The Dr Louise Newson Podcast - 280 - What is lifestyle medicine and how can it help your menopause?

Episode Date: October 29, 2024

Joining Dr Louise this week are Dr Tash Mirando and Dr June Tan Sheren, who are GPs based at Osler Health International in Singapore. Dr Tash and Dr June explain the pillars of lifestyle medicine, including sleep, nutrition and exercise, and talk about longevity and the importance of taking a holistic approach to menopause care. They also discuss menopause care in Singapore, bust myths on how menopause can affect women of different ethnicities and highlight the importance of knowledge and empowerment in making informed decisions about your health. You can find out more about Osler Health International on Instagram @oslerhealth.sg and Facebook at oslerhealthsingapore. 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, and always inspirational personal stories. This podcast is brought to you by the News and Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. On the podcast today, I've got two lovely GPs with me who both work in Singapore.

So Tash and June worked together. I went to Singapore last year, but didn't know them then, unfortunately. So it means we're going to have to reconnect and go back to Singapore. But when I was in Singapore, for those of you that know, it's a great city, everything works. It's easy. It's clean. It's organized. But Rebecca Lewis and I, who I was with, kept looking around and seeing all these men orples or women. We were seeing people and we were seeing less women out in the streets in their 40s, 50s, 60s, certainly some. We went to Little India. We went to

Chinatown. It was really apparent that there is a difference over there. And so I was really delighted when I spoke to Tash, who comes over to the UK and still works over here as a GP. So, very excited to have you both on the podcast, to hear more about your work in Singapore. So welcome. Thank you. Thank you so much, Louise. So Tash, do you want to go first? Just say a little bit about what's taking you to Singapore, because I know you're not from

Singapore initially. Sure. So I'm actually a London, NHS doctor, GP. Yeah. And I moved to Singapore a couple of years ago, really, from a family point of view. to be closer to family who have now retired and moved to Shredaka, which is where I was born, and then grew up in the UK. And really finding my feet in Singapore has been fantastic,

especially because of the clinic I was able to join, which is called Osler Health International, and working alongside June to really improve the quality of life of our patients, especially women, because we co-head menopause in women's health. Yeah, it was a... As you mentioned, I still, I do keep up in my NHS. work. I do my best, but it's just really nice to have that hat on as well and keep up to date with all the latest research and guidelines. Absolutely. And June, what's about you? All right. Louise, first, I just want to say that a lot of women in Singapore know you, they follow you,

and, you know, they are going to be absolutely delighted one morning when they wake up to this episode of the podcast. So thank you for having us. I'm Singaporean. I'm from Singapore. I'm third generation in Singapore and in fact did most of my medical training and education here in Singapore. I graduated from the National University of Singapore in 1997 and went into family medicine. And in my years of residency, I spent about 10 years in the public sector here. In the earlier years of residency in family medicine, menopause was a routine part of primary care. You get menopause treatment, you get HRT prescribed to you in the public sector and government clinics that are known as polyclinics here. And it was routine for me to be prescribing, you know, back in those days, Perman, Pempax, the Pempax seas back in those days.

And I was there when it all came to a halt. But I'm really happy that I am still in practice 20 years down the road and, you know, seeing how women's care has evolved. evolved, how menopause care has evolved and really right now just appreciating how things are coming full circle. Yes. Yeah. And it is. So we're talking about 2002 when the women's health study came out, which was the biggest car crash to women's health, actually. And at the time people were really worried that the rip-un effects, the long-term effects it will have. And it is still having 22 years later on women's health because people are scared of taking HRT, And you're right, actually, I feel very strongly as a clinician that menopause care should usually be undertaken in primary care because as GPs, we're used to very holistic care, we're used to making different diagnoses, often more than one diagnoses in patients.

We don't just look at the heart or the lungs or the bladder. We look at everything. And we're often giving two or three different treatments, sometimes in the same consultation, aren't we? because we also know our patients, and that's the beauty of, I think, being a clinician, when you know what will work for them, what they won't, what they'll understand and what they might not understand. And also, when we're talking the bigger picture about what they can do themselves, because I think in medicine, it can be very dictatorial, you must do this, you must do that, and fit everyone in the same box.

But we don't live our lives like that. So how can we, you know, do medicine like that? So when we're looking at menopause care, there's lots of things we do, aren't there? It's not just one treatment. Absolutely. And one of the things I'm very interested in, I know you are, is a whole lifestyle. And lifestyle medicine has become really topical. And it's something I was not really talked much about nutrition.

I wasn't really taught much. I've talked a lot about physiology of exercise, but not what it means or what it does to people. And we're now talking more about preventative medicine, reducing diseases rather than treating diseases. And lifestyle medicine comes up a lot. And there's lots of lifestyle gurus out there. But there's quite a lot of noise. And sometimes it's easier to ignore all the noise and just think, oh, I'll carry on in my own little space. So what is, Tash, what actually is lifestyle medicine?

How would you define it? So lifestyle medicine is actually evidence-based. scientifically backed approach to prevention of chronic disease and actually looking at reversal. But I would say before anybody talks about medication, even going along the lines of hormones, it's we need to optimize our baseline health because we can throw medication at people to their blue in the face. It may not matter until we really focus on the basics. So what we break it down into is the six pillars of lifestyle medicine. For me personally, sleep is number one.

We've got to optimize our sleep. Looking at adult point of view, it's seven to nine hours of sleep each night. Easier said than done, especially young families who are balancing so many things out. But getting that sleep in order can then help set everything else in place. Second is nutrition, protein, fiber, fats.

Focus on the protein, focus on the fiber. And it's having that balance because then comes exercise. This isn't about just going for walks or doing your full cardio workouts. It's actually looking at strength training. Got to strength train. Lift heavy weights. It's not just about, I know you love your yoga and you're very good at it. But we've got to lift heavy weights.

And that's really, really important. And especially in this part of the world, sometimes it's not, especially in the older generations, It's not something that is considered as important, but we know it is. Osteoprosis risk, looking at osteosarcopenia, it's so important. Moving on to mental health and well-being, looking at your social network, looking at social connectedness. And then if you smoke, stop smoking, sorry. And if you drink, cut back or stop.

So it's really basing it from a science-led approach to those six pillars. Because once we look at optimizing each one of them and building it up, even if, say, a stressful situation comes up, you already have your sleep in order. You've got your nutrition. You've got your exercises back up. So you can balance it for that short period of time, which means anything else we do on top of that works a lot better. And I find that a lot in menopause consults is the women who actually really focus on those lifestyle measures in optimizing their help. do a lot better on hormone therapy. Absolutely.

And our body likes homeostasis, our brain does, but our bodies as we like. We all like routine and we like the same. But if we've got into the wrong routines, it's a sort of, can be a downward spiral as well, can't it? And you throw low or changing hormones into the mix. As you say, when you're stressed or you haven't slept, you'll go for maybe a comfort food or you'll go for something. and if your habits aren't great, it's going to compound the worse of bad habits anyway often, isn't that? And so when we talk about, you talk quite clearly obviously about prevention, which is wonderful,

which is what we should be doing, of course. Absolutely. What would you say to, for those people who don't really think about doctors preventing disease, it's more about we're treating illnesses. What would you say is so important for preventing disease? So, you know, in all the talks, the educational talks that we give that, Tash and I do individually as well to raise awareness on menopause and in consultation at the micro level as well. You know, we emphasize so much on preventive measures that include lifestyle

measures that really form the cornerstone, the foundation of health and well-being. And I like to say to my patients that during this menopause transition, this is a really good opportunity. for you to relook your state of health and well-being at the moment and see what lifestyle measures, what aspects sleep, your nutrition, your activity level, your mental well-being, what aspect can be further optimized at a sustainable level, something that will set yourself up for the longer term, for better, for really good health and well-being for the longer term. So I know, yeah, many people might, you know, like back to your question, Louise, ask why are we as doctors giving advice on preventive care? Well, I would say that's very natural to us as GPs and family physicians.

That has, you know, always been one of the core pillars of family medicine. It's not just curative. It is preventive care. It's a huge part of what we do. And I like to be able to provide that and reinforce that with patients we see. Yeah. And it's interesting. So I did a lot of hospital medicine before I went into general practice.

And when I did my obstetrics and gynaecology job, it was probably the first time I thought about preventative medicine because I was thinking about preconception counseling. So if people are organized enough and thinking further ahead and planning a pregnancy, I know it doesn't always happen for everybody, we spend quite a lot of time, don't we, especially as DPs, in preparing for the pregnancy, making sure the women's as healthy as possible. So it's a great time doing the pillars, as you exactly say, thinking about nutrition, thinking about smoking everything, because then it gives the mother the best chance and the developing fetus when it happens to. So it was then that I thought, gosh, actually that's really good investment of time. Whereas before in hospital medicine, it's very reactive.

You know, bed six is a heart attack, bed seven is an asthma attack. And you're just literally playing ping pong really. you're just literally going from one thing to another to another, and you're maybe speaking to the person that had an osteoprotic fracture, perhaps you should have some vitamin D, but that's still the treatment. You're not really preventing. And so I remember thinking, oh, that's good.

Yes, wow. And then just asking every consultation, I've always done it, do you exercise, what's your diet like? Do you smoke, do you drink? And what's your sleep like? and it takes minutes. And actually some patients then have said to me, you know what, just you asking that question

maybe feel really guilty. And so I don't buy, you know, fast food anymore, or I just started exercising a bit. And it's not like I've lectured them. I've not even said, like, it's just that question. And I think, I don't know what you think, but often you don't expect your doctor to be interested in you somehow. And does that resonate with you?

Yeah, absolutely. I think you just need to ask the question and not say anymore. And that, you know, turns on a switch that makes patients start to think about, oh, yes, you know, what other aspects of their lives can they work at? And it also helps to build the rapport in that relationship. Because as GPs, that is fundamental as family physicians is, for me, it's special. You really get to know your patient. You get to know the families. And that you have all the information.

You can work things out before they've been walking through the door. Something's not right today. What is going on? And you don't really need the impact. So I had a patient when I was a general practice, lovely, lovely lady. And she was in her late 70s. And she was morbidly obese. And she cared for her husband who sadly died from a cancer.

And I knew him very well as well. And then about 15 years ago, I had pancreatitis, and I was really ill. And when I got better, I had time off her, I got better. And she saw me and she said, see, Dr. Newson, all these seeds and these food that you eat aren't helped. Are they not all healthy? And I hadn't even remember talking about seeds. I must have said something about just wrinkles some seeds or do something. And she was really funny.

But then I said, well, okay, I get what you're saying. But actually, you know, nutrition is really important. We had a little chat, talked a lot about her poor husband. And I stopped talking about her weight because she knew she was really overweight. And the last thing you want is someone's shaming you when you've not come in for that problem. So I'm very respectful, as I know you are to your patients. And then she lost, I kid you not, four stone in weight. And it was just before I left General Prentice.

It took a year or so. And I said, what was the trick? How did you do it? She said, well, I just, we had that joke about seeds. And then I thought, actually, now I'm going to prove her wrong. So I've thrown away all the cakes. I don't nibble. I don't.

And her arthritis in her knees was so much better. She honestly was a different person. And actually, I said, gosh, you know, so many people say, I've left it too late. I can't change my life. So I can't lose weight. such thing. And there isn't, and she'd really, and I thought, well, a little throwaway comment, but I could tease her a little bit because I'd known her for like 15 years. I thought that's incredible. When you have that mutual respect, but if I'd gone into her and said, right, let's look

at your kitchen cupboard, let's reduce your food, it would have been detrimental for our relationship. It's also picking and choosing. You can't do everything all at the same time. So a lot of the work we do is about a very 360-degree view. They may come in with one thing, but you say, actually, let's start with this, which is completely different to what they came in with, and let's break it down and work on it. Because if you go home with four or five things, you have to suddenly change, it's really difficult.

It's overwhelming, isn't that? It is completely overwhelming. So it's finding that one or two things, breaking it down, and working on that and then building on it. and we're lucky because we have the privilege of time. Just helping patients to prioritize steps involved. And what's the feedback being like with your work? It's fantastic.

We're busy. We're busy. But it's so rewarding. I mean, having a rewarding job is amazing. It's very humbling, but it's very enjoyable, of course. But actually, knowing that you're helping future health, I think is incredible, isn't it? especially looking at it, you mentioned future health. There's a lot on social media also about longevity

and breaking that down into health span and lifespan. We've set up the first public sector longevity clinic here in Singapore at Alexandria Hospital. And it's about looking at that gap between health span, which is the age until you're healthy, and lifespan, which is when you die. And unfortunately, that gap can be 10 years. So being unhealthy for 10 years,

is really not great from a quality of life point here. So it's what can you do now? Absolutely. And that is really important, especially when you look at areas of deprivation and certain ethnicities as well, because that ten years actually can expand even longer, especially in women.

And obviously I'm going to mention menopause because of the podcast, but we know that menopause extends that too. So there's good work, especially women, as you know, who have an early menopause at a younger age, the longer they are without hormones, the worse their future health is. And that's just fact. And that's because of the anti-inflammatory nature of our hormones. And so looking at all these pillars is crucial.

But when you talk, they've gone to so many longevity talks because I'm so interested in it. But they always miss hormones. And it's not just even in women. Men have testosterone, which is very anti-inflammatory. And also men have Estridan and progesterone. There's no research done into that. But I do feel like with patients who take HRT and feel better, it's then so much easier for them to do their lifestyle things

and their sleep often improves and everything else. I mean, do you find the same? We do. And a lot of the times it's finding that balance, getting the women on the right hormones for them in the safest way and then building on the rest of it as well. It all goes hand in hand. but doing it in a way that's not overwhelming as well.

So there's a lot of interest in Singapore these days into lifespan and health span because Singapore's life expectancies are one of the highest in the world. And we also have one of those rapidly aging populations. The statistics are that 1 in 4 by 2030 would be over the age of 65. And that becomes closer to one in almost two by 2050. Gosh. Yes, I know, gosh. So there are a number of very important initiatives that the government has put into place now

to address this issue of the rapidly aging population. Osteoporosis has always been a major public health concern. Back when, you know, 20 years ago when I mentioned town menopause care was part of routine practice, It was primarily to address the issue of osteoporosis. Yeah. Yeah, one in three women over the age of 50 in Singapore have osteoporosis. Isn't that? Just ridiculous.

And the rates of hip fractures in Singapore are the highest in all of Asia. So I do think that right now with the priorities going into resources and channeling interests in looking at. the rapidly aging population. I do think that there would be interest in menopause care, in enhancing women's health in this transitional period. Yeah. It's interesting because you talk about osteoporosis,

which is so important, but so many people still don't know what it is, or they don't realize the impact of infidelity osteoporotic fracture, especially of the hip, but even the wrist can be really disabling for a lot of people, as we've seen, but especially the pain from osteoporotic fractures in the spine as well. You know, it can really, really affect people.

And we know that HRT can reduce osteoporosis, but we also know that it can treat osteoporosis because it can build strength. And it's often forgotten that as well, isn't it? How important the hormones are for our bones. And it's interesting because so many times I go to lectures by menopal specialists, and they talk about giving HRT for symptoms, and it's usually for flushes and sweats,

and we know there's a myriad of other symptoms. But people seem to forget about disease prevention, and even if we only look at osteoporosis, there is still really good evidence, and if I had a choice between a bisphosphonate or hormones for treating osteoporosis or preventing osteoporosis, I know I would take HRT because it's got better safety data for a start. Do people use HRT for osteoporosis treatment or prevention in Singapore other than you?

In the past, yes. In the past, yes. But currently, currently, the guidelines on osteoporosis prevention and treatment still have, yes, lifestyle measures. It is fastened and a little mention about HRT right at the bottom. So, yeah, that bit of evidence hasn't quite caught up yet, unfortunately. But it's interesting when you look at how common osteoporosis is, especially in Asian women, and how that's forgotten. And a lot of people, well, I've been taught, and I'm keen to know, same few, because of maybe their diet, might be have more soy in their diet, that they have less symptoms. So then there's a lot of people saying, well, menopause isn't really a thing in certain ethnicities or certain countries because they're not having the same hot flashes and sweat.

That's so, that's great that you brought that up because that is what some patients have come to say to us because their own doctors have told them, oh, Asian women don't suffer from menopause, which is just ludicrous, right? I think what fed into that was that 20 years ago, there was a smallish study here in Singapore that looked at the types of symptoms that women in Singapore suffered. And they found that vasemotor symptoms, hot flashes in Naysway. were not as common as muscle eggs had joined pains. And so, you know, I don't know how, but people took that to mean, oh, Asian women don't suffer between the menopause. But the truth is, interestingly, this finding has been validated more recently in a couple of studies that the National University of Singapore

published just a few months ago that found that muscle aches and joint pains were the number one symptom across the major ethnic groups. the Chinese, Malays and Indians, followed by sleep disturbances, I think, and then vaginal symptoms, and then physical and mental exhaustion, followed by hot zaches and now sweats. And to me, I think that, you know, it's a whole process of its one mechanism of osteosarcopenia. We have such high rates of osteoporosis. We cannot ignore this top symptom of menopause. in Singapore, which is myalgia and arthroalgia,

I think this all goes together and really need to be looked at too. Yeah. So as you mentioned about the earlier one goes through menopause, and it's looking at from an average age, we always talk about 51. But here in Singapore, it's 49, and in South Asian women could be 47. So if you think of timelines of the perimenopause, this whole concept of you're too young to be the perimenopause. I'm not saying everyone should just assume they are.

You know, we rule things out, we examine, we check on other organic causes. But there shouldn't be such a thing as you're too young to go through perinopause. Yeah. And as he said, you know, especially at a young age, it's making sure that women get the care they need. Yeah. And that is so important because we don't know. Often it's retrospectively we can see in the age someone started being perimen.

perimenopausal and someone was lecturing to something I went to recently and they were saying there's a early perimenopause and then late perimenopause stage and they were saying one's at age 47 and one's at age 49 and I thought how do you know because you don't know when you become menopausal so it's only like looking back in time but then we know that for most people you want to start treatment in the perimenopause anyway so most of us don't know the data about menopause and it doesn't matter but we know. we don't want to be missing out on those preventative health measures, especially even just carrying on talking about osteoporosis. We don't want to wait to people of menopause and then

start thinking about what can we do to improve your bone density because it's dropping in the perimenopause, isn't it? I think one of the other sort of things we deal with is blood tests, hormone blood tests, requests and having that conversation about when it's appropriate when it's not. But there, you know, it's a lot of tests being done and it's when you have that conversation and explain things, it really makes a big difference. So that's a lot of the times sort of the talks and the education work. Yes. June and I do. A lot of questions come up with, but why aren't you testing my hormones?

Yes. And it's really interesting, isn't it? So we do do blood tests, but we often are looking at vitamin D levels and ferretin and thyroid. And obviously you can't treat unless often in medicine, unless you have. a test result. But it's different in perimenopause and menopause. And that makes people feel really uncomfortable sometimes. But then I often say these people, look, I have migraines. No one's done a brain scan on me. No one's done a blood test to diagnose my migraines. It's gone on my history. And also when I've tried different treatments for my migraine, I have what's called a therapeutic

trial. Someone gives me a treatment and says, this might work. And then like the triptans, you go through different ones and some have awful side effects. so I can't take that again. Okay, we'll try this one. And that is very much the same with hormonal treatment, isn't there? And it's a concept of a therapeutic trial, and the fact that if you want to have a therapeutic trial on or off, that's a choice. Yes. And as long as that choice is educated, you've been educated on that choice, you understand the risk benefits.

At the end of the day, you know, women know themselves better than anyone else. And as you can tell, many women do come to us. with all these blood tests already done, and they've been told, oh, they're not menopausal, go find another solution for your issues. And, yeah, we take the opportunity to then educate them and let them know what we can do about this, regardless of the blood test results. Yeah, really important, isn't it? And then, you know, we choose what exercise we do.

We choose what we eat. And I think treatment for a condition or preventing a condition, is no different actually. It is choice. And I think as GPs, we're used to sharing choices and working with our patients. So it is, as I said before, very privileged to be in this position where we're working with our patients. It's not a one-way transaction when we see patients, and it's constantly evolving. And like you say, the relationship we have is weaved into those consultations, which is so important. So I'm very grateful for your time. There's so much more we can talk about, but I'll have to come over to Singapore or you'll have to come over here.

Yes, please. In your next in the UK, you'll have to come and visit us. I will. Thank you. We always ask for three take-home tips, which is really hard when there's two of you. So I'm going to extend to four so you could do two each. So I'm very keen on two things each that you think for lifestyle that people can achieve that's reasonable. if they're perimenopausal, menopausal, or just listening for pleasure. Because I don't think lifestyle should be that different regardless of your hormonal status or not, or gender or not.

I think we're sure we're having seven lifestyles if we can. So two things each. I go with you, Tash, first, that you would recommend. Certainly. For me, it's go for gold when it comes to your quality of life. Get that protein in, get that fiber in. And ladies, please strength train. I'm talking lifts, some heavy weight safely.

My second is don't be afraid of hormones. What we have now are body identical hormones using the safest way. So have a conversation with the right person and see what works for you. Just don't be afraid. Thank you. Over to you. I'm a big picture sort of person. So I want to say that menopause presents a wonderful opportunity for all of us to

set ourselves up for health and well-being for the longer term. And it might mean resetting, re-looking life goals, rebuilding, regrouping, maybe even reinventing ourselves in order to put ourselves on the right track for the next stretch of our lives. And secondly, knowledge empowers. Do not be afraid to ask questions. Yeah. Do not be afraid to question what you think, is common knowledge and has been enshrined into our health beliefs, right? Do not be afraid to seek out knowledge so that you can make informed decisions for yourself and can therefore take charge of your own health and well-being. Oh, I love that. It's really good. It's all about being in control and knowledge totally is power. And I like the way we can challenge others. We can challenge ourselves.

we can change our mind, we can change direction. It's all achievable. But starting is sometimes the hardest part of any job, isn't it? So people have started by listening, and I hope people have got a lot out of this podcast. I've really enjoyed it. So thank you ever so much for your time. Thank you so much for having us.

Thank you very much for having us. You can find out more about Newsome Health Group by visiting www.newsonhealth.com. And you can download the free Balance app on the App Store or Google Play.