The Dr Louise Newson Podcast - 298 - What is healthy ageing?

Episode Date: March 4, 2025

This week, Dr Louise Newson is joined by Professor Cassandra Szoeke, academic professor, general physician, consultant neurologist and multi-award-winning clinical researcher and author. As principal investigator of the Women’s Healthy Ageing Project, the longest study of women’s health in Australia, she authored the book Secrets of Women’s Healthy Ageing and has several hundred published articles in academic journals. This week's episode explores the topic of healthy ageing, including the connection between inflammation and chronic diseases, the importance of physical activity, mental health, and the role of nutrition and gut health in inflammation. Dr Newson and Professor Szoeke also emphasise the need for a holistic approach to healthcare and the importance of prevention. Click here to find out more about Newson Health.

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 News and Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on my podcast, I've got another guest from the other side of the world. So in Melbourne, Australia, I've got with me Professor Cirkey, who is Director of Women's Healthy Aging Project.

And she is also an author. She's very active, academic and incredibly clever. So I feel very honoured that she's agreed to join me on the podcast today, even though it's very late at night for her. So thanks ever so much, Cassandra, for coming today. My pleasure. So I don't know whether you know, but some of my listeners know that I've got a pathology degree as well. And I spent a good nine months with a professor of biochemistry, actually.

Sadly, he's died now. I wish I could go back in time. asking me more questions, because he spent a lot of time talking about monocytes and macrophages, which are types of white cells. I'm talking about how important they are to fight infection. But when they go wrong, they can become pro-inflammatory, so increase inflammation. And there are various circumstances in our environment that make our body become more against us, really, and increase inflammation. And I was sitting there thinking, oh, what's this got to do with helping people with heart attacks or what's this going to help people with cancer?

Because I wanted to do cancer medicine. And then by the end of the whole course was a year, the BSC, but after nine months, it suddenly clicked. And I thought, actually, this is all related. Like the relationship of heart disease and cancer is there. Like dementia and osteoporosis is there. But no one had taught me this ever before. And that was in 1992.

And lots of people still don't understand. And so there is so much that is. really relevant and even more relevant to the work that I'm doing now with hormones. So before we get into all the science, I'm just keen to hear a bit about your background and how you got to where you are now and what fueled your interest. Well, in Australia, we have a very similar system of medical training to the UK. And so that means we do do general training as general physicians before we specialize in a subspecialty area of internal medicine.

So I became a physician first, which is a very long, long program. And then after that did my training as a consultant neurologist. And then I did an epilepsy fellowship because, of course, you have to know everything about one little molecule nowadays. But I am a generalist in my heart and in my being. And so when I was moving into academia, I got really interested in healthy ageing because the area I actually looked at, which you believe, after doing an epilepsy fellowship, was epilepsy and cognition.

I, of course, had many of the younger patients as a young consultant neurologist, and they were on anti-convulsant medications, and they're all at uni because I work at the hospital that's associated with the university, and they were telling me that on these medications, they just couldn't think as well anymore. So I got really into cognition, and when you start looking at these diseases, if I could say this, the disease we used to associate with aging, thought of as aging diseases,

I suddenly realized that it was this whole encapsulated inflammatory cascades. So all the chronic diseases of ageing have an inflammatory component to them. Which is so relevant. And certainly, as you might know, I trained as a physician as well. So had a long training before going into general practice. And no one really talked about aging or what it meant. And even now, I don't think so, because you just Google aging and it's always anti-aging face creeps, isn't it?

It's trying to keep us young. rather than prevent aiding, and that's quite different, I think. Well, I think there's so many funny things about the word ageing and how it's perceived in Western culture, perceived much better in Eastern culture, actually. But I also think we forget that ageing was 27 in the 1900s, you know. And, you know, 1960s, aging was 50. And it's only in the last two decades,

the mean age has been over 80, age of death. so our perception of aging is an entirely different. And I know you're interested in asking about hormones and aging today. And I mean, just looking at what I just said, when the mean age of menopause is 50 and the mean age of death is 50, then you're not getting many postmenopause of women to be able to do any research or do any study or have any knowledge about what is postmenopause for women. And yet today, in your country and mine where women's mean age is over, Brady, we're living a third of our lives in postmenopause. So this is an incredibly important part of our lives that we know so little about. It's so relevant, isn't it? And I think

somebody recently actually at a meeting I went to, she said, oh, it's interesting, isn't it, because orca whales are the other mammal that has menopause, and it's all about nurturing, and it's about you being there for your grandchildren and your wisdom and knowledge as menopoles or women. And I said, I think you've missed the point, actually. That's part of aging is great because when you're older, you have got more wisdom, more knowledge, you can nurture hopefully better, you've got lots of life skills. But that's not the same as being menopausal without hormones. And, you know, we can't be tortured more than we are already by being not allowed our hormones that do more than just stop a few hot flushes or severe hot

flushes for some women, but it's more than that. And I think for many years, they've been, because they're referred to as sex hormones, but they're not about sex and they're not about gender, actually. They are biologically active chemicals in our body that men and women have them. We all, everybody has them in different quantities and amounts. But like you say, it wasn't so relevant even a hundred years ago because we didn't live so long without our hormones. And the women that did, you know, we only need to look at the, uh, number of women locked up in asylums and, you know, mental health that was misdiagnosed, perhaps when it could have been related to menopause. But now we look at the huge burden of

disease because people are living longer. And sometimes it's not, I'm not blaming everything on not having hormones, but it's definitely a contributory factor. And one of the things about the study which I lead here in Australia, it's the longest running study of women's health in Australia. And what makes it really remarkable is that, that we have those. It was a study looking from pre to postmenopause. That's how it was originally designed. And so it's got all the estrogen, f-sha, L-S-H, all the measures, menstrual diaries, hormon therapy, all of that. However, it was run by a consortia led by a psychiatrist, so all the mental health measures, and a consortia of physicians. So bone measures,

as well as the hot flushes and all of that. And then also cognitive measures, and we have amyloid scans of these women's brains. And, you know, that sort of study is really rare, actually. So you'll get the menopausal studies that kind of stopped after menopause, having defined that transitional period. And so it's actually really rare. I mean, I guess it's rare to get any study funded more than three to five years, let alone the fact for aging, these chronic diseases of aging, so I'm talking about osteoporosis, osteoarthritis, heart disease, diabetes, dementia. These take three decades. decades to develop. So if you're not doing a study for three decades, you can't possibly see

what's actually going on. You're taking snapshots here and there. Yeah. So what's been the biggest things or the most interesting areas that you've found with your research so far? Oh my gosh. I mean, our study has got hundreds of publications because it was going for a decade before I joined as a little PhD student. And I personally have more than 200 publications. So that's a huge question. It's such a huge question. But, you know, I will, you know, if there's a sound bite I can give, it would be this, and it sounds trite, but it isn't.

If there's one thing you go out and do for healthy aging, whether it be brain, heart, bone, inflammation, mental health, the one thing you can do that's best in all of these metrics in all the different papers we've done. It's physical activity. It's the one thing you can do that is actually the best for healthy aging. That's so interesting, isn't it? And I was at an event last night, and we were talking about how to make the best of your menopause

and make it as healthy as possible, and just as we get older, whether we're men or women. And it's something that I don't think I was taught enough about as a medic. We talked a bit, or we learned a bit about ossexual. osteosarcopenia, this loss of muscle and bone mass that occurs, but not the importance of exercise and regular exercise as well, which is so important, isn't that? Yeah, again, I think, you know, we have to look at the fact that we've increased our mean age of death dramatically, exponentially over the last two decades.

And so we're still playing catch-up with what happens when we don't die of a heart attack at 50 or of an infectious disease at 30. Yeah, really interesting and relevant. And obviously nutrition is a key part as well, isn't it? Well, you know, talking about inflammation today with you, you know, the gut is a key role player in inflammation, it turns out, which is something that wasn't known a couple of decades ago. But now we're seeing there's a gut brain axis,

there's a gut everything axis, and it's because of inflammation. So that gut, good microbiome, you know, that's actually having antips. anti-inflammatory actions throughout the body. In addition to, of course, we need key nutrients and micronutrients. With the oversupply of food now, we can all get calories. But micronutrients are really important. In the old days, we had to forage for food.

We were actually getting quite a few micronutrients in all of that veg that was predominant in our diets. I mean, certainly people's nutrition has really changed even over the last few decades. But we see a lot of women, and I speak to a lot of women who have symptoms related to irritable bowel syndrome. So bloating, some heartburn, maybe some constipation, just those symptoms where in the past we would have diagnosed irritable bowel and given all sorts of treatments, actually often really do improve with hormones. And even testosterone can have a massively beneficial effect on people with heartburn and other bowel symptoms. I do wonder how much is a direct effect of the hormones and how much is an indirect effect because the hormones are affecting the gut microbes.

It's just a really interesting relationship, I think, that hasn't been explored enough that I've read, but I think it's something that is so important. I completely agree. We need to do a lot more work in that space, not just that, but the mental health. So, of course, the gut is highly reactive to anxiety. Everyone knows that because everyone gets butterflies in their stomach. before they go on stage. So the gut is highly reactive to our mental health status.

And of course, you know, there's a lot of evidence, especially in hormone responsive mental health, which is a new field that's, you know, developed where people have gone through menopause and they're resistant to some of the antidepressant medications and when put on hormones actually improved. So it's very interesting. We never knew there was hormone responsive mental health.

And it is absolutely key. We see a lot of women who are in quite crisis actually mentally when they come and see us and they've often been seen by mental health teams and been given different psychiatric medication, some of it quite heavy duty. And no one's thought about the hormones. And I didn't realize even when I did psychiatry as a junior doctor because no one had taught me. And now with these women, we often give them hormones for their other physical symptoms, knowing that they're menopausal or perimenopausal. But the first time I did it, I didn't really think that it would improve their mental health as much as it does. Certainly having the right dose of hormones, but also testosterone as well, has an massively, in my clinical experience, beneficial effect on mental health, which was something that has not really been explored much at all. It makes sense when we know the role of testosterone throughout our brains. But I'm not really sure why it's been neglected so much when we know that our hormones are made in our brains and work as neurotransmitters, yet it's sort of been all about periods and fertility when we think about not having our hormones.

I think there's a labelling issue with women's health. So I think often when they say women's health, you know, people go, oh, right, tell me about boobs and bits. Yes. And so, you know, as a neurologist, I can tell you, when I'm at a women's health conference and somebody comes in late to the the seminar and they slip in the back and they look up at the screen and they see a brain scan, they think they're in the wrong seminar. Whereas, you know, to me, the leading cause of death in your country and mine, in women, leading cause of death is dementia. So how we cannot understand that women are brains. So I do think a lot of women's health has been done by obs and guine and they're probably not so focused on the brain. But, you know, as dreneralists,

anything that crosses that blood-brain barrier because not, Not everything does. It's a pretty, that's why we call it a barrier. Yes. You know, not everything crosses that blood bone barrier. And estrogen certainly does and has enormous impact on neural cells. Yeah, and I think that's when you see. I was at an event and it was about translational research, which was great.

It was a real honour to be invited. And they said, oh, Louise, we've put you on this table, number, whatever. And it's with other women's health researchers. I said, but I'm interested in health sort of women, not so much women's health. and they sort of looked really. And of course I'm interested in endometriosis and fibroids and period problems, but I'm more interested actually in cardiovascular disease and metabolic syndrome and dementia. And it's that change.

I think being a woman who's interested in health of women, immediately people think it's gynie problems or maybe like you say, breast problems. But it's not. I really like the way you say that health of women. maybe that's what we should be re-badging it as, because that's the bit that hasn't been done really well. You know, you just look at the amazing investment that's been done. In my country, we have an endometriosis action plan. We have a national plan for PCOS. Breast cancer, survival rates have been going up every year, which is incredible. So when you focus on things,

you can really improve health. So maybe you're right. We need to rebranding. I'm pleased you agree. I totally think it's so important. When we look at, like you say, the diseases that are causing mortality, but also morbidity as well, you know, the longer we live, the more likely we are to have diseases. And they are the diseases that are affecting us day to day. So it's not so much, of course, it is the age we die, but it's our journey to that age. And it's how many times are we going to be admitted in our 70s and 80s, hospital. How is our cognitive state going to impair us? What about our physical state? Am I going to be dependent on a carer in my 80s? I absolutely don't want to. I want to keep strong and

physically and mentally healthy. And that's what's draining our healthcare system and I'm sure yours as well, is people who have diseases associated with aging, but then there are other the people that have accelerated aging and more inflammation, which is compounded by not exercising adequately, not eating the right foods, not having the right hormones, and also looking at stress, looking at our gut microbe, there's everything together. And I think so much in medicine, we can't be siloed. You know, you as a neurologist, stopping your work at the bloodline barrier would be completely wrong. But there are a lot of neurologists that don't look at the Look, I think you're so right. Often when we say healthy aging, people say, what does that mean?

Because they're so caught up in the word aging. And I think, you know, aging is something that's a chronological measure of how many years we've been on Earth. And that, you know, doesn't harm you. So there's many people who die at 99 still carrying some, you know, logs up mountains in those, you know, so-called blue zones where you can find people who are living very very, you know, very functionally and well into their 90s. So it's not the age that's the issue. We forget sometimes that age is also a measure of how many years we've been smoking, how many years we've had high blood sugars, high blood pressure, high stress, as you mentioned.

I mean, the stress issue isn't trivial. I know when we say stress, people might think we're talking about being stressed out, but people who are lonely, who say that they're lonely, we can actually measure that their immune system is depressed. they're more likely to get infections. We can actually physiologically measure the damage to the body from people feeling lonely. So, you know, this idea of stress, I think we're just scratching the surface of what that means for our long-term health. Absolutely.

And there are certain things that will increase the amount of stress that we have. So if we don't sleep, for example, that's going to increase stress, which is also going to have metabolic changes in our body. and I feel a lot of times, especially as a physician in the past, I've been just putting sticking tape on things. And I was reflecting recently about the medications that I prescribe now as a physician. And they're very few. And it's not because I've forgotten how to prescribe, but actually people I see don't need as many medications. Whereas in the past, you know, I was prescribing a lot of statins, a lot of blood pressure lowering medication, a lot of painkillers, a lot of antidepressants actually for people. Because I, you know, I was prescribing a lot of statins.

I was seeing things in isolation and I was very reactive in what I was doing because I was, you know, treating a raised blood pressure or treating a raised cholesterol. Rather than what I do now is taking a step back and thinking, well, why have they got raised blood pressure and why have they got raised cholesterol and what is their nutrition like? What's their exercise like? What's their hormonal status like? And yes, they might need short terms and medication to lower their blood pressure to allow for their exercise, their nutrition, their hormones to be rebalanced properly. But I don't start medications like that thinking I'm going to carry them on for decades. And certainly as an older GP, I would spend a lot of time deprescribing, which sounds a bit weird,

but actually stopping medication is really rewarding actually as a doctor. Because it's so easy, isn't it, to add on more and more medications. and a lot of most medications actually do have side effects, and a lot of them we don't know the long-term effects, do we? Especially on cognition and our brain, but also on our bones and cardiovascular system. Yeah, exactly. And I think, you know, the point you raised about sleep is so key.

People don't think of sleep as important, but as a neurologist, it is immensely important for the brain. And we're talking about it causing stress, And it's not just the kind of you get stressed out if you haven't slept, but we can look at people sleeping and then becoming sleep deprived. And again, measure their blood, measure their cerebral spinal fluid, and actually show there's more inflammatory markers. There's more byproducts that haven't been cleared because during sleep,

those byproducts get cleared. So, you know, it's stressing the system as in pushing a plank too hard so it breaks, not just some sort of mental concept of stress. It's a physical stress to the system as well, not having sleep. And, you know, on the medications, you're so right. I think, you know, what do they call a Band-Aid medicine, where, you know, people keep getting cut and then you put a Band-Aid on, whereas what we should be looking much more at prevention. When I worked at CSRO, which is our Kongwold agency, we had a preventive health flagship, and we demonstrated to the government that they spent less than 1% that the health care budget on prevention.

mention, you know, and I do think that we have, you know, for good reason when we're still trying to work out what diseases were, very focused on fixing problems that we were finding. And what we've got to do is not develop those blocked arteries, you know, not develop diabetes, try and prevent it from happening. I mean, the treatments are getting better all the time. But I think anyone who's living with diabetes would say they'd rather not have it. Absolutely. It's so important.

And we know the chronic diseases of 189. When WHO wrote a report showing 80% can be prevented. It's a degree, and, you know, prevention is key to so much. And I remember going to a lecture about eight years ago now with Professor Walter Rocker, who has actually been on the podcast from the Mayo Clinic, talking about his work, looking at, I'm sure you're aware of it, you know, women who are young who have a bilateral euphrectomy, so they have their ovaries removed under the age of 40,

and the increased incidence of diseases that occur. And I remember thinking, yeah, I know about heart disease can increase. I know osteoporosis, dementia can increase. But then he's talking about even kidney disease, chronic kidney disease, which I hadn't realized at the time, but also all the different mental health conditions. So obviously I knew that clinical depression increases the longer we are without our hormones, but schizophrenia, psychosis, drug addiction as well, the COPD, you know, lung disease. And then thinking, gosh, this is massive actually.

And that's when I think you sometimes do need a light bulb moment, don't you, when you're reading things? And I suddenly then went back home and got my pathology notes out. And one essay I had to write, it was a three-hour essay. And it had to write, is atheroma a marker for cancer? Now, for those of you who are not sure, atheroma is the, you get this sort of fatty deposit lining the blood vessels that accelerates and then that increases risk of cardiovascular disease. it's often the start of cardiovascular disease, so heart disease. And so I read this title. We had like 20 different titles we could choose one three-hour essay.

And I had this and I was like, oh, this is so exciting. But actually it's connecting this inflammation. So the inflammation that occurs in the endothelium, the lining of the blood vessels, which increases atheroma, is actually very similar to this inflammation that occurs with cancers as well for many cancers. And like I said before, when you think about our immune cells that fight infections, especially our monocytes and macrophages, they all can be really, really protective. They're like our army that protect us, not just from infections, but from disease.

But if they've got the wrong microclimates, the wrong conditions, they will turn against us and they will become very inflammatory and produce all sorts of cytokines chemicals that will worsen. And I remember thinking, actually, this is all related because, If you've got low hormones, eustodial, progesterone, testosterone, you've got the wrong nutrition. So you're eating the wrong chemicals, if you like, going into our bloodstream. You're not exercising. You're not just leaving your same stress. And then you add your poor gut microbes.

You can see how the poor body gets completely confused and starts being inflammatory. And then that's really hard sometimes to take back because it's a slow process, isn't it? getting back and reducing inflammation. It is, and one of the things about inflammation in the body is it is a cascade. So once it gets started, it can actually build on itself and get out of control. And every one of these chronic diseases that are aging has inflammatory mediators. Totally. And I also think, you know, I send lots of time with my patients explaining it is going to take a long time.

There's not a quick fix. and you can't, you know, do an exercise class and then expect to feel amazing the next day. Of course, you might a bit. But you have to, your body has to relearn. You know, if you break a bone in your body, it takes several weeks to improve. If you have a bruise on your arm, it can take quite a long time to really improve properly. And I think internally, sometimes we're quite impatient with our bodies, aren't we? And we expect things to happen quicker. And then people can get disheartened. and then think, well, what's the point of exercising or what's the point of stopping all these busy drinks that I'm drinking? Because it's not really having any short-term effect. But longer term, it really can make a huge difference, can't it? Oh, absolutely. I mean, the research absolutely shows that.

You know, it's, I think, again, you know, this focus we've had on the Band-Aid approach, you know, if you break your hip, you get a titanium new one, stronger than the one you had before. And if you block every vessel around your heart and manage to survive, you know, they'll just do bypasses. So we do have this kind of attitude of the quick fix. But again, anyone who has had bypass surgery, you know, that is no small thing. And it's much better to what we're now able to do, even with some of our newer medication, is remodel those arteries.

So actually reverse some of the damage that's been done. Yeah. Absolutely. And I mean, some of the incredible research they've run in the brain, they've shown that exercise can actually increase hippocampal size. Yeah. I mean, our brain is quite plastic in some ways that it will respond. And even just looking at the blood supply through the brain, if we reduce inflammation in our endothelium, we can open up our blood vessels a bit more. Even that will make a difference.

But actually, our brain really does respond to a different environment, which is something that we don't. always think about actually and it's so crucially important. So we've got a lot to do and a lot of it is I feel a lot of my work is educating people so they can make decisions that are right for them. And we are all different. We all know that we could do certain things differently or better and it's just picking what's going to be the best thing for you at the stage of your life to improve your future health and hopefully prevent as many diseases as possible. So I'm really interested to hear about your research over the next few years and how things change and improve. So I'm very grateful for your time today, sharing some of your incredible knowledge. But before we end, I'll always ask

the three take-home tips that I'm going to focus on the brain, actually, because obviously you being a neurologist. So three things that we as women should really focus on. when we're thinking about keeping our brain as healthy as possible as we get older? So I would say the three things to do. One, the physical activity that I already said. And it is just by far, and I mean, we've looked at cholesterol and HDL and LDL and blood pressures. And you can imagine a thousand different things we've looked at at every time

physical activity comes up way in front in terms of its impact on improving brain. The second is to talk about cholesterol. So there's a lot about cholesterol. However, in women, it's not cholesterol. You know, there's the good cholesterol, which is HDL cholesterol and the bad cholesterol, which is LDL cholesterol and cholesterol. But for women, it looks like in all the research for heart and for brain, and of course the two are interrelated, HDL is really important for women.

So that's the good cholesterol and keeping it up. And in fact, because most of the studies were done in men for heart disease and for men, because they have large vessel disease, whereas women tend to get small vessel disease, cholesterol and LDL has been really important for male health. And those medications have all been targeted at cholesterol and LDL. There's now development of medications to target HDL, but the vast majority of our older medications, they actually don't impact on your HDL. But green leafy vegetables and exercise can increase your HDL.

So while we're waiting for the tablet design for women, actually that's the way to improve your HDL. And then the third thing I would say, which women actually do really well, which is probably why we have a survival advantage, is social connection. I think we do underestimate it. And in our increasingly complex and Zoom-related environments and the busyness, where now everyone has to do everything, I think it's really important to remember because it's not about how many friends you have

or certainly not how many Facebook friends you have, but women sometimes feel very alone. They're looking after a lot of people, they're in busy households, busy workplaces, but I think that's really important for women too. So they'd be my top three. I love it. And all of those are achievable

and something that we all should continue to work on. So I'm very grateful, and it's been really interesting talking to you. So thanks so much today. You know, you too, Louise. It's been a pleasure. You can find out more about Newsome Health Group by visiting www.new.org.

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