Dr Adam Staten and Kate Davies - One Day Tests Special

0:00This week's episode of The Midpoint is a little bit different. It's brought to us in collaboration with our friends at One Day Tests. I was drawn to working with one day tests because a lot of the information I have around my health is based on instinct or long term changes. So I wanted to see if the nuances of what my blood could tell me would make a difference to my habits. Now, we're fed a lot of information about how we're living longer and what is really good for us. And then a lot of information about the opposite, our health challenges and lifestyle problems. So I sat down with Medical Director Dr Adam Statton and Kate Davis, Clinical Lead for Women's Services at One Day Tests, to chat about what a lot of this really means and how understanding our biomarkers can give us a confidence to make positive changes.

0:47So let us know on Instagram what minor changes you've made that have had a real impact for you. And for more information, visit www.onedaytests.com. Kate, Adam, thank you so much for sitting down and having a chat about well first of all we're going to talk about the state of the nation in terms of health where are we at in the UK in terms of the big challenges that is affecting the health of the nation? Well there's quite a few challenges I mean I think one of the big challenges at the moment is actual mental health which we know is an enormous problem you know lots of anxiety and depression certainly since we've come out the other side of the COVID pandemic mental health seems to have absolutely ballooned but mental health tends to have a big impact on your physical health and the two things interact a lot and you know with physical health we have we see the same same problems have been around and growing for some time obesity related issues related to blood sugar problems high blood pressure smoking is still quite common and actually a major issue and a growing issue is actually inactive lifestyles so people having very sedentary lifestyles which leads onto all kinds of other health problems and in terms of life expectancy in the uk has that shifted at all with regard to the things that you're talking about there are people living longer but with those conditions yes i mean that that is the life expectancy has steadily increased over the last 50 100 years um and now i think it's around 80 slightly over 80 for women slightly under 80 for men um but what hasn't changed massively is the healthy life expectancy so if you look on average in the uk the healthy life expectancy which is you know living your life with good health is um is only about 62 so i know shocking yeah so you could be living for another on average 18 years but with health with some kind of health problem yeah and actually there's quite a discrepancy around the country so if you live in the northeast of england your healthy life expectancy at the moment it's about 56 so it's even even more stark really um so and that's really when we talk about preventative health care and things like that it's trying to close that gap between healthy life expectancy and total life expectancy so that people are living more of their lives well and healthy and happy and all that goes with that what i'm seeing though in in kind of sharp comparison i guess to that is that young people have more of an interest in their health whether it be performance and working out and so they're using technology so wearables to understand their bodies better and my hope is therefore we actually and that end ends up with as they get older they're going to be more healthy more aware so perhaps in 30 years 40 years we'll have less health issues for that proportion of people that are interested in the health and obviously there's an awful lot of people that either aren't interested in the health or can't be interested in the health for educational reasons or whatever.

3:47But I think there's definitely a shift there. Yeah, I think there's lots of opportunity now for taking a proactive approach to your health. Just convicting people to do it, I suppose, is the challenge. And in terms of that, let's talk a bit about people being proactive. As a GP who's seeing people all the time with a range of conditions, do you see people taking control of their health and wanting to be proactive? I think there is a big divide. I think there are some people who are very proactive and other people who are a bit more sort of head and sound about it. I mean, there are some massive screening programmes, very good programmes that the NHS runs.

4:24So things like cervical screening, mammogram screening, bowel cancer screening through the post. The uptake for those is still only about 70%. So even those kind of life-changing, or the life-saving interventions, the uptake is not quite as good as it should be. and if you look at something like the NHS health check which is targeted mainly at cardiovascular risk looking at blood sugar and cholesterol and things like that it's only about 40 to 50 percent uptake so there's definitely more that could be done so from what you just said there not enough people are using the access they have or have access to those kind of preventative screening programs exactly I think you know I think actually and the more people that do go through those kind of screening programs the healthier will be as a nation really and those kinds of screening programs obviously if it's a one-size-fits-all is not necessarily going to get everything because the nhs can't screen everything for everybody no absolutely that's i guess that's the that's the issue that's the challenge as well that we have i mean they're very much population population health measures so you look at what can you do for the greatest good for the greatest number of people but they are very one size fits all as you say and um i suppose slightly blunt instruments so if you're someone who's really interested in digging down more deeply into your health or you know want more detailed overall picture of your health then then well i suppose we are we are one of the other options i suppose when you are really interested in your health and you enjoy being proactive and you then get kind of fed messages because of our algorithms and you understand more and more.

5:58So it would be easy to assume everybody's getting the same messages, wouldn't it? Yes. Yeah. In fact, we talked about this earlier. We did. That's exactly what we said. It's exactly the same thing that for some people, it's a sort of constantly reinforcing thing. But if you are not interested in that, in that to start with, then actually it completely passes you by. You're not seeing the health messages that are coming out, which is where I guess social media, when used responsibly, can be beneficial. But if you're not reaching that group it's also cultural isn't it i think my sister lives in america and having your bloods you know your markers is just routine everybody does all the time i remember as a kid even watching kind of american tv shows and hearing people talk about things like that and and that isn't something that's been in our vernacular really um as we've grown up no and i think that's true in all places in europe as well often we have european patients come you know living in living in this country who come with with an expectation of annual bloods for example um And yeah, I think that is probably a gap in what we're able to provide or what the NHS can provide really because of resource constraints, really.

6:56I think, yes, there's a gap there with the NHS, but I think people are generally becoming more empowered. And certainly we're seeing that they're coming and asking for it. That's what they want to do. So maybe some of that culture from the US is filtering through, as does everything anyway. And so that we will have more and more people wanting to be more empowered and knowledgeable with their health. Is the UK doing enough, though? Could we do more to help promote preventative measures, screening or other ways of being proactive with your health? Well, I think there is probably more to be done.

7:31As I mentioned, some of the uptake and the screening programmes we do have is not great. So reaching more of those people to encourage them to do those kind of screening programmes is really important. and I think a lot of the drive to sort of preventative healthcare comes from people themselves rather than it's not really sort of national strategy to it. Yeah, and some people feel that somebody else should be doing it. There's that mindset that somebody else should be. They're quite passive about their own health almost. Exactly, and I think actually the big thing is to sort of give people the knowledge to allow them to be much more active.

8:07so what are the big factors affecting health in terms of lifestyle at the moment is it the usual stuff that we know is is bad for us i mean it is it is sort of the same same old things it's it you know the boring things about having a healthy diet exercising more not smoking drinking moderation um but they work yes yes they are they do and that is exactly the message that people should be listening to i mean actually one of the biggest threats is a little bit unexpected is the amount of time we spend sitting um so actually you look at the wealth health health organization they identify a sedentary lifestyle as the fourth biggest killer in the world um and in the uk i mean average adult spends more than nine hours a day sat down and we're all working from home more aren't we that's that's part of the problem so it's not even as though you've got a commute you're you're sitting at your desk yes you're not even getting up to walk somewhere far away for lunch because your kitchen's three steps that way exactly so so yeah so it's quite easy just to find yourself sat down and that's on top of lying down at night presumably as well so yeah so there's a large portion of your 24-hour day is spent sedentary exactly yeah yeah and it's um and just you know by itself that is a it's a killer basically it's a big risk factor even if you strip out the additional risks that it causes obesity and blood sugar problems and and all the other things that go along with inactivity um i just saw a clip the other day actually of a of a doctor talking on a podcast saying it's so boring but instagram won't tell you this it's eating well exercising and you know there are other being sociable all the other things that kind of complete you as a person and have but they're the kind of fundamentals aren't they it's not a magic kind of no you know pill that we're all waiting for yeah i think i'm going to say that's another Well, I mean, everybody wants a hack, don't they?

9:53Everybody wants a quick fix. And ultimately it's about a whole picture of a healthy lifestyle, really. And do you, as a GP, do you, when you talked about mental health at the very beginning there, how easy is it for you to talk to people about their physical health being as one almost with their mental health in terms of trying to promote that idea of holistic kind of health? Yeah, I think it can be difficult. I think actually there's been quite a long time in Western medicine, this fairly artificial divide between mental health and physical health. And you have to see them really as a whole picture.

10:27I mean, people who are depressed are generally less active, less motivated and often do things like comfort eat and all those sort of other bad behaviors like sort of alcohol and things like that. And that's part of being depressed. So if you manage the depression, a lot of the lifestyle stuff will follow. but really the best approach is to tackle both directions. So how can individuals take more control over their health? I think taking responsibility to become empowered as much as you possibly can. So get knowledgeable. And certainly, you know, I talk about this a lot from a women's health perspective.

11:04You almost become your own women's health advocate, your own women's health expert, because only you know about your body, whether it's men's health or women's health. you know more about your body than the doctor sat in front of you and I think there's there's often a difficulty in advocating I think that for me is the first step is get knowledgeable and advocate and then you can then start to hopefully get the right advice and do the correct things yeah I think it's knowledge on two levels it's knowledge about about conditions and what is a healthy lifestyle and then there's the knowledge of your own body in terms of sort of factual what is my blood pressure what is my cholesterol what's my blood sugar looking like um and being informed in both those ways yeah because if you have those markers then you have something to compare don't you if something does start to feel like it's going wrong it's a good place to start the very beginning i talked to you about longevity and the average you know lifespan and you talked about the average health span as well if we're if we're living longer we we want to live full and healthy lives don't we it's no point just pushing the the age kind of up and up if we're not having a healthy life and doing things that we want to do yeah i think the healthy life expectancy is the real thing we should be aiming at really because if you're living the last few years of your life and really poor health you're not gaining as much as as you might do why should people be taking blood tests i think it gives people a great opportunity to understand their body from the inside and to take action.

12:34So if they're having a blood test and they can see that things aren't quite right, they've got the ability then to make changes. And actually having regular tests as well so that you can really see that change actually can be quite motivating as well to be able to see where you're making progress. Yeah, I think it's an opportunity to become more proactive about what you're going to do with your health. Because lots of the things you might check for in a blood test aren't necessarily going to cause any symptoms for you. So for example, if your blood sugar is slightly raised you won't necessarily have any symptoms from that if your cholesterol is raised you definitely won't have any symptoms from that and actually knowing that there's a problem now is a good opportunity to intervene rather than waiting the 10 or 15 years when it will really be a problem you mentioned a few of the things that you can test from a blood test but there are so many biomarkers aren't there so many so so give us an example of the kind of things that every day kind of illnesses and diseases that you can kind of intervene early and pick up well almost anything to some extent does your blood show you everything uh well it doesn't necessarily show everything i mean obviously there's structural structural issues and things like that it's not going to show you my arm's broken yeah well actually my inflammation markers might be higher yes and you might there are some blood tests but it'd be a it'd be a an odd way to come out the diagnosis of a broken arm um so um yes i mean most diseases have a are a process right there's most of them aren't they sort of flick a switch and suddenly you've got this problem so if you look at something like chronic kidney disease which again is something that won't necessarily cause any symptoms um you can be living really happily and completely unaware of the fact that your kidneys are gradually deteriorating until quite later on in the process and the same would be true of liver disease because the liver liver can compensate for a long long time until suddenly it says i can't do this anymore and then you identify the problem which is worrying isn't it that that can all be happening and you don't know what's going on in the body yeah i mean it's sort of a marvel of evolution really that we are able to cope with all that you know insult to our system so when you say no symptoms so say you had chronic kidney disease yeah or you're you're about to be you know you're on the cliff of kind of realizing that for some other reason what would what would the first physical manifestation of that be well often it's very vague you know sometimes it's sort of lacking lack of energy and fatigue um and then as the process evolves you know you will get um as the kidneys fail for example you get issues with sort of uh itching as certain you know your rear biomarker raises and you might get swelling sort of a deema of the legs and the abdomen.

14:57But before you get to that, you could see in your blood that that would be coming down the track. You could, yeah. Yeah, you could see it at an early stage. And there are, for kidney disease, for example, a lot of it's caused by high blood pressure or diabetes or other health issues, which you can intervene with to help stop the progression, basically. What kinds of other problems can you detect early then? I think, I mean, I'd say it's almost anything. I mean, issues with the immune system or pre-diabetes, early anemia, any sort of organ really that's having an issue, problems with your bone metabolism, nutritional deficiencies, hormone problems.

15:40I quite like with pre-diabetes that actually if you find out that you're pre-diabetic, you can do something about it. Yes, absolutely. Yeah. Yeah. And that's a big life changing thing to reverse. Huge. Yeah. And for a long time, we didn't think we could reverse diabetes, did we? And, you know, now we know that we can. And to know, to get that information early is quite significant. Yeah. Yeah, absolutely. And of course, you can have quite a lot of biomarkers tested at one time, can't you? Which is, you know, kind of useful for people who don't like want to keep going back, testing for one more thing and one more thing.

16:16In terms of private blood testing, how can that help do you think with the kind of proactive uh story that we're talking about of getting hold of your health and and going for further screening well i think the the advantages of private blood testing is one is convenience um the other is a choice on what you choose to look at um which you can tailor to whatever your particular health goals are um and the third thing is sort of having control over the schedule with which you keep an eye on that so you know you may want to monitor something much more closely than for example would be standard practice on the nhs if you're talking about your cholesterol improving or have you got fatty liver disease and you're making lifestyle changes to correct that so it's really being in control of what you're testing and how often you test it and you're talking about diseases and illnesses of course some people want to test their bloods because they're a performance athlete or they're doing something and they might be training for something that they've never trained for before and to see how that's affecting them.

17:18So there are positive ways to be proactive with their health as well. Absolutely. Well, it's a bit of a sort of shift in mindset really as opposed to treating illness to maintaining wellness. And as you say, a lot of the people that come through our service are interested in optimising their performance and keeping themselves well rather than reacting to the fact that they don't feel well. And of course, blood tests can show sometimes worrying things, can't they? And if you go proactively to go and get your bloods tested, you know, you might think everything's going to come back. OK, you might be looking for something that, you know, is maybe a little bit awry.

17:52But it can be something that, you know, could be a little bit worse than you're expecting. It's not, you know, and then how you deal with that is obviously the next stage. Yeah. Yeah. So, I mean, I think I would say that on blood testing, minor abnormalities are very common. often nothing to worry about but clearly when you do blood tests there's a chance of picking up something significant that needs to be addressed we i mean that can range from anything from you know for example our service our lab picking up the phone and saying actually this doesn't look good you need to get yourself to a and e to booking to speak to one of our gps just to talk about lifestyle measures that will improve what you're seeing on the blood tests and you said that you are going to pick up abnormality so so not every blood test if you had a load of biomarkers is going to be in range yeah so it's not necessarily that there's a cause for concern no and that's where the gps will explain to you exactly what it means because i think we do sometimes see people that have had blood tests done and they see the little red explanation mark next to it and it does cause some anxiety so actually having the ability to book in and have that consultation to give them the information and reassure them is is huge yeah and then we think that's taken in context as well because you know what is an abnormal blood test according to the reference range might be a normal blood test for that particular patient depending on their background and history and things.

19:12So it is, I mean, sometimes these little red exclamation marks you get next to the blood test do look worrying. But without going too technical on it, but the way reference ranges are set is that they capture sort of about two thirds of the population. So there's a lot of people who fall out of that anyway. Right. And so they do take interpretation. And of course, with certain tests for female hormone kind of profiles, they'll be different throughout the month absolutely that's why we interpret them based on where you are in your cycle so if you're in the follicular phase ovulatory phase or in luteal phase and again that often takes some explanation because if people see that levels are looking I often get the kind of conversation of my levels are like really close to the to the you know the reference range limit or the lower limit I'm like that's fine you're in limit that's fine And if somebody does want to use it proactively for health and lifestyle, how can they then modify and kind of use the bloods to improve that?

20:11Well, I think there's a number of ways. Some people like to just do a sort of regular blood test. So almost like an MOT each year to see what their state of health is. Other people would like to do it as a sort of before and after. So if you're about to undertake a new exercise regime or a new diet, some people like to see where they started from and then check again and see what the progress is. I think it just it depends what your personal goals are really. And do you see people who you must see a wide range of results of people who are very, very fit, kind of, you know, their results are very, very different if they're looking at high performance in sport.

20:45Yeah. And actually, sometimes very, very fit people have abnormal results, you know. So there's a marker called creatinine kinase, which is a marker of muscle damage. Very often we'll see people coming through our service who have high creatinine kinase and it's just because they're working out. I had that with my blood test because I'd done weights that morning. Yeah. She told me I shouldn't train for two days the next time I do it. And I said, two days? And she said, oh, I'd done quite a hard weight session. And she was quite surprised. She thought I was on high doses of creatine. Okay. Yeah.

21:14So, yeah, it's quite interesting. No, it is interesting. But, yeah, as you say, lots of people want to monitor their, you know, make sure they can maintain their performance by making sure nutritional status and all things like that are in order. There's so much, I mean, you know, it is a kind of open-ended question. What can you test for? But there must be themes that you see with people in certain demographics. And, you know, whether it's somebody who's at a stage in their kind of fertility journey that they're looking at or the other end of fertility, if you like. So do people tend to fit into those kinds of categories quite neatly?

21:49Or am I kind of being too presumptuous? I don't know how neat it is. I suppose the two big areas is cardiovascular risk. Lots of people want to check that. So blood sugar. It still is the biggest killer. Yeah. Oh, absolutely. Heart attack is the biggest killer in the UK. And it's definitely something people should be looking at. And I do think generally people are very interested in hormone levels, whether that's fertility and menopause related or for men, testosterone. Everybody's checking their testosterone at the moment. Yes, they are, aren't they? It seems to be quite a common thing that we're seeing more and more and more.

22:19Is that testosterone through kind of the whole life kind of span for men or is this looking at PSA or? Well, so, yes. I mean, the testosterone thing is there's, weirdly, we're not quite sure why it's happening, but levels of testosterone in the general population of men seems to be gradually dropping. Probably related to various lifestyle factors, environmental factors. So lots of men are worried that their testosterone levels are dropping, particularly if they've got symptoms like low libido or erectile dysfunction. Um, so actually quite young men are testing quite regularly. Um, obviously levels do decline with age.

22:55So older men are often interested as well. The PSA testing is, is interesting because, um, um, again, much more awareness now of that than there was, and it's still not a national screening program for PSA. It's a bit of a muddled situation at the moment. Um, but, um, it's an, it's an important test. um so are there specific tests that are recommended for men and you know if a man comes to you and says i'd like some blood tests would you say go for this particular kind of biomarker or yeah it depends a little bit on age but generally speaking um without one sound sort of boring repeating myself but cholesterol blood sugar are two big ones um having baseline levels of your kidney function, liver function are helpful.

23:41And a full blood count is useful as a marker of your sort of overall state of health, but how your immune system is working and, you know, any chance of anemia and that sort of thing. In men a little bit later in life, PSA testing is important. So the current suggestion really is over the age of 50, men should be thinking about doing their PSA testing um it's um it's a slightly uh contentious issue because lots of people would like to see that rolled out as a screening program um and with PSA you do have to interpret it slightly carefully in terms you can get a lot of what we call false positives and you can also get false negatives but in generally in generally speaking if a man is healthy it's a good idea to have your PSA tested just a reassurance more than anything usually and same question really regarding women women so the same blood tests that um adam has described obviously not psa and then there's obviously the more female orientated blood tests that for women you know during their reproductive lifespan so female sex hormones prolactin is also quite useful vitamin d testosterone particularly if you're if we're wanting to rule out pcos and then as you go into the kind of perimenopause stage.

24:59Slightly tricky because we don't tend to recommend hormone testing for women over the age of 45 because hormones are fluctuating. So of normal age menopause, we wouldn't necessarily say that you need to have blood tests done because diagnosis is made on symptoms alone. But we know that menopause is very common to happen early. So and that can happen in a woman's 20s, 30s and early 40s. So in that case, that's when you when you knew something was not quite right that you might want to consider having blood tests done and then symptoms i guess as well because one of the great things i love about the way that the suggestions are set out on the one day test website is that tiredness for example you know if that's what you're presenting with i'm just tired all the time there are certain markers that will be a better indicator of perhaps what that's leaning towards yeah absolutely i mean so take something like tiredness it's there's a really big spectrum of illnesses that can cause tiredness you know um everything yeah i mean one of the big things that we normally test is thyroid function so an underactive thyroid is a cause of tiredness but so is diabetes liver disease kidney disease anemia perimenopause perimenopause yeah so um so it is it is um it's one of those complaints that actually when people come come to see you about it um you do need to do a big almost scatter gun approach really to say what what could this be because it could be almost anything so adam what kinds of full body MOT blood tests are there?

26:23Well, so basically the term full body MOT blood test is a blood test that covers, well, I suppose it's full, I was going to say full body, but you know, a multiplicity of things. Because you hear people saying, I want everything checked. Yeah. And I suppose it's as close to that as you can reasonably get. So what we'd expect to be included in a full body MOT would be a full blood count, which looks at your immune system and your body's ability to carry oxygen around. Tests for major organs like liver and kidneys, a range of micronutrient tests. So usually common things like vitamin B12, iron, vitamin D.

26:59And then normally as part of these full body packages, hormone tests, which vary slightly as to whether it's a man or woman taking the test, but you'd expect it to include thyroid function, testosterone, estrogen, progesterone. So why should someone consider taking a full MOT? I think it is a very good way of having an immediate snapshot of your state of health. It will give you an awful lot of information from a single test, essentially. So the clinic time, for example, for a blood test is about 15 minutes, and after 15 minutes you will have a good picture of your overall health, and it will point you in the direction of any areas that need attention really.

27:43So you might then decide to focus on one area that you then monitor because we talked about people going regularly to test their markers. It might be that there's something you don't need a full MOT next time. There's just one area you're looking at. Exactly. Yeah. So, I mean, if you've identified that actually everything looks good, but your cholesterol is high, you might just choose to monitor that for a period of time. For other people, they might find a number of things and can just choose to monitor those things as they go on. Can I show up at your GP practice and get anything like this? Does the NHS offer a standard blood test?

28:13Well, the NHS health check, which you can title to from the age of 40, it's entitled to every five years, is more limited, essentially. It usually involves a blood sugar check, a cholesterol check and a blood pressure check. And those are in themselves very useful things, but they are obviously quite limited. So I've had a full MOT test a couple of months ago. and that the area that i kind of want to focus on is um cholesterol yeah um if i wanted to have another mot though just generally would it would it six months a year how often should i be doing that a lot of people choose to do it each year as a sort of annual thing um but um again it depends if you're going to make interventions you might want to do it sooner than that so people often if they're changing a lifestyle will want to see a change at six months to make sure they're on the right path so i mean i suppose the beauty of the service we have is that you can choose how frequently you do it but but usually six months is a good time period to see a change in your health and does the full mot combine with any other health checks well i mean it's useful to have if you're going to do that kind of mot test it's useful to have um things like your bmi checked and your blood pressure checked um we can actually do those in our clinics as well but they with those all those biomarkers and the weight height and blood pressure you do get a very good picture of your overall state of health.

29:32Can the results of a full MOT then help me live a healthier lifestyle? Well, usually it's by picking up something that you're not aware of. You know, you've usually picked up something that's not yet causing problems that might do in the future. That might be something like cholesterol or blood sugar problems that we talked about, or it might be something less sort of life endangering, like you'll find your vitamin B12 is a bit low and actually you would feel better with that topped up. um so it can can be used for all kinds of reasons that many of which you might not expect you know because um because most of us are living you know fine fine enough um with with the set of blood tests we have essentially and you may not recognize or you may not know that there are early signs of things that could be corrected kate are there some common signs uh regarding women's health issues that are often overlooked?

30:24Yeah, I think the most common thing, and I think actually something that women really need to be aware of is their menstrual cycles. Because that can tell us so much about your female health. So if you've got a normal menstrual cycle, you're having regular menstrual periods, then actually your menstrual health is probably pretty good, as long as you've not got heavy painful periods and that you're having that regularity so anything out of the ordinary and I'm always really conscious that women should never have to put up with heavy painful periods should never have to have irregular cycles and often we're gaslighted and told that oh well you know that's that's just normal but it's not so I'm really keen that women do fight to get answers if they do find that their menstrual cycle is not right because that is such a strong indicator for your health.

31:16So what do you think women should be screening then to be proactive with their health? Are there any particular things that they should be looking at? So general screening, so thinking about cervical screening, you know, that's from kind of in your early in your reproductive life and then you move on, don't you, to probably sexually transmitted infection screening, which again is really important, especially if you're changing partners, that's vitally important. And then obviously you go through pregnancy and then as you start to become older, you were offered mammograms and then you're into the perimenopause and thinking about how you can look after your health and longevity as you transition to the menopause.

31:53And in terms of disease prevention, what can women do specifically to help them live healthier lives for longer? Yeah. So I think being active, being strong, you know, I think we put a lot of emphasis, don't we, into cardiac health, which obviously is really important. But for women also strength is really important. So strength training, particularly because as we transition to perimenopause, we're going to lose a lot of that strength. So keeping yourself and your bones strong and healthy from a really early age, having really good nutrition, exercising. Again, as we've talked about the boring things, ideally not smoking, limiting your alcohol.

32:32So you're not having too much, avoiding recreational drugs, checking your sexual health. Those are the things are important. Kate, how can women tell if their hormones are out of balance? I think probably their first indication will be that there might be changes in their menstrual cycle. So they might start to have either long cycles or short cycles, but they also might have other symptoms. So they could notice that, you know, hormonally they're not feeling great. Perhaps they've got suddenly start to get PMS, which they weren't experiencing before, or they have other symptoms associated. So hormonal acne, for example.

33:05So that would be the first step that you might think, start to think something's not quite right here and maybe then want to investigate it a little bit further. And if you do, how do you know which hormones you should be testing? So if you're thinking about reproductive health, we want to be looking at our female sex hormones. So estrogen, progesterone, luteinising hormone, follicle stimulating hormone. So hang on, they all sound quite like if I didn't know what they meant, do I go, can I see all those or do I just, is there one test that captures all of that? So we've got the female health test.

33:35So that encaptures all the ones that we feel that are important to monitor your female health. And you might also add testosterone into there. You might also think about thyroid as well because that's also part of your hormonal health. So you would guide me to the right test for my hormones. Absolutely, yes, yes. But equally on the website, it's really clear to see what would be the right test that you might need. And once I have that information on my hormones, Is that it? Is that the clear picture for my kind of female hormone health? I think it's a starting point, particularly as there's times in our reproductive life that actually our hormones are fluctuating more than others.

34:11So, for example, perimenopause, your hormones are all over the place. So one snapshot isn't enough. And it might be that you need more blood testing to really understand exactly what's happening. How do female hormones, this is a big question, affect your health? How would I, you know, what are the symptoms that apart from PMS, what other things would be going on? So I suppose the biggest one that would impact on your hormonal health is that if you have PCOS, so polycystic ovarian syndrome, and you tend to have elevated testosterone levels, although not always, PCOS is so complex. So there's so many different symptoms that you might have or might not have.

34:48That's a really strong indicator, is it? Yeah, absolutely. And actually identifying that you're not ovulating. so the hormones can be out of kilter we've just got such a finite balance of our hormones and for everything to be working correctly they need to be in absolute balance and often they're not and and i think there's i think people get really worried about their hormonal health understandably because it is important and actually a sign that we're having a regular menstrual period is a sign that you're having you have good hormonal health so should women who are concerned about anything to do with their hormone health be having more regular checks then?

35:29I think if you are concerned that there is an issue so if you're noticing these symptoms I think it is important to get this checked. It might be that you get it checked and you either something's identified like PCOS or you could go on to have further investigations and they're identifying endometriosis or any other ovulatory condition then you might want to then have more regular testing to understand what's happening and actually to see any benefits to any lifestyle changes that you might make particularly surrounding PCOS which can make a significant difference so you might want to then monitor every six months or yeah I think every six months is probably reasonable and then I think it's important not to not think about the other tests that are important particularly if say for example a diagnosis of PCOS you need to then be thinking about your lipids for cholesterol because you've got a higher risk of cardiovascular disease you've got a higher risk of diabetes so you'd be wanting to think about those other blood tests as well to help you get a better diagnosis and then to manage your your health going forward Adam obviously I referred to Kate there and deferred to her in terms of the female health picture but I would defer to her too but you you have obviously women who come in and see you with with their hormones how helpful is it if they can bring a profile to you of their hormones it is i mean it is helpful and depends on the um on the condition they're querying but um it um it as i said you know we've discussed earlier it's sort of done half the work already you know come in and you can see actually there's an issue here and that immediately makes you think well for example is this pcos rather than endometriosis or actually is this woman perimenopausal um because that's something particularly the perimenopause and menopause is is much more in people's consciousness now than it was and whereas we had previously always thought about well this is a thing that happens to women in their late 40s early 50s um we're now recognizing that lots of women are having symptoms early 40s 30s you know even even younger so it's um and it's easy to overlook because it can be blamed on numerous other problems basically how can a man tell if his hormones are out of balance well so i mean in the hormone that most men are interested in is testosterone.

37:40I suppose in a similar way to how estrogen is so important for women, testosterone is the main male hormone that maintains sort of male characteristics. It can be tricky because sometimes the symptoms are vague and might be a sign of something else. But the main issues, if you have a problem with your testosterone, is loss of libido, maybe erectile dysfunction, lack of energy, low mood and a loss of motivation. And those are the kind of symptoms that men are usually worried about when they when they start thinking about testosterone and then they can do something about that if they know it's low so there's there's a there's a couple of things you can do one is there are lifestyle changes that will help with testosterone um they are as always the most boring things which is maintaining a healthy weight alcohol in moderation avoiding recreational drugs um making sure if you've got diabetes that's well controlled um but there is treatment available for testosterone deficiency um a number of options including injectable options and gels and the main two treatments really for it and are there other hormones that men need to be aware of there are they're not necessarily specific to men um thyroid hormone you know sorry thyroid function is is important thyroid is incredibly important in controlling all aspects of our metabolism um and actually can present again in very non-specific ways so that's if you're worried your hormones are out of balance then that's a good one to check um and it's not really a direct hormone test but obviously blood sugar blood sugar problems are related to hormones in terms of insulin and and things so again and again can present with those sort of very vague symptoms so are there specific hormone tests that are suitable for men or is it again picking a range of things that you know might cover your symptoms it's often a range of things um testosterone is probably the main well it probably the main hormone that men are interested in specifically as opposed to women so they can just get their testosterone tested and nothing else that would that be you can just test your testosterone with that if you like to yeah would you recommend doing a combination of things if men are concerned about their health picture i think generally i would probably recommend a combination um the because the symptoms of testosterone deficiency are quite vague um they could equally be a number of other problems so testing your testosterone and finding out oh that's fine is might be falsely reassuring if there is actually another issue going on so generally testing a range of range of things at the same time is a good idea and in terms of how often they check is it similar to women in terms of you know you'd say every six months or so to get a yeah again it depends it depends on how you feel and what your goals are um the one thing with testosterone testing is it's quite sensitive to the time of day so we normally tell people to have the test done between 7 and 11 a.m because that's when levels tend to be highest so taking it the wrong time of day or taking it when you're actually unwell you know with a with anything like a flu or something like that will give you false readings so we normally suggest with testosterone you know focusing on that specifically that if you have a low level you should always have it repeated because you might not have a low level the next time you check right so it could be a month apart it does yeah so if you find a level to be low on one test, we'd normally recommend testing it again about four weeks time.

40:58Kate, what is one day test and how does it work? So one day test is a private blood testing service. We also have consultation service as well. So an individual can request a blood test and they could just do that if they're happy with that. And they can then see their results. They might want to take their results to their GP or they might decide to have a consultation with us. and we offer a range of services. So GP service, fertility, menopause, a whole range of different things you can probably add to that, Adam. And so that not only do they get the blood test, but they can then actually get, have a consultation and get information specific to their blood test and for their general health.

41:36Because the way it's presented, obviously, you know, that you can get an exclamation mark telling you that something is a little bit worrying or perhaps a cause for concern. But most people can't interpret results themselves very easily can they no well all the results do come with um a an interpretation or or um information advice so for example if you've got something slightly abnormal it'll come with a high level may mean one of these things a low level may mean one of these things and some suggestion as to how that should be followed up um if you want more detailed discussion and more sort of bespoke to you then booking in to speak to one of our and one of our clinicians is a good idea who can go through things in detail and talk you about next steps and And I'm asking a question, which I think the answer is in the name and it's on the tin.

42:22How long does it take to get your results? Well, I think we do pride ourselves on having a fast turnaround, but most results are either same day or next day. There is some results that do take longer, but the vast majority is same day or next day. And you've talked about the service that you can offer in terms of helping people interpret, but also talk through results that might be a little bit concerning for them. and then after that it's up to them how they proceed with that information yeah exactly i think our main standpoint is actually empowering people with the knowledge to do what they want to do with their health so that's our sort of and they're very welcome to book back in with us for a review they might want to choose in six months time to have some more blood tests and we can follow them up that way as well thanks so much for listening and i look forward to hearing about your health insights.

43:10For more information, visit www.onedaytests.com.