Dr Louise: Yoga, it's really important for me. So whenever I do a yoga practice, as you probably know, I do a headstand as well. And there's two reasons for doing a headstand. One is I really enjoy it. I think it is really good for me to have that extra blood flow to your brain. The second is something that a lot of people can't do. So when I'm being bullied or pulled down or, you know, put off on the stakes, I think about these people and think, can they do a headstand? Probably can't. So there's a bit of a power.
Dr Rupy: Why do women struggle with weight during and after the menopause? This is the key question I'm putting to Dr Louise Newson on today's podcast, as it is the most commonly asked question that I get from not only Doctor's Kitchen followers, but also from patients as well. She is the perfect person to be discussing this topic, as Dr Louise Newson is one of the UK's leading medical experts on the menopause and has championed women's health for years. I also discuss with Dr Louise the three key things that all women should understand about the menopause. If you don't know Dr Louise, having worked as a GP as well as opening the Newson Health Menopause Clinic, she has built a wealth of knowledge from first-hand experience of treating perimenopausal and menopausal women, and she's also written the fantastic book that I'm recommending to everyone, including patients, called The Definitive Guide to the Perimenopause and Menopause, which lays out everything women need to know to understand and reclaim their power during this stage. It covers key facts about hormones, an essential guide to HRT, navigating early menopause, exercising and eating during the menopause, as well as taking care of your mental health. Today, we also discuss the unlikely way in which Louise found out about her own menopause, which just goes to show how unaware we could all be about these symptoms. Remember, you can watch this podcast on YouTube and you can see Louise's beaming smile in our wonderful new studio, as well as the studio kitchen. And the easiest way to support the Doctor's Kitchen is to go on YouTube, subscribe and hit the notification bell. It really does help us out. And another way in which you can support is by downloading the Doctor's Kitchen app, which you can do for free. You can get access to all of our recipes, specific suggestions, tailored to your health needs. And yes, we are adding menopause as a health goal in the next month. I'm also excited to announce that Android users will have access to the app in the early part of 2024. We're hoping to do it for January. And if you want to be the first to find out about it, you just know what you need to do. You need to subscribe to the newsletter, Eat, Listen, Read, and the Seasonal Sundays one. We send it out every single week. You can subscribe right now in the link in your podcast player or on the doctorskitchen.com/newsletter. And we send out recipes every single week, plus lots of things that I'm reading and talking about and thinking about. And it is the best way to keep abreast of everything to do with nutritional medicine. For now, on to my podcast with the wonderful Dr Louise Newson.
Dr Rupy: Louise, fantastic to have you here again. Why do women struggle with weight during and after the menopause?
Dr Louise: So, great question, but there's loads of answers. There's not one easy answer for that, as you know. So a lot of it is related to the menopause being a metabolic problem, as you know. So oestrogen, progesterone, testosterone all have really important biological roles in our body. So without the hormones, lots of our processes don't work as well. As you know, it's harder to metabolise sugar. You know, a lot of people find that they are more prone to insulin resistance, to type two diabetes because of the changes that occur with oestrogen. So you've got that side of things, but then you've also got the other side of things that a lot of people have symptoms such as reduced motivation, poor energy, muscle and joint pains, absolutely just blunted affect. Like you just can't be bothered to do anything. And it's really hard to describe unless you've been there to just this whole, like sometimes my children text me CBA, can't be asked. And it's that like, oh. So if you're feeling all of that, I can watch you cook and get so much inspiration, but actually, if I it's too painful to pick up a pan because I've got joint pain, if I'm feeling exhausted and overwhelmed and my whole life is catastrophizing, how am I going to then just go, oh, that five-minute recipe looks so wizzy. Oh, but I've got nothing in my fridge. I've got to go to the shops. I've got to. So there's so many reasons where you just pick for something that's not so good. We also know that when your sugar, you get sugar cravings when your oestrogen levels are low. So lots of women, and I did for many years, before your periods is where you just like your body's telling you, I need sugar, I need sugar. And you know, you probably saw it as a doctor, people come to you and think, maybe I'm diabetic because I've got these sugar cravings. And of course, diabetes is when your sugar level's high, but they've always adjust the hypos with diabetes. And for years, I never even thought about, could that be related to hormones? But of course, but if you it's not just a few days, if it's most days, people are. And then poor sleep is a really common symptom. And you know, and I know that if you're tired, what do you do? You make yourself a drink. Oh, maybe I'll have a biscuit. Maybe I'll, you know, just to try and keep myself awake. So there's so many reasons, but it's really hard for women actually, for those women. Some women don't. Some women will fly through, not have any symptoms, not have any weight changes, but it's really hard. And I know I look back with so much regret as a GP because so many women would come to me and say, do you know what, Dr Newson, I have not changed anything. My lifestyle is the same, my exercise is the same, my diet is the same, and look at me, I'm putting on weight. And that also happens because our bodies are designed to have oestrogen. It is a hormone that's really important for us, as you know. So if we don't have it, what does our body do? It tries to make it. Well, you might know, I only realized more recently that our brain produces oestrogen. It's not just about our ovaries, but if we haven't got enough in our bloodstream, our fat cells produce oestrogen, but it's a very weak, it's not a great type of oestrogen. It's actually oestrone rather than oestradiol. It's very inflammatory, but it's more commonly made in the fat cells that are in the midline. So that sort of midline spread is often your body going, can I have a bit more oestrogen actually? So lots and lots of reasons why it happens.
Dr Rupy: It's so interesting, isn't it? That middle-aged spread that a lot of women struggle with. And I remember like getting loads of questions about this as a GP and not really having a full answer for it until I realized that link between fat cells producing that weak agonist for oestrogen and just overproducing and you just get the consequences of the oestrogen deficiency. It's pretty amazing actually. Your your body has evolved to try and adapt as much as possible.
Dr Louise: Of course it does. And it adapts all the time. I mean, our hormones are so interesting, aren't they? Because they never flat line. They're always and they're working with other hormones as well. But I know myself when I was in my mid-40s, I've always been fairly slim. And I looked down and where my seat belt was across, I'm like, oh my god, like where's this little bulge come from? And that that sort of muffin top thing. And I remember once my mother who doesn't mince her words said, you've put on a bit of weight there. I was like, what do you mean? And and also I was really irritable as well because I didn't realize at the time I was perimenopausal and I found I just go, you know, really lamping her saying, but she was right because I had put on some weight, but I had no idea why. But also, even if you just think about sleep, okay, I'm really interested in sleep because it's so important. As you know, it repairs our body, doesn't it? It's it's crucial. When we've known for many years that poor sleep is associated with increased inflammation in the body, increased risk of diseases, but also obesity as well. And as you know, if you don't change anything, but you don't sleep very well, you will put on weight. That's just medical fact, isn't it? So there's so much against menopausal women actually.
Dr Rupy: I mean, I I love the way you sort of introduced that framework of thinking. It's not short-termism. It's not something that happens over a couple of years and then goes away. It's something that you're going to have to deal with and and figure out a strategy for over the next 30, 40, 50 years. Um, and I think getting into that mindset of thinking about the long term is really important for people. So you're actually laying down a plan for life rather than just something that is in isolation.
Dr Louise: Absolutely. And I think that is crucial and I wish I'd thought more about it at medical school and I'm sure you do as well. Like, why are we just thought or taught to be reactive in everything? Why do we wait for a disease to happen and then go, oh, we can give you a treatment, we can give you a drug. Like, why can't we be thinking, what can I do to be the best and healthiest version of myself? And how can I reduce the risk of diseases? Not just proper diseases, but also my mental health, my physical health, my my sleep, everything it all interacts. And we just don't get taught that. It's always like, wait for you to have your type two diabetes or your hypertension and then we'll address it. Or you know, and and that's such a shame. So the the earlier we think about and add a layer and complexity of hormones, the sooner we can do something about it.
Dr Rupy: I I think we could definitely talk a lot more about the sort of the medical system and everything. Let's drive home some key messages for our audience here. I I I voice noted you yesterday. I was like, I want to change up the podcast a little bit and just give sort of three large sort of nuggets of information that at least anyone listening to this, man, female, can can take away from from our conversation. So, if there are three things, let's dive into the first nugget of information that people should take away from the menopause and and what you want people to to know.
Dr Louise: I think the most important thing is for me as a physician is that the menopause is obviously something that happens to every woman at some stage in their life. So 51% of the of the population directly will be affected by it. So we can't ignore it. That's the most important thing, I suppose. But also that it's related to our hormones and it's bigger than just a few symptoms. The symptoms we can talk about and of course they can really affect adversely many women, but it's about the longer term effects of those hormones not being there in the body. So I've really thought and challenged people for a while thinking it should be actually rebranded and reframed as a female hormone deficiency with health risks because if you talk about a deficiency, if I told you you were iron deficient, you'd be going, well, how do I get iron? Do I take it? Do I eat it? What do I do? Um, and after all, that's what it is because our ovaries stop working either because we're older or because they've been damaged or removed or whatever. Obviously, I've already said the ovaries aren't our only source of hormones, but they are an important source of hormones. So without them, we have to think about the consequences. So I think that's really important because we know oestrogen and testosterone and progesterone are very anti-inflammatory in our body. If we don't have them, we have more inflammation, we have more inflammatory diseases, heart disease is number one killer, isn't it? With dementia globally. We know taking hormones back reduces the risk by 50%. We've got to wake up to these statistics. It's really important that people understand that hormones are not there just for fertility or not just there for our periods. They go into our brains, they go into our bones, they go into our bloodstream, they go everywhere in our body. So thinking about what the menopause is is really important. I think the other thing that's really important is actually thinking about the treatment for the menopause.
Dr Rupy: I just want to go on to just double click on that point around rebranding this period, um, or this this stage of of life that leads to, you know, um, the the the next phases of someone's life. A lot of people have an issue with the terminology of female hormone deficiency. Why why do people push back against that sort of idea of rebranding it?
Dr Louise: I think it's some of it is due to ignorance in the in the huge, you know, the the true sense of the word because we've been taught for many years that menopause is when periods stop. It's a year after the last period. So it's all about gynaecology. It's about and if it's not about periods stopping, it's about fertility. Now, I have a bit of an issue in that. Firstly, I don't want to wait a year to diagnose any of my patients. Like, how weird? Like you see someone and go, no, come back in a year's time. I can't diagnose you yet. That's just doesn't happen, does it in medicine? But then a lot of people don't have periods if they've had a hysterectomy or they use a coil. You know, that's a really weird concept to be defined by your periods. The other thing is people talk about reduced or no fertility. And I also have an issue in that. Not everyone wants children, not everyone wants to be defined whether they're fertile or not. And for many cultures, it's actually really negative to not be fertile. So they don't want to know whether they're fertile or not because they it could really affect their status in their communities. But also about 3% of women under the age of 40 have an early menopause. And a lot of those women are not infertile, they have reduced fertility. So we can't define it by fertility. And then I suppose, you know, I've got a pathology degree, I'm quite geeky. So I think, well, what are hormones? What goes on? What what gets produced? Well, these hormones go into our bloodstream and they're just chemical messengers. And then when you look at the power in their brains, so when we look at balance app and look at how many, which are the commonest symptoms that people are registering and logging, it's brain fog, it's anxiety, it's low mood, it's memory problems, it's fatigue. So it's not about what's happening in with our gynaecological organs and it's not even about flushes and sweats. So then you think, well, what's going on in our brains? Well, actually, these hormones are neurotransmitters. They're chemicals that help other neurotransmitters. They all work really well. And I read recently, it's very interesting actually. If your brain is damaged, one of the first things it does is produce more oestrogen to repair the brain. Wow. I did not know that. No. And this is an article from like 20 years ago because we know how important oestrogen is. Isn't that interesting? Yeah. Yeah. So you you sort of think, well, actually, then it is a deficiency because that's just fact. You can argue that black is white and people do, especially on social media, but actually, if you've got lower hormones because your ovaries aren't working, maybe deficiency is not the right word, low levels of. You know, but that's essentially just describing what it is on the tin, isn't it? But I think also no one's been interested in the menopause for many years because like we weren't taught about it, were we? Which is crazy. Yeah. We talked about this last time. I couldn't believe just how ignorant we are. And then it's sort of been handed over to the gynaecologist because of the definition of fertility and periods. And no disrespect to gynaecologist, they're very good, but they're surgeons at the end of the day. They want to be seeing people who have pathology of their organs, so, you know, fibroids, endometriosis, different gynaecological cancers. They don't really want to be dealing with people who have a systemic illness or a systemic symptoms. The same way that if I had an underactive thyroid gland, I wouldn't go and see a head and neck surgeon. I would see an endocrinologist. But then actually, endocrinologists for some reason don't get taught very much about sex hormones. Um, in Australia where I've just been, it's a lot more endocrinologist, but over here it's always the gynaecologist. And so then again, the gynaecologist, as you know, have quite quick training into gynaecology. They don't do general surgical training, they don't do medical training. They just really go straight into gynaecology. Whereas actually, you know, I've got a massive medical background. So I've done cardiology jobs, rheumatology jobs, I've done um, neurology jobs. You know, so I'm used to every system in the body. And so then when you think about our hormones getting everywhere and you think about the diseases, you know, if I say to a gynaecologist, how many people have you seen with dementia? How many people have you seen with osteoporosis? How many people have you seen with having a heart attack? Probably most of them will say none because it's not part of their training. Whereas most of us will go, yeah, I've seen loads. And actually, I've I've seen so many women with osteoporosis that have been in so much pain, I would never want to be like them. Or so many women who've been, you know, late diagnosis for a heart attack because we know the presentation is quite different in women. So that's where I think it's just and the other thing I think is that it's really sad, lots of people don't have this professional curiosity. I think as you know, medicine's really hard and it's getting harder. So you're on this hamster wheel of like, well, I do this because that's what I've been told. You know, I've been told that X medicine is really good for Y disease, so that's what I'm going to do. And if you haven't got that curiosity, you don't go home and go, oh, let me just read the guidelines. Oh, let me just look at the original paper. Let me just see. And you know, I'm very fortunate. I've worked with the Royal College of GPs for many years and I used to write a lot of their essential knowledge updates. So when a new guidance came out, I was to summarize it. Yeah. Which is quite hard, but you have to go to the original sources. You can't take the top line headline. It's like reading the front page of the Daily Mail and thinking everything's true. You've got to go back to the original sources. Yeah. Um, but so much in medicine, we're all so busy that you do read the top line and then you forget a guideline is just a guideline. It's not law. And medicine is an art as well as a science, but you have to be backed by the science, by the right sort of science as well.
Dr Rupy: Yeah, I I think that thread around professional curiosity is a really, really interesting and important one because there is an assumption from people who aren't in the field that we do do deep dives into academia, we do know the guidelines inside out, and we do have this deep curiosity of things that are outside our discipline. And I remember like when working in A&E, so I've done for many years, I was the one to sort of introduce that curiosity to my colleagues. And actually what happens in a lot of cases is people tend to get curious around sort of nutrition, for example, or lifestyle medicine if they've had an insult to themselves or someone that's very close to them, rather than the patients that they see in the first hand. And then after they've had the introduction, that's when they're like, oh, I had that patient. Yes, I can understand like put the dots together. So it's a really interesting one, but I I feel like this curiosity is sort of growing, I would say, perhaps because of the rise of social media and people like yourself talking about it. But um, that's a that's a really important point that I wanted to underline there for the for the listeners.
Dr Louise: Yeah, it's it's really important. It's really important that people are engaged. And actually, I think what's happening with a lot of my work is that people who are being affected are quicker to understand what's going on than maybe the clinicians that are looking after them. Yeah, yeah. And, you know, I've I've just reread Elena Cleghorn's Unwell Women. It's the most amazing book. But you know, women have been neglected for centuries. You know, we've all been made out that it's our womb is is what's evil for us. And if you think of the word hysterectomy and hysteria, you know, we were locked up in asylums many years ago after having a hysterectomy. And then, you know, people have for many years documented people's um, mental health has changed throughout their cycle and they thought it was our womb wandering in our body that was causing this. Um, and then they've looked at different ways to try and suppress women's um, mental health, trying to improve them. So, you know, even giving lobectomies to to women. Yeah. You know, it's women just it's almost convenient for women to be quiet and silenced. And, you know, mother's little helpers, the benzodiazepines that were given. Of course, that was just to try and quieten down perimenopausal and menopausal women. And so again, we're sort of putting our head up going, hang on, mentally, it's really affecting us. No, it's all about flushes and sweats. Don't be ridiculous. So, yeah, it's it's there's a bit of the science, but there's a bit of a women are just not being heard. And it's gone on and on and it's going on. But I think what's happening with our generation because of social media is women are going, actually, no, this isn't right. I want a choice. And I think that's where I said at the beginning, it is about choice. You know, if I was sitting in front of a doctor and they said, look, you could choose to have your natural hormones back or you could choose antidepressants for your low mood. I don't know whether you've got clinical depression or it's your hormones. Which would you like to try? Well, I'd go for some natural hormones first, thanks. And if they don't work, I'll continue them because they've got health benefits, but I'll take an antidepressant as well. But I wouldn't just go and have an antidepressant. Do you see what I mean?
Dr Rupy: You want to look upstream and you want to get to the foundation of the problem, which I mean, there's a big sign there, like this is what happens to your hormones. So why don't we try replacing those?
Dr Louise: It's not rocket science. It's actually not. And Rebecca Lewis, who you know, the clinical director with me, often referred to me as Simmelvice. And uh, I don't know if you know the story of Simmelvice. No, no, tell me. Really interesting Austrian gynaecologist. There was a play recently called Simmelvice, um, which Mark Rylance played this guy. He was an amazing play. But he basically was a gynaecologist in the 1800s and half of the hospital he worked at, the women were delivered by gynaecologist, the other half by midwives. But the mortality rate for the women and the babies. Yeah, okay, yes, I know the story. But no one believed him when he said there's a there's a difference. And so the main guy said, it's because of the building layout, the windows, there's something happening with the windows or whatever. So when he went on holiday, he swapped them so that the other side were doing the the the deliveries for the doctors. The mortality rate was still higher in doctors. And then he suddenly thought, what else is going on? The only other difference is they were doing the postmortems next to the delivery suite for the doctors. And the women, of course, weren't allowed to go into the postmortem, the autopsy room because they were of a, you know, nervous disposition, of course, women are so much more fragile than men. But they would wear the same aprons, have their dirty hands and then go and deliver a baby. So he then thought, maybe if we wash our hands, there's something and no one knew about germs then, but there's something coming from our hands and the aprons to these women. And they just said he was mad and he was excluded from all professional societies. Oh, I didn't know that. He wasn't allowed to to present his data. He kept saying, they said, no, it's not. No, it's not. And in the end, he ended up in a mental hospital and he was straight jacket and he was beaten to death. And it's really sad. I had no idea about that. Yeah. And now it's like, you know, what's the biggest thing that's made a difference to health is hand washing, sanitation. But he was really, really and and so many times, like I I as you know, I get really upset with not being listened to often. And I often say to my husband, am I demented? Am I mad? Have I have I misreading certain papers or academic articles because I'm so convinced how healthy hormones are, but I I can't read any of these other papers because they're not there. It's just white noise of people trying to sort of shut me down. But it's, you know, and even if you look at Louis Pasteur, he wasn't even a doctor. So no one believed him. It's really interesting. I didn't realize that either. What? Oh my word. No, I gave a presentation. I'm I'm on the board of something called women, which is women in medicine International Network. And I was talking about medical gaslighting and the menopause. So I was just about to say it sounds like you've been gaslit by women are, you see. Women come to see us and they say, I've been told it can't be my hormones. I've been told I need a relaxation tape. I've been told, you know, we see lots of women who are on antidepressants, on antipsychotics, on lithium, ECT. Recently seen very few women have been given ketamine infusions and they've said, I think it could be my hormones. No, it's not your hormones. You've got bipolar, you've got manic depression, you've got schizophrenia. So it's so they're being gaslit really, aren't they? It's Yeah. Yeah.
Dr Rupy: This brings us on to the second point. That was a long number one. Yeah, no, it's great. I mean, I got two stories out there that I hadn't come across the Simmelvice and the fact that Louis Pasteur wasn't a doctor. I'm going to do more reading on my medical history. Um, so treatment, yeah, so this is a obviously a very big topic that you're very passionate about.
Dr Louise: Yeah, so I think the other thing with number two would be looking at treatment when we think about hormones and looking at rather than what are the risks of taking it, spin it on its head just for maybe for just next year. Let's just do it for a year and see what happens. What are the risks of not taking hormones? And I think that's going to be a really interesting question that people should be asking themselves. And there will be some people who won't want to or have been told they can't. Some people have been told they can't. There's never a no in medicine. There's a, there might be more risk, let's discuss it. But we can also think about vaginal hormones because everybody can have those, whether you've had an oestrogen receptor breast cancer or not, they're still safe. And the government have recently put out something trying to reduce urinary tract infections because urosepsis is really common in women. So that's sepsis as you know, due to a urinary tract infection. Lots of women have cystitis, lots of women have urinary tract infections. And there's overwhelming evidence that using vaginal hormones, either oestrogen or um, prasterone, which contains DHEA, so it converts to oestrogen and testosterone, really reduces, you know, urinary tract infections. So those should be considered first line. So if anyone's on a treatment for an overactive bladder, for incontinence, if they're using Tena lady pads or incontinence pads, the first thing they should be thinking of, why am I not using vaginal hormones?
Dr Rupy: Is this something, do you have do we have any stats on the prevalence of those symptoms? Because from my anecdotal experience, very common.
Dr Louise: Oh, it's really common. And you know what, a lot of women won't say. So some of my friends will say, no, I've got no problems. And then they'll go, oh, but I've stopped running now because, you know, I just get a bit of a trickle or coughing and sneezing or so they're but that's normal. They're sort of it's been normalized so much. And some of the marketing for the pads and whatever else has helped in some ways, as in it hasn't helped really, because people then go, oh, well, I just pop a pad in and everything's fine. But it's not. And it's literally a sticky plaster. Yeah. And then also, obviously, there's big pharma, so there's lots of drugs now that we can use for overactive bladder, but they all have side effects. A lot of them are based on like an oxybutynin, affects acetylcholine, antimuscarinic. We know those drugs increase risk of dementia. I've already said menopause increases risk of dementia. Why on earth would you take that? Some people, don't get me wrong, need to have these drugs, but if anyone's on those drugs, they should also be using vaginal hormones. And we've been doing some really interesting work with some people and some urologists in America who've done a lot of these studies. And it's outrageous actually that we're not giving, you know, um, vaginal hormones first line, not even just to people who are menopausal or perimenopausal, but women postnatal, women who are on the contraceptive pill, any woman who has urinary symptoms, we should be thinking about that because they can also improve the flora, the the the microbiome of the vagina as well and have really beneficial effects. And they're really low dose and they're really safe. You know, in medicine, you want the safest thing first, the thing with the less side effects, with the best efficacy. And so that's something that I think question two should be, why am I not on either systemic hormones or vaginal hormones or about 20% of women on HRT need vaginal as well. So thinking more about hormones.
Dr Rupy: This is what I love about you, Louise, because not only do you bang the drum and not only do you give the information out to the public, but behind the scenes and perhaps people don't realize this, you go and you speak to the specialist directly. You go and present to the conferences or the meetings or whatever. And so you're actually speaking to the urogynaecologist, the urologist, what you know, whatever discipline. I mean, you're probably like inundated with how many meetings you have to go to because of the fact that menopause affects so many different specialties, right?
Dr Louise: But you know what, I love it because, you know, in medicine, it's about connecting with people and sharing knowledge. And I think that's probably why I'm disrupting because some people don't like knowledge being shared even with patients. But actually, I feel it's almost like our duty to give our patients as much information as possible. And I've always done a lot of work as a medical writer and everything else because you get better consultations, don't you, when your patients come from an from from power and knowledge. Um, but it's also collaborating. So part of my am I Simmelvice type, am I going mad? Is that, well, let's talk to other people and see what they're doing and talk to people I really respect. So when I've been talking a lot recently to the most amazing Lisa Mosconi, who I'm sure you know, a neuroscientist. Yeah, she's been on the pod twice. Yeah. And um, I've just been looking at her new book, which is coming out soon. I've just read it all and gone through it with a red pen so the hormone bits are accurate. And and she's brilliant. We had such a great call, but that three years, maybe more, five years ago, I spoke to her and she's like, oh, hormones, oh, HRT, oh, because she's not a doctor. She's a neuroscientist. So she's working with doctors who talk about the risks of HRT. So she was a bit sort of, oh, Louise, you you would say that. And now she's like, oh my goodness, the role of oestrogen in the brain and we're going to start researching testosterone in the brain as well. And she's just come and that's what you do. If you're a really good, clever person, you know, if I'm telling you black is white, you'll go, don't be ridiculous, but actually, maybe she's got a point. Maybe I ought to go and read. And that's where the conversations are just brilliant, you know, because Lisa has gone off because I've been pushing her and sending her papers. And then she's like, actually, Louise, yes, this is, you know, and then I said to her, look, none of it is very surprising. She's telling me about some of the studies that she's done, which she'll report on soon. And I'm talking about my clinical practice and it they all work. It's the same. So it's that and that's where when you when you talk to like-minded people, and that's where medicine can make advances because we have to look, you know, when Sackett talked about evidence-based medicine, you talk about the clinical evidence as well as the scientific evidence and marrying them up. And I think for too long, people have tried to make the menopause into a scientific evidence thing on very limited evidence. And that's part of the problem, as you know, with the WHI study. They've been trying to just look at the data and it you know, people don't work out of textbooks. You know, we're all different. So we all have different symptoms. We have different life experiences. We have different requests for treatment, but that's fine.
Dr Rupy: Yeah. And I think that's where the clinical experience really pays dividends because you can have that frank conversation with someone about the benefits and the risks. And I think it's an interesting idea to flip it on its head in terms of, okay, here are the risks, but these are the benefits or what are the risks of you not having this treatment, for example. So it's a it's a it's a good thing, I think for us as clinicians to think about often as well.
Dr Louise: Yeah, I think so, because it just just opens your mind then, doesn't it?
Dr Rupy: Yeah, absolutely. Okay, so that's number two. That was slightly shorter. I thought you were going to go for a bit more actually. Yeah. Sorry, I just put it in there, isn't it? That's good. That's all good. Uh, so what what what would you say is the third thing that all people need to to know about the menopause?
Dr Louise: This might sound really obvious, but I think people need to know that the menopause lasts until the day we die, because so many times people think, I'll just get through it. I'll get through to the other side. I'll battle through my symptoms because my mum did and my sister did and my auntie's doing it or whatever. Um, so I think that is a really important thing. And even clinicians often think it's it stops when symptoms stop. Yeah. Yeah. And I think we need to remember that it doesn't stop. You know, and so then it makes us sharpen our minds and think about more what we're going to do. Yeah. So I think that's a really important. It's quite a short one, isn't it?
Dr Rupy: No, no, no, it's quite it's very important though, because if you think about it through the spectrum of what happens after the menopause, you know, I mean, we've talked about some of the depressing statistics regarding increased risk of uh, osteoporosis, increased risk of dementia, increased risk of cardiovascular disease and coming up with a plan. And you're coming up with a plan of how you're going to deal with that and balance the risks of treatment and all the other things that you do talk about in your books as well regarding nutrition and lifestyle and mindset. I think that's an important consideration for medicine in general, not just through the lens of women's health.
Dr Louise: Yeah. Yeah, no. It's really important because thinking, you know, and I we won't need to discuss it now, but you know, is is the menopause an illness or is it a disease? I could talk for hours about that. It's the same as you could probably is obesity a disease or an illness or is it not? And actually, you know what, I don't really care. It's associated with health risks and that's what we've got to wake up to. And it's the same with hypertension. Is that an illness or a disease? Because it doesn't cause symptoms. You know, if I had high blood pressure today, it probably wouldn't cause me any problems. The problem is it will last unless I do something about it. And it's exactly the same we need to think about that side of things.
Dr Rupy: That's a really good parallel to use because in a lot of cases, hypertension doesn't have any symptoms. What I keep on telling my patients, I keep on telling my family members as well, like just because you can't feel anything, doesn't mean you're not at high risk. And I guess that's a fantastic lens to view menopausal women who do not have symptoms.
Dr Louise: And I think that is crucially important because there's so much, like I've already said of women not being listened to. So sometimes even at some of the meetings where they're more senior meetings with sort of government or whatever, and I'll say, well, take the suffering away. Just pretend no one has any symptoms. We still need to think about the health risks. And that sort of plays with people's minds because for so long we've only thought about symptoms of the menopause. And I think that's the only way where we're thinking about global health, how important it is, because then there's this thing, well, in some cultures and languages, we don't have a word for the menopause. And Japanese women eat more soy, so they have less symptoms or or Asian women don't have symptoms. Well, of course they do, but they don't talk about it. They might talk about their total body pain or they might talk about their headaches. But of course, but let's forget about the symptoms. Let's look at Asian populations or some Asian populations where there's a far increased risk of cardio metabolic problems, increased risk of type two diabetes and obesity. And actually they have a lower average age of the menopause. So let's just think about it as a metabolic, it's a cardio metabolic problem, the menopause. So let's take the symptoms away and then that really blows people's minds, but we have to.
Dr Rupy: I want to talk a bit more about your light bulb moment uh that you referenced at the start of your book. Uh I can't remember it was both books, but I think it was certainly probably surprising for a lot of people that someone who has seen thousands of patients themselves didn't recognize the symptoms themselves of of of the menopause. What could you tell us a bit about how you found out?
Dr Louise: It is so embarrassing. So because it was in 2015, so um, what happened as a medical writer, I I already said I do the essential knowledge or I did the essential knowledge updates for the Royal College of GPs. So my remit was to review the nice guidance that had just come out. And um, actually I was training to be a menopause specialist, so I'd done a two-day course the day the nice guidance came out. Um, so that's only eight years ago now. And I thought, oh, this is interesting. And I'd before that, if you were my patient and you came to me and said, I'm getting flushes, I'm menopausal, I'd give you some tablet HRT. I really was a one-size fits all, just have it. Because I didn't know what else to do, you know? Um, but I wasn't looking for it, if you see what I mean, and I didn't realize all the myriad of symptoms and so forth. So as I said, when you are asked to write something, you can't just do the top line. So I had a couple of weeks where I literally, it was a lovely, I love like reading papers and getting very excited by science. So I literally went back to the the papers, but a lot of the papers were pre-WHI, so before the women's health initiative study, which flawed um, HRT prescribing. And looking at all the biological effects of hormones, reading about inflammation, and I did a lot about inflammation in my pathology degree. So I even got out my notes from 1992 many years ago. And it all just then suddenly you get this light bulb moment go, wow, wow, wow. Writing all this. And then um, I became a fellow of the Royal College of GPs and we had a family lunch and a family friend said, Louise, you've got so much knowledge and information, why don't you set up a website? And I went, I've got not time for that. And the next day, I had this menopause doctor.co.uk website in my inbox, like, just click on this link, said Anthony, I've set up some basic stuff. So I started writing some information um, because this was writing for non-clinicians. But then I was really tired and I write a lot and work a lot in the evening because of having three children, it's the time when they've gone to bed, I run to my desk and that's it for the next few hours. And I kept looking at my husband and go, Paul, I'm just exhausted. Like I feel like I'm pregnant. I knew I wasn't, but it's just this like you've been drugged tiredness. It's not, you know, sometimes you're a bit tired, you know, that 3:00 in the afternoon slump, you go, right, I'll just maybe have a cup of tea or I'll do something or go and get some fresh air. Like you couldn't and I was and Paul, I've known him since I was 18, just goes, yeah, you look a bit rubbish actually. You're like, you look really sallow, you look with. So then I was like, I'm really cross, really. Everything was just an effort. Everything was like thinking through treacle and I just couldn't be bothered. Like I was saying at the beginning really, a lot of those symptoms. I do quite a lot of yoga, but I was just whenever I did with my Lycra on, I'd look down at my tummy and think, oh no, this is like, you know, I'm putting on weight. I had muscle and joint pains. So that was yoga, if you, as many people know, do yoga, if you do a good practice and flow through, it's lovely. But if you don't, you feel like a rusty tin can, it's horrid. Um, and I just was getting less and less interested in things, but the worst thing was I was getting night sweats. So I was waking up at 3:00, 4:00 in the morning, just dripping in sweat. I'm not a sweaty person. And I'd look at my husband sleeping and think, I can't wake him up, but I need to strip the bed. So I feel like I've wet myself. Honestly, it was horrible. So I'd go and get a towel, lie on it, think, oh, and then because I think I said to you, I had pancreatitis many years ago. As part of my recovery, I was getting a lot of night sweats. Okay. Probably because the pancreatitis had affected my hormone levels then, I don't know, but that's another story. Yeah, yeah. So then I said to my husband, oh my gosh, I'm really worried about my pancreatitis coming back because it was so awful. And he said, well, maybe you've got a lymphoma. And I said, oh, yeah, because a lymphoma, that's a type of cancer where you get night sweats. So, you know, you always catastrophize as a doctor. I love how he suggested that so casually. Oh, maybe it's just. And then I said, but I don't want to go and find out because I want to set up this menopause clinic and I want to, I'm just starting doing this work. Classic Louise. I know. And Jessica, my oldest daughter was showing me how to use Instagram then because it was like a new thing. She's like, Mommy, post every day. Some of the stories you're telling me in the clinic about people who are tired, have joint pains, who are waking up in the night, you know, all the things that I was getting. I thought, oh, okay. So I said, I can't, I haven't got time to go to the doctors. I really don't want to. Let's just leave it a bit and see. But I was getting worse and I was feeling awful. And then I thought, maybe I'm depressed. Then my migraines were getting so much worse. And my my dad when he died, he had a brain tumor. So I thought, and he presented with a headache. So I'm thinking, oh no, what else is going on? And it's quite horrible actually. It makes me realize for patients, when you don't know enough, you can really easily catastrophize about your health. And then I thought, well, I'll never get an appointment. And who's going to take me seriously? And I've only got a 10-minute appointment. So do I talk about my headaches or my joints or my low mood or my, you know, it's like it's and then I won't be taken seriously if I go and say, I think I've got a lymphoma. You know what I mean? It's just you've really got the like the experience of a true patient there. And then, um, and then I remember very, very clearly actually, as I said to you, we're very fortunate, we've got an arga in our kitchen. So it's quite warm in there anyway. And I was chopping an onion, trying to cook ready for the next day because I always sort of prepare a lot of food. And my daughter, my middle daughter then was about 13, 14, and she was just getting into a bit of social media, flicking her hair. She's um, she's great, but she's always pushed me on the edge a little bit. We're very similar in personalities. That's why. So I said, Sophie, you just need to switch your phone off and go upstairs, have a shower, go to bed. I'm really sick of keep asking you. And I remember putting down the knife thinking, God, this is really frustrating. She went, Mommy, do you know what? You are so miserable. You are so angry all the time. Do you think maybe you need your period? Because you're a bit like some of my friends who get a bit emotionally labor just before their periods. And then I remember putting down the knife and going, oh my goodness, Sophie, I've not had a period for months. And then it's this complete light bulb. Ah, all these symptoms that I'm having, of course, that's what I'm writing about. I was lecturing to people saying, it's not about hot flushes and sweats, it's about. It was just this amazing. So I felt like hugging her, although I couldn't because obviously I was cross with her. Yeah. But then, you see, this is the next part. And I think this is what drives me to work so hard, is then I sat there thinking, right, so how am I going to get help? How am I going to get HRT? Because I knew from my friends, the practice I was registered at, there was only one doctor that would prescribe HRT and she was part-time, and she was still only prescribed like the tablet type and I wanted the the natural body identical hormones. So I thought, what do I do? I can't prescribe for myself. I can't get my husband to prescribe. I want to see someone properly. I want to really, you know, have a good treatment plan. So then the consultant that I knew really well, I knew was really fully booked. So I phoned up and it was in the June time. And he said, the receptionist said, oh, the appointment's the 23rd of December. I was like, do you know who I am? And it's like, of course she doesn't know who I am. Like I was so cross. I have apologized to her since. I was so But then, but this shows how bad my mind was, because I remember being with my daughter Jessica, we were just having a a drink. We'd gone out somewhere in London because I remember we were sitting outside and saying to her, look, in 10 minutes, I've got to make this really important phone call because he's this guy fitted me in. He said, I can talk to you at 9:00. So great. So it's 10:00 to 9:00. I said, look, in 10 minutes, I'll make this phone call. 5 past 9, he phones me and says, Louise, you were going to phone me. I was like, oh my god, I'd forgotten. That's how bad my mind had been, which again is quite hard to describe when, you know, when your mind's working, but it was everything was so difficult. And I was like, oh, I'm so sorry, I'm so sorry. Yes, I really need your help. I'm really struggling. And and then I started HRT and my mother-in-law who's been on it for many years and my mum was like, so you're feeling better? And it's like, no, I'm not. I don't feel any different. Maybe my night sweats have improved, but nothing really felt better. I increased my dose of oestrogen, felt a little bit better. And then the consultant said, what about trying some testosterone? I was like, oh, right, isn't that male hormone? Isn't that going to give me a beard? All the things that people needlessly worry about. But I'd already written, don't forget, a lot about testosterone, read about it, read about its effect in our brains, in our muscles and so forth. So I said, well, there's nothing to lose. And I um, started using testosterone after about three or four months, I was like, right, this is amazing. I have come back and I should have really started it probably 10 years ago. You know, I it's and and then I thought, actually, this is so wrong that even me as a white middle class educated doctor struggled to get the right treatment that I had to pay for. Like, why is this happening? And so I think that's what was the sort of the final thing that thought, you know what, I'm not going to stop until everybody that wants hormones can have them. And whether that's 10% of people or 90% of people, I don't really care. But that's where it's about choice. And that's where it's been stripped really because I can't think of any other medicine that's evidence-based, that's in nice guidance that's being denied to people. Yeah. Yeah.
Dr Rupy: It's a it's an incredible story and I just love the impetus that was your child having to tell you that you're menopausal.
Dr Louise: It's quite something, isn't it? I know. But I think that's the that's where if I could have number four, which you probably won't let me, is like everybody needs to know about it. It's not a woman's problem because 49% of the population will indirectly be affected because they'll know someone. And I don't know if you saw I did a podcast with my 12-year-old daughter. And I saw it on Instagram. I saw a snippet. She's so sweet. Well, I was doing my 20-year-old because it's it's like kick-ass generation. Like she uses body identical hormones for her migraines to to smooth over her hormones and that's her decision and it's worked really well because she gets some PMS as well. But when I was trying to arrange the date, my 12-year-old says, well, Mommy, what about me? Can't I? I thought, oh, I know if I could talk for half an hour to you on a podcast about menopause. She did so well. But actually, she's going people need to know. And it's like, yeah, they do. It's really important because you want other people to recognize it. You don't but what you don't want though is for people to go, oh, Louise, you're a bit hormonal. Oh, never mind. What I really want is somebody to say, do you know what, there is help, there is treatment and read this book, listen to this, watch this, just work out what's the right help for you because I think that's part of the problem now is that there's lots of people now talking about the menopause, so much so that people are just a bit bored with it. But they're recognizing it, but they're not actually taking the next step of working out what to do about it because they think it's just a few symptoms that will last a little length of time. Do you see what I mean? So it's the next step is really important.
Dr Rupy: Absolutely. And I think, you know, it's more than just a public service because you're improving not just the quality of people's lives and their healthiness of it, but the productivity. It's going to have a knock-on effect on businesses and the growth of the country, etc, etc. So there's just so many wide ramifications of people being better educated and having better access to treatments that as you said, is already in nice guidelines. It's really about access. Yeah. Um, we could talk a lot more. I know you've got more than four points to hit, but I think those are like really important, you know, the rebranding element, the availability of treatments, the um, the fact that this is a lifelong um, stage and uh, the fact that everyone, uh, male or female needs to know about it. Let's go into some quick fire questions that we crowd sourced from some of our community. We've already answered a couple of them actually. So you talked about stress and sleep. How do you deal with stress? Because you're you're incredibly busy. Every time like we chat on the phone or like you send me a voice note, so I'm running between here and there. You've got to go to Houston after this. How do you sort of introduce a bit of calm into your life and stress less? I I'm personally interested in that.
Dr Louise: Yoga. It's really important for me. So whenever I do a yoga practice, as you probably know, I do a headstand as well. And there's two reasons for doing a headstand. One is I really enjoy it. I think it is really good for me to have that extra blood flow to your brain. The second is something that a lot of people can't do. So when I'm being bullied or pulled down or, you know, put off on the stakes, I think about these people and think, can they do a headstand? Probably can't. So there's a bit of a power. The other thing is that I'm quite good with and the yoga's taught me this to be mindful and to meditate a bit and to enjoy the moment. And maybe it's the fact that, you know, my my dad was, you know, died when I was nine, that I you've got to savor every moment in life. And that sounds really cheesy, doesn't it? But actually, none of us know what's around the corner. So there's no point me waiting until I'm older and I'm more financially stable and I can be with my children or go, you know, on a holiday to the sunset with my husband. I've actually got to enjoy what I'm doing. But also making the most of each available moment. So like I've got a list of a thousand things to do, but whether I worry about it or not, I'm here doing this podcast with you. So why don't I enjoy every moment of it? Because I'm not going to have it again. And it's the thing someone said to me, you always regret not doing something, but you don't regret doing it. And so it's sort of just trying to live in the moment and not not pull myself down. But don't get me wrong, there are lots of times where I'm just, oh my goodness me, not trying not to get overwhelmed, but I'm good at sleep. I don't sleep for very long, but I've really trained myself to sleep well and switch off because I do.
Dr Rupy: How do you do that? Because I struggle with that. I really struggle. I've started, um, I mean, one of the best because I wear an aura ring. I'm not sponsored by them or anything, but yeah, I think it's great. Um, uh, I if I eat three hours before go, at least three hours before going to bed, sleep's great. Really, really good. If I eat anywhere in between that window of three to zero, I I know that I will end up waking up at like 3:00, 3:30 in the morning. And then as soon as I wake up, my mind starts. Oh, that's hard. It is hard. It's really hard. And it's like, you know, I feel like a bit of a fraud sometimes. I talk about sleep and all these like, you know, these sort of like things that you should be doing and like bedtime lighting and taking away TV, electronics, all that kind of stuff. But I I struggle to put it into practice myself. But it's interesting that you don't have an issue with it.
Dr Louise: Yeah, and it's interesting. So when I was, I wish I'd had my aura ring when I was perimenopausal because I'd spend about nine hours in bed and I'd be, as I say, I was exhausted. So I'd go straight to sleep, but then I'd be wide awake at 2:00, 3:00. Sometimes it'd be my night sweat would wake me up, sometimes it's just waking. And of course my hormone levels were low then. So having hormones definitely, and it's the biggest thing that patients thank me for is the sleep coming back. Oestrogen and testosterone and progesterone, it all can have really beneficial effects on our sleep. So that obviously, yes, you can do all the things that everyone knows, the self-care things really. But also I I do know how to meditate. So if I wake up catastrophizing about whatever's going on in the business, I will just switch off my brain. And I used to worry that I couldn't meditate well, but for those listening, often it's just thinking, visualizing and clearing your brain. Just I I sort of pretend my brain's covered in Teflon. So any thoughts that come in, I'm just literally deflecting them. And that's a really good way of just like.
Dr Rupy: I'm going to use that. Teflon brain. I like that. Yeah, yeah.
Dr Louise: So that's quite, that is a good thing. Because otherwise I used to read all these books about meditation and then I'd be thinking, am I sitting in the or lying in the right place? Am I breathing right? Am I this? So you think about it. So your brain's full of other stuff. And what you want to do is empty your brain. And then I also think is thinking about sleeping is resting. So even if I'm not physically asleep, I've just got to rest every single organ and part of my body. And so and if you're really rested, of course, then you'll drift off to sleep. So I think the power of thinking about, well, it doesn't matter if I'm awake or not. What matters is I'm resting and restoring my body. And then often that really helps too.
Dr Rupy: When you meditate, do do you use uh, guided meditations, music, silence? Is it just
Dr Louise: Just silence. Because if I put something on, I'll start to listen to that.
Dr Rupy: Then you start. Yeah, yeah. I so I I I use silence as well. I actually use my aura ring as well. It's turning to be an ad for aura ring. They don't sponsor, they should sponsor us. Um, uh, I I use my my ring just to see like what my heart is doing and like what my heart rate variability is doing. Um, and I enjoy the silence, but sometimes I do enjoy a nice guided meditation in the morning just to sort of get myself in the right frame and just put some training wheels on.
Dr Louise: Yeah. When I'm very lucky, so I have um, someone that comes and teaches me yoga, Ashtanga yoga on a Wednesday morning. So it's my big reset of the week. Amazing. Um, someone called James Critchlow, who's in his 60s now. He's been doing yoga before yoga was really a thing. And and his voice is so calm. So even if he never taught me, just hearing him, he's just how you imagine a yoga teacher to be. Yeah. Yeah. So I often, sounds mad, doesn't it? Thinking about James when I'm in bed with my husband. It's not that. It's he's taught me to, you know, leave your baggage outside the room. This hour and a half yoga that I do on a Wednesday morning is about me and my mat and focusing. And I think the ability to focus on what you're doing, in the same way when people say, how do you how do you get so much done? Because if I have a spare five minutes, I will do something really constructive in that five minutes. I won't just go, well, I do sometimes go on my phone and scroll the, you know, media, of course. But but a lot of the time I will be writing an article, sending an important email, doing things. And then I'll switch off and go to the next thing. So I think it's that. And I've often said to James, I wonder what I'd be like if I hadn't done yoga for 20 years. I do wonder if I'd just been doing like high intensity exercise or running or something different because I think as part of your planning for your menopause is thinking about the exercise, what's it doing for you? Because a lot of people, as you know, exercise because they want to lose weight or they want to look physically good. But it's got to be, it's a bit like eating, you've got to do it from within and it's about how you feel, not how you look. And it's so superficial our lives at the moment, aren't they? You know, you look at everyone's Instagram, they all look so happy. You're not going to put your family arguments on your Instagram all the time or the times that you're really miserable. So I think just realizing that also you personally are responsible for what you do and what you eat and how you are. So we can always blame other people. We can always sort of think, oh, I'll do it tomorrow or whatever. But we are we've got to take responsibility for what we do and what we are and who we are. And I think once you realize that, it takes many years to realize that. But once you realize that, then you've got to be at peace with what you're doing. And it's not and know you're never going to be perfect and you're never going to please everyone. Because otherwise you set yourself up to fail, don't you?
Dr Rupy: Yeah, absolutely. Absolutely. Um, I've got two other quick fire questions because I know we could talk more about them. Um, how do you think about protein? Uh, so there's a lot of sort of attention being given to uh, protein particularly uh, as as we age. And there's sort of like two kind of camps, I would say. There's like the plant-based camp, the blue zone sort of camp, which is low protein, high fiber, focus on on diversity and plants. And then you've got the sort of more pragmatic camp, which is sort of like, you need protein, you need to stave off sarcopenia, which is an inevitability as we age. And I think there's a lot of confusion. So I'm really interested in to
Dr Louise: Well, you know what, it's so interesting because I think women's health is really controversial, but I tell you what, nutrition is even more. Sometimes I look at people and you must get it. It's just like, what? So I think there's two things there. I think the first thing is we're all different. So I don't think you can give the same diet to the same people and have the same effects. And I'm sure you'd agree with that. I think that's really important. And I think secondly, we just need to think of a balanced whatever we're doing. So even the plant-based, you've got to have more protein. Some of the people that are just pushing protein, it might be fine for them here and now, but actually, let's look at the bigger picture. And yes, if I was exercising hard core every day, of course I'd need more protein. But I'm not. So I think it's we shouldn't be shoehorned into something. And I think we should do what's right for us. And often with with food, you do experiment a bit. And I think it's really sad when people are, oh, I'm having a pure vegan diet because I've read this and I know it's going to help. Or I'm going to just have this, you know, like look at the Atkins diet from ages ago. You know, he was obese, wasn't he? When he died. So I think I think don't worry about changing your diet, but experimenting and you know, I don't eat meat, so I am conscious that I probably should have more protein, but there are ways of having protein. You don't always have to have meat. You know, there's there's I think variety, but not being too worried if you're not getting it right. Because I think it's so hard with food because you have to eat. And then we tie ourselves up in knots all the time, don't we? And I still think, I hope you agree, there's sort of 80, 20%. Yeah, yeah. If 80% of what you're doing is good, then don't worry about the 20%. And I think that's probably because you always hear one side of everything, don't you? And there's there's no there's no randomized control studies about whether pure protein or pure this. Of course we can't. You can't.
Dr Rupy: Because it's we're dealing with like real world scenarios. And in reality, we're not in a metabolic chamber where you can exactly quantify your macronutrients, the availability of a particular protein.
Dr Louise: Of course you can't. And if if I eat meat in Stratford-upon-Avon and you eat meat in London, it's going to be different anyway. So you can't even compare with that. And then also, you know, you look at blue zones, but I'm very interested in epigenetics. Well, their genetic makeup is going to be very different. So what they eat and how that affects their genetics is going to be very different if we eat it. So there's it's a reflection of our ancestry and you know, how we've always lived.
Dr Louise: Of course it is. Yeah, absolutely. So I think you just want to eat to be healthy, but how do you define healthy? Is it mental health, physical health? Is it? And, you know, no one really knows, do they? But I think enjoying food, I don't need to tell you, is really important because I really feel sad when I see people having like protein powders and that's their, you know, Yeah. You know, I don't really like it, but if I, you know, I mix it up in a massive tub of granola that I make, so I'm still enjoying it. But I, you know, so
Dr Rupy: I'll give you a protein uh, recipe. It's a plant-based one. It's got like hemp seed, shelled hemp seeds, it's got um, some pumpkin seeds, a nut butter and a few other bits, um, that are actually really good as sources of plant-based protein. Um, but it's not sort of that sort of chalky powder you get with some vegan protein. I I mean, I don't drink any of that stuff. Um, but yeah, I think it's really interesting because I think there's a tendency to just veer towards specific metrics of, well, you need two grams per kilogram of body weight, um, in terms of protein. You need to make sure that you're spreading that across three different meals because you can only absorb 25 to 30 grams of protein at every single meal time. And the reality is we're so different. And it really is a reflection of our genetics, our exercise, um, uh, performance every single day. I think our mental well-being as well. It's loads of loads of different things.
Dr Louise: So much. And, you know, as you know, I get migraines. And if I exercise at the wrong time or too long, it will trigger a migraine. So it's all very well saying, oh, you should get up and do three hours of yoga before you eat or have time restricted eating of 15 hours. Great, but I don't want a migraine every day. So you've got to change or or I've got to take my children to school. So I can't, you know. So I think that's where personalization of medicine, of any practice is is really key because otherwise you just compare yourself with others and you're going to fail.
Dr Rupy: Yeah. Last question, and this is a controversial one. Uh, what have you what have you changed your mind on over the last three years, if anything?
Dr Louise: No, I yeah, I've I've got quite an open mind and I've changed my mind on obviously thinking about hormones. I've changed my mind thinking about how important they are rather than being scared of them. Okay. I've changed my mind on how I think about others actually, in that I suppose I've become more selfish as I've got older. Okay, yeah, yeah, you can say that. In that I think there's always going to be noise, there's always going to be people saying things, but there's also it's trying to um, keep focused, I think is has been really important for me. Um, and so I've changed my mind of trying to get people's opinions and trying to select who I get opinions from. And it's a bit like with the children, you know, she said that, she said this. Right, do you like them? Do you do you think they're good people? Well, no, because it's always the bullies that often aren't. Well, just ignore them then and enjoy the things that make you feel happy. And I've spent years telling my children that. So now I've got to tell myself and I think having that not just a Teflon brain to help me sleep, a Teflon body and just keep being focused and the other thing I'm really trying to do is surround myself by really good people because it makes makes things easier, but it also makes you happier. It's like if you have a happy person, you're going to be more happy, aren't you near you. So I think it's just changing that where you can't please everybody sort of mentality.
Dr Rupy: Yeah, that's great. I think and I've seen that in you. I think, you know, you've had targets on your back to put it lightly uh, over the last few years and your disposition has definitely changed from one that's trying to battle with them and actually just being accepting of it and just getting on with your job. And you're doing that so well, Louise.
Dr Louise: Oh, thank you. You're very sweet.
Dr Rupy: No, you're great. You're great. I'm a big supporter. I'm a big fan of you. And uh, I really appreciate you you spending this moment with us.
Dr Louise: Oh, well, it's been great. So it's so lovely to be here in your new studio. Cheers. It's so so so great. And thank you for lunch.
Dr Rupy: Of course, of course. Anytime you're in London, you've got to come, you've got to come for lunch.
Dr Louise: I will. You'll regret saying that.
Dr Rupy: I was wonderful.
