Can we get healthier as we age?

Rob: Hi there, it is Rob here, and I really hope that you have enjoyed this series of our Healthy Living Podcast. 

Of course, in that time, we have looked at weight – loss supplements and jabs, creatine and protein powder, and we have also busted some of the biggest myths around diet and nutrition. Well, in this week's final episode of this current series, we have got something really special for you.

On Thursday, the 22nd of January, we recorded a live episode in front of a live virtual audience, where we asked the question: can we get healthier as we age? It was a brilliant discussion with an expert panel, and we really hope you enjoy it.

For now, though, I will hand you over to my colleague and the host of this special live podcast, Lisa Webb.

Lisa Webb: Hello and welcome to this first – ever live podcast from us here at Which? This is the last episode of this current series of our Healthy Living Podcast, and today's focus is all about whether or not we can get healthier as we age. I am Lisa from Which?, and joining us, we have from Which? our public health nutritionist Shefalee Loth.

Shefalee Loth: Hi.

Lisa Webb: We have got specialist dietitian and director of City Dietitians, Sophie Medlin.

Sophie Medlin: Hi.

Lisa Webb: Presenter, podcaster, and Sunday Times best – selling author, Kate Lawler.

Kate Lawler: Hello.

Lisa Webb: And we have also got family GP specialising in women's health, author, and medical broadcaster, Nighat Arif.

Nighat Arif: Hello, everyone.

Lisa Webb: I want to get us started here with Shefalee from Which? Now, people are going to know Which? for certain things. They know us as the guys that bang on about washing machines and vacuum cleaners and those sorts of things.

Kate Lawler: I used you for my washing machine! And we're very good at it, Kate, thank you.

Lisa Webb: But we are not talking about that stuff today. We are talking about health and well – being. Why are we talking about that?

Shefalee Loth: Okay. So, first of all, Which? has been in the food, nutrition, and health space for a long, long time. But we have definitely ramped up our work in this area in the last year or so. And the reason for that is in recent years we have just seen so much health information being pushed online, on social channels, often by people who aren't qualified to give that information.

And what this has led to is a huge misunderstanding, lots of consumer confusion, but also just a lot of nonsense out there that people are following. And so Which? really wanted to get into this space – really to be a voice of reason, to cut through the noise, cut through the nonsense, and help consumers make the right choices for their health and well – being.

Lisa Webb: Yeah, and you mentioned there that there is a huge amount of confusion and actually misinformation. I think there can be some quite deliberate misinformation and dangerous misinformation sometimes. And I think actually, Nighat, it would be really interesting to hear from you, particularly if we are talking about your patients. Are you seeing misinformation as a problem?

Nighat Arif: I am seeing misinformation in my patients, in my family, in my friends. There is nobody that I talk to that hasn't seen some bit of nuggets of misinformation and they will run it past me. And that is really lovely. I am honoured that they do that and have that much trust.

Kate Lawler: You should charge them for it, though.

Nighat Arif: I don't charge them for it. I am missing a trick there. But we are seeing a rise in this because people are turning to the internet. And so there is a term for it: cyberchondria.

Kate Lawler: No, there isn't. Cyberchondria!

Nighat Arif: Yes. So just like hypochondria, where you read something in a magazine – it used to be the Daily Mail or whatever Good Housekeeping magazine – now suddenly people are going onto the internet, finding something, and that is making them really anxious or believing that they have that condition because the internet told them that that is the case.

Kate Lawler: It is not often people seeking it out. You are just scrolling and you will see someone go, "Did you know peas give you cancer?" and you are like, "What?" Everyone seems to be a professional and everyone seems to be a doctor now. You mustn't do this, you mustn't do that. It is a wild west.

Nighat Arif: And especially if the information is coming from someone that you really like and trust – air quotation mark that – that influencer that you've grown up with or you might have liked them because they've shown a certain aspect of their life or given an insight to you and they've said, "Actually, I went and this is the thing that I've learned".

It makes you convinced that you have that as well. And people like validation. We are mammals who love other people to go, "There, there, I'm going to validate what you have," whether that is right or wrong. And unfortunately, that is what comes into my clinic.

Lisa Webb: So, Kate, you live your life online a bit here. Do you find yourself – do you think you've got cyberchondria? Is it something that you can recognise?

Kate Lawler: All the time. My husband is constantly saying, "Why do you think you've got everything?" Every single symptom I ever get, I will read something and I will send it to him. Although he did send me something and go, "This is you". He thinks I've got ADHD. So he is like, "Get yourself checked". But I was always sending him that. "Thank you for telling me 13 stories in two minutes," which I'm very capable of.

But other than that, I do go out and I go, "Oh, I'll read something," and then I will do a deep dive on it. Dangerously on social media, I just see so much stuff and I believe it. I don't anymore, to be fair. I am actually quite good now. I think when it first started happening, I was very much sending him stuff going, "Do you think this is me? Do you think this is our child?" So I think I've got better at now trusting that I do not go to social media for medical advice and I will not believe everything I read on social media.

Lisa Webb: What's changed there? What made you think actually social media is not the place for me to get this information?

Kate Lawler: Because when you think about it, if you're watching Dave in Wigan give you advice about what's healthy – no, you need a GP. I've got Nighat's number now. I just call Nighat.

Nighat Arif: Which she actually does. That is actually the most sensible thing to do. You touch base with your nutritional colleagues, you touch base with people that is their bread and butter and they've got years of knowledge in that specialism. And that is the missing jigsaw. So I'm not trying to say to people don't go on the internet, because it is sometimes – if you're very lonely and you're living with that chronic condition or the pieces of the jigsaw puzzle aren't falling into place, it totally makes sense to go onto the internet and get that validation and go, "Actually, I'm not going crazy," but just run it past someone who is a professional.

Lisa Webb: So one of the things I've noticed about being on social media is – as soon as I clicked over the age of 40, the algorithms knew it. They just knew it. And I started immediately being peddled every supplement I can think of. And some of them I'd never heard of, some of them are things that I was thinking, "Hang on, why do I want to take that?"

Sophie, we've got you here who has got loads of experience in the field of supplements and diet. Are you seeing vast amounts of misinformation around supplements particularly? And is it targeting women more than anyone else, or is it for everyone?

Sophie Medlin: Listen, supplements have always been around. They've been around for a long, long time. But I think when I started my career 20 years ago, supplements were still – "Oh, my GP's told me I need to take iron," or "I might need to take folic acid when I'm getting pregnant," but it wasn't anywhere near what the supplement industry is now. It's been growing massively and growing exponentially since the pandemic, actually. People became very interested in preventative healthcare and some of that is positive.

And some of it means, like Kate perhaps, you've got a cupboard full of supplements that you're not taking. And I think it's a real minefield. Some supplements are really beneficial and very evidence – based, and some are absolute nonsense. And as I have had 20 years' experience in the field – I formulate supplements, I work with the supplement industry, I work with Which? on reviewing supplements – still sometimes my patients come to me and say, "I'm taking this. Do you think I should be taking this?" and it's something I've never heard of. And that to me shouts – there's so much out there and it is a real minefield and people are vulnerable to these messages that come out.

I do think because there's been this huge wave of interest and companies getting very involved in the menopause space, that's where women are being so heavily targeted at the moment because often young men who are entrepreneurs have gone, "Oh, there's really good money to be made in the menopause space," rather than it being someone who's genuinely engaged in and has experience in that space and is creating products that are really needed.

Kate Lawler: What are the nonsense supplements? I'm dying to know. Which ones just outright just don't take it? What's a fad?

Sophie Medlin: There's so many. I think where we're at the moment with medicinal mushrooms, there's just not enough research to say for sure whether we should be taking them or not.

Lisa Webb: Is that the same thing as I keep being pushed this – adaptogens? Is that the same thing? I keep being told I need to take lion's mane and cordyceps. In my head, aren't cordyceps that thing from The Last of Us that turns us into zombies that we should be terrified of?

Sophie Medlin: Yeah, these are the sorts of things we're talking about. Adaptogens, mushrooms, mushroom products are part of the adaptogen story. They are – at the moment, there's just not enough evidence to say we should be taking them. But the way they're marketed is really clever. And when we look at often a lot of these mushroom products, actually the benefit you're getting or the reason you feel better is because they often also contain something like caffeine or another sort of stimulant that gives you that pick – me – up and you think, "Oh great, I don't feel as buzzy as I did with coffee," but you're still getting a whack of caffeine and it is – a really messy space and really poorly regulated. And that's why there's so much nonsense out there.

Shefalee Loth: We had a story actually – Which? had a story out today that's been picked up quite a lot about misinformation and misselling of products, and specifically in the weight – loss sphere, talking about loads of really mainstream retailers who've been advertising weight – loss supplements. And there are rules around what you can and can't say about these products, what they can and can't do, but often they're being touted as things like "fat burners" or something that can assist you from losing weight from your belly.

Sophie Medlin: And GLP alternatives – GLP supplements.

Shefalee Loth: Exactly.

Lisa Webb: And is that something that is concerning for you that this is happening so much?

Sophie Medlin: Yeah, absolutely. And I think we had a huge wave of weight – loss supplements in the early phases of supplements becoming popular – early 2000s, mid – 2000s, for example. And then now because of the GLP – 1 – the weight – loss jabs and medications – now people are looking for a cheaper alternative to that and supplement companies have caught on to that and gone, "Oh, hang on, I can ride on this wave. People are searching for weight – loss solutions. I can sell them this fibre powder that might keep them a bit fuller for longer, but it's certainly not going to do the same thing as a prescription medication," not that people should necessarily be taking them if they don't need them.

But ultimately, it's a space where wherever there is a space or even a vulnerability, supplement companies – unethical supplement companies – will jump on that and go, "We can solve all your problems and cure everything". And as you said, many of the claims that are out there are illegal. I could spend my whole life reporting people on social media and elsewhere where I see supplements being advertised to the ASA – Advertising Standards Authority – but it would be a waste of my time because it's a never – ending tidal wave of nonsense.

Lisa Webb: Supplements is something that our audience is very keen to talk about. We've had lots of questions already in about supplements. One of the key things that seems to be coming through here: people asking, "Are supplements needed as we age?" but also "Can we just do it through diet? Is there something that we can do here that isn't about taking extra stuff?" So I'd be quite keen to hear from all of you about this point because is diet alone enough? Nighat, have you had to advise people on this much?

Nighat Arif: Personally, and looking at what my patient cohort group is, I would say diet is enough if you're making the right choices and you're not taking out certain food groups at a certain point in your life. And also, it depends where you are – so for example if I – I do women's health, so I mostly see female patients in my practice. And if I'm looking at them, it depends where they are on their biological journey.

So if I'm seeing a young girl who's 12 or 13, has just started her periods and they're heavy, the last thing I want her to do is cut out iron, so I would suggest that as she's menstruating, then to take iron supplementation if she feels tired or weak. We need to investigate that further, why she's losing so much iron. But actually in Nature magazine, Professor Lesley Regan wrote a really great article where they looked at the data of what a normal period is. And we realised that actually even on a normal period, menstruating women are losing a milligram of iron anyway out of that.

And so we need to be thinking of replacing that through diet first, but if that's not appropriate, then topping up on an iron supplementation is reasonable. Then we get to pregnancy, then I would say definitely folic acid and vitamin D, so important for spina bifida, neural – tube diseases. And then if we're looking at perimenopause, again, we know that magnesium is so important for sleep and that's when supplementation can be great if you're not thinking down the road of – hormone replacement therapy.

So they definitely have a role to play and like Sophie was saying, it depends on looking at what the data really does back, and that's where I step in as a GP and recommend it. There are some times when things like ashwagandha can be quite well – received for hot flushes and night sweats, and also black cohosh can work quite well for some of my patients, but I've got to be really careful with the liver toxicity.

Kate Lawler: What is that?

Nighat Arif: So it's a medication that can help with hot flushes – and fatigue and irritability and can be quite good for sleep. So it's a great supplementation. It's been around since – it's Chinese medicine, isn't it?

Sophie Medlin: Yeah.

Nighat Arif: So it's been around for over a thousand years and we've just got to be really careful that it doesn't interact with the liver. Same as St. John's wort – been around for a very long time, used in the right quantities, making sure there are no other medications that are interacting with it, can be great as something that can lift your mood or even assist with sleep. So in the perimenopausal phase, that works really well for a lot of my patients and it gives them the ability to make sensible choices, to be able to exercise, to be able to have that meaningful connectivity with someone because they're not hampered down by the symptoms of that biological transition that they're going through.

Lisa Webb: Yeah, that's fascinating. The fact that you can supplement different areas in order to really boost yourself. Because I know Kate, you've been doing Veganuary.

Kate Lawler: I have.

Lisa Webb: So no animal – based proteins or anything this month.

Kate Lawler: No. I've not eaten meat for about eight or nine years now, and I totally forgot that when I gave up meat, I would be very low in iron because I wasn't substituting it with enough iron – rich foods. So I became quite anaemic, and I was also having quite heavy periods when I gave up meat – not when I gave up meat, but at that time.

So I should have replaced with iron supplements, and eventually, I did, felt much better. Then my friend said, "Oh, you should also replace B12," gave me these supplements of B12, but I was being given a megadose and I started getting really bad side effects and was overdosing on B12, so I stopped taking those. And then perimenopause hit, my sleep went out the window, started taking magnesium, it made me poo four times a day. Not for me.

Sophie Medlin: Wrong type of magnesium, I'm assuming.

Kate Lawler: Oh my goodness! I was like, "Something – " you know, and immediately my mind goes, "Changing my bowel habits, something's wrong," and my husband was like, "You just started taking magnesium". I was like, "Four times a day? I'm regular but I didn't want to be that regular". So I stopped taking the magnesium.

I take a sleep supplement at night now, which is just – a natural one, which is lovely and it sends me into a nice sleep. No four poos a day, still quite regular. And now after all the supplements – I have to say the algorithm since again, since I turned 40, as well as lately it's just dogs, dogs, dogs, and babies, dogs and cats, everything dog is pushing me that, but it's also pushing – the supplements.

So the sleep supplement I take now is great, but I also now just take one supplement because – I've been seeing creatine, the algorithm was pushing me collagen, it was pushing me magnesium for sleep. And I was just – my cupboards were full and I wasn't taking any of them regularly. And now I think I'm in a much healthier place because I take one multivitamin that Sophie helped create, thank goodness. When I told her that I was taking the Heights Vital, she was like, "Oh thank goodness," because again, I read loads of stuff about multivitamins if they're full of filler and binders they're really bad for you.

I wanted one that was plant – based as well so that Omega – 3 is made of algae, which is great. So I take my multivitamin, it's got iron, B12, zinc, iodine, biotin, vitamin D – it's got all of that. And then I was, when I was on my periods, taking iron as well, but my HRT I've upped and since I've upped my estrogen, my periods have completely stopped – or I've come out and I'm now in menopause. I don't know. But I've stopped having periods now, so I don't take iron.

Lisa Webb: But in terms of some of the stuff that you were being peddled initially and you're going, "Oh, I need to try this, I've got to take collagen," one of the things that I see all the time is videos of people sticking scoopfuls of collagen powder into their morning coffee. And I think in my mind, collagen's the thing that you're meant to slap on your face. And am I meant to be eating my skincare? Is that where we're at? What is this?

Sophie Medlin: Yeah, I think collagen's a really interesting one. If you'd have asked me this question maybe even 18 months ago, we would have said there's no research to support it, we don't really think it's making any difference. And actually, in the last 18 months, there has been some really interesting research understanding much more about how collagen supplements can be used not just for ankle injuries, sprained ligaments, those sorts of things –

Lisa Webb: Does it work for that?

Sophie Medlin: Yeah, there is evidence for that, yeah. For recovery, injury recovery quicker, but also now for skincare and how your skin looks and appears and how people feel their skin looks. Listen, you can take collagen capsules, you can take it however you want to, you don't have to take it at all. Equally you could make soups with bones in them – not for you my love – but you could make soups with bones in them and then you'd get loads of collagen and you could do it like we used to traditionally, if you know what I mean. So there's ways around it and you don't have to take it, but there is some benefits to it and we do know that now.

Kate Lawler: What about plant – based collagen?

Sophie Medlin: No benefits.

Kate Lawler: Brilliant!

Lisa Webb: Is it a thing? Can you make collagen from plants?

Sophie Medlin: Well, you can't technically, but they take the components of collagen and then make them up, but it's not the same at all, it's not going to work in the same way in your body.

Kate Lawler: Can we talk about creatine? Because it's everywhere at the moment. "You need creatine, you need creatine". My friend went and started taking it and then went to a GP and he was like, "Your liver's working overtime to try and get rid of all this creatine that you don't need, stop taking it".

Shefalee Loth: So actually – Sophie and I have recently reviewed creatine supplements for online at Which? And because we've reviewed them, we're not saying you've got to take them. We've said we know people are taking these, so actually let's look at them, let's look at 20 or 30 that are on the market and see which are the best.

Now, the evidence for creatine is actually quite strong. It is one of the most widely researched supplements, and the evidence that exists for it is mainly around exercise. So there are two authorised health claims for creatine: one is about intensity of exercise in the gym, and the second one is about muscle improvement for over 55s.

And so when you take it when you're working out at the gym, it can help your performance and it can help muscle regeneration. There is newer evidence that's looking at whether it can help cognitive health and brain fog and things like that, but actually it's still very early days for that and so nothing is concluded yet.

Sophie Medlin: Yet. Fingers crossed. Well, if it is, that's another one to add to the cupboard. But I should just add – if you're looking at creatine for things like brain fog, the thing is it works at best if you're exercising. So actually the best thing for things like brain fog or muscle recovery is actually to do effective exercise.

Kate Lawler: That's it, and also you can't just take creatine and expect to get muscle. You've got to be working out. That is the problem we have – people are taking – I see this in my clinic – people are like, "I'm taking all this creatine," but they're actually not physically using it anywhere because they're not exercising.

So it's just going to get – we call it a dump in the liver or a dump in the kidney. And so too much of something will also cause an issue in regards to kidney stones is the classical one that we see.

Kate Lawler: I'm a massive advocate for exercise. I've always exercised my entire life and I've never felt better than when I exercise. When I hit perimenopause, my desire to exercise just dropped to the floor and I was gutted because I just feel like I don't have it in me anymore and I wish I did have the get – up – and – go.

I know now is the time I need to exercise more than ever, I need to do weights, I need to make sure I'm protecting my bones. And you were just saying about creatine – the best thing you can do is exercise. As we age, what is the best form of exercise for anyone watching that doesn't know?

Shefalee Loth: I would say for women especially is weight – bearing exercise. So my algorithm is full of people saying, "Lift weights, lift weights, lift weights," and actually as we age, our muscle mass does decline really quite rapidly. So as women and as men, we do need to do that weight – bearing exercise to maintain our muscle mass.

Nighat Arif: And I would say anything that's got resistance. So even if you're going to use your body – so yoga, tai chi, if you're going to walk, go swimming – so water, anything that's going to go resistance against your body is going to be the best thing.

And also – that's shown to be great for muscle, but inclusively bone as well because we start losing muscle mass around the age of 30 and bone by the age of about 36. So young as that. And we think, "Oh no, we don't have to worry about this until we're in our 60s". No, it's not like that.

Lisa Webb: So does resistance training actually – does it grow bone or does it just stop bone disappearing?

Nighat Arif: No, no – it helps restore muscle. So anything that's going to help restore the collagen and the fibres in the muscle and make that get stronger. Remember – we've got the most amount of tensility within our muscles and if that is able to do really well, it then supports the bone.

Because your immune system sits around the ends of your bones and is constantly regenerating and looking after. So you've got these wonderful things called – osteoblasts and osteoclasts and they take away old bone and lay down new bone. It's like literally every three months you get a new tarmac on your bones, every single bone in your body.

And this process – if you keep your muscles going, hence why the myth is, "Oh well if I exercise, I hurt". No, no, no – you need to exercise so that you stop hurting in the future. And the reason is because as the muscles are stronger, it facilitates the immune system to do their job better. And so that swapping over of new and old bone, you don't even notice it.

Until that process gets even slower as we age – and that's when we're like, "Ooh," and we all make that noise as we get older.

Lisa Webb: I feel like I'm doing that a lot. Actually, we've had a question from someone who submitted a question about this saying – they've asked specifically about CrossFit, but I guess this can apply to anything – they've said, "Can CrossFit be an answer for becoming and remaining strong in your 70s?"

I love the idea of someone doing CrossFit in their 70s. So impressive! But they've also said, "When should you call it a day regarding physical activities?" And I really want the answer here to be "never," but tell me, when should you call it a day regarding physical activities?

Nighat Arif: Two reasons why: one is if you physically are worsened with your pain – so pain would be another thing as well – and secondly, if it's too much pressure for your cardiovascular system. So we say if it pushes your blood pressure up, then please that would be another reason to go and check it out with your doctor, what you can do. And that's when you step down – so you're not doing that level of intensity. And I'm not talking that I'm expecting someone to say intensity is a marathon, it could be that lifting say 5 kilos, actually that's not a good weight for you come down to 2.5.

Lisa Webb: Yeah, so the other thing that they've added onto this question here, they were saying about what you've said, they're thinking about the impact of exercise on an older body – such that there's no time where somewhere doesn't hurt. And I think a lot of people can relate to that. Everything hurts!

Nighat Arif: Everything always hurts! I'm telling you that everything hurts. But also just the process of inflammation and exercising that inflammation and going away. Because we are such a multi – complex body, then we are going to ache somewhere else – but don't allow – do what you can with that ache.

If it means rubbing on some deep heat gel to bring that inflammation down topically so that you can continue to exercise, that's important. And that's the variety in exercise is really important. Don't just stick with one and that's the only one that you do. You've got to be able to do different sorts of exercise.

So I'm a 41 – year – old perimenopausal woman. I started swimming when I was about 40, having had a fear of water all my life. But I can't just swim, I also started doing weightlifting, I've also started doing a bit of yoga, started learning tai chi. And this isn't like a brag – I'm not bragging – no, I'm not bragging – but I mean I can't do it well at all.

Kate Lawler: Tai chi expert over here!

Nighat Arif: No, no, no – but I mean I can't do it well at all. But I do it, that's the thing. Even if you do something badly and you're not like an Olympian swimmer, who cares? As long as you're in the water.

Lisa Webb: I mean there are very few of us who are Olympian swimmers, let's be honest. One of the other questions we've had here about things like building muscle: they say that over 50 and keep hearing that they need more protein, but is this only for building muscle? Because they're saying it's so confusing, I just don't know what I need more of – do I need more protein?

Sophie Medlin: Hopefully fibre's taking over from protein a bit. I think one of the tricky things especially with this generation now who are going through perimenopause and getting older is that a lot of the messages that were pushed were about women shouldn't be eating too much protein and should be careful with healthy fats and things like this.

So there is a generation of women who are just not eating a lot of protein, never have eaten a lot of protein. And so when a lot of the women that I speak to will say, "I'll have soup for lunch and then I'll have maybe a bit of chicken in a stir – fry for my evening meal," for example. And actually we need to be trying to get at least two decent doses of protein in a day in order to make sure that we are meeting all of our protein requirements.

Lisa Webb: What are we calling a decent dose?

Sophie Medlin: Like a full chicken breast or a couple of eggs at breakfast or lunch, that sort of thing is a decent portion of protein. And the problem that we have is that people aren't consuming enough and then muscle mass starts to deteriorate in our 40s and then we end up later in life with something called sarcopenia, significant muscle loss.

And so really we do need to be thinking about protein in our midlife in order to make sure that we are having a healthy later life. Does that mean that we all need to be taking protein supplements? Definitely not. We don't need protein powder – adding these things that are what I would call an ultra – processed food into our diets.

It's not necessarily the right way to go. If you're someone who is doing loads of bodybuilding and you're maybe quite heavy, then you might need loads of protein every day and a protein powder might be convenient for you. But ultimately everybody can get enough protein just from diet alone and you're better off focusing on having a nice portion of healthy protein at each meal three times a day and maybe a high – protein snack and you'll get plenty of protein every day.

Lisa Webb: And then we'll all be ready to do CrossFit in our 70s.

Sophie Medlin: Of course! Perfect!

Lisa Webb: One of the other things that people have talked about a lot here is exercise, the proteins and stuff, but rest and recovery is obviously really key for when it comes to exercise, but I think sleep is something we're seeing a lot of people asking us questions about. Kate, you mentioned magnesium. I think you'd taken a magnesium supplement that reacted on the poo.

Kate Lawler: My husband takes magnesium every night – he swears by it – he says it helps him stay in a deep sleep. I took it, then had the bowel issue so I just stopped. But I don't get enough sleep. And my sister won't mind if I say this, but she's older than me, she looks better than me, but she is an absolute – she goes out every weekend, she drinks alcohol Friday, Saturday and Sunday, and she looks amazing, but she sleeps from – 8:00 PM to 7:00 AM.

Whereas I look after my body much more than she does – hi Kelly if you're watching – but I don't sleep as much, I sleep about six to seven hours a night and I feel exhausted. And I always say to my husband, "We've got to go to bed earlier, we've got to go to bed earlier". But then something comes on like a really good box set –

Nighat Arif: It's hard, isn't it?

Kate Lawler: – and I'm just, "I'll watch one more episode," and then or I'm working late and then we don't go to bed until – midnight. And it's just not enough. But then I'm starting to think looking at my sister, maybe sleep is the key.

Lisa Webb: So one of the things I hear anecdotally is that women need more sleep than men. Is that true or is that just more internet misinformation? Can I get away with telling my other half that I need two more hours' sleep than he needs to deal with the dogs?

Nighat Arif: There is science behind why women need more sleep, but then our sleep comes out of kilter purely because of our cycles. So our periods underpin our sleep cycle quite a lot. And that's because – we have four stages to our cycle. The key bit is the luteal phase – so that's a week to 10 days before you have a bleed.

In that week to 10 days before your bleed, what classically happens is your estrogen decreases – your progesterone and a little bit of your testosterone. Come follicular phase, you're like, "Oh, I'm horny as anything". The luteal phase is actually where that aspect of the estrogen decreasing really knocks off your melatonin.

So that's why you feel a bit irritable. So women, we do classically say – it's advisable that when you get sleep that you get good sleep. Conversely, after having a baby, postnatally women find it really difficult to sleep. And I actually think that's an evolutionary thing because as you have a baby, you need to feed them and look after them because their pure survival and their way to survive is if the adults are awake.

So I remember – I was like a cat. If anything moved, I'm up, I'm ready – thinking there was anything that was happening. And the same conversely happens as we get to perimenopause. We know that the reduction of estrogen and interestingly testosterone has come into the conversation over the last four or five years and we've realised testosterone isn't something you need for a bit of sexy time and your libido.

Testosterone is actually really important for your cognitive function and your sleep function as well. Because we've just realised – February 2025, actually, that the female brain makes testosterone, which we never understood before.

Lisa Webb: Does this not indicate that we just have not been looking at women?

Nighat Arif: Exactly. It's horrific when you look at the gender bias when it comes to medical research. But the fact that women do need more sleep is vital because we need to replenish a lot more. So if you see your other half lying on the sofa and she's having a snooze in the middle of the day, it's not because she's lazy, she's probably in her luteal phase and that's her recovery.

Lisa Webb: Shefalee, we've tested magnesiums, haven't we? And do we actually have any views here about whether or not it does anything?

Shefalee Loth: Yeah, so we've reviewed magnesium supplements. And you were taking the wrong type, Kate. That's what I can say because magnesium supplements have lots of different types. Well, there's lots of different forms of magnesium in there.

And when Sophie and I review supplements we look at the dose – is it too high, is it too low, is it right? We also look at the bioavailability of the nutrient.

Lisa Webb: What does that mean? Because that word pops up a lot and I hear "bioavailability" and I hear "microbiome" and I'm like –

Shefalee Loth: Those are different things, but the bioavailability is how easily absorbable the form of that nutrient is. So with magnesium some forms are more absorbable than others. We also look at what additives and fillers are in these supplements. So are they packed full of things that really shouldn't be there?

Lisa Webb: Why would they be? Is it just making something cheaper?

Shefalee Loth: Yeah, pretty much. Some fillers are there for a reason, but some aren't and they don't need to be. Such as sugar in a supplement, it's not necessary. And then, when we've got our top scorers, we send those off to a lab to be independently tested.

So that we know they contain what they say they do before we then say, "Right, well out of magnesium supplements these are the ones that we think are best buys or great value". So we can pinpoint where people should go should they want to take one.

Kate Lawler: Do you take magnesium, either of you?

Sophie Medlin: Do you know what? I have been twitching in my sleep. It doesn't bother me but it bothers my husband, so I've been taking it recently but I'm very lucky to be an absolute champion sleeper, so I don't take it normally.

Shefalee Loth: So I started because my sleep's been really affected as I've got older and since having a baby, which it was really interesting to hear what you were saying. But it gave me really vivid dreams – we talked about this – so I had to stop taking it because my dreams were just off the scale.

Nighat Arif: My husband gets really vivid dreams. I don't think he's put two and two together it's magnesium. But there's loads of different types of magnesium as well. What are the ones that are good?

Sophie Medlin: The one that doesn't cause symptoms is magnesium bisglycinate. Bisglycinate. Yeah, so that's the best one. And sometimes people are particularly sensitive and you might want to, for example, empty the capsule and just take half – rather than a full dose and see how that suits you first – of all.

Lisa Webb: Is it something you ought to try in small doses and then work up to, or just whack it in and hope for the best?

Sophie Medlin: Most people will be fine – but some people will be sensitive, especially if you've got sensitive digestion anyway. So it's worth thinking about that half – a – capsule thing to start with and seeing how that goes.

Lisa Webb: I think I get quite confused by magnesium because Shefalee and I were talking about this earlier. In my head, magnesium's that thing – remember when you were a kid at school in science you'd set fire to it and it would burn really brightly? Do we actually want to eat that?

Nighat Arif: We do! We want to put that in.

Sophie Medlin: But iron is actual iron!

Kate Lawler: I'm going to be out there licking rocks.

Lisa Webb: Okay, so we're talking a little bit about sleep and we've had quite a few questions – people saying that they need advice on sleeping, saying "I'm awake all night at least once a week due to menopause I think, any tips on that and how we can try and get some better sleep?"

Nighat Arif: So there's great guidance from the British Menopause Society about sleep and actually what you can do about it. We realised it's because of something really interesting that happens, there's a gut – brain reaction that happens at the brain and it's these incredible receptors called GABA receptors.

So they sit in our gut and they absorb a lot of the things, particularly hormones like serotonin. Now serotonin, depending on what paper you read, between 90 to 95% of our serotonin is actually made in our gut and then reconstituted back into the brain.

Exercise and muscles, etc. – that's why you feel so good because your serotonin goes up, your happy hormone and your dopamine – that great hormone that makes you feel alert and happy as well as oxytocin.

Estrogen – if you think of it, estrogen is – I've likened it now over the years of working with estrogen – it's this lovely lubricating hormone. It lubricates all your blood vessels, it's a component of your immune system, it allows your gut to do what it needs to do and we've got the greatest amount of microbiome – so this amazing research that's happening about the gut microbiome and estrogen as well.

So in perimenopause, as estrogen is decreasing, you're not able to absorb that lovely serotonin. So at night – time as your brain is getting ready – that circadian rhythm is kicking in to go, "Right, she needs to go to sleep now," and the lowering of the estrogen means those GABA receptors can't open up or close at the right time to allow you to have enough melatonin.

So patients will go, "I actually fall asleep fine, Doctor Nighat. Then I'm awake at 2:00 in the morning and I don't know why I'm awake, or I wake up at 5:00 in the morning or it's just become a thing I'm an early riser". It is literally because of the absorption of the neuroreceptors in your brain.

So this is where HRT is first – line. So the British Menopause Society have said do think about hormone – replacement therapy. So try and bring back your estrogen as much as you can – so don't wait for your sleep to get so horrific that then you think about HRT.

So estrogen such as a patch, gel or spray. And this is where micronised progesterone can work really well. So micronised progesterone such as Utrogestan or Gepretix or generic progesterone which is micronised is bioidentical and it actively works on the small bowel – so on those lovely GABA receptors and it allows that progesterone to help boost your melatonin and your serotonin in your brain.

So we've started looking at patients just to give them progesterone on its own just to see if it will help with their sleep because they might not need estrogen.

Kate Lawler: My husband takes magnesium every night – he swears by it – he says it helps him stay in a deep sleep. I took it, then had the bowel issue so I just stopped.

Lisa Webb: You mentioned there – about talking about food and exercise for dementia and sleep being a thing. I wanted to talk a little bit about food again. We're going backwards – I'm sort of jumping around a bit, maybe that's perimenopause.

But so one of the things that people have been asking us about here is about losing weight, finding it harder to lose weight as they get older, but the other one is about whether or not eating things, whether you need to change what you eat as you get older, whether or not your requirements are changing.

And one question here, someone who's actually listening live at the moment says: Is there anything wrong with eating the same meals every day based on the correct balance of micro and macro nutrients? Is there any evidence to suggest that that's not good for you?

Lisa Webb: I find myself being influenced while I sit here talking to you because I'm going, I wake up every night at 3:45 and can't go back to sleep for two hours. Is this me? Are you describing me right now?

But the amazing thing is – and sorry I'm taking over, but the key thing is that we always talk about exercise and diet as being one of the things to prevent dementia in the future. Sleep is the third key thing.

So the Lancet produced 11 key bits of – ways to ward off dementia from childhood and early teens and pollution and hearing, etc. – if you have a – if you have a difficulty hearing issue then your risk of dementia increases by five times.

But actually lack of sleep – and I think that if you look at the statistics, women are five times greater of having dementia than men – and I don't think that's just an accidental statistic.

Kate Lawler: I didn't know that!

Nighat Arif: And so it has to be because from the moment that we start our periods from the age of 12, our sleep comes out of kilter and we put up with it.

Lisa Webb: We – we do have to finish it there because that is all we've got time for. We have got loads more advice on our website which.co.uk/health. We've got a free fortnightly health newsletter that rounds up everything that our brilliant team has been up to.

But all that we've got time for now is for me to just say thank you so much to this panel. You have been amazing, incredible!

Kate Lawler: Free advice!

Lisa Webb: And it is – just been brilliant and I've been so invested in everything that you've been saying and I'm going to go and take all of this away. But until next time, thank you so much for joining us.