Nutritional Recommendations and Advocacy

Hi, I'm Im Valk. and I'm Jathan Cohen, and welcome to our breakdown. This is a very special month. It is women's Health Month. Yay. In honor of Women's Health Month, we're revisiting one of our most informative episodes that we have done regarding women's health Perry Menopause, menopause, We did it last year with Dr. Mary Claire Haver, one of the most trusted names in women's health. She's a board certified OBGYN. She exposes the hidden truths Aout menopause and perimenopause, the real cause of that weight you can't seem to get rid of, mood swings, anxiety, depression, sleep disruptions, how perimenopause can often be worse than menopause, and also she tackles the myths surrounding hormone replacement therapy and what you can do to make the right decision for you We also covered what most doctors are not telling you you need to know about your health and the scary fact that doctors only receive one hour of study on menopause education during their education. It's kind of frightening. It's very frightening considering that fifty percent of humans are female and will experience menopause Dct. Haver also reveals proactive steps you can take to lessen future symptoms, including how hormone replacement therapy can help you with brain fog, fatigue, and how to avoid losing muscle mass, which is critical to aging in a healthy and safe way. She talks about the best exercises for menopause weight loss and why women's gut health is so different from men's and how that impacts your menopause journey. It's not all doom and gloom though. She also has some incredible menopause success stories. It is never too late to take control of your health today, women Just before we get to the episode, I have a quick favorite ask that will only take a second. Check to see if you're subscribed. Click that subscribe button anywhere you're listening. It helps support the show and it's totally free. And now, in honor of Women's Health Month, enjoy our episode with doror Mary Claire Haver Break it down Dctor Mary Clire Hver. welcome to the Bakown. Thanks for having me We've been waiting for you for a very long time some might say through all of menopause I wonder if you can sort of give us a little bit of an overview. How did you get here? How did you become the lady that everyone asks about menopause I was a very well trained but very basic OBGYN. so I was went through, you know, medical school residency, the whole traditional route and went into initially three years of private practice in Houston, which is the area that I've kind of lived for the last thirty years And then I went back into academics and became a professor back at where I did my residency program starting in two thousand five I ran the residency program. I had a private practice through the university. I taught, you know, kind of in And I would have considered myself a really amazing doctor. You know, I still do But until I went through my own menopause journey I realized there was a humonggous gap in my knowledge So when I really think about it, and I've talked to multiple people across the country, I got one hour of menopause in medical school in a four year curriculum One lecture And in my OBGYN residency, of which I am insanely proud of everything I learned had six hours of menopause. There were no menopause clinics. There was no real clinical training. We had six one hour lectures during reproductive endocrinology in my second year And that was it talked a little bit about osteoporosis and medications to treat that, but we didn't talk much about prevention if I really think about it I had one professor who I ended up going into practice with when I came back who had a very special interest. So everything I kind of knew about menopause and perimenopause I learned from him. becausecause I would run down the hall and be like, what do I do with this? you know So when I went through my journey I got completely blindsided. And realized This is I can't survive. I cannot live like this. And I very reluctantly went on hormone replacement therapy, absolutely terrified that I would kill myself with breast cancer. because that's what I understood. My my last year of my residency, my chief year is when the women's Health Initiative study, you know, I'm kind of the last of residents who even thought about prescribing hormone therapy and then our hands were slaopped when the WHI came out So I kind of moved forward with that thought, process of, well, it's more harmful than good and we really only want to give it if there's absolutely nothing else that's going to work for her, including antidepressants and neurontin and other medications So Here I am. very menopausal and I had been on birth control pills for a really long time to treat polycysticovarian syndrome and I did really well on them. I had nothing bad to say about that And when I got off, my brother passed away, all this kind of happened at once, and I was really grieving his death and then I was having horrible hot flashes, incredible bouts of depression, incredible bout of anxiety, like getting up at two in the morning and everything I've ever done, you know Every person I've ever heurt, you know, all of that's just swirling and I couldn't turn it off. And I just thought, oh, I'm grieving. this is normal for my life stage And then when the grief fog started to lift at about month six after his death of June of twenty sixteen I started realizing, I'm still not okay. Like I feel the grief leaving and I'm able to not think about him constantly and you know all the regret But I'm still struggling and And then I realized, when was my last period? Okay, I'm the expert I let myself for months And I never had regular periods, but I started putting two and two together. and then the hot flashes were just absolutely hammering me. And We pretty much know in medicine that a hot flash is almost always menopause. you know, if you're a certain age, you know, I was like, Oh my go Godd I am in Menopause. And so I went and got the bloodw to confirm it and then really struggle with what do I do about these hot flashes? I can't sleep, I can't live like this And I went on the medication, I went on estrodol or Cy patch was my first My practitioner had a nurse practitioner I worked with And we went on Comy Patch and Hopfashes went away and was sleeping like a baby And then all of a sudden all these other things got better. My joint pain got better. my resilience got better. I stoppednapping at the kids as much. My relationship with my husband improved. My kids were teenagers while all this is going on. so, you know, help us all when that's I was we're at your exact stage right now. And So I mean, like I was like wait a minute. okay. And then I was also dealing with new weight gain, which as a thenin person my whole life, who had thenin privilege, This was not okay. You know, I had really, so much of my self worth was tied into my weight And suddenly that was taken away from me. And you know, it sounds very vain, but like That was what all of my patients were complaining about. and I had given them all the same advice, Work out more eat less justust try a little harder. comeome on, honey, you got this. And it wasn't working for me. It wasn't working for anyone else. So when I kind of first I started looking in a menopause. It really was from the lens of why are so many of my patients gaining weight? And I didn't understand the body composition changes. It was just the scale, right So I called the PhD nutrition department and half of them were my patients at the time. I was working at a big university And I was like, what the hell is going on? And they're like, ye, there's some new studies coming out about body composition, how it's tamenabol. So they're shoving articles at me and I'm going down rabb hole after rabbit hole and I'm realizing, wait a minute. ton of data here about Menopuse, that know Americ Collge of OBGN, the American Board is not putting in front of me for my CME. I'm learning all kind of important stuff, but There's nothing about menopause and all of this stuff is important. All of my patients are going through this. So I start talking about it on social media really start about weight gain and menopause and body fat and belly fat and all the things Things started exploding just because I said the word menopause. I mean, I started, like all of us did, with zero followers, right? and your my dopamine' going off because I'm getting so many views and I, you know, they're sharing and I'm like, wait, all this you know, it wasn't with this grand intention that I would become TikTok famous or whatever famous. I really started on Facebook just sharing with friends and family And then it got so big, I developed a business account just to separate pictures of my children from, you know, talking about medical things and started getting friendly with other people who were growing on social and using that, learning how to use it as a tool for massive education. So from Facebook then COVID hit And my kids were like, Mom, you should do this TikTok thing. And they're showing me videos of doctors kind of dancing but teaching and pointing to like So that's I started I was literally like shaking to music and pointing to informational slat. You know, I put in the little floating words of belly fat, weight gain, and you started talking about nutrition and vitamin D and that really exploded. So in the first year of may being on TikTok. And again, everyone was on social because of COVID We grew to a million followers and it just I was letting my followers inform You know, ask the questions. They're like my frozen shoulder be related to menopause and instead of me saying no I would be like, I don't know, let me che Actually, there's an article here And so as I'm growing, learning myself, teaching everything I'm learning on social, I'm making more friends in the space, finding other experts, people who are really focusing on this So it really just grew organically I'm fascinated about the frozen shoulder. Yeah. because it speaks to A lot of people are having symptoms that they are not related orr they don't don't realize. Yeah. So let's go back to the lack of education problem, right We're not focusing on women's health after reproduction ends at all And what most clinicians don't realize, there's a few pockets that do, is that we have estrogen receptors everywhere in our body in our brains and our bones and our muscle and our gut and our lungs, kidneys, you know. And when those estrogen levels fluctuate in perimenopause and decline post multiple organ systems can be affected, and it looks very different So instead of the cliche hot flashes, which eighty five percent of us have therermmal reggulatory center in the hypothalamus is kicking in periimenopause and menopause You know, we can stabilize that with Neuronson can do it sometimes. and you know some of the SSRIs might do it, but giving the women back estrogen. We'll fix that problem, but guess what? Her generital urinary system gets better Her brain fog decreases, herer rate of mental health challenges decrease. I mean, it's And so many clinicians don't know this. I did not know this until three years ago There's so much to get into with kind of the practical Right. Um, but I do want to talk about You know, six thousand women reach menopause every day in the United States This is something that affects fifty percent. fififty one. Right. fifty one percent of the humans on this planet. And yet your training provided for a dismal amount of education. tiniest sliver. and you where someone specializing in women's health. You look at vaginas all day. All day. You're delivering babies. You're helping people regulate their hormones during pregnancy. and yet The one aspect of life that Falls off a cliff. Falls off a cliff. You wereing so little training about. It's such a source of rage for me when I think about, you know, and shame that it took my own menopause To be completely honest, I was a terrible menopause doctor. For most of my career and I'm so sorry if any of my former patients are listening, please forgive me, I'm doing everything I can to rectify that What were you trained to tell people This is a normal part of life only to recognize hot flashers of vas of motor symptoms as truly a symptom of menopause. We did learn about the loss of bone and bone density, but almost as a natural part of aging Not so much as a menopause thing. It just happens to happen to women in menopause and here's some medication to grow the bone back, right? Nothing about prevention. other than rolling up theubs so she doesn't fall Okay. and then General urinary system, we were learning a little bit about that, but almost like you wait u till it breaks and then we fix it. We have a very reactive healthcare system. And you know, I'm super proud of what I learned, but man, massive gaps. And it's not an individual clinician problem. It is a systemic problem rooted in the history of women in medicine. So considering that yes, women' not men with uteruses. Soen women used to die earlier, That's true. But ye It's been a minute since women died in childbirth actively as a routine of childhood diseases, infections and childbirth death from, you know, from being pregnant, R or having a baby, then you get, you know, most of those women actually lived past menopause. Right. So this is what's fascinating to me. We've hundredundreds of years, if not thousands, right? where we've had women liivving into this phase of life and I just I mean, forget about rage. It's like the sorrow that I feel for women who were just told, o, this is your existence. You marry someone that you likely don't love. You were told to marry him or it's expected that you marry him because culturally for you know then you on his property. you have to take care of his parents, PS, right Half your kids may die of some disease unless you're in a certain echelon you know of income earning. and access to healthcare And then you raise these kids, you probably don't have a career. No one really seems to care what your interests are And then once they leave the house, you're stuck with this dude who still wants three meals a day and two snacks And then things will happen to your body and your mind that just feel Miserable miserable and out of your control Right And you're just told that's what being a woman is Yeah And there are certain parts of the world today and a lot of ke parts of medicine today. how we practice Western medicine that say the same thing. including A lot of the people who controlled the menopause microphone You know If you go right now to Pubbed which you and I know, you know, which is a clearinghouse for medical research articles that are vetted And you type in the word pregnancy Right now you get a little over one point one million articles. importantportant stuff. They're studying everything. Right. We know lots about pregnancy. We probably have a lot more to learn, but you know, great. But what those number of articles wrote? That's the number of times, the word pregnancy is mentioned in artle one point one million times So brain powerower NIH funding. research dollar, you know, all the things that it takes to crank out that amount of research. If you type in the word menopause It is a little over ninety eight thousand So more than ten to one So we're one tenth of where we are for pregnancy. You type in the word perimenopause, It is about six thousand eight hundred I have a ten year process. You're in perim menopause a lot longer than you're pregnant I have an alert on my phone every day, more women will go through perimenopause and menopause than have children. Only eighty sevenishh percent of women bear children. So for whatever reason, choice or they just can't So, you know, I'm like, am I only worth is this part of my life the last third of my life when I am living my best life? I'm my smartest, most full of wisdom. I'm ready to lean in and kick ass I'm not worth All this money we spent on getting me pregnant, which I'm very grateful for keeping me pregnant There's so many reasons why this is happening and it's not a quick fix. But you know this is the reality of where we are today. I'm going to ask kind of a this is a human question. I'm asking you, you know less as a doctor and more as a human When I hear these things As a woman, how can I not feel tremendous amount disappointment and despair about how medicine has evolved to either Iignore me Tell me I'm crazy or just ignore the fact that I have needs. It's so weird. I'm not trying to make a conspiracy of it. Right No like, o, they h women and they don't want. But it's like that's so crazy. Awesome books on the subject. Unwell Women by Eleanor Cleghorn and then It's all in her head by Elizabeth Coman So Elizabeth is a rest oncologist and she looks at it from, you know, so we got one woman who's a social scientist, incredible work. and both of them shook me to my core because I see it. like you have to step back from your training. It is what it is. You go through and then you realize It's all in her head was a thing. You know, W wasas it written in the chart, but I was taught that women tend to somaticize their feelings And men what did that mean to you as a clinician It's all in her head. You know, she's a little bit crazy. Oh God, you know, I'd see the laundry list of Pblems coming in. So I have this really sad story from my residency. If you read the book, it's called the WW And WW was a code we used for something called the whiny womoman. And if she was Caucasian, the whiny white woman, WWW And W So I was an intern. I just finished labor and delivery nights, you know rockking suckking all night delivering babies. It's this crazy high energy sleep all day party all night, you know kind of thing. And then boom, next block is gynecology and we had two days in the OR and three days in clinic, and then we'd rotate So my clinic days, you rush to the clinic. Now this is I'm dating myself paper chart days. So there be stacks like seventy charts of all the patients we had to see that day. and these poor ladies are all waiting in the waiting room And the upper levels, so the third and fourth year residents run to grab the surgery cases because they want to operate, right? They get to get their numbers. And that leaves everything else for the lower levels. and the interns get the drugs, right? So I'm just like picking through the last few charts. and I pulled this woman's chart. She's in her forties. She has a laundry list of complaints, weight gain, not feeling great, brain fog, you know, some joint pain, doesnn't want to have sex, vagina hurts a little bit, but her periods are so regular. sounds like yesterday for So So and I'm like, huh So my upper level comes up because they're in charge of me to make sure I don't kill anybody. And it's a dude, and he's super sweet and I love him, but he's in cowboy boots. I mean, like total Texan. I you know, I did my training in Texas. Cowboy boots with scrubs. That's the thing with his long white coat. he's go, what you got? And I said, oh, patient, blah blah blah, blah And he goes,mm didid check for thyroid? And I said, yes, ye had that check a couple weeks ago in familyamily medicine. it was normal. And he asked for a few things, reasonable things. And he goes, well You got a whiny woman. You got a WW. And I said, excuse me. He said, whiny woman And he said This is just what women go through at the age. P her on the knee, Telller's going to be okay struck a few more labs, but probably they're going to be normal and this is just what it is This was taught to him. I am not putting laying the shirt is at the blame of any individual doctor. because these most docts are good people who want to help people. This is how this is the mindset of how we were trying. Now, we didn't write in the chart That was not taught to me by my professors. This was lower handed down from upper to lower level So I internalized that. I was going to say, so when you when you hear someoneled up, R someone s to you've got a whiny right when someone says to you, you've got a whiny woman. As a doctor, you're thinking, there's nothing I can do for her. There's really not. I'm just gonna hold her hand and be sweet to her and tell her home, It'll be okay, it'll pass or whatever, what I can do, have some wine, go for a jog, you know Just some nebulous, ridiculous advice And I just didn't know enough to know that this woman was probably imerimenopause That's the most powerful part. You didn't know enough.. Be as painful as that story is We want to get angry at the doctor, but literally he has no fe framework in order to we were taught nothing about perimenopause. Like when I say we got six hours of menopause, that was What happens when you go into a variant failure Right And so nothing about the transition between the two. Absolutely nothing. So not dissimilar, you know, and I'm a home birth, you know, that kind of birth hippie. We see the same, you know, often in sort of pregnancy and OBGYN circles in that We're treating this as a crisis about to happen, right? A lot of women are kind of taught, here are all the things that could go wrong. right, right? This is like, we know what to do if you hemorrhage. We know what to do, God forbid, if you need a se an emergency C section, or we know how to prepare all these things But in terms of seeing this as a part of life that's normal, natural, beautiful, has ups and downs, complexity, that's kind of the way we've looked at Per menopause and menopause, right? What's the crisis? Like all if their bones start breaking and if they're falling. and if they're if they have prolapse, right and their uterus like goes out on the fl. at forty percent increased risk of increasing diagnosis of mental health disorders. The divorce rate, the highest time for a woman to commit suicide is between the ages of forty five and fifty five The most likely time for her to have a new autoimmune diagnosis is in perimenopause. We have the most rapid loss of muscle mass through the perimenopause transition, the most rapid expansion of visceral fat in the perimenopause transition That's a big fucking deal. It's not beautiful And I'm going to say this, I' I love being menopausal, right? Kiss my period goodbye. I am living my best life. But had I not rethought the process and made some significant changes to my life, I would not be here So let's talk about some of these significant changes. Less than four percent of eligible menopausal women use hormones approved by the FDA. Approved by the FDA. So we think that the actual use is probably double when you add in compounded options, which are imposible sorry, that's not a e percent. Yeah. Even if I'm being generous with this statistic, even if you told me ten percent of eligible women Even if you told me fifty percent of eligible women That's not enough. So before the WHI, we were at about thirty eight percent to forty percent FDA usage and it was mostly permanent and Pm Pro. Talk about the WHI People still still, people still believe. Let's just say it. I'll let you say it, you're the doctor What do people believe about hormone replacement therapy? That is dangerous morearmful than good It's going to give you cancer. It's going to give you cancer. I'm gonna to get it cause this is what. Do I want to get breast cancer? that it will somehow cause a malignant transformation from a healthy cell into a cancerous cell. That is not how cancer biology works. We have estrogen, you know Premature variant in efficicy are variant failure, right? Women going through menopause before the age of forty have a fifty percent increased risk of breast cancer. That's a thing though that we know and we know about it. So you know, I have a million statistics I can throw at you, but the hysteria the misrepresentation and the announcement it was Estrogen causing breast cancer was the number two medical news story in two thousand two. It went viral before the internet, right? It was on the cover of every big major newspaper. It was on all the big magazines. That's how people shared information back then I was the chief resident. like It scared the hell out of us. And then no one and it's been walked back. All the findings have been walked back. We have I don't know. So I'm giving I'm giving you the opportunity phone that shared the hysteria has not shared. So I did not know this information Until so I had already written Galveston di. I was sitting at my first bigig Menopause conference, which is in San Diego U And I saw Averon Blooming and Sharon Malone and Carol Tais, Avon and Carol wrote U Eestrogen matters And Sharon was the MC. And they were talking about everything from the WHI and the statistics and everything being walked back. And I sat in the audience and I was on HRT very reluctantly at the time, knowing I was going to kill myself, but I couldn't live either way, so I might as well die breast cancer. and But happy and Tears my daughter was sitting, she just got accepted to med school and tears are running down my face What's the I did not know this I have been practicing medicine for how many years. This was not put in front of me by ACOG, by the American Bard of OBiin. What the hell is going? I didn't even know the Menopaus society exist. Well were living life considering you were on borrowed time because you chose to use hormone replacement therapy for yourself. Right. And so I was like And that that moment sitting in that audience My life changed And I thought've and you know, I probably had a couple hundred thousand followers, which is amazing. You know, back then, I was like For the rest of my life, my job is to spread this message about the safety and efficacy of hormone replacement therapy and how And then finally in twenty twenty two The Medapal Society changed the guidelines but the American Coege of Oen has not changed there since twenty fourteen. It still says moreore dangerous lowest amount for the shortest time possible I sometimes wonder If there's a danger to everything being thrown into the perimenopause menopause bucket. Yeah. And I as my critics left to talk about that. Here's the thing. A lot of random things will happen to you as a human being on this planet, whether you're a woman Wh're man. where exactly. So what is what is aging is How do you entangle the two? And some people are just kind of like unicorns and have like a bunch of crazy symptoms that now a lot of times people like, well, you're in perimenopause so. So what we are learning. Let me take you through a patient experience in my clinic. She comes in her usually by the time they get to me, they've been to six, eight doctors. they've been gaslit. They are on multiple medications for They're individually treating each symptom that they have. No one has kind of put it together that this might all be estrogen related. orr she's just coming in de Novo. Not on anything like please help me I'm dying. you know, I feel horrible O Im just want to be proactive and set me up for success through the next thirty years. I'm like, okay So I do do a lot of blood work becausecause a lot of these symptoms are similar to hypothyroidism nutrition deficiencies You know, I don't want to m diabetes, I've dialilosed loop diagnosed lupus this year So, you know, I'm doing a lot of blood work to rule out Ccominant causes or overlapping causes And then for a lot of patients, we start a trial of hormone therapy and see what gets better and then we kind of pursue. So so many things are related to aging, but we know we have accelerations. So for example We tend to develop atheroscoratic plaques as humans, as you know once we get older, but that process accelerates through menopause. So a woman's LDL cholesterol tends to dramatically through the menopause transition with not a change in diet and exercise. That freaks women out. Like that's one of my most viral videos. They're telling me that I must be literally eating fried food all day or because I don't eat meat or dairy and they're like, what are you eating? I'm like, I promise nothing has changed Insulin resistance goes up. So we have new pre diabetes, we have Homo IR scores going up, you know, with no changes. So a woman's visceral fat, which is cosmetically why they come to see me sometimes, which is the intraabbdominal fat. and this, you know, subcutaneous fat Cosmetically distressing gives us curves really not that biologically active, right? It It is not pro inflammatory, not nearly as much as the intraab abdominal fat, very different forms of fat A woman in pre menopause, body fat percentage, total body fat Eight percent is visceral. age matched women take her through the transition. it goes up to twenty three percent twenty ch. That's a huge change. That's like you're not fitting into your clothes. You look like a different. And I don't have to tell a woman this is happening. She knows. R And now in our clinic, I have a body scanner so I can actually measure her muscle mass, measure her visceral fat, measure her total body fat and give her know, then we start talking about the next thirty years. And know, what are your risks? What's your mom? Let's talk about your women and your family diseases and how we're going to move you away from that path Is there a one size fits all answer here? So how do you how do you get around that as a patient? As a patient. So I ask for permission and then forgiveness. you know, Tell them in perimenopause, it's like pinning the tail on a moving donkey because you are going through this very dramatic fluctuations on the downward trend of your hormones and it is wreaking havoc. Symptoms are probably worse in perry and full, especially the cognitive and mental health changes. They dond to stabilize post menopause Um And then in postminapos, it's easy becausecause they bought them out and I'm just replacing, right? But in Perry, it's a lot more challenging. So I say, you know, we have a lot of options here. We have multiple formulations, we have multiple doses We have multiple ways to get it in your body And so we're going to have to figure out what is right for you and I don't have a magic wand to figure that out. So let's be patient. You know let's give this X amount of time. And then if this isn't working or you develop X, and Z, then we're going Consider another formulation dose adjustment, whatever we need to do You just identified why most women are not getting appropriate care Like that's it I mean And I don' train our clinicans. Well, Well, first of all, we're not training our clinicians and also, you know, I love to give my example. I grew up at Kaiser you know, my dad was a public school teacher and that was the insurance I was given. Yeah. And we had you know, I rail a lot about just sort of the system here because I know what it's like to be given a ten or fifteen minute slot by a doctor who will probably say to someone, I've got a whiny woman I'm going to put her on SSRI's, or I'm going to sedate her. I'm going give her ZanX. and hope that she stops complaining So a woman, you know Across the Menopaus transition we double the rate of SSRI use. and Beautiful data coming out of Australia in the last couple of years looking at treating mental health changes in peri menopause with hormone therapy. Wow and they are doing great And they're responding much better than they are to SSRIs. SRIs are kind of resistant in perienopause. So what does that look like? I mean, obviously Big phharma doesn't love this story. So when you look at treatment, you know, you're in periimenopause You have kind of two branches of options. We have replace, like suppress and replace, which is the doses found in contraceptives. If you think about contraceptives were made to stop pregnancy, right They have multiple other uses, but they're off label. like acne, like heavy periods, etcetera. We use them for a ton of stuff becausecause they suppress the hypothalamic pituitary ovarian axis, right? They shut the whole thing down and then by using hormones and you have those hormones in your system. So suppress and replace versus support, which is given menopause hormone therapy doses which stabilizes for a lot of women doesn't provide contraception, will not control her heavy periods, and will not suppress all ovulations But it is enough, we think to feed back to the brain, to say calm up down. becausecause if you think about why we ovulate each month, it starts in the brain, not the ovary. The ovary is just a machine that pumps out hormones and eggs, you know each month Our hypothalamus is constantly sensing our blood from puberty till death, looking for estrodialols And when those levels decline It will send a signal to the pituitary gland saying, hey, it's called GNRH. you know, hey, dude, we're getting low pump out,, tell the ovaries to do their job Tuitary pumps out, L HHNSH, I'm simplifying something very complicated. And then we have these little cells around the egg, the follicular and granulosa cells that areound, you know they have receptors, then that's where the steroid hormones are made, are sex hormones So we pump out estrogen with ovulation, that's pikes. and then after the ovulation, the corpus luteium creates progesterone. and that cycle goes month beautifully like an EKG every month in a healthy woman. veryery predictable. on day fourteen, she's going to do this, day twenty one, she's going to do that. We've all seen the curves Perimenopause is when you reach a critical egg threshold level because surprise, females are born with their entire egg supply runs out Men get to make their stuff fresh. he's like, don't look at me Every day until they die, it gets harder, but they can still produce firm and all the things uill death, usually and week Fall off this cliff. So in perimenopause, the feedback cycle to the brain goes catywampus. So the brain is like, where the hell is my estrogen? I sent the signal And so we get bigger bursts of GRH, which makes bigger bursts of FSH and LH, which then causes these massive dumps of estrdiol. So we get these wildly fluctuating on the downward trend, levels of estrdiol, progesterone never kind of kind of catches up. And the brain hates it directly affects our neurotransmitters and throws a wrench in thingss So and our cognition, ADHD, new diagnosis, the world goes crazy every time they even say that, all these women in the internet. Like is it social media or is it very metab right. I don't actually know how to ask this question because I think it may be controversial is that of course, women are having massive health changes going through this. process. However, a lot of humans in general aren't in the best health St start with. Right How you show up healthwise when you start going through this change tendency, right? So if you are on the healthier end, if you are already eating low processed foods and you are exercising regularly and you are prioritizing your sleep and you're getting therapy and you're doing all the things, right You tend to have an easier transition as far as your basic symptoms. And you, you know, we all have a genetic shelf life of our egg supply. We can speed that shit up. if we smoke, if we're stressed, If you look at trauma like So there was a study done on women who were sexually abused who then had kids who were sexually abused. And they go through menopause nine years eight to nine years sooner than they would have, like had they had a twin Okay an identical twin who did not have trauma. Can you talk a little bit about that mechanism? So this was the only study where they looked at this. And what we are seeing now that people are actually looking at this is Whatever your trauma, you know, whatever your cortisol levels in your stress the ovaries will take a hit. So if you're inflamed, either through radiation Sgery, smoking You are decreasing your follicular count. And rapidly, you know, you were shaving off years of life off of your ovaries. Now what we don't know is if you were genetically programmed, if everything was perfect in your world and you had no stress and you ate perfectly, then your ovaries are still going to die at fifty one. Can we extend that? Now there's a lot of research in the fertility world going Are there ways to extend the life of the ovaries? Should we all be getting one ovary removed at twenty five and then reimpllanted at fifty? You know, is that a thing Are we going to create a superhuman race of females? you know, who live forever? So one way to think about this is Women are racing towards process in this change and almost like a professional athlete, I want to prepare as much as humanly possible for that added stress because it's going to help as I go through that maximize or minimize actually the effects. And yes, of course, medicine should support, but what can people be doing before they get into that change to best prepare them? we look at, you know, what are the long term effects of menopause as far as muscle mass loss and visceral fat gain. So high fiber diet. So if I could go back and talk to my thirty five year old self, right? Or even my kids are in their twenties What do I tell them Nutrition over calories. You know, I grew up in my medical life Thin is healthy, Thin is healthy, Thin is healthy. What I didn't realize I was chipping away at my bone and muscle strength, which I will desperately need in my seventies and eighties. We reach our maximum bones, you know, natural bone and muscle strength. We can impprove on that, but it is work. You can't just like live a normal life, you know, like not work out. So like prioritize protein, prioritize plants, limit your processed foods, you know, all the things because that's going to keep your cardiomet metabolic system healthier All of that and so I'm telling my kids that now because in my mind back in my thirties, I was doing aerobics And I never lifted a weight until I was in my late forties. L burning stuff. That's what we were supposed to do. Yeah, Workout more atighte less. That was the key to health and happiness and looking cute in a bikini. And I'm like, God, if I could just go back and lift some damn weights, you know, in my thirties because now I'm fighting low genetically low muscle mass. And my mom, I mean, all of this I'm ever so selfish But, you know, my mother has Alzheimer's and fell at New Year's and broke her hip. And so it is horrific what this disease process is doing to her and no one in her life to her about prevention. No one talked to her about what she needed to do at thirty at forty at fifty to decrease her rate. My mother jopped which is why her heart is probably so healthy and she's not going to die, but she's going to have this long protracted course in her elder years of complete loss of independence which is ultimately, once you get through the fire of menopause and you get back your shit together Now my patients are like, I don't want to be like my mom Help me What do we need to do I'm like, o Reasonable. Let's, you know, get to the gym, lift weights, protein you know Keep your brain active, keepe your community connections, get your friend group going. You know, like all these things we know decrease the rates of dementia as we age. to my patients are like, let's put out the fire. Now we're going to build a path for the next thirty years. so you you know, no one expects to liifer over. That's the other thing. All the wellness bros are like, we're gonna li to one hundred and twenty, no,. And I'm like, no woman wants to live to one hundred twenty. Not like this They're like, I just want to not break. I just want my brain not to break. I don't want to lose my independence. I don't want to be peeing in the bed. You know, I don't want to lose my continence That's all they want. And I'm like, okay definitely things we can do Beacause guess what? women willon't live longer than men? B four to five years But it's not, we live twenty five percent of that life in poorer health than a male twin would. The trauma piece is so fascinating, and I really I want to know so much more about that Is it true that you know, even in kind of a normal menstrual cycle and a normal kind of variability, that women who have trauma or more difficult backgrounds struggle more on a monthly basis as well. Is this something anecdotally you've seen? Aecdotally, and I'm sure there's data. I just I've been so focused on menopause that I haven't looked at, you know Well, no, I guess the reason I was asking is PMS AMDD. R know is a real thing, absolutely a real thing. So I think that was sort of that's sort of the question I'm getting at you know, um, For women who like never could get through a cycle without feeling suicidally depressed, right? For women who have these kinds of patterns where kind of like your whole life, you feel like you're struggling hormonally and you tried the pill and you tried this and all these things I see them in perimenopause absolutely collapse because it's so much worse because what used to look like the EKG and they could like You know, now it's so much bigger, higher faster, longer And they're really, really struggling. Wow Or you know, they had a little bit and they could manage it. and then all of a sudden it's like, wham. Yeah, I've heard and what my hope was, which hasn't been my experience, was that, you know, once you stop getting your period For a lot of women, there's a tremendous amount of relief. Oh yeah. womomen who experience so if you have traumatic periods. Well, right. So can you talk about for women who, let's say, have had a lot of depression with periods who find relief in menopause So who are those women versus the ones who are like, all of a sudden, I'm depressed. What do I do? Yeah. so we have a subset of women, you know with PMS PMDD and really heavy heavy periods, you know once and very traumatic things associated with their menstrual cycles that You know, it's almost like after hysterectomy, if that's their course, you know, they're like, I got my life back. I don't this is not a thing for me to worry about anymore. And I'm just u. And I wish I would have done this sooner And so we do see women who really struggled with those things. Once we take the fluctuations out and they base they flatline, they feel better. Those things are removed. Now their bones are still deteriorating and they're brain fog and, you know, all the things, but they're cholesterol's going up, but they're just so much happier that they don't have that monthly traumatic experience right I wonder if you can talk a little bit about this increase in autoimmune diagnosis. You, A lot of women and I think social media has been a place where a lot of people can share a lot of this A lot of women are surprised that there are actually Categorizations and diagnoses for what used to be a kind of a conglomeration of symptoms that many people were told were just in your head. What's happening during perimenopause and menopause that is contributing to this these diagnoses? So estrogen is a really powerful anti inflammatory hormone And it's very, very protective and win those levels w Now there's kind of two schools because some autoimmune diseases Like in pregnancy, if you have an autoimmune disease, tendency in pregnancy as you get a honeymoon period And then when the hormones crash postpartum, we see not only they come back, they come back with a vengeance. So I'm always watching when I did obstetrics, I've given up that part of my practice I was always you know warning watching checking levels labs looking for inflammatory markers for my lupus patients are like a really good. though pregnancy is really stressful on the whole body system. Lupus patients tend to not do well, you know, in pregnancy. If she kind of ran the gauntlet, then I'm like really checking postpartum So estrogen seems to be protective for a lot, not all of autoimmune diseases. So we take that protection away And then boom they come possible that the appropriate replacement of estrogen that we might be able to prevent autoimmune diseasees or well no, but you know, But I'm saying is this a technique or at least to familiorate some symptoms? It's definitely an area we should invest a lot of money into studying But you know, menopause got there's not even a division and well who knows what's happening with the NIH, you know, right now. Historically in twenty twenty three. I not be in five billion dollar budget fifteen million went to Menopause. There's not even a Menopause section All women go through menopuss It affects all of us fifteen million. It'szer zer of the budget went to studying women after reproduction ends So when you think of all these symptoms, you know, in particular the the special kind of weight gain. You think of thinning hair You know decreased libido and you know those are the most distressing. Right fatigue is the other. most fatigue, brain fog. Are there women listening who, upon receiving appropriate hormone replacement therapy might see those things literally go away? Absolutely In my clinical practice and in the menopusese, like my little ragdad group of menopause friends who are doing clinical care. You know, we have a group chat every day, we're sharing articles, information, you know, it's our own little think tank. And it just is astounding to us I can show you patient letter after patient letter I've got my life back you know, it's not perfect. You're not twenty five again, but you're back to your level of resilience. this You built this life with stresses that you took on, you knew, you had children, you have aging parents, you had all things, you had it You had it. You were kicking it And then all of a sudden you can' That has been taken away And Giving a woman back the ability to manage the life she built is the greatest gift I could ever give her What about ADHD We talk about brain fog Obviously, people are experiencing low energy brain fog, making it hard to concentrate. So the brain fog seems to be the worst in perimenopause. So when the fluctuations happen, that is really jacking with neurotransmitters and how signals are going across and how we're processing in the brain and Lisa Musconi, who has written the Menopause brain and done tons of research. She actually has now moved into the private sector with funding and she's doing a ton on Alzheimer's So If you're not on the path to developing Alzheimer's It does tend to get better. Unfortunately, it can take years And a lot of women, like one in five in the UK and at least one in ten in the US are leaving their jobs becausecause of this feeleel they can do their job safely or adequately because of this disruption. And so what we're seeing with hormone replacement therapy, and then they go in and they have what a four percent chance right now of being treated with hormone therapy. So we got ninety six percent of women who are raw dogging menopause and You know, they're quitting their jobs. They're moving on to and maybe that's good. Maybe it was a job that was toxic or, you know, they're leaving marriages. They're they're doing a lot of things that had they been given a chance and maybe it was a marriage that she didn't need to be in. But you know, This is changing Decisions and changing what a woman feels like she can do. And just thinking about the economic cost, like Yeah. so McKinzie report, they actually looked at what the economic and oh God, who was it? One of the big menopause researchers coming out of the Chicago, I think, looked at what they feel like the economic impact is. And it is billions when you look at time off When you look at women, who are having to go to the doctor and what the economic cost of all of this is It's astounding. I mean, just the loss from the workforce is astounding the trade offff for actually taking the money for preventative care would have such huge downstream benefit. It's so short sighted to not have the research, to not have the preventative effect. So that's been looked at as well and what they feel like the economic impact would be if all women who were candidates were offered and say half accepted. The cost savings to Medicare and Medicaid and insurance would be Unbelievable because oral estrodiol is two dollars Estra doial patches are twenty for the month I mean, this is not, we're not talking Ozmpic prices. This is this is like affordable for the vast majority of women, you know, and mostly covered by insurance. they're not being offered. What's stopping the mainstream this here fe breast cancer The Wen's Health Initiative. it has You know Peter isity, I'm staling his word He feels like it is the big and and Marty Macrey Biggest FO in the history of medicine is the Women's Health Initiative, how the misinterpretation and just the hysteria around, you know, was propagated and never walked back in a reasonable fashion. And guidelines are still struggling. The NIH database now says We prevented X amount of cases of breast cancer, which they did not We've prevented heart disease, Jesus, God Almighty, it's protective against heart disease You know, we know that it is so protective of the endothelium. It decreases the rate at which we form clots and plaques and calcifications And atheros sclerosis, it cuts year by year. the If you start between the ages of fifty and sixty, we can cut your risk of heart disease fifty percent per year given that window of opportunity. How do we get people to trust the doctors that they do have to see. So again, they weren't trained. So this is not your doctor being an asshole. This is your doctor who was not allowed to receive this information in a timely fashion. This is a doctor who did I was that doctor, right? And I didn't have the time to go seek training outside of what was put in front of me I was forced to see patients in a ten, fifteen minute window, including a pelvic exam, so with their legs and stirups, while I'm still talking and getting histstromp. I need fifteen minutes. I would get into the stirups and feel comfortable. I was expected to do all of my charting on my own time at home when I'm trying to be a mom and a wife and stay married and do all the things What this medical system has evolved into is sick care Very little prevention you know, It is what it is. And you know for that reason, and there's no medical model that will support what take it takes to do good menopause care, you know, in the current insurance system, which is an hour long visit, really. 'ause there's a lot of stuff. My symptoms take fifteen minutes just for me to list them. you know, And I don't think, and let me be clear to your listeners, I don't think all of women's health after reproduction ends should be dumped in the lap of the poor busy OBGYN This should be mandatory education for every medical student, for every clinician, for any clinician who touches a female Menopause, you know, what happens to the human body after estrogen walks out the door and ovaries fail should be part of cardiology and nephrology. I mean, it affects everything. I've been told more about cagel exercises than anything. A literally giving birth to two humans That's kind of what is offered. you know, And I used midwifery care obviously because I was a homebirth person. Any anyone ever talked you about pelvic floor physical therapy and all the No, I mean, that's the thing. like Even beyond that It's something we need to start telling women in their twenties and thirties, like while they're out like partying and having a good time Also This is the way to is going to expand to the size of a bowling ball And you're going to push a human through a layer of muscle and tendons that, you know, you were designed to do this, It's not gonna be the same. We were also designed to run marathons. We gota prep for that. Yeah, ye. Well think and I think sort of, you know, what I'm sort of reflecting on is There was so much more attention paid to like gettinget your uterus back to its size and making sure your vagina is in good shape after having kids Inead of, you know, every ob visit that I had after that was like, are you doing your Kgels? inststead of You're on the cus of a tenure process. that is going to rock your body and your brain in ways that' not screening for periimenabr were not, you know, it's not built into the well woman exam. And then if you so say you find a provider, one of the four percent, right that is educated and willing and knows what they're doing. Usually midwives are the only ones who was who were knowing this. They were the only ones willing to talk about it. It really, you know, it' it's just it's a systemic issue Let's talk about gut health Yeah What should people know What are the misconceptions that are leading people astray Well, I learned zero about it in medical school, zero about it in residency. Everything I've learned, it's like through other providers and through CM me and through, you know, but it's really, it was considered woo woo. I remember learearning about the transmutation, watching like a little bacterium go through the wall of the the colon and it took ten years for that paper to get even recognized and, you know that could actually happen And the whole gut health thing was met with such skepticism And now it's becoming more widely accepted. but you have this whole generation of physicians I don't know anything about it and don't know how to talk about it or treat it. And so it was me going back to school. well, training and getting the culinary medicine certification where I really learned about the gut health. and I've worked with Zoe who and I did the Zoe test, had to collect my own stool sample and send it off and get everything tested suuper fine. I had to eat the blue cookie and wait til my poop turned blue. That was a party. but u But I science, you know, did it for science and Female gut microbiome completely changes to that of a man's after a menopause. We've got the estrobalome, which is the subsection of gut bacteria recirculate estrogen through the gut is dramatically affected by menopause. I did not know that was a thing. I did not understand the metabolism of estrogen. We get a boy gut We get a boycott And then with that comes all the boy things like increasing risk of heart disease. risk I'm glad I'm not the only one. So that is one surprise of perimenopause So what else what are the other symptoms that women develop that are more similar to men after their change in gut? Well, there's symptoms and then there's There's, you know, the cholesterol. before so let's talk about heart disease, right? Before menopause, a woman enjoys a much lower risk of cardiovascular disease Once she goes through menopause, we pass you guys up And we massively passed you guys up. So our risk factors And gut health is part of it, right? And just looking at the quality of the gut microbiome of the number of species, you know, so we lose the amount, the overall how many we have and the amount of species. So females tend to have healthier guts and they feel like it's part of the circulation of estrogen. The estrogen helps to keep the gut healthier, the inflammatory the whole nine yards that away and disrupt it We tend to be less healthy and hormone replacement then allows them to maintain their female gut or it still changes. Yeah starting to look at that, but Zoe, who was studying doing school samples is looking at gut health for women on HRT versus not and they're seeing what appears to be a healthier gut you know, maintaining the health of the gut microbiome with HRT And it's like oral more than system, you know, there's pros and cons to everything because if you're ingesting the estrodiol, it's going through the gut versus transdermal you know The first pass effect of the liver, you know, we have pros and cons to both both mapids And there are other things that Women should be doing, obviously eating a diverse range of Absolutely. Fiber is a huge. Plant protein, pllants and protein, that's what I preach to my patients, especially on a GOP one. What about probiotics I'm a fan, so I'd prefer for them to get them. There's okay, so when I look at the data on inflammatory markers in post menopause and gut health and post menopause, it's hard to find a study that doesn't include probiotics Eating something rich in probiotics. when you look at cultures that have a diet rich in probiotics like a lot of Asia, they don't do dairy, but they're doing fermented foods heavily. So they're getting their probiotics that way Most in the U. S, the main source of probiotics is yogurt, but unfortunately the way we create yogurt commercially available yogurt in this country. they dump so much shit in there about it just cancels out anything healthy. You know, what I talk talk to my followers, patients, whatever is I do playain Greek yogurt just straight up Nothing in it. you add your stuff to it. So I'm like, heemp flex, chia, nuts, seeds, you know, berries, whatever. you need, you know, drizzle of honey if that's your jam But, um to you know then you can add in the additives and make sure that they're healthier, But that's a great source of probiotics. Studies are done though, with probiotic supplementation, and they're kind of all over the place. So there was one done on obese women with hypertension and they supplemented with bifidobacterium and maybe lactobacillus And they saw better blood pressure, better gut health. So I always quote to my patients, you know, women who eat dietsertion and probiotics, plus or minus a supplement If you need it, have lower visceral fat. But you're just restocking the pond. You can't like take a round of probiotics and expect, w, you know, if you're cranking that stuff, it goes straight through. And for the portion of the population that doesn't eat dairy or can't process, there are also non dairyight. There are other v tofu, There's lots of fermented foods. It's a taste thing sometimes. So if you just can't do it You might want to consider. For the days I don't have yogurt I willll take my probiotic supplement. People still think that tofu gives you cancer also. You can throw that in with the rich and soy are they actually anti carcinogenic? So yeah. Vitamin D Huge fan. Most people are deficient in vitamin. So when you get in a menopause, we're up in the eighty percent range. and that tracks with my patient population. So we're looking at, if you use sixty as optimal Probably ninety percent of my patients are suboptimal. and it's really hard to get enough in our diets. The way our absorption goes down All of that gets hard. Talk a little bit about vitamin D for people who may not know about this Vitamin D is a vitamin. It's also a hormone. and it has multiple receptors throughout the body, almost as much as estrogen. It is just a cofactor in so many enzymatic processes in the body. And so we know people who are deficient in vitamin D, which is most people have haair loss, weight gain, increasing cardiovascular disease risks, like all of the c metabolic risk factors tend to get worse And bone density, right with low vitamin D intake. Really tough to get enough in your diet. You know, I always say diet first, you know, get it through nutrition. Wh is it we fatty fish, salmon, tuna, mackerel. You gotta e curp ton of mushrooms, but they're there. You know, to get enough. And a lot of people don't want to eat fish because it's full of mercury and metals and other things. Al whereere else is vitamin D So mushrooms mushrooms And those are kind of the two real main sources. So we don't have like a plethora of places we can get it from some dairy. So yeah, you can get it from dairy. And some people are like, well, I'm out in the sun all the time but they're not out enough with enough exposed skin at the right periods of time. and so few people live in that small bracket of the world, right You can actuallyabolive and metabolize it. And then what if you're drug completed? You're not doing much of that either. That melanin that's protecting you against cancer is also decreasing the amount that you can convert in the skin So I see a lot of argument, you know base, oh, I'm out in the sun. I'm like, arere you naked? Are you in this latitude range, you know there And not that this is prescriptive, but what are the general ranges of supplementation that someone should be looking at? So sure, you should get a baseline before you start. So if for whatever reason you are jamming on your own without needing to be supplemented, then don't take it You know However, that's not most people So get your level checks, see where you're at. If you're deficient You can go up to four and some papers, say five thousand without worries of toxicity. Vitamin that's stored in fat you can become toxic. So there's the random person who got the fifty thousand once a week and took it every day for a month. She's a little toxic, okay So it's hard to become toxic on vitamin D, but it can happen. So we always caution. and that fifty thousand is prescriptive straint. So over the counter You know, I'm giving, I'm starting at four to five thousand a day. That's, but if they're already deficient, I'm giving them fifty thousand a week as a loading dose Taking the forty five, you know, ours is for I have one. commercialally available. That's four thousand on the other six days of the week. We re check in twelve weeks, see if they're like back up in a nice greatate range and then we maintain A lot of my patients in me included once or twice a year, I'll have to go back on the higher dose to Boost me back up You know, get me to where I need to be with the fifty thousand a week What about magnesium Everyone talks about it. It's like I'm a fan. I take it. And there's a thousand different types. notot really, but there's a lot. There's a lot. There are different forms ofag. So magnesium is a mineral And people like, oh, I check my magesum level. it's fine. Well, that's great. It's a water based mineral that you peay out every day So a one time blood test is not telling you what your stores look like or you know, we don't use a one time blood test of magnesium only to see if you're severely hypo or hyper, know, which can happen in cardi It's important in cardiovascular disease. So Most people dietarily with the standard American diet are not getting enough magnesium in their diet U It's something that fluctuates minute to minute in our bloodstream and peoples it in Magnesium is of. I like pumpkin seeds for my favorite source of magnesium, but a lot of people supplement. So milk of magnesia, we've all heard of it doesn't really absorb well until the bloodstream stays in the gut, pulls water into the gut and induces Bowel movements, diarrhea, That's why we take it for constipation It's why it's in mag, you know, it's why we use it and go lightly for getting prepped for bout. If you haven't had a colonoscopy, remember very important So you know, you're going have a lot of magnesium, but it's not going to get into your bloodstream U Then there's other forms that absorb rapidly into the bloodstream and raise the levels, but doesn't really cross the blood brain barrier that well. And then there's Mag al theerinate magine or mag that does cross the blood brain barrier, has great studies for SSRI resistant depression that it looks really promising for that I've taken it for sleep. They just they did a comp Or my wor ring. So they did some studies. O is starting to do a lot of studies in sleep and menopause. I'm actually flirting with them for their scientific board. getet involved in some of those studies because sleep disruption is real and hormotherapy does not help everybody. for, you know progesterone is actually estrogen will stop the hot flash if that's what's waking you up. but For people who were having the middle of the night awakenings or restless legs or the anxiety at night Jestsone is magical. And so just as an overview, if what are the names because you went you o gosh, there's so many magnesium Ltherurinates. So that's mage neuromaga the n. So that one's very specific. It crosses the blood brain bar well. so they're studying it in kind of neurological things Then there's Mag citrate, Mag oxide, Mag glycinate. you know, there's probably twelve there that are being used and they are all touting specific benefits, a lot of cherry picking of data going. But I'm like You know, if you're trying to raise your magnesium levels Fine. you just don't want to become, you know, take too much of it And people are finding relief from X Y, and Z I wonder if You know, I I don't I don't mean to you know, be this downer person, but I know a lot of people listening are not going to have access to the kind of care of Let's do blood work and then let's set a zoom appointment for fifteen minutes to go over your blood work and make changes. And just in my own journey through perimenopause and menopause, like, it's taken, I mean, I've been to like three different specialists, tried like at least a dozen different combinations of things, right? And it takes this kind of tinkering.. So lets let's say for someone listening if they don't have access to that, and that may not be in their life plan What are the five recommendations you would make nutritionally Yeah for people to take on, know that they can go to the market Go to Whole Food,, Go to wherever. What would be the five things you would suggest people to Limit processed foods as much as possible. Okay Okay, That is just never gonna serve you. You know, occasionally it's fine. We all have emergencies. I was eating processed food. yesterday. I was stuck in a car for four hours, you know Um, but that should not be the main source of your diet. Fast food should not be the main source of your diet. you know really dial in on an anti inflammatory kind of program whatever that looks like, whether it be Mediterranean, we kind of base Galson diet on that. like really avoid processed foods as much as possible.. Make sure you are getting enough protein Most women are not. So when we looked at WHI WHI is just a data set. There's great information in there. It's just kind of how things were interpreted and things that were blown out of proportion. But when we looked at frailty scores for women living in nursing homes who were on the WHI and they looked at protein intake. They found that women with the highest cartile, like one point six grams for every kilogram of lean body massk were much less likely to be frail You know, You need protein to be strong. Like that's just the like third grade And when you grew up in the mind of caloric restriction is is the way to be healthy. Protein for most women in the US took a vac seat. R. We weren't focusing on, you know, most women in the US right now have no protein with breakfast, a little bit with lunch and they kind of stack evening and they're only getting thirty to forty grams, maybe fifty sixty total for the day and that's likely less than half So things So things that people can do if they're not gonna eat let's say, a breast of chicken or a piece of fish. S days I am gnawing on a chicken breast allready. R. But can you can supplement with healthy protein powders. You can get those in smoothies. you can sneak it in other ways.. Okay, so uppping protein. Okaykay so that's two. So I need three more. Upping protein. Yeah. Look at your movement, your exercise Okay, Well, you're talking you want me to go nutrition. Yeah, I didn't know if you'd be like, everyone should take vitamin D or you know? Yeahah get your vitamin D level checked and absolutely supplement if you are low. It will turn your life around. If you're running around with a vitamin D level of fifteen, I can rock your world just by giving you vitamin D. Sos like get that vitamin D level checked. and supplement you know, if you feel like It's necessary. Fiber fiber Most women are getting ten grams of fiber per day, ten to twelve maybe We need twenty five minimum thirty five for optimal cardiovascular. measure fired by poops No, no. no. Okay. I mean, you can have a general, you know, but I have you've seen those poop videos where they're showing all the different consistencies of poop. A lot of stuff goes into that. But You know, you should be having something like toothpaste or you know The consistency of a toothpaste is every day, a formed st, not diarrhea, but, you know, But fiber is it's vegetables. Like when when I think of fiber, I'm always like, o eating my rice and my grains not really. It'ss that are high in fiber. It's avocado. you know, those are like I'm like chia seeds. Seeds, nuts, avocado, beans, those are going to be like the biggest bain for your buck. to make sure and surprised, they're also packed with a whole lot of other shit that makes you healthy. So vitamins, minerals, nutrients. So like you looking for plant based sources for fiber? Well, that's where they come from But you know, doing like really zooming in on high fiber foods is going to really It's like a lot of buttons the same time. Okay and then limited added sugars. So Keto movement everybody stopped dating sugar. My go God, it's horrible horrible turns out Things that contain sugar from God, fruits and vegetables are not that bad for you. You know But it's when we add sugar O drink soda. O drink soda or alcohol which your high sugar contents, we are seeing tremendous effects to multiple, you know, your insulin, your cortisol, your cholesterol, like all of that. So women who limit their added sugars to less than twenty five grams a day, not say you could never have an occasional treat or you know your coffee with however you like it If you limit those, you are going to do way better. You're going to have less insulin resistance, you're going have lower viscal fat, and you're going to haveess cardiovascular disease The other thing I wanted to ask you about Let's say someone is ready to go to their doctor to try and bring this issue up, right? A woman feels like she hasn't been listened to So yeah, what would you recommend I is it is shameful to say. you cannot expect You're fabulous. OBGYN, who did incredible care who you have adored your entire life When you cross this threshold and this is the new phase of your life, they most likely did not receive enough training to be helpful. And they may be wonderful. And I hope for your sake that they admit it They say I have no time This is not my area of expertise. So what's a way that someone can advocate for themselves in this arena? So on our website, you know and if you go on Instagram, you go to my link and bio, we have the Menopause empowerment guide And the first two things are how to find a doctor who went who got more training You go to the Menopa Society Menopaus. orga you look for a certified provider. Not everybody on the list is takaking the test, right? It's not perfect Our website we have Crowdsourced Testimonials from our followers, D did you have amazing care And they write this beautiful paragraph for whatever, and then we look them up by city and state and we organize it So that's another way to do it There's some fabulous online companies. telemedicine companies that have been developed just for menopause care. And they're female founded. they saw a gap, they saw a need, and they decided to fix it. someome of their protocols and I agree with what they're doing. And if you're someone who, let's say, maybe doesn't have an OBGYN that's treating them at this phase of life, but you're kind of going to your regular doctor I haveing articles the latest position statement from the Menopause Society on menopause hormone therapy that they can print out. the article from the cardiology from Circulation, the Journal of Circulation that listed the, you know, safety and efficacy and heart protective values. Those two articles together. you can just slide them if your doctor's willing to learn. If they admit they don't know, say here get started here. And I'm like, listen Just tell them this, use this script I would like to try this for three months And I'll come back and tell you how I'm doing. Does that sound fair That works for most Yeah, I think a lot of people have trouble and just from the questions that we, you know, have kind of gotten from our from our listeners and our viewers think a lot of people don't feel listened to. And many women, you know, also separate issue, but it's concurrent with this We're not taught to be advocates for ourselves and especially if it's If it's an authority figure, in many cases, if it's a man, you know, we sometimes can feel pushed aside or like we don't know how to advocate for ourselves. If you could give kind of your sort of like minute of empowerment to women what would to advocate for yourself at this time of your life Be if you're not the CEO of your own healthcare, the system was not to serve a woman in menopause. And I'm fighting to change that, but we're not there yet So you have got to take the reins here or bring an advocate with you who's gonna to fight for you if you can't do it This is really going to help a lot of people. Where can people go to find all of the things that just talk' Dr. Mary Clarire All one word you your MARYCL AI. And then we have a website the Pause Life, where we have blogs schoolools, aids, guides, it's all free. Go check it out. you know, lots of resources for you to advocate for yourself. and all the science behind it Thank you so much.'relcome. I really appreciate not only the information, but the sort of the encouragement of advocating for yourself because While the information is fantastic If you can't communicate that to a person. It goes nowhere. You know, she has created a citizenss guuide to menopause advocacy, simimple steps for transformative change. It's something that is so important for practitioners, but also for patients to be able to say, this is happening to me. It's not in my head. It's a thing. and Hormones can help me and I have the right to have access to them. And obviously there are women for whom that is not an option because of Um cancer and you know, certain genetic profiles. But you know, what what she's speaking to is the vast majority of women should have access to this and deserve to get more information about it. It's not an overstatement to say that there's a revolution happening revolution and understanding what's really going on for people in the list really long list of symptoms that people think are dispperate but are actually underlying have an underlying related cause that can be solved It can be addressed. For sure. People don't need to suffer this extent without getting help. And the fact that the medical system had no information about this. Well, fifty one percent of people appreciate you saying that. So thank you. The books you mentioned, the subtitle is Truth and lies, early medicine taught us about women's bodies and why it matters today. It still does matter today that outdated information has not caught up to mainstream care Hope you enjoyed this episode. Sure grateful that we had Dr. Haver on from our breakdown to the one we hope you never have. We'll see you next time It's my Bxs breakdown. She's going to break it down for you. She's got a neuroscience PhD or two on fiction. So now she's gonna break down. It's a breakdown, and she's gonna break it down