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in 2023 85% of women are complaining of menopausal symptoms 10.5% are receiving treatment or therapy I mean it would be
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as if your testicles shoveled up in diet at 51 that's the equivalent let's get started Dr Mary CLA Haver renowned
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menopause expert with more than 2 million followers helping countless women through their menopause
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experiences menopause is inevitable suffering is not but a woman is more likely to be prescribed an
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anti-depressant for her menopause than hormone therapy women by the thousands are like oh my God I had no idea that's
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when I realized no one's talking about this so here's their laundry list of symptoms we've categorized about 70 so
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there's brain fog changes in her sexual function weight gain but here's the scary things and the studies have been
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done we see either a new onset or worsening of depression anxiety bipolar
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ADHD risk for cardiovascular disease and diabetes increases recurrent urinary tract infections which is a major cause
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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
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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
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away from me if I'm not careful but there's lots of things that
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we can do for example we see a dramatic loss of muscle mass focus on strength training this is going to determine your
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longevity as you age strength over skinny what about your diet I developed a program for my patients and it's not
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rocket science it's whether you're a man or a woman menopause is going to affect you because
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it's going to affect 50% of our society and there is
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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
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answers how do we help how do we talk about it what is it how does it affect
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the human body if you're in a relationship with a woman that's in per menopause which can start at 30 up to a
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woman that is currently going through menopause in her 40s or 50s or 60s what
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should you do to support her what can she do to support herself this subject
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of menopause has exploded in public conversation thankfully but there's
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still so many unanswered questions and that's why today I invited one of the
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leading voices on menopause globally onto my show even as a man that won't go
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through menopause myself but has a partner and a mom that certainly will
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there's something that everyone can learn from this and I implore all men who maybe clicked on this episode or
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were sent this link to listen please just listen because you can learn
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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
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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 you you
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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
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thank [Music]
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you Dr Mary CLA Haver why' you do what you
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do you know I started out in medicine the way most people do I wanted
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to help people and in our training in school we get to have a little taste of
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all the different Specialties and my very last rotation in my third year was
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OBGYN and I really liked surgery I really liked some of the surgical sub
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Specialties so I thought that would be my path but then when I delivered my first baby and all that Rush of emotion
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and dopamine and how beautiful that whole process was I knew that that was going to be my calling and so I did the
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traditional four-year residency and loved it and really did well and went
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into private practice um after about three years of doing the Private
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Practice route I realized I missed being an academics I wanted that ability to do
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research and be around students and teach as well as take care of patients so I went back on his faculty and
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everything was going great I was very successful I was you know doing psmears and babies and birth control and all the
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things the traditional OB gen does and then I was aging as my patients were
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aging too and when I got to my 40s I
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realized that there was a big gap in my education and knowledge around menopause
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so I started researching most of my patients were coming in the pain point was weight gain and they were like I'm
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not doing anything different I'm working out I haven't changed my diet and that
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little voice in my head was like work out more less you know we tend to move less we tend I was just going
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with the script that had been handed to me for years that calories in calories out is the only way and you know in
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medicine in the US we have very little background in nutrition we learn nothing in medical school very little in
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residency as far as what nutrition actually is and how it can affect our
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bodies and so I started struggling with my own menopause my patients were all
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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
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gain was mostly centered around the midsection and I was learning about viseral fat and subcutaneous fat and the
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differences and what's going on with our muscle mass and I'm like there's a much bigger picture here than just calories
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in calories out so in my I enrolled at tulan University in their culinary
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medicine program and just my mind was blown by how much I didn't know as far
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as nutrition and inflammation and aging and and how it all affects but where was this menopause piece and so I took
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everything I learned and I developed a little program for my patients um which became the Galviston diet and it really
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was just a passion project for me and then I started talking about it on social media and realized that as my
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social media presence grew and the conversation got bigger and bigger that there were so many women suffering
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probably the majority of women in menopause were suffering not just from weight G pain but from muscular skeletal
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issues mental health brain fog you know skin Changes hair changes nail changes
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and I just kept doing deeper and deeper Dives and realizing no one's talking about this no one's talking about the
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multi-organ system you know failure that a lot of women are going through and
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they're suffering in silence and Physicians aren't helping we're not trained and so I thought and my it's
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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
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with us and then um the other is 20 and they were like Mom you've you've got the
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social media presence you really need to use it for good and that's kind of where
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that conversation exploded for me on social media and where I realized by reading the comments what a much bigger P you know
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what was really happening in the menopause world and how we need to bring it to the Forefront for people that
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don't understand menopause um they might think it's that it's a small issue affecting a small group of
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people but how many women are are affected currently by per menopause menopause and postmenopause sure so
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right now about a third of the female population of the world is in Perry full
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or postmenopause um you do not it's not optional all of us go through it and
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because we have such individual expressions of how it affects our bodies what we know now is that there are
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estrogen receptors in every organ system of our body and when those levels start declining we see
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a very wide variety of a spectrum of of syndrome where it used to just be thought it was a few hot flashes and
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some night sweats maybe your sleep's disrupted your genital urinary system is
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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
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health our capabilities our skin our bones our kidneys you know vertigo ttis
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frozen shoulder anytime I post about those on social media the internet explodes and women by the thousands are
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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
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been dismissed for so long and told it's all in their head and if we think about from sort of Perry to postmenopause what
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is that sort of typical and I know that's a tricky word to use but what is the a sort of average typical age range
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and then also what is the sort of more um possible age range so it could start
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between this age and this age so in the US and in most of Europe the average age of menopause which means one year after
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your last menstrual period is 51 par menopause which is when your body
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recognizing recognizes there's some declining estrogen levels and you're beginning to be symptomatic can start 7
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to 10 years before that so normal menopause is still 45 to 55 MH and so if
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you do the math and back that up 7 to 10 years it is completely reasonable for a 35-year-old woman to be begin to
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experience some of the symptoms of per menopause so let's start with what is it
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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
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fle so we're going to talk about gonads right what's goads gonads are um where
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our so in men it's the testes okay and where you're making your genetic material to you know where you're making
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sperm right and in a female it's going to be ovaries M her ovaries so the
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difference big differences between male and female and how that process happens is that males make their genetic
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material fresh constantly the minute they go through puberty until basically they die unless they have some medical
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issue females on the other hand our eggs develop while we're in utero and our
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mothers so while we're in the womb we're she's five months pregnant with us we have our maximum eggs that we're ever
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going to have and those are meant to last us until we go through menopause and so they lay dormant until we go
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through puberty and then they wake up again and we start ovulating so we have this monthly and a healthy person
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cyclical you know hormones rise and EB and flow with our cycles each month we have a period you get pregnant you don't
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get pregnant the whole process starts over again well because we're born with that egg supply through time we're
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decreasing the amount and the quality of those eggs so when a woman hits the age
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of 30 um she she is down to about 10% of the egg supply that she had at Birth and
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when she's 40 it's down to about 3% and so and it gets harder and harder
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for that EB and flow of the natural hormones to do its job and we start seeing fluctuations in her periods and
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then organ systems that are beginning to notice the lack of estrogen estrogen is a really powerful anti-inflammatory
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hormone and most of our body system so the muscular Skeletor syndrome of menopause is really starting to be
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talked about quite a bit now and we're looking at things like frozen shoulder aralas generalized aches and pains and
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most Physicians aren't aware of this you know most know about hot flashes and night sweats and sleep disruption but
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now that we're really opening the conversation as to how many organ systems are affected we are seeing
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people coming out of the woodwork just so happy to know that they're not crazy and they're being validated and what's
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happening at these sort of three stages so so we have the per menopausal stage which is from what I've understood there
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when estrogen levels start to drop right so we start seeing disruptions in the
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force so instead of that nice monthly estrogen surge with ovulation and then the progesterone goes up we start the
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elongation sometimes or they even get closer together I call it the zone of chaos what used to be a very
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reproducible dependable system starts failing so some women will have irregular periods meaning they're
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spacing out they skipping periods other will have really heavy periods like like
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you know hemorrhagic almost um and again individual um the way the body reacts to
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this is very individualized from Patient to Patient doctors love something that follows a list a
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checklist right you know we have all these complicated things we have to learn and we have these checklists but
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menopause it's like pinning the tail on a moving donkey and in per menopause the it's very very chaotic estrogen surges
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then it goes away for a while like a woman and per menopause can feel completely fine for a few months everything goes Haywire then she's fine
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again you know and not only is her estrogen declining her testosterone is declining as well so we're seeing loss
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of muscle mass we're seeing changes in her sexual function we're seeing decreased strength you know there's some
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some really good studies showing how testosterone also affects our mental health and our cognition as well why
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does this happen from a sort of like an evolutionary or so the anthropologist
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have looked at this heavily and there's we're there's only a couple of species in the world that go through menopause
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humans are one there's a species couple of species of whales and I think they've now discovered one of the giraffes
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species of giraffes can do it but the by and large most mammals will die while
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they're still ovulating you know like they're not going to go through a menopause um and so there's something
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called the grandmother hypothesis where there was an evolutionary Advantage for women to survive if she stopped the
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ability to have children at some point now again you have to temper this with
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humans have prolonged their lifespan and their health span because of modern medicine so probably when we evolved we
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weren't living this long you know a woman my age was pretty rare I'm 55 and
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so you know it it's hard to say I think we have outlived how we were genetically
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built and so we're living longer and being forced to like deal with the consequences of that so so then the next
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stage is menopause MH and so menopause itself is really that it's just really
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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
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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
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confusing because what if she's had a hysterectomy or doesn't bleed because of a surgery or an IUD or something well
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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
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in her menopause journey and then postmenopause is the rest of your life you know the hot flashes might go away
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night sweats might go away brain fog might get better but pretty much everything else is going to continue to
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progress in a very linear fashion until you die without estrogen replacement to
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put it lightly you seem somewhat dissatisfied with the current set of answers that um the medical field but
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just Society at Large are offering for women in the sort of per and post and
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menopausal phase of their life and I've sat here with a lot of women who are experiencing menopause at one stage or
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the other and they also seem to be at a loss for answers um I was sat here two days ago
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with um a very very successful woman who you know has all the resources in the world and she basically and and this is
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someone that has all the answers people come to her because she has has the answers and the one thing she doesn't seem to have answers on in her own words
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in her life at the moment is menopause she's rummaging around the internet Googling things finding contradictory
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information and when you sat down you you you had that same energy like you feel like women have been dare I say let
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down by a system I think the medical system is letting them down I think Society is letting them down our our
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value and our worth in medicine you know I came through this wonderful training program
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I'm very proud of what I learned I'm very proud of the care that I gave except I was a horrible menopause
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provider for probably 15 years I knew what I knew I relied on my training and
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I didn't look outside of the traditional confines of training this is such a systemic problem
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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
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said because I think it really highlights how women are treated in
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medicine um when I was in training we had these upper level residents so we
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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
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um to take care of patients and so we have Obstetrics and we have Gynecology as like divisions in our training so in
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Gynecology everything gets lumped together Pediatrics menopause we had no specific menopause Clinic I maybe got
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six hours of lecture in a four-year curriculum and so have these women coming in in midlife and they had
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multiple complaints they didn't feel good they weren't sleeping they were gaining some weight they were you know
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aching they you know just this laundry list of things that were a little on the vague side
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and my upper levels would say oh gosh good luck with that you've got a ww on
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your hands and that was code we never wrote that in the chart this was not taught to me by faculty this was just
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kind of a handed down in the lure of training and a ww was a whiny
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woman and that was code and now I know that she was Perry menopausal suffering
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from her list of symptoms of now which we've categorized about 70
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and they're they they were frustrated because they they didn't think they could help her now remember the Women's
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Health Initiative which was a study that was supposed to do a lot of good for women it was originally designed um and
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it was stopped in 2002 that was the end of my training program was 2002 so I'm I
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come from one of the last groups of physicians in the US that were ever trained in hormone replacement therapy
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and then it the rug was pulled out from under us so the Whi there were mistakes
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there was misinformation in the reporting and there was a misinterpretation of the results all of
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that has been walked back relooked at we know that for the vast majority of women hormone replacement therapy is safe and
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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
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for the vast majority of women recently I just saw the numbers 85% of women will
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come in with complaining of what we know now this was in 2023 FDA looked at the
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numbers 85% of women are complaining of menopausal symptoms 10.5% are receiving
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treatment or therapy today is there something in you that feels somewhat even though you're doctor
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somewhat let down by the medical system um or skeptical about the medical system
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for personal reasons I yeah I I'm one of those women you know I thought I'd be
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one of those girlies who would just Breeze through menopause because I was thin and I was you know thin meant
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healthy I still you know that mentality was alive and well when I trained and through most of my practice I I I came
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through a very fat phobic you know uh training and medicine as a as a whole is
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very um biased against weight people's weight and
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so now that I've done a deep dive into nutrition and done a deep dive into menopause and really sat there and
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listened to patients and realized that you know women who were gaining weight
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with menopause you they've done nothing different they're still exercising they're eating the same the only thing that's changed for them is their
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hormones and they're being categorically dismissed at multiple doctor's visits or Worse here's their laundry list of
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symptoms the root cause is menopause but it's not recognized and one medication could have
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taken care of everything but they're going to seven eight nine different Specialists on seven eight nine different medications to handle each
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symptom whereas all they needed was just to get her hormones back and she would
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feel amazing and be able to you know age the way she should when we talk about
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the potential um Health implications of women that are going through menopause
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it's not just ww right it's much more um
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that's how she feels though and that's how she's categorized probably by people around her but the There's real Health
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consequences and life altering Health consequences lifespan reducing Health consequences yes what are those so we
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know that a woman's r and and the studies have been done it's not just aging of course aging plays into this
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but when you add in menopause as an independent risk factor her risk for cardiovascular disease
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increases her risk of diabetes increases her insulin resistance starts going
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haywire immediately your your listeners and your you know people who watch on
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YouTube will be shocked I'm going to say how many of their cholesterol levels shot up in their 30s and 40s with no
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changes in diet and exercise you know we see cholesterol levels changing skin
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hair teeth the dental changes the inner ear changes the vertigo is incredible
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the frozen shoulder is Legion um whato frozen shoulder frozen shoulder is an
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adhesive capsulitis of the shoulder joint and it is very common in menopause
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so estrogen has this amazing anti-inflammatory effect especially in our bones and joints and muscles and
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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
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over the bone where the muscles attach becomes encapsulated and adhesed and stuck and so you have to get in there
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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
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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
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your arm above here that's one of the one of the studies that I you know presented a lot
00:22:59
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
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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
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they know this is something that it's not your fault you didn't do anything your just estrogen levels dropped which
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led to increasing inflammation in those joints and is have they seen that there's a a reduction in lifespan in
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women that go through menopause that aren't treated in a certain way so we know that um women on HRT have a lower
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all cause mortality what's HRT hormone replacement therapy or menopause hormone
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therapy so in the studies that have been done the observational studies and in the Whi women who were on
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hormones um especially beginning early in their menopause okay so
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estrogen there is a win of opportunity for reduction of some of this burden of disease and it is very in starting in
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per menopause or within the first 10 years of your menopause that's the sweet spot for being able to decrease your
00:24:05
risk of diabetes decrease your risk of cardiovascular disease and dementia when
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we go beyond that we start losing those benefits because estrogen is better at prevention than cure and so my my
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medical school daughter was like Mom I'm never going to be without estrogen I'm going to start in Perry menopause like
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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
00:24:30
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
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estrogen Supply we just support all starting in Perry menopause you know offer it to all women not all women will
00:24:42
choose it and I support that but you know we're not having the conversation and they're not being given the choice
00:24:48
so what age with your daughter would you advise her to start uh hormone
00:24:53
replacement therapy if she so chooses so I would say um we start checking levels
00:24:59
and we start looking probably in late 30s certainly if she starts having any symptoms out of the normal you know
00:25:05
she's living her best life you know doing all the right things for her health and all of a sudden she's not
00:25:11
sleeping well or she's having aches and pains or she's noticing you know changes in her body most women can tell you
00:25:17
something was wrong I couldn't put my finger on it but I knew that something in something in me had changed and I
00:25:23
wasn't responding to things the same way you know their mental health had changed or you know the way their gut had
00:25:29
changed their gut health you know just just there's barely an organ system that's not affected by this I sometimes
00:25:36
wonder because you know there's the person going through it and then there's those around them and they might know
00:25:42
themselves that something's wrong the person that's going through per menopause or menopause but the people around them won't understand typically
00:25:49
what's going on with that person so they'll they might do their old ww thing that's you know or they might label them
00:25:55
something else they might misdiagnose it as another man Health predicament I remember a woman in my life who went
00:26:01
whose Behavior changed around this age and I didn't know about per menopause or menopur it's in hindsight now that I
00:26:07
look back and go oh my God everyone around this person thought they had bipolar or something right I mean it it
00:26:17
it's probably contributing to divorce rates maybe in a good way you know at this time I I one of the positive things
00:26:24
I see about menopause is that when women are cutting the things in their life
00:26:30
that don't make sense anymore they're not putting up with you know as a society we tend to take on everyone's
00:26:37
burden and um you know take on the emotional labor in a lot of relationships take on the organizational
00:26:43
labor and I see because they're struggling so much with just staying afloat they're able to just quickly say
00:26:51
no I'm not doing this anymore you know you need to pick up whichever relationship they're in you you need to
00:26:57
pick up your your end of the bargain here you know I can't do all of the organizational labor the emotional labor
00:27:03
and I've I have a patient who's a divorce attorney and she said I really think a significant percentage is of
00:27:11
this divorce is menopause and either they're prioritizing what's important to them or they're not getting the support
00:27:18
that they need and how can we give them the support that they need so I think it's important
00:27:25
that we talk about it I encourage every single patient I have all my followers on social media tell your story tell
00:27:33
your story to anyone who will listen tell your daughters tell your nieces tell your sons tell your loved ones like
00:27:39
make this a normal part of a conversation so that we see it coming we
00:27:44
understand what might happen and that no one feels crazy and alone when they're going through it and then we need to do
00:27:52
a much better job in our medical system of providing support for these women in whatever way they need it hormones non-
00:27:59
hormones cognitive behavioral therapy you know there's lots of things that we can do not just hormone therapy is not
00:28:05
the Cure All for everything we have to support the whole toolkit right we have to prioritize our sleep get the exercise
00:28:12
that we need focus on strength training when a lot of us in my generation never did that we were aerobics you know
00:28:17
focused on being thin and small it's time to be strong you know this muscle
00:28:23
mass that you have is going to determine your longevity and your functionality as you age and menopause is you know that
00:28:29
loss of estrogen and testosterone is tearing our muscle units apart which is leading to osteoporosis as well I want
00:28:37
to go through that whole to toolkit um but I also want to just before we move there understand why women don't
00:28:46
sometimes communicate that they're going through per menopause or menopause what is the is there a stigma Associated we
00:28:52
talking about it yeah I think there's shame and stigma associated with aging with Fe females aging and then you're
00:28:58
you're layering on this loss of fertility and in the medical field when you look at funding in the US for
00:29:05
research studies Women's Health like I think it's 55 billion the National Institutes of Health in the US you know
00:29:10
for all research studies and that's outside of what Pharma is funding and
00:29:16
Women's Health gets about 15 billion and the majority of that is spent on getting
00:29:23
people pregnant keeping them pregnant you know and fertility issues menopause
00:29:29
gets I think 15 million Jesus Christ yeah it's like 0.03% if I did the math correctly
00:29:38
of all F you know are we not as important as we were when we were fertile does do our lives not
00:29:46
matter it's ridiculous to me when we can intervene and help and have give these
00:29:51
women a longer life and a better quality of life and how many women is that I know we said it as a fraction earlier on
00:29:57
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
00:30:04
there's what 47 million new entrance into the sort of per menopausal
00:30:10
postmenopausal category every year 1.2 billion billion right and H and so many
00:30:17
of them have no education at their fingertips have nowhere to turn are you
00:30:22
know 85% are going in to their Healthcare provider's office complaining help me
00:30:27
and being turned away and leaving with more questions and answers and only 10% are even having the discussion for
00:30:33
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
00:30:40
convinced they're going to get cancer and that that study's been completely dismantled and walked back we have good
00:30:46
information that came out of that study but you know the the pro the the thought that estrogen causes breast cancer is
00:30:52
the worst thing that came out of that study because it's not true the mental health implications as
00:30:58
well I really want to get into the the hormone replacement therapy and all that stuff but the mental health um implications for women do we see an
00:31:04
increase in depression and those and the consequences of depression I guess depression anxiety bipolar um the entire
00:31:13
Spectrum ADHD so we see either a new onset or worsening of disease so I'm
00:31:20
telling my patients or I'm telling people on social media you may have done fine and done well with your depression
00:31:25
on your SSRI don't be shocked if it is no longer working at that level you
00:31:31
either have to increase the dose so no one right now is advocating for Primary
00:31:37
Therapy of depression to be estrogen replacement but we do know from the
00:31:42
studies that it is an very powerful adjunctive tool and that it can be preventative for new onset depression if
00:31:49
you start in Perry menopause women who start hormone therapy and per menopause have a lower incidence of new on set
00:31:54
depression in their menopause suicide it so I've looked at these numbers and
00:32:01
it CO's kind of skewing things because we did see increased suicide rates but we definitely see an uptick uh
00:32:07
especially in Caucasian women not so much in women of color uh in the US in the per menopause and menopause time
00:32:14
frame inflammation what is what is inflammation sure so inflammation um
00:32:20
there's there's it's there's chronic inflammation and there's acute inflammation so acute inflammation is
00:32:26
what we need to survive it is the body's reaction to a foreign Invader basically
00:32:31
or to an injury or an illness so you twist your ankle right and so we injure
00:32:37
that tissue these uh chemical Messengers are spread from the injured tissue which basically tells our immune system sin
00:32:44
blood that way send the the you know white cells and the red cells and you know all the cells that are going to
00:32:49
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
00:32:57
inflammation also happens when we get viruses and other illnesses chronic inflammation is this lowgrade kind of
00:33:03
under the radar inflammation that's happening in the background so autoimmune disease is a lot of chronic
00:33:09
inflammation but we also see aging itself you know we can't change the fact we're aging but menopause dramatically
00:33:17
increases the amount of chronic inflammation that a female will go through just based on the lack of
00:33:23
estrogen and testosterone in her body I'm trying to figure out why the lack of estrogen um and the droing estrogen
00:33:29
causes inflammation so it turns out estrogen is a really powerful anti-inflammatory hormone so we're just
00:33:34
like removing that protective blanket and now you're you're just aging faster
00:33:39
because of it ah okay so we need to make sure that we reduce inflammation by any
00:33:45
means necessary and that was the sort of the one of it was the second component of the galison diet anti-inflammation
00:33:51
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 or
00:33:58
choose in a supermarket sure so I try to teach the principles in the form of let's add things in rather than restrict
00:34:04
because then we get into eating disorders and so what keeping tabs on your added sugars keeping those less
00:34:10
than 25 but fiber and that's one thing most people are not paying attention to how much fiber are you getting in your
00:34:16
diet per day and most women are getting about 12 grams per day and the minimum
00:34:22
we should be getting is 25 vitamin D is another huge one about 85% of my
00:34:27
patients and women in menopause are vitamin D deficient not just low I mean deficient we are protecting our skin
00:34:34
against sun damage of course we're staying indoors more we're on our screens all the time but we're also our
00:34:39
guts changing and our ability to absorb vitamin D is decreasing so making sure that you are checking your vitamin D
00:34:46
levels regularly and supplementing when you need to or eating foods rich in vitamin D that's another one and does
00:34:51
vitamin D reduce inflammation yes okay so vitamin D is a it's it's a vitamin but it's also a hor hormone and it has
00:34:57
multiple functions in the body and so vitamin D deficiencies are linked to lots of chronic diseases you're more
00:35:04
likely to have hypertension diabetes stroke you know all of the top seven of 10 causes of death in women and so
00:35:11
keeping those low it's also mental health you know lots of vitamin D receptors in the brain and so you know
00:35:17
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
00:35:23
or doctors that I've spoken to on this show have spoken about five especially in the last like six months you know
00:35:29
people historically speak a lot about protein and all these kinds of things but for some reason everyone seems to be
00:35:35
talking about fiber all of a sudden so fiber does lots of things for us it slows down uh the absorption of glucose
00:35:43
into the bloodstream so that keeps our insulin levels lower over time it feeds
00:35:48
our gut microbiome soluble fiber so there's two types of fiber they're soluble and insoluble so insoluble is
00:35:53
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
00:36:00
gut and kind of moves things quicker through the colon soluble fiber dissolves in water that's the Cloudy
00:36:06
part that is the food for our gut microbiome that is the Prebiotic you don't need a Prebiotic if you're getting
00:36:12
enough fiber in your diet per day and so keeping that gut microbiome fed and healthy and happy is going to do a
00:36:19
multitude of things like that kind of data is exploding right now in the research world as to where the gut
00:36:25
microbiome how to keep it healthy and what organ system it affects um our our
00:36:30
gut microbes make these things called oxy butat which are then absorbed into the bloodstream and and people who have
00:36:36
high levels of oxybate are actually healthier and have less coronary artery disease less dementia less less
00:36:41
everything so really nutrition when I talk about the menopause toolkit hormone therapy is just one very
00:36:48
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
00:36:54
nutritional basis the way you should and what are some sort of fiber dense or fiber rich foods that are in you know
00:37:01
every Supermarket avocado chia seeds nuts berries your cruciferous vegetables
00:37:08
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
00:37:15
in uh lean meats uh or any so it's going to be your fruits and veggies and seeds
00:37:21
and nuts asparagus tomato spinach celery uh asparagus celery yes tomato nuts so
00:37:27
much just think of things that you know the crunch is usually from the fiber okay fasting MH I'm a fan it's not
00:37:36
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
00:37:43
things that will undo the goodness of fasting in your eating window if you're not careful and so um the there's good
00:37:51
data though on neuroinflammation and fasting and on systemic inflammation and fasting so so I recommend fasting for
00:37:58
the systemic inflammatory benefits and we do see some really nice lowering of
00:38:03
insulin levels overall from fasting there's so many different types of fasting people talk about so when I'm
00:38:10
teaching fasting to my students or to my patients I recommend the 168 so that's
00:38:15
where Mark matson's data so that's 16 hours of fasting in a row followed by about an 8 Hour eating window now for
00:38:22
other you know again it's individualized some people do with a 14-hour fast you
00:38:28
know a 15 hour fast 16 is just kind of something to shoot for and if someone's going to consider incorporating fasting
00:38:34
into their life give yourself about a six week trial you know don't just try
00:38:39
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
00:38:46
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
00:38:52
window to 615 and I did that for you know 3 or 4 days until it felt normal now natural I wasn't hungry then I moved
00:38:58
it to 6:30 and then I just kept bumping that window out in 15minute increments
00:39:03
over weeks and by week five I remember sitting at my desk and I had my lunch ready to go and I was still at the
00:39:09
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
00:39:16
slowly let my body adapt and adjust and then I've been fasting gosh since 2015
00:39:22
probably 2014 and um and it's just a normal natural part of my life I don't
00:39:27
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
00:39:33
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
00:39:39
more work done it's when I do my best research it's when I do my best communicating with my followers is in
00:39:45
the morning you'll often if you follow me on social I'm always in my pajamas with a cup of coffee um while I'm getting ready for work because I just
00:39:51
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
00:39:57
the synapses tend to not work as quickly for me I was thinking about this too like an evolutionary lens why fasting
00:40:04
makes sense and why this sort of narrative that we're meant to have breakfast lunch and dinner you know
00:40:09
maybe breakfast I don't that's a social construct there's really not great science now there are humans that will
00:40:15
do better by eating more meals more frequently and that's why I say fasting is not for everyone especially if it
00:40:20
triggers an eating disorder if you have diabetes or you have you know hypoglycemia fasting may not be for you
00:40:26
but most people can do it successfully and so I really encourage people to experiment with it and see how they do I
00:40:31
was wondering if I always try and think through like an evolutionary framework and I was thinking about how in our
00:40:36
hunter gatherer past we would have meals were not available 24/7 yeah and we
00:40:43
would have needed like a really focused brain to go out on the hunt so this explains why when we're like hungry our
00:40:48
brain's working better it almost seems like there's more I don't know oxygen or nutrients in the brain the brain tends
00:40:54
to work better using the keton Tes for fuel than uh glucose though though glucose is the preferred fuel in the
00:41:00
body you know and um but but when they did studies they were animal studies so
00:41:05
take this with a grain of salt but you know and they did their mazes you know the animals tended to get through the
00:41:11
maze quicker and learn quicker when they were fasted rather than after they were fed they were a little lazier ketones
00:41:17
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
00:41:25
Matson and and that those researchers were doing their work their research in Alzheimer's and Dementia you know there
00:41:32
was no keto diet they were just knowing that people were utilizing ketones for fuel which is a normal natural process
00:41:38
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
00:41:43
glucan Genesis and then it switches to Fat to burn for fuel and so um now
00:41:49
there's people who like to take exogenous ketones I've I've never experimented with that I don't you know
00:41:55
that's I don't have any literature menopause to support that use and the third component of the galston diet is
00:42:01
this idea of fuel refocus right so that's looking at you know
00:42:07
food we're looking at the macro and micronutrients so I'm really going hard on fiber and vitamin D and magnesium and
00:42:14
things that we tend to as a gender be deficient in especially with menopause
00:42:20
so I'm really trying to highlight those things to make sure instead of counting calories let's see how much vitamin D
00:42:26
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
00:42:31
foods that we should be having in terms of that's I originally developed Galviston diet for weight loss you know
00:42:38
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
00:42:45
20% protein um but I think if you know doing it again the where I'm counseling
00:42:51
my patients now is I'm going much higher on protein what I've learned since that book was written was how important
00:42:58
protein intake is to maintaining muscle mass I'm also talking a lot about creatine um and and there's some nice
00:43:06
studies done in in the we call it the elderly 65y olds and and above which I'm
00:43:12
nine years from that right now and so and how creatine supplementation just creatine supplementation on its own well
00:43:18
combined with weightlifting we're seeing bigger gains in the mopal patient post menop pulle patient yeah bigger gains in
00:43:26
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 perent to this conversation so what
00:43:33
we're well what we know in menopause is that you know aging combined with a menopause we see a dramatic loss of
00:43:39
muscle mass with the menopause process and so in that first 10 years of
00:43:45
menopause we could lose up to 10 sometimes 15% of our muscle mass and that muscle mass is going to determine
00:43:52
your resistance to sugars so your insulin resistance is really tied to your muscle mass your functionality your
00:43:59
ability to recover from a fall um and the other thing is what most people
00:44:04
don't understand is the muscular skeletal unit acts as one so when we have low muscle mass you are
00:44:10
dramatically increasing your risk of osteoporosis now right now this might shock you but
00:44:15
50% of females will have an osteoporotic fracture before they die and this is
00:44:22
almost completely preventable what is an osteop paic fracture so osteoporosis is when we lose
00:44:29
the density of our bones through so estrogen so all of our life we remodel
00:44:35
our bones right we chew up bone we lay down new bone and so we reach our maximum bone density as females at about
00:44:41
age 35 and then it slowly starts to decline through the aging process and then when we get to menopause it
00:44:48
dramatically we see it just massive loss of bone so this loss of bone makes the bone
00:44:54
weaker and much more likely to fracture when it when we fall and so if you fall
00:45:01
and break your hip in menopause 30% of women with surgery will
00:45:08
die in the first year 70% will die without
00:45:13
surgery and that year is marked by horrific pain and not being able to move
00:45:21
and just really really miserable people and so and so much of this is preventable going on hormone therapy
00:45:28
getting adequate exercise doing the resistance training eating the protein adding in the creatine making sure
00:45:33
you're getting enough enough vitamin D is going to be huge at protecting our my population from this happening as we age
00:45:41
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
00:45:47
referenced a study previously which sort of scared people yes the Women's Health Initiative
00:45:53
yeah and that study suggests Ed that there was an increase in breast cancer if someone did hormone replacement
00:45:59
therapy so let's break it down um originally the study was designed to see if we knew it from observational studies
00:46:05
was hormone replacement therapy going to truly be protective for cardiovascular disease that was the function of the
00:46:11
study in women who took it versus women who did not we knew from observational studies that yes they had a much lower
00:46:17
risk of death from cardiovascular disease and and all cause mortality as meaning death from many cause as well as
00:46:25
um heart disease in itself okay aosc orotic heart disease so but that's observational the way to
00:46:33
prove these things is to do a randomized controlled study versus placebo so
00:46:38
finally finally this is 1998 women were getting money like there was a new female head of the National Institutes
00:46:44
of Health they were funding this study this was so exciting women were lining up in droves to sign up for it but
00:46:50
because the endgame was to prove whether or not it was protective for cardiovascular disease disease the
00:46:56
average age of the patient was 63 years old so that they could see if it was
00:47:02
going to affect heart disease because women tend to get that in their 60s and 70s right so they recruit they Dev
00:47:10
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
00:47:17
placebo arm and then a medication arm when you don't have a uterus you don't absolutely have to have progesterone
00:47:24
when you have a uterus it's required to give a woman progesterone as well or progestin as well to protect the lining
00:47:31
of the uterus from the estrogen unopposed estrogen can cause IND demetrial cancer but we can negate that
00:47:36
by giving her progesterone you following me so we have an estrogen only arm and
00:47:42
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
00:47:49
they saw in the estrogen plus progesterone arm after 2 years was a very slight increase risk of breast
00:47:56
cancer versus placebo now you have to understand there's a difference between absolute
00:48:02
risk and relative risk so the relative risk went from so the absolute risk went
00:48:08
from four out of a thousand women per year to five out of a thousand women per
00:48:13
year so one out of a thousand women treated in the estrogen and progestin Norm develop breast cancer where over
00:48:20
Placebo that is a 25% relative risk increase m and that is the that is the
00:48:27
statistic that set the world on fire so the researchers held a huge press conference at the Watergate hotel in
00:48:35
DC every major news Outlet this was before the internet and and announced
00:48:40
that estrogen causes breast cancer now remember these women were on estrogen plus the progestin which is called
00:48:46
pra the estrogen only arm continued for a few more years because the women on
00:48:51
estrogen only not only did they not see an increased risk of breast cancer they they had a I think it was a 20% decrease
00:48:58
risk of breast cancer relative of yeah relative risk yeah and the relative
00:49:04
mortality went down 40% so we think it's because estrogen feeds a breast cancer
00:49:11
cell but it doesn't cause breast cancer we our highest levels of estrogen are in pregnancy and it's so rare to ever be
00:49:17
diagnosed with breast cancer and a healthy breast cell has estrogen receptors and all that estrogen receptor
00:49:23
positive means is that that breast cancer cell went from healthy to cancer through a mutation but retained its
00:49:30
estrogen receptors and so we can use those receptors against the cancer cell to treat the breast cancer so that study
00:49:37
has been walked back multiple Studies have been done but like the the whole mindset has not changed myself as an
00:49:45
Oben was still the lowest dose for the shortest amount of time and only in women where absolutely nothing else is
00:49:51
helping her hot flashes menopause was defined by the vasil motor SYM symptoms that's it you know vaginal estrogen
00:49:59
which is just putting estrogen locally in the vagina so one of the biggest things we see in a huge amount of
00:50:05
patients like well over 50% is something we call genital urinary syndrome of
00:50:10
menopause and it is the bladder the vagina and all of the tissue in between
00:50:16
all has a lot of estrogen receptors and we take the estrogen away that tissue becomes very thin we lose elasticity we
00:50:23
see recurrent urinary tract infection the most likely treatment to help a
00:50:29
woman in menopause with recurrent urinary tract infections which is a major cause of death for women is
00:50:35
vaginal estrogen and it's safe for everyone even with breast cancer and so even that option is taken off the table
00:50:42
for so many women who are suffering needlessly with horrible painful intercourse dryness you know recurrent
00:50:49
UTI and it's just such a simple thing to help a woman and fix and they're not being offered that treatment is vaginal
00:50:56
estrogen the only form of administering estrogen so we have no so when we look
00:51:01
at hormone replacement therapy we have um or any medication we have like steroids is a good way to think of it so
00:51:08
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
00:51:14
therapy right so vaginal estrogen cream there's pills there's there's different ways to put it in the vagina but that's
00:51:19
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
00:51:27
everything our brains our bones our general urinary you know from the inside out and so you can ingest it there's
00:51:33
creams there's patches there's Rings there's pellets that are now available there's multiple ways to get this
00:51:39
medication into your body and what's the most popular form of
00:51:45
administering administering uh hormone replacement therapy so it depends on the country so in the UK it tends to be a
00:51:51
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
00:51:58
the most easiest pharmacologic option to get in the UK in the US it tends to be the patch for the nonoral form we also
00:52:05
have pills available as well there's a caveat with estrogen pills there's something whenever we ingest anything
00:52:11
food medication goes into our stomach into the intestines and then it gets picked up by the portal hepatic
00:52:17
circulation the liver and so the the portal vein goes straight to the liver for processing and when that bump of
00:52:23
estrogen or testosterone typically hits the liver we see some problems with and
00:52:28
for testosterone it's liver toxicity and for estrogen we see bumps in our clotting factor and so you'll see a lot
00:52:33
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
00:52:41
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
00:52:47
or or even a pellet then we bypass the liver and we don't have the increased risk of clotting are there any other
00:52:54
side effects you know in life there's no such thing as a of free lunch and so um
00:53:00
it estrogen so we have to look at each so when we look at hormone replacement therapy we have our estrogens we have
00:53:06
our androgens which would be testosterone um DHEA and andrine diione
00:53:11
and then we have our progesterone which is uh the bioidentical form progesterone there are synthetic progestin available
00:53:17
but I tend to just prescribe the progesterone and so each of them has issues that might happen so with
00:53:23
estrogen you can see headaches so that's kind of a red flag for us we worry you
00:53:29
can see migraines getting worse so those are patients you have to be really careful with going low dose um you can
00:53:35
see unexplained so 40% of patients on menopausal hormone therapy will have
00:53:41
vaginal bleeding doesn't mean it's a period we have not woken your ovaries up they're gone we are just stimulating
00:53:47
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
00:53:52
on its own if it persists past several months we'll get Ultra ounds to make sure we're not missing a pup or something there but um it's it's one of
00:53:59
the things I warn my patients about so things I worry about you know headaches some women depending on the formulation
00:54:05
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
00:54:12
have some kind of an allergic reaction to the adhesive so then we have to look for Alternative forms so thankfully
00:54:17
there are multiple forms on the market and for patients we have to do some trial and error to find out not only
00:54:23
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
00:54:28
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
00:54:34
thousands of messages a week probably and you know I walked into your practice
00:54:40
where would you start with me so I start by letting you tell your story I tell my
00:54:45
story and it's a typical story that you hear right yeah what happens next symptoms so I will will get blood work
00:54:52
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
00:54:58
Define if she's Perry or postmenopausal especially if she's had a hysterectomy um I'll get a lot of blood
00:55:04
work around checking her thyroid a lot of things look like menopause right so you know fatigue and night sweats that
00:55:11
might be hypothyroidism weight gain hypothyroidism autoimmune disease all this rheumatoid arthritis I want to make
00:55:17
sure I'm not missing something else that looks a light like Perry menopause so I'm doing blood work around that
00:55:22
nutrition deficiencies vitamin D um basic labs for her blood count and her electrolytes I'm I'm doing this full
00:55:29
panel okay but then I'm beginning to treat immediately and so we have a discussion around her sexual Wellness is
00:55:35
she struggling with desire then we'll have a discussion around testosterone um
00:55:41
so I'm struggling I've got my desires gone okay so it's very common so when we
00:55:46
talk about female sexual function there's kind of five buckets why a woman would be suffering or not happy okay one
00:55:52
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
00:55:58
partner all that so we we have a discussion about that then there's an arousal disorder where that's what most
00:56:04
men are treated for when they talk about libido issues it's really nothing's wrong here they're struggling to
00:56:10
maintain an erection and so we use Viagra and those type of medications for that for so if a woman has an arousal
00:56:15
disorder vaginal Viagra can be helpful for that so we we talk about that we talk about orgasmic disorders some women
00:56:22
have NE about 10% of women will never have an orgasm in their life imagine if that was 10% of men I
00:56:29
think it would be a National Emergency I think there would be you know we would divert military funding in the US to get
00:56:35
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
00:56:43
who are in Secure relationships love their partner miss that part of the intimacy that they used to have that
00:56:48
desire to initiate that desire yes this seems like a good idea that goes away with menopause a lot and so so for those
00:56:55
women testosterone might be helpful or there's a couple of FDA approved medications as well Addie and VII and so
00:57:01
we have talks about costs and you know how to get it prescribed and you know testosterone there's no FDA approved
00:57:07
option for women so quite often I will have to cound that medication for them at a local compounding pharmacy versus
00:57:14
going to uh Dwayne Reed or a CVS or Walgreens to pick it up using their
00:57:19
insurance so I know that that you're coming from the ukuk our health systems you know are a little bit different but
00:57:25
because my reach is so large now I try to include you know all the different Health Systems when I'm talking about
00:57:30
your options give me a case study of a patient that walked into your door and
00:57:36
gosh you know I had okay I had a patient who came in and uh her name is Michael
00:57:45
and she won't mind me saying it because we're really good friends and she came in and typical overweight not sleeping
00:57:54
some brain fog issues some a Jo joints aching aches and pains all the things
00:58:00
and um sweetest woman absolutely adored her husband you know like um but was
00:58:07
struggling with desire as well so we started her you know I developed a nutrition plan for her she hired a
00:58:14
personal trainer she got to the gym she got serious about you know M lifting um
00:58:19
she started on hormone therapy and she is my biggest cheerleader you know on social because she's constantly she's
00:58:25
lost probably about 60 pounds of body fat because we get to measure her so in my clinic I have a inbody scanner where
00:58:32
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
00:58:38
probably G gained maybe 10 pounds of muscle lost a tremendous amount of fat
00:58:43
she feels amazing she has this beautiful you know she's back to her intimacy level that she desired so much before
00:58:50
she is absolutely thriving on all aspects and she's constantly sharing her studies her her story online so that
00:58:56
other women can learn that they don't have to suffer as well and she just can't believe the thing that makes her
00:59:02
angry is that she didn't come sooner and that she suffered for so long without
00:59:09
looking for help and she couldn't find it she came from San Antonio which is about a three and a half hour drive to come and see me so here's the scary
00:59:16
thing for me or it's honorable I have patient so I have this menopause Clinic I started two years ago and I have a
00:59:22
waiting list that's longer than this wall and women are flying in regularly
00:59:27
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
00:59:33
can't find menopause care in their backyard you know that they have to get on a plane to come and see me because
00:59:41
they cannot find care wherever they are so I've started a a a list of providers
00:59:47
on my website that my followers recommend them where they found good menopause care they write a testimonial and we just compile them and we just
00:59:53
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 minapa society now called nams
01:00:00
I mean now called the mopa society they rebranded has a list of certified providers on their website as well I got
01:00:06
an email sent to me after listening to one of the episodes on this podcast from what appears to be a very helpless
01:00:13
husband it was a very very very long email and they had said that one of the conversations we'd had on this podcast
01:00:18
about menopause at one point had really helped them but the key question that remained for that person was when does a
01:00:25
supporting partner know how and really at what point to help because you know no male
01:00:34
partner wants to turn around to their wife and go I think you've got menopause and starts diagnosing them but they also
01:00:40
don't want to just sit back and be quiet I think you it's usually begins with
01:00:49
something you can't quite put your finger on she's reacting differently she's not as resilient as she used to be
01:00:57
she's not managing situations the same way
01:01:03
and I think once we start taking this shame and the stigma out him suggesting
01:01:09
that perhaps this is menopause will not cause her to fly off the handle I think
01:01:15
you know normalizing this conversation removing the stigma it might make everyone go oh I mean I didn't realize
01:01:22
it in myself you know thought it was grief related and and I was like wait
01:01:27
when was my last Peri when was my last period oh I think I'm in menopause I
01:01:34
mean I was and then I was like oh God menopause you know even for myself it was such a negative connotation I had
01:01:41
that Sex in the City episode in my head when Samantha thought she was in menopause and how horrible it was for her and then turns out she wasn't and
01:01:48
everything was better again and I'm like gosh is this you know first of all I
01:01:53
applaud him him for wanting to try to do something because so many you think
01:01:58
women don't understand what's going on and so one Bravo for wanting to be helpful
01:02:05
two say it with love say it gently let's and then find a provider or find a
01:02:12
healthcare provider to go in and start the conversation and I one of my be my
01:02:18
best visits with my patients are when their Partners come and that the conversation is held together and it
01:02:25
really opens their minds you know to what's going on in her body and helps understand like what we can do
01:02:30
therapeutically what needs to be done at home this is a special time for her she's going to need extra help we're
01:02:36
going to get through this you know it doesn't have to destroy your sexual life or your relationship or whatever it
01:02:42
definitely can take a toll if left untreated but you know bless him for
01:02:47
doing it like we talked about a little bit earlier you know there's probably a fair amount of dissolutions of
01:02:52
relationships because no one's talking about this process and what it could do to someone this might be a really stupid
01:02:59
question um but I know I'm no uh I ask a lot of stupid
01:03:06
questions Dem men go through anything like this so there's a lot of debate about menopause um the short answer is
01:03:13
not really we see men's testosterone levels Peak at
01:03:19
about age 19 no shocker there and then this very slow kind of downtick until
01:03:25
they stabilize at about age 35 to 40 and then they stay stable for the rest of their lives but there's a difference
01:03:32
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
01:03:41
normal men's range is from 236 to about a thousand so there's a big you know
01:03:47
man-to-man variation and there is a lot of men who are supplementing when they
01:03:53
come in on the low in and they're feeling a lot better now this is not my area of expertise this is not you know I
01:03:59
just read a lot of This research you know on testosterone and men are included in it and so they are finding
01:04:05
that they are having better cognition feeling better having more energy Etc
01:04:11
but there is no manop pause their testicles don't stop working I mean it
01:04:16
would be as if your testicles shriveled up and died at 51 that's the
01:04:22
equivalent gosh I do have to say at the start of this
01:04:30
conversation when you said if that was happening to men the reaction would be different I have to say I think I agree
01:04:39
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
01:04:46
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
01:04:54
through a menopause were dismissed as psychological and really had multiple
01:05:01
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 warts you
01:05:07
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
01:05:14
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
01:05:20
woman right now in 2023 is more likely to be prescribed an anti-depressant for
01:05:26
her menopause than hormone
01:05:31
therapy multiple reasons for that the way we were trained the way we were taught to to approach a woman's medical
01:05:37
issues and also the fear unfounded fear around the women's health initiative and
01:05:42
what it did to you know Physicians feeling confident about prescribing hormone therapy is there anything else
01:05:48
that you do on a day-to-day basis in your life that um we haven't talked about yet is is
01:05:54
there any sort of apps or tools so I really like headspace I know there's
01:05:59
some good meditation apps I really thought meditation was woow woo and
01:06:06
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
01:06:13
went through menopause and suffered so horribly from the mental side effects
01:06:18
and the death you know all this happening at once uh to me with my brother's death aging parents teenage
01:06:24
girls in the house you know and realize something's got to give and so I hired
01:06:29
like a counselor you I went to therapy and she recommended um getting an app to
01:06:36
help guide me through meditation and that has really turned the needle for me really yeah how you know carving out
01:06:43
that it's just five or 10 minutes in the morning to think of what I'm grateful for focus
01:06:50
on that gratitude you know and I love teaching that to patients and to my followers of of really putting yourself
01:06:57
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
01:07:03
plate and just giving my brain that time to just relax and let it flow and just
01:07:10
let the thoughts you know and just focus on on me for that that's really made a
01:07:16
huge difference for me what role does sleep play in all of this so sleep disruption is massive massive massive
01:07:24
in per menopause and menopause and when we don't sleep we see everything I tell
01:07:32
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
01:07:39
itself that's when we that's when we build muscle that's when you know our
01:07:44
our brain resets that's when our our whole body you know and if you're having disrupted
01:07:50
sleep and you're waking up at 3: in the morning and your brain is raised say I mean everything is worse your cortisol
01:07:56
levels spike your insulin resistance goes up your you know everything gets worse and so when my patients come in we
01:08:02
focus on sleep first and nutrition pretty much and if easier said than done
01:08:08
though right sleep if the EST if their sleep disruption is due to hormones then
01:08:15
it's such an easy fix I just give them back the water they were drinking and they sleep again where the struggle is
01:08:20
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
01:08:26
sleep medicine specialist one of the things that we now see a correlation is a sleep apnea even in a thin patient and
01:08:32
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
01:08:39
a weight problem and what is sleep apnea that's when so sleep apnea is when you stop breathing um or you snore quite a
01:08:46
bit you you see the pallet relaxes and you were not getting as much oxygen you know into the body and into the brain
01:08:52
it's a big health risk and what is your personal sort of exercise regime what are you do so you know I came from the
01:08:58
long the 20 years of just trying I was exercising to be smaller MH and now I'm
01:09:03
I'm moving to be stronger and so now I'm doing resistance training so I have a
01:09:09
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
01:09:15
when I'm working from home and and working on the galison diet or the new book I'm doing it on my treadmill but at an incline so I'm really working on my
01:09:21
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
01:09:28
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
01:09:34
genetic low I'm very thin individual was not blessed with a lot of muscle mass and the fact that I focused on being
01:09:41
thin for so long and that was my social currency is you know I was thin I was healthy probably I've lo you know I lost
01:09:48
that that window of opportunity to gain more muscle easily in my 20s and 30s so what I what I would would tell my
01:09:54
35-year-old self what I preached to my daughters is focus on being strong not small you know muscles strength over
01:10:01
skinny and so the muscle mass that you develop now is going to serve you so
01:10:07
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
01:10:13
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
01:10:21
my personal window think you told about yeah so I tend to um I break my fast at
01:10:28
around noonish typically if I'm hungry before if I'm traveling or you know on a plane I I don't do well on a plane
01:10:34
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
01:10:40
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
01:10:46
I've got I'm doing you know I'm loading up on protein I'm doing something green
01:10:51
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
01:10:59
the anti-inflammatory benefits and for the healthy fats and for the fiber and so I've got all that so I'll break my
01:11:05
fast at about noon and then between patients I'm constantly snacking I'm really focusing on protein for myself I
01:11:12
don't have a weight problem um and so I'm trying to get stronger and so my protein needs have really increased and
01:11:18
so I'm sometimes doing a protein bar or a shake middle of the day um to help
01:11:24
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
01:11:29
kind of discuss what do we have in the freezer we'll pull out some salmon or you know we'll we'll make some I don't
01:11:35
know uh burgers or something and um you know we try to be protein Centric and
01:11:41
then we're adding in like a beautiful salad with lots of avocado and chickpeas um on the side so I think I
01:11:48
covered it all yeah so I'm typically done eating by 8:00 p.m. um
01:11:54
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
01:12:00
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
01:12:05
if you had a megaphone and you could speak to every woman right now the 1.2 billion that we talked about earlier
01:12:12
that are in that per menopausal or the menopausal phase or postmenopausal and you had to communicate one message to
01:12:18
them and I'm actually going to bring in everybody else as well because although it's just those women I've mentioned
01:12:24
everyone around them in their life probably needs to hear s somewhat similar message so they can play supporting roles in that individual
01:12:30
struggle what would you say down that menopause to those women and the the loved ones so my Mantra is menopause is
01:12:38
inevitable suffering is not but you're going to have to advocate for yourself
01:12:44
because Society has failed us our medical system is is built to fail the
01:12:50
menopausal woman and there is good help out there you're going to have to do the leg work I've got tons of resources on
01:12:56
my website to help you you know lists of Articles to print out and hand to your doctor system you know um uh symptomatic
01:13:04
sheets that you can like keep track journals that you can hand to your physician um any way that I can help you
01:13:10
advocate for yourself because I can't be everyone's doctor but that this is real you're not crazy this is happening and there are
01:13:17
lots of things that we can do even non- hormonal don't feel like if you're not a candidate for hormone therapy that
01:13:22
you're stuck you know exercise nutrition other pharmacology stress reduction
01:13:27
sleep it's time to take care of yourself first so that you can have the best end
01:13:33
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not to be taken as investment advice or a financial promotion as you guys know I'm a big fan of hu I'm an investor in
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stev bundle link and check it out back to the episode your family have a history of Health complications and
01:15:54
illnesses right yeah what is that history but also has that played into your overarching perspective about
01:16:00
nutrition the Health Care System how it treats people so my I'm one of eight
01:16:06
children I have six brothers and um my oldest brother Jeep died when I was 9
01:16:12
years old from acute lymp esthetic leukemia one of the most common forms of childhood leukemia now the Cure rate is
01:16:19
95% and but at the time he was put into remiss and then he came out of remission in his
01:16:26
late teens and died like a year and a half later so my childhood was but that
01:16:32
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
01:16:39
from Louisiana where I grew up to St Jude's Hospital the last ditch effort to try to you know find another
01:16:45
chemotherapy regimen which he failed and that kind of kind of drove me but you know it was it was leukemia it was
01:16:51
childhood it was one of those things fast forward to 20 he died in 2015 so
01:16:57
2010 my brother I knew had HIV and um had also contracted hepatitis and he was
01:17:03
doing great on his HIV meds um his counts were good he was healthy functional he'd been with the same
01:17:09
partner for over 30 years but then his his liver was getting worse and worse and worse he also struggled with
01:17:15
alcoholism and so that kind of combination was really hard to watch and
01:17:21
love him through his choice es you know and uh he ultimately died in 2015 he had
01:17:27
a stroke and then I was able to go to his end of life care and the first book
01:17:32
I wrote um I talk about him in the book because in my rush to deliver his care I
01:17:39
forgot my own and that's when I realized I was menopausal was through my grief process I thought I was grieving I
01:17:44
gaslit myself like no no no you're not sleeping you're you're waking up all night you're you know upset your mental
01:17:50
health and your brain fog is all because you're just gri geving his death and then um my next brother Jude uh was
01:17:58
diagnosed with stage four esophageal cancer um
01:18:03
shortly uh he was diagnosed when Bob died and then he survived a few years um
01:18:09
so Bob died at 56 and Jude died at 57 and I'm
01:18:15
55 and I don't you know I know a lot of it was lifestyle but I still have those
01:18:21
genetics and I'm about to survive three of my six brothers and um out outli and
01:18:29
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
01:18:36
for HRT are all I want to see my grandkids one day if if I'm lucky enough
01:18:42
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
01:18:48
choice might get taken away from me if I'm not careful so you know a lot lot of
01:18:53
what I do and why I do it is because I have to I may not get the
01:19:01
choice what an incredibly important Mission you're on and what incredible work you're doing
01:19:07
um because there are as we've talked about there's been a group of people in society that haven't have kind of been I
01:19:14
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
01:19:21
been a real shift in recent times towards the conversation around menopause and hopefully these conversations if anything at all will
01:19:27
dismantle the stigma which is often the first sort of all that needs to fall for people to be able to take action and
01:19:33
have those conversations and just speaking from my own experience I didn't really understand what any of this stuff
01:19:38
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
01:19:44
conversation about it and like oh my gosh like you know maybe when I was in school someone should have told me about
01:19:51
this phase of life we talk about how to get a job but it seems to fall off you
01:19:57
know the education system seems to stop caring once we've had kids almost that's what we're experiencing here as well
01:20:04
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
01:20:10
people is it so science-based but it's so accessible at the same time that's always been my superpower I think is and
01:20:18
I I realized that very quickly in my career was that I had this Knack of being able to take something really
01:20:23
complicated and break it down into terms that people could understand MH that you know most people would be able to grasp
01:20:31
and walk away from and you have nuance and empathy which is the necessary ingredients when you're talking about
01:20:36
subject matter like this where everyone's symptoms are typically quite different from one another and they will have different circumstances we talked
01:20:43
about other you know conditions and contraindications that might be complicating things um and you seem to
01:20:50
have a really wonderful empathetic view on all of those things and an appreciation everyone's circumstances
01:20:55
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
01:21:03
30-year-old man I have a partner that I love um I have a mother that I love I
01:21:09
have an older sister that I love my sister is my partner's 30 as well my sister's 36 my mom is 60 now nearly 60
01:21:19
now I um I challenge you to have this conversation with her and ask her about her experience I really applaud all the
01:21:26
and I don't know whether I should say this or not but I really applaud all the men that got this far in this
01:21:32
conversation and chose to listen and have an appreciation that the betterment of 50% of our population who are going
01:21:38
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
01:21:46
and having the conversations that will bring down the stigma and and the suffering of what is currently about 1.
01:21:52
.2 billion people but will be 50% of people in our population so I highly
01:21:58
recommend everybody goes and checks out both this book which is the Galveston diet but also can we pre-order the
01:22:04
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
01:22:11
sure um the latest May the latest May okay and that's called the new menopause so you can pre-order that now wherever
01:22:19
wherever um you get your books and that's the culmination of many decades of very very hard work so I'm very very
01:22:25
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
01:22:30
we have a closing tradition on this podcast where the last guest and also your website's an incredible resource for all of this all of the things you
01:22:35
talk about right and your social channels Etc we have a closing tradition on this podcast where the last guest leaves a
01:22:41
question for the next guest not knowing who they're leaving it for and the question here
01:22:47
is you get one last conversation with somebody you love a
01:22:52
child maybe your husband maybe someone else what you say to them in that
01:22:58
conversation that maybe they haven't already had I love
01:23:10
you there's nothing more than love I've had done
01:23:18
it three times my dad too my um
01:23:24
Bob and Jude were five years apart and my dad was shortly after Jude you know
01:23:29
I'm watching my parents bar three kids was a lot
01:23:36
um just
01:23:41
love thank you you're welcome thank you so
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savings and ring in the most wonderful time of night eight sleep currently ships within the UK USA Canada and
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select countries in the EU and Australia do you need a podcast to
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listen to next we've discovered that people who liked this episode also tend to absolutely love another recent
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episode we've done so I've linked that episode in the description below I know you'll enjoy
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[Music] it