Oestrogen, your heart and the menopause
This week on the podcast Dr Louise is joined by Dr Felice Gersh, who is double board-certified in OB-GYN and Integrative Medicine, and specialises in female health, with a focus on managing female hormonal dysfunctions.
She is the author of the book PCOS SOS: A Gynecologist’s Lifeline to Naturally Restore Your Rhythms, Hormones, and Happiness, and recently published a paper on oestrogen and cardiovascular disease, and a 2021 paper on HRT.
Here she talks about the family of oestrogens and the important role of hormones on the heart. Finally, she shares three tips on improving heart and whole body health:
- Eat a lot of phytoestrogen-containing foods – so every kind of plant in all the different colours, including beans, nuts, seeds, fruits, vegetables. They are nature’s gift to us.
- Sunlight is like happy medicine. Try to get sunlight in the morning, midday and watch the sunset every chance you get. This will help you to sleep better, make more serotonin, and help to set your master clock in your brain, which tends to drift when we lose our oestrogen production.
- Move. Your fitness status is more predictive of healthy longevity than your blood pressure. Think of your fitness, strength, flexibility and balance as a critical part of your life so get active in every way you can.
You can follow Dr Felice on Instagram @dr.felicegersh and Facebook @felicegershmd.
Click here for more about Newson Health.
Transcript
Dr Louise: [00:00:11] Hello, I’m Doctor Louise Newson, I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-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 Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on my podcast, I’m very excited to introduce to you Dr Felice Gersh, who is from America, and I have been reading some of her work for a little while, and I’m here really to explore and talk more about the role of our heart and hormones, which is so important. So thank you so much for joining me today. [00:01:22][71.9]
Dr Felice: [00:01:23] Oh my pleasure. [00:01:24][0.5]
Dr Louise: [00:01:25] So before we get started about how important our heart and hormones are, really keen to hear just a bit about your background and why you’re doing what you’re doing and how you’ve come to where you are now in your career. [00:01:38][12.3]
Dr Felice: [00:01:39] Well, I’ve been a practicing OB-GYN for decades, and even from the beginning of my practice, for some reason I haven’t really figured it out, I knew that there was more to providing optimal care than just providing surgeries and pharmaceuticals. So I incorporated my ancillaries. From the very beginning of my practice, I had a nutritionist, I had a psychologist, a massage therapist, biofeedback, actually, I had an acupuncturist. So I had like an array of additional types of care. And then a number of years ago, I decided after thousands of deliveries, it was my time to hang it up and not do any more deliveries and obstetrics. And then I had this void in my life. It’s like, what am I doing? When I started looking at what was happening in medicine, and I looked at some of the pharmaceuticals and how little they differed from placebo in some cases. And so I went on my own personal journey, and I did the two-year fellowship in integrative medicine at the University of Arizona School of Medicine, and became one of the first in the world to become dual board certified in OB-GYN and in integrative medicine. And then I basically started questioning everything even more so than ever. And from way back when, like with the Women’s Health Initiative, I knew from the beginning that that was ridiculous. I begged my patients to stay on hormones, that this was not making any sense, but about half of them stopped and about half of them stayed. And it was the pressure was so great from the outside world, and it just became one of my battles to say hormones, it’s like we were talking before we started, it’s like really simple thinking when you think about it, like if there’s something in the body that is insufficient or deficient, we add it. I mean, if if you didn’t have enough thyroid hormone, we would give you thyroid hormone. If you don’t have enough of a vitamin, we, you know, like B12, we make sure you get B12. And just because every female on the planet at a certain point will stop having ovarian function doesn’t make it OK, it doesn’t make it healthful. And it is definitely a hormonal deficiency state. It is what it is. And you can’t like coat it with a silver lining. It just is what it is. And we should just treat it, as was the case before the Women’s Health Initiative. So it became one of my missions to educate doctors, every kind of practitioner, and the population of women out there about what these beautiful, I call them now life hormones, not sex hormones, life hormones actually do in the body. And of course, the cardiovascular system is not exactly an optional part of the body to keep optimised. And that is one of every system of the body that is incredibly involved and impacted by these hormones. [00:04:32][173.7]
Dr Louise: [00:04:33] It’s so interesting, isn’t it? Because when we say hormones, they’re just chemical messengers. And we’ve got hundreds of them in our body. And then when we talk about hormone deficiency, there are lots of hormone deficiencies because there’s lots of hormones that can decline with certain conditions like you say, you know, diabetes or hypothyroidism. But then I think there’s something about those three hormones, oestradiol, and progesterone, testosterone that everyone gets really scared and confused about. And like you say, you know, I don’t think they should be called sex hormones because they’re not about sex or gender, because males and females have the same hormones. They don’t define us as women because men have them their just levels are different. But also for so long it’s been the menopause is about periods and we have to wait a year, you know, after our periods stop before we can actually have that official menopause badge. But actually how many women don’t have periods? And actually I don’t want to be defined by my womb or about whether my ovaries are working or not, because those hormones get produced in other areas of our body as well. So you could still have a deficiency and still have periods and still have your ovaries working. And then obviously that occurs a lot in the perimenopause as well, doesn’t it? And we’re all individuals. So the lower level is of oestradiol in me might be different to how it’s affecting you. Because the way our body responds to the different levels of hormones varies. But it’s almost been made to be very simplistic when we talk about it’s a gynaecological problem affecting our ovaries and womb. So then people then forget the importance of other organs in our body and how these hormones have really important and quite wonderful effects in our body, don’t they? [00:06:16][102.5]
Dr Felice: [00:06:16] Well, absolutely. And I keep trying, well you and I think exactly the same, because I keep trying to change the dialogue off of periods. I say, if women have a hysterectomy, they still go through this process. The menstrual cycle is just one manifestation of the effects of these hormones. It is about ovarian ageing and it’s about loss of hormones. But like absolutely all these hormones that you mentioned, the, you know, oestradiol, progesterone, testosterone, they’re also neuro steroids. They’re produced, every one of them is produced in the brain as well and in other tissues. So, you know, like fat tissue and so on. So these are hormones that are doing a whole variety of things. There are receptors all through the body. And I always keep talking, I figured this out really early in my career, that the prime directive of life, whether we want to have babies or don’t, and I’m totally for choice, but the thing is, it is what it is. Again, our bodies are designed for reproduction, and to be successful, you need every organ system working in the same time zone. You need every organ system optimally functioning because pregnancy is the ultimate stress test. Finally, it’s being recognised. Once again. I figured this out long ago. You know, unhealthy women are not going to do very well during pregnancy. It’s the ultimate stress test of a woman’s body, and particularly of the heart, because the heart of a pregnant woman has to pump at least 50% more blood volume. And of course, this is now manifesting in pregnancy, with women having problems like going into heart failure. It’s like a real huge problem. That’s why I talk about optimisation of health preconceptually. But the other ultimate stress test after pregnancy is going through menopause. And we use that word, I just want to change it to like ovarian senescence or you know, just change the name. But we’re never going to change the name. But there is a lot of changing of name so maybe if we did a campaign. But the thing is that the other ultimate stress test is loss of those hormones from the ovary and the whole stage of life called menopause or postmenopause. But like you said, which is so critical that it’s a timeline, it’s a process. And this arbitrary definition of menopause really leads to a lot of harm in so many ways because the so-called, you know, perimenopause, this decline and also fluctuation of hormones during the years preceding that final period are a time of many changes and negative changes in every organ system, and this has been well documented. Loss of collagen in the skin, you know, bone, changes in loss of muscle, the beginnings of sarcopenia, changes in brain function, the onset of loss of nitric oxide and then changes in vascular health. I mean, throughout the body there are changes in the the vaginal tissues can be changing long before the final period. Women start to have more changes in their bladder health and start having more incontinence or bladder infections. Every organ system is impacted by what I call hormone insufficiency from the ovarian production, the decline, and then ultimately, when none is produced of progesterone and oestrogen, oestradiol, that’s the ultimate deficiency. And then I always try to explain about testosterone, which is another critically important hormone that women have. But more is produced indirectly. When you talk about the androgen precursor, actually from the adrenal gland, and so that is a different kind of a process, because we do know that the area of the adrenal gland that produces these androgens, called the zona reticularis, actually does typically shrivel and produce less with ageing. But that’s not directly related to the menopause. So it’s like so much confusion about what these hormones are doing, where they’re coming from. So I’m glad we can help set some of it straight. And understanding that these hormones are really interacting with all the issues involving cardiovascular health. And that’s like producing the blood flow that triggers the supply of nutrients and oxygen to every cell in the body. And of course, it’s very involved in protecting the brain. You know, that so-called blood brain barrier, which gets pretty leaky. So just like you can have, I’m sure everybody knows, like leaky gut, you can have leaky blood vessels, leaky arteries. And that’s not a good thing either. And so there’s so much that we just need to spread the word that these hormones, like oestradiol in particular, is critical for the function of many enzyme systems that are directly and indirectly linked to cardiovascular health. [00:11:23][306.6]
Dr Louise: [00:11:24] And that’s so important. You know, the only thing I learned or that got taught, actually, when I was at medical school in the 80s, was that women seem to be protected from heart disease until the age of 50. And then afterwards things changed. So it didn’t, it wasn’t even menopause because they just said age 50. And I remember coming out of the lecture theatre and thinking, what happens to a woman when she’s 50? Like it can’t just be a birthday party suddenly she gets heart disease. What is it? And then obviously thinking about the role of oestrogen. But no-one talked to us about oestrogen when I did endocrinology. And it was never about oestrogen, progesterone, testosterone, never ever. And it was only really when I was starting to read more and more about inflammation and how our immune system is primed and changed if we have low oestradiol levels and then thinking about, well, there must be an associated risk. And then we’ve always been taught or some of us weren’t we were taught following, you know, WHI awful study that oestrogen increases risk of heart disease. And I’ve been to lectures where gynaecologists are saying, if you start HRT at 61, you have an increased risk of heart disease. If you started at 59, you’ll have a lower risk of heart disease. And again, you think, well, how does that work? How does suddenly the same hormone that’s in our body suddenly turn against us? Our body’s are clever, right, but they’re not that clever they know when our birthday is and they can decide to work differently. But I think sometimes in medicine, you just take what you’re told and you run with it, and you have very little breathing space or headspace to come up for air and think, why is this happening? And I’ve been fortunate that I have had some time to think and reflect and know basic biology. And I think when you’re talking about nitric oxide, how important that is, that helps keep our blood vessels open, we think about how atheroma, the sort of furring of the arteries occurs with all this inflammation. And knowing that oestradiol improves nitric oxide, reduces endothelial inflammation, and reduces atheroma, it makes physiological sense, doesn’t it? [00:13:34][130.1]
Dr Felice: [00:13:35] Yes. In fact, I have another paper that I can provide to you that was published about a year and a half ago, maybe not even, in Mayo Clinic Proceedings. And it was on the renin-angiotensin-aldosterone system, known as the RAAS, and oestrogen oestradiol. And, you know, that’s another thing that we’re going to talk about because that gets so confused in people’s minds. But oestradiol actually is like runs the on-off switch. So we say modulates the on and the off switch for this very complex system that has both pro- and anti-inflammatory pathways and different peptides like angiotensin II can actually act in both directions, depending on how things are sort of set up, which makes people very confused because even the doctors and many doctors, even cardiologists, don’t even understand that this is like a dual system, and it has double pathways that can be either pro- or anti-inflammatory, and the baseline natural state should be in the anti-inflammatory state. And oestradiol sort of turns on and off which one is like to create the pro-inflammatory state, which is really lifesaving in a certain situation that if you have, say, trauma and you start bleeding, well, the body wants to keep you alive. So you’re going to activate certain types of systems. So you’re going to start retaining fluid. Right. And you’re going to increase aldosterone. That is you know the steroid hormone from the adrenal gland. You’re going to create vasoconstriction. Your arteries are going to get narrower and tighter to try to maintain blood pressure so you don’t go into hypovolemic shock and basically have total vascular collapse and die. You’re going to speed up your heart rate so you can pump whatever blood you have to keep it going around, and you’re going to activate your immune cells so that the trauma area will be infiltrated by immune cells to try to protect against invading pathogens like bacteria getting in through a laceration. And all of these things are truly life saving. The problem is for when women go through menopause, when you lose oestradiol, you lose that control system and it goes into like the default system, which is pro-inflammatory. And that’s why they prescribe pharmaceuticals for hypertension that are very impactful on this system. You know, the ACE inhibitors and the, you know, the ARBs that block them. So these are things that block the enzyme systems of this pathway or some of the receptors involved. And the doctors have no understanding that actually oestradiol is the master modulator of this entire system. And the reason that by age 65, 75% of women have hypertension is because they lose this vital life hormone, oestradiol, which is really keeping things in the natural state of anti-inflammatory, keeping the RAAS system properly functioning. So you don’t have all these systems coming into play, and then you have to give a drug to try to have a diuretic to get rid of that extra fluid and relax the arteries and, and then slow the heartbeat with a beta blocker. So once you understand the system, how oestrogen in the form of oestradiol modulates it, you can understand why each of the specific pharmaceuticals that are involved in treating hypertension are just working through different ways that this dysfunctional pathway is affecting the pro-inflammatory system. And no longer is it pro survival. It’s now harmful. But if we act early on and we provide oestradiol, we can maintain the proper function of the RAAS. And that’s just one system. And like you mentioned that in terms of the pro-inflammatory state, we now know that when you have pro-inflammation you get oxidation of cholesterol. And this is another very confused thing, the whole thing about cholesterol. So cholesterol is very regulated by oestradiol. And after menopause cholesterol almost always will rise. And then it’s only when it gets oxidised or like rancid that it gets carried in as damaged tissue, gets picked up by roving immune cells called macrophages. And they gobble it up because it’s damaged tissue now, because cholesterol has to be carried around the body in like an envelope, like you wouldn’t drop a cheque in the mailbox. You have to put it in an envelope. And cholesterol needs its envelope, the apolipoprotein. And if it gets rancid, it’s like damaged tissue. And the immune cells are attracted to pathogens and damaged tissue. So it gobbles it up. And then they’re circulating with all this oxidised, rancid cholesterol. And if you have damage in your artery lining, the intima, which will happen when you don’t have enough nitric oxide, which is supported by oestradiol, these immune cells line up along the damage lining the intima, some of them work their way into the artery wall through cracks and fissures, and they get stuck. And they attract more immune cells because they create more damage. And then basically you end up with like a garbage dump in your artery wall, and if it becomes very unstable and inflamed, it can rupture. And this is not like 90% blockage plaque. This is much earlier type of plaque and it’s just unstable plaque. It doesn’t have to be filling the whole like vascular space. So could be like 30% so-called blockage or 40. And the things that nobody’s looking at, right. And all of this is helped to be prevented by oestradiol because oestradiol also modulates so many enzyme systems, including what’s called paraoxonase-1, also known as PON1, which helps to prevent oxidation of cholesterol. So that’s just another area that is so critical. [00:19:41][365.8]
Dr Louise: [00:19:43] It’s so important. And it all interlinks as well. And there’s also, you know, prostaglandins and prostacyclins and all these… [00:19:49][6.1]
Dr Felice: [00:19:50] All of that. [00:19:50][0.3]
Dr Louise: [00:19:50] And, you know, I did a pathology degree and I did a lot of cardiovascular medicine. And it’s all so obvious because I know it. But I know there’s a lot of people that wouldn’t understand it because I’ve never been taught it. And if you don’t know how the body works to that degree, you don’t really understand the full consequences of how when it doesn’t work and what is needed to really make the biggest difference from within. So we’re just talking about endogenous oestradiol. So it’s the oestrogen that we produce when we’re younger. And our bodies are incredible, aren’t they? I mean, they really are amazing how everything is in tune. Everything’s in balance. And you’re talking about this, it is a balance. You know, we don’t want our blood vessels to be wide open and have really low blood pressure that we faint every time we stand up. But then we don’t want our blood pressure to be so high every time we stand up that we get a stroke. So our body is constantly making these fine changes all the time that we don’t realise until it’s not there. And I see a lot of people with postural hypotension. They stand up and then they do feel very woozy. And often it’s related to low oestradiol, but also low testosterone as well, because testosterone can be very good at regulating blood pressure and the control of our, the tone if you like, of our blood vessels. So and they work with other hormones, you know, like our cortisol or adrenaline, we know that they can affect the the vasculature as well. And really important when we think because cardiovascular disease is number one killer really worldwide for women isn’t it. And if a woman does have a heart attack, actually she’s more likely to die from that heart attack than a man and less likely to be diagnosed, because often women present slightly differently to men as well, and don’t always respond to the same drugs because a lot of the drugs have been tested on men, not women haven’t they? [00:21:48][117.7]
Dr Felice: [00:21:48] Absolutely. Like it’s like another thing, like with the heart, that makes it so different. As I mentioned, the heart of a pregnant woman has to pump 50% or more blood volume. So the female heart has to be more energetic, actually. And one of the areas that doesn’t get looked at enough is the creation of energy in the heart, which is through the action of mitochondria. And it turns out that mitochondria are very regulated in terms of their creation of energy, that the electron transport chain relies on oestradiol for its proper functioning. And in the process of making energy like ATP, you create a byproduct that is very toxic. It’s like a waste product of the mitochondria called superoxide, like two oxygens, and it’s poison to the mitochondria, and it has to be modified into hydrogen peroxide so it can diffuse out because superoxide can’t get out of the mitochondria. But if it’s converted to hydrogen peroxide it can diffuse out and be converted to water, which is harmless elsewhere in the cell. And that requires the function of an enzyme, manganese superoxide dismutase, which requires oestradiol also for its proper function. And so women, when they’re looked at in menopause, and this is sometimes in the early stages, you can do an ultrasound, an echocardiogram on the female heart and you find that it’s actually stiffer. It’s like a lesser energised heart. And this is seen in the relaxation. So there’s two things with the heart the contraction and the relaxing, the emptying and the filling. And every focus is typically on the contraction or the emptying. And that’s systolic. That’s when the blood pressure is the higher blood pressure. And the diastolic phase when it’s relaxing and filling is so ignored in women. And that’s actually a very somewhat I mean, men sometimes have it, but it’s way more in women this condition that is called diastolic dysfunction. Or it starts with mild diastolic and it’s really a stiffer heart. And that can lead to a special kind of heart failure, which is heart failure with preserved ejection fraction where it still can pump out but it can’t relax. And that could be just as deadly. And it’s like ignored. And I’ve even seen echocardiogram reports where they don’t even, like tell the patient that they have mild diastolic dysfunction. And just like you said that the answer that they think is, well, so many women have it. It’s just like typical. Well so typical isn’t good. It’s like like women, like you said, die more of their first heart attack. And by age 65, that sort of unfortunate magical age when women are really not, they no longer have what I call the halo effect of the former oestrogen that they made. And things are really starting to manifest, and they die and have more strokes and ruptured aneurysms than do men and women still think they’re like heart disease isn’t their problem until it is, because this like a fact that like every doctor is taught that women are more protected till age 50. And honestly, there are articles published and it drives me crazy that really talk about it all as ageing. It’s not about hormones, it’s about this sort of nebulous ageing thing. Like it’s not related to anything but years lived, not to deficiencies of the body, which is really what I think of as ageing. When you don’t have the right nutrients, when you don’t have the right hormones, you’re going to have suboptimal cellular functioning. So it’s like like you said, what is the mechanism that could possibly explain the change in the benefit to the evils of hormones? Just because you add a year? And this is another thing I always say, the vast majority of the cells of your body are all different ages. Like that’s why we have stem cells to replace cells that die. So when a new cell is made in your body, it is genetically programmed to do whatever it’s supposed to do. It doesn’t say, oh well the body I’m in is now 62, so I’m going to behave differently even though I’m genetically programed because all the cells in your body, they don’t even know how old you are. You know, there’s only a few, like maybe in the heart or in the brain that are still there from the day you were born. Everything else is turned over, like your bones turn over about every seven years. You don’t have the same cells. They do what they supposed to do if you give them what they need, which starts with the instructions. Like you said, the messengers that just give information so that the cell knows what to do with all the nutrients, macronutrients, micronutrients, so it can produce the proper enzymes, peptides, structures and everything else that goes into play. [00:26:45][296.6]
Dr Felice: [00:28:16] Yeah, absolutely. It’s so important for everyone to understand that oestrogens are a family. And that is similar to like if you say fats. Everyone now knows that there are different types of fats. And if you have manufactured fat like trans fat, it’s evil. So we don’t want to mix up the evil manufactured twin with the biologically natural types of fats, like, you know, omegas-3 and some of the, you know, the omega-6s that are coming from nuts and avocados. We don’t want to mix them up. So when you have the understanding that oestrogens are a family and only E2, oestradiol, they each have like the B vitamins, they have a letter and they have a number. So E2 is oestradiol. And only oestradiol binds to the different oestrogen receptors in a balanced, appropriate way. And it turns out, for example, that every cell in the body, it seems like it has oestrogen receptors and many have progesterone receptors. And the innate immune cells, the ones that are like the attack animals of the body that respond to any type of trauma or infection, they’re predominantly alpha. So oestrone, which is E1, which is a unique oestrogen that comes from oestradiol. But it like you mentioned in menopause, it’s produced predominantly in fat tissue, not from the ovaries, because the ovaries aren’t doing it at all. And it’s converted from androgens that are coming predominantly from the adrenal gland into oestrone. And then when you have a lot of inflammation, that’s inflammageing of ageing that occurs in postmenopausal women because they don’t have the oestradiol, it actually, this inflammation down regulates the enzyme that could reconvert oestrone into oestradiol. So you get stuck with all this oestrone, which activates the alpha receptor, which triggers the innate immune cells to be in a pro-inflammatory state. So you can think of it that only oestradiol has the on-and-off switch for inflammation. Oestrone is only the on switch, and oestriol, which is the oestrogen dominant E3 from the placenta in pregnancy, is mostly on the beta receptor. So that’s more like it’s this simplistic but more like the off switch to keep women who are pregnant from activating their immune cells to attack and kill their foetus. So everything’s about, you know, adjustment for successful reproduction, but you don’t want to have a body filled with all oestrone or all oestriol when you’re not pregnant, you don’t want that, you want oestradiol. And then they also confuse, like you said, manufactured oestrogens and also progestogen, which is a made up word for a chemical mimic or endocrine disruptor for progesterone. And they often use the word oestrogen when you’re talking about totally endocrine disruptors, xenoestrogens. They don’t use the right word. So vocabulary matters. So I keep trying to change every slide that says oestrogen to oestradiol. So that people don’t get confused. So I’m so glad that we brought this up because it has created massive confusion. Even high-end journals are publishing articles that misuse these words. They’ll say in the article progesterone when it’s progesterone mimic, like MPA medroxyprogesterone acetate, which is an endocrine disruptor for progesterone. And it has very different effects. Just like trans fat is not the same as omega-3 fatty acids, they’re different even though they come under the same like umbrella. But wow, like, think of them as sort of like in the wrong situation, the evil twin. [00:32:09][232.2]
Dr Louise: [00:32:10] Ah it’s brilliant. It’s so important. I know there’s a lot of information in this podcast, and it makes sense to me but for people haven’t heard it, the first time. Please listen to it again, because this is so important when we’re thinking about our future health, especially our cardiovascular health, but also the difference between different hormones. And that’s crucial for the work that we’re doing, trying to educate people more and more. So I am so grateful I could have you on my podcast all day because it’s just brilliant. So thank you. But before we end, need three take-home tips. So three practical things that people should understand when they’re thinking about the role of hormones and cardiovascular disease. [00:32:51][41.2]
Dr Felice: [00:32:52] Well, no matter how we give hormones in menopause, we can’t recreate the exact environment of our beautiful ovaries. So we have to try to come up with lifestyle modifications, which we should do at every stage of life. So the three things I would say is eat a lot of phytoestrogen-containing foods. And that is basically all the plants out there. So every different kind of plant, whether it’s like a bean, a nut, a seed, a fruit, a vegetable, all these magical polyphenols have phytoestrogen effects and they are nature’s gift to us, OK? So eat across the wide spectrum of plants out there, all the different colours. They’re like magical. Sunlight. Sunlight is like happy medicine. So try to get sunlight at the right time of day, like get out in the morning, midday and watch the beautiful colours of the sunset every chance you get. They will help you to sleep better. You’ll make more serotonin, the happy neurotransmitter, and it will help to set your master clock in your brain, which tends to drift when we lose our oestrogen production. So then you’ll be able to keep proper time zones for all your organ systems. And the other advice is get out of your chair and move, OK, because fitness is a vital sign. It’s actually your fitness status is more predictive of healthy longevity than is your blood pressure. And you really want to think of fitness, your strength, your flexibility, your balance as a critical part of your life. So get moving and do things that are fun. Get active in every way you can. [00:34:39][107.5]
Dr Louise: [00:34:40] Brilliant advice. So thank you so much for your time today. I really, truly enjoyed it. So I look forward to speaking again on the podcast with you. Thank you. [00:34:49][8.4]
Dr Louise: [00:34:53] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk, and you can download the free balance app on the App Store or Google Play. [00:34:53][0.0]
END
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