. But I just thought, oh, put my yoga stuff on and just thought, no, I'm just going to sit and stare into space. I was, you know, so, and that's the same often with men with low testosterone. But, you know, it's not just taking the hormones that's given me the motivation. I still have to do yoga. There's no point me not doing exercise and thinking my hormones will do everything. And sometimes in medicine, this is a generalisation, but people think taking a medicine will cure them,

whether they're taking a statin or another drug or they've got diabetes. But I feel it's something that was missed in my medical education about how important nutrition, exercise, sleep, being with our friends, family, being loved, being cared for. those are more important sometimes than any drug that we can give. Those are the pillars. Those are truly the pillars. And when we talk about, you know, HRT for men and women or even oral supplements and what have you, I always tell patients they're supplements, they're not substitutions.

And they should be additive and supportive of lifestyle changes. And that all of those things that you mentioned. And I think that nutrition is really the cornerstone, whether, you know, a cardiac surgeon and a menopause specialist are having a podcast for whatever reasons it may be because I think there's so much overlap when we are treating, you know, the patient that has the disease, not the disease the patient has. Yes. And I think that diet is the cornerstone because that's how we internalize. 90% of the outside world. And so that's what our body is going to be most reactive to. So if we start there, forget, like, if you don't want to exercise, you don't want to move

every day, you just making that change to a whole foods diet, essentially meaning no processed foods. And the European countries do much better than we do. The American diet is beyond, beyond horrific. If you don't think so, just spend a day in an airport and watch as the world. goes by, just making that change, I think we would have a dramatic impact where we would either cure or attenuate probably 60 to 70 percent of chronic disease. And then you add those other things of movement, whatever form that's in, whatever works for you, doesn't matter. Because

in the end, we all do have our own instruction manuals. Yours is different than mine. And that's okay. You know, it's not a paperclip that fits every stack of papers. you know, then you add all of those components, and it's amazing the transformation, as I'm sure you've seen in your patients as well, that when you just do the simple things and do them regularly with consistency, no, in a week you don't see a difference. In a month, maybe a little change, but in a year or two years or three years or like where you are now after figuring out what your instruction manual will. is with HRT and yoga and what have you, it's transformative.

And it's really, then it doesn't become willpower to maintain a diet. It's an aversion because you don't want to go back to feeling badly. And that's a very different type of motivation for individuals. You know, do I want to eat that cake? Do I want to eat that donut? Well, if you consciously say, I know I'm not going to feel great, eat the donut. It's, oh, fine. But most people say, you know what, I don't want to feel like that again.

So I'm going to skip the donut and I'll find something else. So I think that the nutrition is such a key piece. And for whatever reason, it's the hardest part for most patients. Because we all have to eat. And it's so easy to eat badly, so much easier than it was 20, 30, 40 years ago. And so I really feel for future generations, but knowing nutritional value, how you can hack and eat well when you're busy as well. Just be a bit more prepared is really important.

So there's lots. I'm going to have to get you to come back sometime because there's so much we can talk about. But I'm going to throw this on you. I hope you realise I always ask for three take-home tips. So three things that women and men, I should include, can do to help their future cardiac health. What can we do to really look up? We've only got one heart. It's crucial.

How can we keep it as healthy as possible? Well, we've touched on all of them. Really, don't smoke. It is the single worst thing you can do for your health in general. From a cardiac standpoint, from a blood vessel standpoint, for the risk of lung cancer, I mean, really, if you're going to pick one thing, like take the cigarettes and the baby out. Number two is, you know, figure out what's your instruction. manual is from a nutritional standpoint. And that takes time and it takes energy to do that. You know,

there's a lot of different ways to go about figuring out what that is. But if you just start with real food, just real food, there's so much edible food product out there. You know, the old adage, the longer the shelf life, the shorter your life. And I think if you avoid those things and start there, that's huge. And then the third is this idea of stressing your body with exercise, resistance training, some aerobic training for sure, and recovery. Also very important to include putting sleep at a high level of priority. And I think those are kind of the three buckets that make a tremendous difference, not just with our heart health, but with our lifespan and our overall health span in general, I think that those are the things that

that we can control most of the time. Sleep can be tough. I struggle with that personally, and I can understand that. But there's a lot of different methods out there to approach each of these pillars. And those would be the three big categories that I would want people to really take away. Amazing. Unachievable as well, which is also really important. So I'm very grateful for your time, and I look forward to speaking to you again, Jeremy.

Thank you. Thank you so much. Talk to you soon. You can find out more about Newsome Health Group by visiting www.newsonhealth.com. UK. And you can download the free balance app on the App Store or Google Play.