The Expat MD

The Expat MD Health optimisation and Longevity Medicine Consultant

26/08/2026

Nursing homes... Not what you want at the end of life. Getting up from a toilet or from a chair - yes. You do want to be able to do that.

The 5 times sit to stand test (getting up and down from a chair as quickly as you can 5 times) is a good measure of how good your muscles are functioning.

Ideally you want a hard chair and cross your arms. Make sure you actually sit on the descent.

You can look up the normal ranges, but you're in competition with yourself. Aim to get better over time.

This means not just practicing this move, it means taking care and improving your entire muscle health.

Imagine yourself at 90 fully independent with those who love you around you, doing the things you enjoy. That is the goal.



If you've ever tried to lose weight (everyone), have a family history of diabetes, heart disease, dementia or stroke (mo...
30/06/2026

If you've ever tried to lose weight (everyone), have a family history of diabetes, heart disease, dementia or stroke (most people), then knowing whether you're metabolically healthy is vital if you want to prevent disease.

Using a continuous glucose monitor is one tool that has changed my patient's behaviors like no other.

Real time information directly seeing how your lifestyle directly impacts your health.

This is amazing technology not just for type 1 diabetics who no longer need to prick their fingers multiple times per day, but for all of us.

Who out there has worn one for 2 weeks? I didn't expect my findings but in retrospect I had to be actually honest to myself about my choices.

We all have choices. 90% of the time make the harder one. Then the 10% won't make a blind bit of difference!

Look out for yourselves and your loved ones

Dr Natalia x

As you peel the onion layers back to support people to improve and optimise their health, sometimes you'll find that the...
02/06/2026

As you peel the onion layers back to support people to improve and optimise their health, sometimes you'll find that they lack important gut microbes.

We are still very much learning about how they all interact with each other. However, a widely studied one is called Akkermansia muciniphila (not philia by the way!).

It is sort of like the caretaker of the gut lining. I like to think of it as the gardener 🙂. It feeds off the mucin in the mucous layer, then feeds other beneficial microbes with its metabolites. It also improves barrier function and interacts with immune pathways.

Testing it in isolation without having a more complete microbiome analysis isn't the full picture however.

Nevertheless, you'll be hearing more about this little guy in years to come!

Polyphenols, diverse fibres and minimally processed foods will help it thrive - so raid the fruit & veg section of the supermarket tomorrow!

Happy munching 🙂.


01/06/2026

Improving your health often starts in the gut. We have keystone species that are vital for our health. Many of us are lacking them due to our modern lifestyles and generations of antibiotics.

If there is one bacteria you need to know about, it is Akkermansia muciniphila. I often see it absent in patients who suffer with weight gain, chronic fatigue and type 2 diabetes.

Is your longevity doctor checking your microbiome? Do they know how to interpret it? It's not as easy as a yes/no answer because you need to look at the entire picture.

Nevertheless, AI will come to your rescue one day, so it's time to start educating yourself!

27/05/2026

Eating/cooking needs to be simple and quick.

Before you eat, think about what you're putting into your body to nourish it. Whatever you're consuming, it'll be sending messages to your microbiome and to the rest of the body.

Beneficial bacteria will thrive on a variety of different types of fibres and polyphenols (the colourful compounds in fruits, vegetables, herbs and spices).

Healthy fats are also important to help absorb the fat soluble vitamins and support your cell membranes. Olive oil is rich in polyphenols, as well as balsamic vinegar.

Salads all the way in the heat!

Happy lunchtime 🙂

01/05/2026

The poison is in the dose. The dose is smaller than you think. In fact, alcohol has no real safe limit. Red wine is NOT good for your health, despite the tabloid headlines.

However, it is culturally the widest accepted poison on earth. Many of us drink it now and again.

Normal liver function blood tests do not reassure me. Reducing the poison, however much your drink, is a good idea. There are many health benefits. Brain, heart, liver, stomach, oesophagus, hormonal health, the dreaded wrinkles.

If you're going to drink, there's an argument doing it earlier in the day, so it doesn't affect your sleep. And one drink is very different to 3.

Remember, less is always better.

I once sat on a committee focused on improving adolescent mental health.There were doctors, psychologists, teachers, pol...
27/04/2026

I once sat on a committee focused on improving adolescent mental health.

There were doctors, psychologists, teachers, policymakers.

Everyone was trying to help.

But I remember vividly sitting there thinking, something's not right. 

All the solutions were downstream—therapy, medication, crisis support.

Important, yes.
But it felt like emptying a leaking boat with a teaspoon.

On my way there, I had passed 20 fast food outlets in a town of 80,000.
Hardly anyone walked. Public transport was minimal.

Third spaces were coffee chains—mostly drive-through.

And in clinic, I was seeing more and more young people with:
obesity, anxiety, ADHD, depression.

We were treating the symptoms.

But what about the environment shaping them?

Movement. Light. Food. Connection. Community.

Support services matter—sometimes they are lifesaving.
But prevention starts much earlier.

It starts with how we design our towns, our systems, our daily lives.

Longevity doesn’t begin in adulthood, it should really start in kids. I did paediatric training before I became a GP, so I can see the potential.

But the doctors can't do it alone. If you're involved in planning anything to do with towns or infrastructure consider how the decisions you make today will impact the generations to come.

I work with all ages through a longevity focused lens to help maximise the joy in our lives and reduce ill health.



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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.

Just before COVID hit, I sketched out an ideal patient work up. Not the usual minimal GP check up. Something that was pr...
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.




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