Here we delve into another aspect of our health that is often less spoken about: mental health. Older people are more likely to experience contributing factors to depression and anxiety, such as physical illness or personal loss, but how many seek help? In this episode, comedian Mary Coustas (aka Effie) shares her very personal story, and we get insight from clinical psychologist Dr Charlotte Keating on how to better care for your mental health. About the episode – brought to you by Australian Seniors.  Join James Valentine as he explores the incredible stories of Aussie characters, from the adventurous to the love-struck. Across 30 inspirational episodes, Life’s Booming explores life, health, love, travel, and everything in-between Our bodies surprise us in ways we never thought possible as we age, so in series five of the Life’s Booming podcast – Is This Normal? – we’re settling in for honest chats with famous guests and noted experts about the ways our bodies behave as they age, discussing the issues and awkward questions you may be too embarrassed to ask yourself. Mary Coustas is one of Australia’s most loved actors, comedians & corporate speakers. In 1987 she became a member of the ground-breaking stage show ‘Wogs out of Work’, where her comic creation Effie was born. She is about to embark on a national tour, called UpYourselfness.  Dr Charlotte Keating is a clinical psychologist with a PhD in neuroscience, who runs her own private practice in Sydney's Lower North Shore. She is a passionate advocate for everyone's mental health, and has a particular interest in helping executives, parents, and young people. If you have any thoughts or questions and want to share your story to Life’s Booming, send us a voice note - [email protected]. Watch Life’s Booming on Youtube  Listen to Life's Booming on Apple Podcasts Listen to Life's Booming on Spotify Listen to Life's Booming on Google Podcasts  For more information visit seniors.com.au/podcast  Produced by Medium Rare Content Agency, in conjunction with Ampel Sonic Experience Agency   Transcript: James Valentine: Hello and welcome to Life's Booming Series 5 of this most excellent and award winning podcast. I'm James Valentine and in this series we're going to ask the question, is this normal? I mean, as we age, stuff happens to us. Our bodies change, things fall off, we get crook, stuff doesn't work as well as it used to. There's nothing we can do about it, we're getting older, we're ageing. But which bits are normal? Which bits do we have no control over? Which bits can we do something about? That's the kind of questions that we're going to be asking in this series, Is This Normal? of Life's Booming. Now, of course, if you enjoy this series, leave us a review, tell all your families and friends about it. And we want to hear from you as well. You can contribute to this. If you've got questions about things in particular that you want to know, perhaps there's some particular wear and tear happening to you, let us know. We'd love to see if we can answer that question in the series. We're going to look at things like menopause, gut health, mental health, lots of other burning questions. So think about those areas. And if there's something in there that's specific to you that you'd like us to cover, let us know. On this episode, we'll delve into another aspect of our health that is perhaps less spoken about, zeroing in on mental health. We'll be speaking to clinical psychologist Dr Charlotte Keating, who is currently practising in Sydney. But first, let's introduce someone you might know as Effie, comedian Mary Coustas. Well, hello. So we're going to talk some mental health. We're going to talk about these kind of things. What affects you as you get older, how you deal with it as you get older, what changes. What have you noticed, Mary?  Mary Coustas: Here's the thing. I love contrast. I love contradiction. I like all those things that when put together make for a more interesting mix. You feel more yourself, obviously, with age. You've worked through what matters and what doesn't, and hopefully you've found a healthy place to put what you've learned, either in practice or out there into the world. And I do it through laughter, mostly. But your body goes through something else that you should have anticipated, but you didn't. So I found the whole menopause thing really tricky, particularly for me, because when I was going through perimenopause, I was doing 10 years of IVF. So it was hard for me to know that I was going through perimenopause because I was taking IVF drugs, to have my now daughter. So then I missed that. And then I was much later, I came to motherhood late. And so then after I gave birth to my daughter, I was going through menopause, but you think because women are so accustomed to discomfort – and I'm not talking about marriage – sometimes it's that we don't connect the dots enough. So I thought it must be because I've just become a mother and the hormones from that, and I didn't realise it was the menopause thing. And the menopause thing plagues us in many different ways, but mentally it's a big one. It was the biggest one for me.  James Valentine: Before that, I mean, it's a bit of a cliche to say that the comedians are often doing that because of anxiety, because of various mental health issues. Were you that? Is Effie the outcome of that? Mary Coustas: No, I mean, yes, I had anxiety. I had a dying father. That doesn't help. Like he was unwell from before I was born. So that was the only true anxiety, apart from the racism that I encountered and then turned into a career.  James Valentine: Yeah. You mentioned that, like, Effie's a response to racism. I suppose I hadn't quite realised that. Explain how that came about.  Mary Coustas: Well, I was very confident growing up in a working class multicultural suburb. And then we moved as a family. My dad was very much a bigger picture sort of guy and said, we need to go where you can get a better education. And unfortunately that was in a very white area and I was the little seed. From the multigrain that made it into a very wide area. And I was spotted immediately. You know, everything about me. I was very into fashion. I had my Suzi Quatro haircut. I was on it. I paid a terrible price for that. For being different.  James Valentine: How old were you? Mary Coustas: I was nine. And it peaked I think a year or two in, and I just couldn't find a way to make it work for me. I was ostracised and it was tough. It was very, very tough because it was coinciding with my dad's health. And it was a very defining moment for me. And I hated the suburbs. I still get a little bit, oh god, I've got to get back to the inner. Because I feel like that's where we celebrate togetherness a bit more. We don't drive up a driveway and close the garage door and say goodbye to the day and everyone around us. I don't like that isolated feeling. So, the minute I stood on stage during my high school years, in musicals, which is ridiculous, I don't sing at all, but I mime brilliantly, I just went, okay, this is my stage, and this is where I can express myself. The Greeks built this thing thousands of years ago and they knew something and it's my thing and because I love the older generation so much and their stories, and this is beautifully folding into the conversation that we're having. I was never bored with that generation and what they'd experienced in their village stories and how they came to Australia and what that was like for them. So the marriage of that obsession with the older generation, with finding a healthy outlet to express the big noose that was hanging around my social neck, which was race, Wogs Out of Work happened.  I served Nick Giannopoulos as a waitress. He just graduated from acting school and so had I. I didn't know him. But then he told me, we went to the same primary school, the same Greek school. I mean, it was just so bizarre. And then Wogs Out of Work happened and that was the thing that changed the conversation in Australia. It was such a humongous stage show that really addressed the elephant in the cultural room and then discovered that the elephant was the best thing ever. And there were lots of elephants and there were giraffes and big lions and so I think the world has changed. Well, certainly mine has. And I think there are a lot of people out there that are now super confident. And Effie was the perfect way to illustrate a young girl like so many Greeks. On paper, Effie would appear as failed, I would imagine, her English isn't great. She's working class. She's primarily uneducated, she left at Year 10, went and studied hairdressing.  Walks into any room, whether it's with the prime minister in the room, which I've done a lot of, that high-end corporate stuff. Any room, any place feels worthy, feels relevant and still 35 years in, is that example of someone that is because of self love. It's funny because my current stage show is called Upyourselfness, and Effie, in that, says it's the only immunity we have left is to love who we are. And in the show prior to this one, this one is about political correctness and language. And as I said, Effie's never been great with language, but she's been great with feelings and demystifying things. The show before this one, Effie talked about lockdowns and COVID and she admitted to her own mental health issues. So I think she's a great mouthpiece for me to express so much of what I want to say about the world. She comes in a very animated form and I think people believe everything she says because it is based in truth, my truth. And then I wrap it up in her little boofy exterior and accent and put it out into the world. And so she was born out of necessity and out of my truth.  But yeah, I'm a very hyper sort of person, never been diagnosed with anything other than plenty of energy. And if I look at my mother who's 85, she's got plenty of it too. So I've used energy, and we were talking about this before we started, about how it's important to put the right words with things and then sometimes you can conveniently put a different word that makes it sound better or worse. Some people would look at, say, adrenaline and think that it was adrenaline rather than anxiety because it is a rush and it is something that you can put a positive spin on. I've seen a lot of people that have built great lives and careers out of using adrenaline, and then manifests later as an anxiety. So I am no expert in this. I know what I've gone through.  James Valentine: That's why we've got Charlotte. It's okay. Good. You know what you've gone through.  Mary Coustas: Yeah. And I believe that if you're a human being, you're going to have mental health issues. We're feelers.  James Valentine: Is that true, Charlotte? Is that an accurate observation? We're human beings, so we're going to at some point deal with, it could be anxiety, depression, whatever the label, we're going to deal with something.  Dr Charlotte Keating: Yeah, I think it really is. It's incredibly common, one in six people across their lifespan will experience some sort of mental health challenge, be it depression or anxiety. So I think most of us have either experienced it or have known someone who will, or has.  Mary Coustas: I suppose when I say it, I mean like we're all going to experience grief. We're all going to experience sadness. I mean, not the greatest hits of what we know mental health to be these days, which is a handful of really intense feelings. But I'm just talking about being human. Talking to somebody who's going through something very difficult that you love, or seeing a stranger you don't know on the street that evokes the empathy and all those beautiful things that reminds us of how human we are. We can't have all those feelings without suffering through plenty of them, whether they're directly ours or not. James Valentine: Is it, Charlotte, what that Mary is describing is the anxiety, the depression, those kind of things, those mental health issues – is it when those feelings are too much or become extreme? Or is anxiety, depression, something else?  Dr Charlotte Keating: Yeah, I think it's a really important distinction, James. I think for people who are experiencing depression or anxiety, sometimes those can be emotions that go with everyday life. I think certainly for older Australians, who perhaps have had less opportunity or exposure to the sorts of knowledge, awareness and information that younger Australians have today. They can often, I was thinking about what you were saying earlier in terms of your journey, they can go to the GP and perhaps present with, I have a lot of adrenaline, or I'm feeling quite tired, and not necessarily link those sorts of symptoms to perhaps there is something going on, physical or mental, that could represent perhaps more than just feeling off. I think sometimes we might feel off for a couple of weeks and we might just put it to the back of our mind and keep going. And it can be after really having let it go for some time, that in fact if you do have a chat to your GP or you do have a look, you're like, actually I've been feeling not quite myself for more than two weeks. It could in fact be months, maybe even years.  And whether it's low energy, low motivation, lack of enjoyment or pleasure in the things that might have typically brought it, perhaps even difficulty doing the things you have to do, even things like self care, memory, attention, all of those sorts of things we go, oh, that's probably because I'm tired or or what have you. They can be signposts that there is something going on that possibly you could get some help and support.  James Valentine: But I suppose for a lot of older Australians, it's also the thing to do with those things was to put it to the back of the mind, was to just go on, was to not sort of, what's all this stuff about, mental health? We didn't do that. We just got on with it, Charlotte, you know, it's all very well for you and your fancy diagnosis. We just got on with things.  Dr Charlotte Keating: It's absolutely true, James. And I was having a little look at some of the statistics on help-seeking, for Australians. And certainly for younger Australians, just for a point of comparison, 14% of 35 to 44-year-olds will seek help for their mental health concerns. Whereas 6.8% of 65 to 74-year-olds will seek help. I was actually heartened that there was a percentage of people who would.  James Valentine: Doesn't sound like many though, does it?  Dr Charlotte Keating: It doesn't.  James Valentine: In either group, really?  Dr Charlotte Keating: In either group, exactly. When you can consider the impact it can have on daily life and functioning. But 95% of older Australians see their GP and the GP is the first port of call often for being able to help with these experiences.  James Valentine: I was really struck by what you said, Mary, when you said women are used to experiencing discomfort. And so, therefore, perhaps tend to just roll it into, aagh, it's another one of those things that happens to me. They're not recognised, necessarily, that it could be a mental health issue.  Mary Coustas: It's funny what Charlotte said. I know a lot of older people that I'm close to that go to their GP to probably deal with more mental issues than physical ones. I mean, they're there way too regularly and if you have a good GP that is a good listener and loves what they do and loves their patients, you go there and I think they were stoic. They had to be. These conversations weren't being had then.  And I've been inspired by that generation so much for so many reasons. Sometimes you just have to force yourself to get on your feet and keep moving. I've experienced that personally on occasions, where just too many things happened at the same time that were too heartbreaking for me to be able to pretend it didn't. There was no hiding from heartbreak and grief and trauma and all those things, but I just think that a lot of people are terribly lonely and I think a lifetime can yield a lot of upset and grief and loss. Potential loss of physical capacity, loss of people you've loved, loss of opportunity, loss of all of those things. James Valentine: I wonder, Charlotte, if we're on two different streams here. The difficulties of life are one thing, and the extreme difficulties that Mary's describing there that so many have dealt with, that she's dealt with herself, will bring rise to moments of tension, of pain, of anguish. This is different from mental health?  Dr Charlotte Keating: Oh, it's a really good question. I think what we're really deciphering here is how do we respond to what life involves, what the journey involves. I think it's probably fair to say by the time people have lived multiple decades on the planet there is a sense of stressful life events and experiences that they've all, that they've all had. Some are certainly worse than others.  There can be a compounding effect to some of those. When we think about war or we think about growing up in other countries and things like that, there's all sorts of cultural differences as well with how we process those experiences and in fact, grief and loss as well. And I think that can also lead to questions we ask ourselves about what is normal, with respect to how we process grief, how are we supposed to do it, when is it that it might be important to perhaps seek some support in that way. You've described some stories, certainly Mary, where I'd be interested in understanding more about your experience of grief. I think for many people, perhaps it can be understood in the context of stages of grief. Kübler-Ross is someone that people are quite familiar with in the five stages of grief, being denial or shock, anger, then a sense of bargaining, what could I have done differently, and those sorts of things, with depression and sadness toward the end, and then some level of acceptance of what the loss might be at the end. And those stages aren't necessarily sequential.  James Valentine: Yeah. Or even in that order.  Dr Charlotte Keating: Or even in that order, and I think that there isn't necessarily a timeline, everybody's lives are so different. Their experience is so unique, together with their own sort of personality constructs and uniquenesses. And so, I think if you are listening and you're in a process of grief yourself and you're wondering if you might be a little bit stuck in some of that processing and as you said, Mary, it can be because sometimes there hasn't been a culture of being able to express emotionally or talk about experiences. So you might try and busy yourself or distract yourself or find ways to try and push it aside.  But it does come out, we are biological and physical beings, it's important to be able to express it. And so I would recommend if there is grief you're going through, that's really persistent, very painful and difficult, you're finding it hard not to excessively avoid, or perhaps overthink the challenge at hand, it's really impacting your capacity to get on with your day-to-day, I'd recommend having a chat with your GP about it, or if a loved one you can see is experiencing that, try and talk with them about it.   James Valentine: I suppose we don't have to think of it in terms of when we go to seek help, GP, psychologist, psychiatrist, whatever it might be, we don't have to see it in terms of there must be something wrong with me. Dr Charlotte Keating: That's it.  James Valentine: That I've got a mental health disease. You know, we can go and talk for all sorts of reasons, and maybe I only need to go for half a dozen times. Dr Charlotte Keating: Absolutely. James Valentine: Maybe it's only a short period of time where you need to just be able to talk to somebody neutral, somebody who's not in the family, someone who's outside of the situation. Mary Coustas: Yeah, look, there's a very healthy love of self when you allow yourself to express your journey and your feelings and it's not this taboo thing that we need to dismantle that instantly.  James Valentine: Have you sought help?  Mary Coustas: Yeah, I have. My dad's death was a massive loss, but that was not a tragedy. And then I had a grandmother who I was lucky enough to fly to Greece, my mother's mother, and my mum and I flew there and we were with her when she was dying and that was an honour. And that was the perfect death. You know, she was 93. That was all brilliant.  But I lost a child. And that's a very different loss. And I was given a superstar grief counsellor who is probably one of the most impressive humans I've ever met. Has done better work than I don't know what else. I mean, a brain surgeon would do it with a knife. She does it with openness and no judgment. And she navigated me through what was territory I never dared to imagine, and even beyond that. When I was then pregnant with my now daughter, I was worried that that would rob me of the joy I was finally faced with. And so I had to go and see someone. But someone alerted me to that. My obstetrician, Vijay Roach, super duper star, he's the one that got me Deb de Wilde, who was my grief counsellor. He said, I think you need to go and talk to somebody because he knew my concerns. I'd worked so hard to finally get what I wanted and I didn't want to be in denial of what I'd experienced prior to that. That had happened, but I wanted to put it somewhere healthy and I went and saw somebody and they said, look, there's two ways you can deal with this, you can tell yourself that it's a fear fantasy and you've concocted it, but that doesn't work for you, that wasn't a fear fantasy, that was a reality you survived. So let's take that one off the table, and let's just accept that you have these feelings, these feelings will come and go, and you let them pass through you.  And I did the work. She gave me some exercises to do, and I've got to tell you that on the day of my daughter's birth, I went back to the same hospital where my other daughter had died, and I was in, literally, in the same spaces with the same faces. And I did not connect the two until there was a male nurse that got put on. And he'd also lost a child. And he approached me just before I went into the theatre to deliver my daughter. And it came through another human being. And he said I needed to see the happy part of the story. He was wanting to build up his hope for what was ahead for him. So it happened in the most perfect way. James Valentine: That was a good moment because I could almost imagine, oh, why did you choose this moment to come and talk?  Mary Coustas: Oh no, it was a great moment. And then we had a bit of a cry and I went in and then I was so present to what was about to happen and then when I was being wheeled out holding onto my daughter, high as a kite, I looked at him and we smiled. It was just beautiful. It was like something in the movies, you know. James Valentine: Yeah. Charlotte, as people age, unfortunately, these kind of moments will happen, a child can die. Not necessarily in birth, but your 20-year-old, your 25-year-old. You’re 60, 70, 80, your child can die. Your partner can die. Your friends start to die.  You yourself will start to face things that are going to be extremely difficult. And again, I wonder whether we conflate these things into, you'll only go and talk to a psychologist or counsellor of some sort, the priest when it's really extreme, or if you've actually got some sort of mental health issues.  Again, this is not the case, is it?  Dr Charlotte Keating: Yeah, I think it's shifting a little bit, James, but I think it has long been that challenge of, oh, unless I'm really at breaking point, then that's for somebody else who really needs it. That's not for me.  James Valentine: I had to have had a nervous breakdown. Dr Charlotte Keating: Yeah, I think that's exactly right. And I think that as you just both described, life is full of challenges and losses at various different stages, whether it’s when you're trying to start a family or, as you get older, family members might have challenges or problems going on themselves. It could even be in the context, there were things we don't ordinarily think about, say retirement, and moving towards something that you've derived a great deal of sense of self worth, purpose, meaning.  There's a change in one's sense of self or identity that can surround that and even things like irritability and anxiety can be linked to those but people don't necessarily know. Sometimes they do, but they don't always necessarily know and sometimes it'd be so valuable, as you said before, Mary, having a conversation with someone who really can change the trajectory of subsequent experiences you have, not even just the one that you might be seeking some sort of counsel for. Mary Coustas: Yeah. And I also think with these conversations, the people that will help you get on the road to alleviating some of the discomfort of being human are not often the doctor. Someone else will tell you about it, you will have a conversation, this is where it's important we stay close and we keep talking to each other. And I don't want this to be simply about what is difficult because there are so many great joys. And if you can get to those highs, you're going to get to those lows, you know? But friends or someone like in my case where people have said I had an issue, with something like that, you should talk to. And it just makes it feel much more natural and less taboo-ish if it's coming from someone who's done it themselves.  And we need to keep reminding ourselves. That's why campaigns like R U OK? Day and all of those beautiful things that people have put out there, just to remind ourselves that some days are going to be better than others. And there are memories and triggers everywhere for us, especially if you've gone through difficult things that can evoke those feelings to come back up to the surface. And we know that community is a huge part of what makes people happy in that whether you're watching the Blue Zones documentary series or listening to people from The Happiness Institute or wherever you go to find your insights into what is healthy and what breeds longevity.  And it is community. And it is a priest, in those days, or an older family friend that perhaps isn't directly in your family, or someone you can go to and talk to about the things that are weighing you down. And I think that even podcasts like this are so useful to just say… You can't afford to ignore those things that are very difficult to get through. We're not supposed to get through this stuff alone.  James Valentine: Yeah.  Mary Coustas: We're born in communities and surrounded by people, and we should take complete advantage of that. James Valentine: And it makes me think that particularly for men, as you say, are perhaps not as accustomed to talking, not as accustomed to having those sort of friendships that women have, that I'm often quite jealous of. It's like, how come you've got these four friends you go and talk to all the time? Men need to cultivate that. Men need to learn to cultivate that, and perhaps particularly in retirement, those work contacts have gone, and you need to learn how to have those conversations that are intimate, that are real, and have that group of friends. You play golf with them, you play tennis with them, it doesn't matter what the initial contact is, but start to change the nature of the conversation at the bar afterwards.  Mary Coustas: But don't you think golf,  the reason why it's taken off so much is two: one, you're competing with yourself, right? And that's the healthiest competition there is, as far as I'm concerned. I always say to my daughter, you're not competing against anyone else, you're competing against yourself.  But also it allows for talking time between moments, and I think that's why particularly so many men are drawn to golf.  James Valentine: Yeah, that's right. But I think this is something, Charlotte, for men to probably deliberately consider, you might need to deliberately think about cultivating that group that's perhaps got a different kind of talk going on. Dr Charlotte Keating: I think that's right, James, and I'm hesitant to say, but I almost want to say, watch what the women around you do, and try and go, okay, well, that's what they talk about, or those are the sorts of things maybe I can do that too. I think as well, there's leaps and bounds being made in places and spaces like the Men's Shed, definitely a place where the capacity to be vulnerable and connect and really talk honestly is created.  And I think if you're going for exercise in the morning, you can often see perhaps the end point of the cycling gang, they're having their coffee and they're actually just talking and chatting a little bit.  James Valentine: But stop talking about bikes, fellas. Come on.  Mary Coustas: Stop avoiding the real issue.  Dr Charlotte Keating: I wouldn’t argue with that. But I think it's trying to take the opportunities where they might present and then also thinking about what sorts of hobbies and things do I like doing? Maybe I've played golf once every couple of years or, if I had to, maybe I'll actually pick it up with some determination. Or tennis or cycling or walking or swimming.  Mary Coustas: Or in the case of the Greeks – because I spend a lot of time in Greece, I've got a house there and all my family apart from my mum and my brother are in Greece – the men meet every day and have coffee. Every day.  James Valentine: Do they talk? Do those old men sit there and talk?  Mary Coustas: They talk about everything. James Valentine: Real stuff? Mary Coustas: Real stuff. Greeks, we like to think that our feelings live on the outside of our body. We're very verbal and expressive.  James Valentine: Right, right. If only you could keep some in.   Mary Coustas: Yes, exactly. Do I really need to know that every little detail?  But you see them and my house is around the corner from the oldest cafe in the area and they gather there every morning. And they play backgammon and they chat about what's happening with their kids, and their grandchildren and what they have to do that day, and then they meet up again, either later when it cools down again for the evening, but they're out.  And I think one of the best things that you could do, and I say it to so many people when we're chatting about this, is you've got to be careful of the conversations you're having inside your head. And you've got to get outside of your head and into, all of you, into a physical world, into a social world. Because you can talk yourself into anything. There's no objectivity coming through that non-stop monologue that's happening internally.  And it's good to be able to go somewhere. Whether it's a doctor, whether it's a group of friends, start a new routine, have something to do that gets you up and out every day to, to mix with others, to learn from their stories, to be able to express yours. These are all super healthy things.  Dr Charlotte Keating: So well said.  James Valentine: Mary and Charlotte, what a beautifully rich conversation that was. Thank you so much. Mary, thank you so much for your openness through all of this.  Mary Coustas: My pleasure. That's my favourite thing to talk about, is human beings.  James Valentine: Yeah, but the fact that you've been able to write about your suffering, and express that so publicly, so so well, that's so important too, and I thank you for it.  Mary Coustas: Well that’s one level of the therapeutic process is to be able to put it outside of yourself somewhere, whether it's in talking or in writing. I mean, I'm lucky that I'm in a public domain so I can put it out there for others to respond to.  And my whole career has been about dispelling taboos, and talking about the difficult things. And I wrap it in a capsule of comedy and that's what makes people happy. And it’s what makes me happy. And that's my antidepressant. It’s a very joyful job, but I try to shove in as many issues in that capsule as I can to sort of liberate myself and everyone that's there.  James Valentine: You do it beautifully and joyfully and thank you so much. Charlotte, thank you for sharing your expertise. Great to meet you.  Dr Charlotte Keating: You too, thanks James. James Valentine: Dr Charlotte Keating runs her own private practice on the Lower North Shore in Sydney and Mary is about to embark on a national tour called Upyourselfness. You've been listening to Series 5 of Life's Booming: Is This Normal? Another season will be coming along later this year, so stay tuned wherever you get your podcasts. I'm James Valentine. Thanks for listening.See omnystudio.com/listener for privacy information.

In this episode we spotlight gut health, and all the normal, and more unusual, health issues connected to our digestive systems. We speak to clinical nutritionist and the author of The Gut Repair Plan, Sarah Di Lorenzo, plus Melbourne chef and founder of Made by Tobie, a home delivery meal service, Tobie Puttock. About the episode – brought to you by Australian Seniors.  Join James Valentine as he explores the incredible stories of Aussie characters, from the adventurous to the love-struck. Across 30 inspirational episodes, Life’s Booming explores life, health, love, travel, and everything in-between Our bodies surprise us in ways we never thought possible as we age, so in series five of the Life’s Booming podcast – Is This Normal? – we’re settling in for honest chats with famous guests and noted experts about the ways our bodies behave as they age, discussing the issues and awkward questions you may be too embarrassed to ask yourself. Sarah Di Lorenzo is a clinical nutritionist and author of four books, including her latest, The Gut Repair Plan. She is resident nutritionist for Sunrise and Weekend Sunrise, and is passionate about sharing information about a healthy diet and eating the right foods to help with sleep, stress, weight loss, immunity, and slowing down the ageing process.  Chef Tobie Puttock began his career in Melbourne, before travelling and cooking around the world, including alongside good friend Jamie Oliver, who shared his passion for simply cooked food. His most recent focus is his own brand of frozen ready meals, Made by Tobie, with a focus on producing meals that aren’t harmful to us or the environment.   If you have any thoughts or questions and want to share your story to Life’s Booming, send us a voice note - [email protected]. Watch Life’s Booming on Youtube  Listen to Life's Booming on Apple Podcasts Listen to Life's Booming on Spotify Listen to Life's Booming on Google Podcasts  For more information visit seniors.com.au/podcast  Produced by Medium Rare Content Agency, in conjunction with Ampel Sonic Experience Agency   Transcript: James Valentine: Hello and welcome to Life's Booming Series 5 of this most excellent and award winning podcast. I'm James Valentine and in this series we're going to ask the question, is this normal? I mean, as we age, stuff happens to us. Our bodies change, things fall off, we get crook, stuff doesn't work as well as it used to. There's nothing we can do about it, we're getting older, we're ageing. But which bits are normal? Which bits do we have no control over? Which bits can we do something about? That's the kind of questions that we're going to be asking in this series, Is This Normal? of Life's Booming. Now, of course, if you enjoy this series, leave us a review. Tell all your families and friends about it. And we want to hear from you as well. You can contribute to this. If you've got questions about things in particular that you want to know, perhaps there's some particular wear and tear happening to you, let us know. We'd love to see if we can answer that question in the series. We're going to look at things like menopause, gut health, mental health, lots of other burning questions. So, think about those areas and if there's something in there that's specific to you that you'd like us to cover, let us know. On this episode, Getting to the guts of it, we spotlight gut health, the normal, and the more unusual health issues connected to our digestive systems. We speak to clinical nutritionist and the author of The Gut Repair Plan, Sarah Di Lorenzo, plus Melbourne chef and founder of Made by Tobie, a home delivery meal service, Tobie Puttock. Sarah Di Lorenzo: Hi, thank you so much for having me.  James Valentine: Why are you a nutritionist? I can't even say it! Sarah Di Lorenzo: Nutritionist, a clinical nutritionist. Why? I started with my own gut health, really, was what drove me into becoming a clinical nutritionist. I just did really notice around the age of 15 that foods affected me differently. I noticed it with white bread in particular, and I would go home and say to my dad, who's a psychiatrist, a doctor, and I'd just say, I don't feel well when I eat that food. And he goes, oh yeah, yeah, we all feel like that from bread. It's probably a Greek thing, whatever. You'll be fine. Don't worry. And so I watched my dad always living his life bloated, and I was like, yeah, yeah, it's not great.  And then when I was in Italy when I was 18 for a few months, it was the most incredible experience that I clearly just couldn't enjoy, because I had gut issues, I had non-coeliac gluten insensitivity, self diagnosed. And then I ended up after that, when I came back at that young age, I was doing my science degree at Sydney Uni, I came back and I was like, I need to work on my gut because my quality of life is not great. And so it dominated my life and I just couldn't enjoy my life. And so that's what I started doing was working on my own gut and I'm 51. So that's like 30 years ago, more so 32 years ago, I started, I realised then, so I went through my own gut healing journey and have spent a lot of those younger years just looking at my own rest and retest, trying different foods, creating menus, creating diets, I just did it as a hobby and a passion.  And then I went on to study nutritional medicine after that, when I realised that it was really my calling. I feel like I'm a healer. I do. I've healed myself and now I want to heal everyone else. James Valentine: Now, let's go to chef Tobie. Hello Tobie.  Tobie Puttock: Hello, how are you today?  James Valentine: Thank you so much for joining us. It's fantastic to get some time with you. This is something that's close to you. You think about the gut a lot. Tobie Puttock: My wife, when we first met, she was very controlled by her stomach issues. So obviously all tied in with the gut. She had food poisoning when she was younger so badly she was hospitalised for a few days – not from my cooking! I didn't know her at this stage, it was in the UK, and it really screwed her gut up.  So I remember for the first about three or four years of our relationship, everything was dictated by that. And it was IBS basically. And I didn't really understand, I'd never met anyone with such an issue before. And, you know, we'd have dinner plans, we'd be all ready to go. And suddenly her stomach would start to feel uncomfortable and we'd have to cancel dinner. Our whole life revolved around the stomach issues and after being together a few years, I had the opportunity to write my first cookbook. We were living in the UK at the time, we came back to Australia and I met an amazing person named Dr Sue Shepherd. She goes under a different surname these days, but she is kind of a guru in the gut health space and she spent some time with my wife and basically together we adjusted her diet and she solved her own issues. So she no longer has IBS. James Valentine: That's great. And it's come on a lot, hasn't it? Our consciousness of the gut, eating for our gut biome, I would say it's a way of thinking about food that's come up about in the last decade or so. Tobie Puttock: Yeah, 100 per cent. Being in food for my career and my whole life revolves around food, I see things jumping in and out of fashion and gut health has been a huge fashionable topic for a long time, and now it seems to have mellowed out into actual just fact. People accept that your gut is super important and eating the right foods and gut health really can make a huge difference to your life. James Valentine: Yep. Well, let's plan a diet, a pantry for good gut health. What kind of dishes, what kind of ingredients do you focus on if you're thinking gut health?  Tobie Puttock: Well, first of all, I try and eat as little processed foods as possible. So I also have quite an empty pantry at most times, but obviously fermented foods are fantastic, I do a lot of fermenting. After I jump off here, I will be going to make sauerkraut this morning, but things like kimchi, most fermented foods, are fantastic. And then there's going to be, if you do have things like IBS, there's going to be a lot of trigger foods that will be quite acidic as well. But yeah, definitely for me, we have a lot of sort of robust greens, lots of cavolo nero, Tuscan kale, brussels sprouts and all the good stuff there. James Valentine: Right. I like that description of robust greens. These are the tough ones.  Tobie Puttock: All the brassicas. So we're steering, you know, I think things like cos lettuce are fantastic and they're sexy and rocket lettuce and all that kind of stuff. But I remember a few years ago, it was probably 2013, I made a big life change, I just got spat out of kitchens, I was probably quite unhealthy without realising it, I was just going through life as a lot of people did and I was insanely stressed. And I started doing a lot of yoga, and my wife, at the time, was seeing a personal trainer and trying to get shredded. And she was going to the personal trainer a couple of times a week, but coming home to eating my Italian food that I cook in restaurants, which I now wasn't cooking because I wasn't in restaurants. And she gave me a list, this amazing list of all the things we can have as much as we want of, things we should never have, and things we can have in moderation. And we started cooking from that list. And I should also pop in there that we tried to conceive and it didn't happen naturally. And they tried to tell us – well, they did tell us – that IVF would be the only way. And with a total diet overhaul cutting out all processed foods. And I don't want to say that kale saved our life or anything, but it kind of gave, you know, kind of did a little bit. I lost probably six kilos of body fat, my wife lost 10, and she wasn't big to begin with. We conceived naturally, and we kind of look at those as some of the fondest years of our life. And then we had a kid and started eating junk food, and did the reverse of that because we were young parents – or new parents, I should say. Yeah.  James Valentine: Yeah. All hail kale, I say. So Sarah, what happens to our gut as we age? What are the sort of things we need to be aware of as we're 50, 60, 70? What's happening? Sarah Di Lorenzo: A lot's happening. I mean, I kind of noticed this when I thought, even myself, like it ages. It's as simple as our gut does age. We don't produce as much saliva as we used to. But if you think about eating, say a highly processed meal when you were young and be like, oh that was okay. Or even getting blind drunk when you were young. And then you think, well, that was okay. You go and now in your 50s, you go and eat a big processed meal and you're like, oh gosh, you kind of really do feel it. Or you go out and have a big night on the drink. The next day people will notice it.  James Valentine: The next two days.  Sarah Di Lorenzo: People notice it. They really feel it. So look, it ages. At the end of the day, when you really look at it, first of all, we don't, as I mentioned, there's just not as much saliva. People don't produce as much of the digestive enzymes, so like lactase, so people notice things like, oh I'll hear things in clinic, I just don't really seem to process dairy like I did when I was young. Well, cause you're not producing enough digestive enzymes, so it comes that whole process ages as well, and there's just, even the way our peristalsis, the whole system is… James Valentine: Is that swallowing? Sarah Di Lorenzo: Yes, swallowing issues, chewing. People tend to change their diet as they're older. If they've got things like dentures or dental issues, it can start right from there. So, the microbiome changes. The microbiome is the habitat which our microbiota live in. So I always explain that to people.  James Valentine: This is all the bacteria in our gut.  Sarah Di Lorenzo: Bacteria, fungi, viruses.  James Valentine: This is the new thing. This is the newer discovery. This is not stuff we understood. You know, when you were first going, I don't feel so good.  Sarah Di Lorenzo: Correct. Yeah, this is all new stuff and it is fabulous. When I was actually reading all this stuff and I was putting this book together, I'm just in awe of our gut. Like, I'm so impressed by it. I really am. The residents that live there, that I might point out, our gut bacteria, weigh two kilos. Yeah. Yeah.  James Valentine: Isn't that amazing? Two kilos of biomass of living stuff.  Sarah Di Lorenzo: I find that fascinating.  James Valentine: So like, do they change if we don't look after them?  Sarah Di Lorenzo: Correct.  James Valentine: Or do we need to do stuff? Are we trying to keep a youthful gut or do we need to understand our maturing gut? Sarah Di Lorenzo: Well, there is that, but look, we do need to take care of it. And this is one thing that I see as people age what they don't do is they don't create that diversity. So our gut bacteria love, love, love a diversity in our diet. So as we age, we tend to eat the same things every day. People have the same breakfast every day, the same lunch, the same dinner. They don't eat a lot.  Now, it's actually, and that's one of the biggest problems. So as you age, it's really important to make sure that you've got that diversity to feed that good bacteria in our gut. We want those colonies broad. We want to feed, because all the different bacteria do different things. Like we've got a bacteria, which is my favourite one, called akkermansia muciniphila. James Valentine: But that's easy for you to say. Say that again. It's a what?  Sarah Di Lorenzo: Akkermansia. It's my favourite bacteria. I love this bacteria. We want lots of it, so akkermansia muciniphila is one that keeps us at a healthy weight. And then you've got like bifidobacterium, which actually helps break down the food we eat. I know you're looking at, if anyone could see James right now! James Valentine: No, it's impressive. Okay, very, very good. It's like when people see birds and they use the Latin name. It's like, very good. Well done.  Sarah Di Lorenzo: Now I've lost my train of thought. Yeah, sorry. Okay, as we age… James Valentine: Yeah, as we age. I think what I'm interested in is, like, with a lot of things we want to stay, we need to stay, youthful. Is our gut like that, or should we be allowing our gut to mature? Sarah Di Lorenzo: I would want to be keeping my gut as young as possible. Definitely. The other thing we forget is medications that people take as they age. So medications can really impact gut health. And we know that. People often take laxatives when they're older. There is actually this recent study that came out that showed that people who use laxatives – not stool-bulking laxatives, but actual laxatives – have a 51% increase in their risk of dementia, which shows that gut brain axis. So there's a lot of things that can, stress is a really big one. It can be stress with ageing, stress for whatever, that will impact gut health. But it is creating that diversity and we only eat I think, 75% of the adult population only eat from 12 different plant types over the course of the week. That's some research that I have seen. So one great thing that you can do to start to improve and feed all those different colonies down there, like akkermansia, and grow more of them, the one thing you can do is make sure, a little test you can do, is make sure you're eating 30 different plant species over the course of the week. James Valentine: And Tobie, how do you approach getting that diversity in the diet?  Tobie Puttock: Yeah, there's a lot to be said for it. General nutrition, I have a basic understanding of, but my main thing is making things taste good. Which is what I wanted to do with my book, The Chef Gets Healthy, which was about making everyday food. Because I think as a society, we tend to look for easy answers for big problems.  And I remember at one stage, the fried southern chicken burgers were trendy. And then on the other end of the scale, you had Pete Evans pushing these really super hardcore diets like the paleo diets. And I always think that the answers lie somewhere in the middle. You don't need to go to these extremes. James Valentine:  Okay. Well, give us some insights into what you do with these sort of things. Cause I think sometimes people say, look, the fermented foods, kimchi, sauerkraut, they're good. And then you should be eating more of the brassicas, the broccoli and the sprouts and all that sort of stuff. But if you're used to the steak and veg, if you're used to the pizza, you don't know what to do with this stuff. Tobie Puttock:  Yeah, it's true. And I believe that you can still eat all that. You just need to add in vegetables. So I think as a society we're getting better at this, but until recently we've eaten way too much protein. Aussies tend to eat beef or lamb, or similar sort, four to five nights a week and even more seven nights a week. I remember speaking to somebody saying, oh, you should have fish once or twice a week. And they had no idea. They never cooked fish. They had no idea of the health benefits of that as well. But my belief is that we need to pull back on eating meat, substantially, for so many reasons, you know starting with environmental, but also our health as well. So I believe a great diet and a lot of research has been done on this and proven, the Lancet report has shone some great light on this, which is that we should probably eat a vegetarian diet three to four nights a week. Eating meat is expensive, so you can save that money that you're not spending by cutting meat out of the diet three to four nights a week. And then when you do eat meat, eat a fantastic cut of meat that's sort of grass fed, comes from a reputable supplier, therefore we're not fuelling the inhumane farming trade. And you will notice huge differences. Now, simple ways to cook vegetables. I've worked in very technical kitchens and it's funny, because since I've been out of kitchens since 2012, I've often realised that cooking vegetables, the easiest way, is often the most flavoursome and nutrient-beneficent.  So, I grew up with a British father who grew up in a family which was often, I think, frozen vegetables, or vegetables that were cooked until all the chlorophylls and colours had gone out and they were grey. I do the polar opposite of that.  So, I'm not into a raw diet, but I think you need to cook vegetables until, for example, with kale. Let me talk you through one of my favourite quick dishes. So we do a breakfast, which is, baked eggs and kale, and fantastic. And my meat-eating friends who I've given this to just go bananas for it.  So it starts in a pan with a little bit of olive oil, and garlic and chili – so aglio e olio base – and you sauté that off over a low-to-medium heat until the garlic starts to soften and become translucent, at which stage you break in some kale – and cavolo nero, which is a type of Tuscan kale, is also fantastic. Even more robust leaves than the traditional green kale that we're familiar with now, with those stems which are really fibrous. I normally leave those out and keep them for a juice or similar, but they've got a lot going on, our body needs them, but for this particular dish, not the best. So break off the leaves, sauté them around, mix them through with the oil and the garlic and the chili until it just starts to green, at which stage you can crack a couple of eggs into there. And then normally over the top of that, I break some feta cheese into there, dabble a little bit of natural Greek yogurt, some hemp seeds, a little good pinch of sea salt and pepper, bung the whole thing into the oven just until the eggs are set. We're talking two, three minutes.  So you can make this whole dish, if you're good, in under 10 minutes. And it's got a lot going on there. You're going to get all that beautiful fibrous veg from the kale in there. And the protein from the eggs, the hemp seeds are fantastic, and the whole thing just tastes amazing. It's a delicious breakfast. But kale can be really, really easy to cook. I mean, it's as simple as sautéing it down for a couple of minutes.  James Valentine: So Sarah, tell us more about feeding our gut bacteria.  Sarah Di Lorenzo: So we want to feed these guys with prebiotics. So that's what they eat. Bacteria need these prebiotic-rich foods, which are the foods people just don't get enough of.  They might go and take probiotic supplements, but you need the pre's to feed the pro's. It's as simple as that. Prebiotic-rich foods, fibre, that we can't digest as humans, but the bacteria feast on them. And so we want all of those wonderful foods. Now things like asparagus, apples are great, onions, garlic, oats, and all great foods, sourdough is another good one. All excellent foods that we should really be eating. Leek, Jerusalem artichoke, they're all coming to my mind now. You can see my mind is flowing in with them. I've unlocked that part of my brain, which is full of prebiotic information and let it flow out. Yeah. So we need to actually feed them to grow. And in turn, their waste product, the bacteria waste, is what we as humans thrive on, it's critical for our overall health and wellness. And we call their waste, which is called a postbiotic, is actually a short-chain fatty acid, or it's called butyrate. So butyrate feeds our colon cells. It makes the wall of our gut strong and firm, which is what we want. We don't want it inflamed and leaky, where you get what's called leaky gut syndrome that leads into migraines and headaches. And so that's called post. I'm obsessed with butyrate. I just want so much butyrate. I would drink it. So you can see that’s how it all kind of works.  James Valentine: Yeah. Yeah. And so we should be getting all this through foods, not through supplements, pills, little liquids, you know, things that are meant to sort of put it there. Just do it through the stuff that you eat? Sarah Di Lorenzo: Correct. But if you were, for example, someone who was taking a course of antibiotics, because the antibiotics, whilst they're amazing and they save lives and they wipe out the bad, they also wipe out the good. So if I was to have to go on a course about antibiotics, I would take probiotics, I would take them in supplement form, but I would also make sure I was feeding that, just having a bowl of oats for breakfast or having some asparagus, asparagus is a good one, or just throwing a lot of onion and garlic in my food, making up shots of different… just adding it in where you can. James Valentine: This is so much when we start to hear, the Mediterranean diet, that it covers all of these things, doesn't it? You cook with onion and garlic, there's oil on stuff. You will have sort of an oats or, you know, muesli type thing for breakfast or a cookie that's like that. This is the stuff.  Sarah Di Lorenzo: Correct. And also all the legumes you forget that are so high in fibre. I think Westerners just forget about legumes. And they are…  James Valentine: This is your chickpea, your beans, all that sort of stuff.  Sarah Di Lorenzo: Yes. Lentils and chickpeas and beans, and they dominate the Mediterranean diet and people shy away from them because when they eat them – and this is the whole problem with fibre. We don't eat enough fibre. That is a huge problem. Part of the ageing process is people just don't eat enough fibre. Because when you introduce fibre to people that aren't used to it, they get flatulent and distended. And they go, oh I've got FODMAPs or I've got this. And I'm like, no, no, no. You just had too much fibre, too quickly. You have to introduce fibre slowly to people to get them over it. That's what I've written. The four-week plan of my book is just that slow introduction of fibre so people don't get those symptoms.  But it is a common base of the Mediterranean diet and the gut bacteria, it’s all about feeding these guys, making them happy, making them grow, making all the good ones grow. And in turn, supporting our health. It's pretty simple, but when you do the deep dive into it and look at all the different types of bacteria and as you can see, there's bacteria for mental health, bacteria for weight, bacteria for skin, bacteria for heart. And so we want lots of them, not just feeding one, which is why you can see that diversity is really important. James Valentine: So I suppose I'm thinking that we had a long period of time where we worried about the heart. You know, there was a lot of focus on the heart. The heart's the thing. You have to deal with that. And then we've had a period of time where, look, it's weight. Weight is most important. You know, you've got to keep the weight off and make sure that you're at the right weight and that sort of stuff. Is the gut just sort of the trend? Is it just the sort of the thing that everyone's talking about now? Because we're bored of talking about the heart or something like that. Is there more to it than that?  Sarah Di Lorenzo: I think that when you think about trends and fashions in health, like, okay, well, cardiovascular disease, clearly it's a leading cause of death and disability. So it's always going to be there. I do feel there are trends. I think trends are what you've got to be really careful of. Like at the end of the day, the heart's the centre, I mean, you have to take care of your heart health, and it still is that, it is the leading cause. And then weight is something that I feel it's evergreen. Look, at the end of the day, excess weight is inflammation, inflammation drives disease, it's just as simple as that. Any patient that comes into my clinic, and sits down, and, oh hi Sarah, look, I'm here for my menopause, my gut, my cardiovascular, and I've seen them 15 to 20 [times], and I will say to them, okay, I'm not going to sit here as your practitioner, and just do a treatment protocol for your cardiovascular condition.  Because you're carrying 15 kilos of weight.  So it all ties in together, so every single patient that sees me has to get to a healthy weight, because I know that it's so inflammatory. Adipose tissue is like this. It's big, it's proinflammatory cytokines, it is inflammation. Inflammation drives disease. And number-one of the diseases is depression. Before you start going to cardiovascular, diabetes, thyroid, arthritis, or before you even go down that path, metabolic syndrome, it is the driver. And as far as gut goes, people who are overweight have poor gut health. I'll tell you an exception to that though. So people who are overweight, talk to them about getting to a healthy weight and working on increasing that. The only exception would be, when I think, cause I'm right now, I'm just scanning all my patients that are currently in my clinic while I'm talking to you, is someone who would come in with H pylori [helicobacter pylori], and undiagnosed. So I had a lady who brought her husband in. And this is quite a funny story. They're both 45, great couple, no kids, living their best lives. They don't want kids because they're fabulous and they want to just travel and enjoy. She can't cope with the amount of times he farts in a day. So she's just like, he farts way too much. James Valentine: How many would be too much?  Sarah Di Lorenzo: Well, I'm going to ask, I'm going to do a pop quiz on you James. Okay. How many farts do you think we should be doing a day as humans?  James Valentine: I would go for around the dozen.  Sarah Di Lorenzo: Not bad. Okay, 15 to 22, so yeah, you weren't far off. This guy was just farting all day. So I asked her that and she said it's constant. Like it's probably every five minutes. And she said it's actually ruining our marriage. I said, yeah, fair enough. And she can't sleep in the same room as this poor guy. So healthy weight, fit guy, Lebanese, so ate a lot of raw meat. I knew that there was something going on. I knew he had a parasite of some kind. So I just sent him off for a test, came back, he had helicobacter pylori. And so we cleared up the H pylori, their marriage is back on track.  James Valentine: And he's back to the 15 or 20 that we should all be doing… Sarah Di Lorenzo: …instead of doing about a thousand. So that would be the exception. And what I do see is people that come back in from travelling to places like Indonesia, who come back and they've had Bali Belly or different things, so they're the ones I also see, which again, where a parasite has impacted their gut, and it does ruin people's lives.   James Valentine: Let's say I'm 70, I've never done any of this. Can I change? Is my gut going to change? Is it all too late?  Sarah Di Lorenzo: It's never too late. I don't care, like actually, I had someone write to me this morning, because I did a post about how much I hate artificial sweeteners, and they said, is it too late? I've had my whole life living on Equal, and I drink Diet Coke every day, and I've got diabetes. No, it's never too late. I will always say, I will never give up. I will fight for someone's health to the end.  James Valentine: Tobie, for general gut health, if you're doing as you describe, you have two, three, four vegetable-based dishes a week, you're more conscious of eating some raw greens and that sort of stuff, you can have a pizza on Friday night? Yeah, you can have a glass of wine. It's not to say you've got to get rid of these things? Tobie Puttock: No, it's about balance for me. It's like, I still have Cadbury chocolate in the fridge. I love that stuff, but it's about the majority of the time eating as well as you can. And of course we know we sort of started to get into the realm of biohacking now. And we've got all these tech billionaires who will look you dead in the eye saying they're going to live to 150. And we've got, I forget the gentleman's name. He's reversing his age. He's a tech billionaire in Silicon Valley and he's now got the innards of about a 30-year-old and he's about 45 and he's going back about three years for every year. So there's a lot to be said for that. Now we know that through processed diets, this shortens your life,100%. And we don't even have all the data yet, but a lot of the processed foods and I get really worried about these younger generations who can't cook, they're all into the cooking shows and they love watching it as eye candy, but they can't cook, which for me is such a basic life skill. But if you look at all the oldest living people in the world without gut issues and all these kinds of things, they're eating very natural foods. They're in, you know, the Mediterranean, they're in Japan and they're eating just a lot of good produce.  James Valentine: Yeah. Now, coming back to you, Sarah, what are your thoughts on this? Sarah Di Lorenzo: So when I do gut repair work with people, the thing is, you get these people in, and I'll say, OK, so give me what are you eating today? I don't really know, I kind of, oh so you wing it, you ad lib the day. OK, so when I have an ad libber or someone who wings the day, all right, give me a 24-hour recall. So that's my next question. Oh, yesterday, oh, I had a couple of pieces of toast. Ah, a bit of jam, I don't know, I just had that on the fly, grabbed a coffee. Had some Arrowroots at work or at home with the wife watching, you know, more breakfast television. Oh, I don't know what we had. Oh, we had leftovers for lunch, that's right. Oh, my mum cooked, my wife cooked a spaghetti bolognese for the grandkids that came over in the afternoon. Oh, we had some bikkies or whatever. A bit of chocolate. They don't really know. And it's a lot of highly refined processed food, which is really dry, which really increases the production of insulin, which is driving disease, etc. So when I say to them, right, do my gut repair plan for four weeks, I am taking them from what they think is okay as a Western diet. They might even be having a white bread sandwich for lunch or a stir fry for dinner. To me, that's a Western diet. So when you take someone from that and you say, right, do all your food prep, get everything organised, start your program. And you put them on my program, which is a gluten-free program – number-one common allergen – first thing to go is headaches. And then you get that clarity of the thought instantly within three days you'll feel better. Energy, body systems working well, better sleep, better mood. And within three days, I'll get messages. I see her on my day three of the gut repair. I've gone to the toilet twice today, three times today, I had a really good night's sleep. I feel my energy's really up in three days. So you can see, as I mentioned in the beginning of our chat, eating rubbish food and going out and hammering yourself on the booze, you get that input, like you picked two days. So you think two days of healthy eating.  The gut does respond. So it will respond very quickly within three days. But to really overhaul it, I would say minimum three months. But it has to be lifelong.   James Valentine: Yeah. What a great conversation. We've been into the stool. We've farted a bit together. We have. We've got the boy working. Yeah. I love it. We've covered so much good ground. And yet all of it is in an area that we've really only just started to think about. We should be thinking about all the time. It's sort of one of the most simple things we can do, isn't it? Sarah Di Lorenzo: It's so basic.  James Valentine: It’s really just, eat a lot of plants… Sarah Di Lorenzo: …eat well, avoid processed food,  James Valentine: …the stuff that comes in a package and it's processed, it's going to be bad for you.  Sarah Di Lorenzo: Reassess your health, stay on top of it, diversity, plants, hydration, exercise, sleep well, stress management tools are really important for the gut brain axis, for the stress, taking care of your nervous system. It's never too late. It's never too late.  James Valentine: It's never too late. Get on with it. Happy gut, happy life.  Sarah Di Lorenzo: Absolutely. That's it. That's the foundation for everything.  James Valentine: Thank you to Sarah and Tobie for your delectable advice. You've satisfied our hunger for knowledge of a healthier gut. You've been listening to Life's Booming, brought to you by Australian Seniors.See omnystudio.com/listener for privacy information.

Embarrassed about asking your doctor something? We’re doing it for you. Our experts are going to answer some of those concerns you might have that are a bit quirky, less dinner chat, more private google search type questions. Our expert doctors are getting the stigma out of the way and getting you on your way to a healthier life.  About the episode – brought to you by Australian Seniors.  Join James Valentine as he explores the incredible stories of Aussie characters, from the adventurous to the love-struck. Across 30 inspirational episodes, Life’s Booming explores life, health, love, travel, and everything in-between Our bodies surprise us in ways we never thought possible as we age, so in series five of the Life’s Booming podcast – Is This Normal? – we’re settling in for honest chats with famous guests and noted experts about the ways our bodies behave as they age, discussing the issues and awkward questions you may be too embarrassed to ask yourself. This episode, we hear from Sydney GP Dr Sam Hay. Also known as Dr Kiis, Sam is director of the Your Doctors network, health expert for Kidspot, and was host of Embarrassing Bodies Down Under and Amazing Medical Stories. You'll also hear from geriatrician Dr Simon Grof, who has been a consultant geriatrician at Victoria’s Eastern Health since 2014, and is Chief Medical Officer at Jewish Care Victoria, who talks through some questions of ageing in later life. And Dr Mohammad Jomaa is a Sport and Exercise Physician, who has a special interest in sports-related injuries and their management, and shares his advice on mobility and healthy exercise for over 50s, to maintain longevity.   If you have any thoughts or questions and want to share your story to Life’s Booming, send us a voice note - [email protected]. Watch Life’s Booming on Youtube Listen to Life's Booming on Apple Podcasts Listen to Life's Booming on Spotify Listen to Life's Booming on Google Podcasts For more information visit seniors.com.au/podcast. Produced by Medium Rare Content Agency, in conjunction with Ampel Sonic Experience Agency   Transcript: James Valentine: Hello and welcome to Life's Booming, series five of this most excellent and award winning podcast. I'm James Valentine and in this series we're going to ask the question, is this normal? I mean, as we age, stuff happens to us. Our bodies change, things fall off, we get crook, stuff doesn't work as well as it used to. There's nothing we can do about it, we're getting older, we're ageing. But which bits are normal? Which bits do we have no control over? Which bits can we do something about? That's the kind of questions that we're going to be asking in this series, Is This Normal? of Life's Booming. Now, of course, if you enjoy this series, leave us a review. Tell all your families and friends about it.  And we want to hear from you as well. You can contribute to this. If you've got questions about things in particular that you want to know, perhaps there's some particular wear and tear happening to you, let us know. We'd love to see if we can answer that question in the series. We're going to look at things like menopause, gut health, mental health, lots of other burning questions. So think about those areas and if there's something in there that's specific to you that you'd like us to cover, let us know. On this episode of Life's Booming, we're tackling your frequently asked questions. Embarrassed about asking your doctor something? Today, we're going to do it for you. Our experts are going to answer some of those concerns you might have that are a bit quirky, a little bit less, “I can talk to my friends about this or at a dinner party”. It's more, I've got to get on Google and search this up on my own. Whether their patients voice them or not, together with our doctors, we're getting the stigma out of the way and we're getting you on your way to a healthier life. Some of you have sent in voice notes to ask us questions. Terrific, thank you so much. If you want to ask a question, you can visit the website or the link in the show notes and share a voice question. We're going to be chatting to Sydney GP, who's known as Dr Kiis, from army veteran to hit morning radio and director of the Your Doctors network: this is Dr Sam Hay. And you'll also hear from geriatrician Dr Simon Grof as well, and we'll talk about some questions of ageing in later life with him.  But first up, let's meet Sam. Sam, nice to meet you.  Sam Hay: Yeah, you too. How are you?  James Valentine: Yeah, very, very well. I suppose I'm thinking that the relationship with the GP changes as you age. You know, and unfortunately perhaps you start to get to know them really quite well. You see them a lot.  Sam Hay: Absolutely, I think for younger people, they don't fully understand what the worth of a good GP is to them. And then as people drift through their middle years, they certainly start to have more of a relationship.  James Valentine: So let's say post 50, what are the kind of things you'd recommend that we, that I should be coming to see the doctor, once a year, once every couple of years?   Sam Hay: I think there are some people out there who truly are looking after their health very, very well. They have no problems. They're very lean. They exercise a lot. They eat a great diet. They don't smoke. And they have literally nothing going on. And then they come and get a check-up and we literally find nothing. So those people, sure, they probably can go a couple of years between visits to the doctor. But in general, over the age of 50, I like to see patients every single year for a check-up because we want to pick up very early the major risk factors for the big things that are going to cause problems down the track, and those big ones are heart attacks, strokes and diabetes. James Valentine: And what do you pick up? What are you looking for?  Sam Hay: Well, we want to do a general check-up. And in that we're looking at blood pressure, weight, waist, from an examination perspective. Then we want to check the history, how are they going, how much exercise are they doing, what's their smoking, what's their general diet like, what are their stress levels, so where does mental health potentially fit into that. Pretty much all the time we'll do a set of blood tests, and once again, doing a general screen, but trying to pick up the big risk factors that come in, cholesterol, diabetes, a couple of other simple things. And then the major cancers that we need to be screening for. So your major community ones are going to be bowel cancer, cervical cancer, breast cancer, having a conversation with the doctor about prostate cancer screening. But then the last bit overall is we're going to look at somebody's family history. So what have they got in the family that might be putting them at more risk and does it influence all of those things? And do I have to do any other tests?  James Valentine: We've also, you know, again, I'd say if you're 50 and over, you've grown up with the notion you only see the doctor when you're sick. Sam Hay: Correct. And so it's people understanding that check-up is important. Even if the last three check-ups have been completely normal and fine, what we're trying to do is we're trying to pick up your cholesterol or your diabetes or your blood pressure or something else before it falls off a cliff. James Valentine: Yeah. This would make such a difference to you, wouldn't it, Simon, if we were all doing this in our 50s and 60s?  Simon Grof: Oh, absolutely. And I must reinforce that having a good GP is just the number one thing, I think. And we see that in hospitals all the time where some of our older people have not seen a GP for 40, 50 years; there's no-one regular, and just to have that touch point to call the GP who has that relationship and to get some of that background story is just so, so, so crucial. So, couldn't agree more.  James Valentine: Let's look at a few frequently asked questions. Do you see many 85-year-olds still smoking, Simon? Does anyone turn up? They're out for a sneaky… [inhales]. Simon Grof: People do smoke. Strangely enough, I had a virtual consultation the other day and I logged on. An 89-year-old lady, once again widowed, and she had the whole time during the hour-long consultation, and she kept on apologising saying, “I'm sorry it's a habit I can't give up.” James Valentine: And what are you seeing in smoking habits, because we are into a generation that have largely given up, you know, at 50 or 60 or so. Sam Hay: I've definitely seen a drop-off in cigarette smoking and an increase in vaping and a complete misunderstanding about the risks of vaping.  James Valentine: And what's being misunderstood? Sam Hay:  What I find fascinating is, what was it, 50 or 60 years ago, the government was endorsing cigarettes across the world. And then they realised, hang on a minute, these cause disease. And so that, all the governments had a massive flip.  And the community struggles to understand why the government won't endorse these things. Because we don't know the risks. And one of the biggest risks are that we don't really know what these chemicals do when they're vaporised and you inhale them. The second thing is, the majority of vapes that people are using come from underneath the counter, which means they're being produced in factories where you just don't know the chemicals that are in there. So yes, some of the vapes you can get from pharmacies, etc., are going to be more reliable and therefore, for want of a better word, safer, but it's all these other ones that we don't know about. And we are seeing injuries, there are people going to hospital, there are people dying, it's in the media. So it fascinates me that people are still seeking it out.  James Valentine: Yeah. I genuinely believe that anything positive that's being said about vaping is tobacco industry propaganda. But people do say, well, at least it's a way to get off smoking cigarettes. Sam Hay: So this, I think, is the challenging thing because there does seem to be a place for vaping in a harm minimisation program for people who are smoking. So for getting people off the smokes because in vape products that you can get through pharmacies, we have much more reliability about what's in them. We do understand that they seem to be much safer than smoking. So using them in a quit smoking regime, it's generally accepted that they are valuable and useful. For non smokers to take up vaping, still not recommended whatsoever.  James Valentine: Vision. Is this something that you see a lot of that you have to deal with? People start to get cataracts. They start to have eye conditions that they didn't experience before? Simon Grof: Yeah, we do. And as we get older, there are a lot of age related visual disturbances and vision is so crucial.  A story that I can think of, I had a patient of mine who just kept on falling and would present to hospital, would get to the emergency department. There wouldn't be any broken bones, they'd check out the sensation and his power in his body and then send back home. And by the third or fourth time, someone said, let's just give this person a little bit more time in hospital. So it ends up being on my ward and my very astute junior register actually had a look in his eyes. No-one had actually got an ophthalmoscope before and had macular degeneration and off to get some treatments and was, you know, not having any further falls. So I think we sometimes don't think about it. We want to find sometimes the more complex things in medicine, but sometimes it's just taking a step back, being thorough, as what geriatricians and what GPs do, and just making sure you're asking the right questions.  James Valentine: At some point, do you look at people and go, well, this can't be ageing. At another point, a few years down the track, you go, well, this is ageing. Sam Hay: And it's not as simple as that because I think people are maintaining their general health and their fitness for longer. And I think this whole concept of when do you suddenly become old and when do you suddenly start becoming affected by all these old age diseases? It certainly is shifting. I don't tend to look at patients as an age, and therefore this is an age related thing. I tell you, I go, you've got arthritis, you've got a heart problem, you've got a kidney problem, whatever it might be. And just keep it as simple as that.  James Valentine: Yeah, yeah. And I suppose, is there a bit of a trap for the geriatrician as well, Simon? It may not be ageing, it might be something else.  Simon Grof: Yeah, that's absolutely correct. And when in the hospital setting, when my junior doctors are describing and telling me about everyone new that's being admitted to the ward, the age for me is somewhat irrelevant. It's more about their social history, what they're able to do on a day to day basis, where they live, what they can get up to. And it's usually the family that are the worriers still managing their tablets.  As we do age, we do have more comorbidities and their ailments, such as some heart problems, some problems with the breathing, problems with the bladders and bowels. And when you were younger, that didn't seem to bother people too much, but with the accumulation of these, it can be quite difficult to manage as we get older, and I suppose there's a very small threshold.  Whereas, if you were to get a urinary tract infection, that is an infection in the bladder, that can sometimes contribute to problems with peeing, urine to be retained in the body, or it can cause you to go a bit more frequently as we get older. Potentially, a small thing like that can actually have a wide range of issues and complications, and sometimes something like a urinary tract infection, can actually go on and lead to a sudden memory and thinking problems.  And we see that quite commonly, whereas people and older people present to the hospital setting with a urinary tract infection with other things that might be seen as minimal, and they've got a condition that's called a delirium, which is really a sudden change in their memory and thinking with their orientation, with their ability to focus. And that could be quite stressful for both them and for family members, because these things can come on quite suddenly. James Valentine: Over the last few years, we've learned so much about vaccines. You know, it's been such a constant topic of conversation. And it's made, vaccines became age-related, didn't they? Through, during COVID-19, there were various vaccines. Well, you better go and have your boost if you're over 65, and we're going to make that available to you. Well, now you can get your retrovirals if you're over that age, and you know, you better get in and get those. Take me through vaccines for sort of 60-plus. What are you seeing? What can people get?  Sam Hay: I think the general population doesn't fully understand the burden that influenza has. It is a big risk to kids under five and to the elderly bubble of people. There's no magic age group, but we've kind of delineated it at about the age of 65. It's really any adult with any chronic health condition is going to be at high risk from influenza. I am a major advocate for getting your annual flu shot. We need it every year because protection starts to drop off quickly and it's a virus that changes, mutates, so therefore we've got to try and keep up with that, with our updated shots. As we age we get a higher risk of lung conditions and lung infections, you know, pneumonia. And so there's one or two vaccines out there against pneumonia, which are incredibly effective at reducing the number of people that are going to end up in hospital with Simon.  James Valentine: COVID? What's the current thinking on COVID-19? Sam Hay: So people should be up-to-date with their boosters. And this is a conversation to have with your doctor. It really is, to determine what your risk is. So I think people could be up to about their sixth shot if they sort of kept on getting them. But if we go back to the guidelines, they're really saying we only need, from the guideline perspective, three to four shots, definitely. And people could have access to those extra ones. So that's as of the beginning of 2024.  I look at it somewhere in the middle, in that if people have a cluster of medical issues that are going to increase their risk, then they should consider those regular vaccines. If they're looking after people who are at risk, perhaps more boosters. If you're going travelling or into high risk environments, then you may want to consider it.  James Valentine: And what do you see in aged care and among your patients? Are they keen to still get vaccines or they go, ah! Simon Grof: COVID in residential aged care now is still a huge issue and I'm trying to promote vaccines to the older people and their families as well, but you have a lot of people who never took it up to start off with. So you're not going to convince them now, but the people in the middle, the target audience take up these boosters, which are better. Because they do attract and they target against the newer type of variants of COVID. It's more to stop the seriousness of the actual infection and then stopping them presenting to hospitals. So I think in a residential aged care environment, we're still pushing it, which is at odds with what's happening in the community.  James Valentine: At what age am I too young to go and see the geriatrician?  Simon Grof: That's a really good question and that's a question we get asked quite commonly. Essentially a geriatrician is a doctor with specialist training and caring for the health of older people. The term is, I suppose, geriatric medicine. And geriatricians like myself diagnose and treat age-related medical conditions. And the age usually is above 65. But you know what? Really, is it above 65? Most of the people on my ward, or I see in residential aged care, are 85 and above. So, is 85 the new 65? I don't know. James Valentine: Oh, let's not put it that way around. That seems wrong! But there must be many a condition that would have been better off if we were starting to deal with it in our 60s.  Simon Grof: Absolutely. Similar to the heart where, you know, they say middle age is when you really need to up your game and, you know, continue the consistency with the exercise, continue the consistency with eating well, not smoking, alcohol, all the things we hear about. It's similar for the body, similar for the brain, similar for everything into old age as well. So the sooner we can start and the sooner we can look after things, the better it is. And you know, we might be living to 150 soon, who knows.  James Valentine: All right, let's talk about mobility and exercise and bring in sports physician, Dr Mohammad Jomaa, UK educated and now in Sydney, where he's practising as a sports physician. Thanks so much. Mohammad Jomaa: Thanks, James. It's been a real pleasure to jump on and speak to you today.  James Valentine: So what's your general advice for exercise for over 50s?  Mohammad Jomaa: Exercising safely is paramount. It usually is injuries and complications, which stops people from exercising at all in the first place. So we need to use exercise as a means to reduce the risk of our injuries, as opposed to increase the risk of injury through exercise. Doing nothing is bad for us, but we also know that doing too much is bad for us. And so where's the sweet spot? Finding that is all about figuring out where your current function is and very cautiously and gradually increasing from there, giving you enough time to recover and get stronger so that you can keep building and building. James Valentine: So do you have a recommended exercise regime for perhaps, you know, 50-plus?  Mohammad Jomaa: Everyone has a different starting point. Everyone has a different goal. And so exercise prescription is always very nuanced. It's very tailored. It's a science as well as an art. So any good exercise program needs to have cardiovascular exercise, strength training, and stability training. And I'll talk a little bit about each one of those.  Cardiovascular exercise, which is our aerobic exercise, is the mainstay and no matter what our age is, it's very trainable. The bad news is that if we don't maintain it, it will typically decline by about 10 to 15 percent per decade. So about one or one-and-a-half percent per year.  And that can really add up and it can affect the way that we live and the things that we can do as we get older as well. Absolutely everyone should be doing about 30 minutes every single day of what we call zone two exercise. The Australian guidelines call it moderate exercise. Essentially, it's a bit hard work, but if you were pressed, with some discomfort, you could talk in full sentences. And that's the best way to measure that you're in that zone two range. This is essentially our general maintenance, it helps with chronic diseases, and there's lots of evidence that shows that it supports in the management of metabolic diseases like diabetes, cardiovascular disease, reduces our risks of stroke. It actually improves and reduces the risk of cognitive decline and Alzheimer's disease as well. Strength training is really essential to do maybe two or three times per week. Usually we encourage compound resistance, which means hard work, heavy loads lifted or moved around. And this has to be done safely, and so it's always important to have this tailored for you. One of the most common exercises that I prescribe for patients over 50 is that I get them starting to push and pull a sled; we'll find a gym with a sled track. Typically we'll start with around a quarter of the patient's body weight on the sled, and we'll just have them two or three times a week pushing and pulling that sled for 20 minutes.  And it can be really hard work but it also is a very comprehensive exercise as well. And it's really safe. You can imagine if you're trying to pick up something really heavy or carry something really heavy on your back, there's a higher risk of injuring yourself than if you're trying to push something over and you just can't, or pull it over and you just can't. So there's some safety there to that as well.  And then, yeah, finally something that's so important, especially as we get older, is stability exercise. So, stability exercises, the best way to get involved with those are to just join a local tai chi or yoga or pilates or any other mat-based mobility exercise program local to you. With patients who aren't inclined to do that, I talk them through specific balance exercises they can do, standing on one leg, standing on a pillow to make it a little bit harder, and we introduce some movement and instability with that as well. The reason stability is so, so important, and mobility, which is a factor of that as well, is that it's essentially our insurance as we get older. Really major cause of patients coming into hospital and it can be a life-changing event. So it's something to really, really be avoided. And so stability exercises are really important as an insurance against that.  James Valentine: So what about heart health? What's good exercise there?  Mohammad Jomaa: One thing that we're quite well aware of, and this is a great thing for the heart, maybe not so much for our muscles and bones, the heart is always trainable. We can improve our cardiac output, we can improve our VO2 max, which the heart contributes to quite a lot. And that's our ability to consume oxygen and our level of maximal output. When it comes to just general age and ageing, then the main issue with the heart is the development of atherosclerosis, which is the name of the gradual hardening of the arteries in our whole body, but importantly the ones that lead to our heart as well. If you're the sort of person who develops heaviness and tightness in the chest with physical exertion, with exercise, then that's something that definitely needs to be checked out as well. And that's something that your sports doctor will ask you about. Exercise is so incredibly good for us that it's better than any medical intervention really that we can do. There's a lot of evidence that shows that exercise and our underlying fitness are the primary definers of how long we live and how we live towards the end of our days as well.  And so you absolutely have to make it a part of your life as best as you can. Seek help from a sports physician or an exercise physiologist to get you going. Even the smallest amount of exercise for someone who doesn't have an exercise baseline will have huge benefit as well. So if you're someone who's just completely sedentary, there's lots of studies that show anywhere between an hour to 90 minutes of just walking per week, which is, you know, 15 minutes a day, can massively improve your health factors and improve the quality of your life in the medium to long term. So get exercising and stay healthy.  James Valentine: That's very good. I'm thinking, you know, 50-plus, have an excellent 50th birthday. Have a great time. For your 51st birthday, go get a check-up. and start doing an annual check-up after that. Then you're well ahead of the curve, right?  Sam Hay: Yes, but can we bring it forward to the 50th birthday? James Valentine: You want it on the 50th?  Sam Hay:  Yeah, don't wait till the 51st! James Valentine: Let me have the party, you know, then after that I'll go, you know. Sam Hay: Wait a couple of weeks if you have to, then come in. James Valentine: Okay, straight after that. All right, but through your 50s start, start the check-ups. And then with geriatrics, Don't be frightened of it. Simon Grof: We're nice people. We like a conversation. We'll spend time with you, or unfortunately sometimes your GPs can't, and we'll have a plan and we'll work that plan out together. You know, you're not going to be put in a home just because you see one of us. I promise you that. Sam Hay: I've started to explain why I refer people off to specialists in a different manner nowadays.Because some people feel that they're going to see a geriatrician or a knee doctor to get a diagnosis of dementia or to get a knee replacement. Whereas what we're going for is we're going for an opinion. We're going for an assessment. We're going for what do they feel is the problem and what are the potential management or follow-up options?  The patient then decides what they want to do. That's where we need to think of using our specialist more and be freer in just going and getting their opinion and then look at what the management might be down the track. And that's where I use geriatricians for that advice and education and that baseline.  James Valentine: Well thanks to all our experts today, to Sam, to Simon and Mohammad for getting us into the frequently asked and sometimes, you know, a little bit uncomfortable questions. Let us know if any of our doctors today gave you the golden solution to your health's concern. Or did you find out something you didn't even know that you needed to know? We'd love to hear from you. You've been listening to Season 5 of Life's Booming: Is This normal? Brought to you by Australian Seniors.See omnystudio.com/listener for privacy information.

The stigma around menopause is slowly peeling away, but many of us still suffer in silence. In this episode, we take a lighter look at the often unglamorous side-effects of menopause – from hot flushes and brain fog to facial hairs and mood swings – hearing from Aussie comedian Jean Kittson, who is living her best life on the other side, and getting the medical rundown from celebrity GP and passionate women’s health advocate Dr Ginni Mansberg. About the episode – brought to you by Australian Seniors. Join James Valentine as he explores the incredible stories of Aussie characters, from the adventurous to the love-struck. Across 30 inspirational episodes, Life’s Booming explores life, health, love, travel, and everything in-between Our bodies surprise us in ways we never thought possible as we age, so in series five of the Life’s Booming podcast – Is This Normal? – we’re settling in for honest chats with famous guests and noted experts about the ways our bodies behave as they age, discussing the issues and awkward questions you may be too embarrassed to ask yourself. Jean Kittson has been entertaining audiences for decades with her wit and humour, both of which she brings to the fore in her candid and hilarious take on menopause, You're Still Hot to Me, the book she wished she had read during the momentous time in her life. Dr Ginni Mansberg is a well-known celebrity doctor based in Sydney, with television appearances in Embarrassing Bodies Down Under, Sunrise, The Morning Show, and Things You Can't Talk About on TV. She is also the author of The M Word: How to thrive in menopause. If you have any thoughts or questions and want to share your story to Life’s Booming, send us a voice note – Watch Life’s Booming on Youtube Listen to Life's Booming on Apple Podcasts Listen to Life's Booming on Spotify: Listen to Life's Booming on Google Podcasts For more information visit seniors.com.au/podcast. About Australian Seniors Produced by Medium Rare Content Agency, in conjunction with Ampel Sonic Experience Agency SSMR0502_240229_Menopause the other side_Final James Valentine: Hello and welcome to Life's Booming Series 5 of this most excellent and award winning podcast. I'm James Valentine and in this series we're going to ask the question, is this normal? I mean, as we age, stuff happens to us. Our bodies change, things fall off, we get crook, stuff doesn't work as well as it used to. There's nothing we can do about it, we're getting older, we're ageing. But which bits are normal? Which bits do we have no control over? Which bits can we do something about? That's the kind of questions that we're going to be asking in this series, Is This Normal? of Life's Booming. Now, of course, if you enjoy this series, leave us a review, tell all your families and friends about it. And we want to hear from you as well. You can contribute to this. If you've got questions about things in particular that you want to know, perhaps there's some particular wear and tear happening to you, let us know. We'd love to see if we can answer that question in the series. We're going to look at things like menopause, gut health, mental health, lots of other burning questions. So think about those areas and if there's something in there that's specific to you that you'd like us to cover, let us know. When it comes to women's health in older years, it turns out that the hot flushes, the brain fog, the facial hair, the mood swings can all be linked back to the one thing and that's menopause. In this episode, Menopause the Other Side, let's take a look in some detail at the common symptoms, the experiences, and life on the other side of it. We'll get some answers about menopause, the ‘M’ word, from the queen of morning television, Dr Ginni Mansberg. But it gives me great pleasure to welcome, of course, to thispodcast as well, Jean Kittson, who wrote a fantastic book called You're Still Hot To Me, dealing with her experience and her research into menopause. Jean Kittson, hello. Jean Kittson: Hello, James.   James Valentine:Still so hot? Jean Kittson: Yes, I am, actually. Every now and then. James Valentine: Is this the 10th anniversary? Is it 10 years since you published? Jean Kittson: Yes, it is. 2014 it came out. It's into its sixth reprint now, something like that. Women still keep going through menopause. James Valentine: The book didn't fix it? Jean Kittson: No, that's right.And I thought I'd finish and everyone's finished. No, they're still going. Of course they're still experiencing menopause. And just the other night I was out with some younger women and they're still struggling. Trying to work out what the best way to handle it is and what treatment to get and they're still people pushing back around different treatments like HRT. I was really surprised. We've come on a lot more than we have 10 years ago, people are speaking about it, but there's still a lot of ignorance really, misinformation. James Valentine: It still seems to be an area of mystery, really, and half whispered truths. Oh well I've heard you should do this, and what about the other? Jean Kittson: Yes, I think people are still afraid it's going to impact on their work because the Australian Human Resources Institute did asurvey and they found that the majority of women would not mention menopause at work because they thought they'd be considered old, sidelined for leadership positions.With all the stigma still attached to menopausal women. So there's still a lot of, I don't want to talk about it in the workplace. And that of course translates to, I don't really want to talk about it at all. James Valentine: Yeah, and leading into it, let's say you're 30 or 40. You're not even thinking about it. Jean Kittson: No, well that's the thing, and yet when I was doing my book, I found that most of the women I randomly chose to interview were having their first hot flushes around 40, 42. And we're always told it's around 50, 52, 55, that area. But many, many women will start going through perimenopause, which is another part of menopause that I didn't even know existed until I went through menopause. So there's perimenopause that can start 10 years earlier. And some women are thinking, they’ll follow the Hollywood style. Oh, I’ll have a baby. She had a baby naturally at 50. So can I. I'll just keep putting it off. What? Well, was that a hot flush? What the hell? What am I going to do? You know, so it comes as a terrible shock. And I think there's a lot of things about women's bodies that need to be talked about more openly. Fertility, ovulation, menopause, all those sorts of things. James Valentine:Yeah. If only it happened to men. Jean Kittson: If only, we'd never hear the end of it. James Valentine: That's right, we'd have championships in it. Jean Kittson: Yeah, that's right. James Valentine:Set world records, all that kind of stuff. Jean Kittson:You'd have, you know, months off. Yeah. Menopause month off. James Valentine: Do you know, he's battling with menopause but still CEO. What a guy. Jean Kittson: That's right. Hang on, you can't talk to him for a moment. James Valentine: That's right, just wait. Jean Kittson:All the windows are open. James Valentine: He's a little bit emotional but come back tomorrow, he'll be fine. Jean Kittson: We were going to have a board meeting, it's cancelled. But don't worry about it, it’s menopause. James Valentine: What? Oh, that's fine, no worries. I went through it myself, man. On you go. Good on ya, chaps. Is it as simple as, like, it was happening to you and you found it difficult to find relevant information, what you needed to know? Jean Kittson: Oh yeah, that's why I wrote my book.I wrote the book I needed. I needed to find the facts out about menopause, and I found out so many other facts about my own body that had never been talked about. We're just sort of more primed, our whole body is primed to have sex when we ovulate rather than other times of the month. But we're told that women are just ready for it every day of the freaking week. James Valentine: Yeah, and let me clarify that. That was men who decided that one? Jean Kittson: Can't say it ain't so. Just because men don't understand women and don't like it when we get a little bit feisty, a little bit irritable, start giving our kids a burnt chop. You know, in the old days, we were diagnosed with climacteric insanity and locked up. And if men of a certain age got a little bit feisty, a little bit irritable, they were elected to parliament. James Valentine: That's right. That's very good. Dr Ginni Mansberg's with us. You've met! Jean Kittson: Yes, we have, Ginni, hello. Ginni Mansberg: Hello darling, how are you? Hello to both of you. James Valentine: Thank you so much for coming. Is this, like, I think what we've got to is, I'm sort of seeing, we shouldn't necessarily think about all these things as separate? It's the entire cycle of life and the entire fertility cycle of a woman that we should be discussing, not as though there's this thing that happens to people called menopause. Ginni Mansberg: Absolutely. I mean, a lot of people don't realise that menopause itself is a single day that happens 12 months from the first day of your last period. Only, you probably didn't know it was your last period at the time because your periods were all over the show, often for up to several years before you go into menopause proper. And we call that perimenopause. I call it hormone hell. Your hormones are giving you a triple pike with a half flip because they are going up and down like a yo-yo, and our brains and our bodies really don't like those fluctuating hormone levels. So often, exactly as Jean was saying, the worst of it comes in your mid to late 40s, not in your late 50s. That's not it at all. In fact, sometimes life gets a lot better on the other side of the rainbow after menopause. James Valentine: Hang on, just take me back. You said a single day, menopause is a single event. Ginni Mansberg: It is. So it's defined as 12 months from your last period.That's really problematic for women who, for example, have a hysterectomy before they go into menopause. It doesn't make any sense for those women whatsoever because their hysterectomy might have been at age 40, their ovaries were fully functional and don't go into decline for another six years. That's a problem for women who use contraceptives like the Mirena coil that have some progesterone in their coil. They don't have regular periods either. So there is a movement to change that definition, but that's what we've got at the moment, that single day. 12 months after you had your last period. James Valentine: Yeah, we describe it, Jean, as it seems to me like it’s anything from about 45 to 75, a whole period of life. Jean Kittson: Yes, that's right. That's right. I haven't heard the single daydefinition before, I must say, but of course it is 12 months after your last period, so if you can count to the day, that's the day you are officially, and probably, you know, medically, scientifically, in menopause. James Valentine: What happens on that day? Jean Kittson: You buy a bottle of champagne! James Valentine: Ginni, what happens on that day?   Ginni Mansberg: Mostly it's not a lot different from the perimenopause that precedes it. And those early postmenopausal years, that's why I think getting hung up on definitions is problematic from a medical perspective. It's not like once you hit menopause on that day, everything changes. It's not like that at all. In fact, the treatment is fairly similar whether you've gone through menopause already or whether you're in that lead up, but your hormones are still giving you hormone hell. James Valentine: Jean, when you were looking at this, did you find a treatment for menopause? Jean Kittson: Well, when I started going through menopause, I was asking around my friends, what's going on, and they said, oh, it's probably menopause, and most of them didn't take any treatments, and they said it was a breeze for them, or they didn't really like to talk about it. Some of my friends said, I'm on HRT. Other people were saying, HRT is deadly, you'll get breast cancer. It was during that time. It wasn't long after the Women's Health Initiative brought out the report that linked HRT to breast cancer and everyone dropped off using it.But then it was found 12 years later to be flawed and HRT is the best way to go. So I had to keep being a fully functioning woman. I had kids at home, elderly parents, I was full-time job. I couldn't stand on stage and start perspiring and mopping my brow, and that's the first time I had a hot flush. I was talking to all these young Czech guys from Ericsson or something. It was a corporate gig, and I'm standing on stage in a silk top, gold silk top. And then I'm going, is it hot in here? That's probably the first time I mentioned that, you know, out of the million times I've mentioned it since. And I started mopping my brow, and then I looked down, and my whole top had turned like camouflage. I had rings of sweat under my boobs, I had them down the side, and then I thought,I have to do something radical about this. So I went to a gynaecologist, I talked about HRT, I realised there was a lot of fear that a lot of women suffered, a lot of women would leave their jobs because they thought they weren't coping with work, but they actually weren't coping with their menopause symptoms. I realised it was like in so many aspects, women were afraid, they suffered, there were these taboos, they were without information, they couldn't lead fully functioning lives, basically. And so, their biology was in denial, and one of the reasons they denied their biology and didn't talk about it was because when we were allburning our bras and things like that, we wanted to be equal to men, the same as men in the workplace. We didn't want to admit that actually there's things that are going to happen biologically that are going to affect our jobs. Not for the worse. We just have to work around it. Like we've got the little kitchen tidies in the toilets now. You know, in the old days, men would say, Oh, don't listen to her. She's on the rags, when we got our period. If you said that now, you'd be considered a fossil and a twerp. So we've got to get the same with menopause. So there's lots of great treatments, but Ginni would know. James Valentine: Ginni, we might come back to treatments. Let's just discuss the symptoms. First of all, you know, Jean's first moment is ghastly. Thank you for repeating it. But the range of symptoms is also extraordinary, isn't it? Ginni Mansberg: Yeah, everything from palpitations to shortness of breath to itchy skin, a whole lot of stuff that goes on below the belt. Hot flushes is the one that most people know about and that's because it's really common and very visible. So 75% of women will experience those hot flushes. They're not always dramatic, like Jean’s. Some women just run hotter and a lot of women experience heat at night, so that interrupts their sleep. We see a lot of insomnia. About 80% of women will experience what we call brain fog. So you can't remember, oh, what's that thing that you write with that leaves ink on the page? Can't remember the name of it.What's that thing that I need to get into the lock of my house? Can't remember that thing. Forgetting people's names, being on a Zoom call and forgetting the name of the project you're working on, that 80% of women will have that, but a lot of people don't realize that this is peak time for mental health issues in a woman's life. So one in three women will experience some sort of mental health problem. Anxiety and depression are the main ones, and they have particular hues. We often call it the ‘peri rage’. People are just so angry and so annoyed, and they don't understand why they're so angry with people, but lashing out and acting what they feel like is very inappropriate. They're very remorseful and quite paranoid, very thin skinned, very easily offended. Now, when you put those things together, it's not surprising exactly as Jean says, that untreated, 10% of women will leave the workforce altogether at this time, an additional 14% will decide to go part time or to significantly reduce their hours, an additional 8% of women will either ask for a demotion or actively avoid a promotion, say no to a promotion that's offered to them. And then we can't understand about number one, the gender pay gap, but number two, the fact that Australasian women retire with so much lower levels of superannuation and the Australian Institute of Superannuation Trustees has estimated that for Australian women alone, menopause costs between $17 and $35 billion a year in lost revenue and lost superannuation because they are exiting the workforcebecause of this hormonal glass ceiling. Now that doesn't happen to everyone, but I think that those numbers are costing the Australian economy enough and women enough that we need to be taking it more seriously and not just saying it's a couple of hot sweats. Suck it up, princess. James Valentine: Yeah. But I think Jean highlights the difficulty here for many women is to say, is that unless the society acknowledges it, unless the entire workforce and all of our structures acknowledge the existence of these things, it's very difficult for an individual woman to suddenly say in the workplace, actually, can we just deal with my menopause?Um, you know, is that okay? Can we accommodate that now, please? Ginni Mansberg:I think we really need to talk about the study that Jean talked about called the Women's Health Initiative Study that came out in 2002. So if you allow me just a couple of minutes to explain what happened and why we are in a bit of a disaster today. So untilthat study came out, around the 1990s, big cohort studies – so when you look at big populations – what scientists had found was that women who were taking the older forms of HRT had lower levels of heart disease. And so the National Institutes of Health in America decided to mount a massive study, 110,000 women, that was a prospective placebo controlled trial. Don't worry about the details. It's just a really, really good study. And they took women with an average age of 63 who had never had hormone therapy and gave half a placebo and half hormone therapy to look at what would happen to their rates of heart disease and other illnesses. What they didn't expect to find was this. For every 10,000 women who took a placebo, there were 30 cases of breast cancer. But for every 10,000 women who took this old-school form of HRT that we no longer use at an average age of 63, when the vastmajority of women are well past their symptoms and don't need it anymore, when they started it at that age, there were 38 cases of breast cancer per 10,000 women. The result of that finding was that, and on top of the fact that no, they didn't have any less heart disease, they decided to cancel the study. But instead of talking about those relative risks and the fact that this was not in the population that used hormone replacement therapy in real world trials, they went to the papers and said, hey, this stuff causes breast cancer. And a fewthings happened as a result of that. Number one, 80% of women worldwide threw their HRT in the bin and all the menopause symptoms got rebranded as just like a wrinkle, like a bit of, if you can't handle that, you're a princess. You shouldn't need this stuff. It's very dangerous. The second thing was, and this is really important.There's a legacy of this today, was the doctors were no longer taught about menopause. It went out of the curriculum. I, with all of my postgraduate experience, have never had any formal education on menopause. Everything I know is self taught by joining the various menopause societies around the world because it is not taught to medical students.It's not taught to GPs. It's not taught to gynaecologists these days. This is a real problem. There are also still black box warnings that exist today on the newer forms of HRT that women are likely to be prescribed that don't even have that increased risk. In fact, with that study, if you took the subset of women in that 110,000 women study, who took the HRT at anaverage age between 50 and 60, there was no increased risk of breast cancer. So in the real world, use of that old school HRT, there was no increased risk of breast cancer. But the legacy today means that women are told that it's a shameful thing to ask for any help for it. You shouldn't need it because the treatment is dangerous. It makes women think that getting treatment for it isputting their own lives at risk. It also means that doctors are not skilled up to help women in this situation. And research, you know, there was no research that was done on this topic for decades. That is starting to turn around as women like Jean, who really was a pioneer in 2014 when her book came out, nobody was talking about it. And she really, really smashed that stigma. We can't thank you enough, Jean. But as doctors in my generation, the Gen Xers, hit this age group ourselves, we're going, hey, what the hell? What the hell happened to our medical education, and how have we let women down so badly, which we have. I think we're turning the corner, but I just wanted to explain the background for why we are where we are now. James Valentine: That is riveting, andI mean, Jean, I almost don't know what to make of that. You know, when you say, a gynecologist isn't trained in this, a doctor today. You mean a doctor today, sitting in medical school, how'd they come after the end of six years, and at no point did anybody say, right, this term, menopause. Jean Kittson: There's a woman called Professor Susan Davis in Melbourne, and she's training doctors in menopause and more women's health, but there wasn't a subset of women's health. And I don't think there ever was one, because I remember this gentleman, he was about 70, coming up to me at a book signing.And he said he was a GP and he said he trained in the 1960s in England. And he said, I'd like to buy your book. Because I've never, he said, the only time at medical school that menopause was ever mentioned was when we were sitting in a lecture theatre, all men, mainly men, sitting in a lecture theatre. They wheeled a woman into the centre of the lecture theatre, a woman of a certain age. And, um, she was introduced as a menopausal woman. And she looked around and she said, my husband doesn't bother me anymore. And that was it.My husband doesn't bother me. So, that was her, that was their lesson in menopause, that obviously women just go right off sex, that's it. You know, nothing else. James Valentine: That's the most crucial factor that happens in the whole thing. Jean Kittson: Yeah. But importantly, what Ginni's saying about the study that linked HRT to breast cancer, there was a new study that came out in 2012, so 10 years later, that explained why it was wrong and what Ginni was saying.As you get older, you're more likely to get breast cancer anyway. So they were using people into their 70s in this study. But what happened was when women threw away their HRT was doctors started prescribing antidepressants to deal with it instead. So we have this huge sort of flood of women on antidepressants because they felt confident with that.They felt if they prescribed HRT and their patient got breast cancer, they could sue, you know, it was all up in the air. There was a lot offear in the medical world. So now all these women are on antidepressantswhen what they're experiencing once again is what Ginni said, hormonal fluctuations. Ginni Mansberg: Anxiety is more common than depression during the peri and menopausal years. In fact, trigger warning, one in three women will get this anxiety and depression. It is peak time for anxiety and depression in a woman's life. It's also peak time for suicide in women is 45 to 55. And it's clearly a hormonal thing. And we very rightly in this country focus a lot on postnatal depression. And we don't focus enough on midlife women's depression. What we do see is that if you did have a history of previous hormonal anxiety and depression, on the pill, postnatal, it'll almost inevitably come up again during this period, this perimenopausal period. But we see it a lot in women who have never experienced it before, and severe depression, like a lot of these women can be hospitalised. What we also know, exactly to what you were saying, Jean, about the use of antidepressant medications, at best they are about 75% effective, which is better thannothing.But they do leave 25% of women or people in general who don't respond to them. That level of effectiveness goes down to around about 50% in women who are going through perimenopause and menopause, whereas the hormone replacement therapy is in fact, 76% effective. So nothing is 100% effective, but this is clearly a hormonal issue. And if you speak to Professor Jayashri Kulkarni, who is from the HER Centre at Monash University, who is a world leader in menopause andall psychiatric disorders. Her first port of call will always be a hormone treatment and she will only bring an antidepressant medication in if somebody has severe symptoms, for example, they're suicidal or they can't function or they literally need to be hospitalised and that will only be for a short time and then she gets them off it again and they stay on the hormone replacement therapy. So it's a very different treatment now to what we used to do only 10 years ago, even just when your book came out, Jean. James Valentine: Jean, I think you highlighted another aspect of this is the time of life at which this occurs. A woman is going to very often have perhaps teenage children,children moving into adulthood. She might be starting to go really well in her career. Her parents are now 70 or 80. You know, there's a lot going on at the point at which this hits. Jean Kittson: Yes, well, women really are at their peak now in their careers. Once, a hundred years ago, the average age of mortality of a woman, a woman would die at 57, so you hit menopause, you die. Menopause is the least of your problems. But now we're into our late 80s, mid 80s, late 80s. We've still got a third of our life to live and we still are working and running a family and the kids are probably still at home and we've got our elderly parents. Just as you say. So the time of life when menopause hits is really a very intense time of life for women.There's so much going on. And you may finally be getting into the position at work where you're feeling really comfortable and you know what you're doing. You have all this knowledge and expertise and understanding, and thensuddenly you're battling with something physically that is undermining your ability to manage all these different aspects in your life. And you have to micromanage so much stuff in life. And when you're not getting sleep, I think that's probably one of the worst things, not getting sleep. Then your anxiety and everything, it goes up. Because you're waking up during the night with these hot flushes or night sweats or whatever you want to call them, that's why you really need to get some proper support. And now we know, I went on HRT for 10, 12 years, it was fantastic. I couldn't have managed without it. I felt really good. And now there's so much information that it's good for your bowels and your heart and your brain and youreverything, isn't it? Your skin. There's so many things it actually helps in a woman. James Valentine: Ginni, is HRT the only treatment? I mean, people will see a range of stuff that's beingsold to them or is available. Ginni Mansberg: Yeah, so there are womenwho can't have HRT or don't want to. And I think what I'm passionate about and a lot of doctors now are passionate about is autonomy of women to have their own choices and HRT is one choice and if women choose not to or can't have it because they have a breast cancer which has what we call oestrogen receptors on it then we give them HRT and there's a possibility we can actually make their cancer worse. So not everyone can have it. In that situation, we need to have a range of issues. What I love about HRT is of the 53 symptoms that we've so far identified, everything from palpitations and itchy skin to incontinence, and of course, your hot flushes and your depression. It's the only one that wraps up, I guess, every single symptom and helps every single symptom. That's what's nice about it. However, a lot of women don't even have a lot of symptoms. So what we can do is target your symptoms individually with different medications and antidepressants is definitely an option, although none of them are as effective as hormone replacement therapy. Because menopause is having a bit of a moment now, but because women are still left with this lingering doubt about the safety and efficacy of hormone treatments, there is a whole raft of products that have come to market promising all sorts of symptom relief, mainly in the supplement space, but also in the tea space, in the wellness powder space. Promising a whole lot of things that we have fairly good evidence do not work whatsoever. But, once you put an ‘M’ on it, and put a pink bow on the cover – we call it ‘meno-washing’.You're going to now charge double for a menopause herbal product than you are for a normal herbal product. Because women are vulnerable, plus we are pretty good consumers. We are generally now, us Gen X women, prepared to go and buy things for ourselves if we think they're going to contribute to our wellness. So my concern is if you are going to buy one of these menopause products, I would really run it by a doctor who has experience in hormone replacement therapy. And other menopause management, a lot of women will get a placebo effect. In fact, in studies, it's up to 75% placebo effect. In my experience, you'll get a good six to maybe 12 months out of a placebo effect. But meanwhile, you're getting to the point where, do you remember I talked about the Women's Health Initiative and I told you that the women who started it late ran into problems. That's the best thing that came out of that study. We know if you are over 60 or if it's been more than 10 years since your menopause, you can't start HRT anymore.It confers a very big number of risks for you. James Valentine: Well, it seems to me, Jean, we started saying your book is 10 years old. So this is one of the firstvolumes and first statements to break through a lot of taboo about it, a lot of non conversation. You said, look, things are a little better. We've come some way. I'm not feeling that necessarily by the end of this conversation. It seems to me so much further to go. Any one thing you want to happen right now? Jean Kittson: I would like women not to just google menopause because then they will get so much misinformation.There are really reputable organisations with the correct information, with the facts, and that is places like the Menopause Society that Ginni mentioned, the Jean Hailes foundation, Ginni's probably got a finger on more of them now, I don't go to them, but both those places have the facts. Get the facts because there's so much misinformation and it's really controllable. It's a great time of life. If you can get a good sleep and you haven't got the anxiety and you've got control over that, it's wonderful not having to fork out all this money on sanitary products. And you can wear white jeans again, you can go swimming without fear of attracting sharks, it's brilliant. The whole thing is really very, very liberating, but take control over it. Get the right information, get the facts. Don't just chat to people and try and get it that way, becausethere's so much misinformation. James Valentine: Yeah. Ginni, any one thing you want to see happen right now? Ginni Mansberg: Yes, if you head to the Australasian Menopause Societywebsite, and then click on find a doctor, you will find a doctor who has a particular interest in menopause and is unlikely to give you the sort of like, oh, you can't have HRT, it's dangerous, kind of advice that I'm still hearing every day. We have made, Jean and I have made, menopause sound absolutely horrendous, which untreated it is. Treated, it is not. Treated, you have a normal life. You do not need to leave the workforce. You do not need to end your marriage. It is peak time for divorce. You don't need to have a fight with your best friend or sister. You can actually have a normal life. And I would urge women not to see this as an inevitable and natural phase of life, so just something to be borne by women or just seeing it as there's nothing you can do. There’s so much we can do for you. Please let us help you and let you get your life back because you don't need to just put up with it. James Valentine: Thank you so much. Fabulous conversation. Thank you so much for sharing so much information and experience with us here on Life's Booming. Jean Kittson: Thank you, James, for the opportunity to keep talking about menopause. Talk it up! Ginni Mansberg: Thanks, guys. James Valentine: Well, if you want to know more, you could do no better than to read Jean Kittson's book You're Still Hot To Me.As we said, it's still out there. It's still a very vital book examining the conditions for menopause in Australia. And Dr Ginni Mansberg's book is called The M Word, and it's doing the same thing. It's looking at the medical basis, as we keep saying, the facts about menopause. Well I hope you enjoyed this episode of Season 5, Life's Booming, Is This Normal? Brought to you by Australian Seniors.See omnystudio.com/listener for privacy information.

Changes to our joints, bones and muscles are often attributed simply to ageing ‘wear and tear’, but is that true? From creaky joints to hip and knee replacements, physiotherapist Rod Grof takes us through the top musculoskeletal risks as we age, while Logie-winning actor John Wood shares his own health story, and how health impacts his life. About the episode - brought to you by Australian Seniors.  Join James Valentine as he explores the incredible stories of Aussie characters, from the adventurous to the love-struck. Across 30 inspirational episodes, Life’s Booming explores life, health, love, travel, and everything in between. Our bodies surprise us in ways we never thought possible as we age, so in series five of the Life’s Booming podcast – Is This Normal? – we’re settling in for honest chats with famous guests and noted experts about the ways our bodies behave as they age, discussing the issues and awkward questions you may be too embarrassed to ask yourself. Acting veteran John Wood is no stranger to treading the boards. From Rafferty’s Rules and Blue Heelers to comedy revue Senior Moments and Ensemble Theatre’s newest show, The Great Divide, John has been entertaining audiences for more than 40 years. Rod Grof is a Melbourne-based physiotherapist and principal of Platinum Physio. Experienced in treating a range of musculoskeletal injuries and conditions in clients across the lifespan, Rod helps his older patients to live more active lives, with less pain.   If you have any thoughts or questions and want to share your story to Life’s Booming, send us a voice note - [email protected]. Watch Life’s Booming on Youtube Listen to Life's Booming on Apple Podcasts Listen to Life's Booming on Spotify Listen to Life's Booming on Google Podcasts For more information visit seniors.com.au/podcast. Produced by Medium Rare Content Agency, in conjunction with Ampel Sonic Experience Agency   Transcript: James Valentine: Hello and welcome to Life's Booming Series 5 of this most excellent and award winning podcast. I'm James Valentine and in this series we're going to ask the question, is this normal? I mean, as we age, stuff happens to us. Our bodies change, things fall off, we get crook, stuff doesn't work as well as it used to. There's nothing we can do about it, we're getting older, we're ageing. But which bits are normal? Which bits do we have no control over? Which bits can we do something about? That's the kind of questions that we're going to be asking in this series, Is This Normal?, of Life's Booming. Now, of course, if you enjoy this series, leave us a review, tell all your families and friends about it. And we want to hear from you as well. You can contribute to this. If you've got questions about things in particular that you want to know, perhaps there's some particular wear and tear happening to you. Let us know. We'd love to see if we can answer that question in the series. We're gonna look at things like menopause, gut health, mental health, lots of other burning questions. So think about those areas and if there's something in there that's specific to you that you'd like us to cover, let us know. From creaky joints to hip and knee replacements, let's find out the things that are really gonna affect our muscles and our bones, our musculoskeletal system. Someone who knows muscles a lot better than me is Melbourne based director of platinum physio, Rod Grof. Rod helps his older patients to live more active lives with less pain and he can share what commonly happens to our bodies as we age and also what we can do about it. But before we bring on Rod, let me introduce someone who's very familiar to you. You're gonna know him. He's a great guy and a marvellous actor. You got to know and love him in Blue Heelers. He's currently in the ensemble theatres The Logie winning actor. Hello, John Wood.  John Wood: Hello, James. How are you?  James Valentine: Good. You're a bit crook.  John Wood: Oh, I'm not that crook. I've had Rheumatoid arthritis for about the last 15 years and it sort of slows you down.  James Valentine: What did you first notice?  John Wood: Pains in the ankles, really. You know, quite severe pains in the ankles and difficulty getting around. And then I started to notice it in the hands, you know, like it was, you know, the knuckles were really swelling up and the hand was very difficult to move, but I also discovered I had Gout in, certainly in this hand, this hand I had an MRI done on and it was full of uric acid. James Valentine: Yeah, right. And were they, what did they say at the time, was that compounding, were they separate things or compounding one another?  John Wood: Well, they're separate and you take different medication for them both. I mean, you take allopurinol for the gout and methotrexate for the arthritis and I've started taking curcumin recently, which seems to settle things down a bit, and mersynofen.  And this week, I've had, I don't know why it's happened, but I seem to have something like bursitis. There's no lump or swelling or anything, but the elbow has been giving me jib James Valentine: It just happens. It's like, what do you do? It just happens, doesn't it? Everything starts to go a bit. How long a period, like from say the ankle pain to the joints, are we talking months, years?  John Wood: Not very long. It was, it just seems that I've got Rheumatoid everywhere. You know, like it's, apart from slowing me down a bit, it hasn't really affected my work, except for one occasion I auditioned for the Harry Potter musical and they had us marching up and down and across and sideways and doing all sorts of stuff and that was all fine, then this associate director from England said, now I want you all to fall down. And I said, I can't even get on the ground to play choo-choo trains with my grandkids. So I said, it's a big mistake getting me to fall down. He said, nevermind fall down anyway. So I fell down and I had to be helped up by Julie Forsyth and a couple of other women. James Valentine: And so it doesn't impede you that much, but it's painful. John Wood: It's always very painful. Yeah. But at the moment, it's not too bad. I guess you get used to it as time goes on. And I've been lucky that the methotrexate has stopped any, you know, the stuff that says swelling.  James Valentine: Yeah. It doesn't seem to be there.  John Wood: No, no. And you know, I remember seeing old ladies when I was a kid, you know, whose fingers were really gnarled and bent.  James Valentine: And sort of folded into a claw almost.  John Wood: Yeah, yeah.  James Valentine: It’s shocking. And so apart from the drugs, what else have you, what else have you tried? Exercise, diet?  John Wood: Oh I'm trying, I'm staying at Kirribilli at the moment of course, and it's a bloody long walk up to the shops at Milsons Point. Just about, you know, like I'm getting fitter.  James Valentine: Well let's bring in Rod. He's Director of Platinum Physio and he helps patients like you, you know, with, I suppose, the non chemical approach and trying to get that bloody long walk to maybe go a bit bloody further.  Rod, thanks for joining us. What are you hearing and what John's telling us? Rod Grof: I'm hearing a very common story. We have plenty of patients who come into our clinic with Rheumatoid arthritis. And you said John, 15 years ago was your onset of it. So often we hear that Rheumatoid arthritis’ onset is between the ages of 30 to 50 years of age.  And you're currently taking methotrexate: just for our listeners, that’s actually a immunosuppressant, so it's going to slow down the immune response and in turn reduce, hopefully reduce the inflammatory response as well. And starting in the ankles, that's fairly common, but more so starting in the hands and the feet is probably the first point. And then it progresses to the knees, the ankles and as you've mentioned now, the elbows.  James Valentine: You think the elbows are Rheumatoid?  Rod Grof: There's a very good chance that it would be, yes.  John Wood: Oh great, right.  Rod Grof: But again, without a proper assessment, we can't categorically tell you that. But just interestingly that you mentioned that, you know, when James asked you about the exercise side of things, there's some really great non pharmacological interventions, John, that you could really get involved in.  And one of them, which I could speak really highly about would be something called hydrotherapy, which is exercising in warm water at approximately 34 degrees Celsius, and just being able to really get a good workout and have a really targeted workout, which will address your muscles as well as your tendons and your ligaments that are ultimately affected by Rheumatoid arthritis to help improve things like your flexibility and we need to know, have you noticed that you've had changes in your flexibility, your mobility over the years?  John Wood: I’ve never been all that flexible. I had, I was told when I was in my early teens, I had back trouble and the doctor discovered that I had two L5 vertebrae and I, you know, like most men, I used to use my spine like a crane and just, you know.  James Valentine: And so is that like, so during the course of the rheumatoid arthritis, say the last 15 years, has anyone suggested exercise or anything apart from drugs? John Wood: Well, I was doing my own exercise. I was walking in the RACV club pool at a place called Healesville in Victoria. And it's really great exercise because it's 1. 2 meters deep. It's a heated pool. It's not heated to as warm as Rod suggested but, it's great. I mean, you know, walking through water and I used to do it. James Valentine: That was sort of self prescribed, wasn't it? You just thought this is good. John Wood: Yeah, yeah. I just thought this is, you know, like the water takes a bit of weight off the joints.  James Valentine: But no one has said at any point, you know, when you go back to get it checked or, you know, no doctor or anybody else has said anything, just go and have a chat to the physio.  John Wood:No.  James Valentine: No. No. You hear that a lot, you know, a lot of people don't know what you can offer, Rod.  Rod Grof: Yes, that is the case. And our physio association are really pushing forward the campaign just to give the general public to get a good understanding of the breadth of what we do. And it's not just about musculoskeletal. We also treat patients neurologically. We also treat patients, you know, cardiothoracic wise as well. So there's a lot that patients don't know that physios can do except for massaging, you know, Chris Judd on the sidelines at an AFL game.  James Valentine: Yeah, yeah. Or, you know, or actors who need a little bit of help. Rod Grof: Yeah, absolutely.  James Valentine: Can't get up off the Harry Potter stage at any point. So would you consider it now, John? Like, you know, like we can go in a little bit more about what it actually offers. Are you open to stuff, you know?  John Wood: Yeah, yeah, of course I am. Yeah, yeah. I'd be very happy to talk to Rod. I believe you're in Melbourne, so.  Rod Grof: Yes, I'm based in Melbourne. John Wood: I’m just here, up here, working at the moment.  James Valentine: So Rheumatoid arthritis, how common is that? Rod Grof: Rheumatoid arthritis is fairly common. It's a condition which is an autoimmune disease, which basically means that your body essentially is attacking itself. It's malfunctioning. And it's different to other forms of arthritis or the more popular or more well known type being osteoarthritis, which is more of your wear and tear type of arthritis. With Rheumatoid arthritis, that is when the body is actually attacking the lining of the joints, and that causes the redness, causes the swelling, and really a significant amount of pain and loss of function. James Valentine: Then that would suggest to me it's kind of curable. You know, can we take something to fix it?  Rod Grof: So sadly it actually isn't curable. However, it can be managed. So that's where I come into the picture. The non pharmacological side of things is you know, exercise, good sleep nutrition, stressing less, having a really good lifestyle and being active; yoga, meditation, mindfulness, all of these things are really important to help manage that condition from a non pharmacological perspective. And when you go and see the quacks, see the docs, they're the ones that are going to feed you all the different pills. And I always say this, if there was a pill for exercise, every single doctor would be prescribing it.  James Valentine: Yeah. But in some ways, it is the hardest one to do if you don't, if you haven't had a discipline of it in your life, it can be very hard to start.  Rod Grof: Absolutely. You know, we have plenty of patients that come through our door that are across the lifespan and some of them have never walked into a gym in their life. An active gym is a real central feature of our physiotherapy clinics.  James Valentine: So what’s going on in this gym? What are you doing?  Rod Grof: So in the gym we're actually completing some physio supervised exercise. So we're actually taking the patient through a Physio tailored exercise regime, which addresses whatever their deficits are.  James Valentine: We said, you know, if you haven't had exercise as part of your life, where you're not used to gyms, maybe that can be a bit forbidding. I mean, the other difficulty that can come with ageing is that you're not as limber as you once were, or you've got another injury or a knee problem or something that may interfere with you doing the exercise. Rod Grof: Absolutely. So often as well, having other niggles is a massive deterrent. And again, we've had patients that come in all the time and say, look, I used to be a runner and you know, I unfortunately was climbing a ladder one day and doing some housework and I fell off the ladder and I landed on my knee and I had to go to surgery and I had to go to hospital and have surgery. And unfortunately that moment in time has really prevented them from going on to do any form of exercise or rehabilitation. Whereas that's the time that should really be the impetus and really give you that motivation to start getting better because there's just so much that can be done.  James Valentine: It's common at this point to start to have, I've got a bit of a creaky knee and a bit of a dicky hip and my elbow is a bit weird when, you know, the sun's at 45 degrees and I just played tennis three days ago. You know, it can all feel a little bit ill defined or you've had a bit of a go at a couple of things and nothing much happened or changed. That's what it can feel like at this age. Hang on. I'm describing myself. You know like and you're not sure whether to seek treatment for every creaky bit that's that's going on.  Rod Grof: Yes, so what you're describing is, you know, noisy knees is a great example. The reality is if it's not painful and not affecting your quality of life, just play on. Don't worry about it. We become so obsessed and we hear so much about, you know, bone on bone and my joints are creaking and cracking. Well, there's plenty of evidence that suggests that people who are bone on bone actually don't have any pain. And there are those that have pristine looking joints, and can't get off a couch. So based on that, there's really good evidence, really important lifestyle choices that you can still make. And based on that, we would encourage you, even if you're hearing all these interesting sounds in different parts of your body, work through it, and if it's progressively getting worse, that's when you do seek treatment. James Valentine: Do you start with the physiotherapist? Do I go to a GP? Do I go to some other doctor and then get referred to you?  Rod Grof:  It's a great question. Now, I believe when it comes to musculoskeletal related conditions, go straight to your physiotherapist. Here in Australia, you don't need a referral, so it's very, very accessible. Often we'll have patients that will go to a GP and the GP says you need to go see a physiotherapist straight away. Also, there are some GPs though, that might go, Oh, okay. You've got a bit of a creaky shoulder. Maybe we need to go and do an X-ray or do some imaging. So I've seen people walk through my door with a wheelbarrow worth of scans. I'm talking about scans, including X-rays, MRIs, CT scans, ultrasounds over the last 20 to 25 years in relation to whatever joint it is that's bothering them. Now, these people have done the ring around. They've gone doctor shopping and seeking answers and they come through our door because this one doctor in the last 20 years who they've seeked has said, why don't you go and see a physiotherapist? So they come into our door and the first thing we ask them is, have you ever seen a physio? They say, no. Have you ever done any form of exercise? They say no. Okay. Well, great. Here's a starting point. And I try to soften it. I didn't say we've got a gym out here. Let's go and do some gym work because again, the idea of going into a gym can be quite terrifying for people because they think of macho men with their tops off and flexing their muscles in the mirror. So just to sweeten it up a bit, it's more of a rehabilitation center and that just kind of takes the edge off it a bit. And that way we at least get that buy in and introduce them into that gym setting. Let's talk a little  James Valentine: bit more about the difference between Rheumatoid and Osteoarthritis, because I think we've spent a fair bit on Rheumatoid. Osteo comes on when in your life, what's it caused by, what is it?  Rod Grof: Absolutely, so Osteoarthritis occurs, you know, pretty much over the age of 40 years of age. There's different degrees of it, different stages of it. It is a Progressive condition and you know, it's, it's part of the, unfortunately it's part of the ageing process. Like we get gray hair, like we get wrinkles, that's all age related changes. These things are common with arthritis where ultimately, or osteoarthritis, where the cartilage that lines the joint changes.  And that can be as a result of different mechanical stresses that you put through your joints and more commonly, wear and tear and genetics, you know, unfortunately we can't really fight genetics.  So one of the biggest, I guess, risk factors that you can't change for arthritis is your age, your sex, and also your genes. When I say sex, it's more common in females than it is in males. Now arthritis, unlike Rheumatoid arthritis affects more of your major weight bearing joints, i.e. predominantly your hips and your knees.  Okay. And again, you might get sensations of what you described before, which was the noisy sounds. We call that crepitus. That's the medical term for it. Specifically, you might get some bony enlargement as well around the particular joint that you're working with. And unfortunately there are factors as well. The other risk factors that are actually modifiable are things like improving your muscle strength. Improving your level of physical activity and also again, just ensuring that you're living a healthy lifestyle.  James Valentine: Yeah. So when this first occurs, can you slow it down? Can you end up, can you get rid of it?  Rod Grof: So again, you can, it's not that you can get rid of osteoarthritis. However you can slow it down and you can by doing all of those modifiable, implementing most of those modifiable factors, as I said, particularly exercise, weight loss is a really big one as well. And by the way, this is quite an interesting fact, which I'm sure your audience will find very interesting. For every 10 percent of body weight that we lose, there is a 50 percent reduction in the amount of loads going through our knee joints.  James Valentine: Yeah. Well, that's amazing. So I lose 10 kilos. It's like 50 kilos less through my knee. Is that what that means?  Rod Grof: So it's 50 percent less load going through the knee. So as a great example, I had a gentleman who I saw last week and I've been seeing him for the last few months. He came in initially with significant knee pain referred by an orthopedic surgeon for physio prior to having a knee joint replacement. And we had our discussion about what are the first line of interventions and treatments that we can do to assist you and hopefully potentially slow down the process or delay the operation. But again, he was on a wait list. So in his mind, it was happening. I go to him, do me a favor. Let's try and lose 10 kilograms. Go consult with a dietitian and let's get you onto an exercise program which consisted of twice weekly exercise under physio supervision as well. And this patient now came in last week. He weighs 90 kilograms. He couldn't walk. He couldn't get off his chair without pain. He couldn't walk around the block. He couldn't go to his letterbox.  And now this guy is walking and getting up and picking up his grandchildren off the floor completely unrestricted. It's quite astonishing. And he's a really great example of what, you know, physical activity and looking after yourself and being motivated can do. So he's actually now completely called off that joint replacement. James Valentine: Now for many, it will end up in surgery. Is there an ideal age? Is there a right age for this sort of thing? What are the conditions in which you would go well, okay, yes, you're going to have to replace the hip. You're saying that it's hips and knees that get most affected by osteoarthritis. So that's the things we tend to replace, isn't it? Rod Grof: Absolutely. So the most common areas of the most common joints that get replaced are our hips and our knees. So at what point would you get the operation? Again, everybody's different. Typically these operations have around a 15 to 20 year lifespan as well before you have to go in again and get it revised. And that can be quite a big procedure and one that, you know, surgeons are happy to do, but if you can delay it, the better. So ideally, 65 to 75 year olds are the most common age bracket that will end up having a joint replacement. Any earlier would suggest that your arthritis has progressed quite significantly and it needs to really affect your quality of life because at the end of the day, it's not a magical bullet. It's the last resort. As in terms of the triage of what needs to be done, education, exercise, weight loss is number one. The next phase is looking at things like injection therapy, taking pain relief, taking anti-inflammatory medication. And again, if that's still not giving you the quality of life that you're after, that's when you look at having joint replacements.   James Valentine: Rod, let's just think about other general wear and tear things that happen at this age. We've, we've talked about hips and knees. We've talked about the two main arthritis things. What are the other main sort of physical wear and tear we're going to expect? Rod Grof: Sure. So our tendons, which connect our muscle to our bones, different bodily structures that with time, they go through that wear and tear process as well. And again, the solution to ensure that you don't have any issues like what we call the medical term for a previously was known as tendinitis. Now it's actually been changed to a tendinopathy because we know there's not really inflammation per se in the tendon. But the issue is the actual genetic or the makeup of the tendon as we get older, the collagen fibers become a bit more frayed and disorganized, and that is part of the aging process. So again, what's the solution for it? James Valentine: Can I guess, can I have a shot at this? Let me see. Might it be exercise? Might it be some resistance? Could diet be a factor here?  Rod Grof: All of the above. Fantastic. So it's pretty simple.  James Valentine: I've been listening so far.  Rod Grof: It's a very simple solution. And again, I can't emphasize, and you can hear my passion about what I,  this is why I do what I do. My motto is to keep people active and healthy, to live the life they love. And by doing so, We're able to ensure that they can pick up their grandchildren, go for a walk with their friends singing Taylor Swift around the park, and really have a really great quality of life and enjoy the last 30, 40, 50 years because here's no reason that we should let age get in the way. James Valentine: Let's bring John back in. John, is it, you know, anything in particular that you want to, you've been listening to the kind of conversation we've been having, anything you want to ask Rod? John Wood:  How does one go about visiting you? I mean, I would be very happy to come and have a chat at some point.  Rod Grof: So if you want to come directly to the clinic or directly to any physiotherapy clinic. I would ask a few questions cause some clinics don't necessarily offer management of Rheumatoid arthritis. It might be slightly out of their scope.  James Valentine: And there's simple sort of exercises you'd start with. What would be, if he signs up, what would be some of the first things he might be doing? Rod Grof: So look, mainly the exercise that we'll focus on initially would be in relation to just improving your overall mobility and giving you a structured walking program as well and just gradually. Increasing the distance, the time over a period, because we know going too hard too soon can actually have worse outcomes as well. Especially in over 65s, balance is a really big issue. We know that one in three people over the age of 65 fall.  John Wood: Well, you know, I have noticed that I'm more prone to falling over, not being able to get my underwear on, stuff like that.  James Valentine: All right, well, you know, on to more pleasant things really, John. You're in a show. You're acting in one.  John Wood: I am working, yes.  James Valentine: You are working, which is excellent. It's a new David Williamson play. It is. Now from memory, David Williamson, I think he's retired more times than Melba, hasn't he?  John Wood: Well not yet, but the last play I did of David's was his last play.  James Valentine: Right.  John Wood: Yes, I did that in 2020. We were closed down in our last couple of weeks by COVID.  James Valentine: Ah, right, right.  John Wood: And then, I got on a plane and went home with a whole lot of people. Gladys had let off the…  James Valentine: Oh, the ruby princess!  John Wood: The ruby princess.  James Valentine: Oh so you probably brought it into Melbourne. You're probably patient zero for Melbourne.  John Wood: Well, I could well be. James Valentine: So, some, you know, two, what now, four years later, three or four years later, he's back with another play. I mean, I don't want him to stop, but he keeps telling us he is. And so, it's a new play called The Great Divide.  John Wood: Yes, and it's an interesting piece and it's getting better and better all the time. The best writing in it, for my money, is the scenes between the younger women, who's a mid thirties mum and a seventeen year old daughter. And the writing for those scenes, it’s terrific, you know, like the relationship's wonderful and the girls are terrific.  James Valentine: Tell me a little bit about that rehearsal process. It's interesting you say it's getting better. I suppose in most of our minds we think, you know, David Williamson's there at the desk, he completes the script and then, there you go fellas, just say what I just wrote.  And I think this is another thing to realize with Australian plays, isn't it, is that we often see them very fresh. Whereas the thing from overseas, we might have, it might have been through a lot of rehearsal, a lot of different productions.  So, you know, this, you'll have a chance to see something here that's absolutely brand new.  John Wood: Yeah, we had a session yesterday afternoon at four o'clock where a group of people from the ensemble audience that pay money to come and watch the director at work. And so we've already, yesterday, been in front of a small audience of about 20. And we had a quick Q& A afterwards. And you know, it certainly worked for them. But there was one lady there who wanted to ask me about a line that I'd done in Crunch Time.  James Valentine: Right.  John Wood: And, you know, I spend the whole play trying to get one of my family to give me the lethal injection. James Valentine: Right.  John Wood: And I had forgotten all about this, but I have a line which says, Oh, if you want anything done, you've got to do it yourself. And this woman had picked up on that and she had a copy of the text and it wasn't in the text. And I have no recollection of myself and Mark Kilmurray discussing putting, putting that line in. James Valentine: Right. It must have popped in there, at some point. How physically, how do you find it when it's, you know, six shows a week, eight shows a week, you know, we'd been talking about your arthritis and these sort of things. That’s a big physical demand; you'll be in the season soon enough, and you're a veteran of doing this. Physically, how do you find it now?  John Wood: I don't think I have any major problems with it. You know, the arthritis is mainly under control, unless this elbow thing that Rod told us is probably arthritis.  James Valentine: Yeah, sorry about that.  John Wood: But I don't, you know, like I've been managing to stay working for most of the time, you know, when Blue Heelers came to an end, I was massively disappointed, you know, because it had been 12 years of just having to drive into the city and do the show and be on a pretty good wage and…  James Valentine: That's enough of that, young fella. John Wood: Yeah, ‘Doyle, my office’. And you know, like to suddenly lose that income was shocking. But I've been working in the theatre pretty much all my career. You know, when I was doing Blue Heelers, I was also doing Williamson's play, The Club, all over the country.  James Valentine: Great play.  John Wood: And, yeah, it's the funniest play ever written in Australia, in my view. It is just hysterically funny.  James Valentine: But that's good if you don't find the season taxing. John Wood: I can't imagine what I would do if I stopped acting.  James Valentine: Well, that's, I think you're a great advertisement for, you love it. So why stop doing it? You know.  John Wood: Well yeah, I can't, I can't imagine what I would do. It'd be nice if there was more financial reward involved in the industry, but I mean, we were left high and dry by ScoMo and his government during COVID, you know, like, shocking. I mean, you know, like his attitude to the arts and music I think was appalling.  James Valentine: John, you know, you said that you did, it started in your ankles, perhaps 15 years ago. If you think back to sort of you know, in your 30s to your 50s, perhaps when you're doing Blue Heelers, no signs of anything, anything that you perhaps should have dealt with. John Wood: I was going to a chiropractor. I, you know, I went to chiropractors for years, and I have since had a partial discectomy, you know, where they just cut a little, slipped down your spine and cut off the excess disc and that was fine, and I'm very careful with the way I use my back now. I've stopped using it as a crane, and, so that was the first year of Blue Heelers, so that was 1994, and the worst thing about that was I was supposed to go to the UK with Lisa to do publicity and I went into hospital to have the operation. And I kept looking out the window thinking, not very far away from here the crew and the cast are having a wrap party, and I'm missing it.  James Valentine: Well, it's fabulous to get some time with you, and I know we're going to see you on stages and screen, you know, for many years to come.  I hope so.  Despite everything spreading to your elbows and everywhere else. Um, but, Rod, thanks so much for everything you've offered. Absolutely fantastic.  Rod Grof: My pleasure. It's been fun.  James Valentine: We'll see you again.  Rod Grof: Thank you very much.  James Valentine: John. Thanks so much for being on the program. Great to catch up with you. And as we say, be talking about it's in the great divide by David Williamson. It's on at the Ensemble Theatre in Sydney until the 27th of April. I'd like to say, you know, break a leg, but I don't think that's probably good advice at this point.  John Wood: Oh, it's a pleasure to be here. Thanks, James. It's lovely to see you. James Valentine: Thanks so much to Rod Grof as well from Platinum Physio in Melbourne. You've been listening to Season 5 of Life's Booming. Is This Normal? Brought to you by Australian Seniors.See omnystudio.com/listener for privacy information.

Linked to metabolism and even menopause, weight gain for many over 50s seems inevitable, but is it really? We ask celebrity GP Dr Brad McKay for his take, and speak to author Jacqui Hodder about how she overcame an expanding waistline to embark on a trip of a lifetime.  About the episode - brought to you by Australian Seniors.  Join James Valentine as he explores the incredible stories of Aussie characters, from the adventurous to the love-struck. Across 30 inspirational episodes, Life’s Booming explores life, health, love, travel, and everything in between. Our bodies surprise us in ways we never thought possible as we age, so in series five of the Life’s Booming podcast – Is This Normal? – we’re settling in for honest chats with famous guests and noted experts about the ways our bodies behave as they age, discussing the issues and awkward questions you may be too embarrassed to ask yourself. Jacqui Hodder is a Melbourne-based writer and teacher who embarked on a once-in-a-lifetime trip to track turtles in Costa Rica, documenting her journey in Turtling in Tortuguero. Overweight and prediabetic, she underwent a health and fitness overhaul to help her prepare, and keep up, on the month-long adventure.  Sydney-based GP Dr Brad McKay is an experienced TV and radio broadcaster, podcaster, columnist and author of Fake Medicine. He appears regularly on The Today Show, The Drum, ABC Radio, triple j, Triple M, has presented Catalyst on the ABC and hosts several medical podcasts for health professionals. He's also on the editorial board of The Medical Republic. If you have any thoughts or questions and want to share your story to Life’s Booming, send us a voice note - [email protected] Watch Life’s Booming on Youtube Listen to Life's Booming on Apple Podcasts Listen to Life's Booming on Spotify Listen to Life's Booming on Google Podcasts For more information visit seniors.com.au/podcast. Produced by Medium Rare Content Agency, with Ampel Sonic Experience Agency Transcript:  James Valentine: Hello and welcome to Life's Booming series five of this most excellent and award-winning podcast. I'm James Valentine and in this series, we're going to ask the question, Is This Normal? I mean as we age stuff happens to us, our bodies change, things fall off, we get crook, stuff doesn't work as well as it used to. There's nothing we can do about it, we're getting older, we're ageing. But which bits are normal? Which bits do we have no control over? Which bits can we do something about? That's the kind of questions that we're going to be asking in this series, Is This Normal? of Life's Booming. Now, of course, if you enjoy this series, leave us a review, tell all your families and friends about it. And we want to hear from you as well. You can contribute to this. If you've got questions about things in particular that you want to know, perhaps there's some particular wear and tear happening to you. Let us know. We'd love to see if we can answer that question in the series. We're gonna look at things like menopause, gut health, mental health, lots of other burning questions. So, think about those areas and if there's something in there that's specific to you that you'd like us to cover, let us know. And now, on to this episode of Life's Booming, Middle age spread.  Weight gain weighs you down. Both literally, it's gonna weigh you down, slow your body down, and also mentally. You don't feel as good, you're sluggish. You probably don't like the way you look. Whether it's sitting there around your gut, or it's sitting there on your bottom, or it's making your legs fat, or wherever it's gathering. The gaining of weight is something that we all have to face as we get older. And it's not, often not pretty. And not really what we're hoping for. So, how do you lose weight? What do you have to do? Do you have to go off to the 6am bootcamp? Do you have to just eat beans for the rest of your life? What are you going to have to do about it? We've got two good people to talk to about this today. A regular on Australian television programs such as Today and The Project. Kiwi born, now Sydney based GP Dr Brad McKay is going to answer some of these questions and bring his medical knowledge and experience to this. But we've also got someone who's going to tell their story, and it's a very powerful tale. A few years ago, Melbourne author and teacher, Jacqui Hodder, was planning to go on a life changing trip. She wanted to head to Costa Rica, and she wanted to volunteer to help the turtle population there, to survive and to deal with all the threats that are happening to all the wildlife around the world. This was going to take a month. She was going to go there for a month. But it was going to be a physically demanding trip. So, she realised she was going to have to get fit and deal with this. But she'd also just had some big health news as well. It's a great story and inspiring.  James Valentine: Hello, Jacqui.  Jacqui: Hi, James. How are you? James Valentine: Yeah, good, good. Now, what do you usually do? What kind of work do you do? Jacqui: I'm a high school teacher. I teach English and I teach vocational education. And I also look after the careers in the school.  James Valentine: Okay. Oh, you're the career counsellor. Jacqui: I'm the career counsellor. That's right.  James Valentine: Okay, so we come to you, and you tell us, look, you really should be a physiotherapist and then we turn out to be astrophysicists, is that it? Jacqui: Well, the theory is these days, five different careers, not jobs, but careers in your lifetime.  James Valentine: Well, that's kind of you. You've got whole other careers as well, right? Jacqui: Absolutely. Yes. Done many different things over the years, for sure.  James Valentine: And tell me, you write as well.  Jacqui: I do. Yes. I've always wanted to write. I've written a little book about this journey, but also written some short stories and things like that as well. So yes, quite a lovely passion of mine for sure.  James Valentine: And it was, it was part of a writing project that led you to have to deal with some health issues.  Jacqui: Um, the way it came about, if you're happy for me to go on with the story, I was teaching a year nine civics education class, and we had a guest speaker come in who'd been to Costa Rica, and she had worked with a jaguar project in the jungles of Costa Rica, and she was putting all these images up on the board of armadillos and toucans and turtles that she'd worked with. This was at the end of the first year in lockdown in Melbourne, and it was via zoom. And I think something just spoke to me. I think that want for adventure, that, that exciting allure of something different than my house and being somewhere else really grabbed me. It just spoke to me. I thought that's really what I want to do. But obviously because we're on this program, I was quite overweight. I had some health issues. So the first challenge was, would I be able to do it? I had to be able to, according to the program I wanted to go and volunteer with, I had to be able to walk four to five hours on soft sand every night in the tropical humidity, plus, work with the turtles as well at night. So it was quite a physical program I was setting myself up for. So, I just turned 60, this was the beginning of January 2022, and I wanted to go for long service leave in the September. And so I set myself a goal of trying to get fit, fit enough to be able to walk those distances for that length of time. I had to also be able to walk eight to 12 kilometres on the soft sand as well, that was what the guidelines were. So I started off, and I remember my first session was down near where I live, walking down to the beach, along the beach, and then back up this set of stairs and panting quite remarkably as I got to the top, not sure if I'd make it. And that was the beginning.  James Valentine: It sounds like a big aim to me. It's like you've gone from sort of zero to a hundred. You're sort of, you're not going, ‘might just walk around the block’. It's like, I need to be able to rescue wildlife in Costa Rica. It sounds big. Jacqui: Exactly. Right. I just, I don't know. I don't know if you have those moments in your life where things just speak to you. And I was just like, I want to do this. That's something that was very clear in my mind, but I knew I had to get to a certain level of fitness to be able to do it, and I was quite overweight. I was probably about, probably reaching almost 100 kilos and I'm quite a small person. I was five, I'm five foot two and a half. Not was, but I am. So it was quite a challenge. Yes. So, I started with the fitness. I just knew I had that goal of making that distance for that length of time on the soft sand. That was the kind of significant part.  James Valentine: And nothing else up until then, nothing else had prompted you to want to lose weight, right?  Jacqui: Not quite true. I mean, I've been overweight. I've struggled with weight my whole life and I have tried various diets and I've lost weight, but it's always crept back on and that's the significant part for me. How do I keep it off? So, I knew I could lose weight if I really put my mind to it. At that stage, the goal wasn't so much to lose weight. It was to get fit enough to do the program. But when it got closer, I started to worry about keeping up with the young people because I knew there'd be young people on this experience. I knew I was going to be someone who, you know, was the oldest probably. So, I wanted to be able to keep up with the young people at night.  James Valentine: Don't we all? Jacqui: So, I got to April. And I was on holiday, and I was standing up from taking a photo of this family on the beach and I felt something go twang and it was my intercostals. So, I went to the physio and the physio said, she just laid it out for me, which was actually great for me. I didn't know I'd be able to take it so well. She said, Jacqui, you're going to have to go to the gym three to four times a week and do weight training and resistance for the rest of your life.  James Valentine: Wow.  Jacqui: Okay. That's what I need to do, super clear. So, I started going to the gym as well as walking. I still really wasn't losing the weight. James Valentine: Let's go back to, also just go back to that sort of first walk, you know, we left you, you were sort of panting up the stairs back to your house, right? So, that was in that first walk, did you also go, oh, I've got a long way to go?   Jacqui: I’ve got a long way to go, but I knew if I could dedicate a regular routine to walking, I knew I'd be able to get, it was the distance I was worried about and the time.  I couldn't ever quite make three and a half hours totally on the soft sand and I had to be able to do four to five hours.  James Valentine: Wow. Jacqui: It's really hard walking on soft sand. In fact, when I came back, I swore I'd never walk on a beach ever again.  James Valentine: I don't like having to get back to my towel, quite frankly. So, you know, to do five hours just sounds impossible.  Jacqui: And as it turns out, it was probably overkill, but I can explain that. A little bit later.  James Valentine: Yeah, right.  Jacqui: But yes, I was gradually building up. So, I was going pretty much Mondays after school, I was going Wednesdays, Fridays and on the weekend I'd try and do a long walk, walk on the weekend as well. James Valentine: And you were maintaining that, so that discipline was staying with you, you can see the aim, you can see the turtles on the beach, you can see where you're going.  Jacqui: The motivation was so clear. And that's partly also the challenge because when I came back, I knew the trick would be how to maintain that weight because I wouldn't have that clear motivation anymore. So yes, going to the gym and walking, my routine was getting quite busy at this point because I was going three times.   James Valentine: How many months out from the trip did the intercostals go?   Jacqui: That was April, and I was going in September.  James Valentine: Yeah. So, during that period you then start to do what, do daily gym routine you were saying, daily gym weight routine and walking. Jacqui: I was going to the gym three to four times, so Monday, Wednesday, Friday, Saturday, and then walking as much as I could on those days, but also the in between days as well. But obviously I'm working full time. So, the long walks I could really only do on the weekend.   James Valentine: So, what was happening to your weight? Jacqui: The weight, actually, to be honest, wasn't really changing. I was feeling like I wasn't panting up the stairs anymore. So, I could tell I was getting fitter, but I wasn't actually losing weight. So, when it got to June, I thought, I actually need to take an extra step here, because again, I guess I would be a little bit embarrassed. If I was going to be going to Costa Rica and working with young people, and there I was a very overweight, older person. So in June, I went on a program that I've been on before I knew it worked, which is the CSIRO Wellbeing, Total Wellbeing Diet. And I actually picked up a new book, which is the low carb one, because actually that was the other thing I hadn't mentioned was I had been diagnosed as pre diabetes in April as well.  I've also been on high blood pressure medication and high cholesterol medication for a long time as well.  James Valentine: Right. You've got it all going on at this point. So, you've got to deal with pre diabetes, you've got the intercostals have gone, you've got to get to the gym, you're trying to lose the weight. Jacqui: Yeah.  James Valentine: This is a lot to encompass, isn't it? Prediabetes, what does that suggest is going on?  Jacqui: High blood sugar, so basically, it's a precursor to type 2 diabetes, which is a very serious health issue, as you know.  James Valentine: But at that point it can be dealt with, with diet, right?  Jacqui: It can be, yes. And the doctor was very good. He explained everything to me of what I could do to change my lifestyle, which I was happy to say I've tried, I've already started doing. I've already started the walking, not to lose the weight. I don't think I've ever found, like in terms of the psychological part of losing weight, the kind of fear of health issues has never, unfortunately, been a motivation for me. I'm not sure why, but the motivation to work with turtles was working.  James Valentine: Isn’t it funny what it'll take to get us to do some stuff? So by April, May, June, you're at the gym. You're dealing with the diet, you're trying to lose the weight. You're walking, you're slogging yourself through the sand. It's a, it's a brutal routine you've really got onto. What the CSIRO diet, just tell us a little bit more about that. I mean, part of my general understanding is in some ways it's quite straightforward. It's a sort of, you know, meat and salad and you'll be good.  Jacqui: Well, the low carb one actually does, they're not so meat focused because originally that was kind of what we knew about the diet was how much meat or protein was involved.  But the low carb one substitutes a lot of nuts and fish and not much bread or pasta or obviously the carbs. And what I love about the Total Wellbeing Diet, I think, is they have a 12-week program and it really clearly outlines what you need to eat at breakfast and the quantities, lunch, dinner, and it has recipes in there, and it's 12 weeks. And 12 weeks feels manageable. It's a chunked-up amount of time. So, I knew if I could go on the 12-week diet, well, I hoped I'd be able to lose the weight because I had before being on that diet and I succeeded. I lost probably about half of what I've totally lost by the time I was in Costa Rica, so it did work. James Valentine: Okay. Okay. Well, we might leave a cliff-hanger there and we'll, you know, be able to build towards what happened in Costa Rica. Did the turtles attack? We’ll get to that part of the story. But I might bring in our very helpful doctor here, Dr. Brad McKay is with us. Hello.  Brad: Hello. Hopefully I can be helpful.  James Valentine: Yes. Excellent. Well, what kind of things are you hearing in that story? I mean, one of the things that struck me is, the exercise wasn't working. We all think we'll be able to burn that fat off. Not necessarily.  Brad: Yeah, it's, it's a very common presentation. So, very commonly, people like Jacqui will be wanting to lose the weight, they'll increase their exercise, they'll change their diet, and the evidence sort of shows that you might be able to lose about two percent of your body weight doing that. If you're really giving it a red-hot go, you might be able to get to five percent of your body weight being lowered, but it's really, really hard to push past that. And if you stop doing what you're doing, so if you stop starving yourself, then you tend to go back to that pre-existing weight. Your body loves to sabotage you and it loves to get back to your highest weight that you've ever been.  James Valentine: Right. So why, I mean, we see all those lean swimmers and football players and they run around all the time and they, you know, they eat a good diet to try and be great athletes. Why are they so skinny and I'm so fat? Brad: Well, they may be younger than you, so that's one thing. But also often those athletes haven't been overweight before. They haven't gone into an obese category, so they've maintained their weight.  Their body isn't trying to sabotage them. It's not trying to get to that heavier weight because they haven't been at that weight before.  James Valentine: Right. And so this has a lot to do with ageing, does it? When we get to a certain age, the weight is going to stay there? Brad: Yeah, so as time goes on, then we generally sort of like waver, we go up and down with our weight, and so every time you're in that flux of change, your body's trying to get to that highest level. So, just with a graph, if you're looking along this wavering line, it just slowly tends up all the time, because that's what your body is trying to do, it's trying to store energy. Evolutionarily, we have designed, our body has sort of evolved to be like that.  James Valentine: So, we're always, so as we age, we always, our body wants to put on more weight. Brad: So, our body wants to store energy to keep us alive for longer in case we can't kill that Saber-toothed tiger next week. We've got to have that energy on board.  But when we have lots of food around, when we have fast food, when fast food is cheap, when we're not exercising as much, if we're not racing around, and competing in Olympic sports, then yeah, we tend to put on that weight. And so that's a very common story.  James Valentine: And so, does that just keep on going? At 50 it'll be X and at 60 it's X and a half? Is it that sort of thing?  Brad: So it's not guaranteed. So, a lot of people do increase their weight and they're able to maintain, increase their exercise and they're able to maintain their weight at that level. Some people get really sick, and they lose lots of weight as well. There's also metabolic factors. There are hormone factors involved too. So, there's lots of variation. It's not inevitable.  James Valentine: So, when Jackie was just exercising, that wasn't doing it. What's the difference when you add diet? Brad: Well, if you're exercising to improve your health, you need to be exercising for about 150 minutes per week. And that's getting to a really high level where you're feeling puffed, where you may be able to have a brief conversation with somebody, but you're not able to sing. That's a great description in medicine for that. James Valentine: But I can't sing anyways.  Brad: You're screwed, yeah. So, the other part of it is if you're wanting to then lose further weight, then you need to be doing about 300 minutes every week at that level.  James Valentine: Right.  Brad: So, if you're wanting to then gain that further, then you've got to be really strict with your diet as well, and certainly a lot of the evidence does just look at the energy in versus energy out. So yeah, if you're not exercising and not using up that energy, then your body is going to store it somewhere.  James Valentine: Right. And so by diet, do we just mean eat less?  Brad: That’s also the type of food that you're eating as well. So, if you're eating lots of saturated fats, lots of fat, meaty products, if you're eating lots of white bread and carbohydrates, then yeah, like you're going to be, yeah, maintaining that and your body is going to love that and want to hold on to it. James Valentine: Oh, so different foods are held onto more resolutely by the body.  Brad: There's a lot more energy that's in certain foods compared to others. So, for example, if you're eating lots of vegetables, then you can feel full, if your stomach is full of beans, for example. But you've also got lots of fiber. It takes a long time for your body to digest that fiber. So, you'll have a little bit more energy for longer, rather than just bread that dissolves in your hands. before you're even able to put it in your mouth. So, your whole gut is sort of activated and it takes energy as well to break down that food too. So, the more rough your food is, the more whole greens you have, the more nuts you have, then yeah, it takes longer for your body to break it down. And also, it's not packed full of sugar, which is easily getting into your bloodstream and spreading around.  James Valentine: Now Jacqui, were you, did you know this sort of stuff when you went onto the CSIRO diet? Did you learn it as you went through?  Jacqui: Yeah, the thing about always struggling with my weight is I tried many, many different diets. Kind of know the facts and figures. I'm not sure I knew exactly why there were so many nuts in this particular diet, but it makes sense hearing what Brad's talking about for sure.  James Valentine: What are the things that struck you about the CSIRO diet? What was different?  Jacqui: I like the structure and I really like how each week is, like, it's a 12-week program and each day is pretty much designed for you in terms of quantities, in terms of what you need to eat, in terms of recipes.  So, I find that in a busy life, very straightforward to follow. The trick is what you do afterwards. Once it finishes.  James Valentine: What do you mean by that? Oh, once it finishes. Yeah. So, you mean after the 12 weeks, it doesn't say week 13 Mars Bar?  Jacqui: Well, I actually, I've got some little tips that have helped me, but one of them I think is for me having a day off every week. I hope that's not too naughty, but you know, just because I mean, it's very hard to stick to the same thing day in, day out. So, I give myself like a little treat one day a week where I just think I am going to have some hot chips for lunch, or I'm going to have pizza for dinner or something like that. And then I go back onto it again the next day.  James Valentine: Yeah. What do you think, Brad? Brad: Yeah. So, Jacqui’s exactly right. So, what you're wanting isn't just a 12-week program. You're wanting to be able to follow that eating habit for the longer term. And so often you do need a day off because if you don't, you will just fall over at the end of that 12 weeks. You'll go back to your previous eating habits. So yeah, I think it's crafty and it's helpful to do what Jacqui’s been talking about. So having those days off and being okay with you, giving yourself a break, giving yourself a bit of leniency. Because you're needing that, to do that in the longer term.  James Valentine: Why don't most diets work? I mean diets usually fail, don't they?   Brad: A lot of diets fail. A lot of people are going along this whole dietary cycle where they are trying everything under the sun. And not one diet works for everyone. Everyone has different metabolisms. So, what may work for Jacqui may not work for you. So yeah, you will have lots of Instagram influences and people online telling you that their green smoothie is going to be helpful for you losing weight.  James Valentine: But it's also, diets will often be around a fad, which will be, you know, one particular food, or one particular activity, or one particular way of thinking. Now again, that's hard to maintain, isn't it?  Brad: Yeah, if you're on a grapefruit diet, then you're probably not going to be doing that forever. James Valentine: Yeah, yeah. What's different about the CSIRO one?  Brad: So, it's a bit more about healthy eating, and having healthy habits, and being able to continue it in the longer term. Also, the variety is really important because you're needing to not get bored by that grapefruit that you're having every day. You're needing that variety, that spice of life.  James Valentine: Yeah. The other thing I was struck by Jacqui, and let's, I asked you this sort of a little earlier, but you know, let's talk about it a little bit more. The motivation was, is so curious in a way, it is quite an extreme thing that it's like you suddenly went, I wouldn't mind white water rafting, you know, kayaking or something. It's like you took quite a big step. It took a motivation that was a big step out of your normal life. Why had motivation failed before? What, what, why doesn't the motivation of just, I want to lose weight, I know that's important. Why isn't that enough?  Jacqui: It's interesting, isn't it? I mean, if I knew the answer, maybe I wouldn't have waited till I was 60 to finally lose some weight. And also, I do feel it's a very fragile truce I have at the moment. I feel like I have to trick myself. I have to check. So little tricks I have is to check what's for breakfast the next day in the program, the night, the day before, just so that I can, every day I'm making that decision. Today I'm going to follow it. If I don't, I can fall back into old habits, but Brad, I had the doctor say to me it can take two years for the body to stop wanting to sabotage yourself. And so that really helped me as well because I thought, okay, if I can get up to two years, I've still got to remain vigilant. I had a mantra, be vigilant because losing that weight was my last chance. I felt if I put the weight back on this time, I'd never take it back off again.  James Valentine: That's interesting, isn't it? Like that I wouldn't have really known that because I think most of us think I'll lose 10kg and then I'll be fine.  Brad: Yeah. I suppose the thing is there's no magic number as well. So, I'm not sure whether that doctor's coming up with two years for it is often like a longer term sort of like hunger and a drive for food. It's a very primitive reaction. There is some sort of changes. So, if you have been eating a lot and then you have been eating less, then your stomach will shrink a little bit over time. And so, if you're having food, your stomach will stretch earlier and so you'll feel fuller quicker. So that may be what they were talking about. But yeah, your body wants to sabotage you forever. Sorry, Jacqui. It wants to sabotage all of us.  James Valentine: But does your appetite sort of change? I mean, like I want pizza. I want chips. I want pies. I want cake. If you change it, does it just take a few years for you to start to, I want salad. I want tomatoes.  Brad: So, a lot of my patients will find that, yeah, if they're, if they're on a diet, if they change their diet, they will often continue to have this voice, this hunger, telling them to go to the fridge and telling them about the foods that their body is craving for. So and I think that that voice diminishes a little bit over time, but it's still going to be there.  James Valentine: Jacqui’s superpower is she changed her whole appetite?  Jacqui: Well, gosh, like I said, it's quite, I know it's fragile. I know I can, I just went into the fridge the other night and had a little binge. Just the stress, you know, but I have to think, no, go back on it the next day, back on it the next day. James Valentine: Yeah, it's a beautiful description. You've used a fragile truce, isn't it? And I'm sure a lot of people with addiction would feel a similar sort of thing. And there'd be lots of aspects of our life where we have a fragile truce.  Jacqui: Yeah, I do feel like it's been a little bit of an addiction over the years, the eating, you know, it has been that thing I've used, I think, to comfort myself, not very healthily. So, yeah, I'm definitely, I've got that vigilant, be vigilant in my head for sure. That's what I do.  James Valentine: Yeah. And let's go back, Brad, to the motivation, the fact that this, you know, Jacqui conceived of this Everest, climbing Everest-type desire. That's powerful, isn't it?  Brad: Yeah. So, I suppose one thing that I'd be wanting to mention is that people can be motivated, they can be driven, and they have every aspiration of reaching their goals. And then often, they aren't able to do that. Their metabolism works against them, their hormones work against them, their body. works against them. And they will often feel like a failure. And I think this is just this horrible sort of occurrence that just permeates throughout the world. We often have a stigma towards obesity and people being overweight. And we often blame people for just putting things in their mouth. But it's not people's fault that they're gaining weight. And it's not their fault if they can't lose weight. There are just so many other factors involved with it. And we try to simplify this as people and our understanding of it. We try to put it in a box. And so, yeah, it's just a reminder that if Jacqui has got the motivation and drive and has some tools in her belt that she can use to get to that level, and she's happy with her weight and where things are at, that is amazing. That is fantastic. But yeah, some people aren't that lucky. They aren't that fortunate and there are, and it's not their fault if they can't reach it. James Valentine: Yeah. Did you feel those kinds of things that Brad was describing there, Jacqui? And, and I'm wondering, do you necessarily feel a victory or an elation now?  Jacqui: No, I mean, certainly sometimes when I put some clothes on and I am pleased, you know, that I'm thinner than I was, but one of the things I think, absolutely what Brad said.  My message would never be to shame someone. I never wanted like a before and after photo, for instance, because I've seen them all. I've seen those photos on TV or the magazines.  Brad: They just changed the lighting, Jacqui.  Jacqui: Because I've, you know, inverted commas here, but I feel like I've failed so many times because and that's, I guess, part of the fragile truce. Now, you know, I feel like I could, I don't know how to word it properly, but I suppose go backwards and, I never want anyone to feel that, you know, I've got it sorted because I'd be the last person to say that. If I had it sorted, I would have 40 years ago.  James Valentine: Yeah. Well, I almost wonder where there's a sort of like an almost reverse thing if you, if you're feeling great now and everyone's complimenting you now, it almost sort of, it doubles, the shame of the past.  Jacqui: Or the pressure to, to keep it off.  James Valentine: Or the pressure of it. Or sort of like, oh, so that's, it is, everybody is just sort of incredibly admiring of skinny. There is only skinny, you know, that sort of, that sort of thing is wrong too, isn't it?  Brad: It's a great way to force an eating disorder. James Valentine: Yeah. A great way to force an eating disorder. Let's consider age as a factor in here, Jacqui’s done this at 60, which is pretty impressive, you know, I've barely got the motivation to do anything anymore, really. So the, is it, is it harder, is it physically harder to be losing weight, and I suppose a big factor of that will be a psychological thing. Mate, why am I bothering? This is me now. You know, come on, you know, let me enjoy myself. Really? What have I got to gain? You know.  Brad: I think it's, it's also mobility. And so over time we accumulate problems, we develop injuries. And so, it gets harder and harder to move. Our heart doesn't work as well as what it did when we were a teenager. So, we can't quite get to that level of exercise, yeah, that endurance, that ability to go all of the yards that we're needing to, to exercise enough to bring down our weight.  James Valentine: But we can do diet.  Brad: We can do diet. But again, it can be very, very restrictive.  James Valentine: Yeah. Do we talk about it incorrectly, really? We should be talking about how hard it is, not, we've got this easy one fix. Try this diet. Come to my bootcamp. We'll be able to, able to fix everything.  Brad: I think in medicine we are trying to change that narrative for decades. So, trying to talk about like healthy eating habits and, yeah.  Trying to teach teenagers, uh, which foods to eat so they won't end up overweight or obese over their, over their life. So, I think our way of changing with television, with the media, and trying not to stigmatise people for their weight as well. This is sort of like a weird conversation that's going on right at the moment.  Not fat shaming people, and people are talking about like being fat fit where they may be overweight, but they're actually like healthier than what I am at the moment.They can run a marathon. I couldn't do that at the moment.  James Valentine: Yeah. It's worth underlying that, isn't it? Because that's a reasonably recent change. We've gone from a sort of sense that we've got to point out to these fat people that they need to lose that weight because it's no good for them. You know, your heart's struggling, you'll get diabetes. We've changed, we've changed, that attitude's changed considerably. Brad: I think it's a real interesting time at the moment. We've gone from fat shaming to now being like fat fit and body positive. And now with the introductions of a range of different medications that are all coming around the world, which are enabling people to lose more than that five percent that they could do under their own steam, getting down to 10, 15%. Some of the medications that are coming around the corner could get even up to 25% loss of your body mass. This is sort of like disconnecting people's relationship with food. It's allowing them to change their body type. And I'm really sort of intrigued to see what happens with the social discourse and social understanding of that as we've gone from body acceptance, and this is how it is, to oh well, they're a skinny bitch because they've been using this drug. James Valentine: Yeah. Are you supportive of the Ozempic Revolution? I guess it's one of the brands that people might be more aware of than others.  Does that seem like a good thing to you?  Brad: Overwhelmingly, it's positive. So having one injection a week is suitable for a lot of people. But it's not just about the weight loss. Like, some people look better and that's what they're going for, fine. But if you're losing like 10 percent of your body mass, then it's going to decrease your risk of high blood pressure, decrease your risk of diabetes, decrease your risk of heart attacks, other heart disease. Decrease strokes, also decreases your risk of getting a whole bunch of cancers that are related to obesity and being overweight too. So, it's overwhelmingly, this is, yeah, a good, a good thing around the world.  James Valentine: Yeah. Jacqui, if that sort of thing had been available through the years or now, do you subscribe to that? Would you be happy with that?  Jacqui: Very tricky. I'm not, I'm not actually sure. I mean, I was so reluctant to go on medication of any kind. I always wanted to try, if I was going to lose weight to try and do it, I suppose, inverted commas again, naturally. Because I, but I mean, Brad's absolutely right. I mean, I don't know everyone's metabolism, like everyone struggles in their own way with these things.  But certainly in terms of what Brad was saying, I think for me, I was so pleased to come back from Costa Rica and the doctor ran the blood tests again and I was not prediabetic anymore. So certainly, in terms of losing weight, it certainly helped my health prognosis, I would say. My heart blood pressure, high blood pressure medication went down by half as well. I'm still on those tablets just because we have a history of family heart disease, heart disease in the family. But, in terms of losing weight, it did actually have some health benefits, absolutely.  James Valentine: Well, when we left Jacqui, she was about to embark on a flight to Costa Rica to save the turtle population of the beach there. Jacqui, pick us up with the adventure. What happened? What happened when you got there? Could you do the walk?  Jacqui: So, yes, for all their kind of, you know, you need to be able to walk four to five hours every night, 10 to 12 kilometres on soft sand on the black beaches of Costa Rica on the Caribbean coast.  Yeah, we didn't actually go out every single night, so I could get some rest time in between. And most of the nights, we would walk for a while, for sure, there was a lot of walking, but then we'd stop and work a turtle, which means we'd get in the pit with the turtle, we'd measure it, we'd body check it, we'd go under the turtles to catch the eggs and count them.  So, the physicality was the walking, but also getting in the nest with this very big base, trying not to get sand flipped everywhere by their very strong flippers. James Valentine: So, you were the Steve Irwin of turtles at this point. You're Crikey! Look at this, look at this fella. Describe the turtles. What species are they and what do they look like? Jacqui: So, this is the second largest in the world, Australia has the largest, but, largest in the Western Hemisphere of endangered green sea turtles. This is their nesting beach, so peak season they were coming up onto the beach and laying their eggs. They're quite fascinating creatures.  James Valentine: And how many, like in the thousands? Jacqui: Oh yes, could be in a whole season, even tens of thousands, yes. But obviously they have their perils, I mean they are endangered, and human predation has a lot to do with that.  James Valentine: And so, is that what the task was, was mainly to protect them from things like that or?  Jacqui: So, it's collecting data for Sea Turtle Conservancy in Costa Rica. That was the organization I went with.  James Valentine: And did you turn out to be, was it a bunch of sort of slim young gap-year type people who were running around doing this and you?  Jacqui: Yes, yeah. But there was one lady who, accidentally, I didn't know, and it was just random that she was there at the same time who was about my age. So, I was very fortunate how that worked out, but the young people were wonderful. They took me under their wing, and they made me feel like I was their mama for sure. They were lovely.  James Valentine: And as like you were so motivated to go and do this, this obviously turned into sort of like, this is a journey that I really want to make. This is my dream sort of adventure to go and do this.  Jacqui: It was life changing in so many ways. I think just, I mean, the young people were so inspiring, their love of conservation, their love of nature, the willingness to kind of be involved in something like that for months at a time. But obviously in terms of my weight and my fitness and my breadth of understanding about the world, I never, didn't even really know where Costa Rica was before I went. James Valentine: What's next? Because having conquered that, it sort of feels like, well, what can I take on now?  Jacqui: Well, yes, that's right. We did spend a little bit of time in Spain and discovered hill walking, which is very good for the fitness as well. And then, hopefully maybe India at the end of this year, but we'll see how we go. James Valentine: Fantastic. Brad, I'm inspired. You know, like I sort of feel a little bit ashamed. I sort of think, oh, I wouldn't mind a house down the South coast for a while. That could be good.  Brad: Are you training for cheetah conservation?  James Valentine: Yeah, cheetah conservation. You need to chase down a cheetah and just inject it for a moment. James Valentine: Just measure its fore paw and then, you know.  Brad: Work it up. Count its eggs.  James Valentine: Yeah. Have you got anything like that? Or do you have a sort of dream journey or something like that that you'd love to do? Brad: I'm a bit of a veteran at Burning Man, so I often, yeah, like, pack up my stuff and then go into the middle of the desert and try to make sure that I'm fit enough to survive in Nevada with very little resources. James Valentine: Were you there for the big muddy one this year?  Brad: I was trapped in the mud.  James Valentine: Really?  Brad: For quite a few days, yes. James Valentine: Oh, that's a very good annual adventure. And I think your weight might be a little crucial there too.  Brad: You lose a few kilograms, yeah. When you're struggling through, through muddy sand. James Valentine: Well look, fantastic. Great conversation. Thank you so much for, you know, Jacqui, thank you so much for sharing so much there. That's a very personal story that you've revealed for us. And thank you so much.  Jacqui: Thank you very much indeed, for the honour.  James Valentine: Brad, thanks for your expertise. Brad: Thanks for having me. James Valentine: For more about Jacqui Hodder and her weight loss journey, you can read her book. It's called Turtling in Tortuguero. And Dr Brad McKay’s got a book out as well, it's called Fake Medicine. You'll see the links in the show notes, you'll find them in bookstores and libraries right now. I think you'll agree, great story from Jackie and terrific information from Brad.  You've been listening to Life's Booming, Is This Normal? Please leave a review or tell somebody all about the show. If you want to know more, head to seniors. com.au/podcast. You'll get our earlier series there and more episodes. I'm James Valentine. I'll see you next time for another Life's Booming.    Tortuguero! Turtling in Tortuguerro! I love just dropping into accent for one word, it's always very powerful. Okay.See omnystudio.com/listener for privacy information.

Join James Valentine as he explores the incredible stories of Aussie characters, from the adventurous to the love-struck. Across 30 inspirational episodes, Life’s Booming explores life, health, love, travel, and everything in between. Our bodies surprise us in ways we never thought possible as we age, so in series five of the Life’s Booming podcast – Is This Normal? – we’re settling in for honest chats with famous guests and noted experts about the ways our bodies behave as they age, discussing the issues and awkward questions you may be too embarrassed to ask yourself. If you' have any thoughts or questions and want to share your story to Life’s Booming, send us a voice note - [email protected] Watch Life’s Booming on Youtube Listen to Life's Booming on Apple Podcasts Listen to Life's Booming on Spotify Listen to Life's Booming on Google Podcasts For more information visit seniors.com.au/podcast. About Australian Seniors Produced by Medium Rare Content Agency, in conjunction with Ampel Sonic Experience AgencySee omnystudio.com/listener for privacy information.

After receiving a life-changing cancer diagnosis, award-winning surf writer, husband and father-of-two Tim Baker turned his attention to making peace with his mortality and living in the 'now'. If you' have any thoughts or questions and want to share your story to Life’s Booming, send us a voice note - click here Watch Life’s Booming on Youtube  Listen to Life's Booming on Apple Podcasts  Listen to Life's Booming on Spotify:  Listen to Life's Booming on Google Podcasts  For more information visit seniors.com.au/podcast. Produced by Medium Rare Content AgencySee omnystudio.com/listener for privacy information.

How does anyone get drawn into a cult and how, when the extreme beliefs that have ruled their lives prove baseless, do they recover? Tune in as David Ayliffe shares the lessons from his own experience.See omnystudio.com/listener for privacy information.

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