The No.1 Menopause Doctor: They’re Lying To You About Menopause! Mary Claire Haver

In 2023, 85% women are complaining of. menopausal symptoms, 10.5% are receiving. treatment or therapy. I mean, it would. be as if your testicles traveled up and. died at 51. That's the equivalent. Let's get started. Dr. Mary Claire Haver. renowned menopause expert. with more than 2 million followers. helping countless women through their. menopause experiences. Menopause is. inevitable, suffering is not. But, a. woman is more likely to be prescribed an. antidepressant for her menopause than. hormone therapy. Women by the thousands. are like, "Oh my god, I had no idea.".

That's when I realized no one's talking. about this. So, here's their laundry. list of symptoms. We've categorized. about 70. So, there's brain fog, changes. in her sexual function. weight gain But, here's the scary. things, and the studies have been done. We see either a new onset or worsening. of depression, anxiety, bipolar, ADHD, risk for cardiovascular disease and. diabetes increases, recurrent urinary. tract infections, which is a major cause. of death for women. They're suffering in. silence, and I was one of those women. I. want to see my grandkids one day. I want.

to watch these women I've raised grow up. and, you know, be the women they're. meant to be, and that choice might get. taken away from me if I'm not careful. But, there's lots of things that we can. do. For example, we see a dramatic loss. of muscle mass. Focus on strength. training. This is going to determine. your longevity as you age. Strength over. skinny. What about your diet? I developed a program for my patients, and it's not rocket science. It's. Whether you're a man or a woman,

menopause is going to affect you because. it's going to affect 50% of our society. And there is 1.2. billion women being affected by. menopause right now. And whether you're. a man or a woman, most of us don't have. the answers. How do we help? How do we. talk about it? What is it? How does it. affect the human body? If you're in a. relationship with a woman that's in.

perimenopause, which can start at 30 up. to a woman that is currently going. through menopause in her 40s or 50s or. 60s, what should you do to support her? What can she do to support herself? This. subject of menopause has exploded in. public conversation, thankfully. But, there's still so many unanswered. questions. And that's why today I. invited one of the leading voices on. menopause globally onto my show. Even as. a man that won't go through menopause.

myself, but has a partner and a mom that. certainly will, there's something that. everyone can learn from this. And I. implore all men who maybe clicked on. this episode or was sent this link to. listen. Please, just listen. Because you can learn something, too. And for everybody new to this channel, can you do me a favor? If you like what. we do here, you like the guests we have. on, and you like the show that we bring. to you, can you hit the subscribe. button? It is the single thing and the. only thing I'll ever ask of you. I would.

love you to join us on this journey, and. if you do, I will repay you, and that is. a promise. Do we have a deal? Thank you. Dr. Mary Claire Haver, why do you do what you do? You know, I started out in medicine. the way most people do. You know, I. wanted to help people. And in our training and school, we get.

to have a little taste of all the. different specialties. And my very last. rotation in my third year was OBGYN. And. I really liked surgery. I really liked. some of the surgical subspecialties, so. I thought that would be my path. But. then, when I delivered my first baby and. all of that rush of emotion and dopamine. and how beautiful that whole process. was, I knew that that was going to be my. calling. And so I did the traditional 4-year. residency and loved it and really did.

well and went into private practice. Um. after about 3 years of doing the private. practice route, I realized I missed. being in academics. I wanted that. ability to do research and be around. students and teach as well as take care. of patients. So, I went back. on as faculty. And everything was going. great. I was very successful. I was, you. know, doing pap smears and babies and. birth control and all the things a. traditional OBGYN does, and then I was.

aging as my patients were aging, too. And when I got to my 40s, I realized. that there was a big gap in my education. and knowledge around menopause. So, I. started researching. Most of my patients. were coming in, the pain point was. weight gain. And they were like, "I'm. not doing anything different. I'm. working out. I haven't changed my diet.". And that little voice in my head was. like, "Work out more, eat less." You know, we.

tend to move less. We tend I was just. going with the script that had been. handed to me. for years that calories in, calories out. is the only way. And, you know, in. medicine in the US, we have very little. background in nutrition. We learn. nothing in medical school, very little. in residency as far as what nutrition. actually is and how it can affect our. bodies. And so, I started struggling with my own. menopause. My patients were all. struggling, and I decided to go back to. school to learn more about nutrition.

because I felt that there was a big. piece missing here because this weight. gain was mostly centered around the. midsection, and I was learning about. visceral fat and subcutaneous fat and. the differences and what's going on with. our muscle mass, and I'm like, "There's. a much bigger picture here than just. calories in, calories out.". So, in my I enrolled at Tulane. University in their culinary medicine. program, and just my mind was blown by. how much I didn't know as far as. nutrition and inflammation and aging and. how it all affects, but where was this.

menopause piece? And. so I took everything I learned and I. developed a little program for my. patients, um which became the Galveston diet, and. it really was just a passion project for. me. And then I started talking about it. on social media and realized that as my. social media presence grew and the. conversation got bigger and bigger, that. there were so many women suffering. Probably the majority of women in. menopause were suffering not just from. weight gain, but from musculoskeletal.

issues, mental health, brain fog, you. know, skin changes, hair changes, nail. changes, and I just kept doing deeper. and deeper dives and realizing no one's. talking about this. No one's talking. about the multi-organ system, you know, failure that a lot of women are going. through, and they're suffering in. silence, and physicians aren't helping. We're not trained. And so, I thought And. my It's really my kids who I have two. daughters. One's 23, she's in medical. school right now, and she's um she's.

actually here with us. And then, um the. other is 20, and. they were like, "Mom, you've you've got. the social media presence. You really. need to use it for good." And that's. kind of where that conversation exploded. for me on social media and where I. realized by reading the comments. what a much bigger pic you know, what. was really happening in the menopause. world and how we need to bring it to the. forefront. For people that don't understand. menopause, Mhm. um they might think it's that it's. a small issue affecting a small group of.

people. But, how many women are are. affected currently by perimenopause, menopause, and postmenopause? Sure. So, right now, about a third of. the female population of the world is in. peri, full, or postmenopause. Um. you do not It's not optional. All of us. go through it. And because we have such. individual expressions of how it affects. our bodies, what we know now is that. there are estrogen receptors in every.

organ system of our body. And when those. levels start declining, we see a very. wide variety of a spectrum of of. syndrome where it used to just be. thought it was a few hot flashes and. some night sweats. Maybe your sleep's. disrupted. Your genital urinary system. is going to take a hit. Um your bones. are going to get weaker. But, what we. know now is how much it's affecting our. mental health, our capabilities, our. skin, our bones, our kidneys, you know, vertigo, tinnitus, frozen shoulder. Anytime I post about those on social. media,

the internet explodes. And women by the. thousands are like, "Oh my god, I had no. idea." You know, and just the validation. piece was so huge for them to make. because they've been dismissed for so. long and told it's all in their head. And if we think about from sort of peri. to postmenopause, what is that sort of. typical And I know that's a tricky word. to use, but what is the. ab sort of average typical age range? And then also, what is the sort of more. um. possible age range? So, it could start. between this age and this age. So, it In.

the US and in most of Europe, the. average age of menopause, which means 1. year after your last menstrual period, is 51. Perimenopause, which is when your body. recognizing recognizes there's some. declining estrogen levels and you're. beginning to be symptomatic, can start 7. to 10 years before that. So, normal. menopause is still 45 to 55. Mhm. And. so, if you do the math and back that up. 7 to 10 years, it is completely. reasonable for a 35-year-old woman to. begin to experience some of the symptoms.

of perimenopause. So, let's start with what is it? Um and. I would love you to explain this to me. like I'm a 10-year-old. Okay. Because I'm sure there's a lot of people. that are both men and women that aren't. fully So, we're going to talk about. gonads, right? What's gonads? Gonads are um where our. So, in men, it's the testes and where. you're making your genetic material to, Okay. you know, uh where you're making sperm, right? And. in a female, it's going to be ovaries, her ovaries. So, the difference big.

differences between male and female and. how that process happens is that. males make their genetic material fresh. constantly. The minute they go through. puberty until basically they die unless. they have some medical issue. Females on the other hand, our eggs. develop while we're in utero in our. mothers. So, while we're in the womb, we're she's 5 months pregnant with us, we have our maximum eggs that we're ever. going to have. And those are meant to. last us until we go through menopause. And so, they lay dormant until we go.

through puberty and then they wake up. again and we start ovulating. So, we. have this monthly in a healthy person. cyclical, you know, hormones rise and. ebb and flow with our cycles each month. We have a period, you get pregnant, you. don't get pregnant, and the whole. process starts over again. Well, because we're born with that egg. supply, through time we're decreasing. the amount. and the quality of those eggs. So, when. a woman hits the age of 30, um she is down to about 10% of the egg.

supply that she had at birth. And when. she's 40, it's down to about 3%. And so, and it gets harder and harder. for that ebb and flow of the natural. hormones to do its job and we start. seeing fluctuations in her periods and. then organ systems that are beginning to. notice the lack of estrogen. Estrogen is. a really powerful anti-inflammatory. hormone in most of our body systems. So, the musculoskeletal syndrome of. menopause is really starting to be.

talked about quite a bit now and we're. looking at things like frozen shoulder, arthralgias, generalized aches and. pains, and most physicians aren't aware. of this. You know, most know about hot. flashes and night sweats and sleep. disruption, but now that we're really. opening the conversation as to how many. organ systems are affected, we are. seeing people coming out of the woodwork. just so happy to know that they're not. crazy and they're being validated. And what's happening at these sort of. three stages? So, we have the. perimenopausal stage, which is, from.

what I've understood there, when. estrogen levels start to drop. Right. So, we start seeing. disruptions in the force. So, instead of. that nice monthly estrogen surge with. ovulation and then the progesterone goes. up, we start the elongation sometimes or. they even get closer together. I call it. the zone of chaos. What used to be a. very reproducible, dependable system. starts failing. So, some women will have. irregular periods, meaning they're. spacing out, they're skipping periods. Others will have really heavy periods.

like like, you know, hemorrhagic almost. Um and again, individual um. the way the body reacts to this is very. individualized from patient to patient. Doctors love. something that follows a list, a. checklist, right? You know, we have all. these complicated things we have to. learn and we have these checklists, but. menopause, it's like pinning the tail on. a moving donkey. And in perimenopause, the it's very, very chaotic. Estrogen. surges, then it goes away for a while. Like a woman in perimenopause can feel.

completely fine for a few months, everything goes haywire, then she's fine. again, you know, and not only is her. estrogen declining, her testosterone is. declining as well. So, we're seeing loss. of muscle mass, we're seeing changes in. her sexual function, we're seeing decreased strength, you. know, there's some some really good. studies showing how testosterone also. affects our mental health and our. cognition as well. Why does this happen? From this a sort of like an evolutionary. or So, the anthropologists have looked. at this heavily and there's we're only.

there's only a couple of species in the. world that go through menopause. Humans. are one. There's a species couple of. species of whales and I think they've. now discovered one of the giraffes. species of giraffes can do it, but the. by and large, most mammals will. die while they're still ovulating. You. know, like they're not going to go. through a menopause. Um. and so, there's something called the. grandmother hypothesis where there was. an evolutionary advantage for women to. survive if she stopped the ability to.

have children at some point. Now again, you have to temper this with. humans have prolonged their lifespan and. their healthspan because of modern. medicine. So, probably when we evolved, we weren't. living this long. You know, a woman my. age was pretty rare. I'm 55. And so, you. know, it it's hard to say. I think we. have outlived how we were genetically. built. And so, we're living longer and. being forced to like deal with the. consequences of that. So, so then the.

next stage is menopause. Mhm. Um. So, menopause itself is really that it's. just really one day in your life. It's. when you can throw the hammer down and. say, "I'm never going to ovulate again. I'm done." And so, if a woman's over the. age of 45 and she hasn't had a period. for a year, that's the definition. Okay? Now, it gets confusing because what if. she's had a hysterectomy or doesn't. bleed because of a surgery or an IUD or. something? Well, then we can't use her. periods to help judge and that's where. we start doing blood work to see, you.

know, where she is in her menopause. journey. And then postmenopause is the. rest of your life. You know, the hot flashes might go away. Night sweats might go away. Brain fog might get better, but pretty. much everything else is going to. continue to progress in a very linear. fashion until you die without estrogen. replacement. To put it lightly, you seem somewhat. dissatisfied with the current set of. answers that. um the medical field, but just society. at large are offering for women in.

the sort of peri- and post- and. menopausal phase of their life. And I've. sat here with a lot of women who are. experiencing menopause. at one stage or the other and they also. seem to be at a loss for answers. Mhm. Um I was sat here two days ago with um a. very, very successful woman who, you know, has all the resources in the. world and she basically can and and this. is someone that has all the answers. People come to her because she has the. answers. And the one thing she doesn't.

seem to have answers on, in her own. words, in her life at the moment, is. menopause. She's rummaging around the. internet, Googling things, finding. contradictory information. And when you. sat down, you you you had that same. energy like you feel like women have. been, dare I say, let down by a system. I think the medical system is letting. them down. I think society is letting. them down. Our our value and our worth. in medicine, you know, I came through this wonderful. training program. I'm very proud of what. I learned. I'm very proud of the care. that I gave except.

I was a horrible menopause provider for. probably 15 years. I knew what I knew. I relied on my training and I didn't. look outside of the traditional confines. of training. This is such a systemic problem. that. I mean, I'm going to tell you a story. and this is this is true. and it's embarrassing, but I think it. needs to be said cuz I think it really. highlights. how women are treated in medicine. Um.

When I was in training, we had these. upper level residents. So, we have a. hierarchy where you have different years. of training. So, I was in the early. years, maybe my first year, and we had. these clinics that we would run. um to take care of patients. And so, we have obstetrics and we have. gynecology as like divisions in our. training. So, in gynecology, everything gets lumped. together. Pediatrics, menopause. We had. no specific menopause clinic. I maybe. got 6 hours of lecture in a 4-year. curriculum. And so, we'd have these women coming in. in midlife and they had multiple.

complaints. They didn't feel good, they weren't. sleeping, they were gaining some weight, they were, you know, aching, that, you. know, just this laundry list of things. that were a little on the vague side. And. my upper levels. would say, "Oh gosh, good luck with. that. You've got a WW. on your hands.". And that was code. We never wrote that. in the chart. This was not taught to me. by faculty. This was just kind of a. handed down in the lore of training. And. a WW was a whiny woman.

And that was code. And now. I know that she was perimenopausal. suffering from her list of symptoms of. now which we've categorized about. they're they're they were frustrated. because they they didn't think they. could help her. Now, remember the. Women's Health Initiative, which was a study that was supposed to. do a lot of good for women. It was. originally designed. um and it was stopped in 2002. That was. the end of my training program was 2002. So, I'm I come from one of the last.

groups of physicians in the US that were. ever trained in hormone replacement. therapy and then it the rug was pulled. out from under us. So, the WHI, there were mistakes, there. was misinformation in the reporting, and there was uh misinterpretation of. the results. All of that has been walked. back, re-looked at. We know that for the. vast majority of women, hormone. replacement therapy is safe and. effective and can give a woman her life. back um if she chooses to take it. But.

that option has been taken off the table. for the vast majority of women. And. recently, I just saw the numbers, 85% of women will come in complaining of. what we know now, this was in 2023, FDA looked at the numbers, 85% women are complaining of menopausal. symptoms. 10.5% are receiving treatment or therapy. today. Is there something in you that feels. somewhat, even though you're a doctor, somewhat. let down by the medical system.

um or skeptical about the medical system. for personal reasons? I. Yeah. I I'm one of those women. You. know, I thought I'd be one of those. girlies who would just breeze through. menopause because I was thin. And I was, you know, thin meant healthy. I still, you know, that mentality was. alive and well when I trained and. through most of my practice. I I came. through a very fat phobic, you know, uh. training. and medicine as a as a whole is very,

um, biased against weight people's weight. And. so. now that I've done a deep dive into. nutrition and done a deep dive into. menopause and really sat there and. listened to patients. and realized that, you know women who. were gaining weight with menopause, you. know, they've done nothing different. They're still exercising. They're eating. the same. The only thing that's changed. for them. is their hormones.

And they're being categorically. dismissed at multiple doctor's visits or. worse. here's their laundry list of symptoms. The root cause is menopause, but it's. not recognized. And one medication could have taken care. of everything, but they're going to. seven, eight, nine different specialists. on seven, eight, nine different. medications to handle each symptom. Whereas all they needed. was just to get her hormones back and. she would feel amazing and be able to, you know, age the way she should. When we talk about the potential.

um. health implications of women that are. going through menopause, it's not just. WW. Right. It's much more, um. That's how she feels though. And that's. how she's categorized probably by people. around her. But the there's real health consequences. and life altering health consequences, life span reducing health consequences. Yes. What are those? So, we know that a. woman's risk and and the studies have. been done. It's not just aging. Of.

course, aging plays into this, but when. you add in menopause as an independent. risk factor, her risk for cardiovascular. disease increases. Her risk of diabetes increases. Her. insulin resistance starts going haywire. immediately. Your your listeners and your, you know, people who watch on YouTube will be. shocked. I'm going to say, "How many of. their cholesterol levels shot up in. their 30s and 40s with no changes in. diet and exercise?". You know, we see cholesterol levels. changing skin, hair, teeth, the dental.

changes, the inner ear changes, the. vertigo is incredible, the frozen. shoulder is legion. Um What's frozen. shoulder? Frozen shoulder is an adhesive. capsulitis of the shoulder joint. And it. is very common in menopause. So, estrogen has this amazing. anti-inflammatory effect, especially in. our bones and joints and muscles. And. frozen shoulder is super common and it.

takes about 2 years of therapy to get it. to break up. So, the capsule that is. right over the bone where the muscles. attach becomes encapsulated and adhesed. and stuck. And so, you have to get in. there and break it up and do lots of. training. So, like a woman wouldn't be. able to reach behind her back to do her. bra. She that's one of the things or you go. to take a picture with your girlfriends. and you can't. put your arm or you can't lift your arm. above here. That's one of the one of the studies. that I, you know, presented. A lot of. the stuff I do on social, I'll present.

the studies because I like to I like to. have data. And, you know, I'll get. 10,000 comments. on, "Oh my god, that happened to me. That happened to me. That happened to. me." Not that I can fix it. but at least they know. this is something that it's not your. fault. You didn't do anything. Your just. estrogen levels dropped, which led to. increasing inflammation in those joints. And have they seen that there's a a. reduction in life span in women that go. through menopause that aren't treated in. a certain way? So, we know that, um,

women on HRT have a lower all cause. mortality. What's HRT? Hormone. replacement therapy or menopause hormone. therapy. So, in the studies that have. been done, the observational studies and. in the WHI, women who were on hormones. um, especially beginning early in their. menopause. Okay? So, estrogen. there is a window of opportunity for. reduction of some of this burden of. disease and it is very in starting in. perimenopause or within the first 10.

years of your menopause. That's the sweet spot for being able to. decrease your risk of diabetes, decrease. your risk of cardiovascular disease and. dementia. When we go beyond that, we start losing. those benefits because estrogen is. better at prevention than cure. And so, my my medical school daughter. was like, "Mom, I'm never going to be. without estrogen. I'm going to start in. perimenopause. Like I'm not going to be. one of those women who's ever off. estrogen." Of course, she's my daughter. and listens to me on social media all.

day. So, she's a little biased, but she. says, "Why why can't we get to that. point where we have no gaps in our. estrogen supply? We just support. starting in perimenopause, you know, offer it to all women. Not all women. will choose it and I support that, but, you know, we're not having the. conversation and they're not being given. the choice." So, what age would you your. daughter would you advise her to start. at. hormone replacement therapy if she so. chooses? So, I would say, um, we start. checking levels and we start looking.

probably in late 30s. Certainly if she. starts having any symptoms out of the. normal, you know, she's living her best. life, you know, doing all the right. things for her health and all of a. sudden she's not sleeping well or she's. having aches and pains or she's. noticing, you know, changes in her body. Most women can tell you. "Something was wrong. I couldn't put my. finger on it, but I knew that something. in something in me had changed and I. wasn't responding to things the same. way. You know, their mental health had. changed or, you know, the way their gut. had changed, their gut health." You.

know, just just there's barely an organ. system that's not affected by this. I sometimes wonder cuz, you know, there's the person going through it and. then there's those around them. And they might know themselves that. something's wrong, the person that's. going through perimenopause or. menopause, but the people around them. won't understand typically Mhm. what's. going on with that person. So, they'll. they might do their old WW thing, that's. a, you know. or they might label them something else. They might misdiagnose it as another. man's health predicament. I remember a.

woman in my life who when whose behavior. changed around this age and I didn't. know about perimenopause or menopause. It's in hindsight now that I look back. and go, "Oh my god, everyone around this person thought they. had bipolar or something.". Right. I mean. it it. it's probably contributing to divorce. rates, maybe in a good way. You know, at. this time. I I one of the positive things I see. about menopause is that. women are. cutting the things in their life that.

don't make sense anymore. They're not. putting up with. you know, as a society we tend to take. on everyone's burden and um, you know, take on the emotional labor in a lot of. relationships, take on the. organizational labor. And I see because. they're struggling so much with just. staying afloat, they're able to just. quickly say, "No, I'm not doing this. anymore. You know, you need to pick up. whichever relationship they're in. You need to pick up your your end of the. bargain here. You know, I can't do all.

of that organizational labor, the. emotional labor. And I've I have a. patient who's a divorce attorney and she. said, "I really think a significant. percentage is of this divorce is. menopause and either they're. prioritizing what's important to them or. they're not getting the support that. they need.". And. How can we give them the support that. they need? So, I think it's important. that we talk about it. I encourage every. single patient I have, all my followers.

on social media, tell your story. Tell your story to anyone who will. listen. Tell your daughters. Tell your. nieces. Tell your sons. Tell your loved. ones. Like make this a normal part of. the conversation so that we see it. coming, we understand what might happen. and that no one feels crazy and alone. when they're going through it. And then we need to do a much better job. in our medical system of providing. support for these women in whatever way. they need it. Be it hormones, non. hormones.

cognitive behavioral therapy, you know, there's lots of things that we can do. Not just hormone therapy is not the cure. all for everything. We have to support. the whole toolkit, right? We have to. prioritize our sleep. Get the exercise that we need. Focus on. strength training when a lot of us in my. generation never did that. We were. aerobics, you know, focused on being. thin and small. It's time to be strong. You know, this muscle mass that you have. is going to determine your longevity and. your functionality as you age and. menopause is, you know, that loss of.

estrogen and testosterone is tearing our. muscle units apart, which is leading to. osteoporosis as well. I want to go. through that whole toolkit, um, but I also want to just before we move. there. understand why women. don't sometimes communicate that they're. going through perimenopause or. menopause. What is the Is there a stigma. associated with talking about it? Yeah, I think there's shame and stigma. associated with aging, with females. aging and then you're you're layering on. this loss of fertility. And in the.

medical field, when you look at funding. in the US for research studies women's. health, like I think it's 55 billion in. the National Institutes of Health in the. US, you know, for all research studies. And that's outside of what pharma is. funding. And women's health gets about. 15 billion. And the majority of that is. spent on getting people pregnant keeping. them pregnant. you know, and fertility issues. Menopause gets, I think, 15 million.

Jesus Christ. Yeah. It's like .03%. if I did the math correctly. of. all. you know, are we not as important as we. were when we were fertile? Do our lives. not matter? It's ridiculous to me. When we can. intervene and help and how give these. women a longer life and a better quality. of life. And how many women is that? I. know we said a as a fraction earlier on. or a percentage, but that's like I think. in your book I read it's 1.2 billion.

women by the end of this year. Yeah. And there's what, 47 million new. entrants. into this sort of perimenopausal. postmenopausal. category every year? 1.2 billion. Billion. Right. And how And. so many of them. have no education at their fingertips, have nowhere to turn, are, you know, 85% are going in to their. health care provider's office. complaining, "Help me." And being turned. away and leaving with more questions.

than answers and only 10% are even. having the discussion for hormone. replacement therapy. And then if they're. given it, they're so terrified because. of the misrepresentation of the Women's. Health Initiative, they're convinced. they're going to get cancer. And that that study's been completely. dismantled and walked back. We have good. information that came out of that study, but, you know, the the the the thought. that estrogen causes breast cancer is. the worst thing that came out of that. study because it's not true. The mental health implications is what I. really want to get into the the hormone.

replacement therapy and all that stuff, but the mental health implications for. women. Do we see an increase in. depression and those and the. consequences of depression, I guess? Depression, anxiety, bipolar, um the. entire spectrum, ADHD. So, we see either. a new onset. or worsening of disease. So, I'm telling. my patients or I'm telling people on. social media, you may have done fine and. done well with your depression on your. SSRI. Don't be shocked if it is no. longer working at that level. You either.

have to increase the dose. So, no one. right now is advocating for primary. therapy of depression to be estrogen. replacement, but we do know from the. studies that it is a very powerful. adjunctive tool. And that it can be preventative for new. onset depression if you start in. perimenopause. Women who start hormone. therapy in perimenopause have a lower. incidence of new onset depression in. their menopause. Suicidality? So, I've looked at these numbers and.

COVID's kind of skewing things cuz we. did see increased suicide rates, but we. definitely see an uptick especially in. Caucasian women, not so much in women of. color in the US in the perimenopausal. menopause time frame. Inflammation. Mhm. What is What is. inflammation? Sure. So, inflammation, there's there's it's there's chronic. inflammation and there's acute. inflammation. So, acute inflammation is. what we need to survive. It is the body's reaction to a foreign.

invader basically or to an injury or an. illness. So, you twist your ankle, right? And so, we injure that tissue, these chemical messengers are spread. from the injured tissue which basically. tells our immune system, "Send blood. that way. Send the the, you know, white. cells and the red cells and you know, all the cells that are going to fight. and heal this. You're going to swell, you're going to have pain that's going. to keep you off of that joint so that it. can heal, right? So, acute inflammation. also happens when we get viruses and. other illnesses.

Chronic inflammation is this low-grade. kind of under the radar inflammation. that's happening in the background. So, autoimmune disease is a lot of chronic. inflammation, but we also see aging. itself, you know, we can't change the. fact we're aging, but menopause. dramatically increases the amount of. chronic inflammation that a female will. go through just based on the lack of. estrogen and testosterone in her body. I'm trying to figure out why the lack of. estrogen. and the drop in estrogen causes. inflammation. So, it turns out estrogen.

is a really powerful anti-inflammatory. hormone. So, we're just like removing. that protective blanket and now you're. you're just aging faster because of it. Ah, okay. So, we need to make sure that. we reduce inflammation by any means. necessary. And that was the sort of the. one of it was the second component of. the Galveston diet, anti-inflammatory. nutrition. If I wanted to have a low. inflammation diet, you said there about. the sugar. Is there anything else that. I've got to be aware of or avoid or. choose in a supermarket? Sure. So, I try to teach the principles.

in the form of let's add things in. rather than restrict because. then we get into eating disorders and. so, what keeping tabs on your added. sugars, keeping those less than 25, but. fiber. And that's one thing most people. are not paying attention to. How much. fiber are you getting in your diet per. day? And most women are getting about 12. g per day and the minimum we should be. getting is 25. Vitamin D is another huge. one. About 85% of my patients and women. in menopause are vitamin D deficient,

not just low, I mean deficient. We are. protecting our skin against sun damage, of course. We're staying indoors more, we're on our screens all the time, but. we're also our gut's changing and our. ability to absorb vitamin D is. decreasing. So, making sure that you are. checking your vitamin D levels regularly. and supplementing when you need to or. eating foods rich in vitamin D. That's. another one. And does vitamin D reduce. inflammation? Yes. Okay. So, vitamin D. is a it's a it's a vitamin, but it's. also a hormone and it has multiple. functions in the body. And so, vitamin D.

deficiencies are linked to lots of. chronic diseases. You're more likely to. have hypertension, diabetes, stroke, you. know, all of the top seven of 10 causes. of death in women. And so, keeping those. low it's also mental health, you know, it lots of vitamin D receptors in the. brain. And so, you know, first thing I. do is check a vitamin D level on my. patients when they come in. So, many of. my nutrition-based or medical or doctors. that I've spoken to on this show have. spoken about fiber especially in the. last like 6 months. You know, people.

historically speak a lot about protein. and all these kinds of things, but for. some reason everyone seems to be talking. about fiber all of a sudden. So, fiber does lots of things for us. It. slows down the absorption of glucose. into the bloodstream. Ah. So, that keeps. our insulin levels lower over time. It feeds our gut microbiome, soluble. fiber. So, there's two types of fiber. There's soluble and insoluble. So, insoluble is what kind of when you mix. up a fiber supplement, you see the stuff. precipitate down to the bottom. That's. the insoluble fiber. That's what pulls. water into the gut and kind of moves.

things quicker through the colon. Soluble fiber dissolves in water. That's. the cloudy part. That is the food for. our gut microbiome. That is the. prebiotic. You don't need a prebiotic if. you're getting enough fiber in your diet. per day. And so, keeping that gut microbiome fed. and healthy and happy is going to do a. multitude of things. Like that kind of. data is exploding right now in the. research world as to where the gut. microbiome, how to keep it healthy and. what organ system it affects. Um our our gut microbes make these.

things called oxybutyrates which are. then absorbed into the bloodstream and. and people who have high levels of. oxybutyrates are actually healthier and. have less coronary artery disease, less. dementia, less less everything. So, it. really nutrition, when I talk about the. menopause toolkit, hormone therapy is just one very small. part of the puzzle, but nutrition should. always be first. Like it doesn't matter. how many hormones you take if you're not. covering your your nutritional bases the. way you should. And what are some sort of fiber-dense or. fiber-rich foods that are in, you know,

every supermarket? Avocado, chia seeds, nuts, berries, your cruciferous vegetables, things that. are crunchy, that's fiber. That's making. the crunch. Apples, you know, um there's. so many. Don't find much fiber in uh. lean meats or any. So, it's going to be. your fruits and veggies. and seeds and nuts. Asparagus, tomato, spinach, celery. Uh asparagus, celery, yes. Tomato, not so much. Just think of. things that, you know, the crunch is. usually from the fiber. Mhm. Okay.

Fasting. Mhm. I'm a fan. It's not for everyone. It's not a great way to lose weight. The. data on weight loss is conflicting at. best. You can eat a lot of things that. will undo the goodness of fasting in. your eating window if you're not. careful. And so, um. the there's good data though on. neuroinflammation and fasting and on. systemic inflammation and fasting. So, I. recommend fasting for the systemic. inflammatory benefits. And we do see.

some really nice lowering of insulin. levels overall from fasting. There's so many different types of. fasting people talk about. So, when I'm teaching fasting to my. students or to my patients, I recommend. the 16:8. So, that's where Mark. Mattson's data. So, that's 16 hours of. fasting in a row followed by about an. 8-hour eating window. Now, for other, you know, again, it's individualized. Some people do great with a 14-hour. fast, you know, the 15-hour fast. 16 is. just kind of something to shoot for. And.

if someone's going to consider. incorporating fasting into their life, give yourself about a 6-week. trial, you know, don't just try to go 16. hours without food if you've never done. it before. Your body will adapt. And so, the advice I got and what I do and what. I teach now, so, I used to break my fast about 6:00. in the morning before I exercised. So, I. pushed that window to 6:15 and I did. that for, you know, three or four days. until it felt normal, natural, I wasn't. hungry. Then I moved it to 6:30 and then. I just kept bumping that window out in.

15-minute increments. over weeks and by week five, I remember. sitting at my desk and I have my lunch. ready to go and I was still at the. hospital at the time and saying, "Oh my. god, I made it. It's noon and I don't. feel bad, you know, like So, I had just. slowly slowly let my body adapt and. adjust and then I've been fasting, gosh, since 2015, probably 2014. And. and it's just a normal natural part of. my life. I don't even think about it. anymore. Have you noticed any effects of.

that? You know, I do so many things. Yes, it's hard to tell. And so, it's. hard to tell, but initially, I do find. when I'm fasting, the clarity of my. thought is much better. I get much more. work done. It's when I do my best. research. It's when I do my best. communicating with my followers is in. the morning. You'll often if you follow. me on social, I'm always in my pajamas. with a cup of coffee um before while I'm. getting ready for work cuz I just get so. excited about something I learn and I. want to share it with everyone. And so I. do find that once I break my fast the. synapses tend to not work as quickly for. me. I was thinking about this through.

like an evolutionary lens why fasting. makes sense and why this sort of. narrative that we're meant to have. breakfast, lunch, and dinner. You know, maybe breakfast at That's a social. construct. There's really not great. science. Now, there are humans that will. do better by eating more meals more. frequently and that's why I say. fasting's not for everyone especially if. it triggers an eating disorder. If you. have diabetes or you have, you know, hypoglycemia, fasting may not be for you. but most people can do it successfully. And so I really encourage people to. experiment with it and see how they do.

I was wondering if I was trying to think. through like an evolutionary framework. and I was thinking about how in our. hunter-gatherer past. Mhm. we would have Meals were not available. 24/7. Yeah. And we would have needed like a. really focused brain to go out on the. hunt. So this explains why when we're. like hungry our brain's working better. It almost seems like there's more I. don't know oxygen or nutrients in the. brain. tends to work better using the ketones. for fuel than uh glucose. So the glucose. is the preferred fuel in the body, you.

know. And um but but when they did. studies, they were animal studies so. take this with a grain of salt but you. know, when they did the mazes, you know, the animals tended to get through the. maze quicker and learn quicker when they. were fasted rather than after they were. fed. They're a little lazier. Ketones you can also use ketones as an. energy source if you use the keto diet. You can. You can. Um but I think, you. know, when Mattson and and that those. researchers were doing their work their. research in Alzheimer's and dementia,

you know, there was no keto diet. They. were just knowing that people were. utilizing ketones for fuel which is a. normal natural process. We sleep. And so. we burn through the glucose in our. bloodstream then we burn up what's in. our liver in the you know, gluconeogenesis and then it switches to. fat to burn for fuel. And so um now there's people who like to. take exogenous ketones. I've I've never. experimented with that. I don't, you. know, that's I don't have any literature. menopause to support that use. And the third component of the Galveston.

diet is this idea of fuel refocus. Right. So that's looking at, you know, food. uh we're looking at the macro and. micronutrients. So I'm really going hard. on fiber and vitamin D and magnesium and. things that we tend to as a gender be. deficient in especially with menopause. So I'm really trying to highlight those. things to make sure instead of counting. calories, let's see how much vitamin D. you're getting every day. Let's see how. much fiber you're getting every day. And is there a certain sort of ratio of.

foods that we should be having in terms. of So I originally developed Galveston. diet for weight loss, you know, um. but if I had to write it over again. So. I went really heavy on fats, you know, healthy fats, lower on carbohydrates and. 20% protein. Um but I think if, you. know, doing it again the way I'm. counseling my patients now is I'm going. much higher on protein. What I've. learned since that book was written was. how important protein intake is to.

maintaining muscle mass. I'm also. talking a lot about creatine. Um and and. there's some nice studies done in in the. we call it the elderly 65-year-olds and. and above I'm 9 years from that right. now and so and how creatine. supplementation just creatine. supplementation on its own well combined. with weight lifting we're seeing bigger. gains in the menopausal patient. Postmenopausal patient, yeah. Bigger gains in muscle. Bigger muscle mass and strength. Yeah, I. was going to ask you about this whole. muscle mass um point. Why is muscle mass.

so sort of pertinent to this. conversation? So what we're Well, what. we know in menopause is that, you know, aging combined with menopause we see a. dramatic loss of muscle mass with the. menopause process. And so in that first. 10 years of menopause we could lose up. to 10 sometimes 15% of our muscle mass. And that muscle mass is going to. determine your resistance to sugars. So. your insulin resistance is really tied. to your muscle mass. Your functionality, your ability to recover from a fall. Um.

and the other thing is what most people. don't understand is the musculoskeletal. unit acts as one. So when we have low muscle mass, you are. dramatically increasing your risk of. osteoporosis. Now right now, this might. shock you but 50%. of females. will have an osteoporotic fracture. before they die. And this is almost completely. preventable. What is an osteopathic fracture? is when we lose the density of our bones.

through So estrogen So all of our life. we remodel our bones, right? We chew up. bone and we lay down new bone. And so we. reach our maximum bone density as. females at about age 35 and then it. slowly starts to decline through the. aging process. And then when we get to. menopause, it dramatically we see a just. massive loss of bone. So this loss of bone makes the bone. weaker and much more likely to fracture. when it when we fall. And so.

if you fall and break your hip. in menopause. 30% of women with surgery will die in. the first year. 70% will die without surgery. And that year is marked by horrific pain. and not being able to move and just. really really miserable people. And so. and so much of this is preventable. Going on hormone therapy, getting. adequate exercise, doing the resistance.

training, eating the protein, adding in. the creatine, making sure you're getting. enough vitamin D is going to be huge at. protecting our my population from this. happening as we age. We can prevent the. majority of this. I want to talk specifically then about. this hormone replacement therapy you. mentioned there. There's you also. referenced the study previously which. sort of scared people. Yes, the Women's. Health Initiative, yeah. And that study suggested that there was. an increase in breast cancer if someone. did hormone replacement therapy.

So let's break it down. Um originally. the study was designed to see if we knew. it from observational studies was. hormone replacement therapy going to. truly be protective for cardiovascular. disease. That was the function of the. study. in women who took it versus women who. did not. We knew from observational. studies that yes, they had a much lower. risk of death from cardiovascular. disease and and all cause mortality as. meaning death from any cause as well as. um heart disease in itself. Okay, atherosclerotic heart disease. So.

but that's observational. The way to. prove these things is to do a randomized. controlled study versus placebo. So. finally finally This is 1998. Women were. getting money. Like there was a new. female head of the National Institutes. of Health. They were funding this study. This was so exciting. Women were lining. up in droves to sign up for it but. because the end game was to prove. whether or not it was protective for for. cardiovascular disease, the average age. of the patient was 63 years old.

So that they could see if it was going. to affect heart disease because women. tend to get that in their 60s and 70s, right? So. they recruit, they develop develop two. groups. We have women with uteruses and. women without women who had had. hysterectomies or were born without. uteruses. And so each of them had a. placebo arm and then a medication arm. When you don't have a uterus, you don't. absolutely have to have progesterone. When you have a uterus, it's required to. give a woman progesterone as well or. progestin as well to protect the lining.

of the uterus from the estrogen. Unopposed estrogen can cause endometrial. cancer but we can negate that by giving. her progesterone. You following me? So. we have an estrogen only arm and an. estrogen and progesterone arm and they. each have a placebo. So off we go. Let's. take our meds. Let's take our placebo. and let's start measuring. What they saw in the estrogen plus. progesterone arm after 2 years was a. very slight increased risk of breast. cancer versus placebo. Now, you have to understand there's a.

difference between absolute risk and. relative risk. So the relative risk went from So the. absolute risk went from four out of a. thousand women per year. to five out of a thousand women per. year. So one out of a thousand women. treated in the estrogen and progestin. arm. developed breast cancer where over. placebo. That is a 25% relative risk increase. Mhm. And that is the that is the. statistic that set the world on fire.

So the researchers held a huge press. conference at the Watergate Hotel in DC. Every major news outlet with This is. before the internet and and announced. that estrogen causes breast cancer. Now. remember, these women were on estrogen. plus the progestin which is called. Provera. The estrogen only arm continued for a. few more years because the women on. estrogen only not only did they not see. an increased risk of breast cancer, they. had a I think it was a 20% decreased. risk of breast cancer. Relative? Re of.

Yeah, relative risk. And the relative. mortality went down 40%. So and we think. it's because estrogen feeds a breast. cancer cell but it doesn't cause breast. cancer. We are highest levels of. estrogen are in pregnancy and it's so. rare to ever be diagnosed with breast. cancer. And a healthy breast cell has. estrogen receptors and all that estrogen. receptor positive means is that that. breast cancer cell went from healthy to. cancer through a mutation but retained. its estrogen receptors. And so we can.

use those receptors against the cancer. cell to treat the breast cancer. So that. study has been walked back. Multiple. studies have been done, but like the the. whole mindset has not changed. Myself, as an OB/GYN, was still the lowest dose. for the shortest amount of time and only. in women where absolutely nothing else. is helping her hot flashes. Menopause. was defined by the vasomotor symptoms. That's it. You know, vaginal estrogen, which is.

just putting estrogen locally in the. vagina. So, one of the biggest things we. see in a huge amount of patients, like. well over 50%, is something we call. genital urinary syndrome of menopause. And it is the bladder, the vagina, and. all of the tissue in between all has a. lot of estrogen receptors. And we take. the estrogen away, that tissue becomes. very thin, we lose elasticity, we see. recurrent urinary tract infections. The. most likely treatment to help a woman in.

menopause with recurrent urinary tract. infections, which is a major cause of. death for women, is vaginal estrogen. And it's safe for. everyone, even with breast cancer. And. so, even that option is taken off the. table for so many women who are. suffering needlessly with horrible, painful intercourse, dryness, you know, recurrent UTIs. And. it's just such a simple thing to help a. woman and fix, and they're not being. offered that treatment. Is vaginal. estrogen the only form of administering. estrogen? So, we have No. So, when we.

look at hormone replacement therapy, we. have. oral and non-oral medication. We have. like steroids is a good way to think of. it. So, say you have a rash and you go. to your pharmacy and you pick up a you. know, cortisone cream. That's That's. local therapy, right? So, vaginal. estrogen cream, there's pills, there's. there's different ways to put it in the. vagina, but that's considered local. therapy. It's not absorbed systemically. We're just treating it kind of at the. moment. Systemic therapy is when it's. treating everything, our brains, our. bones, our genitourinary, so you know,

from the inside out. And so, you can. adjust it. There's creams, there's. patches, there's rings, there's pellets. that are now available. There's multiple. ways to get this medication into your. body. And what's the most popular form of. administering administering. hormone replacement therapy? So, it depends on the country. So, in. the UK, it tends to be a gel or a cream, which is where most GPs, if you can get. one that will follow the guidelines and. prescribe it. I think it's the most. easiest pharmacologic option to get in.

the UK. In the US, it tends to be the. patch for the non-oral form. We also. have pills available as well. There's a. caveat with estrogen pills. There's. something whenever we ingest anything, food, medication, goes into our stomach, into the intestines, and then it gets. picked up by the portal hepatic. circulation, the liver. And so, the the. portal vein goes straight to the liver. for processing. And when that bump of. estrogen or testosterone, typically, hits the liver, we see some problems. with And for for testosterone, it's. liver toxicity, and for estrogen, we see.

bumps in our clotting factor. And so, you'll see a lot of women who are. terrified of hormone therapy because of. this potential risk of blood clots. They. either have a genetic risk of blood. clots, or a gene, or they've had a clot. in the past. But if they avoid oral. estrogen and go with a non-oral form, like the patch or the ring or or even a. pellet, then we bypass the liver, and we. don't have the increased risk of. clotting. Are there any other side effects? You. know, in life, there's no such thing as. Of course. free lunch. And so, um. it.

estrogen, so we have to look at each. So, when we look at hormone replacement. therapy, we have our estrogens, we have. our androgens, which would be. testosterone, DHEA, and androstenedione, and then we. have our progesterone, which is uh the. bioidentical form progesterone. There. are synthetic progestins available, but. I tend to just prescribe the. progesterone. And so, each of them has. issues that may happen. So, with. estrogen, you can see headaches. So, that's kind. of a red flag for us. We worry. We can. see migraines getting worse, so those.

are patients you have to be really. careful with going low dose. Um you can. see unexplained So, 40% of patients on. menopausal hormone therapy will have. vaginal bleeding. Doesn't mean it's a period. We have not. woken your ovaries up, they're gone. We. are just stimulating that tissue um in. the lining of the uterus, and it's. bleeding a little bit. It's usually. self-limited. It can go away on its own. If it persists past several months, we'll get ultrasounds to make sure we're. not missing a polyp or something there. But um it's it's one of the things I. warn my patients about. So, things I.

worry about, you know, headaches, some. women, depending on the formulation. So, for the patch, it has an adhesive, right, to get it to stick to your skin. And there's a probably 10% of women will. have some kind of an allergic reaction. to the adhesive. So, then we have to. look for alternative forms. So, thankfully, there are multiple forms on. the market. And for patients, we have to. do some trial and error to find out not. only which formulation's going to work. best for her, but also what dosing is. going to work best for her. So, if I was. a menopausal woman and I came to you and.

I said, I need help. You get I mean, you. must get thousands of messages like. that. Thousands of messages a week, probably. And you know, I walked into your practice, where would. you start with me? So, I start by. letting you tell your story. I tell my. story, and it's a typical story that you. hear. Right. Yeah. What happens next? Symptoms. So, I will we'll get blood. work. Sometimes I'm getting hormones to. see if if I'm not clear where she is in. her journey, I may get blood work to. help me define if she's peri- or. postmenopausal, especially if she's had.

a hysterectomy. Um I'll get a lot of blood work around. checking her thyroid. A lot of things. look like menopause, right? So, you. know, fatigue and night sweats, that. might be hypothyroidism. Weight gain, hypothyroidism. Autoimmune disease, all. this rheumatoid arthritis. I want to. make sure I'm not missing something else. that looks a lot like perimenopause. So, I'm doing blood work around that. Nutrition deficiencies, vitamin D, her basic labs for her blood count and. her electrolytes. I'm I'm doing this. full panel, okay?

But then I'm beginning to treat. immediately. And so, we have a. discussion around her sexual wellness. Is she struggling with desire? Then. we'll have a discussion around. testosterone. Um. So, I'm struggling. I've got my desire's. gone. Okay. So, it's very common. So, when we talk about female sexual. function, there's kind of five buckets. why a woman would be suffering or not. happy, okay? One is a relationship. disorder, and no amount of medication. really helps with that. So, we want to. make sure she's in a good place with her. relationship, supportive partner, all. that. So, we we have a discussion about.

that. Then there's an arousal disorder, where that's what most men are treated. for when they talk about libido issues. It's really nothing's wrong here. They're struggling to maintain an. erection. And so, we use Viagra and. those type of medications for that. For. So, if a woman has an arousal disorder, vaginal Viagra can be helpful for that. So, we we talk about that. We talk about. orgasmic disorders. Some women have. About 10% of women will never have an. orgasm in their life. Imagine if that was 10% of men. I think. it would be a national emergency. I.

think there would be, you know, we would divert military funding in the. US to get this fixed. And it's just. something we don't talk about or offer. much help. And so, then that leaves. desire. So, most women who are in secure. relationships, love their partner, miss. that part of the intimacy that they used. to have, that desire to initiate, that. desire, yes, this seems like a good. idea. That goes away with menopause a. lot. And so, for those women, testosterone might be helpful, or. there's a couple of FDA-approved. medications as well, Addyi and Vyleesi.

And so, we have talked about costs and, you know, how to get it prescribed. And, you know, testosterone, there's no. FDA-approved option for women. So, quite. often I will have to compound that. medication for them at a local. compounding pharmacy versus going to. Duane Reade or a CVS or a Walgreens to. pick it up using their insurance. So, I know that you that you're coming. from the UK, our health systems, you. know, are a little bit different. But. because my reach is so large now, I try. to include, you know, all the different. health systems when I'm talking about.

your options. Give me a case study of a. patient that walked into your door and. Gosh, you know, I have Okay, I had a a. patient who. came in. and. uh. her name is Michael. And she didn't mind me saying it cuz. we're really good friends. And she came. in and typical, overweight, not. sleeping, some brain fog issues, some. major joints aching, aches and pains, all the things.

And um. sweetest woman, absolutely adored her. husband, you know, like um but was. struggling with desire as well. So, we. started her, you know, I developed a. nutrition plan for her. She hired a. personal trainer. She got to the gym. She got serious about, you know, lifting. Um she started on hormone therapy, and. she is my biggest cheerleader, you know, on social because she's constantly She's. lost probably about 60 lbs of body fat. cuz we get to measure her. So, in my.

clinic, I have a in-body scanner where I. can measure muscle mass and visceral. fat. So, it's not just the number on the. scale. I'm able to tell them. So, she's. probably gained maybe 10 lbs of muscle, lost a tremendous amount of fat. She. feels amazing. She has this beautiful, you know, she's back to her intimacy. level that she desired so much before. She is absolutely thriving on all. aspects, and she's constantly sharing. her studies her her story online so that. other women can learn that they don't. have to suffer as well. And she just.

can't believe. the thing that makes her angry is that. she. didn't come sooner, and that she. suffered for so long without looking for. help. And she couldn't find it. She came. from San Antonio, which is about a 3 and. 1/2 hour drive to come and see me. So, here's the scary thing for me, or. it's honorable. I have patients, so I. have this menopause clinic I started 2. years ago. And I have a waiting list. that's longer than this wall. And women. are flying in regularly to come and see. me, which is such an honor, and I'm so.

grateful that they trust me. But it's. ridiculous that they can't find. menopause care. in their backyard. You know, that they. have to get on a plane to come and see. me because they cannot find care. wherever they are. So, I've started a a. a list of providers on my website that. my followers recommend where they found. good menopause care. They write a. testimonial and we just compile them and. we just look online to make sure it's a. real doctor and they have a phone number. that works. You know, um and then the. the North American Menopause Society, now called NAMS, um now called The.

Menopause Society, they rebranded, has a. list of certified providers on their. website as well. I got an email sent to me after. listening to one of the episodes on this. podcast from what appears to be a very. helpless husband. It was a very very. very long email and they'd said that one. of the conversations we'd had on this. podcast about menopause at one point had. really helped them, but the key question. that remained for that person was. when does a supporting partner. know how and really at what point to.

help? Because, you know, no male partner wants to turn around to. their wife and go, "I think you've got. menopause." and starts diagnosing them. But they also don't want to just sit. back and be quiet. I think. you. it's usually begins with something you. can't quite put your finger on. She's reacting differently. She's not as. resilient as she used to be. She's not. managing situations the same way. And.

I think once we start taking the shame. and the stigma out, him suggesting that. perhaps this is menopause will not cause. her to fly off the handle. I think, you. know, normalizing this conversation, removing the stigma, it might make. everyone go, "Oh, I mean, I didn't. realize it in myself." You know, I. thought it was grief related and and I. was like, "Wait, when was my last. period? When was my last period?".

Uh. Oh. I think I'm in menopause. I mean, I was. And then I was like, "Oh god, menopause." You know, even for myself it. was such a negative connotation. I had. that Sex and the City episode in my head. when Samantha thought she was in. menopause and how horrible it was for. her and then. it turns out she wasn't and everything. was better again and I'm like, "Gosh, is. this. You know, first of all, I applaud him. for wanting to try to do something. because so many, you think women don't. understand what's going on. And so,

uh one bravo for wanting to be helpful. Two, say it with love. Say it gently. Let's. and then find a provider or find a. healthcare provider to go in and start. the conversation. And I one of my best. my best visits with my patients are when. their partners come. And that the conversation is held. together. And it really opens their minds, you. know, to what's going on in her body and. helps understand like what we can do.

therapeutically, what needs to be done. at home. This is a special time for her. She's going to need extra help. We're. going to get through this. You know, it. doesn't have to destroy your sexual life. or your relationship or whatever. It. definitely can take a toll if left. untreated. But you know, bless him for. doing it. Like we talked about a little. bit earlier, you know, there's probably. a fair amount of dissolutions of. relationships because no one's talking. about this process and what it could do. to someone. This might be a really stupid question.

Um but I'm no. I'm no uh I don't ask a lot of stupid. questions. Do men go through anything like this? So, there's a lot of debate about. menopause. Um. the short answer is not really. We see. men's testosterone levels peak at about. age 19 or so or there and then this very. slow kind of down tick until they. stabilize at about age 35 to 40 and then. they stay stable for the rest of their. lives. But there's a difference between.

in there's a big variation from man to. man. where the curve the shape of the curve. looks the same. But as far as. normal men's range is from 236 to about. a thousand. So, there's a big, you know, man to man variation. And there is a lot of men who are. supplementing when they come in on the. low end and they're feeling a lot. better. Now, this is not my area of. expertise. This is not, you know, I just.

read a lot of this research, you know, on testosterone and men are included in. it and so they are finding that they are. having better cognition, feeling better, having more energy, etc. But there is no manopause. Their testicles don't stop working. I. mean, it would be as if your testicles. shriveled up and died at 51. That's the. equivalent. Gosh. I do have to say. at the start of this conversation when.

you said if that was happening to men. the reaction would be different. I have. to say I think I agree. I think that because it's one side of. the population, I think it's kind of. been overlooked over the last 10, 20, 30. years. Mhm. Um but if it was. And men or both genders, I think it. would be a different response. And so. much. of what women were going through in. menopause were dismissed as. psychological. Mhm. And I really had multiple times in their.

life, you know, it's all in her head. We. never said it's all in his head. That's. not a thing on the wards. You know, it's. all in her head was very much alive and. well in my training and a long a lot of. my practice. I I find myself now. even having to pull myself back a little. bit just because that was ingrained so. much to always look for the. psychological reason. I mean, women A. woman right now in 2023 is more likely. to be prescribed an antidepressant for. her menopause. than. hormone therapy.

Multiple reasons for that. The way we. were trained, the way we were taught to. to approach a woman's medical issues and. also the fear uh unfounded fear around. the Women's Health Initiative and what. it did to. you know, physicians feeling confident. about prescribing hormone therapy. Is there anything else that you do on a. day-to-day basis in your life that um. you we haven't talked about yet? Is. there any sort of apps or tools. I really like Headspace. I know there's. some good meditation apps. I really.

thought meditation was woo-woo and. not. anything that, you know, I I would just. sit there and and my brain would be. bouncing all over the place. But once I. went through menopause and suffered so. horribly from the mental. side effects and the death, you know, all of this happening at once uh to me. with my brother's death, aging parents, teenage girls in the house, you know, and realized something's got to give. And so, I hired like a counselor, you.

know, I went to therapy. And she. recommended um. getting an app to help guide me through. meditation and that has really turned. the needle for me. Really? Yeah. How? I you know, carving out that it's just 5. or 10 minutes in the morning to. think of what I'm grateful for, focus on. that gratitude, you know, and I love. teaching that to patients and to my. followers of of really putting yourself. first, you know, the thought of you have. to put your own oxygen mask on first.

before you can go take care of your. family and all the other things on your. plate. And just. giving my brain that time to just relax. and let it flow and just let the. thoughts, you know, and just focus on on me for that. That's. really made a huge difference for me. What role does sleep play in all of. this? So, sleep disruption is massive massive. massive in perimenopause and menopause. And. when we don't sleep we see everything. I.

I tell patients if you're not That's the. thing we need to work on first. We need. to get you sleeping because nothing's. going to work until your body is able to. restore itself. That's when we That's. when we build muscle. That's when, you. know, our our brain resets. That's when. our our whole body, you know, and if. you're having disrupted sleep. and you're waking up at 3:00 in the. morning and your brain is racing, I. mean, everything is worse. Your cortisol. levels spike, your insulin resistance. goes up, your, you know, everything gets. worse. And so, when my patients come in,

we focus on sleep first. and nutrition pretty much. And if Easier. said than done though, right? Sleep. If the estro. if their sleep disruption is due to. hormones, then it's such an easy fix. I. just give them back the water they were. drinking and they sleep again. Where the. struggle is if someone's never been a. good sleeper, then that's probably out. of my area of expertise. I'm going to. send them to a sleep medicine. specialist. One of the things that we. now see a correlation is a sleep apnea.

even in a thin patient in menopause in. women. We're seeing a big bump in the sleep. apnea rates in women who are um. they don't even have to have a weight. problem. And what is sleep apnea? That's when. people. So, sleep apnea is when you stop. breathing. um or you snore quite a bit. You you see. the palate relaxes and you're not. getting as much oxygen, you know, into. the body and into the brain. It's a big health risk. And what is your. personal sort of exercise regime? What. do you So, you know, I came from the. long. the 20 years of just trying I was.

exercising to be smaller. Mhm. And now I'm I'm moving to be stronger. And so, now I'm doing resistance. training. So, I have a treadmill that I. set up on an incline. Um and I do a lot of Zoom calls there. I. do lots of meetings there. So, when I'm. working from home and and working on the. Galveston diet or the new book, I'm. doing on my treadmill but at an incline. So, I'm really working on my legs. I. will wear a weighted vest so that I'm. getting the upper body. So, I'm doing. this for bone density. Um, I'm doing a lot more lifting than I. ever ever ever did in my life because I.

have a body scanner in my office. I have. sarcopenia. I have a genetic low I'm. very thin individual was not blessed. with a lot of muscle mass and the fact. that I focused on being thin for so long. and that was my social currency is you. know I was thin I was healthy. Probably I've lost you know I lost that. that window of opportunity to gain more. muscle easily in my 20s and 30s. So what. I what I would tell my 35-year-old self. what I preach to my daughters is. focus on being strong, not small. You know, muscle strength over skinny.

And so the muscle mass that you develop. now is going to serve you so much more. than the lack of fat or this perceived. lack of fat that you think you need. Um, don't worry about the curves that you. have. That's that's natural. That's. that's the way you're built. Let's get. some muscle. And what about your diet? So what my personal. Yeah, yeah, yeah. Eating eating window I. think you talked about. So I tend to um. I break my fast at around noonish. typically. If I'm hungry before if I'm.

traveling or you know on a plane I don't. do well on a plane without food. And so. but on a normal day when I'm like going. to clinic and the night before is when. my diet starts. I will pack up my meals. and snacks that I'm going to take to the. office with me when I see patients. And. so I know what I've got. I'm doing you. know I'm loading up on protein. I'm. doing something green, some kind of a. green veggie. I'm doing lots of fruit. I've got nuts and seeds. I eat nuts and. seeds all day long um for the.

anti-inflammatory benefits and for the. healthy fats and for the fiber. And so. I've got all that. So I break my fast at. about noon and then between patients I'm. constantly snacking. I'm really focusing. on protein for myself. I don't have a. weight problem. Um and so I'm trying to. get stronger and so my protein needs. have really increased and so I'm. sometimes doing a protein bar or a shake. middle of the day um to help with that. and then in the evening now we're empty. nesting so it's just my husband and I. And so he you know we'll kind of discuss.

what do we have in the freezer or we'll. pull out some salmon or you know we'll. we'll make some I don't know uh. burgers or something and um you know we. try to be protein centric and then we're. adding in like a beautiful salad with. lots of avocado and chickpeas. um. on the side. So I think I covered it. all. Yeah. So I'm typically done eating. by 8:00 p.m. Um. if it's an office day I'll either. exercise when I get back. I'm struggling. to get up I do a lot of great work in.

the morning so it's hard for me to get. to the gym and the office. So I'll save. my workout for when I get home from. work. If if you had a a megaphone and. you could speak to every woman. right now the 1.2 billion. that we talked about earlier that are in. that perimenopausal or or the menopausal. phase or postmenopausal and you had to. communicate one message them. I'm. actually going to bring in everybody. else as well because although it's just. those women I've mentioned. everyone around them in their life. probably needs to hear some somewhat. similar message so they can play. supporting roles in that individual.

struggle. What would you say down that menopause. to those women and the the loved ones? So my mantra is menopause is inevitable. Suffering is not. But you're going to have to advocate for. yourself because society has failed us. Our medical system is is built to fail. the menopausal woman. And there is good. help out there. You're going to have to. do the legwork. I've got tons of. resources on my website to help you. You know, list of articles to print out.

and hand to your doctor, system you know. um. uh symptomatic sheets that you can like. keep track journals that you can hand to. your physician. Um any way that I can help you advocate. for yourself cuz I can't be everyone's. doctor. But that this is real. You're. not crazy. This is happening and there are lots of. things that we can do even non-hormonal. Don't feel like if you're not a. candidate for hormone therapy that. you're stuck. You know, exercise, nutrition, other pharmacology, stress. reduction, sleep. It's time to take care. of yourself first so that you can have.

the best end of your life that you. deserve. In 2023 I launched my very own private. equity fund called Flight Fund and since. then we've invested in some of the most. promising companies in the world. My. objective is to make this the best. performing fund in Europe with a focus. on high growth companies that I believe. will be the next European unicorns. The. current investors in the fund who have. joined me on this journey are some of. Europe's most successful and innovative.

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favorite products from Huel including. the black edition salted caramel flavor. which is super high in protein and has. 17 servings per container. My favorite. Huel bottle here which comes with my. bundle and also the brand new and very. exciting Huel complete nutrition bars. This is chocolate caramel. You can see. from the empty box in front of me that. I've eaten most of them right? Me and my. team here. If you leave these on the. counter for 5 seconds they'll go. I'm. going to say something I've never said. When Huel first made their bar many many. years ago I tried it and I didn't like. it. So I've never talked about it on.

this podcast. They've spent roughly the. last two to three years making a brand. new bar which I absolutely love and. that's why I now talk about it because. it's a product that I eat. If you want. to order them yourself and get started. on your Huel journey the link is in the. description below. In this podcast. episode wherever you're listening to it. there'll be a Steven's bundle link and. check it out. Back to the episode. Your family have a history of health. complications and illnesses, right? Yeah. What is that history but also has. that played into your overarching. perspective about.

nutrition Yeah. the health care system, how it treats people? So my I'm one of eight children. I have. six brothers and um my oldest brother. Jep died when I was 9 years old from. acute lymphocytic leukemia, one of the. most common forms of childhood leukemia. Now the cure rate is 95%. and but at the time he was put into. remission and then he came out of. remission in his late teens and died. like a year and a half later. So my childhood was.

that that year and a half was all about. trying to save him. And everything my family did of taking. him to Memphis which was so far from. Louisiana where I grew up to St. Jude's. Hospital. the last ditch effort to try to you know. find another chemotherapy regimen which. he failed and that kind of kind of drove. me but you know it was it was leukemia. It was childhood. It was one of those. things. Fast forward to 20. He died in 2015 so 2010 my brother I. knew had HIV and um had also contracted.

hepatitis. And he was doing great on his HIV meds. Um his counts were good. He was healthy, functional. He'd been with the same. partner for over 30 years. But then his. his liver was getting worse and worse. and worse. He also struggled with alcoholism and so. that kind of combination. was really hard to watch and love him. through his choices, you know. And uh he. ultimately died in 2015. He had a stroke. and then I was able to go do his end of.

life care. And the first book I wrote um. I talk about him in the book because. in my rush to deliver his care I forgot. my own and that's when I realized I was. menopausal was through my grief process. I thought I was grieving. I gaslit. myself. Like no no no you're not sleeping. You're you're waking up all night. You're you know upset and your mental. health and your brain fog is all because. you're just grieving his death. And then um my next brother Jude uh was. diagnosed with stage four esophageal.

cancer. Um. shortly. uh he was diagnosed when Bob died and. then he survived a few years. Um so. Bob died at 56. and Jude died at 57 and I'm 55. And. I don't you know I know a lot of it was. lifestyle but I still have those. genetics and I'm about to survive three. of my six brothers. And um. out through outlive. And I know that.

these choices that I make with my. nutrition, my exercise, my sleep, my. stress reduction, what I call the. menopause toolkit, you know, and my. choice for HRT. are all I want to see my grandkids one. day. If if I'm lucky enough to have any. I want to watch these women I've raised. grow up and you know be the women. they're meant to be and that choice. might get taken away from me if I'm not. careful. So you know a lot of what I do. and why I do it is. because I have to. I may not get the. choice.

What an incredibly important mission. you're on and what incredible work. you're doing. Um. because there are as we've talked about. there's been a a group of people in. society that have. kind of been I guess disillusioned but. they've also must have felt incredibly. isolated in their experience and what. they were going through. And it seems. that there's been a real shift in recent. times towards the conversation around. menopause and hopefully these. conversations if anything at all will. dismantle the stigma which is often the. first sort of wall that needs to fall.

for people to be able to take action and. have those conversations. And it just speaking from my own. experience, I didn't really understand. what any of this stuff meant until I. started doing this podcast and I had the. first couple of guests on and then. someone said the word menopause to me. and then we started having a. conversation about it. And I go, "Oh my. gosh, like you know, maybe when I was in. school someone should have told me about. this phase of life. We talk about how to. get a job, but it seems to. fall off, you know, the education system. seems to stop caring once we've had kids.

almost. That's what we're experiencing. here as well. It's really really crazy and the work. you're doing is so unbelievably. necessary and what I love about the way. that you you write and how you educate. people is it's so science-based but it's. so accessible at the same time. That's. always been my superpower, I think, is. and I realized that very quickly in my. career was that I had this knack of. being able to take something really. complicated and break it down into terms. that people could understand. Mhm. That, you know, most people would be able to.

grasp and walk away from. And you have. nuance and empathy which is the. necessary ingredients when you're. talking about subject matter like this. where everyone's symptoms are typically. quite different from one another and. they will have different circumstances. We talked about other, you know, conditions and contraindications that. might be complicating things. Um. and you seem to have a really wonderful. empathetic view on all of those things. and a real appreciation that everyone's. circumstances are entirely different. Um. I'm excited and I'm really looking. forward to having more conversations.

like this and learning more because. although I am a 30-year-old man, I have a partner that I love. Mhm. Um I. have a mother that I love. I have an. older sister that I love. My sister is. my partner is 30 as well. My sister is. 36. My mom is. 60 now. Nearly 60 now. I I challenge you to have. this conversation with her and ask her. about her experience. I really applaud all the and I don't. know whether I should say this or not, but I really applaud all the men that.

got to this far in this conversation and. chose to listen and have an appreciation. that. the betterment of 50% of our population. who are going to go through something is. the betterment of all of us. Exactly. Um. and that they also have a role that they. can play in being a support and. encouraging and having the conversations. that will bring down the stigma and and. the suffering of what is currently about. 1.2 billion people but will be 50% of. people in our population. So, I highly recommend everybody goes and. checks out both this book which is the.

Galveston Diet but also can we pre-order. the upcoming book now? Yeah, it's available for pre-order. wherever you buy books. And you'll think. it'll be out in 2024 in. For sure. And. the latest May. The latest May, okay. And that's called the New Menopause so. you can pre-order that now wherever. wherever um you get your books and. that's the culmination of many decades. of very very hard work. So, I'm very. very excited to read through that myself. and the Galveston Diet book is out now. as well. It's been out for a little. while. Um we have a closing tradition on.

this podcast with the last guest and. also your website is an incredible. resource for all of this all of the. things you talk about, right, and your. social channels, etc. We have a closing tradition on this. podcast where the last guest leaves a. question for the next guest not knowing. who they're leaving it for. And the question here is. you get one last conversation. with somebody you love, a child, maybe. your husband, maybe someone else. What you say to them in that. conversation. that maybe they haven't already heard?

I love you. There's nothing more than love. I've had done it. three times with my dad, too. My um. Bob and Jude were five years apart. My. dad was shortly after Jude. You know, and watching my parents bury three kids.

was a lot. Um. just love. Thank you. You're welcome. Thank you so much. Quick one, I discovered a product which. has changed my life called Eight Sleep. and they are now a podcast sponsor. You. guys have probably figured out by now. that I'm pretty obsessed with optimizing. my health and specifically my sleep and. I think my sleep has been a bit of a. personal revelation for me, the.

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