The Body Reset Women Over 40 Actually Need (Fat Loss, Energy & Hormones)

1. RCDr. Rangan Chatterjee0:00

   No one size fits all. Every woman is gonna need a slightly different, uh, I guess a lifestyle prescription, if you will. But I wonder if you could just talk us through what are some of the common things that people can do that are gonna help them with their hormonal symptoms?

2. AMDr. Annice Mukherjee0:14

   And, uh, just to give you a background, this goes back to the fact that I, I worked very much in a tertiary referral menopause service. Women who, over the last 20-odd years, who had the most severe problems, s- uh, uh, symptoms related to particularly menopause, would get referred to specialist clinics, and I worked at, at Christie Hospital, which was a cancer hospital, and I looked after many women who'd had, um, an early menopause from cancer treatment, many women who'd gone through breast cancer and developed menopause. So I was there being asked, how do we treat these symptoms? You know, how do we, how do we treat the symptoms in someone who can't safely take HRT, and how do we treat the symptoms, and this was very much, um, my, m- my later experience from when I went to Salford in about 2005, was women were coming to me on HRT already and still suffering from symptoms. So then I think, well look, I've got to find out if they're already on treatment, how do I make them better? If, if they can't have that treatment, how do I help these pa- patients get better? And so my clinical experience then went to my general medical experience and looking at a patient holistically, looking at any other medical problems that might be contributing, and that's important because, you know, I might say w- women in perimenopause might be anemic. Y- if you treat that, you're reducing-

3. RCDr. Rangan Chatterjee1:36

   Yeah

4. AMDr. Annice Mukherjee1:36

   ... the burden of symptoms. Hypothyroidism is actually, although w- we can diagnose it much easier now because of thyroid function tests, hypothyroidism is, it's 10 times more common in women than men. It's really common in the demographic 40 to 60 years. Other medical problems should be treated. So, you know, I, I addressed that. There are other non-hormone medications which we haven't talked about, which I'd like to cover, for those women who are told you can't have HRT, and they feel like they're missing out-

5. RCDr. Rangan Chatterjee2:04

   Okay

6. AMDr. Annice Mukherjee2:04

   ... because we're talking about HRT all the time. But then, you know, I, I would talk to my patients and they'd, you know, we'd try a few things and we'd optimize the anemia or the thyroid or, you know, try some non-hormone medications. And they'd go, "Yeah, but I'm s- you know, I'm still feeling exhausted. I've still got aches and pains." So then, you know, and this is clinical experience, this, really, is that I'd then go, right, I'd go, "Just tell me a little bit about your lifestyle." And it would invariably, themes come up of overcommitment, of women expecting too much of their bodies, not having enough downtime, not having good sleep patterns, not having good nutrition, often too much alcohol, too much smoking. This is not rocket science.

7. RCDr. Rangan Chatterjee2:45

   Yeah.

8. AMDr. Annice Mukherjee2:46

   This is easy, but it's not something that we tend to do in conventional medicine.

9. RCDr. Rangan Chatterjee2:49

   Yeah.

10. AMDr. Annice Mukherjee2:49

    We have too-short consultations and so I, I started to look into this. And actually, funnily enough, when you, when you get good at it, it doesn't take that long to go over it.

11. RCDr. Rangan Chatterjee2:57

    Yeah.

12. AMDr. Annice Mukherjee2:57

    A- and the other thing is major life events because again, talking about that midlife rollercoaster, as we get older, major life events hit us more and more, you know, men and women as you [laughs] as you, as you get older. And the other thing is historic trauma is a big factor in, in the experience of symptoms with other medical conditions. So there's lots of themes, and I will ask patients about different, you know, lifestyle, historic traumas. Um, and then it's about there are themes as, as to what, what people can do, but it's not the same for everybody. And as you say, there's not a one size fits all, not with medication, not with lifestyle. Because if you're absolutely exhausted, you're s- you're sitting at your desk and then you're sitting on your sofa, you don't see daylight, you haven't got energy to go and cook fresh food, so you're eating ready meals-

13. RCDr. Rangan Chatterjee3:51

    Yeah

14. AMDr. Annice Mukherjee3:52

    ... maybe smoking and drinking too much as coping strategies, and again, alcohol is a cope- an unhelpful coping strategy, it can, over a number of adult years as your life gets busier or more stressful, you know, it, it can all sort of hit you. You then got hormone symptoms, and we're expecting a miracle cure with hormone treatment, but actually we need to be sitting back. So the first thing I would say in terms of lifestyle to every woman I see regarding menopause is how much are you moving? And I'm not saying go and do a marathon. I'm not saying go and, you know, be an expert at yoga or do HIIT classes because there's no one size fits all, and actually, if you try and do too much too quick, you're back to square one. It's snakes and ladders.

15. RCDr. Rangan Chatterjee4:35

    Mm.

16. AMDr. Annice Mukherjee4:35

    It's about starting where you are and making small changes. I sometimes describe them as microdosing your lifestyle.

17. RCDr. Rangan Chatterjee4:42

    Yeah.

18. AMDr. Annice Mukherjee4:42

    And, um, just tiny moments. If you're exhausted, don't expect yourself to go for a 30-minute walk, but if you do, if you don't do any exercise, you could start off by just going around the block and getting some daylight for five minutes in the morning, and then building very, very slowly. There is an amazing woman who I follow on social med- media called Joan MacDonald. Her Instagram is trainwithjoan. She-

19. RCDr. Rangan Chatterjee5:04

    Oh, is she sort of 70, 80?

20. AMDr. Annice Mukherjee5:06

    She's just turned 77.

21. RCDr. Rangan Chatterjee5:08

    Yeah.

22. AMDr. Annice Mukherjee5:08

    Joan at 46 didn't really do much exercise, and then she decided with her daughter to, um, start doing some exercise. She didn't think I'm gonna be, at 77, I'm gonna be like, ah, you know, an internet sensation-

23. RCDr. Rangan Chatterjee5:24

    [laughs]

24. AMDr. Annice Mukherjee5:24

    ... which she is, actually. She didn't think that. She just, she just said, "I just went one day at a time and I built up slowly." She never had... She didn't put pressure on herself. She didn't have over expectations. Joan is like a miracle. I mean, she's amazing. She's absolutely amazing.

25. RCDr. Rangan Chatterjee5:42

    She's really strong, isn't she?

26. AMDr. Annice Mukherjee5:43

    She's incredibly strong. She's built up gradually. And she's not saying, you know, "I'm, I'm in a deficiency state and I'm a mess." If you look at Joan, she is the picture of, I think, what pretty much most women would think they want to be like when they're 77. It's, or if not every single woman on the planet. She's amazing. She's so healthy.And she's, she's done it all through lifestyle. The, the key to that is make small changes, because Rome wasn't built in a day. N- and we all want quick fixes. We all want to do a miracle diet, a c- a clever hack, a, you know, a boot camp for six weeks and, and suddenly drop, you know, the, you know, four stone in weight that we've gained over three decades, you know, or suddenly be fit when we haven't done any exercise for 20 years.

27. RCDr. Rangan Chatterjee6:29

    Mm-hmm.

28. AMDr. Annice Mukherjee6:29

    And that isn't realistic. So it's about starting where you are and building up. So that exercise, uh, nutrition, I mean, as, as you're aware, nutrition is a real trigger topic. Loads of people have different views. My mantra regarding nutrition is clean whole food. Keep your plate full of real food, not processed, ultra-processed. Not packets, jars, you know-

29. RCDr. Rangan Chatterjee6:53

    Yeah

30. AMDr. Annice Mukherjee6:53

    ... ready meals, but actually just real food. You know, fresh fruit, veg, nuts, seeds, lentils, pulses. We eat a lot of processed foods. I think... I say to my patients, "Do you eat processed food?" They go, "No." And I said, "Oh, do you have any bread, pasta, cakes, biscuits, pizza, pastry or noodles?" And they're going, "Oh yeah, I have those." And I went, "Well, that is processed, right?" So, and I'm not saying exclude it-

Episode duration: 1:43:17