My handsome colleague Danyal is convinced I’m taking medication.  He can’t believe a person can be so upbeat and energized whilst being so busy! I’m not on medication as it turns out, but there are certain things that I do that make me function on all cylinders. I’m by no means perfect, and I certainly have my bad and low moments, but I want to share with you what I do on a regular basis to stay on fabulous form: Get my ‘5 a day’  – normally in a juice. I love ‘fast’ food. A juice is an easy way to get my 5 a day all in one shot. I need good nutrition to energise myself and set me up for the day. It also helps take away my cravings for not so good food throughout the day. I normally go with something green, like spinach, apple, mango or pineapple, cucumber, avocado with added supergreen powders like wheatgrass and spirulina. Then if I do eat cake later in the day, at least I can feel less bad knowing I had a good nutrient shot in the morning! Prayer and gratitude  – The single biggest influence on my life and mood at the moment is prayer. Connecting to a higher source, asking for guidance and signs to be my best and give my best to others is very important to me. I understand not everyone is religious, so a daily gratitude ritual is also important. I am constantly feeling thankful for all I am blessed with. I make it a priority to write this down or recall 3 wonderful things every morning and every evening, and even at spare opportunities. I cry – I cry a lot . Sometimes in joy, often in sorrow. It’s very important to be in touch with your emotions. Repressed emotions can lead to stress, increased cortisol and increased risk of illness. Deal with your emotions by getting them out in the open. Connect with yourself. I’m not saying you have to cry on the tube to that lovely Heathrow Christmas Ad (sometimes I can be too in touch with my emotions!) but don’t suppress emotions.  For those of you not quite as comfortable with free flowing emotion, you might prefer to write down how you are feeling and why in an emotion journal to help you understand yourself. Know yourself  – I know myself better than anyone else does. I have good instincts, I trust my habits. For example, I know I’m not good in the mornings, so I have stopped telling myself I am going to wake up at 6am to go to the gym, only to feel frustrated myself that I stayed in bed! I make realistic goals for myself and work things into my routine. I always try and do more, I always want to push myself and sometimes I berate myself for not doing more, but at the end of the day, I do ok overall, so I need to stop trying to do more and instead fit things into my routine and what has worked for me time and time again. Supplements  – I don’t over-supplement, but I keep my immune system up with B vitamins, magnesium, vitamin D3 and keep my gut healthy with probiotics and digestive enzymes. I take a hair and skin supplement over winter, and if I am feeling run down I take an immune booster.  When I am stressed out I take some ashwaganda, an ayurvedic herb, that helps.  I assess how I am feeling and then supplement appropriately. Be kind to myself  – and to those I interact with. I try and be gentle with myself when I am stressed out or busy or eat a whole giant bar of dairy milk fruit and nut. One mad move doesn’t make me a bad person, and isn’t everything I am.  I try to be kind to people I meet, I don’t always succeed and I’m not perfect, but I try. It’s more important to be kind than to be right. You feel good, and you’ll leave others feeling good too. I love doing things for others. It is rewarding, and stops me being too egocentric. Routine  – I do better when I have a steady routine. I work better when I sleep and wake up at similar times. I work better when I schedule in regular exercise and prepare my juices. Life can get so busy and I have a slight self-destructive streak, but when it does, I come back to my routine.

We all want to live longer, but only if we are healthy. My job is to get people healthy and feeling great. Here are my top tips on healthy ageing: #1   Know your blueprint We all have a unique blueprint that is our genes. We used to think that we just have our genes and there’s nothing you can do about it. We now know that this isn’t the case. I test for over 300 genes that can be modified to reduce your chances of getting a heart attack or stroke, preventing osteoporosis, improve your antioxidants, improve your detoxification and reduce inflammation in your body. Some of the genes will tell you the best diet for your unique gene type, the sort of exercise you need to do (sadly the answer is never no exercise!) and even how much alcohol you can drink. Knowing your ‘blueprint’ is empowering as you can make changes in your diet, personalise your supplements and modify your lifestyle accordingly to feel better today whilst also improving your health long term.  #2   Find out where you are on the map – use your GPS Knowing your blueprint is all very well, but what about finding out what’s going on right now? I often do telomere testing with patients which tell you how old your body really is. If you’re ageing on a cellular level, we can do something about it. I also check my patient’s vitamins, minerals, fatty acids, antioxidant levels and amino acids to create a total program for them based on what’s going on in their bodies right now.  This fits well with the gene testing. For example, if your genes show you need a high intake of B vitamins, we can check those vitamins to see if you’re getting enough right now or if this needs to be adjusted.  #3   Balance your hormones Do our hormones drop as we get older, or do we age because our hormones reduce? Keeping our hormones optimum, whether you’re a man or woman is key to feeling young, looking young and ageing well. Studies have shown in women, optimum hormone replacement at the time of menopause can reduce all causes of mortality compared to women who don’t take hormone replacement. Healthy levels of testosterone have been shown to prevent heart attack in healthy men. It’s important to see someone who has a lot of experience in balancing hormones, like myself, so they can personalise this to suit you and monitor treatment. #4   Lifestyle is key The most important factor is always lifestyle. Managing nutrition, getting good exercise, reducing stress, drinking lots of water and getting quality sleep is key to feeling good. I help my patients create realistic plans where they can stay healthy and have it fit in with their hectic schedules.

How we approach health is constantly evolving. Whilst the basics often remain the same, there are constant new and interesting trends always occurring. So here are some of my health prediction trends for 2018. #1   Basics but with a modern twist The foundations of health can’t ever change. The most important things are always good sleep, good nutrition, managing stress and moving your body. However, we can hack our health by using modern technology. For example, to improve sleep we can use devices like the Fitbit to monitor our patterns, use white noise machines like Marpac Dohm to help improve sleep quality by creating soothing background noise and mask outside sounds. There are podcasts like ‘Sleep with Me’ that can help you fall asleep, and a multitude of apps such as Headspace, Relax with Andrew Johnson and Calm which can help you to manage stress. Don’t fear using technology, use it to hack your health. #2   Personalised Health Care Plans There are multitudes of different diets out there that work for different people. Paleo, Mediterranean, low fat…. they can all be good, but which one is good for you? Now you can take the guess work out of it and find out what type of diet is best for your genetic make-up and what sort of exercise your body responds best to (spoiler alert: the answer is never no exercise!). Other genes that can be looked at are methylation genes, which if they aren’t working well can increase your risk of inflammation, certain cancers, heart disease, making low levels antioxidants and causing problems with mood, sleep and vitamin D levels. You can also see how your body deals with alcohol and smoking, and how your body processes certain medications. For people taking hormones, we can see how you process them and if there’s any increased cancer risk with taking HRT. This will lead to personalised health care plans of supplements, nutrition and exercise to keep you healthy. #3   Holistic Therapies There’s lots of research that shows that holistic treatments like acupuncture have benefits. Taking time out to have therapies you enjoy can give you time to relax and could potentially help your symptoms. Lots of my patients have treatments such as reflexology, massage, Bowen’s technique, see a life coach or an osteopath. #4   Meditation, but not as you know it Visualisation is where it’s at. Research shows that visualisation improves your immune system and health. Studies show that people who visualise themselves at being at their optimum weight do lose more weight than people who don’t. Other studies have shown that patients with breast cancer visualising their cancer cells being destroyed had better outcomes than patients who did not. So, incorporate some visualisation into your meditation time.

In my quest for wellness, I decided to do an adrenal stress test to see if stress is making me ill. For those of you who don’t know, an adrenal stress test measures your cortisol levels. It is done by spitting in a tube four times in a day to track your cortisol and see if they are elevated at any point. Why is this important? So I’m always banging on about how elevated cortisol levels cause inflammation in the body, and inflammation causes increasing weight, an increase in gut symptoms, fatigue, insulin resistance and even it regular functioning of cells which can contribute to most diseases and weakening of your immune system. So I did my spit tests, on a normal busy working day, after a month of considerable stress. It was fairly easy to do, the only thing I was concerned about was contaminating the samples by getting some of my pink lipstick in them! Then I froze them all and posted them off. The results were interesting to say the least.   So my cortisol is elevated first thing in the morning and last thing at night, but in the middle of the day I’m almost flat lined! I guess my work isn’t that stressful as I love it and love my patients, which is great, but what about the other times of the day? So what have I done about this? Well, I’ve decided to do the following to reduce my inflammation: #1 I’ve stopped watching intense TV shows like The Walking Dead just before bed! Yes I know I’m always banging on about not watching TV just before bed, as it affects your melatonin, but I also think it’s what I’m watching that is having an effect. My body doesn’t know the difference between a stress from watching something on TV all being chased down an alley way, it responds in the same way. So I need to reduce the amount of stress I have in the evening. So I still watch the walking dead, just at a different time of day! #2 Taking ashwagandha in the morning. Ashwagandha is a plant based supplement that is used in Ayurveda a lot. It is an adaptogen, which means it helps your body to adapt to whatever is going internally on a cellular level, and therefore can help me to reduce my elevated cortisol. #3 Lifestyle changes I’m also always banging on about the importance of lifestyle! So I’m trying to get my 7-8 hours sleep, eat clean and exercising regularly. A lot of my stress can’t be modified, which means I need to learn to manage it better. So I’m taking up spiritual practices to help me with this. #4 Heart Rate Variability There have been many studies done to show that managing your heart rate variability can reduce stress and improve health.  Heart Rate Variability (HRV) biofeedback is a relatively new technique for training people to change the variability and dominant rhythms of their heart activity. The use of HRV biofeedback began in Russia in the early 1980s where it was applied to the treatment of asthma and numerous other conditions. Research is now going on to apply HRV biofeedback techniques to a variety of medical and psychiatric conditions, including: anger, anxiety disorders, asthma, cardiovascular conditions, chronic obstructive pulmonary disorder (COPD), depression, irritable bowel syndrome (IBS), chronic fatigue, and chronic pain. Because it engages the parasympathetic nervous system – it is also thought to reduce stress and elevated cortisol. I have an app and a little monitor that measures mine, and then I can follow breathing exercises to regulate it. The logic is that the more you practice something the easier it becomes, and hopefully eventually it will become second nature! The best thing about it is I can do it on my phone (whilst watching The Walking Dead!) so it’s easy to do anywhere and it’s convenient.

I’m fasting at the moment and it’s long 18 and a half hour days, so it’s even more important for me to be healthy during this month. In the old days we would eat loads of fried foods and sweet things as it ‘can’t count’ if you’ve been fasting all day! That’s old school mentality and nowadays it’s more important to eat well and eat right, especially on hot days during 18 hour fasts. Many people fast for other reasons, such as cellular regeneration, mental strength and anti-ageing purposes. There’s good evidence that fasting for 16 hours helps with weight loss, reduces insulin resistance and helps lipid metabolism. My favourite Chris Martin fasts once a week too… Here’s my top tips for fasting in a healthy way: #1  Drink plenty of water after breaking fast, I’d recommend 1.5-2 litres to stay hydrated and avoid headaches and lethargy. #2  Make sure you have plenty of protein to stop muscle break down. #3  Eat a some good carbohydrates such as sweet potatoes or rice, your body needs some after not eating for so long. #4  It’s natural to want something sweet. Most Muslims break fasting with dates, which are rich in natural sugars, fibre, magnesium and potassium. Full disclosure – I sometimes have chocolate cake! But it isn’t ideal as it can cause blood sugar spikes effecting energy. Plus I felt pretty bloated after the cake. A Pulsin bar full of natural sugars and raw cacao and is also gluten and dairy free is a better option. #5  I like to have a soup made with bone broth when breaking fasting – it’s good for your immune system, digestive system and rich in nutrients. #6  It’s very important I get my nutrients even when fasting so I have a shake every morning (2.30am!) made with Nutri Advanced Superfoods Plus powder, rich in antioxidants and far more than my ‘5 a day’. I also have some protein like eggs or some gluten free bread with peanut butter to get me ready for my fast and the day ahead. I don’t want to overload my body with supplements but I do have my probiotics in the morning. #7  Sleep is so important, I try and get 7-8 hours, even if it is broken. When you’re tired your hunger hormones like leptin kick in to make you feel it more. #8  Ramadan isn’t just about food, it’s about being spiritually connected. I try and use my free time to strengthen this connection. This makes the whole process much easier!

For those of you who know me well, you’ll know I’m a traveler. It’s one of the things that makes my soul come alive. It’s one of the reasons I started The ALiVE Retreat – I wanted to share my passion and I always get great insights and experiences that change me when I travel and I hope the attendees on the retreats get a taster of this. So off I went to Peru, not quite with a backpack but some light luggage, an open mind and ready for adventure. I did lots of great stuff in Peru – met Incas, went to villages, hung out with an alpaca, but the real reason people come to Peru is to go to Machu Picchu, and I’m no different. For those of you unfamiliar with it, Machu Picchu is an ancient city that was only uncovered in 1911 and has been preserved in its original condition. It’s one of the new 7 wonders of the world. So I was pretty excited and hoped to not only see it, but get some cool photos for Instagram.  I really fancied one of me looking out to the city looking wistful and poetic. You know the one I mean. If you don’t, it’s this one. So I wasn’t too thrilled when I arrived and this was my view…yes it was raining too! So what was the plan? A common theme in my life and I’m sure many others is how to cope with reality over expectation. I have high expectations for myself and the people I surround myself with. Part of it comes from wanting them and myself to be the best we can be. I’m a girl from the Welsh Valleys and I now run my medical practice in Knightsbridge in London. It didn’t happen overnight but I worked hard and didn’t lose my vision despite numerous ups and very very low downs. But I also expected to be married with kids and a size 10 and that hasn’t happened. And it’s hard for me to admit, but I spend a lot of energy wondering why my expectation isn’t my reality. So whilst up Machu Picchu, in the rain, in the fog and in that oh-so-sexy plastic poncho, I came up with the following steps for accepting reality. Step 1:   Real is better than fake . I like people who are authentic and honest and aren’t perfect and I’m sure you do too. It’s nice to know people don’t need to be perfect to do well. Is it better to have a real experience rather than an airbrushed, Instagram-filtered one? Is it better to actually feel something rather than portray an image that doesn’t fit? Cognitive dissonance is when our actions and words don’t fit in with our values and true beliefs. It can lead to emotional stress which can lead to physical health issues. Step 2:   Higher Power If you believe in a higher power or God then you will believe you’re always being guided to something or someone good for you. Or as Dorris Day would say, Que Sera Sera, whatever will be will be. Step 3: Gratitude If you’re biggest problem in life is not being able to see Machu Picchu because it’s foggy then you need to get a life! I’m alive, I’m relatively healthy, I have a good home, friends and family and a job I love. I’m not homeless, I don’t live in poverty, I’m loved. Did you know, even if you’re in the poorest 1% in the UK, you’re still in the richest 10% in the world. Puts things in perspective right? We all have a moment from time to time but just need to get a grip. Even if we’re ill we have access to health care. There’s always a way. Step 4: Self Actualisation I know who I am and what I’m capable of. I know my strengths and weaknesses. I also know  what my greater purpose is. So I have to be grateful for what I have as my body and mind allows me to travel, to see amazing things, to help other people, to listen, to laugh, to move, to dance, to teach, to feel, to help, to be. So instead of berating myself I have to embrace all I am. So, it was rainy and foggy so I went with my new pals to get a coffee and a Twix, and we had a really great chat and laughed. It turns out as soon as you accept where you are, it seems the universe collaborates to move things. So we decided to go back in and the fog lifted. I got my photo, it wasn’t that one I imagined, it was one that’s all me.

Recently I feel like my health has been failing me. I’ve always prided myself on having a robust immune system, I’ve been quite lucky that I can shake off colds and viruses in a couple of days, and I hardly ever need to take time off work due to ill health. Yes, I am one of those people who are always on the go but I usually have good energy and get up and go, and rarely have had to not do things due to feeling ill. However something has changed in the last few months and I’ve been ill on almost a monthly basis – to the point where it’s affecting what I can and can’t do. It’s also kind of ironic as I’ve recently just started at an intensive workout program, being more mindful of my diet, and I’m taking supplements on a regular basis. I decided to really embody the whole “practice what you preach” thing and yet my health seems to be worse for it. Maybe this is what happens when you hit your mid-30s!! So here I am, alone on the Saturday night of the bank holiday weekend, because I can’t attend one of my best friends’ 40th birthday party because I’m too ill. This sucks. And this also ends here. So I’m going to tell you what I’ve tried to do so far to monitor and modify my health and I’m going to keep you posted on my progress every month. You can hold me accountable! Genomics Testing DNA (genomic) tests are all the rage now, but are they any good? I decided to try them out and see. I’m not that into the tests that tell you your percentage risk of getting dementia – I’m not sure how empowering that knowledge is for me. So I decided to have a full spectrum of tests done that look more at processes in the body; to look at my hormone metabolism, the processes of detoxification and methylation in the body, and DNA diet and sports tests to guide me on what to eat and how to exercise. The tests are really easy to carry out, using a cotton bud-type swab to rub on the inside of your cheek. You post it off and get the results in 3-4 weeks.  The test looks at Single Nucleotide Polymorphisms, or SNPs. SNPs are a variation in a single nucleotide that occur at a specific position in the genome. SNPs underlie differences in our susceptibility to diseases. The point of the test is to identify specific SNPs that can lead to diseases, and then use this information to take certain supplements, nutritional and lifestyle changes that help support the body’s pathways. Helpful, personalized and empowering information. The results were definitely interesting. Firstly, I am not that great at  methylating.  What does that mean in English? Methylation is essentially the process of converting folate in food or folic acid in to methylated folate. This is essential for many processes in the body such as balancing hormones, detoxification, it can also effect mood, sleep and even vitamin D absorption. It can also put your risk up for heart inflammation. The main reason I wanted this test done is because of the profound effect it can have on your mood. I have real issues managing my stress and mood, and it has always felt a little out of my control. As soon as I heard about how methylation can effect this I instinctively knew I had this, as the way I react to things is often more extreme than I  would like it to be. So it was almost a relief to see that any issues I have with stress and mood aren’t entirely due to my inability to deal with things, and taking a supplement will help. Now that I know I don’t methylate well, I am taking a supplement of methylated folate and B vitamins which I will probably have to take forever. I am fine with this, as it is better than taking medication forever plus it is going to cut down my future risk of health issues. Detoxification  My body is pretty good at detoxification and my liver works pretty well.  The most important antioxidant in the body is called glutathione and my body can make it pretty well – phew! But I have a SNP on the receptor for glutathione so my body is going to be less able to use my glutathione. Therefore taking extra glutathione, or the building blocks that help to make glutathione, will be useful for boosting my immune system and will support my body’s detoxification.   Oestrogen Metabolism Bad news, my body doesn’t metabolise my oestrogens as well as it should do. But not to worry, I am going to improve my methylation and take certain supplements that will help me with this. Who’s ever heard of a hormone doctor who can’t deal with her own hormones?! 😉 DNA diet   and sport The best diet for me is a Mediterranean one according to my genetics. This makes sense as my oestrogen test said having no carbs at all would not be good for my oestrogen metabolism. There’s always lots of talk about high protein and high fat diets, but based on my genetics, only moderate fats are good for me, even the ‘good fats’.  The DNA test also looks at the number of MET hours I need to do to stay healthy and fit and maintain my weight. MET stands for  Metabolic Equivalent Tasks  and are a way to measure how much energy you burn up during an activity. Every activity has a MET score, from watching TV to going to a run. The more vigorous the activity and higher the MET value. Unfortunately to manage my weight and stay healthy I need to have a high level of MET hours, 24 a week! This is the equivalent of hitting my 10,000 steps 5 times a week and doing about 3x 1 hour vigorous gym sessions.  So it’s great to know what I have to aim for. So I think this sort of information is really empowering and I am so happy I had my tests done. I have been able to change my supplements to what my body actually needs based on my genetics, and can now make well-informed decisions about my diet and how I manage my exercise. For the women I see taking hormones, I think the hormone balance genomics testing is a game changer. Women often worry about taking hormones, and this could help put their mind at ease. But it is also great to see how the liver is working, check methylation and build your nutrition and fitness program around what you actually need, and take all the guess work out of it. I want to stay healthy and happy for a very long time, and a lot of it can be out of our control, or even luck, but lots of it isn’t, and this sort of information can help us achieve our goals.

I recently watched the BBC documentary  ‘An Insider’s Guide to the Menopause’ . I thought I would share my thoughts about it. I thought that the documentary was extremely well presented, and was a great overview of the different symptoms and stories that menopausal and perimenopausal women can experience and the way they can be left feeling. I am in the privileged position of hearing these stories on a regular basis and understand how devastating it can be to suddenly be thrown in to mood swings, hot flushes, poor sleep and low libido. To all of a sudden lose your confidence and not know who you are anymore. I am glad that this is at last being talked about publicly and I hope it will help take away some of the stigma of this process that all women go through. I felt the documentary was well balanced about the benefits of taking hormone replacement therapy and emphasizing individualized treatments. It was also great that they talked about the importance of lifestyle, such as weight management, nutrition, exercise and psychological interventions like CBT (Cognitive Behaviour Therapy). This is something I look at with my patients, as well as supplementation. My job is often part doctor, part life coach, part therapist and part nutritionist and lifestyle coach – and I love it! The reason I spend a lot of my time working with menopausal women is because I feel that women are really valuable members of society. A woman in her 50’s is probably more valuable than a woman in her 20’s, due to her life experience and wisdom. Yet society continues to judge women mainly on their looks and weight in a way that doesn’t seem to happen to men. We need to break down the barriers around menopause and stop seeing women as ‘washed up’ as they age. I will never forget a powerful woman in her 50’s who works in the City of London in Finance telling me about having to give a big presentation in front of her colleagues and feeling the sweat drip down her face and going red as she had a flush, and seeing her male colleagues in their 20’s sniggering at her. Hearing about this degrading and humiliating experience from a brilliant and bright woman who is being judged by her age and hormonal state made me vow to help as many strong, powerful, wise women as possible to not have similar experiences. Some women feel they have to just suffer at this time of life, or see taking hormones as a failure. Studies are now showing taking hormones at the start of the menopause benefit a woman not only in terms of symptoms, but in terms of cardiovascular health, bone density and neurological health. Hormones should not be feared, but you do need to see an expert who understands all the evidence and can help you weigh up the pros and cons. This BBC show went a long way to help break down these barriers, to show women help is out there and to help women understand that they don’t have to suffer in silence.

I spent some time this week looking at my core values and planning for what I want to achieve in this coming year.  This led me to spend some time thinking about why I do the work that I do. As you probably know, I am a GP and used to do that full time for the NHS for some time. I started to become disillusioned as I felt I wasn’t helping people in the way I wanted to. I want to help empower people and tap into what’s going on with them and evaluate what is important to them and how they can improve their lives. I truly believe that if you feel happy and are living life on your terms, you will feel better, stronger and able to make better health choices, or cope with ill health and improve their condition. After studying integrative medicine, and realising the importance of nutrition and lifestyle changes, I then started learning about hormone balance. I see hormones as the foundation of health – if you have shaky foundations, you can have the best bricks in the world (nutrition and exercise) but they won’t build you a stable house. I’m by no means perfect in my health, but I do believe in taking control of your health and life. If there’s something you’re not happy with, change it.  I can struggle with my own nutrition and motivation to exercise, but I try my best and try to do something good every day for myself. I believe that if you want to improve your health, you can use nutrition, exercise, stress management and other lifestyle changes to help. I do believe that conventional medicine is very important at treating illness, but there is a lot we can do before to try and prevent the illness from happening in the first place.  But I also believe in balance. I’m not an ‘All or nothing gal’, I believe a little bit of what you fancy does you good, and a nothing is too naughty if done in moderation. I often tell people there’s a difference between ‘happy eating’ and ‘sad eating’, and this can apply to food, drink, and other vices.  If done in joy, it will have a less negative effect on your body psychologically and hopefully physically too. So my main values are authenticity, fun and meaningful interactions, and I hope I bring them to the work and consultations I do! I hope you can spend some time looking at your values and bring them to your work and life too.

A patient sent me the following blog asking my opinion, so I thought I would write a blog to address this for everyone who may have similar questions or queries. The blog in question is by the well-respected Dr Heather Currie, read it  here . Dr Currie is an experienced doctor and also runs a site called Menopause Matters. She’s an active member of the British Menopause Society too. A lot of what has been written in this blog I definitely agree with but I do have a slightly different view point on a couple of points. I do agree that the term bio-identical refers to the structure of the hormones used, and does not mean custom made all compounded. Dr Currie says that there are bio-identical hormone preparations available that are licensed, such as Estrogel, Oestradiol tablets, Utrogestan , and this is true. Where ever possible I would prefer to use these medications as my first choice. However, one of my main problems when prescribing for women is due to testosterone. I find testosterone to be a very important hormone for women. It is important for libido, motivation, muscle mass, preventing osteoporosis, focus and concentration and memory. At present, no drug company makes a testosterone dosage for a woman. There are testosterone preparations available but they are in doses that are made for men, such as 50mg a day, where commonly I would prescribe 1mg a day for women. I know certain doctors tell women to “guesstimate” the dose when they give them a preparation made for men, but this isn’t something that I feel comfortable with, so I get my testosterone manufactured in a low dose for women. Other medications can be manufactured in special doses when needed. For example, if a patient needs specific forms, strengths, or a medication that needs to be change from a tablet form to a liquid form or intravenous form, I use a pharmacy that does this for 250 hospitals in the UK. They are not a compounding pharmacy but rather a specials manufacturing pharmacy that can make special doses of medication when needed. They have a strict quality assurance process that tests the medications and quality. Sometimes a patient will have a negative effect due to the medication that has been  prescribed, and therefore I might want to have a lower dose made for them to see if this suits their body better. This is another reason for having hormones manufactured for a patient, as is that it may be their choice or for financial reasons. I do ask my patients to have blood testing of their hormones done from time to time. I have this done at a specific time after they’ve used the hormones, to make sure the levels are not getting too high which might excessively stimulate breast, ovarian, and endometrial tissue. If this is the case I can lower the dosage, and if the patient is having side-effects it is also useful for me to take a blood test to see exactly why this is happening. I also advise my patients to have a pelvic ultrasound scan yearly and regular breast screening and smears. This is because I do not want the hormones to cause overstimulation in these areas. For me, the two most important aspects is not doing harm and being of service to the patients I see and listening to their needs. I try and provide them with options so I can help their symptoms and give them a say in how they are treated. For me, one size doesn’t always fit all. I am also aware that some women feel fantastic on conventional HRT and I have no problem with that either. The key is to look at the person in front of me, listen to them, and treat them holistically, taking into account their preferences and lifestyle.

When your adrenal glands are producing too much cortisol it can make you feel tired, stressed out, fat, irritable and wound up. You can spend your life feeling exhausted all day, and then wide awake at night when you should be sleeping. Your memory and concentration can be impaired and can feel like you have ‘brain fog’.  You may find that you are keeping yourself going all day on caffeine and sugar, and then using wine or sedative medication to unwind. Having a high level of cortisol not only makes you feel bad, but affects your body physiologically. It puts you more at risk for insulin resistance, obesity, high blood pressure, increased cholesterol, and affects your digestive functioning. For most of us it is not possible to LOWER the stress in our lives, instead we have to learn how to MANAGE the stress in a better way. There are ways to manage your stress lower your cortisol that will make you feel more energized and healthier.   Nadi Shodhan (alternate nostril breathing) Nadi Shodhana, or “alternate nostril breathing,” is a simple yet powerful technique that settles the mind, body, and emotions. You can use it to quiet your mind before beginning a meditation practice, and it is particularly helpful to ease racing thoughts if you are experiencing anxiety, stress, or having trouble falling asleep. Take a comfortable and tall seat, making sure your spine is straight and your heart is open. Relax your left palm comfortably into your lap and bring your right hand just in front of your face. With your right hand, bring your pointer finger and middle finger to rest between your eyebrows, lightly using them as an anchor. The fingers we’ll be actively using are the thumb and ring finger. Close your eyes and take a deep breath in and out through your nose. Close your right nostril with your right thumb. Inhale through the left nostril slowly and steadily. Close the left nostril with your ring finger so both nostrils are held closed; retain your breath at the top of the inhale for a brief pause. Open your right nostril and release the breath slowly through the right side; pause briefly at the bottom of the exhale. Inhale through the right side slowly. Hold both nostrils closed (with ring finger and thumb). Open your left nostril and release breath slowly through the left side. Pause briefly at the bottom. Repeat 5-10 cycles, allowing your mind to follow your inhales and exhales. Steps 5-9 represent one complete cycle of alternate nostril breathing. If you’re moving through the sequence slowly, one cycle should take you about 30-40 seconds. Move through 5-10 cycles when you’re feeling stressed, anxious, or in need of a reset button. Cut sugar out of your life Sugar causes spikes in insulin which in turn spikes cortisol and adrenaline. Cutting out sugar from your diet will massively improve this and help to keep cortisol steady. Having a diet rich in vegetables, whole grains, and protein with every meal will also help steady your blood sugars. Laugh more We cannot always do anything to reduce the stress in our lives, but often increasing the pleasure in life can counteract this. Laugh often, watch your favourite comedy TV show (I particularly like Modern Family and you can never beat re-runs of Friends), see actual friends, take long walks and bubble baths….whatever makes you happy. Take supplements Ashwarganda and chamomile, magnesium and B vitamins are all important for healthy adrenal glands. Camomile is relaxing and best taken at night. Gratitude to reduce cortisol Feelings of gratitude reduce feelings of fear and stress. It is important to have a gratitude practice and I have found it so helpful in managing my emotions. Tony Robbins says we should start with something small to be grateful for like a good cup of tea, the roof over our heads, because if we are always looking for something big to appreciate like holidays, or bonuses, we will lose perspective of the other little things that are good for us too. 3 things morning and evening are a good start, either written down or just noted to yourself or said out loud.

Tonight is Friday night, and for the first time in aaaaages, I am staying in . I am wearing a onesie, writing, and watching TFI Friday and eating leftovers. I did have plans to see some friends, who I really love and it would have been so fun, but I couldn’t do it tonight. After a long week at work, I needed some ‘me’ time to recuperate. FOMO is a new trendy acronym that ‘the kids’ are using, which stands for ‘Fear Of Missing Out’. I have lived a lot of my life feeling FOMO. But every time you do something because of FOMO (what if I miss that totally hip party, what if everyone is then talking about it in work for weeks and I wasn’t there?!) you are missing out on something else that you perhaps need more. Perhaps something your body needs, like a rest, or a gym session, or a good night’s sleep. Is putting your needs first and looking after yourself boring? Yes, maybe. But it sure is healthier and good for your spirit in the long term. It keeps you focused on your bigger goals and sets boundaries, which is a healthy thing. So try saying ‘no’ to something over the next week, and in turn say ‘yes’ to yourself. Have a great weekend!