Episode 514: The Best of Habits & Hustle - Dr Mary Claire Haver (The #1 Menopause Doctor)

26:29So I wanted to say, so I want to ask you about HRT, hormone replacement therapy. Who's a good candidate who is not? Is it a myth that HRT is something you should stay away from if cancer or breast cancer runs in your family? I think there's a lot of fear around it. So the HRT is hormone replacement therapy or menopausal hormone therapy, depending where you read. And basically, I look at it as giving your body back the exact same hormones that you used to make when you were your healthiest to allow these critical processes to continue unfettered as well as they could. What's happening is when we lose our estrogen, we have an acceleration of cardiovascular disease.

27:20We have an acceleration of neurodementia. We have an acceleration of osteoporosis and frailty. We have, you know, all these things kind of skyrocket rather than go with this usual path with aging. We have an acceleration of the chronic diseases associated with aging and the diseases specifically affecting women, including autoimmune disease. And women on HRT, especially starting young in their menopause, like early in their menopause, in perimenopause or in the first 10 years of menopause, have a lower all-cause mortality, 50 % decreased risk of cardiovascular disease year for year, and a decrease in cancer.

27:59So where did this come from? Like, you know, don't eat soy because it's estrogen producing, right? Oh, God. Women who have high soy diets have lower breast cancer rates, by the way. So where did this whole thing, remember this whole thing about 20 years ago? Like, I've been staying away from soy my entire life because I thought that that was going to kill me. Never been proven. Never been proven. Nothing. And now when I go and look at demographic data on women, sorry, my lips are dark, on women who have naturally high soy diets, like Asian women, We eat edamame all the time. They don't have breast cancer like we do.

28:31So here's what happened. There was, we've known for years that women on hormone therapy is 38 % of women were on before the WHI. So about 40 % of menopausal women were on HRT, not only for hot flashes and night sweats, but for the protected benefits of decreased osteoporosis, decreased heart disease. We knew that that was the thing, but it was observational data. So there was the healthy woman hypothesis, meaning are women on HRT just healthier because they're whiter and more educated and they have more access to health care, you know, and we're just seeing an artifact? Or is this real? And the way to prove it is a randomized control trial.

29:07So finally, we had a female leader of the National Institutes of Health. She puts the study together. It's amazing. I mean, we're like so excited. It's a high-quality study, thousands and thousands of patients. And they're like, okay, the end result that we're looking for was, is heart disease going to be delayed or stopped with hormone therapy? So they chose the average age of the patient as 63. 63. Okay. Yeah. Not 50, the average age of the woman starting hormone therapy. 63. Why? Because they can't run the study forever. It's too expensive. So we're going to start it later to see if there's cardiovascular benefit because these women aren't going to have heart attacks until they're in their 70s or 80s.

29:44So to save money. And that made sense. They were also tracking multiple factors. They were looking at frialty scores, all kind of stuff. So here we go with this study, and we have two arms. We have women who have uteruses and women who don't. Two groups, okay? The women with uteruses got estrogen and progestogen or placebo, and then the other group got estrogen only because they don't have a uterus or placebo. Here we go. So remember, average age 63. They see that versus placebo, the rate in breast cancer went from 4 out of 1 ,000 women per year to 5 out of 1 ,000 women per year on the medication.

30:20So that is a 25 % increase in relative risk. Not absolute risk. Relative risk. They stopped the study, called a press conference before the paper was published, before any physician could look at it. It was the number one news story, medical news story of 2002. It was on the cover of every single newspaper, ABC, Good Morning America. Nancy Snyderman got on there. It was like, I took all my patients off. People are throwing their estrogen in the trash. The estrogen only arm showed a 30 % decreased risk, you know, of breast cancer. It was the progestogen, which was synthetic. So then, but what did the headline say?

31:01Estrogen causes breast cancer. So this is so interesting because all of relative risk, which is what is like your individual risk as a patient was 0.8%, less than 1 % per year. So then you're saying that anybody who's in perimenopause who has deficient hormones should be going on HRT. They should consider it. They deserve the conversation and that's what's not happening. Not that they would not choose it. It is a shared decision between the patient and her provider. They're being denied access in conversations around it. Doctors are just saying they don't believe in it, like it's Santa Claus, or it's going to kill you, they have it.

31:37All of those findings have been redacted. And what is the reason behind it, like this whole, it's going to kill you? Because if you're just supplementing your body with what it had before, where is the disconnect? How is that something that is dangerous? Okay. So say you breast cancer is a healthy cell that has gone through a malignant transformation, right? Through dits to the DNA. You know, if we look at how we're dividing cells and all that, if your breast cancer cell through the malignant transformation retains its estrogen receptor, which healthy cells have to have to be healthy. Okay. Yeah.

32:17We need estrogen receptors to make the breast cells do what they do. If it retains its breast cancer, its estrogen cell, it is now estrogen receptor positive, and they can use that receptor against the cancer cell to stop the breast cancer from growing. So if you have an estrogen receptor positive cancer that, you know, that we don't want to feed, then you might be getting tamoxifen or CIRM or one of the anti-estrogens or the aromatase inhibitor, you know, to fight your breast cancer. That's totally reasonable. So not everyone is a candidate for a hormone therapy. If you have a hormone-sensitive cancer anywhere in your body to that particular, to estrogen or progesterone, you're not a candidate.

32:57If you have severe liver disease, you're not going to process and break down estrogen the appropriate way. You're not a candidate. If you have unexplained vaginal bleeding, you've not had the ultrasound or workup or biopsies, you're not ready for HRT. So there are, you know, patients, all of these are very nuanced conversations. but just because you've had breast cancer does not mean that you are going to be categorically denied hormone therapy. But what was the first thing you said? If you have hormone, like you said something like if you're somebody that has a hormone issue, like positive cancer, like if you have cancer, not to go on it.

33:31Yes, obviously. But the other, you said cancer, vaginal bleeding, you said it not. And you said severe liver disease. So other than those things, You think that anybody else. Those are the big ones. So like family history, no problem. Blood clots, don't do oral estrogen, do transdermal. You know, again, nuanced conversations, so much misinformation. These poor women are crying to me who are absolutely suicidal at the end of their rope. Like they are miserable. And they've been told, oh, your grandmother had a blood clot. You know, I'm like, what? You know, these people don't know, haven't educated themselves.

34:07The system is not educating them. I agree. We have so much work to do. This is why the truth is most people I know who are getting hormone therapy, they're not going to the regular OBGYN or regular doctor. No, they're going to some back alley place. They're going to a back alley place. They're going to these like rando doctors, these functional medicine yahoos that I don't even know who they are, who are giving them, I don't know what, are these meds. They're going to med spas really is where they're going. They're going to med spas. That's the truth. Dressed up as functional medicine. You know, that's where they're going.

34:37And they're going. Masquerading. Oh, and you can get your Botox. And you can get your Botox. You can get your fill. I mean, I love Botox. Listen, I'm just saying is you're going to these like second rate places that are not even a proper medical facility. So women have a long history in this world of having to go to alternative or back alley places for needed medical services. And they're going to do it. And this is just another example. So where do people find it? Like if I went to my OBGYN. It's getting better. Yeah, no, no. Well, she'll say like, she'll say, Oh, here, take this. Like, what does it think if you do so?

35:13Are you saying, go to your doctor, your regular normal doctor, have a try to have an intelligent conversation about hormone therapy? That does include not just estrogen, but you're saying hormone therapies, also testosterone, progesterone, everything, right? Now, are they just like subcutaneous shots that people are putting in? Or is it like, Maybe, but you can get safe, efficacious, high-quality, bioidentical hormone therapy from your local pharmacy with insurance, if that's your jam, for$30 a month. For all the hormones? No. So testosterone in the U.S. is not FDA approved. And I don't know what the same board is in Canada, but you're going to have to be out of pocket for testosterone because FDA has not gotten a role to improving it for women, even though we have tons of studies to show how helpful it is.

36:04so for my patients we can do i usually do an estradiol patch an oral micronized progesterone and we do some topical testosterone in the form of a cream usually from a compounding pharmacy right that's what my doctor always recommends these creams but the creams from what i understand because like i haven't done any of these but i want to they don't do anything the creams are not very so you never want to do a progesterone cream with estrogen like if you if you do a Remember, it's a huge molecule and it doesn't absorb. Oh, testosterone. Yeah. Yeah. So I've got a couple of trusted pharmacies that work very closely with the pharmacists, but still, they're not as regulated.

36:42No one's going in to test to see in a compounded pharmacy. It's really what they're putting in there. Were they having a bad day that day and they didn't? So the things coming from Walgreens and the FDA approved stuff, they go through extensive testing and monitoring. So we know 98 % of the time what they say is that it is in it. So that's my preferred source. I don't have that option for testosterone because there's not an FDA approved option. And it's really hard in Texas where I practice to get them the men's version. There's a gender ban. And only if you have gender dysphoria or you're transitioning, can you legally get it?

37:18They'll turn you in. Wow. Yeah. So what about pellets? Are you putting people, you can't even do that, right? Absolutely not. No, no. Pellets are just, you know, I don't want to demonize the pellet. It is simply another compounded form of therapy. There's nothing magical about it. It's not better. It's not safer. It might be more convenient, but you can't take it out once they put it in. You're stuck for three months. And let me tell you, it is the most profitable for your physician. So here's the red flag. You go into your pell care provider and they only offer you pellets. All we do is pellets run because you are there to make them money.

37:55Because if they're not having a logical discussion and they're making you promises like, girl you're gonna feel so good you're gonna i don't make those promises i'm like listen we're gonna try this we're gonna try this but nothing's better than your 25 year old ovaries i can't put those back in you you know we were just trying to get you to some level um you can function again and then we'll figure out the rest so it's so funny and only laughing only pellets are in it for the money and not in it for the patient so and they're not dealing with the side effects they're not i mean it's horrible so like but if you're if your physician's like look we got pellets we got patches we got rings you know my patients can't afford pulp you know they're hundreds of dollars a month where they can pay 30 or 40 or 50 maybe and go get what they need i'm only laughing in a not because it's haha funny but like i live in la and uh everyone's running to these particular doctors that i know here and he's just like doing one like he's basically banking like one I'm teaching me like 100 pellets on these people, poor people.

38:57Here's what, yeah, guess what about pellets, about BioT? They don't make a woman's version of the testosterone pellet. They just put the men's low dose pellet in the women. And so normal physiologic range of a healthy female, you can Google it right now for testosterone, is about 25 to 70. Okay, picoagraves per deciliter. Don't worry about that. the biotee literature, I went and signed up on biotee because I wanted to see what they were teaching these people. They say, no, no, no, no one's died yet. Let's run them between 150 and 250. Okay. That is a transitioning level. So basically taking these women and turning them into teenage boys and sure their libido goes up, but this is not without side effects and risk.

39:44And so no, thank you. I would just want, I'm, I try to get my patients 50, 60 in the high normal range. You You know, they're very happy and they're not having the beards and the cholesterol and the side effects and the and the and the and the acne and the hair loss. And that, you know, because that's what I'm scared of. Women are coming to me after getting a pellet. I'm drawing their levels during the three and four hundreds. And I'm like, girl, what are you doing? That is why I am scared to go on these things, because it was going to the guy says to me, because I went to one of my friends who's like, you know, this girl.

40:19she's a famous girl she's like you have to go see my doctor he's amazing he's going to make you feel amazing so i go she's yeah yeah but at what cost right and he wanted to put he's like don't worry we're going to start really low it's going to be at about 100 it's 150 whatever amount that's double that is double high manual for and i said to him i'm like my doctor told me it was about my normal level should be at this place or whatever he's like real he's like he's like medical doctors don't have the knowledge. They don't know. Okay. And so... Guess who taught him that? Oh, you know. BioT. Right.

40:56And this is the best... When the company who's giving you the medicine to put in the patient is teaching you, there's a problem. Well, and also these pellets are like, to your point, 800 bucks a pellet. But obviously I didn't, I do not have any pellet. But the thing that really kind of was scary for me is all these side effects. Like, yeah, does it work for... So it's a really 50-50 split. If I talk to 50 % of my friends or people I know who are on it, they like it. If I talk to another 50%, they gained weight, they got bloated. It's an anabolic steroid. Yeah. So this is the question I have for you.

41:33Who is a good candidate for testosterone? I mean women, not men. Why are half the women just thriving on it? and the other half are really just not liking them. Who's a good candidate for? So, you know, were they not liking it because they were overdosed and they were in super physiologic ranges? They both got the same doses. Like these all, let's see, out of like 10 friends. All the pellets, they were overdosed. So they don't like it because they're overdosed. No, no, no. Like 10 of the women, five of them, let's say, loved it. Five of them did not like it. Now what? What were their levels? All pretty low.

42:12But this is what my, listen, I'm no doctor. But what I noticed were the friends of mine who liked it, they were naturally very thin already. And it wasn't a weight, like they didn't gain weight. The ones who didn't like it, like gain weight because they didn't have the genetics that was going to take them, that was going to keep them at a baseline of being very thin. The thin friends got thinner and more fit. The friends who were a little bit more, like more voluptuous, got more voluptuous and didn't like the... So higher levels of testosterone, you also convert more estradiol. So we start really low and slowly, slowly titrate up.

42:53Most of my patients, you know, have three indications to put a patient on it. Though the sexual medicine docs think that we have testosterone receptors everywhere in our body as well. And they feel like it's probably helping with cognition, with sleep and lots of different things. I started it for low muscle mass my whole life. I've not, you know, I've just was genetically very low muscle. And I'm super high risk for fracture and frailty as I get older based on my family history. And I'm just fighting that tooth and nail. I lift heavy. I do all the things. I was like, I'm an ass in testosterone.

43:26So I started, you know, really low dose. I never thought I had a libido issue, which is what I put most of my patients on for, for decreased hypoactive sexual desire disorder. We've ruled out other causes and it's just down to desire. But I definitely have seen an uptick in that area. and I think I would miss it if it was gone. So I never complained before, but I'm just having like a little more and I am having gains. So, but I am working out like a main, you know, I am heavy lifting very consistently, much more than I ever did. And then I'm eating much more protein than I did before. So what number are you taking testosterone as a doctor?

44:01What do you do? So I'm doing 10 milligrams a day, transdermal. So that comes up, so your levels would be at what point? So my last level checked was at 59. 59. So transdermal, does that mean cream? Cream. Cream, okay.

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46:09Okay, I've got so many other questions. Okay, so let's talk about exercise. We have to talk about exercise. We've been birthed work. We touched upon it a few times. I'm a big believer in strength training and lifting heavy, especially as you age. I know you talk about that as well in your book. What can you tell us on the research? you've done of how strength training and menopause or as you age, the importance of those two are together. So most women peak at their muscle mass at about age 30. And then we have an age-related decline in muscle mass. And in order to overcome that natural progression, we have to work harder and harder and harder every single year, or we're just going to have to give up that, you know.

46:52And And so as we're living longer than men, we're becoming more and more frail in those years. And so when you look at long-term care homes, 66 % are female, 33 % are male. And the most likely reasons a woman is going to be admitted is for dementia and then for frailty. She can't get off the toilet. She can't lift her legs. She can't get off the floor. If she falls, she can't pick herself up. And so this is the end result or she's fallen and broken a bone and can't take care of herself. All of this is pretty much avoidable. But, you know, my generation, our generation, I was a cornea queen. I ran.

47:29Everything was about to be thin. Like my whole focus for movement was to be skinny. Okay, which I had skinny privilege. I ran marathons. I did all this stuff, you know, super proud of that. But God, if I could go back and talk to that girl, pick up some freaking weight, you know, because I chipped away at my bone and muscle strength to be thin. I never looked at nutrition outside of calories. You know, I tried to eat healthy. I didn't know what that was until I went back to school. They didn't teach us that in medical school. Just, you know, don't eat french fries. Okay. So, but for movement, two to three days a week of progressive load resistance training, that scares the hell out of women because they've never done it.

48:07They don't know how, but it is so important. So when they did studies on elderly women, which is 65 plus, okay, I am eight years away from that or nine. How old are you? 55. Oh, you look great though. So almost 56. So they were looking at vibratory training, putting them, they put them in 10 % weighted vests. They had them start lifting. They were doing deadlifts. These women were making major gains in their 70s and 80s for muscle mass and bone strength and osteoporosis. And I'm like, okay, osteoporosis prevention program, let's go. There's great studies on collagen. There's great studies on wearing a weighted vest.

48:41I wear one all the time now when I'm walking the dog, when I'm doing housework, when I'm, you know, walking on my treadmill, which I do a lot of work on my walking desk, but I put the weighted vest on to do it because I'm cheating the system. I'm just, you know, I'm never going to be obese. That is not in my genetics. It would be a lot of hard. I could do it. So, but you know, for me, it's avoiding the frailty card and I want to be 90 and playing on the floor with my grandkids. Yeah, I agree. Great grandkids. You know, I want to be climbing a mountain. I don't want to be on a walker like my mother at 85.

49:13Yeah. Who can barely get around. She can't get in and out of the tub. We're trying to figure out converting her bathroom right now. She sits on the toilet and does a sponge bath. That is the best she can do right now. Wow. You know, and that, no, no. So I'm doing squats like nobody's business right now. Because this is my mother. So these are the things I talk to my patients about. They're not coming in saying, I want a bikini body. We're, you know, those ships have sailed. And it'd be great. I mean, who doesn't want that? But they're like, look, I'm looking at my future. I'm looking at my aunts.

49:44of looking at my mom's, what plan can I get on right now? What habits can I change? What do I need to focus on so that I can be healthy and vibrant as long as possible and not 10 years of horrible morbidity, not being everything in pain, breaking hips, breaking, you know. So women, 50 % of women will have an osteoporotic fracture before they die. Yeah. And men don't do that. Yeah. You know, like very few men. So it happens, but it's rare. And so I want to be like a man. I want to die like a man. They just die. They live and die. We have a protracted, horrible last 10 years of our lives, completely dependent on others.

50:23And that doesn't have to be like that. So this is what we talk about when we talk about menopause care. And this, we're talking for straight training is an essential piece of it. Do you think that cardio, because cardio is known to break down muscle mass, right? I think you need to walk, a brisk walk, a brisk walk with a weight. vest, I stopped running. I stopped going for my knees. I might do a few sprints just to get my VO2 max going, but a few sprints here and there, a little bit of Tabata. You don't have to go crazy. If you're on the couch, get up and walk, baby. That's it. Just walk for me.

50:59The weighted vest is amazing. If you, okay, all right, you're walking. Good. Grab a weighted vest. Let's get some hand weights. Let's work. You have to meet the patients where they are. Saying you need to do three days of a possessive training course, she's going to run out of my office screaming. But, you know, she's like, hey, I'm walking every day. This used to work for me. It's not working anymore. I measure their muscle mass in clinic. I have an in-body scanner. So I'm doing visceral fat, muscle mass. You know, I really can look at their insides and be like, okay, here's the path you're on right now.

51:28Here's what we can do to reverse this. Yeah. I'm a big believer in training for your bone density, for the weighted vest is amazing. And now the cardiovascular data. You know, women are much less, much more likely to decrease their risk of cardiovascular disease by 20 to 50 percent if they strength train. Yeah, absolutely. More than men. Like, they can do less strength training and have more benefits than a man. They can? Wow. They will have more cardiovascular benefits with less work. Oh, I love that. Yeah. Okay, let's talk about semiglutide and, you know, semiglutide, the GLP-1. Yeah. Is there a benefit for going on something like that, like the Ozempics of the world, if you are gaining belly fat from menopause or for perimenopause?

52:19So most of my patients, you know, again, I usually defer to people who have training in obesity medicine. You know, I don't have, unless my patients are obese, and especially patients with lifelong obesity, and they've done everything, they've done every diet, you know, this is a whole mindset. It's more than just mindset for so many patients. But I do think that there's a place. I have a handful of patients on it. We monitor them very closely. Before they leave the office, they know they're coming back every six weeks. We're monitoring their muscle mass. We talk about acceptable muscle mass loss.

52:53We talk about protein intake. Going to the long-term success of you being on semaglutide, where you're going to end up healthier in the long run, is really dependent on the doctor who gives it to you and how they take care of you and monitor you. Weight loss at any cost is rarely sustainable and rarely better for your health long term. And the reason why I'm even asking you this question is because we're talking so much about muscle mass, right? And keeping lean muscle mass on your body. It breaks down. When you lose weight, you're losing fat and muscle. If you severely calorically restrict half of what you lose is muscle, which is why so many people yo-yo because muscle is what controls our muscle metabolic rate so you've lost 10 pounds five of its muscle you immediately put on another 10 pound you know you go back but you've gained 10 pounds of fat and you could never get that muscle back without eating all the protein and doing all the resistance training so this semaglutide is a tool in your toolbox to be healthy you cannot ignore the value of nutrition of movement in the right you know doing the right movement, you know, just getting your shots and not eating is not going to serve you long term.

54:02But also you when you get out, I mean, you're the doctor, I'd like to ask you, once you get off of it, your appetite, I would imagine rebounds. If you don't change your habits, and you go back to your old habits, you're gonna gain the weight back. How do you change your habits? It's not a it's not a habit for it's not about habits. It's about making it's turning off like your your hunger. I'm seeing something different. So my patients are using that food noise going away, that time that they now have in their day as a time to, we talk about this, you know, how they're in it. This is a multifactorial disease.

54:37And we talk about habit changing. Is it successful for everyone? No. But I've seen some beautiful results. And when the patients come in and they've held onto their muscle mass and they see that visceral fat going down, they're watching their cholesterol go down, you know, even in semaglutine plus HRT, they lose 30 % more weight, by the way. Really? More fat. Yes. Wow. Women, menopausal women on semaglutide lose X amount. Women on semaglutide plus HRT lose 30 % more. Wow. I'm signing up. And they're more likely to keep it off because you're more likely to maintain your muscle mass if you have your hormones on board, including estrogen.

55:15That's amazing. I thought estrogen, again, this is a myth. Doesn't it make you gain weight? Is it more? No, it doesn't. Okay. No. Because, because what I have, whenever I, when you're menstruating, you feel like, why do you feel so bloated and water? Water. It's progesterone. It's progesterone. Okay. Gosh. It's a, it makes you retain water, which is why we like blow up when we're pregnant. Is that why? Progesterone is so high enough. Okay. Does that mean semiglutide? I've heard there was a correlation between inflammation and that. Does it help with inflammation? So talking to the obesity medicine specialist.

55:50This is not my jam, right? They feel like because of the lowered insulin levels, which is pro-inflammatory, they don't feel like the semaglutide is in and of itself lowering inflammation. Like it's directly acting on certain receptors that will lower inflammation. They feel like because insulin levels are going down and that means your visceral fat's dropping, that those two things combined are lowering inflammation because insulin is a pro-inflammatory hormone. Well, semiglutin is like an old, it's like the old version. Now everyone's talking about trisepatide. What is the difference between?

56:25My friends call it like iPhone 12 versus iPhone 13. Yeah, that's exactly it. So patients are having less gastrointestinal side effects, less nausea, less diarrhea, less constipation on their trisepatide. And now there's so many that are coming out and they're looking at oral versions as well to make it easier to prescribe. I think it's pretty exciting in the next, you know, and you think you spent money on developing COVID vaccine. These people are spending some money because they know people are going to buy it. And so developing the latest and greatest on, you know, decreasing side effects and improving efficacy.

57:00Wow. Okay. And then how about in terms of supplementation? Is there any particular supplement that you recommend? Yeah. So remember, supplements are not a menopause cure. Take that away, okay? And supplements are meant to supplement a healthy diet. You cannot swallow a handful of pills and expect to have miracles if you don't eat what you're supposed to be eating, okay? So most women are not getting enough fiber in their diets. And so I really advise, try to get your fiber from food, 25 grams per day, push to 30-35 with your supplement. Most of my patients are deficient in vitamin D. Our gut changes.

57:36We're protecting our skin from the sun for good reason. where, you know, there's lots of reasons why we live in climates. Well, it's sunny today in Texas, but, you know, so massive amounts of vitamin D deficiency. So I am recommending a routine vitamin D. I am recommending a certain bioactive collagen for prevention of osteoporosis. Pretty good studies on that. It's called Fortabone. Turmeric is not for everyone, but I sometimes will recommend turmeric, especially if they're having osteoarthritic pain. It does seem to help with visceral fat. It's a pretty powerful antioxidant and anti-inflammatory.

58:07So if you're doing teas or supplements, you know, but just be careful because too much turmeric can be liver toxic. It can. Make sure you're staying. Oh, yeah. Yeah. So, you know, too much of a good thing is not always the best thing. And so, you know, we have some supplements that we take to correct deficiencies. Magnesium is a big one of that. Others, we can take it a little bit higher doses. You know, FDA is to keep you out of a deficiency. Sometimes higher doses of things can be medicinal like magnesium. So magnesium altheranate has been studied in SSRI-resistant depression. It crosses the blood-brain barrier really well.

58:43And, you know, a lot of my patients use it for sleep. So, you know, then we're kind of looking symptom by symptom to see where we can shore up. I'm doing iron studies and all kind of stuff on my patients to see where their decision. Well, you mentioned magnesium. Which magnesium would you recommend? Because it's very confusing. There's lots of different magnesium forms. So like milk of magnesium, right? That gives you diarrhea on purpose. Yeah. is for constipation. So they're, you know, depending on the formulation, some of it stays in the gut and it makes everything move quicker. Some goes into the bloodstream, but doesn't get into the brain.

59:15So that's like glycinate and tarot. Some cause the blood brain barrier. Okay. So most of my patients are on MAG for the neuroprotection, neuro and cognitive benefits or sleep or calm. And so we're going with the L-serenate is what I'm usually recommending, but probably glycinate is not a bad choice either. What does that one do? So L-theronate is for your brain, basically. Yeah, and glycinate crosses pretty well into the brain as well. It's cheaper, too. So there's only one manufacturer of L-theronate in the world. I know this because I looked into trying to provide it to my patients, and it was just too expensive.

59:52And he only farms it out to three or four companies, or I think it's a he. Anyway, so that one's a little more pricey. Which one is it, though? He still has the patent on it, the L-theronate. No, no, no. Which company? Which brand? Oh, Magteen and Neuromag. So Life Extensions is the brand I get it from. Oh, Life Extension. Yes, yes, yes. Gotcha. Okay, good to know. Wow. Okay, well, listen, thank you for this. I think this is great information. And I love that you, like I said, I love that you came on this podcast, you guys. The book is called The New Metapoth by Dr. Mary Claire Haver. She is an OBGYN.

1:00:28Are you accepting patients right now? Not right now. I'm full. I'm full. to, you know, we're expanding our clinic, but right now I cannot take care of the ones I have in my, in my little. Sure. Wow. Well, listen, the book is fantastic. It gives, it gives a really good overview of all these things that we spoke about and it goes more in depth. And I, I'm really just, I'm grateful that you came on this podcast. So thank you for being a guest. You're welcome. And where can people find more information about you if they? So we have thepawselife.com is our website. We have free guides. We have free blogs, tons of information, how to talk to your doctor, what tests to ask for, etc.

1:01:13We are all over social media, Dr. Mary Claire or Dr. Mary Claire Haver on every channel you can think of except for Twitter. I just never got around to that one and now it's weird. But I'm on Facebook and Instagram and TikTok and YouTube are the big ones in Pinterest. All the things. All the things. Thank you. I appreciate you being here. And thank you for just some great, very, very pertinent information. I'm going to send this to all my friends. Well, thank you. Thank you. I'll speak to you later. And maybe I'll see you when you come to LA sometime. Yeah, I'll be heading out there in May. I think uh for we'll have our people send you the stuff I think May 11th we'll be out there for a few days you are oh my gosh I wish I would have known I would have had this in person I very rarely do these virtuals because it's sometimes very technically challenging let's put it that way yeah yeah but uh I think we're gonna make this work so thank you again okay and I'll speak with you soon you're welcome okay all right take care bye Thank you.