Don't Wait for Symptoms with Dr Preeya Alexander

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Today, we're cutting through the internet noise and bringing you a masterclass in high-performance health with one of Australia's, if not the world's, most trusted medical voices, Dr Preeya Alexander. As a practicing GP, author, and AIA health expert, and a media personality, Preeya spends her days on the frontlines of real human health. Today, we're putting her in the hot seat for Ask the GP, a special tackling the most top Googled health questions for high performers, and we're going to ask them of her right now.

We're going to dive deep into the true science of gut health, what alcohol is actually doing to our executive function and our recovery, and the absolute non-negotiables that you need in your daily routine to stay on top of your game without burning out. Dr Preeya, welcome to A Wake Up. Thank you for having me.

And why is it a moment that we have to have that really shocks us for us to look after our health and wellbeing? Look, I'm guilty of this too. And I think when you're kind of coasting, and things are okay, and you've got a really full plate, particularly if you're a caregiver to anybody, you park the things that you know you should be doing because you don't have any symptoms, there's nothing quite triggering the consult with the GP.

And I get it, like I say to people, come and see me when you will, let's do all the prevention stuff. I'm guilty. I am due to go and see my GP, I haven't done it because I'm busy, but I think that people just go, "Well, I'm kind of not feeling anything, and I'm moving, and I'm eating fruit and veggies, and I'm moving the body, and I'm feeling okay, and I've got lots of things on the plate."

And then it's the rectal bleeding or the chest pain. And they come in and we go, "Whoa, we haven't done a heart disease risk assessment, we are not up to date with your bowel cancer screening." And it's because when you're well, I think you just coast.

So I think it's normal, to be honest. I don't think I'm guilty of it, so I think it's fairly normal. We tend to put on hold what we think we don't need when in actual fact those little things that we do do help us sustain that stress and that intense period of time.

It's funny how we have that mentality, like, "I'll just park my health and wellbeing until I actually need to focus on it," and then it's in that period that you're actually compromising it and sabotaging it. So when you do finally go and see your GP and the symptoms are already showing, is that almost like it's a little bit too late? No, it's not too late, and I mean, I guess it depends on what it is that we're talking about, but it's never too late.

And I think that the takeaway on this particular point should be, ideally go and see someone like GP who is sub-specialized in preventative health, that is a big part of our job. But if you do have a symptom, be it a breast slump, a niggle in your chest, rectal bleeding, a change in bowel habit, whatever it is, go early, because you do see people who lame will sit on it for months. And some people avoid and go, "Well, I don't want to know what it is, and I know my mother had breast cancer, and so am I higher risk I'm going to leave the breast slump?

Maybe it will go away." The takeaway has to be, if you do have something, the earlier the better, because even if it is something sinister, even if it is, it's much easier to treat if we pick it up earlier, and the outcomes are better, and that's for bowel cancer, breast cancer, lots of different things. So, you know, if we're planting any seeds today for people, it's the earlier the better.

To diagnose us, and you must see on TikTok and all these other social media platforms, some really interesting ways of diagnosing certain things and then treating them. Have you seen, I mean, it'd be easy to ask you how many of you have seen that are wrong. Have you seen any that are actually accurate?

No, we tend to focus on the negatives of things, and nothing's all good or all bad. That's my kind of motto. Interestingly, we covered a study that looked at this on the health report, which looked at how good ChatGPT, all these language models are actually triaging patients.

So, are they really good or are they really bad? And basically, they were good in the kind of intermediate category, but if you were really sick and you were having a heart attack, it was not so good. It was like, "Go and see your GP in a couple of days."

And if you had really not felt like you had a cold, it would go to the emergency department. So, for stuff on the really innocuous end and the severe end, it didn't perform well. And that's what I see in the consulting room.

So, it's often incorrect and kind of misleads patients, but there are silver linings. I've had a patient who said to me, "Preeya, when I put this into ChatGPT, it did suggest a prolactinoma." And I went, "Oh, that's interesting."

And I went through my brain and I went through the guidelines and I went, "Well, we can do a prolactin level." And they had a raised one. So, it was in fact the AI that had raised it and given the idea to the patient.

And I think as a clinician, I have to be aware of what patients are seeing, but also open to the fact that I don't know everything. Maybe these things can help me in some capacity. I'll consider it.

If it's not unreasonable or causing the patient harm, I'll consider it. Yeah. Mm-hmm.

Yeah. Preeya, that is such a fascinating place to be open to because I've certainly sat in some GP frameworks and they've disregarded what I've said and sent me home with an anxiety tablet and I had a spinal cord injury. But to hear you talk about the use of AI for the positive is really interesting.

What are you noticing are the changes in the way that people understand information? Because before it was, "I just don't want to know, so I'm going to bury my head." Now you're probably seeing information overload, particularly for carers, like for parents.

I know so much and I know that you'll get better treatment if you know more. I saw a study on that recently. How have you noticed it in your own clinic?

Is it helping humans or helping doctors be better doctors? I don't actually use it in the consulting room, so a lot of my colleagues do. They use it as an AI scribe, which will take notes.

And I just haven't adopted it yet because for me, note writing is a really important way that I synthesise the information and digest it and think. And also, medical, legally, it's still not completely, I would say, smooth sailing there. So I'm one of these kind of cautious individuals who watches and waits and I'll come at the end probably.

I think for patients, there's pros and cons. I definitely think for some people, it helps them digest information. So if I see someone and I go, "I think this is celiac disease, you're antibody positive, let's get the gastroenterologist, refer you for a scope.

Get some information in the meantime." Sometimes patients come back and go, "I put it into the AI tool and it helped give me some extra bits and pieces." Great.

That's great if it's reliable info and it's giving you the sources so you know where the information is coming from, it can be good there. For some though, and particularly in the mental health space, I know a lot of patients who, because it's really hard to see a psychologist or a mental health professional or a social worker, whatever you need, it's costly, there's often not availability. So people sometimes turn to the AI as like a therapist and that can be problematic because there's often not the safeguards in place.

We don't know what kind of strategies they're using, if people are at risk, it might not pick it up. That's the area where, when I see it in the consulting room, I feel a bit nervous and I've seen it not go well. The responses are really determined by the quality of question that you ask the AI agent.

Yes. So if you're not asking the right questions, it'll just give you, and it's always answering in the affirmative. It's always giving you the best case scenario.

It's trying to almost please you. The person we spoke to about AI and healthcare, I remember the researcher was like, "These models are designed to appeal to you, to please you, to keep you addicted." And so if you are at risk, there's been some really tragic instances in the US of people actually using these models to self-harm, and they found the loopholes because the model is trying to please you and they found the loopholes.

So yeah, there are risks. There are risks.

And I made a promise to you that I would go and get my bow, like my bowel kit tested, and I went to do it. And it expired by over a year. Can I just go and test?

Yes. And I realized, wow, how many of those would save lives? Because I was shocked at the statistics.

And after this question, I'd love you to elaborate on those statistics because today really is about a wake-up call to take care of your own health and wellbeing. And my husband did it. And he's just over 15, he came back clear.

And I thought that was the easiest test. And one of the issues that I had was the stigma around it. And because it is one of our biggest killers today in Australia, I just want to say to people that the process of it is not pilling in a cup.

You don't have to catch it. You don't have to catch it. It is two pinpricks.

And that is it. And just knowing that now I'm diffused, I will go to how traumatic it could be, but I am going to go and get another kit and do it properly. But just knowing how easy it was, was like, oh, I can imagine how many times people put this test off.

But can you give us the numbers of bowel cancer at the moment and what we can do to prevent that with our gut health? As it's one of the hardest things to do. Well, so there's so many parts to this.

Bowel cancer, we know the rates are increasing in younger people. The reason for that increase is there are many hypotheses going around. And it could be lifestyle factors, dietary factors, genetic factors, environmental ones.

But we know that in younger people, the bowel cancer rates are increasing. That test that you're talking about, you're right, tested is so easy to do, and yet it has one of the poorest uptakes. So about 60% of people, like a huge amount of people, 60% will do it.

40% are like, yeah, I'm not going to do it because of the stigma. They don't realize how effective it is at picking up bowel cancer. But what the test is looking for is microscopic blood in the stool, blood that we can't see with the naked eye.

So if you're looking at the toilet paper, patients say to me, "There's nothing in the bowl. There's nothing in the toilet paper. Don't worry about it, Preeya."

I go, "This is the stuff that the microscope can only see," which is one of the earliest signs of bowel cancer. And despite how effective that test is at picking up bowel cancer, polyps that could turn into cancer, huge proportion, nearly 50% still don't do the test. So the big things with the test are the age reduced from 50 to 45 in Australia.

I think it was last year. There's been so many updates, but basically, because of the rising rates of bowel cancer in the younger population, they said, "Let's start the test at 45, drop the age from 50 to 45." But a lot of people don't know that if you're 40 to 44, so if you're in your 40s but you're not yet 45, so that would be you, so you go into your GP and you can opt into the screening program.

Prior, I'm hearing about bowel cancer, I'm going to be proactive, can I please do the bowel cancer screening program? 100% test, here's the kit, let's do it, after a bit of a counselling session. So you have to opt into it at 40 to 44, but 45, yeah, you start getting screened every two years.

But I'm glad you raised it, it's so easy, the test is so easy. It is so easy, and as a mum, I'm like, "I want to know because prevention is so much better than when you're in the thick of it to treat it."

Gut health. So gut health, look, that's a big hot topic. I haven't done the research personally, I'm just the lucky person who gets to speak to people about it, and the researchers, so I get very excited because of the people I get to speak to.

But gut health is basically, it's a bit of a buzz term now, but what we're referring to really is the gut zoo, it's the gut microbiome, it's the trillions of bugs in your gut, it's the parasites, the bacteria, the fungi, the viruses, and it's a perfect little balance in the ideal world. But for some people, they've got too many of what we call the bad bugs, and some people who really nurture their gut microbiome or have genetic factors that support it have lots of good bugs. And I think the very fascinating thing that I'm sure you're both aware of about gut health is that we are just now learning how critical it is when it comes to the immune system, weight regulation, and mood, brain.

And I do a lot of mental health stuff, and so when I'm prescribing people interventions for their depression, their anxiety, I'm often prescribing lifestyle interventions, but specifically stuff for the gut. Give us those, Preeya, what is it? Okay, so if I come to you and my mental health is struggling, and I'm doing all the right things, I'm exercising, I've got therapy, and my mental health sucks, what can I do for my gut?

I would do it at the start, actually. I wouldn't be waiting for it to suck. I would say, if you came to me going Preeya and we thought you had mild to moderate depression, for instance, very common, I would do basically the psychology interventions, I'd refer you to someone you needed, I'd prescribe physical activity, time and nature, sleep hygiene measures.

It sounds so unsexy, but this is the stuff with evidence, maybe medication if you needed it, but I would prescribe you dietary interventions. And so there's an amazing trial out of Deakin University, the Food and Mood Center, and it's called the Smiles Trial. Smiles is an acronym, so Smiles Trial, and they basically got people with mild to moderate depression in the community, they randomized them to two groups.

In one group, they just carried on as they were, no dietary interventions, eat what you're normally eating. In the other group, they actually implemented dietary interventions. We want you to basically follow a Mediterranean diet, is what it was.

More fruit, more veg, more whole grains, less red meat, ultra-processed foods. And the people in the intervention group, the people who had been told to change their diet had a better improvement in their symptoms of depression. And we are now learning that diet, what we eat day to day, really impacts that gut microbiome and that can have an impact on the mood and the brain.

So I used to talk a lot to patients about gut microbiome and nurturing that, the immune system, weight regulation, and now we're going, the brain, when you're in a really stressful period, you want to dial up the dietary factors to really support the brain. Yeah. All right.

I got very passionate. So there's a lot of talk. We love that.

We love that. But there's a lot of talk when it comes to fermenting foods, for example. The kimchis and the kombuchas, and if I'm having fermented food, then that's good for my gut.

But if your gut's inflamed or you've got leaky gut syndrome, do those things have any significant impact or any mild impact on your stomach? That's it, that's probably a question for someone who does research in the space or gastroenterologist. I mean, leaky gut syndrome is not something that exists within our medical literature, that particular diagnosis.

But if you had inflammation from Crohn's disease or ulcerative colitis, hopefully you are managed well with medical therapies, and there's still definitely benefit to eating a diverse range of fruit and veggies, all the colors, lots of whole grains, limiting artificial sweeteners, which can negatively impact the gut microbiome. All that stuff still counts, even if you've got an underlying diagnosis. Okay.

Preeya, I'll talk to you on nutrition as well. Yeah. I have a co-actician or, you know, if we're talking about pathology underlying, that's quite specific.

Yeah. That's probably gastro, yeah. Okay.

Preeya, with the gut, can you just tell us how wonderful it is in the serotonin and get us excited about the gut? Is it something that, I mean, it's fascinating that we need a study to tell us that non-ultra postures foods are better for us and that we should eat more healthy. Like, that is just insane to think about, but two in three people now have insulin resistance, which talks to a high processed diet food base, like, and that it just, it really is scary that we live in Australia and that most of the food that we're getting now is processed.

So help us understand why we need to look after this wonderful thing that drives serotonin and boosts our happiness, like, give us an overview of that.

And all these little breakdown pathways, you know, the bugs in your gut, the way I describe it to my kids and I get excited is the bugs in that you're feeding the gut bugs. You want to nurture the gut bugs. Yeah, the good gut bugs, and you want to give them food and fuel that they like.

You want them to break stuff down and produce beautiful breakdown things that get absorbed into your serum and impact your, you know, your brain and your mood and weight regulation. And there's a lot of stuff marketed to the gut health because it is such, we're starting to learn the importance of it, but, you know, patients will often say to me, Preeya, what am I doing? Like, I just spoke to a patient about antibiotics they had to take.

And I said, "We've got to nurture that gut microbiome for you. You need the antibiotics. If you don't take it, you're going to be septic.

So how do we nurture the gut microbiome and stop you from getting septic?" And it's really eating lots of fruit and veggies. It's eating a diverse range.

So I'm guilty of loving like celery, carrot, like the, you know, the iceberg lettuce. And I have to go, Preeya, I need dark green Tuscan kale, I need the purple eggplant. You know, you really want a diverse range of colors to nurture the gut bugs.

You want to limit the artificial sweeteners because they do negatively impact the gut microbiome. Fermented foods, Layne, like you said, yogurt. Yogurt is really good.

When I was in to Felice Jacka recently, who is absolute guru in this space from the Food and Mood Center, she was telling me about a study I think they're going to publish on yogurt consumption in women and the benefits because it's a fermented food. Watch this space and water as a drink. And I think that's where many of us kind of, you know, many people kind of, yeah, look at you.

Just like that.

How does it impact the gut health on the same theme? And I'll tell you this super quick. A friend of mine was at drinks with some girlfriends and she wasn't drinking because she's trying to lose weight and she's doing all the right things.

And the girl said to her, "Hey, just have some of this. You can have some of mine." And she's like, "What is it?"

And it was Ozempic. Like, "You can just have a quick hit." And she rang me and she's like, "This is mainstream.

This is like, we're now trading Ozempic at the table." And she asked the girl, "How did you get it?" And she said, "Oh, I told my doctor I just needed to lose the last fight from childbirth."

And I went, "Oh my gosh, it's this way we're at." So Preeya, what are you noticing? What is safe Ozempic health?

And what do we need to watch out for? So this is a big topic. GLP1s, these medications, and we cover this a lot on the health report because there is a lot of emerging research.

And I think we need to be very clear that these medications absolutely have a role. They have clear indications in type 2 diabetes. They have clear indications in people living with overweight and obesity.

And for people with insulin resistance in PMOS or fatty liver disease or knee osteoarthritis and they're living with overweight obesity, these medications can change lives, increase quality of life, improve the chronic disease risk, potentially significantly reduce the risk of cancers. There was a big study that came out which basically mapped GLP1s and the additional benefits so we know that they can protect the heart, the kidneys, the brain from dementia, Alzheimer's dementia specifically. So the medications have absolutely benefit in some.

Does that mean that they're for all? Is what the discussions I'm now having with colleagues and around roundtables? Because what we are starting to see is this movement test where diet culture is starting to get its claws in and is this the new tool to aspire to thinness at any cost?

Because that's the kind of myth that we're sold by diet culture. If you sin, if you aim for this body ideal, you'll be more successful, you'll be happier, you'll be more popular. And this is fed to kids at a very young age.

It's a trillion dollar industry, it's very effective. And what we're starting to see is this kind of use where there's not a clear clinical indication. Is it there to literally shift a few kilos?

Are you really taking on risks like nutritional deficiencies, loss of muscle mass? Just to shed a few kilos, who's prescribing that? Is it ethically prescribed?

Does the person have wraparound care with an exercise physiologist and a dietician? I doubt it often. The other thing we're starting to now see documented, and there's a study that's come out in JAMA psychiatry, that's my memory, but I'm pretty sure it is JAMA psychiatry, that has looked at the use of these medications in people with eating disorders in the United States.

And that is a concern we're now starting to see in Australia as well, is that people are really readily accessing these medications. They may not have a clear clinical indication, you can access it through various pathways, including these telehealth clinics where you never meet anybody, it's a phone call. You can lie about your weight, you may have an eating disorder, you don't disclose it, your regular GP doesn't know.

And there are potential harms, and really these drugs can either fuel an eating disorder, so people with an eating disorder might use them, and these are often vulnerable people, or the drug itself, and I have started to see this, just by administering the drug and the weight shift, it can actually induce an eating disorder in some people where the food noise goes and people start to really become quite obsessive about their food, what is going in, the disordered eating pattern can come. So when I said before, there's not all gone out and all bad, amazing meds for some can absolutely cause harm for others.

And that story test that you're saying is not unfortunately unique. Yeah, and you talk about food noise from all of the people that I know that are on it, and safely on it, and some not so safe, but they're such a wide mix. But I say to them, "What's the biggest thing you've noticed?"

And they said, "The food noise is gone." And I remember the only thing that got my food noise to come down was therapy, was like to deeply go into the wounds, and to go into those triggers, and to see why I was eating for comfort, and eating for sabotage, as opposed to like taking a pill. It's a bit way easier than going to therapy, and confronting your issues around food, and weight, and all the other things.

Food noise. Thank you for that preview. Some people can be really protective.

Right? You know, it can be disabling for some, but for many people with restrictive eating disorders, the food noise is actually switching that off is quite dangerous, if you have atypical anorexia or anorexia nervosa. So yeah, but the psychology element to it tests, yes, absolutely, the gold standard.

Yep, and ideally the dietitian. Yeah. Yeah.

And then other peptides that I've heard are wonderful for recovery, muscle building. It's the same thing when it gets too far when it goes into steroids, and like grey label. So what's a safe use of peptides at the moment for anyone looking at going into it?

So the doctor and me is going to say the unregulated peptide industry is exactly that. It's completely unregulated, and it's a huge issue at the moment, because people can source this stuff from social media, online, and often, you know, when we say unregulated, these are not TGA-tested products, so we don't know what's in them. And to the people who, you know, at universities who are basically studying this stuff and actually taking the vials and going, "Okay, does this have the Wolverine stuck in it?"

or whatever's being sold to people, it actually doesn't, most of the time. And we're now seeing people with acute liver toxicity and some serious side effects, so at the time of recording, this is a highly moving area with the Therapeutic Goods Administration. Yep.

Yeah, we'll move on to that, I think, because, I mean, I grew up with a father who worked in the alcohol industry. I went to parties as a teenager, got drunk. I actually went with a case of beer.

My relationship with alcohol started very young, and now, in my 50s, I have a much healthier relationship with alcohol. But even then, sometimes I can notice, is one glass of wine really heavily impacting my performance? Last night, Kirk and I made dinner together, and we sat down.

I was like, "This meal could actually really use a nice glass of red wine." So, having a healthy relationship with alcohol, I don't think, has a really severe negative impact. But fortunately, you've got a great cellar, too.

I do have a good cellar, yeah. I won't have a glass of wine that impacts me for three days. Right, it does ultimately impact your sleep and your nervous system, doesn't it?

It does. So, the thing with alcohol is that, in Australia, the recommendation is for no more than 10 standard drinks a week for men and women now. Standard drink is 30 mils of wine.

10. So, if you and I lay down... 10 is quite high.

That's a lot. Hang on. Standard drink is 30 mils of wine.

Yeah, 100 mils of wine. Sorry. 30 mils is a shot.

I was going to say. That's just a shot. That's if you're in the city.

They run a tight line there, you know, when they fill it up to the line, they keep going. I confuse spirits and wine. 100 mils of wine.

But if you and I sat down, like, I don't get 100 mil glass at home. Like, it is genuinely usually over that. 150 mils.

Probably. I don't really drink mid-week anymore. Look, where am I going with this?

Alcohol is, if you look at Canada, they've basically said there's no safe level. The recommendation is for zero to reduce the risk of alcohol-related harm. And I very interestingly chatted to the lead author on a study.

He'd done a landmark review on alcohol attributable disease and mapped all the risks of alcohol, which is frightening in terms of increased risk of dementia, increased risk of heart disease. And it was a fascinating interview, but I actually asked him, "With everything you know, do you consume any alcohol?" Like, I just needed to make myself feel better.

And he said, "I drink no more than three standard drinks a week." And I was like, "Oh." He was like, "You know, nothing's risk-free.

You could cross the road and get hit by a car. Nothing's risk-free." Right?

It makes you feel good, particularly if you're stressed or anxious. You have the glass and you go, "Whoa, it's taking the edge off." And social media really normalize that mummy time wine, which you just have it for the chill at the end of the day.

But what happens is, as it starts to change its action on the GABA receptor, it can actually drive more anxiety. And I think most people would know if you've had a couple of drinks and you go to sleep, you sleep well initially, but then in that later portion of the night, like after maybe midnight or 1 a.m., you start to wake quite frequently. And that is because of the way that it acts upon the brain.

So for me personally now, I have really dialed down alcohol, like I don't drink during the week because I just don't sleep well. I can't sleep. And I'm like, "If I'm unslept, my mood is terrible.

I can't deal with the stress. I'm ineffective. I'm a worse parent.

So I just don't do it." Not even a glass. I'm just not worth it.

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But then I think the stress that we add to the worry, it's like we're worried that it's impacting us. So we're stressed about being stressed about it, which then exacerbates the impact on our bodies. And I notice that especially if I go on holidays and give myself permission to drink two or more drinks versus just one, I find that it doesn't have the same impact on me as if it's in the middle of the week.

I agree with you. I agree. Because I think at home you're going to have to function.

So is it a stress? I have to do all of these things. Lying on a beach, like we were just in Portugal, and I was drinking.

I was like, "I was gonna live." You were enjoying life. Yeah.

And the margarita, I was like, "Yes, and you're right." Because I'm like, "I don't need to do much tomorrow except for being at the beach with the kids and, you know, supervise the water." So...

Oh, a state. Yeah. So if you're stressing about the executive function that you have to deploy the following day, then that's going to negatively impact your sleep and your nervous system.

Also, the liver has to process it and eliminate it, right? Which is between one and three? Mm-hmm.

Is it 11 and one? Oh, I don't know what liver is. The liver's always working.

Yeah, I think it's one and three. Yeah, I know, but it tends to be... It's got a charge time.

Preeya, I saw an article that said, once doctors recommended smoking, that said, "A cigarette a day keeps the doctor away," sort of thing. And then that obviously turned on its head that alcohol will be the next version where... And we're already seeing rapid declines of people drinking alcohol for their health and wellbeing and more research is coming out.

Do you think that we will get there with alcohol, that more research, it keeps on coming out that it's, you know, a top factor of cancer? Like that, I saw that research the other day. Yeah.

Are we going to get there in 10, 20 years where it's like, "Actually, you can't drink." Well, I don't think they could ever put those regulations around people's voice. And I was just going to say as well that nothing is risk-free, right?

So like this interview that I've done, and people can go and listen to it on the health report on that landmark review, but he really beautifully illustrates the point that, yes, there are these harms. The more you drink, the more you increase the harm. We don't know what the safe level of alcohol is, but by golly, we've got to live.

We don't know that. Amen. So we're saying we can't live without it.

But I think for me personally, and I've had this debate quite a lot in my head as I found out my family history of heart disease risk and, you know, I want to reduce that and I want to be really aggressive. I've had the real discussion with my husband, "Am I at the point where I would completely eliminate alcohol?" And for me, it's, and I'm quite pragmatic as both a GP and a human.

I'm like, "Well, look, I've significantly reduced it. You know, I'm not drinking every day. I'm certainly not going over the threshold in terms of increasing my risk of Alzheimer's dementia and heart disease."

And it does bring me joy, like to sit with, you know, like you said, with Kirk Layne, like it's with Will and I sometimes just having a beautiful red wine and it enhances the meal with my best friend. That for me is really important, you know, and it's, I think finding balance and going, "Well, nothing is, if you eat a sausage, that's a carcinogen," but, you know, just on the bar sometimes, so you're more likely to go and get hit in your car whilst you're driving. So nothing is risk-free.

I just think we need to, I agree with you, Layne, people can kind of get quite (expletive) down. Well, you've got to take in lifestyle factors. Yeah.

You've got to bring in the lifestyle factors. Because I remember I took my dad to a nutritionist and she said, "You've got to stop drinking alcohol." And I said, "But his walk to the pub is his exercise and daily sense of connection."

So you might as well put a gun to his head if you're going to tell him you can't drink beer. If he can find a low alcohol beer or a low carb beer, if he can cut off at two instead of four.

Like, what boundaries would you recommend to maintain a healthy body but also a healthy relationship with alcohol? What would be the top three boundaries we should all have? You've just nailed it there.

Mate, you've taken the wind out of my sails, Layne. Nailed it. I think for some people a healthy relationship's not possible.

I've got patients where it's got to be zero because one drink escalates to 10. So for some people it's not feasible. Let's acknowledge that.

Okay. If anyone's listening and going, "I think I need to reduce slightly. I want to reduce my bowel cancer, breast cancer risk.

I want to reduce my risk of dementia," and all these things. Number one is consider a low alcohol option. You nailed it there.

That's a good one. Number two is to potentially dilute. So for some patients where we're trying to reduce...

Yes. Correct. I go, "Why don't we do 50 mils of wine, 50 mils of soda water or whatever you're going to do and just slightly dilute it?"

And then the other one is to aim for alcohol-free days. Now for some people in my consulting room, they go to me Preeya, "I'm going to drink nothing in the week and then have 10 standard drinks on the Saturday, so I'm fine." Well, there are harms of binge drinking.

Having more than four standard drinks in a setting is harmful. We know that for the liver, for your blood pressure, for alcohol-related harm, accidents, all the rest. So it's not kind of storing it up.

It's going, "I'm not going to drink maybe mid-week because then my overall intake is low." It's not like, "Let's compensate on the weekend," just for everyone listening. Clear.

Yeah. Something that I've implemented is if I've had a bad day, my default was chocolate wine. Chocolate wine?

Yeah, because like it was whiskey, a nip of whiskey with Chris on the rocks because we developed that trend over COVID. And even the other day I had a bad day and Chris got the whiskey out and he put it on the table and I said, "Isn't it fascinating how we go to it to decompress ourselves?" And we had a conversation about it and I was like, "I'm going to go for a walk."

But it was just having that realization of where I was using it versus where we talk about all the time is like the number one study of happiness is connection. So if it brings you closer, if it brings you joy, I mean they've found old drinking apparatuses that are buried like archeological sites that have remnants of alcohol in them. So we've been doing this tradition.

It's a tribal. It's around the fire. Like I so love that element to having a glass of really beautiful red wine.

So yeah, I'm with you guys that as long as we fix our relationship with it, it's not about the mummy decompression. It's about connection. Yeah.

Yeah. Let's open a bottle. It's all about drinking together.

Yeah. And I think Layne, you said for your father that going to the actual social connection when we talk about wellbeing and harms, particularly as we age, loneliness is a huge one. So, you know, if you're socially connected to people and if that is perhaps part of it, as long as it's not exceeding, you know, the recommendations, then, you know, I say everything in moderation is my motto.

Yeah. Yeah. Except for smoking.

Except for smoking, but including alcohol free beer too. Yeah. I think I like the taste of alcohol.

So does it happen? Yeah. Yeah.

Yeah. We go sometimes have alcohol free cocktails and still top them up with soda water and it's just about the quench. Yeah.

It's about having something other than water. Yeah. And our fridge has been stocked up with the most amazing, different non-our drinks.

Really? Yeah. Because it's just about opening it up and having it as opposed to the alcohol itself.

I realize it's the ritual and the tradition. Okay.

It depends on your age, but can I say the three that people like don't just don't nail? One is a heart disease risk assessment. Have you had one done?

So if you are 45 and older, you should be having a heart disease risk assessment. What do you do with that? Yeah.

So then if you're First Nations, you need to consider it from age 35. If you're diabetic, you consider it earlier. What do you do is the best question ever.

You get a blood pressure check and you need bloods done. We need to check your fasting sugar, your cholesterol, and you can go standard. So Tess, you might come and see me and I go, "Hey, yep, we should be doing this.

Let's put your numbers into the algorithm." I'm a fairly proactive GP, so I would go to you, "Hey Tess, you can do extra stuff that you have to pay for, like your lipoprotein little A, a genetically determined cholesterol that's not yet funded under Medicare. We can get additional information.

We could consider a CT calcium score, again, out of pocket cost and radiation, but let's talk about it if needed." Preeya, how much are these costs? Because I did request all of those the other day and then I went to get it and the lady said, "You could be up for $500, $600."

And I said, "Can you do a check before?" She goes, "No, you can only get it when you get it." Calcium score might cost about $200 and a lipoprotein little A, that blood test of your cholesterol, which is not Medicare funded, maybe $40 to $50 depending on the lab.

But if it's going to save your life, it's worth it. And I guess the thing is what is the guidelines in Australia at the moment in terms of heart disease prevention? And we do not do this well in women, right?

We always go men, heart disease, men, heart disease. Women are at risk of heart disease. If you have PMOS, what used to be known as PCOS, you're at higher risk, significantly higher risk of heart disease.

So you should be doing this. What's PCOS? Polycystic ovarian syndrome, or PMOS, and yeah, sorry.

So the heart disease risk assessment is one. The second one is probably cervical cancer screening, and that is meant to be done every five years, and there is a self-collect test. So you can do the test yourself in the bathroom, everybody.

You don't necessarily need the speculum. So that has been a game changer, but cervical cancer, we're seeing a real reduction in rates thanks to vaccination and also the cervical screening test. And then breast cancer screening for women, which starts usually from age 50.

We can go and get tested in your 40s if you choose to, but you need to weigh up the risks and the benefits, but from 50 mammograms for breast cancer screening. And then, of course, bowel cancer screening, which you mentioned before, skin cancer screening. There's so many.

Yeah. What about the blokes? Blokes.

So it's very similar in terms of the bowel cancer screening, so now starts from age 45, that disease risk assessment, and then we can talk about prostate cancer screening. So it's not a universal program in Australia, but I certainly have patients where I talk about the risks and the benefits and the PSA and the reliability who go, "Yeah, I'm happy to take it on, and we will test the PSA regularly." Yeah.

How do you stay on top of your game? So my non-negotiables are rainbows, so fruit and veggies in my gut. I thought you were going to say actual rainbows, I was like, "I don't even know what to say."

I'm like, "Are there waterfalls?" Are you sure you're a doctor? I want what you're having.

I'm like, "What's under those rainbows?" Well, I think the main gut... She's got great gut, Preeya.

The gut is a non-negotiable for me because I just know I feel better. Psychologically and physically, if I'm eating lots of rainbows, so that's a non-negotiable for me. The second is physical activity, and so I protect that time fiercely.

Like today, I'm super-crunched, but I attended a Pilates class because I know for my body and my brain, it is a performance, like it is key. Absolutely. It's an enhancer.

Is it daily? No, is it daily? I would move my body daily in some capacity.

But if I'm walking to the tram, to the ABC, is it a Pilates class? Is it a brisk walk? I've got a Pilates reformer.

I invest it. Because my husband was like, "Preeya, if you can, when you're writing, do 10-20 minutes on the reformer in between things." He goes, "That's a win."

And I was like, "I love that you're just accommodating this and moving stuff in the rooms." So I will try and move my body. I will do something active every day.

And my other non-negotiable is, and I've learnt this over time, sleep. I will not compromise my sleep. And I think, Will, my husband, who's a plastic surgeon, who's on call often and doing, you know, recons for children and sarcomas, we've got busy lives, but we will go to bed.

Like last night, we're in bed at 9 o'clock. And we read. About sleep.

We're in bed at 7.30. Yeah, well, but sleep is a big one, so I won't compromise on sleep because I know I am shocking if I'm not well-slept. What are your non-negotiables around sleep?

How do you protect your sleep hygiene? So I take the phones away so that I'm not clock-watching. I don't want to hear the buzzing of the phone.

The exception is Will being on call. So that's the only exception we have. I do no screens.

I'm meant to do in the hour before bed, but I prescribe patients, but I try and do like 45 minutes, feeling hard to not start scrolling. And I really do a very clear wind-down ritual. I'm like a toddler.

Everybody knows when we have our shower, our warm shower, we hop into this stuff, we're reading our book in bed, we know this is sleep time. So it's very toddler-like. Yeah, I think we all should implement a toddler sleep routine.

Like the magnesium on the feet, the massage, like putting beautiful oil on your body and getting into nice PJs. We do everything to protect our kids, like pack nice lunchboxes, making sure they're getting all the rainbows, like the more we're adding self-love notes, the more we act as our own toddlers, I think we would get a lot out of our health and wellbeing. Can you explain?

Well, offline, I'm going to have to learn what those routines are because I'm not a mauveur. So you do it beautifully, LB, you've got a great sleep routine. I do have a good sleep routine, yes.

Yeah, you don't need that. No, no. I have a yoga mat next to my bed Preeya, so it's an invitation every night to either slip into bed or lie down and do a five or 10-minute wind-down routine.

And I've noticed that if I do my routine, I sleep better. So it's an incentive to actually just commit the time. But also as the nights are getting longer and colder, putting on something warm to keep me motivated and cozy in that environment, otherwise I just want to crawl into bed and dance another.

Preeya, how do you protect your mental health? I know physical exercise is one thing, but do you journal, do you meditate? What is something that high performers can implement that you use?

Because I'm sure you deal with a lot of stuff and hold a lot of emotional load as well. Physical activity is a big one. I'm a big talker.

So for me, debriefing and venting. And I think, you know, there's pros and cons to being with someone else within the health profession. But will my husband just getting it when I go, "Oh my gosh, this is what's happened.

I'm worried and I'm chasing this result." For me, that kind of partnership and unloading is really important. And I do meditate.

And we meditate as a family, so often will and I will just have a mindful moment. But the kids, you know, we do a lot of stuff on Smiling Mind. And I do find that, you know, like what we did at the start of this podcast, that kind of bringing the brain to the line and the present, not going, "Oh my gosh, I have to do all these things."

Or, "Did I do that thing? I did good enough before." Just bringing it to the line is quite powerful.

So meditation for me is, I'm not always effective at it, but I've just had a psychologist say to me, "Prayer, what's effective, the fact that you're doing it is the win." So I was like, "Oh, I'm going to reframe."

So we'll start with the gut health. What's one thing that people should do to have better gut health or improve the gut? Eat a diverse range of rainbows.

Eat the rainbow, all the color. Is there a supplement that you recommend? And Felice Jacka, who's the guru, says, "You shouldn't need a supplement.

Some people may, but most of us can do it with the dietary factors and the lifestyle interventions." So, do you plan this? Yeah, beautiful Greek yoga.

Well, there is one supplement that I can't live without because I have a compromised immune system because I started taking antibiotics consistently as a child well into my teen years and that's vitamin C. Okay. I cannot function without vitamin C and that's because I exert myself physically.

I'm mentally stimulated. I carry a lot of stress in my body that I'm learning how to manage through meditation and breathing. But if I don't have my daily dose of vitamin C, then I notice my immune system get quite heavily compromised.

Yeah. So awareness, your intuition. Yes.

Yeah. Love it. Okay.

Next thing, alcohol. When I do that reduction, I would try by perhaps going with a lower alcohol option and seeing how you go. Go slowly.

Small tweaks do yield benefit. Or just dilute. Okay.

Smaller things can yield benefit. I think don't be a hero and go, "I'm going zero," just all changes. Yeah.

Health checks. What's one that everyone needs to embrace? Let's go bowel cancer screening.

Let's get those rates up. Let's get the uptake increased. Yeah.

It's a bloody effective test. I just told you, it's not stigmatizing, it's so easy. Yeah.

And one daily habit. I think move the body. Move the body for your physical and your mental wellbeing and get out in nature if you can.

There's evidence that just being in nature, it's published in the journal Nature, you only need 120 minutes a week, but just being in it is good for some psychological wellbeing. Any movement is good for you. It doesn't need to look fancy.

Don't look at Instagram and apps, just any movement that your body can tolerate, good for your body, good for your brain. Amazing. Get out to nature.

I heard from your doctor, right? Yeah, yeah. The number one prescription.

The body's natural antidepressant movement. Yeah. And as we've always said here, if you're feeling blue, touch green.

So immersing yourselves in nature is a beautiful way to do that. Yeah. Immerse yourself in rainbows.

Yeah.

Go and see someone for prevention when you're well. There's huge amounts of power in it. I was going to say, to all of you, that's what I was going to say to you.

Yes. Preeya, is there anything that we haven't covered off today that you'd love to share or get that message out there? No, I think you guys nailed it.

I loved it. Yeah. Okay.

Well, we encourage everyone who's listened today to pick one tool and one tool only and put it into action this week. Because nothing worse than hearing all of this information thinking, "Okay, I have to overhaul my diet. I have to move 120 minutes a week."

You start implementing everything and it gets overwhelming. So Preeya, thank you for sharing your wisdom and your expertise with us today. How can people engage with you?

So I'm on social media, Dr Preeya Alexander, and they can listen to the health report or my own podcast, Happy to Health, so however they like. Yeah. Okay.

Well, we've loved having you on, Dr Preeya. Thank you. Yeah.

We'll get some questions, some Q&A because we love the research. We loved lived and learned life experiences because there's nothing worse than someone telling you how you should live your life. It's about agency and finding one thing.

LB, what's your one thing? Look, I do all these things. My gut health has always been my biggest issue and I am dealing with some challenges at the moment.

But on top of that, I've reached out to get some really comprehensive blood analysis done and I'm working with a variety of different specialists in that. So I'm not putting my head in the sand. I'm aware of the symptoms.

I'm like, "Okay, let's just do something about this," because something different works for everybody. So I went grain free for six months and that was a game changer, but that doesn't work anymore. So I'm now looking for the next thing to manage my gut health.

What about you, T.B.? I'm going to go get that blood test, or the stool test. Or the bowel test.

Bowel test, yeah. I'm going to self-nominate. I was actually just going to use my husband's, but I'm sitting here realising that would be bad.

That would be very bad. Yeah, because he's over 50 and you're just over 40. Yeah, it's the path of least resistance.

So thank you, Dr Preeya. We have loved having you on board today and you are officially part of our dream team. So if this episode has resonated with you, please share it with a loved one.

I think that is one of the best things that we can do. Change is power at action is where life really sits. So book a family appointment, go in together and get your head out of the sand because we can all look after our health and wellbeing for our loved ones, and most importantly, for ourselves.

So this was today's wake up call. We will see you next week. Bye Dream Team.

Toodles.