The Expat MD

21/04/2026

Would you or wouldn't you?

The tests are out there. Expertise is needed to help you navigate the results, but they are impacting and empowering people to take care of themselves.

The decision is deeply personal and the tests won't be for everyone, but they are an option.

19/04/2026

Just before COVID hit, I sketched out an ideal patient work up. Not the usual minimal GP check up. Something that was preemptive. Not waiting till you were actually ill.

Something (and this is crucial) that wouldn't be covered by the usual compensation of a GP. So essentially a private service.

Blood markers, genetics, microbiome testing, toxin testing, imaging. I felt like a bit of an outlier amongst the hard working fellow medics who never came up for air.

I looked high and low for others who were ahead of me. I got interested in ageing research and how I could translate that to my own practice of medicine. I eventually found the ARDD conferences on YouTube!!!

It turns out that many people had been thinking along those lines too.

By 2023, I'd done the first Longevity medicine course for doctors (for free!) that had been created by .evelynebischof and (Alex Zhavoronkov). I will always be indebted to them for creating this so I could learn the basics.

Since then, "Longevity" has become a buzz word.

Educational offerings for medics have also boomed. They range from a couple thousand to over $10,000.

Clinics are offering longevity medicine everywhere. Some looking at the $$$ signs more than the actual science. Some are offering aesthetics and not much else. Others are actually causing harm.

We're lucky we're alive now to see what's coming. I am optimistic that many of us can control much of our health span.

There are those unfortunate patients who did everything right, but still got an awful diagnosis. However, 90% of what I see day to day is the preventable.

But..... Doctors and patients alike need to be more discerning about what they are swallowing, and I'm not just talking about supplements.

The Healthy Longevity Medicine Society is trying to pull the field into a more reputable and standardised playing field, but it's early days.

Like I've said before, buyer beware.

If the New York Times is writing about Longevity medicine then it's part of the Zeitgeist.

Link in the comments if you want to read it.

16/04/2026

Obesity is a well known cause of accelerated aging through a variety of mechanisms.

If you are young and obese, this is even more of a problem because your body is struggling with many more decades worth of an unfavorable biological environment.

This generation of children are expected to live less long than their parents did. The first time in history.

Much of the issue lies in our lifestyles and poor metabolic health.

GLP1 agonists are not the only answer and definitely not the only way to tackle obesity.

However, they are tool that experienced clinicians can use to treat metabolically sick people.

They can improve and extend their lives by preventing the inevitable diseases that would have come along otherwise.

They are currently thought to be the first type of "anti aging" drug.

The catch? Well... If you're metabolically healthy, they may not do much. We don't know yet. Let's see what the research shows in 5 years.

13/04/2026

I just attended a longevity conference was called "Unlocking Geromedicine". It was full of scientists sharing their research and what I found amazing was half a day of lectures around Ergothionine.

This is a substance that CANNOT be made in the body. It has been suggested to be a "longevity vitamin".

It's a potent antioxidant & anti-inflammatory. There is good evidence it protects mitochondrial function.

Cell transporters are found for it in the gut and it is also reabsorbed in the kidney. It passes from mother to child in breast milk.

It goes into every organ of the human body and is thought to be important throughout.

I'll do a carousel for more science if you want. Just let me know!

Essentially - if you're not eating mushrooms, you will be lacking in this and it likely is impacting your health.

Porcinis has 100x more than button mushrooms by the way!!!

Mushroom risotto anyone? 🙂

10/04/2026

The power of the mind... Sending you all positive vibes 🙂

08/04/2026

Wearables are a tool like many things in medicine. They can be brilliant but they can be counterproductive.

Use with caution!

28/03/2026

21/03/2026

It is impossible to know everything about medicine. Research moves at the speed of light and more than 50% of what we learnt in medical school has either been debunked or seriously revised.

We all have blind spots. Doctors can't know everything about everything. It becomes a problem when you don't question your knowledge base.

In 2002, Donald Rumsfeld, US Secretary of Defense, when asked about Iraq's potential weapons:
"Reports that say that something hasn't happened are always interesting to me, because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don't know we don't know. And if one looks throughout the history of our country and other free countries, it is the latter category that tends to be the difficult ones."

Donald Trump should perhaps have thought more about his own unknown unknowns, but we as doctors should always consider them!

20/03/2026

Loneliness is now a well established physiological stressor.

Chronic social isolation raises cortisol, disrupts sleep, weakens immunity, and accelerates biological aging.

Over time, it erodes both mental and physical health.

Sometimes there really is bad luck in terms of our health outcomes. Cancer diagnoses for instance.

However, one thing that we can control are how we interact with the people around us.

To improve relationships with others, we may need to improve the relationship with ourselves. It may not always be easy but I feel this is an aspect that is so rarely discussed in the longevity field.

There is no biomarker for this, except for the fact that if you're alone at 65. By then it is often too late (but not impossible!)

This weekend, go and nurture some of those around you (or yourself!)

Happy weekend.

Love Dr Nat

17/03/2026

Hair..... Sometimes doctors make the worst patients. Knowing something doesn't mean you actually do it or check it.

Finally, I got round to looking after myself. Your hair may seem superficial but it can often reflect what is going on infernally.

13/03/2026

Our patients are our best teachers.

For two years, she lived with severe abdominal pain. Scan after scan, appointment after appointment… yet no clear answer.

At 54, the missing piece turned out to be something that no one (not even her gynaecologist) had considered: oestrogen.

Oestrogen receptors aren’t just in the reproductive organs — they exist all over the body: the gut, brain, joints, skin, bladder, heart and more. When oestrogen levels drop in midlife, symptoms can appear in places we don’t always associate with menopause.

After starting HRT, her pain finally settled. Not because the pain was “in her head”, but because her body was missing a hormone that affects multiple systems.

Menopause is not just hot flushes.
It’s whole-body biology.

If you’re struggling with unexplained symptoms in your 40s or 50s, it may be time to consider whether hormones are part of the story. They may not be, but they might.