PCOS to PMOS: Are We Renaming the Syndrome Instead of Rethinking It?

Aging: Life’s Most Faithful Companion

Aging: Life’s Most Faithful Companion What if aging doesn’t begin when your hair turns grey, your scalp begins to bald, or your first wrinkle appears? What if it begins much earlier—at the very beginning of life itself? In this thought-provoking episode, Professor Pandiyan Natarajan explores aging not as a disease to be conquered, but as one of life’s most fundamental physiological processes. Drawing upon biology, medicine, philosophy and everyday experience, he invites listeners to reconsider many of the assumptions society holds about growing older. For thousands of years humanity has searched for everlasting youth. Ancient myths spoke of fountains of youth, divine nectar and magical elixirs. Today, the quest continues through a global anti-aging industry promising to reverse biological clocks and delay the passage of time. Yet despite remarkable scientific advances, one reality remains unchanged: Nothing is forever. The episode explores why aging is inevitable but poor health is not necessarily so. Many of the conditions commonly labelled as “age-related”—including obesity, hypertension, type 2 diabetes mellitus, osteoarthritis and even some forms of cognitive decline—become more common with advancing age, yet they are not synonymous with aging itself. The discussion also examines the fascinating role of genes and epigenetics. While our genes provide the blueprint with which we begin life, our daily choices continuously influence how those genes are expressed. Nutrition, physical activity, sleep, chronic stress, social relationships and environmental influences all contribute to the biology we eventually inherit. One particularly memorable analogy forms the heart of the discussion: Health is a retirement fund. Every wholesome meal is a deposit. Every walk is a deposit. Every restful night’s sleep is a deposit. Every cigarette avoided is a deposit. Every kilogram not gained is a deposit. Conversely, years of neglect eventually present a bill that biology quietly but faithfully collects. The episode concludes with a practical framework for healthy aging based on current scientific understanding: eating predominantly whole, fresh, minimally processed, plant-based foods; remaining physically active; obtaining adequate restorative sleep; managing stress; nurturing meaningful relationships; avoiding tobacco and alcohol; and maintaining sufficient financial security to reduce chronic life stress. Ultimately, this is not an episode about extending life at any cost. It is about extending healthspan. It is about accepting aging without surrendering to unnecessary frailty. It is about replacing the pursuit of everlasting youth with the pursuit of lifelong health. Because aging is not our enemy. It is life’s most faithful companion. And perhaps, when understood through the lens of physiology rather than fear, aging is not something to resist—but something to prepare for with wisdom, gratitude and purpose. Thank you for listening, and I hope this episode encourages you to begin investing today in the healthiest version of the person you will become tomorrow.

PCOS to PMOS: Are We Renaming the Syndrome Instead of Rethinking It?

PCOS to PMOS: Are We Renaming the Syndrome Instead of Rethinking It? Few conditions in medicine have undergone as many identity changes as what we currently call Polycystic Ovary Syndrome (PCOS). Since Stein and Leventhal first described the condition in 1935, it has appeared under several names—Sclerocystic Ovaries, Polycystic Ovaries, Hyperthecosis Ovarii, Polycystic Ovary Syndrome, and now, following an international consensus proposal, Polyendocrine Metabolic Ovarian Syndrome (PMOS). The motivation behind the latest change is understandable. The term “PCOS” is misleading. Many women with the syndrome have neither polycystic ovaries nor ovarian cysts. The disorder affects multiple physiological systems and extends far beyond the reproductive tract. Yet a fundamental question remains. Will a new name change the lives of women living with this condition? For decades, the ovary became the focus of attention. We surgically removed wedges of ovarian tissue. We later introduced ovarian drilling. We blamed the ovary because it was the most visible manifestation of the syndrome. But what if the ovary was never the primary problem? What if it was responding to biological events occurring elsewhere? In an earlier opinion article, we proposed that the polycystic ovary is largely an epiphenomenon—a consequence rather than the origin of the disease process. In a subsequent study, we further hypothesised that excess weight gain above an individual’s physiological baseline may be the principal precipitating factor in the majority of women who develop PCOS. While this hypothesis requires further prospective confirmation, it provides a framework that deserves serious consideration. This perspective also helps explain an important clinical observation. Many women who achieve sustained weight loss experience restoration of ovulation, regular menstrual cycles, improved fertility and marked improvement in metabolic abnormalities. Established hirsutism, however, often persists because terminal hair follicles that have already undergone androgen-dependent transformation seldom return completely to their previous state and frequently require cosmetic hair removal. These observations suggest that many features of the syndrome are reversible consequences of an upstream process, while others become permanent footprints of earlier disease. If this model is correct, then both “PCOS” and “PMOS” describe manifestations rather than the initiating event. The current discussion therefore extends beyond terminology. It asks how medicine should name disease. Should we name diseases after what we observe? Or should we strive to name them according to their underlying pathophysiology? History reminds us that descriptive names often become obsolete as science advances. The greatest breakthroughs in medicine have rarely resulted from changing terminology. They have resulted from discovering causes. Perhaps the most important question is not whether PCOS should become PMOS. Perhaps it is whether we have yet identified the biological event that truly deserves to be in the name. Until then, we may simply be replacing one descriptive label with another. Patients deserve more than better terminology. They deserve earlier recognition, more effective prevention, treatments directed at root causes, and a deeper understanding of the biology that drives the syndrome. Medicine advances not by finding better names for diseases, but by finding their true causes. If this article stimulates discussion, encourages new research, or prompts us to look beyond labels and towards mechanisms, it will have served its purpose.

Sleep: Your Body’s Night Shift — The Most Productive Thing You Will Do Today

Sleep is one of the most fundamental yet most misunderstood biological processes. In modern life, it is often treated as negotiable—something that can be reduced, delayed, or sacrificed in exchange for productivity, entertainment, or work demands. Yet physiology consistently tells a different story: sleep is not passive rest, but active restoration. During sleep, the body enters a highly organised state of repair and recalibration. The brain consolidates memory, strengthens learning pathways, and clears metabolic waste products accumulated during wakefulness. Neurochemical systems reset emotional tone and cognitive balance. Hormonal regulation is fine-tuned, immune responses are strengthened, and tissues across multiple organ systems undergo repair and regeneration. Far from being “inactive time,” sleep represents one of the most metabolically coordinated phases of human biology. Despite this, society often rewards sleep deprivation. Late nights and early mornings are frequently associated with dedication, ambition, or discipline. However, the physiological cost is significant. Even one night of reduced sleep can impair attention, slow reaction times, reduce working memory, increase emotional reactivity, and compromise decision-making. In safety-critical professions—such as healthcare, transportation, aviation, and emergency response—these impairments translate directly into risk for both the individual and the public. Evolution provides compelling insight into sleep’s essential nature. Sleep persists across virtually all animal species despite its inherent disadvantages, including vulnerability and reduced activity. Such evolutionary conservation strongly suggests that sleep fulfills a critical survival function that outweighs its costs. In biological terms, sleep is not optional—it is indispensable. A key misconception is that sleep requirements are uniform. In reality, sleep duration varies between individuals. While general recommendations of approximately seven to eight hours are useful at a population level, they are not absolute prescriptions. More clinically meaningful indicators of adequate sleep include daytime alertness, cognitive clarity, emotional stability, and sustained functional performance. Another important distinction lies between natural sleep and pharmacologically induced sedation. While sleep medications may have a role in specific medical contexts under supervision, they do not replicate the full architecture of natural sleep physiology. True sleep is an internally regulated biological process that cannot be fully substituted by external agents. Sleep deprivation is often underestimated because its effects accumulate gradually. Unlike acute illness, its impact may not be immediately obvious, but over time it contributes to errors, accidents, impaired health outcomes, and reduced quality of life. It is a silent modifier of risk, influencing both individual performance and societal safety. Ultimately, sleep should be reframed not as time taken away from life, but as time invested in maintaining life. It is a daily, non-negotiable biological process that supports nearly every physiological system. The benefits of adequate sleep are not limited to physical health—they extend to cognition, emotional regulation, productivity, and long-term resilience. In a world that often values constant activity, sleep remains one of the most powerful, accessible, and underappreciated forms of biological care. Respecting sleep is not indulgence. It is a recognition of how human biology is designed to function.

Our Body Is Smarter Than We Think — But Our Conscious Mind Is Not. Too Often the Conscious Mind Gets in the Way

Our Body Is Smarter Than We Think—But Our Conscious Mind Too Often Gets in the Way What if one of the greatest threats to our health is not our body—but our inability to understand it? In this episode/article, I explore a simple yet profound idea: the human body possesses an extraordinary intelligence shaped by millions of years of evolution. Long before we are born, our organs already know their roles. The heart beats, the lungs prepare for breathing, the kidneys regulate our internal environment, the immune system defends us, and every organ works not only for its own survival but also for the wellbeing of the entire body. Yet the conscious mind, remarkable though it is, is continually influenced by our senses, emotions, habits, culture, advertising and the pursuit of immediate gratification. While our physiology quietly strives to maintain balance, our conscious decisions often work against it. The body never stops communicating. It speaks through hunger when nourishment is needed. Through thirst when fluid balance must be restored. Through fatigue when rest is essential. Through pain when protection is required. Through fever when the immune system is fighting infection. These signals are not inconveniences to be ignored or immediately suppressed. They are part of the body’s remarkable communication system—a secret language refined by evolution. Many of today’s lifestyle-related illnesses arise not because the body has failed, but because the conscious mind repeatedly overrides these physiological messages. We eat when we are not hungry, stay awake when our body pleads for sleep, avoid movement despite being designed for it, and seek harmful pleasures despite knowing their dangerous consequences. Good health, therefore, is not simply about treating disease. It is about learning to understand the body’s language and responding with wisdom rather than impulse. As I reflected on this concept, two thoughts emerged that capture the essence of the article: “Physiology speaks quietly, consistently and truthfully; suffering often begins when we stop listening.” And perhaps the most important message of all: “Your body whispers before it screams. Wisdom lies in listening to the whispers.” The episode concludes with the timeless wisdom of Thiruvalluvar: எப்பொருள் யார் யார் வாய் கேட்பினும் அப்பொருள் மெய்ப்பொருள் காண்பது அறிவு. “True wisdom lies in discerning the truth, whoever may speak it.” Perhaps the body has been speaking that truth throughout our lives. The challenge is whether we choose to listen. Acknowledgement: I gratefully acknowledge ChatGPT for the stimulating discussion and for helping organize and summarize the concepts explored in this article.

Our Body Is Smarter Than We Think — But Our Conscious Mind Is Not. Too Often the Conscious Mind Gets in the Way

Our Body Is Smarter Than We Think—But Our Conscious Mind Too Often Gets in the Way What if one of the greatest threats to our health is not our body—but our inability to understand it? In this episode/article, I explore a simple yet profound idea: the human body possesses an extraordinary intelligence shaped by millions of years of evolution. Long before we are born, our organs already know their roles. The heart beats, the lungs prepare for breathing, the kidneys regulate our internal environment, the immune system defends us, and every organ works not only for its own survival but also for the wellbeing of the entire body. Yet the conscious mind, remarkable though it is, is continually influenced by our senses, emotions, habits, culture, advertising and the pursuit of immediate gratification. While our physiology quietly strives to maintain balance, our conscious decisions often work against it. The body never stops communicating. It speaks through hunger when nourishment is needed. Through thirst when fluid balance must be restored. Through fatigue when rest is essential. Through pain when protection is required. Through fever when the immune system is fighting infection. These signals are not inconveniences to be ignored or immediately suppressed. They are part of the body’s remarkable communication system—a secret language refined by evolution. Many of today’s lifestyle-related illnesses arise not because the body has failed, but because the conscious mind repeatedly overrides these physiological messages. We eat when we are not hungry, stay awake when our body pleads for sleep, avoid movement despite being designed for it, and seek harmful pleasures despite knowing their dangerous consequences. Good health, therefore, is not simply about treating disease. It is about learning to understand the body’s language and responding with wisdom rather than impulse. As I reflected on this concept, two thoughts emerged that capture the essence of the article: “Physiology speaks quietly, consistently and truthfully; suffering often begins when we stop listening.” And perhaps the most important message of all: “Your body whispers before it screams. Wisdom lies in listening to the whispers.” The episode concludes with the timeless wisdom of Thiruvalluvar: எப்பொருள் யார் யார் வாய் கேட்பினும் அப்பொருள் மெய்ப்பொருள் காண்பது அறிவு. “True wisdom lies in discerning the truth, whoever may speak it.” Perhaps the body has been speaking that truth throughout our lives. The challenge is whether we choose to listen. Acknowledgement: I gratefully acknowledge ChatGPT for the stimulating discussion and for helping organize and summarize the concepts explored in this article.