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

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0:00In 2023, 85% women are complaining of
0:02menopausal symptoms, 10.5% are receiving
0:05treatment or therapy. I mean, it would
0:06be as if your testicles traveled up and
0:08died at 51. That's the equivalent.
0:10Let's get started. Dr. Mary Claire Haver
0:13renowned menopause expert
0:15with more than 2 million followers
0:17helping countless women through their
0:19menopause experiences. Menopause is
0:21inevitable, suffering is not. But, a
0:23woman is more likely to be prescribed an
0:25antidepressant for her menopause than
0:27hormone therapy. Women by the thousands
0:29are like, "Oh my god, I had no idea."
0:31That's when I realized no one's talking
0:32about this. So, here's their laundry
0:34list of symptoms. We've categorized
0:36about 70. So, there's brain fog, changes
0:39in her sexual function
0:40weight gain But, here's the scary
0:42things, and the studies have been done.
0:44We see either a new onset or worsening
0:46of depression, anxiety, bipolar, ADHD,
0:49risk for cardiovascular disease and
0:51diabetes increases, recurrent urinary
0:53tract infections, which is a major cause
0:55of death for women. They're suffering in
0:57silence, and I was one of those women. I
0:59want to see my grandkids one day. I want
1:01to watch these women I've raised grow up
1:04and, you know, be the women they're
1:05meant to be, and that choice might get
1:08taken away from me if I'm not careful.
1:13But, there's lots of things that we can
1:15do. For example, we see a dramatic loss
1:17of muscle mass. Focus on strength
1:19training. This is going to determine
1:21your longevity as you age. Strength over
1:23skinny.
1:23What about your diet?
1:25I developed a program for my patients,
1:27and it's not rocket science. It's
1:29Whether you're a man or a woman,
1:32menopause is going to affect you because
1:35it's going to affect 50% of our society.
1:39And there is 1.2
1:41billion women being affected by
1:43menopause right now. And whether you're
1:45a man or a woman, most of us don't have
1:49the answers. How do we help? How do we
1:52talk about it? What is it? How does it
1:55affect the human body? If you're in a
1:58relationship with a woman that's in
2:00perimenopause, which can start at 30 up
2:02to a woman that is currently going
2:04through menopause in her 40s or 50s or
2:0760s, what should you do to support her?
2:10What can she do to support herself? This
2:13subject of menopause has exploded in
2:16public conversation, thankfully. But,
2:19there's still so many unanswered
2:20questions. And that's why today I
2:23invited one of the leading voices on
2:26menopause globally onto my show. Even as
2:29a man that won't go through menopause
2:30myself, but has a partner and a mom that
2:33certainly will, there's something that
2:36everyone can learn from this. And I
2:38implore all men who maybe clicked on
2:40this episode or was sent this link to
2:42listen.
2:43Please, just listen.
2:46Because you can learn something, too.
2:49And for everybody new to this channel,
2:51can you do me a favor? If you like what
2:52we do here, you like the guests we have
2:54on, and you like the show that we bring
2:55to you, can you hit the subscribe
2:56button? It is the single thing and the
2:58only thing I'll ever ask of you. I would
3:00love you to join us on this journey, and
3:02if you do, I will repay you, and that is
3:05a promise. Do we have a deal?
3:07Thank you.
3:15Dr. Mary Claire Haver,
3:18why do you do what you do?
3:21You know, I started out in medicine
3:23the way most people do. You know, I
3:25wanted to help people.
3:27And in our training and school, we get
3:30to have a little taste of all the
3:31different specialties. And my very last
3:34rotation in my third year was OBGYN. And
3:38I really liked surgery. I really liked
3:41some of the surgical subspecialties, so
3:43I thought that would be my path. But
3:45then, when I delivered my first baby and
3:47all of that rush of emotion and dopamine
3:49and how beautiful that whole process
3:51was, I knew that that was going to be my
3:53calling.
3:54And so I did the traditional 4-year
3:58residency and loved it and really did
4:01well and went into private practice. Um
4:04after about 3 years of doing the private
4:09practice route, I realized I missed
4:10being in academics. I wanted that
4:13ability to do research and be around
4:15students and teach as well as take care
4:16of patients. So, I went back
4:18on as faculty. And everything was going
4:21great. I was very successful. I was, you
4:23know, doing pap smears and babies and
4:25birth control and all the things a
4:27traditional OBGYN does, and then I was
4:30aging as my patients were aging, too.
4:33And when I got to my 40s, I realized
4:37that there was a big gap in my education
4:40and knowledge around menopause. So, I
4:43started researching. Most of my patients
4:46were coming in, the pain point was
4:48weight gain. And they were like, "I'm
4:50not doing anything different. I'm
4:53working out. I haven't changed my diet."
4:55And that little voice in my head was
4:57like,
4:58"Work out more, eat less." You know, we
5:00tend to move less. We tend I was just
5:02going with the script that had been
5:03handed to me
5:04for years that calories in, calories out
5:07is the only way. And, you know, in
5:10medicine in the US, we have very little
5:12background in nutrition. We learn
5:14nothing in medical school, very little
5:15in residency as far as what nutrition
5:18actually is and how it can affect our
5:20bodies. And so,
5:23I started struggling with my own
5:24menopause. My patients were all
5:26struggling, and I decided to go back to
5:28school to learn more about nutrition
5:30because I felt that there was a big
5:31piece missing here because this weight
5:33gain was mostly centered around the
5:35midsection, and I was learning about
5:37visceral fat and subcutaneous fat and
5:39the differences and what's going on with
5:40our muscle mass, and I'm like, "There's
5:42a much bigger picture here than just
5:44calories in, calories out."
5:46So, in my I enrolled at Tulane
5:49University in their culinary medicine
5:51program, and just my mind was blown by
5:54how much I didn't know as far as
5:57nutrition and inflammation and aging and
5:59how it all affects, but where was this
6:01menopause piece?
6:02And
6:03so I took everything I learned and I
6:06developed a little program for my
6:07patients,
6:09um which became the Galveston diet, and
6:11it really was just a passion project for
6:12me. And then I started talking about it
6:15on social media and realized that as my
6:19social media presence grew and the
6:21conversation got bigger and bigger, that
6:23there were so many women suffering.
6:26Probably the majority of women in
6:27menopause were suffering not just from
6:29weight gain, but from musculoskeletal
6:31issues, mental health, brain fog, you
6:34know, skin changes, hair changes, nail
6:36changes, and I just kept doing deeper
6:38and deeper dives and realizing no one's
6:40talking about this. No one's talking
6:42about the multi-organ system, you know,
6:45failure that a lot of women are going
6:47through, and they're suffering in
6:49silence, and physicians aren't helping.
6:51We're not trained. And so, I thought And
6:54my It's really my kids who I have two
6:56daughters. One's 23, she's in medical
6:58school right now, and she's um she's
7:00actually here with us. And then, um the
7:02other is 20, and
7:04they were like, "Mom, you've you've got
7:06the social media presence. You really
7:08need to use it for good." And that's
7:10kind of where that conversation exploded
7:13for me on social media and where I
7:15realized by reading the comments
7:17what a much bigger pic you know, what
7:20was really happening in the menopause
7:22world and how we need to bring it to the
7:24forefront.
7:25For people that don't understand
7:26menopause,
7:27Mhm. um they might think it's that it's
7:29a small issue affecting a small group of
7:32people. But, how many women are are
7:34affected currently by perimenopause,
7:36menopause, and postmenopause?
7:38Sure. So, right now, about a third of
7:41the female population of the world is in
7:43peri, full, or postmenopause.
7:46Um
7:48you do not It's not optional. All of us
7:51go through it. And because we have such
7:53individual expressions of how it affects
7:55our bodies, what we know now is that
7:58there are estrogen receptors in every
8:00organ system of our body. And when those
8:02levels start declining, we see a very
8:05wide variety of a spectrum of of
8:07syndrome where it used to just be
8:09thought it was a few hot flashes and
8:10some night sweats. Maybe your sleep's
8:12disrupted. Your genital urinary system
8:15is going to take a hit. Um your bones
8:17are going to get weaker. But, what we
8:19know now is how much it's affecting our
8:21mental health, our capabilities, our
8:23skin, our bones, our kidneys, you know,
8:25vertigo, tinnitus, frozen shoulder.
8:27Anytime I post about those on social
8:29media,
8:30the internet explodes. And women by the
8:33thousands are like, "Oh my god, I had no
8:34idea." You know, and just the validation
8:36piece was so huge for them to make
8:39because they've been dismissed for so
8:40long and told it's all in their head.
8:42And if we think about from sort of peri
8:44to postmenopause, what is that sort of
8:46typical And I know that's a tricky word
8:48to use, but what is the
8:51ab sort of average typical age range?
8:53And then also, what is the sort of more
8:55um
8:56possible age range? So, it could start
8:58between this age and this age. So, it In
9:00the US and in most of Europe, the
9:01average age of menopause, which means 1
9:03year after your last menstrual period,
9:06is 51.
9:07Perimenopause, which is when your body
9:10recognizing recognizes there's some
9:12declining estrogen levels and you're
9:13beginning to be symptomatic, can start 7
9:16to 10 years before that. So, normal
9:18menopause is still 45 to 55. Mhm. And
9:22so, if you do the math and back that up
9:247 to 10 years, it is completely
9:26reasonable for a 35-year-old woman to
9:28begin to experience some of the symptoms
9:31of perimenopause.
9:32So, let's start with what is it? Um and
9:36I would love you to explain this to me
9:37like I'm a 10-year-old.
9:38Okay.
9:39Because I'm sure there's a lot of people
9:40that are both men and women that aren't
9:42fully So, we're going to talk about
9:43gonads, right?
9:44What's gonads? Gonads are um where our
9:48So, in men, it's the testes and where
9:51you're making your genetic material to,
9:53Okay. you know,
9:54uh where you're making sperm, right? And
9:56in a female, it's going to be ovaries,
9:59her ovaries. So, the difference big
10:01differences between male and female and
10:03how that process happens is that
10:05males make their genetic material fresh
10:08constantly. The minute they go through
10:09puberty until basically they die unless
10:11they have some medical issue.
10:13Females on the other hand, our eggs
10:15develop while we're in utero in our
10:17mothers. So, while we're in the womb,
10:20we're she's 5 months pregnant with us,
10:22we have our maximum eggs that we're ever
10:24going to have. And those are meant to
10:26last us until we go through menopause.
10:29And so, they lay dormant until we go
10:30through puberty and then they wake up
10:32again and we start ovulating. So, we
10:34have this monthly in a healthy person
10:37cyclical, you know, hormones rise and
10:39ebb and flow with our cycles each month.
10:42We have a period, you get pregnant, you
10:43don't get pregnant, and the whole
10:44process starts over again.
10:46Well, because we're born with that egg
10:48supply, through time we're decreasing
10:50the amount
10:52and the quality of those eggs. So, when
10:54a woman hits the age of 30,
10:58um she is down to about 10% of the egg
11:01supply that she had at birth. And when
11:03she's 40, it's down to about 3%.
11:08And so, and it gets harder and harder
11:10for that ebb and flow of the natural
11:12hormones to do its job and we start
11:15seeing fluctuations in her periods and
11:17then organ systems that are beginning to
11:20notice the lack of estrogen. Estrogen is
11:22a really powerful anti-inflammatory
11:24hormone in most of our body systems. So,
11:27the musculoskeletal syndrome of
11:28menopause is really starting to be
11:30talked about quite a bit now and we're
11:32looking at things like frozen shoulder,
11:35arthralgias, generalized aches and
11:37pains, and most physicians aren't aware
11:40of this. You know, most know about hot
11:41flashes and night sweats and sleep
11:43disruption, but now that we're really
11:46opening the conversation as to how many
11:48organ systems are affected, we are
11:50seeing people coming out of the woodwork
11:53just so happy to know that they're not
11:54crazy and they're being validated.
11:56And what's happening at these sort of
11:58three stages? So, we have the
11:59perimenopausal stage, which is, from
12:01what I've understood there, when
12:02estrogen levels start to drop. Right.
12:04So, we start seeing
12:06disruptions in the force. So, instead of
12:08that nice monthly estrogen surge with
12:11ovulation and then the progesterone goes
12:13up, we start the elongation sometimes or
12:16they even get closer together. I call it
12:17the zone of chaos. What used to be a
12:19very reproducible, dependable system
12:23starts failing. So, some women will have
12:25irregular periods, meaning they're
12:26spacing out, they're skipping periods.
12:28Others will have really heavy periods
12:30like like, you know, hemorrhagic almost.
12:34Um and again, individual um
12:37the way the body reacts to this is very
12:39individualized from patient to patient.
12:41Doctors love
12:43something that follows a list, a
12:45checklist, right? You know, we have all
12:47these complicated things we have to
12:48learn and we have these checklists, but
12:50menopause, it's like pinning the tail on
12:52a moving donkey. And in perimenopause,
12:54the it's very, very chaotic. Estrogen
12:56surges, then it goes away for a while.
12:58Like a woman in perimenopause can feel
13:00completely fine for a few months,
13:01everything goes haywire, then she's fine
13:03again, you know, and not only is her
13:06estrogen declining, her testosterone is
13:08declining as well. So, we're seeing loss
13:10of muscle mass, we're seeing changes in
13:12her sexual function,
13:14we're seeing decreased strength, you
13:15know, there's some some really good
13:17studies showing how testosterone also
13:19affects our mental health and our
13:21cognition as well.
13:23Why does this happen?
13:25From this a sort of like an evolutionary
13:26or So, the anthropologists have looked
13:29at this heavily and there's we're only
13:31there's only a couple of species in the
13:33world that go through menopause. Humans
13:35are one. There's a species couple of
13:37species of whales and I think they've
13:39now discovered one of the giraffes
13:41species of giraffes can do it, but the
13:43by and large, most mammals will
13:47die while they're still ovulating. You
13:49know, like they're not going to go
13:50through a menopause.
13:52Um
13:53and so, there's something called the
13:54grandmother hypothesis where there was
13:57an evolutionary advantage for women to
13:59survive if she stopped the ability to
14:01have children at some point. Now again,
14:03you have to temper this with
14:06humans have prolonged their lifespan and
14:08their healthspan because of modern
14:10medicine. So,
14:11probably when we evolved, we weren't
14:13living this long. You know, a woman my
14:15age was pretty rare. I'm 55. And so, you
14:19know, it it's hard to say. I think we
14:21have outlived how we were genetically
14:24built. And so, we're living longer and
14:26being forced to like deal with the
14:28consequences of that. So, so then the
14:30next stage is menopause. Mhm. Um
14:33So, menopause itself is really that it's
14:37just really one day in your life. It's
14:38when you can throw the hammer down and
14:40say, "I'm never going to ovulate again.
14:42I'm done." And so, if a woman's over the
14:43age of 45 and she hasn't had a period
14:45for a year, that's the definition. Okay?
14:48Now, it gets confusing because what if
14:51she's had a hysterectomy or doesn't
14:53bleed because of a surgery or an IUD or
14:55something? Well, then we can't use her
14:57periods to help judge and that's where
14:58we start doing blood work to see, you
15:00know, where she is in her menopause
15:02journey. And then postmenopause is the
15:04rest of your life.
15:06You know, the hot flashes might go away.
15:08Night sweats might go away.
15:10Brain fog might get better, but pretty
15:12much everything else is going to
15:14continue to progress in a very linear
15:16fashion until you die without estrogen
15:18replacement.
15:20To put it lightly, you seem somewhat
15:21dissatisfied with the current set of
15:24answers that
15:25um the medical field, but just society
15:28at large are offering for women in
15:31the sort of peri- and post- and
15:32menopausal phase of their life. And I've
15:35sat here with a lot of women who are
15:37experiencing menopause
15:40at one stage or the other and they also
15:42seem to be at a loss for answers. Mhm.
15:46Um I was sat here two days ago with um a
15:49very, very successful woman who,
15:52you know, has all the resources in the
15:53world and she basically can and and this
15:55is someone that has all the answers.
15:57People come to her because she has the
15:58answers. And the one thing she doesn't
16:00seem to have answers on, in her own
16:01words, in her life at the moment, is
16:03menopause. She's rummaging around the
16:05internet, Googling things, finding
16:06contradictory information. And when you
16:08sat down, you you you had that same
16:10energy like you feel like women have
16:12been, dare I say, let down by a system.
16:16I think the medical system is letting
16:17them down. I think society is letting
16:19them down. Our our value and our worth
16:22in medicine,
16:24you know, I came through this wonderful
16:25training program. I'm very proud of what
16:27I learned. I'm very proud of the care
16:28that I gave except
16:31I was a horrible menopause provider for
16:32probably 15 years.
16:35I knew what I knew.
16:36I relied on my training and I didn't
16:39look outside of the traditional confines
16:41of training.
16:43This is such a systemic problem
16:46that
16:47I mean, I'm going to tell you a story
16:49and this is this is true
16:51and it's embarrassing, but I think it
16:52needs to be said cuz I think it really
16:54highlights
16:57how women are treated in medicine.
16:59Um
17:01When I was in training, we had these
17:03upper level residents. So, we have a
17:04hierarchy where you have different years
17:06of training. So, I was in the early
17:07years, maybe my first year, and we had
17:08these clinics that we would run
17:10um to take care of patients. And so,
17:13we have obstetrics and we have
17:14gynecology as like divisions in our
17:16training. So,
17:18in gynecology, everything gets lumped
17:19together. Pediatrics, menopause. We had
17:22no specific menopause clinic. I maybe
17:24got 6 hours of lecture in a 4-year
17:26curriculum.
17:28And so, we'd have these women coming in
17:29in midlife and they had multiple
17:31complaints.
17:33They didn't feel good, they weren't
17:34sleeping, they were gaining some weight,
17:36they were, you know, aching, that, you
17:39know, just this laundry list of things
17:40that were a little on the vague side.
17:42And
17:44my upper levels
17:46would say, "Oh gosh, good luck with
17:48that. You've got a WW
17:50on your hands."
17:52And that was code. We never wrote that
17:53in the chart. This was not taught to me
17:55by faculty. This was just kind of a
17:57handed down in the lore of training. And
17:59a WW was a whiny woman.
18:02And that was code. And now
18:06I know that she was perimenopausal
18:09suffering from her list of symptoms of
18:11now which we've categorized about
18:13they're they're they were frustrated
18:15because they they didn't think they
18:17could help her. Now, remember the
18:18Women's Health Initiative,
18:20which was a study that was supposed to
18:21do a lot of good for women. It was
18:23originally designed
18:25um and it was stopped in 2002. That was
18:27the end of my training program was 2002.
18:29So, I'm I come from one of the last
18:32groups of physicians in the US that were
18:34ever trained in hormone replacement
18:36therapy and then it the rug was pulled
18:37out from under us.
18:39So, the WHI, there were mistakes, there
18:42was misinformation in the reporting,
18:44and there was uh misinterpretation of
18:47the results. All of that has been walked
18:49back, re-looked at. We know that for the
18:51vast majority of women, hormone
18:53replacement therapy is safe and
18:55effective and can give a woman her life
18:57back um if she chooses to take it. But
19:00that option has been taken off the table
19:04for the vast majority of women. And
19:06recently, I just saw the numbers,
19:0885% of women will come in complaining of
19:11what we know now, this was in 2023,
19:14FDA looked at the numbers,
19:1685% women are complaining of menopausal
19:18symptoms.
19:1910.5% are receiving treatment or therapy
19:22today.
19:24Is there something in you that feels
19:26somewhat,
19:27even though you're a doctor, somewhat
19:29let down by the medical system
19:31um or skeptical about the medical system
19:34for personal reasons? I
19:36Yeah. I I'm one of those women. You
19:39know, I thought I'd be one of those
19:41girlies who would just breeze through
19:43menopause because I was thin.
19:45And I was, you know, thin meant healthy.
19:47I still, you know, that mentality was
19:50alive and well when I trained and
19:52through most of my practice. I I came
19:54through a very fat phobic, you know, uh
19:58training
19:59and medicine as a as a whole is very,
20:04um,
20:04biased against weight people's weight.
20:07And
20:09so
20:10now that I've done a deep dive into
20:12nutrition and done a deep dive into
20:14menopause and really sat there and
20:16listened to patients
20:18and realized that, you know women who
20:21were gaining weight with menopause, you
20:22know, they've done nothing different.
20:24They're still exercising. They're eating
20:25the same. The only thing that's changed
20:27for them
20:28is their hormones.
20:30And they're being categorically
20:31dismissed at multiple doctor's visits or
20:33worse
20:35here's their laundry list of symptoms.
20:36The root cause is menopause, but it's
20:38not recognized.
20:40And one medication could have taken care
20:42of everything, but they're going to
20:43seven, eight, nine different specialists
20:45on seven, eight, nine different
20:46medications to handle each symptom.
20:48Whereas all they needed
20:50was just to get her hormones back and
20:53she would feel amazing and be able to,
20:55you know, age the way she should.
20:58When we talk about the potential
21:01um
21:02health implications of women that are
21:04going through menopause, it's not just
21:06WW. Right. It's much more, um
21:10That's how she feels though. And that's
21:13how she's categorized probably by people
21:15around her.
21:16But the there's real health consequences
21:19and life altering health consequences,
21:21life span reducing health consequences.
21:23Yes. What are those? So, we know that a
21:27woman's risk and and the studies have
21:29been done. It's not just aging. Of
21:31course, aging plays into this, but when
21:33you add in menopause as an independent
21:34risk factor, her risk for cardiovascular
21:37disease increases.
21:39Her risk of diabetes increases. Her
21:42insulin resistance starts going haywire
21:44immediately.
21:46Your your listeners and your, you know,
21:48people who watch on YouTube will be
21:49shocked. I'm going to say, "How many of
21:52their cholesterol levels shot up in
21:54their 30s and 40s with no changes in
21:56diet and exercise?"
21:58You know, we see cholesterol levels
21:59changing skin, hair, teeth, the dental
22:03changes, the inner ear changes, the
22:06vertigo is incredible, the frozen
22:09shoulder is legion. Um What's frozen
22:12shoulder? Frozen shoulder is an adhesive
22:14capsulitis of the shoulder joint. And it
22:18is very common in menopause. So,
22:22estrogen has this amazing
22:23anti-inflammatory effect, especially in
22:26our bones and joints and muscles. And
22:28frozen shoulder is super common and it
22:30takes about 2 years of therapy to get it
22:33to break up. So, the capsule that is
22:35right over the bone where the muscles
22:36attach becomes encapsulated and adhesed
22:40and stuck. And so, you have to get in
22:42there and break it up and do lots of
22:43training. So, like a woman wouldn't be
22:44able to reach behind her back to do her
22:46bra.
22:47She that's one of the things or you go
22:48to take a picture with your girlfriends
22:50and you can't
22:51put your arm or you can't lift your arm
22:53above here.
22:55That's one of the one of the studies
22:58that I, you know, presented. A lot of
22:59the stuff I do on social, I'll present
23:01the studies because I like to I like to
23:02have data. And, you know, I'll get
23:0510,000 comments
23:07on, "Oh my god, that happened to me.
23:08That happened to me. That happened to
23:09me." Not that I can fix it
23:12but at least they know
23:14this is something that it's not your
23:16fault. You didn't do anything. Your just
23:18estrogen levels dropped, which led to
23:20increasing inflammation in those joints.
23:22And have they seen that there's a a
23:24reduction in life span in women that go
23:27through menopause that aren't treated in
23:28a certain way? So, we know that, um,
23:31women on HRT have a lower all cause
23:34mortality. What's HRT? Hormone
23:36replacement therapy or menopause hormone
23:38therapy. So, in the studies that have
23:40been done, the observational studies and
23:43in the WHI, women who were on hormones
23:47um, especially beginning early in their
23:49menopause. Okay? So, estrogen
23:52there is a window of opportunity for
23:54reduction of some of this burden of
23:56disease and it is very in starting in
23:58perimenopause or within the first 10
24:00years of your menopause.
24:01That's the sweet spot for being able to
24:04decrease your risk of diabetes, decrease
24:07your risk of cardiovascular disease and
24:09dementia.
24:10When we go beyond that, we start losing
24:12those benefits because estrogen is
24:14better at prevention than cure.
24:17And so, my my medical school daughter
24:20was like, "Mom, I'm never going to be
24:22without estrogen. I'm going to start in
24:23perimenopause. Like I'm not going to be
24:25one of those women who's ever off
24:27estrogen." Of course, she's my daughter
24:28and listens to me on social media all
24:30day. So, she's a little biased, but she
24:33says, "Why why can't we get to that
24:34point where we have no gaps in our
24:37estrogen supply? We just support
24:39starting in perimenopause, you know,
24:41offer it to all women. Not all women
24:42will choose it and I support that, but,
24:45you know, we're not having the
24:45conversation and they're not being given
24:47the choice." So, what age would you your
24:50daughter would you advise her to start
24:52at
24:53hormone replacement therapy if she so
24:55chooses? So, I would say, um, we start
24:58checking levels and we start looking
25:01probably in late 30s. Certainly if she
25:02starts having any symptoms out of the
25:04normal, you know, she's living her best
25:07life, you know, doing all the right
25:09things for her health and all of a
25:10sudden she's not sleeping well or she's
25:12having aches and pains or she's
25:13noticing, you know, changes in her body.
25:15Most women can tell you
25:17"Something was wrong. I couldn't put my
25:19finger on it, but I knew that something
25:21in something in me had changed and I
25:23wasn't responding to things the same
25:24way. You know, their mental health had
25:26changed or, you know, the way their gut
25:29had changed, their gut health." You
25:31know, just just there's barely an organ
25:33system that's not affected by this.
25:36I sometimes wonder cuz, you know,
25:37there's the person going through it and
25:39then there's those around them.
25:41And they might know themselves that
25:43something's wrong, the person that's
25:44going through perimenopause or
25:45menopause, but the people around them
25:48won't understand typically Mhm. what's
25:50going on with that person. So, they'll
25:51they might do their old WW thing, that's
25:53a, you know
25:54or they might label them something else.
25:56They might misdiagnose it as another
25:57man's health predicament. I remember a
26:00woman in my life who when whose behavior
26:02changed around this age and I didn't
26:04know about perimenopause or menopause.
26:06It's in hindsight now that I look back
26:08and go, "Oh my god,
26:10everyone around this person thought they
26:11had bipolar or something."
26:13Right. I mean
26:15it it
26:17it's probably contributing to divorce
26:19rates, maybe in a good way. You know, at
26:21this time
26:22I I one of the positive things I see
26:24about menopause is that
26:27women are
26:29cutting the things in their life that
26:30don't make sense anymore. They're not
26:32putting up with
26:34you know, as a society we tend to take
26:37on everyone's burden and um, you know,
26:40take on the emotional labor in a lot of
26:41relationships, take on the
26:42organizational labor. And I see because
26:46they're struggling so much with just
26:48staying afloat, they're able to just
26:50quickly say, "No, I'm not doing this
26:52anymore. You know, you need to pick up
26:55whichever relationship they're in.
26:57You need to pick up your your end of the
26:58bargain here. You know, I can't do all
27:01of that organizational labor, the
27:02emotional labor. And I've I have a
27:05patient who's a divorce attorney and she
27:06said, "I really think a significant
27:08percentage is of this divorce is
27:12menopause and either they're
27:14prioritizing what's important to them or
27:17they're not getting the support that
27:18they need."
27:19And
27:21How can we give them the support that
27:22they need? So, I think it's important
27:25that we talk about it. I encourage every
27:27single patient I have, all my followers
27:30on social media, tell your story.
27:32Tell your story to anyone who will
27:34listen. Tell your daughters. Tell your
27:36nieces. Tell your sons. Tell your loved
27:38ones. Like make this a normal part of
27:41the conversation so that we see it
27:43coming, we understand what might happen
27:46and that no one feels crazy and alone
27:48when they're going through it.
27:50And then we need to do a much better job
27:52in our medical system of providing
27:54support for these women in whatever way
27:56they need it. Be it hormones, non
27:58hormones
28:00cognitive behavioral therapy, you know,
28:02there's lots of things that we can do.
28:03Not just hormone therapy is not the cure
28:05all for everything. We have to support
28:07the whole toolkit, right? We have to
28:09prioritize our sleep.
28:11Get the exercise that we need. Focus on
28:13strength training when a lot of us in my
28:15generation never did that. We were
28:16aerobics, you know, focused on being
28:19thin and small. It's time to be strong.
28:22You know, this muscle mass that you have
28:24is going to determine your longevity and
28:25your functionality as you age and
28:28menopause is, you know, that loss of
28:30estrogen and testosterone is tearing our
28:33muscle units apart, which is leading to
28:35osteoporosis as well. I want to go
28:37through that whole toolkit, um,
28:39but I also want to just before we move
28:41there
28:42understand why women
28:45don't sometimes communicate that they're
28:48going through perimenopause or
28:49menopause. What is the Is there a stigma
28:51associated with talking about it? Yeah,
28:53I think there's shame and stigma
28:54associated with aging, with females
28:57aging and then you're you're layering on
28:59this loss of fertility. And in the
29:01medical field, when you look at funding
29:04in the US for research studies women's
29:07health, like I think it's 55 billion in
29:08the National Institutes of Health in the
29:10US, you know, for all research studies.
29:12And that's outside of what pharma is
29:14funding. And women's health gets about
29:1815 billion. And the majority of that is
29:22spent on getting people pregnant keeping
29:25them pregnant
29:26you know, and fertility issues.
29:28Menopause gets, I think, 15 million.
29:31Jesus Christ. Yeah. It's like .03%
29:35if I did the math correctly
29:37of
29:39all
29:40you know, are we not as important as we
29:42were when we were fertile? Do our lives
29:44not matter?
29:47It's ridiculous to me. When we can
29:49intervene and help and how give these
29:51women a longer life and a better quality
29:53of life. And how many women is that? I
29:55know we said a as a fraction earlier on
29:57or a percentage, but that's like I think
29:59in your book I read it's 1.2 billion
30:01women by the end of this year.
30:03Yeah.
30:04And there's what, 47 million new
30:06entrants
30:07into this sort of perimenopausal
30:09postmenopausal
30:11category every year?
30:131.2 billion. Billion. Right. And how And
30:16so many of them
30:18have no education at their fingertips,
30:20have nowhere to turn,
30:22are, you know, 85% are going in to their
30:24health care provider's office
30:25complaining, "Help me." And being turned
30:28away and leaving with more questions
30:30than answers and only 10% are even
30:32having the discussion for hormone
30:33replacement therapy. And then if they're
30:35given it, they're so terrified because
30:37of the misrepresentation of the Women's
30:38Health Initiative, they're convinced
30:40they're going to get cancer.
30:42And that that study's been completely
30:44dismantled and walked back. We have good
30:46information that came out of that study,
30:47but, you know, the the the the thought
30:50that estrogen causes breast cancer is
30:52the worst thing that came out of that
30:54study because it's not true.
30:57The mental health implications is what I
30:58really want to get into the the hormone
31:00replacement therapy and all that stuff,
31:01but the mental health implications for
31:03women. Do we see an increase in
31:06depression and those and the
31:07consequences of depression, I guess?
31:09Depression, anxiety, bipolar, um the
31:12entire spectrum, ADHD. So, we see either
31:15a new onset
31:17or worsening of disease. So, I'm telling
31:20my patients or I'm telling people on
31:21social media, you may have done fine and
31:23done well with your depression on your
31:25SSRI. Don't be shocked if it is no
31:29longer working at that level. You either
31:32have to increase the dose. So, no one
31:34right now is advocating for primary
31:37therapy of depression to be estrogen
31:40replacement, but we do know from the
31:42studies that it is a very powerful
31:45adjunctive tool.
31:46And that it can be preventative for new
31:48onset depression if you start in
31:49perimenopause. Women who start hormone
31:51therapy in perimenopause have a lower
31:53incidence of new onset depression in
31:55their menopause. Suicidality?
31:58So, I've looked at these numbers and
32:01COVID's kind of skewing things cuz we
32:03did see increased suicide rates, but we
32:05definitely see an uptick especially in
32:07Caucasian women, not so much in women of
32:09color in the US in the perimenopausal
32:13menopause time frame.
32:15Inflammation. Mhm. What is What is
32:17inflammation? Sure.
32:19So, inflammation,
32:20there's there's it's there's chronic
32:23inflammation and there's acute
32:24inflammation. So, acute inflammation is
32:26what we need to survive.
32:28It is the body's reaction to a foreign
32:31invader basically or to an injury or an
32:33illness. So, you twist your ankle,
32:35right? And so, we injure that tissue,
32:38these chemical messengers are spread
32:40from the injured tissue which basically
32:42tells our immune system, "Send blood
32:44that way. Send the the, you know, white
32:47cells and the red cells and you know,
32:48all the cells that are going to fight
32:49and heal this. You're going to swell,
32:51you're going to have pain that's going
32:52to keep you off of that joint so that it
32:54can heal, right? So, acute inflammation
32:57also happens when we get viruses and
32:59other illnesses.
33:01Chronic inflammation is this low-grade
33:03kind of under the radar inflammation
33:05that's happening in the background. So,
33:06autoimmune disease is a lot of chronic
33:09inflammation, but we also see aging
33:12itself, you know, we can't change the
33:13fact we're aging, but menopause
33:16dramatically increases the amount of
33:18chronic inflammation that a female will
33:21go through just based on the lack of
33:23estrogen and testosterone in her body.
33:25I'm trying to figure out why the lack of
33:26estrogen
33:28and the drop in estrogen causes
33:29inflammation. So, it turns out estrogen
33:31is a really powerful anti-inflammatory
33:33hormone. So, we're just like removing
33:35that protective blanket and now you're
33:37you're just aging faster because of it.
33:41Ah, okay. So, we need to make sure that
33:43we reduce inflammation by any means
33:45necessary. And that was the sort of the
33:47one of it was the second component of
33:49the Galveston diet, anti-inflammatory
33:51nutrition. If I wanted to have a low
33:53inflammation diet, you said there about
33:54the sugar. Is there anything else that
33:56I've got to be aware of or avoid or
33:58choose in a supermarket?
33:59Sure. So, I try to teach the principles
34:02in the form of let's add things in
34:03rather than restrict because
34:05then we get into eating disorders and
34:07so, what keeping tabs on your added
34:09sugars, keeping those less than 25, but
34:11fiber. And that's one thing most people
34:14are not paying attention to. How much
34:15fiber are you getting in your diet per
34:16day? And most women are getting about 12
34:19g per day and the minimum we should be
34:22getting is 25. Vitamin D is another huge
34:26one. About 85% of my patients and women
34:28in menopause are vitamin D deficient,
34:30not just low, I mean deficient. We are
34:33protecting our skin against sun damage,
34:35of course. We're staying indoors more,
34:37we're on our screens all the time, but
34:39we're also our gut's changing and our
34:40ability to absorb vitamin D is
34:42decreasing. So, making sure that you are
34:45checking your vitamin D levels regularly
34:47and supplementing when you need to or
34:48eating foods rich in vitamin D. That's
34:50another one. And does vitamin D reduce
34:52inflammation? Yes. Okay. So, vitamin D
34:54is a it's a it's a vitamin, but it's
34:56also a hormone and it has multiple
34:58functions in the body. And so, vitamin D
35:00deficiencies are linked to lots of
35:02chronic diseases. You're more likely to
35:04have hypertension, diabetes, stroke, you
35:06know, all of the top seven of 10 causes
35:08of death in women. And so, keeping those
35:12low it's also mental health, you know,
35:14it lots of vitamin D receptors in the
35:15brain. And so, you know, first thing I
35:18do is check a vitamin D level on my
35:19patients when they come in. So, many of
35:21my nutrition-based or medical or doctors
35:24that I've spoken to on this show have
35:26spoken about fiber especially in the
35:27last like 6 months.
35:29You know, people
35:30historically speak a lot about protein
35:32and all these kinds of things, but for
35:33some reason everyone seems to be talking
35:35about fiber all of a sudden.
35:37So, fiber does lots of things for us. It
35:39slows down the absorption of glucose
35:43into the bloodstream. Ah. So, that keeps
35:45our insulin levels lower over time.
35:48It feeds our gut microbiome, soluble
35:49fiber. So, there's two types of fiber.
35:51There's soluble and insoluble. So,
35:52insoluble is what kind of when you mix
35:54up a fiber supplement, you see the stuff
35:56precipitate down to the bottom. That's
35:58the insoluble fiber. That's what pulls
35:59water into the gut and kind of moves
36:01things quicker through the colon.
36:03Soluble fiber dissolves in water. That's
36:05the cloudy part. That is the food for
36:07our gut microbiome. That is the
36:09prebiotic. You don't need a prebiotic if
36:11you're getting enough fiber in your diet
36:14per day.
36:15And so, keeping that gut microbiome fed
36:17and healthy and happy is going to do a
36:19multitude of things. Like that kind of
36:21data is exploding right now in the
36:22research world as to where the gut
36:25microbiome, how to keep it healthy and
36:27what organ system it affects.
36:29Um our our gut microbes make these
36:31things called oxybutyrates which are
36:33then absorbed into the bloodstream and
36:35and people who have high levels of
36:36oxybutyrates are actually healthier and
36:38have less coronary artery disease, less
36:40dementia, less less everything. So, it
36:42really nutrition, when I talk about the
36:44menopause toolkit,
36:46hormone therapy is just one very small
36:48part of the puzzle, but nutrition should
36:50always be first. Like it doesn't matter
36:52how many hormones you take if you're not
36:53covering your your nutritional bases the
36:55way you should.
36:56And what are some sort of fiber-dense or
36:58fiber-rich foods that are in, you know,
37:01every supermarket? Avocado,
37:04chia seeds, nuts, berries,
37:07your cruciferous vegetables, things that
37:09are crunchy, that's fiber. That's making
37:10the crunch. Apples, you know, um there's
37:13so many. Don't find much fiber in uh
37:16lean meats or any. So, it's going to be
37:19your fruits and veggies
37:20and seeds and nuts. Asparagus, tomato,
37:22spinach, celery. Uh asparagus, celery,
37:25yes. Tomato, not so much. Just think of
37:28things that, you know, the crunch is
37:29usually from the fiber. Mhm. Okay.
37:32Fasting. Mhm.
37:35I'm a fan. It's not for everyone.
37:37It's not a great way to lose weight. The
37:38data on weight loss is conflicting at
37:41best. You can eat a lot of things that
37:44will undo the goodness of fasting in
37:45your eating window if you're not
37:46careful.
37:47And so,
37:49um
37:50the there's good data though on
37:52neuroinflammation and fasting and on
37:54systemic inflammation and fasting. So, I
37:57recommend fasting for the systemic
37:58inflammatory benefits. And we do see
38:01some really nice lowering of insulin
38:03levels overall from fasting.
38:06There's so many different types of
38:07fasting people talk about.
38:09So, when I'm teaching fasting to my
38:11students or to my patients, I recommend
38:14the 16:8. So, that's where Mark
38:16Mattson's data. So, that's 16 hours of
38:18fasting in a row followed by about an
38:208-hour eating window. Now, for other,
38:23you know, again, it's individualized.
38:25Some people do great with a 14-hour
38:27fast, you know, the 15-hour fast. 16 is
38:29just kind of something to shoot for. And
38:31if someone's going to consider
38:33incorporating fasting into their life,
38:34give yourself about a 6-week
38:37trial, you know, don't just try to go 16
38:40hours without food if you've never done
38:41it before. Your body will adapt. And so,
38:44the advice I got and what I do and what
38:46I teach now,
38:48so, I used to break my fast about 6:00
38:49in the morning before I exercised. So, I
38:51pushed that window to 6:15 and I did
38:53that for, you know, three or four days
38:55until it felt normal, natural, I wasn't
38:57hungry. Then I moved it to 6:30 and then
38:59I just kept bumping that window out in
39:0115-minute increments
39:03over weeks and by week five, I remember
39:05sitting at my desk and I have my lunch
39:07ready to go and I was still at the
39:09hospital at the time and saying, "Oh my
39:11god, I made it. It's noon and I don't
39:13feel bad, you know, like So, I had just
39:16slowly slowly let my body adapt and
39:18adjust and then I've been fasting, gosh,
39:20since 2015, probably 2014.
39:23And
39:25and it's just a normal natural part of
39:26my life. I don't even think about it
39:28anymore. Have you noticed any effects of
39:30that? You know, I do so many things.
39:32Yes, it's hard to tell. And so, it's
39:33hard to tell, but initially, I do find
39:36when I'm fasting, the clarity of my
39:38thought is much better. I get much more
39:40work done. It's when I do my best
39:41research. It's when I do my best
39:43communicating with my followers is in
39:45the morning. You'll often if you follow
39:46me on social, I'm always in my pajamas
39:48with a cup of coffee um before while I'm
39:50getting ready for work cuz I just get so
39:51excited about something I learn and I
39:53want to share it with everyone. And so I
39:55do find that once I break my fast the
39:57synapses tend to not work as quickly for
39:59me. I was thinking about this through
40:01like an evolutionary lens why fasting
40:04makes sense and why this sort of
40:05narrative that we're meant to have
40:07breakfast, lunch, and dinner. You know,
40:09maybe breakfast at That's a social
40:10construct. There's really not great
40:13science. Now, there are humans that will
40:15do better by eating more meals more
40:17frequently and that's why I say
40:18fasting's not for everyone especially if
40:20it triggers an eating disorder. If you
40:22have diabetes or you have, you know,
40:24hypoglycemia, fasting may not be for you
40:26but most people can do it successfully.
40:28And so I really encourage people to
40:29experiment with it and see how they do.
40:31I was wondering if I was trying to think
40:33through like an evolutionary framework
40:35and I was thinking about how in our
40:37hunter-gatherer past
40:39Mhm.
40:39we would have Meals were not available
40:4124/7.
40:42Yeah. And we would have needed like a
40:43really focused brain to go out on the
40:45hunt. So this explains why when we're
40:47like hungry our brain's working better.
40:49It almost seems like there's more I
40:51don't know oxygen or nutrients in the
40:53brain.
40:54tends to work better using the ketones
40:56for fuel than uh glucose. So the glucose
40:59is the preferred fuel in the body, you
41:01know. And um but but when they did
41:04studies, they were animal studies so
41:05take this with a grain of salt but you
41:07know, when they did the mazes, you know,
41:09the animals tended to get through the
41:11maze quicker and learn quicker when they
41:13were fasted rather than after they were
41:14fed. They're a little lazier.
41:17Ketones you can also use ketones as an
41:19energy source if you use the keto diet.
41:20You can. You can. Um but I think, you
41:23know,
41:24when Mattson and and that those
41:27researchers were doing their work their
41:29research in Alzheimer's and dementia,
41:31you know, there was no keto diet. They
41:33were just knowing that people were
41:35utilizing ketones for fuel which is a
41:37normal natural process. We sleep. And so
41:39we burn through the glucose in our
41:40bloodstream then we burn up what's in
41:42our liver in the you know,
41:43gluconeogenesis and then it switches to
41:46fat to burn for fuel.
41:48And so um now there's people who like to
41:51take exogenous ketones. I've I've never
41:53experimented with that. I don't, you
41:55know, that's I don't have any literature
41:56menopause to support that use.
41:58And the third component of the Galveston
42:00diet is this idea of fuel refocus.
42:03Right. So that's looking at, you know,
42:07food
42:08uh we're looking at the macro and
42:09micronutrients. So I'm really going hard
42:12on fiber and vitamin D and magnesium and
42:14things that we tend to as a gender be
42:18deficient in especially with menopause.
42:20So I'm really trying to highlight those
42:22things to make sure instead of counting
42:24calories, let's see how much vitamin D
42:26you're getting every day. Let's see how
42:27much fiber you're getting every day.
42:29And is there a certain sort of ratio of
42:31foods that we should be having in terms
42:33of So I originally developed Galveston
42:35diet for weight loss, you know, um
42:39but if I had to write it over again. So
42:40I went really heavy on fats, you know,
42:42healthy fats, lower on carbohydrates and
42:4520% protein. Um but I think if, you
42:49know, doing it again the way I'm
42:51counseling my patients now is I'm going
42:53much higher on protein. What I've
42:55learned since that book was written was
42:58how important protein intake is to
43:00maintaining muscle mass. I'm also
43:02talking a lot about creatine. Um and and
43:05there's some nice studies done in in the
43:07we call it the elderly 65-year-olds and
43:11and above I'm 9 years from that right
43:13now and so and how creatine
43:15supplementation just creatine
43:17supplementation on its own well combined
43:19with weight lifting we're seeing bigger
43:20gains in the menopausal patient.
43:23Postmenopausal patient, yeah.
43:24Bigger gains in muscle
43:26Bigger muscle mass and strength. Yeah, I
43:28was going to ask you about this whole
43:29muscle mass um point. Why is muscle mass
43:31so sort of pertinent to this
43:32conversation? So what we're Well, what
43:33we know in menopause is that, you know,
43:36aging combined with menopause we see a
43:38dramatic loss of muscle mass with the
43:42menopause process. And so in that first
43:4510 years of menopause we could lose up
43:46to 10 sometimes 15% of our muscle mass.
43:50And that muscle mass is going to
43:51determine your resistance to sugars. So
43:54your insulin resistance is really tied
43:56to your muscle mass. Your functionality,
43:59your ability to recover from a fall. Um
44:02and the other thing is what most people
44:04don't understand is the musculoskeletal
44:06unit acts as one.
44:08So when we have low muscle mass, you are
44:10dramatically increasing your risk of
44:12osteoporosis. Now right now, this might
44:14shock you but 50%
44:17of females
44:18will have an osteoporotic fracture
44:20before they die.
44:21And this is almost completely
44:23preventable.
44:25What is an osteopathic fracture?
44:28is when we lose the density of our bones
44:32through So estrogen So all of our life
44:34we remodel our bones, right? We chew up
44:36bone and we lay down new bone. And so we
44:39reach our maximum bone density as
44:40females at about age 35 and then it
44:43slowly starts to decline through the
44:45aging process. And then when we get to
44:46menopause, it dramatically we see a just
44:50massive loss of bone.
44:52So this loss of bone makes the bone
44:54weaker and much more likely to fracture
44:57when it when we fall. And so
45:00if you fall and break your hip
45:03in menopause
45:0630% of women with surgery will die in
45:09the first year.
45:1170% will die without surgery.
45:14And that year is marked by horrific pain
45:19and not being able to move and just
45:21really really miserable people. And so
45:24and so much of this is preventable.
45:27Going on hormone therapy, getting
45:29adequate exercise, doing the resistance
45:31training, eating the protein, adding in
45:32the creatine, making sure you're getting
45:34enough vitamin D is going to be huge at
45:36protecting our my population from this
45:39happening as we age. We can prevent the
45:41majority of this.
45:43I want to talk specifically then about
45:44this hormone replacement therapy you
45:45mentioned there. There's you also
45:47referenced the study previously which
45:49sort of scared people. Yes, the Women's
45:51Health Initiative, yeah.
45:54And that study suggested that there was
45:56an increase in breast cancer if someone
45:58did hormone replacement therapy.
46:00So let's break it down. Um originally
46:01the study was designed to see if we knew
46:03it from observational studies was
46:06hormone replacement therapy going to
46:08truly be protective for cardiovascular
46:10disease. That was the function of the
46:11study
46:12in women who took it versus women who
46:14did not. We knew from observational
46:15studies that yes, they had a much lower
46:17risk of death from cardiovascular
46:19disease and and all cause mortality as
46:22meaning death from any cause as well as
46:25um heart disease in itself. Okay,
46:27atherosclerotic heart disease.
46:29So
46:31but that's observational. The way to
46:33prove these things is to do a randomized
46:35controlled study versus placebo. So
46:38finally finally This is 1998. Women were
46:41getting money. Like there was a new
46:43female head of the National Institutes
46:44of Health. They were funding this study.
46:47This was so exciting. Women were lining
46:48up in droves to sign up for it but
46:50because the end game was to prove
46:53whether or not it was protective for for
46:54cardiovascular disease, the average age
46:57of the patient was 63 years old.
47:00So that they could see if it was going
47:02to affect heart disease because women
47:03tend to get that in their 60s and 70s,
47:05right?
47:07So
47:08they recruit, they develop develop two
47:10groups. We have women with uteruses and
47:12women without women who had had
47:13hysterectomies or were born without
47:15uteruses. And so each of them had a
47:17placebo arm and then a medication arm.
47:19When you don't have a uterus, you don't
47:22absolutely have to have progesterone.
47:24When you have a uterus, it's required to
47:26give a woman progesterone as well or
47:28progestin as well to protect the lining
47:31of the uterus from the estrogen.
47:33Unopposed estrogen can cause endometrial
47:35cancer but we can negate that by giving
47:37her progesterone. You following me? So
47:39we have an estrogen only arm and an
47:42estrogen and progesterone arm and they
47:43each have a placebo. So off we go. Let's
47:45take our meds. Let's take our placebo
47:47and let's start measuring.
47:49What they saw in the estrogen plus
47:51progesterone arm after 2 years was a
47:53very slight increased risk of breast
47:56cancer versus placebo.
47:59Now, you have to understand there's a
48:00difference between absolute risk and
48:03relative risk.
48:05So the relative risk went from So the
48:07absolute risk went from four out of a
48:09thousand women per year
48:11to five out of a thousand women per
48:13year. So one out of a thousand women
48:15treated in the estrogen and progestin
48:17arm
48:18developed breast cancer where over
48:20placebo.
48:21That is a 25% relative risk increase.
48:25Mhm. And that is the that is the
48:27statistic that set the world on fire.
48:30So the researchers held a huge press
48:32conference at the Watergate Hotel in DC.
48:36Every major news outlet with This is
48:37before the internet and and announced
48:40that estrogen causes breast cancer. Now
48:42remember, these women were on estrogen
48:44plus the progestin which is called
48:45Provera.
48:47The estrogen only arm continued for a
48:49few more years because the women on
48:51estrogen only not only did they not see
48:54an increased risk of breast cancer, they
48:55had a I think it was a 20% decreased
48:58risk of breast cancer. Relative? Re of
49:01Yeah, relative risk. And the relative
49:04mortality went down 40%. So and we think
49:08it's because estrogen feeds a breast
49:11cancer cell but it doesn't cause breast
49:13cancer. We are highest levels of
49:15estrogen are in pregnancy and it's so
49:17rare to ever be diagnosed with breast
49:19cancer. And a healthy breast cell has
49:21estrogen receptors and all that estrogen
49:23receptor positive means is that that
49:24breast cancer cell went from healthy to
49:26cancer through a mutation but retained
49:29its estrogen receptors. And so we can
49:31use those receptors against the cancer
49:33cell to treat the breast cancer. So that
49:37study has been walked back. Multiple
49:38studies have been done, but like the the
49:41whole mindset has not changed. Myself,
49:44as an OB/GYN, was still the lowest dose
49:48for the shortest amount of time and only
49:49in women where absolutely nothing else
49:51is helping her hot flashes. Menopause
49:53was defined by the vasomotor symptoms.
49:56That's it.
49:58You know, vaginal estrogen, which is
50:00just putting estrogen locally in the
50:02vagina. So, one of the biggest things we
50:04see in a huge amount of patients, like
50:06well over 50%, is something we call
50:08genital urinary syndrome of menopause.
50:11And it is the bladder, the vagina, and
50:14all of the tissue in between all has a
50:16lot of estrogen receptors. And we take
50:18the estrogen away, that tissue becomes
50:20very thin, we lose elasticity, we see
50:23recurrent urinary tract infections. The
50:26most likely treatment to help a woman in
50:30menopause with recurrent urinary tract
50:32infections, which is a major cause of
50:34death for women,
50:35is vaginal estrogen. And it's safe for
50:37everyone, even with breast cancer. And
50:39so, even that option is taken off the
50:41table for so many women who are
50:43suffering needlessly with horrible,
50:45painful intercourse,
50:47dryness, you know, recurrent UTIs. And
50:50it's just such a simple thing to help a
50:52woman and fix, and they're not being
50:54offered that treatment. Is vaginal
50:56estrogen the only form of administering
50:58estrogen? So, we have No. So, when we
51:01look at hormone replacement therapy, we
51:03have
51:04oral and non-oral medication. We have
51:05like steroids is a good way to think of
51:07it. So, say you have a rash and you go
51:09to your pharmacy and you pick up a you
51:11know, cortisone cream. That's That's
51:13local therapy, right? So, vaginal
51:15estrogen cream, there's pills, there's
51:17there's different ways to put it in the
51:18vagina, but that's considered local
51:20therapy. It's not absorbed systemically.
51:22We're just treating it kind of at the
51:23moment. Systemic therapy is when it's
51:26treating everything, our brains, our
51:28bones, our genitourinary, so you know,
51:30from the inside out. And so, you can
51:32adjust it. There's creams, there's
51:34patches, there's rings, there's pellets
51:36that are now available. There's multiple
51:38ways to get this medication into your
51:40body.
51:42And what's the most popular form of
51:45administering administering
51:47hormone replacement therapy?
51:48So, it depends on the country. So, in
51:49the UK, it tends to be a gel or a cream,
51:52which is where most GPs, if you can get
51:55one that will follow the guidelines and
51:56prescribe it. I think it's the most
51:58easiest pharmacologic option to get in
52:00the UK. In the US, it tends to be the
52:03patch for the non-oral form. We also
52:05have pills available as well. There's a
52:07caveat with estrogen pills. There's
52:09something whenever we ingest anything,
52:11food, medication, goes into our stomach,
52:13into the intestines, and then it gets
52:15picked up by the portal hepatic
52:17circulation, the liver. And so, the the
52:19portal vein goes straight to the liver
52:21for processing. And when that bump of
52:23estrogen or testosterone, typically,
52:25hits the liver, we see some problems
52:27with And for for testosterone, it's
52:29liver toxicity, and for estrogen, we see
52:31bumps in our clotting factor. And so,
52:33you'll see a lot of women who are
52:34terrified of hormone therapy because of
52:36this potential risk of blood clots. They
52:38either have a genetic risk of blood
52:40clots, or a gene, or they've had a clot
52:42in the past. But if they avoid oral
52:44estrogen and go with a non-oral form,
52:46like the patch or the ring or or even a
52:48pellet, then we bypass the liver, and we
52:51don't have the increased risk of
52:52clotting.
52:53Are there any other side effects? You
52:54know, in life, there's no such thing as
52:55Of course.
52:56free lunch.
52:57And so, um
52:59it
53:01estrogen, so we have to look at each.
53:03So, when we look at hormone replacement
53:04therapy, we have our estrogens, we have
53:06our androgens, which would be
53:07testosterone,
53:09DHEA, and androstenedione, and then we
53:12have our progesterone, which is uh the
53:14bioidentical form progesterone. There
53:16are synthetic progestins available, but
53:18I tend to just prescribe the
53:19progesterone. And so, each of them has
53:21issues that may happen. So, with
53:23estrogen,
53:24you can see headaches. So, that's kind
53:26of a red flag for us. We worry. We can
53:29see migraines getting worse, so those
53:31are patients you have to be really
53:32careful with going low dose. Um you can
53:35see unexplained So, 40% of patients on
53:38menopausal hormone therapy will have
53:41vaginal bleeding.
53:42Doesn't mean it's a period. We have not
53:44woken your ovaries up, they're gone. We
53:46are just stimulating that tissue um in
53:48the lining of the uterus, and it's
53:49bleeding a little bit. It's usually
53:51self-limited. It can go away on its own.
53:53If it persists past several months,
53:54we'll get ultrasounds to make sure we're
53:56not missing a polyp or something there.
53:58But um it's it's one of the things I
53:59warn my patients about. So, things I
54:02worry about, you know, headaches, some
54:04women, depending on the formulation. So,
54:05for the patch, it has an adhesive,
54:07right, to get it to stick to your skin.
54:09And there's a probably 10% of women will
54:11have some kind of an allergic reaction
54:13to the adhesive. So, then we have to
54:14look for alternative forms. So,
54:16thankfully, there are multiple forms on
54:18the market. And for patients, we have to
54:21do some trial and error to find out not
54:23only which formulation's going to work
54:24best for her, but also what dosing is
54:26going to work best for her. So, if I was
54:28a menopausal woman and I came to you and
54:30I said, I need help. You get I mean, you
54:32must get thousands of messages like
54:33that.
54:34Thousands of messages a week, probably.
54:36And you know,
54:37I walked into your practice, where would
54:40you start with me? So, I start by
54:43letting you tell your story. I tell my
54:45story, and it's a typical story that you
54:47hear.
54:47Right. Yeah. What happens next?
54:49Symptoms. So, I will we'll get blood
54:51work. Sometimes I'm getting hormones to
54:53see if if I'm not clear where she is in
54:56her journey, I may get blood work to
54:57help me define if she's peri- or
54:59postmenopausal, especially if she's had
55:01a hysterectomy.
55:02Um I'll get a lot of blood work around
55:05checking her thyroid. A lot of things
55:06look like menopause, right? So, you
55:09know, fatigue and night sweats, that
55:11might be hypothyroidism. Weight gain,
55:13hypothyroidism. Autoimmune disease, all
55:15this rheumatoid arthritis. I want to
55:17make sure I'm not missing something else
55:19that looks a lot like perimenopause. So,
55:21I'm doing blood work around that.
55:22Nutrition deficiencies, vitamin D,
55:24her basic labs for her blood count and
55:26her electrolytes. I'm I'm doing this
55:28full panel, okay?
55:30But then I'm beginning to treat
55:31immediately. And so, we have a
55:33discussion around her sexual wellness.
55:35Is she struggling with desire? Then
55:38we'll have a discussion around
55:39testosterone. Um
55:41So, I'm struggling. I've got my desire's
55:42gone. Okay. So, it's very common. So,
55:45when we talk about female sexual
55:47function, there's kind of five buckets
55:48why a woman would be suffering or not
55:50happy, okay? One is a relationship
55:52disorder, and no amount of medication
55:54really helps with that. So, we want to
55:56make sure she's in a good place with her
55:57relationship, supportive partner, all
55:58that. So, we we have a discussion about
56:00that. Then there's an arousal disorder,
56:02where that's what most men are treated
56:05for when they talk about libido issues.
56:06It's really nothing's wrong here.
56:09They're struggling to maintain an
56:10erection. And so, we use Viagra and
56:12those type of medications for that. For
56:14So, if a woman has an arousal disorder,
56:16vaginal Viagra can be helpful for that.
56:18So, we we talk about that. We talk about
56:20orgasmic disorders. Some women have
56:22About 10% of women will never have an
56:25orgasm in their life.
56:27Imagine if that was 10% of men. I think
56:29it would be a national emergency. I
56:31think there would be, you know,
56:33we would divert military funding in the
56:34US to get this fixed. And it's just
56:37something we don't talk about or offer
56:38much help. And so, then that leaves
56:41desire. So, most women who are in secure
56:43relationships, love their partner, miss
56:46that part of the intimacy that they used
56:47to have, that desire to initiate, that
56:49desire, yes, this seems like a good
56:51idea. That goes away with menopause a
56:53lot. And so, for those women,
56:55testosterone might be helpful, or
56:57there's a couple of FDA-approved
56:58medications as well, Addyi and Vyleesi.
57:00And so, we have talked about costs and,
57:03you know, how to get it prescribed. And,
57:05you know, testosterone, there's no
57:07FDA-approved option for women. So, quite
57:09often I will have to compound that
57:11medication for them at a local
57:13compounding pharmacy versus going to
57:16Duane Reade or a CVS or a Walgreens to
57:18pick it up using their insurance.
57:20So, I know that you that you're coming
57:22from the UK, our health systems, you
57:23know, are a little bit different. But
57:25because my reach is so large now, I try
57:26to include, you know, all the different
57:28health systems when I'm talking about
57:30your options. Give me a case study of a
57:33patient that walked into your door and
57:35Gosh, you know, I have Okay, I had a a
57:38patient who
57:40came in
57:41and
57:42uh
57:43her name is Michael.
57:45And she didn't mind me saying it cuz
57:47we're really good friends. And she came
57:50in and typical, overweight, not
57:53sleeping, some brain fog issues, some
57:56major joints aching, aches and pains,
57:59all the things.
58:00And um
58:02sweetest woman, absolutely adored her
58:04husband, you know, like um but was
58:07struggling with desire as well. So, we
58:09started her, you know, I developed a
58:11nutrition plan for her. She hired a
58:13personal trainer. She got to the gym.
58:16She got serious about, you know,
58:17lifting.
58:18Um she started on hormone therapy, and
58:21she is my biggest cheerleader, you know,
58:23on social because she's constantly She's
58:25lost probably about 60 lbs of body fat
58:28cuz we get to measure her. So, in my
58:30clinic, I have a in-body scanner where I
58:32can measure muscle mass and visceral
58:34fat. So, it's not just the number on the
58:35scale. I'm able to tell them. So, she's
58:37probably gained maybe 10 lbs of muscle,
58:41lost a tremendous amount of fat. She
58:43feels amazing. She has this beautiful,
58:46you know, she's back to her intimacy
58:48level that she desired so much before.
58:50She is absolutely thriving on all
58:52aspects, and she's constantly sharing
58:54her studies her her story online so that
58:56other women can learn that they don't
58:58have to suffer as well. And she just
59:00can't believe
59:01the thing that makes her angry is that
59:03she
59:04didn't come sooner, and that she
59:06suffered for so long without looking for
59:10help. And she couldn't find it. She came
59:11from San Antonio, which is about a 3 and
59:131/2 hour drive to come and see me.
59:15So, here's the scary thing for me, or
59:17it's honorable. I have patients, so I
59:19have this menopause clinic I started 2
59:20years ago. And I have a waiting list
59:23that's longer than this wall. And women
59:26are flying in regularly to come and see
59:28me, which is such an honor, and I'm so
59:30grateful that they trust me. But it's
59:32ridiculous that they can't find
59:34menopause care
59:36in their backyard. You know, that they
59:38have to get on a plane to come and see
59:40me because they cannot find care
59:42wherever they are. So, I've started a a
59:45a list of providers on my website that
59:47my followers recommend where they found
59:49good menopause care. They write a
59:50testimonial and we just compile them and
59:52we just look online to make sure it's a
59:54real doctor and they have a phone number
59:55that works. You know, um and then the
59:57the North American Menopause Society,
59:58now called NAMS, um now called The
1:00:01Menopause Society, they rebranded, has a
1:00:03list of certified providers on their
1:00:04website as well.
1:00:06I got an email sent to me after
1:00:08listening to one of the episodes on this
1:00:09podcast from what appears to be a very
1:00:12helpless husband. It was a very very
1:00:14very long email and they'd said that one
1:00:16of the conversations we'd had on this
1:00:17podcast about menopause at one point had
1:00:20really helped them, but the key question
1:00:22that remained for that person was
1:00:24when does a supporting partner
1:00:28know how and really at what point to
1:00:31help? Because, you know,
1:00:33no male partner wants to turn around to
1:00:35their wife and go, "I think you've got
1:00:36menopause." and starts diagnosing them.
1:00:39But they also don't want to just sit
1:00:40back and be quiet.
1:00:42I think
1:00:45you
1:00:47it's usually begins with something you
1:00:50can't quite put your finger on.
1:00:52She's reacting differently. She's not as
1:00:55resilient as she used to be. She's not
1:00:59managing situations the same way. And
1:01:04I think once we start taking the shame
1:01:07and the stigma out, him suggesting that
1:01:09perhaps this is menopause will not cause
1:01:12her to fly off the handle. I think, you
1:01:16know, normalizing this conversation,
1:01:17removing the stigma, it might make
1:01:20everyone go, "Oh, I mean, I didn't
1:01:22realize it in myself." You know, I
1:01:24thought it was grief related and and I
1:01:27was like, "Wait, when was my last
1:01:28period?
1:01:29When was my last period?"
1:01:31Uh
1:01:32Oh.
1:01:33I think I'm in menopause. I mean, I was
1:01:34And then I was like, "Oh god,
1:01:36menopause." You know, even for myself it
1:01:38was such a negative connotation. I had
1:01:41that Sex and the City episode in my head
1:01:42when Samantha thought she was in
1:01:43menopause and how horrible it was for
1:01:45her and then
1:01:47it turns out she wasn't and everything
1:01:48was better again and I'm like, "Gosh, is
1:01:51this
1:01:52You know, first of all, I applaud him
1:01:54for wanting to try to do something
1:01:56because so many, you think women don't
1:01:59understand what's going on. And so,
1:02:03uh one bravo for wanting to be helpful.
1:02:05Two,
1:02:06say it with love. Say it gently. Let's
1:02:09and then find a provider or find a
1:02:12healthcare provider to go in and start
1:02:15the conversation. And I one of my best
1:02:17my best visits with my patients are when
1:02:19their partners come.
1:02:21And that the conversation is held
1:02:23together.
1:02:24And it really opens their minds, you
1:02:27know, to what's going on in her body and
1:02:28helps understand like what we can do
1:02:30therapeutically, what needs to be done
1:02:32at home. This is a special time for her.
1:02:34She's going to need extra help. We're
1:02:36going to get through this. You know, it
1:02:37doesn't have to destroy your sexual life
1:02:40or your relationship or whatever. It
1:02:42definitely can take a toll if left
1:02:43untreated. But you know, bless him for
1:02:47doing it. Like we talked about a little
1:02:48bit earlier, you know, there's probably
1:02:51a fair amount of dissolutions of
1:02:52relationships because no one's talking
1:02:55about this process and what it could do
1:02:57to someone.
1:02:58This might be a really stupid question.
1:03:00Um but I'm no
1:03:03I'm no uh I don't ask a lot of stupid
1:03:04questions.
1:03:06Do men go through anything like this?
1:03:09So, there's a lot of debate about
1:03:10menopause. Um
1:03:12the short answer is not really.
1:03:15We see
1:03:17men's testosterone levels peak at about
1:03:19age 19 or so or there and then this very
1:03:22slow kind of down tick until they
1:03:25stabilize at about age 35 to 40 and then
1:03:28they stay stable for the rest of their
1:03:29lives. But there's a difference between
1:03:33in there's a big variation from man to
1:03:35man
1:03:36where the curve the shape of the curve
1:03:38looks the same.
1:03:39But as far as
1:03:41normal men's range is from 236 to about
1:03:44a thousand. So, there's a big, you know,
1:03:47man to man variation.
1:03:49And there is a lot of men who are
1:03:52supplementing when they come in on the
1:03:53low end and they're feeling a lot
1:03:55better. Now, this is not my area of
1:03:57expertise. This is not, you know, I just
1:04:00read a lot of this research, you know,
1:04:02on testosterone and men are included in
1:04:03it and so they are finding that they are
1:04:06having better cognition, feeling better,
1:04:08having more energy, etc.
1:04:11But there is no manopause.
1:04:13Their testicles don't stop working. I
1:04:15mean, it would be as if your testicles
1:04:18shriveled up and died at 51. That's the
1:04:20equivalent.
1:04:23Gosh.
1:04:27I do have to say
1:04:29at the start of this conversation when
1:04:30you said if that was happening to men
1:04:34the reaction would be different. I have
1:04:36to say I think I agree.
1:04:39I think that because it's one side of
1:04:41the population, I think it's kind of
1:04:43been overlooked over the last 10, 20, 30
1:04:45years. Mhm. Um but if it was
1:04:48And men or both genders, I think it
1:04:49would be a different response. And so
1:04:51much
1:04:52of what women were going through in
1:04:54menopause were dismissed as
1:04:55psychological.
1:04:57Mhm.
1:04:59And I really had multiple times in their
1:05:01life, you know, it's all in her head. We
1:05:03never said it's all in his head. That's
1:05:05not a thing on the wards. You know, it's
1:05:07all in her head was very much alive and
1:05:09well in my training and a long a lot of
1:05:12my practice. I I find myself now
1:05:14even having to pull myself back a little
1:05:16bit just because that was ingrained so
1:05:18much to always look for the
1:05:19psychological reason. I mean, women A
1:05:20woman right now in 2023 is more likely
1:05:23to be prescribed an antidepressant for
1:05:26her menopause
1:05:27than
1:05:28hormone therapy.
1:05:32Multiple reasons for that. The way we
1:05:33were trained, the way we were taught to
1:05:35to approach a woman's medical issues and
1:05:38also the fear uh unfounded fear around
1:05:41the Women's Health Initiative and what
1:05:42it did to
1:05:43you know, physicians feeling confident
1:05:44about prescribing hormone therapy.
1:05:47Is there anything else that you do on a
1:05:48day-to-day basis in your life that um
1:05:52you we haven't talked about yet? Is
1:05:54there any sort of apps or tools
1:05:57I really like Headspace. I know there's
1:05:59some good meditation apps. I really
1:06:01thought meditation was woo-woo and
1:06:04not
1:06:07anything that, you know, I I would just
1:06:09sit there and and my brain would be
1:06:11bouncing all over the place. But once I
1:06:13went through menopause and suffered so
1:06:15horribly from the mental
1:06:18side effects and the death, you know,
1:06:19all of this happening at once uh to me
1:06:22with my brother's death, aging parents,
1:06:23teenage girls in the house, you know,
1:06:26and realized something's got to give.
1:06:28And so, I hired like a counselor, you
1:06:30know, I went to therapy. And she
1:06:33recommended um
1:06:35getting an app to help guide me through
1:06:37meditation and that has really turned
1:06:39the needle for me. Really? Yeah. How?
1:06:42I you know, carving out that it's just 5
1:06:44or 10 minutes in the morning to
1:06:48think of what I'm grateful for, focus on
1:06:50that gratitude, you know, and I love
1:06:53teaching that to patients and to my
1:06:54followers of of really putting yourself
1:06:57first, you know, the thought of you have
1:06:58to put your own oxygen mask on first
1:07:00before you can go take care of your
1:07:02family and all the other things on your
1:07:03plate.
1:07:04And just
1:07:06giving my brain that time to just relax
1:07:08and let it flow and just let the
1:07:10thoughts, you know,
1:07:12and just focus on on me for that. That's
1:07:16really made a huge difference for me.
1:07:18What role does sleep play in all of
1:07:19this?
1:07:20So, sleep disruption is massive massive
1:07:23massive in perimenopause and menopause.
1:07:26And
1:07:27when we don't sleep we see everything. I
1:07:31I tell patients if you're not That's the
1:07:33thing we need to work on first. We need
1:07:35to get you sleeping because nothing's
1:07:36going to work until your body is able to
1:07:38restore itself. That's when we That's
1:07:40when we build muscle. That's when, you
1:07:43know, our our brain resets. That's when
1:07:46our our whole body, you know, and if
1:07:48you're having disrupted sleep
1:07:51and you're waking up at 3:00 in the
1:07:52morning and your brain is racing, I
1:07:54mean, everything is worse. Your cortisol
1:07:56levels spike, your insulin resistance
1:07:57goes up, your, you know, everything gets
1:07:59worse. And so, when my patients come in,
1:08:02we focus on sleep first
1:08:05and nutrition pretty much. And if Easier
1:08:07said than done though, right? Sleep.
1:08:09If the estro
1:08:10if their sleep disruption is due to
1:08:13hormones, then it's such an easy fix. I
1:08:16just give them back the water they were
1:08:17drinking and they sleep again. Where the
1:08:20struggle is if someone's never been a
1:08:21good sleeper, then that's probably out
1:08:24of my area of expertise. I'm going to
1:08:25send them to a sleep medicine
1:08:26specialist. One of the things that we
1:08:28now see a correlation is a sleep apnea
1:08:31even in a thin patient in menopause in
1:08:33women.
1:08:34We're seeing a big bump in the sleep
1:08:36apnea rates in women who are um
1:08:38they don't even have to have a weight
1:08:39problem.
1:08:41And what is sleep apnea? That's when
1:08:42people
1:08:42So, sleep apnea is when you stop
1:08:43breathing
1:08:44um or you snore quite a bit. You you see
1:08:46the palate relaxes and you're not
1:08:48getting as much oxygen, you know, into
1:08:50the body and into the brain.
1:08:52It's a big health risk. And what is your
1:08:53personal sort of exercise regime? What
1:08:56do you So, you know, I came from the
1:08:57long
1:08:59the 20 years of just trying I was
1:09:00exercising to be smaller. Mhm.
1:09:03And now I'm I'm moving to be stronger.
1:09:05And so, now I'm doing resistance
1:09:07training. So, I have a treadmill that I
1:09:09set up on an incline.
1:09:11Um and I do a lot of Zoom calls there. I
1:09:13do lots of meetings there. So, when I'm
1:09:15working from home and and working on the
1:09:17Galveston diet or the new book, I'm
1:09:18doing on my treadmill but at an incline.
1:09:20So, I'm really working on my legs. I
1:09:22will wear a weighted vest so that I'm
1:09:24getting the upper body. So, I'm doing
1:09:25this for bone density.
1:09:27Um, I'm doing a lot more lifting than I
1:09:29ever ever ever did in my life because I
1:09:31have a body scanner in my office. I have
1:09:33sarcopenia. I have a genetic low I'm
1:09:35very thin individual was not blessed
1:09:37with a lot of muscle mass and the fact
1:09:40that I focused on being thin for so long
1:09:42and that was my social currency is you
1:09:44know I was thin I was healthy.
1:09:46Probably I've lost you know I lost that
1:09:48that window of opportunity to gain more
1:09:50muscle easily in my 20s and 30s. So what
1:09:52I what I would tell my 35-year-old self
1:09:54what I preach to my daughters is
1:09:57focus on being strong, not small.
1:09:59You know, muscle strength over skinny.
1:10:02And so the muscle mass that you develop
1:10:05now is going to serve you so much more
1:10:07than the lack of fat or this perceived
1:10:09lack of fat that you think you need.
1:10:11Um,
1:10:12don't worry about the curves that you
1:10:13have. That's that's natural. That's
1:10:14that's the way you're built. Let's get
1:10:16some muscle.
1:10:18And what about your diet?
1:10:20So what my personal
1:10:22Yeah, yeah, yeah. Eating eating window I
1:10:24think you talked about. So I tend to um
1:10:27I break my fast at around noonish
1:10:29typically. If I'm hungry before if I'm
1:10:31traveling or you know on a plane I don't
1:10:33do well on a plane without food. And so
1:10:35but on a normal day when I'm like going
1:10:37to clinic and the night before is when
1:10:39my diet starts. I will pack up my meals
1:10:42and snacks that I'm going to take to the
1:10:43office with me when I see patients. And
1:10:45so I know what I've got. I'm doing you
1:10:48know I'm loading up on protein. I'm
1:10:50doing something green, some kind of a
1:10:52green veggie. I'm doing lots of fruit.
1:10:54I've got nuts and seeds. I eat nuts and
1:10:57seeds all day long um for the
1:11:00anti-inflammatory benefits and for the
1:11:02healthy fats and for the fiber. And so
1:11:04I've got all that. So I break my fast at
1:11:06about noon and then between patients I'm
1:11:08constantly snacking. I'm really focusing
1:11:11on protein for myself. I don't have a
1:11:12weight problem. Um and so I'm trying to
1:11:15get stronger and so my protein needs
1:11:17have really increased and so I'm
1:11:19sometimes doing a protein bar or a shake
1:11:22middle of the day um to help with that
1:11:24and then in the evening now we're empty
1:11:26nesting so it's just my husband and I.
1:11:28And so he you know we'll kind of discuss
1:11:30what do we have in the freezer or we'll
1:11:32pull out some salmon or you know we'll
1:11:34we'll make some I don't know uh
1:11:37burgers or something and um you know we
1:11:40try to be protein centric and then we're
1:11:41adding in like a beautiful salad with
1:11:43lots of avocado and chickpeas
1:11:45um
1:11:46on the side. So I think I covered it
1:11:49all. Yeah. So I'm typically done eating
1:11:51by 8:00 p.m.
1:11:52Um
1:11:54if it's an office day I'll either
1:11:56exercise when I get back. I'm struggling
1:11:58to get up I do a lot of great work in
1:12:00the morning so it's hard for me to get
1:12:01to the gym and the office. So I'll save
1:12:03my workout for when I get home from
1:12:05work. If if you had a a megaphone and
1:12:06you could speak to every woman
1:12:08right now the 1.2 billion
1:12:11that we talked about earlier that are in
1:12:12that perimenopausal or or the menopausal
1:12:14phase or postmenopausal and you had to
1:12:17communicate one message them. I'm
1:12:18actually going to bring in everybody
1:12:20else as well because although it's just
1:12:21those women I've mentioned
1:12:24everyone around them in their life
1:12:25probably needs to hear some somewhat
1:12:27similar message so they can play
1:12:28supporting roles in that individual
1:12:30struggle.
1:12:31What would you say down that menopause
1:12:33to those women and the the loved ones?
1:12:36So my mantra is menopause is inevitable.
1:12:39Suffering is not.
1:12:41But you're going to have to advocate for
1:12:43yourself because society has failed us.
1:12:47Our medical system is is built to fail
1:12:50the menopausal woman. And there is good
1:12:52help out there. You're going to have to
1:12:53do the legwork. I've got tons of
1:12:55resources on my website to help you.
1:12:57You know, list of articles to print out
1:13:00and hand to your doctor, system you know
1:13:02um
1:13:03uh symptomatic sheets that you can like
1:13:05keep track journals that you can hand to
1:13:06your physician.
1:13:08Um any way that I can help you advocate
1:13:10for yourself cuz I can't be everyone's
1:13:11doctor. But that this is real. You're
1:13:13not crazy.
1:13:15This is happening and there are lots of
1:13:17things that we can do even non-hormonal.
1:13:19Don't feel like if you're not a
1:13:20candidate for hormone therapy that
1:13:22you're stuck. You know, exercise,
1:13:24nutrition, other pharmacology, stress
1:13:27reduction, sleep. It's time to take care
1:13:29of yourself first so that you can have
1:13:32the best end of your life that you
1:13:34deserve.
1:13:36In 2023 I launched my very own private
1:13:40equity fund called Flight Fund and since
1:13:42then we've invested in some of the most
1:13:44promising companies in the world. My
1:13:46objective is to make this the best
1:13:48performing fund in Europe with a focus
1:13:50on high growth companies that I believe
1:13:52will be the next European unicorns. The
1:13:54current investors in the fund who have
1:13:56joined me on this journey are some of
1:13:58Europe's most successful and innovative
1:14:00entrepreneurs and I'm excited to
1:14:02announce that today as a founder of a
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1:14:24Fund is regulated by the FCA so please
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1:14:30invest unless you're prepared to lose
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1:14:44is for information purposes only and
1:14:47should not be taken as investment advice
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1:14:50know I'm a big fan of Huel. I'm an
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1:14:57Steven Bundle which is a selection of my
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1:15:01the black edition salted caramel flavor
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1:15:15This is chocolate caramel. You can see
1:15:17from the empty box in front of me that
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1:15:22counter for 5 seconds they'll go. I'm
1:15:23going to say something I've never said.
1:15:25When Huel first made their bar many many
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1:15:48check it out. Back to the episode.
1:15:50Your family have a history of health
1:15:53complications and illnesses, right?
1:15:55Yeah. What is that history but also has
1:15:56that played into your overarching
1:15:58perspective about
1:16:00nutrition Yeah. the health care system,
1:16:02how it treats people?
1:16:04So my I'm one of eight children. I have
1:16:07six brothers and um my oldest brother
1:16:10Jep died when I was 9 years old from
1:16:13acute lymphocytic leukemia, one of the
1:16:15most common forms of childhood leukemia.
1:16:17Now the cure rate is 95%
1:16:20and but at the time he was put into
1:16:22remission and then he came out of
1:16:25remission in his late teens and died
1:16:27like a year and a half later.
1:16:29So my childhood was
1:16:31that that year and a half was all about
1:16:33trying to save him.
1:16:35And everything my family did of taking
1:16:37him to Memphis which was so far from
1:16:39Louisiana where I grew up to St. Jude's
1:16:41Hospital
1:16:42the last ditch effort to try to you know
1:16:44find another chemotherapy regimen which
1:16:46he failed and that kind of kind of drove
1:16:48me but you know it was it was leukemia.
1:16:50It was childhood. It was one of those
1:16:52things.
1:16:53Fast forward to 20
1:16:56He died in 2015 so 2010 my brother I
1:16:59knew had HIV and um had also contracted
1:17:02hepatitis.
1:17:03And he was doing great on his HIV meds.
1:17:06Um his counts were good. He was healthy,
1:17:08functional. He'd been with the same
1:17:09partner for over 30 years. But then his
1:17:12his liver was getting worse and worse
1:17:13and worse.
1:17:14He also struggled with alcoholism and so
1:17:17that kind of combination
1:17:19was really hard to watch and love him
1:17:22through his choices, you know. And uh he
1:17:25ultimately died in 2015. He had a stroke
1:17:27and then I was able to go do his end of
1:17:30life care. And the first book I wrote um
1:17:33I talk about him in the book because
1:17:36in my rush to deliver his care I forgot
1:17:39my own and that's when I realized I was
1:17:41menopausal was through my grief process.
1:17:43I thought I was grieving. I gaslit
1:17:45myself.
1:17:46Like no no no you're not sleeping.
1:17:47You're you're waking up all night.
1:17:48You're you know upset and your mental
1:17:50health and your brain fog is all because
1:17:52you're just grieving his death.
1:17:54And then um my next brother Jude uh was
1:17:58diagnosed with stage four esophageal
1:18:00cancer.
1:18:01Um
1:18:02shortly
1:18:04uh he was diagnosed when Bob died and
1:18:06then he survived a few years. Um so
1:18:10Bob died at 56
1:18:12and Jude died at 57 and I'm 55.
1:18:16And
1:18:17I don't you know I know a lot of it was
1:18:20lifestyle but I still have those
1:18:21genetics and I'm about to survive three
1:18:23of my six brothers.
1:18:25And um
1:18:27out through outlive. And I know that
1:18:30these choices that I make with my
1:18:31nutrition, my exercise, my sleep, my
1:18:33stress reduction, what I call the
1:18:34menopause toolkit, you know, and my
1:18:36choice for HRT
1:18:38are all I want to see my grandkids one
1:18:40day. If if I'm lucky enough to have any
1:18:42I want to watch these women I've raised
1:18:45grow up and you know be the women
1:18:46they're meant to be and that choice
1:18:48might get taken away from me if I'm not
1:18:50careful. So you know a lot of what I do
1:18:54and why I do it is
1:18:56because I have to. I may not get the
1:18:58choice.
1:19:02What an incredibly important mission
1:19:04you're on and what incredible work
1:19:06you're doing. Um
1:19:08because there are as we've talked about
1:19:10there's been a a group of people in
1:19:11society that have
1:19:13kind of been I guess disillusioned but
1:19:14they've also must have felt incredibly
1:19:16isolated in their experience and what
1:19:18they were going through. And it seems
1:19:20that there's been a real shift in recent
1:19:22times towards the conversation around
1:19:24menopause and hopefully these
1:19:25conversations if anything at all will
1:19:27dismantle the stigma which is often the
1:19:29first sort of wall that needs to fall
1:19:31for people to be able to take action and
1:19:33have those conversations.
1:19:34And it just speaking from my own
1:19:36experience, I didn't really understand
1:19:37what any of this stuff meant until I
1:19:38started doing this podcast and I had the
1:19:40first couple of guests on and then
1:19:41someone said the word menopause to me
1:19:43and then we started having a
1:19:44conversation about it. And I go, "Oh my
1:19:46gosh, like you know, maybe when I was in
1:19:49school someone should have told me about
1:19:51this phase of life. We talk about how to
1:19:53get a job, but it seems to
1:19:56fall off, you know, the education system
1:19:58seems to stop caring once we've had kids
1:20:00almost. That's what we're experiencing
1:20:02here as well.
1:20:04It's really really crazy and the work
1:20:05you're doing is so unbelievably
1:20:06necessary and what I love about the way
1:20:08that you you write and how you educate
1:20:10people is it's so science-based but it's
1:20:13so accessible at the same time. That's
1:20:15always been my superpower, I think, is
1:20:17and I realized that very quickly in my
1:20:19career was that I had this knack of
1:20:22being able to take something really
1:20:23complicated and break it down into terms
1:20:26that people could understand. Mhm. That,
1:20:28you know, most people would be able to
1:20:30grasp and walk away from. And you have
1:20:33nuance and empathy which is the
1:20:34necessary ingredients when you're
1:20:36talking about subject matter like this
1:20:37where everyone's symptoms are typically
1:20:39quite different from one another and
1:20:41they will have different circumstances.
1:20:42We talked about other, you know,
1:20:44conditions and contraindications that
1:20:46might be complicating things. Um
1:20:49and you seem to have a really wonderful
1:20:51empathetic view on all of those things
1:20:53and a real appreciation that everyone's
1:20:55circumstances are entirely different. Um
1:20:57I'm excited and I'm really looking
1:20:59forward to having more conversations
1:21:00like this and learning more because
1:21:02although I am a 30-year-old man,
1:21:05I have a partner that I love. Mhm. Um I
1:21:08have a mother that I love. I have an
1:21:09older sister that I love. My sister is
1:21:11my partner is 30 as well. My sister is
1:21:1336. My mom is
1:21:1560 now.
1:21:18Nearly 60 now. I I challenge you to have
1:21:20this conversation with her and ask her
1:21:22about her experience.
1:21:23I really applaud all the and I don't
1:21:26know whether I should say this or not,
1:21:27but I really applaud all the men that
1:21:32got to this far in this conversation and
1:21:33chose to listen and have an appreciation
1:21:35that
1:21:36the betterment of 50% of our population
1:21:38who are going to go through something is
1:21:39the betterment of all of us. Exactly. Um
1:21:42and that they also have a role that they
1:21:43can play in being a support and
1:21:46encouraging and having the conversations
1:21:48that will bring down the stigma and and
1:21:51the suffering of what is currently about
1:21:521.2 billion people but will be 50% of
1:21:54people in our population. So,
1:21:57I highly recommend everybody goes and
1:21:59checks out both this book which is the
1:22:02Galveston Diet but also can we pre-order
1:22:04the upcoming book now?
1:22:05Yeah, it's available for pre-order
1:22:07wherever you buy books. And you'll think
1:22:09it'll be out in 2024 in
1:22:11For sure. And
1:22:12the latest May. The latest May, okay.
1:22:15And that's called the New Menopause so
1:22:16you can pre-order that now wherever
1:22:19wherever um you get your books and
1:22:21that's the culmination of many decades
1:22:23of very very hard work. So, I'm very
1:22:25very excited to read through that myself
1:22:26and the Galveston Diet book is out now
1:22:28as well. It's been out for a little
1:22:29while. Um we have a closing tradition on
1:22:31this podcast with the last guest and
1:22:32also your website is an incredible
1:22:34resource for all of this all of the
1:22:35things you talk about, right, and your
1:22:36social channels, etc.
1:22:39We have a closing tradition on this
1:22:40podcast where the last guest leaves a
1:22:41question for the next guest not knowing
1:22:42who they're leaving it for.
1:22:43And the question here is
1:22:48you get one last conversation
1:22:50with somebody you love, a child, maybe
1:22:53your husband, maybe someone else.
1:22:56What you say to them in that
1:22:57conversation
1:22:59that maybe they haven't already heard?
1:23:03I love you.
1:23:11There's nothing more than love.
1:23:16I've had done it
1:23:19three times with my dad, too. My um
1:23:24Bob and Jude were five years apart. My
1:23:27dad was shortly after Jude. You know,
1:23:29and watching my parents bury three kids
1:23:31was a lot.
1:23:33Um
1:23:36just love.
1:23:42Thank you. You're welcome.
1:23:43Thank you so much.
1:23:47Quick one, I discovered a product which
1:23:49has changed my life called Eight Sleep
1:23:51and they are now a podcast sponsor. You
1:23:53guys have probably figured out by now
1:23:54that I'm pretty obsessed with optimizing
1:23:55my health and specifically my sleep and
1:23:58I think my sleep has been a bit of a
1:23:59personal revelation for me, the
1:24:00importance of it and how much it
1:24:02correlates to how I feel every day, how
1:24:04creative I am, my mood and everything
1:24:06that seems to matter to me. One of the
1:24:08controllables to have better sleep is
1:24:10temperature. If the room's too hot, you
1:24:12won't sleep. Your body needs a certain
1:24:14temperature to sleep but not only that,
1:24:16it needs that temperature to kind of
1:24:18fluctuate through the night starting
1:24:20cool, getting colder and then heating up
1:24:22again which is a reflection of nature
1:24:24and how our ancestors would have lived
1:24:25before central heating and duvets and
1:24:27air conditioning and all this stuff.
1:24:29Highly recommend Eight Sleep. I've
1:24:30spoken to the founder, I understand
1:24:32their mission, I believe in it, they're
1:24:33good people. This is one of those
1:24:35products where once you've tried it, you
1:24:37never go back. Go to savings and ring in
1:24:40the most wonderful time of night. Eight
1:24:42Sleep currently ships within the UK,
1:24:44USA, Canada
1:24:47and select countries in the EU and
1:24:49Australia.
1:24:51Do you need a podcast to listen to next?
1:24:54We've discovered that people who liked
1:24:55this episode also tend to absolutely
1:24:58love another recent episode we've done.
1:25:00So, I've linked that episode in the
1:25:02description below. I know you'll enjoy
1:25:04it.

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