The No.1 Menopause Doctor: They’re Lying To You About Menopause! Brand New Science! (Men Need To Listen Too!): Mary Claire Haver

26:48So they might do the old WWE thing, that's, you know, or they might label them something else, they might misdiagnose it as another mental health predicament. I remember a woman in my life who, when, whose behavior changed around this age, and I didn't know about Peri -Menopause or Menopause, it's in hindsight now that I look back and go, oh my god, everyone around this person thought they had bipolar or something. Right. I mean, it's probably contributing to divorce rates, maybe in a good way, you know, at this time, I, one of the positive things I see about Menopause is that women are cutting the things in their life that don't make sense anymore.

27:28They're not putting up with, you know, as a society, we tend to take on everyone's burden and, you know, take on the emotional labor and a lot of relationships, take on the organizational labor. And I see because they're struggling so much with just staying afloat, they're able to just quickly say, no, I'm not doing this anymore, you know, you need to pick up, do whichever relationship they're in, you need to pick up your end of the bargain here, you know, I can't do all of that organizational labor, the emotional labor. And I have a patient who's a divorce attorney and she said, I really think a significant percentage is of this divorce is Menopause.

28:10And either they're prioritizing what's important to them or they're not getting the support that they need. And how can we give them the support that they need? So I think it's important that we talk about it. I encourage every single patient I have, all my followers on social media, tell your story, tell your story to anyone who will listen, tell your daughters, tell your nieces, tell your sons, tell your loved ones, like make this a normal part of a conversation so that we see it coming, we understand what might happen and that no one feels crazy and alone when they're going through it. And then we need to do a much better job in our medical system of providing support for these women and whatever way they need it, be it hormones, non -hormones, cognitive behavioral therapy, you know, there's lots of things that we can do.

29:00Not just hormone therapy is not the cure all for everything. We have to support the whole toolkit, right? We have to prioritize our sleep, get the exercise that we need, focus on strength training when a lot of us in my generation never did that. We were aerobics, you know, focused on being thin and small. It's time to be strong. You know, this muscle mass that you have is going to determine your longevity and your functionality as you age. And Menopause is, you know, that loss of estrogen and testosterone is tearing our muscle units apart, which is leading to osteoporosis as well. I want to give you that whole toolkit.

29:36But I also want to just before we move there, understand why women don't sometimes communicate that they're going through paramanopausal menopause. What is there a stigma associated with talking about it? Yeah, I think there's shame in stigma associated with aging with females aging and then you're layering on this loss of fertility. And in the medical field, when you look at funding in the US for research studies, women's health, like I think it's 55 billion, the National Institutes of Health in the US, you know, for all research studies. And that's outside of what pharma is funding. And women's health gets about 15 billion.

30:16And the majority of that is spent on getting people pregnant, keeping them pregnant, you know, and fertility issues. Menopause gets I think 15 million. Jesus Christ. Yeah, it's like 0 .03 % if I did the math correctly of all, you know, are we not as important as we were when we were fertile to do our lives not matter? It's ridiculous to me when we can intervene and help and give these women a longer life and a it as a fraction, I don't know, or percentage. But that's like I think in your book, I read it's 1 .2 billion women by the end of this year. And there's what 47 million new entrants into this sort of parry, menopause or postmenopause category every year.

31:101 .2 billion. Billion, right. And so many of them have no education at their fingertips, have nowhere to turn. Or, you know, 85 % are going in to their health care providers office complaining, help me, and being turned away, and leaving with more questions and answers, and only 10 % are even having the discussion for hormone replacement therapy. And then if they're given it, they're so terrified because of the misrepresentation of the mother's health initiative, they're convinced they're going to get cancer. And that study's been completely dismantled and walked back. We have good information that came out of that study.

31:44But, you know, the the the thought that estrogen causes breast cancer is the worst thing that came out of that study because it's not true. The mental health implications as well. I really want to get into the hormone replacement therapy and all that stuff. But the mental health implications for women, do we see an increase in depression in those and the consequences of depression? I guess. Depression, anxiety, bipolar, the entire spectrum, ADHD. So we see either a new onset or worsening of disease. So I'm telling my patients, or I'm telling people on social media, you may have done fine and done well with your depression on your SSRI.

32:24Don't be shocked if it is no longer working at that level. You either have to increase the dose. So no one right now is advocating for primary therapy of depression to be estrogen replacement. But we do know from the studies that it is a very powerful, adjunctive tool and that it can be preventative for a new onset depression. If you start in parimenopause, women who start hormone therapy and parimenopause have a lower incidence of new onset depression in their menopause. Suicidality. So I've looked at these numbers and COVID is kind of skewing things because we did see increased suicide rates.

33:01But we definitely see an uptick, especially in Caucasian women, not so much in women of color in the US, in the parimenopause time frame. Inflamation. What is inflammation? Sure. So inflammation, there's chronic inflammation and there's acute inflammation. So acute inflammation is what we need to survive. It is the body's reaction to a foreign invader basically or to an injury or an illness. So you twist your ankle, right? And so we injure that tissue. These chemical vestuangers are spread from the injured tissue, which basically tells our immune system, sin blood that way, sin the white cells and the red cells and all the cells that are going to fight and heal this, you're going to swell, you're going to have pain, that's going to keep you off of that joint so that it can heal, right?

33:53So acute inflammation also happens when we get viruses and other illnesses. Chronic inflammation is this low grade kind of under the radar inflammation that's happening in the background. So autoimmune disease is a lot of chronic inflammation, but we also see aging itself, you know, we can't change the fact we're aging, but menopause dramatically increases the amount of chronic inflammation that a female will go through, just based on the lack of estrogen and testosterone in her body. I'm trying to figure out why the lack of estrogen and the drop in estrogen causes inflammation. So it turns out estrogen is a really powerful anti -inflammatory hormone.

34:31So we're just like removing that protective blanket. And now you're you're just aging faster because of it. Okay, so we need to make sure that we reduce inflammation by any means necessary. And that was the sort of the one of it was the second component of the garrison diet anti -inflammation nutrition. If I wanted to have a low inflammation diet, you said there about the sugar, is there anything else that I've got to be aware of or avoid or choose in a supermarket? Sure, so I try to teach the principles in the form, let's add things in rather than restrict, because then we get into eating disorders.

35:03And so, keeping tabs on your added sugars, keeping those less than 25, but fiber. And that's one thing, most people are not paying attention to. How much fiber are you getting in your diet per day? And most women are getting about 12 grams per day. And the minimum we should be getting is 25. Vitamin D is another huge one. About 85 % of my patients and women in menopause are vitamin D deficient, not just low, I mean deficient. We are protecting our skin against sun damage, of course. We're staying indoors more, we're on our screens all the time, but we're also our guts changing, and our ability to absorb vitamin D is decreasing.

35:40So, making sure that you are checking your vitamin D levels regularly and supplementing when you need to or eating foods rich in vitamin D, that's another one. And does vitamin D reduce inflammation? Yes. Okay. So vitamin D is a vitamin, but it's also a hormone, and it has multiple functions in the body. And so vitamin D deficiencies are linked to lots of chronic diseases. You're more likely to have hypertension, diabetes, stroke, you know, all of the top seven of 10 causes of death in women. And so, keeping those, it's also mental health, you know, lots of vitamin D receptors in the brain. And so, you know, first thing I do is check a vitamin D level on my patients when they come in.

36:17So many of my nutrition based or medical or doctors that are spoken to on this show have spoken about fiber, especially in the last like six months. You know, people historically speak a lot about protein and all these kinds of things, but for some reason, everyone seems to be talking about fiber all of a sudden. So fiber does lots of things for us. It slows down the absorption of glucose into the bloodstream. So that keeps our insulin levels lower over time. It feeds our gut microbiome, soluble fiber. So, there's two types of fiber. They're soluble and insoluble. So insoluble is what kind of when you mix up a fiber supplement, you see the stuff precipitate down to the bottom.

36:54That's the insoluble fiber. That's what pulls water into the gut and kind of moves things quicker through the colon. Symbol fiber dissolves in water. That's the cloudy part. That is the food for our gut microbiome. That is the prebiotic. You don't need a prebiotic if you're getting enough fiber in your diet per day. And so keeping that gut microbiome fed and healthy and happy is going to do a multitude of things. Like that kind of data is exploding right now in the research world as to where the gut microbiome had to keep it healthy and what organ system it affects. Our gut microbes make these things called oxybutarates, which are then absorbed into the bloodstream and people who have high levels of oxybutarates are actually healthier and have less coronary artery disease, less dementia, less everything.

37:39So really nutrition, when I talk about the menopause toolkit, hormone therapy is just one very small part of the puzzle. But nutrition should always be first. Like it doesn't matter how many hormones you take if you're not covering your nutritional basis the way you should. And what are some sort of fiber dense with fiber rich foods that are in every supermarket? Alvicado, chia seeds, nuts, berries, your cruciferous vegetables, things that are crunchy, that's fiber, that's making the crunch. Apples, you know, there's so many. Don't find much fiber in lean meats or any. So it's going to be your fruits and veggies and seeds and nuts.

38:18Asparagus, tomato, spinach, celery. Asparagus, celery, yes, tomato, not so much. Just think of things that, you know, the crunch is usually from the fiber.

38:31Fasting. I'm a fan. It's not for everyone. It's not a great way to lose weight. The data on weight loss is conflicting at best. You can eat a lot of things that will undo the goodness of fasting and you're eating window if you're not careful. And so there's good data though on neuroinflammation and fasting and on systemic inflammation and fasting. So I recommend fasting for the systemic inflammatory benefits. And we do see some really nice lowering of insulin levels overall from fasting. There's so many different types of fasting people talk about. So when I'm teaching fasting to my students or to my patients, I recommend the 16 -8.

39:12So that's where Mark Mattson's data. So that's 16 hours of fasting in a row followed by about an 8 -hour eating window. Now for other, you know, again, it's individualized. Some people do great with a 14 -hour fast, you know, the 15 -hour fast. 16 is just kind of something to shoot for. And if someone's going to consider incorporating fasting into their life, give yourself about a six -week trial. You know, don't just try to go 16 hours without food if you've never done it before. Your body will adapt. And so the advice I got and what I do and what I teach now, so I used to break my fast about six in the morning before I exercised.

39:48So I pushed that window to 6 -15 and I did that for, you know, three or four days until it felt normal, natural. I wasn't hungry. Then I moved it to 6 -30 and then I just kept bumping that window out in 15 -minute increments over weeks. And by week five, I remember sitting at my desk and I had my lunch ready to go and I was still at the hospital at the time and saying, oh my god, I made it. It's noon and I don't feel bad, you know, like, so I had just slowly, slowly let my body adapt and adjust. And then I've been fasting gosh since 2015, probably 2014. And it's just a normal, natural part of my life.

40:24I don't even think about it anymore. Have you noticed any effects of that? You know, I do so many things. Yes, it's hard to tell. And so it's hard to tell. But initially, I do find when I'm fasting, the clarity of my thought is much better. I get much more work done. When I do my best research, it's when I do my best communicating with my followers is in the morning. You'll often, if you follow me on social, I'm always in my pajamas with a cup of coffee while I'm getting ready for work because I just get so excited about something I learn and I want to share it with everyone. And so I do find that once I break my fast, the synapses tend to not work as quickly for me.

40:57I was thinking about this new like an evolutionary lens. Why fasting makes sense? And why this sort of narrative that we meant to have breakfast, lunch, dinner, you know, maybe breakfast. That's a social construct. There's really not great science. Now there are humans that will do better by eating more meals more frequently. And that's why I say fasting is not for everyone, especially if it triggers an eating disorder. If you have diabetes or you have, you know, hypoglycemia, fasting may not be for you, but most people can do it successfully. And so I really encourage people to experiment with it and see how they do.

41:28I was wondering if I always try and think through like an evolutionary framework. And I was thinking about how in our hunt to gather a past, we would have meals were not available 24 cents. Yeah. And we would have needed like a really focused brain to go out on the hunt. So this explains why when we're like hungry, our brains working better, it also seems like there's more, I don't know, oxygen or nutrients in the brain. The brain tends to work better using the ketones for fuel than glucose. Though the glucose is the preferred fuel in the body, you know, and but but when they did studies, they were animal studies.

42:02So take this with a grain of salt. But you know, and they did their mazes, you know, the animals tended to get through the maze quicker and learn quicker when they were fasted rather than after they were fed. They're a little lazier. He turns you can also use ketones as an energy source of use, the keto diet. You can, you can. But I think, you know, when Matt's in and that those researchers were doing their work, their research in Alzheimer's and dementia, you know, there was no keto diet. They were just knowing that people were utilizing ketones for fuel, which is a normal natural process, we sleep.

42:36And so we burn through the glucose in our bloodstream, then we burn up what's in our liver and the, you know, gluconeogenesis. And then it switches to fat to burn for fuel. And so now there's people who like to take exogenous ketones. I've never experimented with that. I don't, you know, that's, I don't have any literature and menopause to support that use. And the third component of the galsden diet is this idea of fuel refocus. Right. So that's looking at, you know, food, we're looking at the macronutrients. So I'm really going hard on fiber and vitamin D and magnesium and things that we tend to as a gender be deficient in, especially with menopause.

43:17I'm really trying to highlight those things to make sure, instead of counting calories, let's see how much vitamin D you're getting every day. Let's see how much fiber you're getting every day. And is there a sort of ratio of foods that we should be having in terms of that process? So I originally developed galsden diet for weight loss, you know, but if I had to write it over again, so I went really heavy on fats, you know, healthy fats, lower on carbohydrates and 20 % protein. But I think if, you know, doing it again, the where I'm counseling my patients now is I'm going much higher on protein.

43:51What I've learned since that book was written was how important protein intake is to maintaining muscle mass. I'm also talking a lot about creatine and there's some nice studies done in the, we call it the elderly 65 -year -olds and above which I'm nine years from that right now. And how creatine supplementation just creatine supplementation on its own, well, combined with weightlifting, we're seeing bigger gains in the mental possible patient, post -mental -pulsal patient, yeah. Bigger gains in muscle mass. Muscle mass and strength. Yeah, I was going to ask you about this whole muscle mass endpoint.

44:27Why is muscle mass sort of parted into this conversation? So what we're, well, what we know in menopause is that, you know, aging combined with menopause, we see a dramatic loss of muscle mass with the menopause process. And so in that first 10 years of menopause, we could lose up to 10, sometimes 15 % of our muscle mass. And that muscle mass is going to determine your resistance to sugars. So your insulin resistance is really tied to your muscle mass. Your functionality, your ability to recover from a fall. And the other thing is what most people don't understand is the musculoskeletal unit acts as one.

45:05So when we have low muscle mass, you are dramatically increasing your risk of osteoporosis. Now right now, this might shock you, but 50 % of females will have an osteoporotic fracture before they die. And this is almost completely preventable. What is an osteopathic fracture? So osteoporosis is when we lose the density of our bones through. So estrogen, so all of our life, we remodel our bones, right? We chew out bone, we lay down your bone. And so we reach our maximum bone density as females at about age 35. And then it slowly starts to decline through the aging process.

45:47And loss of bone. So this loss of bone makes the bone weaker and much more likely to fracture when it when we fall. And so if you fall and break your hip in menopause, 30 % of women with surgery will die in the first year. 70 % will die without surgery. And that year is marked by horrific pain. And not being able to move and just really, really miserable people. And so, and so much of this is preventable. Going on hormone therapy, getting adequate exercise, doing the resistance training, eating the protein, adding in the creatine, making sure you're getting in a vitamin D, is going to be huge.

46:33You're protecting our, my population from this happening as we age. We can prevent the majority of this. I want to talk specifically about this hormone replacement therapy. You mentioned which swiss scared people. Yes, the women's health initiative. Yeah. And that study suggested that there was an increase in breast cancer if someone did hormone replacement therapy. So let's break it down. Originally, the study was designed to see if we knew it from observational studies was hormone replacement therapy going to truly be protective for cardiovascular disease. That was the function of the study in women who took it versus women who did not.

47:11We knew from observational studies that yes, they had a much lower risk of death from cardiovascular disease and all cause mortality as meaning death from any cause as well as heart disease in itself. Okay. Author's sporadic heart disease. So, but that's observational. The way to prove these things is to do a randomized controlled study versus placebo. So finally, finally, this is 1998, women were getting money. Like there was a new female head of the National Institutes of Health. They were funding this study. This was so exciting. Women were lining up the droves to sign up for it. But because the end game was to prove whether or not it was protective for cardiovascular disease, the average age of the patient was 63 years old.

47:56So that they could see if it was going to affect heart disease because women tend to get that in their 60s and 70s, right? So they recruit, they develop two groups. We have women with uterus and women without women who had had his trajectories or were born without uterus. And so each of them had a placebo arm and then a medication arm. When you don't have a uterus, you don't absolutely have to have a progesterone. When you have a uterus, it's required to give a woman progesterone as well or a progestin as well to protect the lining of the uterus from the estrogen. Unopposed estrogen can cause into material cancer, but we can negate that by giving her progesterone.

48:35You follow me? So we have an estrogen -only arm and an estrogen -in -a -progesterone arm and each have a placebo. So off we go. Let's take our meds, let's take our placebo and let's start measuring. What they saw in the estrogen -plus progesterone arm after two years was a very slight increase risk of breast cancer versus placebo. Now you have to understand there's a difference between absolute risk and relative risk. So the absolute risk went from four out of a thousand women per year to five out of a thousand women per year. So one out of a thousand women treated in the estrogen and progestin arm developed breast cancer over placebo.

49:18That is a 25 % relative risk increase. And that is the statistic that set the world on fire. So the researchers held a huge press conference at the Watergate Hotel in DC. Every major news outlet, this was before the internet and announced that estrogen causes breast cancer. Now remember, these women were on estrogen plus the progesterone, which is called pervera. The estrogen -only arm continued for a few more years because the women on estrogen only not only did they not see an increased risk of breast cancer, they had a, I think it was a 20 % decrease risk of breast cancer. Remincies. Yeah, relative risk.

49:59And the relative mortality went down 40%. So we think it's because estrogen feeds a breast cancer cell, but it doesn't cause breast cancer. We are highest levels of estrogen or impregnancy and it's so rare to ever be diagnosed with breast cancer. And a healthy breast has estrogen receptors and all that estrogen receptor positive means is that that breast cancer cell went from healthy to cancer through a mutation, but retained its estrogen receptors. And so we can use those receptors against the cancer cell to treat the breast cancer. So that study has been walked back. Multiple studies have been done, but like the whole mindset has not changed.

50:40Myself, as an OB -GYN, was still the lowest dose for the shortest amount of time, and only in women were absolutely nothing else is helping her hot flashes. Menopause was defined by the vasomotor symptoms. That's it. You know, vaginal estrogen, which is just putting estrogen locally in the vagina. So one of the biggest things we see in a huge amount of patients, like well over 50%, is something we call genital urinary syndrome of menopause. And it is the bladder, the vagina, and all of the tissue in between all has a lot of estrogen receptors. And we take the estrogen away. That tissue becomes very thin.

51:18We lose elasticity. We see recurrent urinary tract infections. The most likely treatment to help a woman in menopause with recurrent urinary tract infections, which is a major cause of death for women, is vaginal estrogen. And it's safe for everyone, even with breast cancer. And so even that option has taken off the table for so many women who are suffering needlessly with horrible, painful intercourse, dryness, you know, recurrent UTIs. And it's just such a simple thing to help a woman and fix. And they're not being offered that treatment. Is vaginal estrogen the only form of administering estrogen?

51:56So we have no. So when we look at hormone replacement therapy, we have, or any medication, we have like steroids is a good way to think of it. So say you have a rash and you go to your pharmacy and you pick up a, you know, cortisone cream. That's that's local therapy, right? So vaginal estrogen cream, there's pills, there's there's different ways to put it in the vagina. But that's considered local therapy. It's not absorbed systemically. We're just treating it kind of at the moment. Systemic therapy is when it's treating everything. Our brains, our bones are general urinary, so you know, from the inside out.

52:28And so you can adjust it. There's creams, there's patches, there's rings, there's pellets that are now available. There's multiple ways to get this medication into your body. And what's the most popular form of administering, administering a home and replacement therapy? So it depends on the country. So in the UK, it tends to be a gel or a cream, which is where most GPs, if you can get one that will follow the guidelines and prescribe it. I think it's the most easiest pharmacologic option to get in the UK. And the US, it tends to be the patch for the non -oral form. We also have pills available as well.

53:04There's a caveat with estrogen pills. There's something whenever we ingest anything food, medication, goes into our stomach, into the intestines, and then it gets picked out by the portal, a pathetic circulation, the liver. And so the portal vein goes straight to the liver for processing. And when that bump of estrogen or testosterone typically hits the liver, we see some problems with, and we're for testosterone, it's liver toxicity. And for estrogen, we see bumps in our clotting factor. And so you'll see a lot of women who are terrified of hormone therapy because of this potential risk of blood clots.

53:34They either have a genetic risk of blood clots or a gene, or they've had a clot in the past. But if they avoid oral estrogen and go with a non -oral form like the patch or the ring or even a pellet, then we bypass the liver and we don't have the increased risk of clotting. All through any other side effects, you know, in life, there's no such thing as that. Of course. And so it estrogen, so we have to look at each. So when we look at hormone replacement therapy, we have our estrogens, we have our androgens, which would be testosterone, DHEA and and and then we have our progesterone, which is the bioidentical form progesterone.

54:13There are synthetic progestines available, but I tend to just prescribe the progesterone. And so each of them issues that might happen. So with estrogen, you can see headaches. So that's kind of a red flag for us. We worry. We can see migraines getting worse. So those are patients you have to be really careful with going low dose. You can see unexplained. So 40 % of patients on menopausal hormone therapy will have vaginal bleeding. Doesn't mean it's a period. We have not woken your ovaries up. They're gone. We are just stimulating that tissue in the lining of the uterus and it's bleeding a little bit.

54:47It's usually self -limited. It can go away on its own. If it persists, past several months, we'll get ultrasounds to make sure we're not missing a polyp or something there. But it's one of the things I'll warn my patients about. So things I worry about, you know, headaches, some women, depending on the formulation. So for the patch, it has an adhesive, right, to get it to stick to your skin. And there's probably 10 % of women will have some kind of an allergic reaction to the adhesive. So then we have to look for alternative forms. So thankfully, there are multiple forms on the market. And for patients, we have to do some trial and error to find out not only which formulation is going to work best for her, but also what dosing is going to work best for her.

55:25So if I was a menopausal woman and I came to you and I said, I need help. You get, you must get thousands of messages like that. Thousands of messages a week probably. And, you know, I walked into your practice. Where would you start with me? So I start by letting you tell your story. I tell my story and it's a typical story that you hear. Right. Yeah. Weapons next symptoms. So I will, we'll get blood work. Sometimes I'm getting hormones to see if if I'm not clear where she is in her journey, I may get blood work to help me define if she's parry or postmenopausal, especially if she's had a hysterectomy.

55:59I'll get a lot of blood work around checking her thyroid. A lot of things look like menopause, right? So, you know, fatigue and night sweats, that might be hypothyroidism, weight gain, hypothyroidism, autoimmune disease, all this rheumatoid arthritis. I want to make sure I'm not missing something else that looks a light, light parry menopause. So I'm doing blood work around that nutrition deficiencies, vitamin D, her basic labs for her blood count and her electrolytes. I'm doing this full panel, okay? But then I'm beginning to treat immediately. And so we have a discussion around her sexual wellness.

56:32Is she struggling with desire? Then we'll have a discussion around testosterone. So I'm struggling. I've got my desire is gone. Okay, so it's very common. So when we talk about female sexual function, there's kind of five buckets why a woman would be suffering or not happy, okay? One is a relationship disorder and no amount of medication really helps with that. So we want to make sure she's in a good place with her relationship, supportive partner, all that. So we have a discussion about that. Then there's an arousal disorder where that's what most men are treated for when they talk about libido issues.

57:03It's really nothing's wrong here. They're struggling to maintain an erection. And so we use Viagra in those type of medications for that. So if a woman has an arousal disorder, vaginal Viagra can be helpful for that. So we talk about that. We talk about our gasmic disorders. Some women have about 10 % of women will never have an orgasm in their life. Imagine if that was 10 % of men. I think it would be a national emergency. I think there would be, you know, we would divert military funding in the US to get this fixed. And it's just something we don't talk about or offer my tell. And so then that leaves desire.

57:39So most women who are in secure relationships love their partner, miss that part of the intimacy that they used to have that desire to initiate that desire. Yes, it seems like a good idea. That goes away with menopause a lot. And so for those women testosterone might be helpful or there's a couple of FDA approved medications as well, Adi and Vileci. And so we have talked about costs and, you know, how to get it prescribed and, you know, testosterone. There's no FDA approved option for women. So quite often I will have to compound that medication for them at a local compounding pharmacy versus going to a Dwayne Reed or a CVS or Walgreens to pick it up using their insurance.

58:17So I know that you're coming from the UK, our health systems, you know, are a little bit different. But because my reach is so large now, I try to include, you know, all the different health systems when I'm talking about your options. Give me a case study of a patient that walked into your door and, you know, I had, okay, I had a patient who came in and, uh, her name is Michael. And she'd have won't mind me saying it because we're really good friends. And she came in and typical overweight, not sleeping, some brain fog issues, some major joints, aching, aches and pains, all the things. And, um, sweetest woman, absolutely a daughter, husband, you know, like, um, but was struggling with desire as well.

59:05So we started her, you know, I developed a nutrition plan for her. She hired a personal trainer. She got to the gym. She got serious about, you know, mutt lifting. Um, she started on hormone therapy and she is my biggest cheerleader, you know, on social because she's constantly, she's lost probably about 60 pounds of body fat because we get to measure her. So in my clinic, I have a, in body scanner where I can measure muscle my ass and visceral fat. So it's not just the number on the scale. I'm able to tell them. So she's probably going gain maybe 10 pounds of muscle, lost a tremendous amount of fat.

59:39She feels amazing. She has this beautiful, you know, she's back to her intimacy level that she desired so much before. She is absolutely thriving on all aspects and she's constantly sharing her studies, her story online so that other women can learn that they don't have to suffer as well. And she just can't believe the thing that makes her angry is that she didn't come sooner and that she suffered for so long without looking for help. And she couldn't find it. She came from San Antonio, which is about a three and a half hour drive to come and see me. So here's the scary thing for me or it's honorable.

1:00:14I have patients, so I have this menopause clinic I started two years ago. I have a waiting list that's longer than this wall. And women are flying in regularly to come and see me, which is such an honor and I'm so grateful that they trust me. But it's ridiculous that they can't find menopause care in their backyard, you know, that they have to get on a plane to come and see me because they cannot find care wherever they are. So I've started a list of providers on my website that my followers recommend where they found good menopause care. They write a testimonial and we just compile them and we just look online and make sure it's a real doctor and they have a phone number that works, you know, and then the North American menopause society now called NAMS, now called the menopause society they rebranded has a list of certified providers on their website as well.

1:01:02I got an email sent to me after listening to one of the episodes on this podcast from what appears to be a very helpless husband. It was a very, very, very long email and they'd said that one of the conversations we'd had on this podcast about menopause at one point had really helped them, but the key question that remained for that person was when does a supporting partner know how and really at what point to help because, you know, no male partner wants to turn around to their wife and go, I think you've got menopause and starts diagnosing them, but they also don't want to just sit back and be quiet.

1:01:39I think you, it's usually begins with something you can't quite but your finger on. She's reacting differently. She's not as resilient as she used to be. She's not managing situations the same way. And I think once we start taking the shame and the stigma out, him suggesting that perhaps this is menopause will not cause her to fly off the handle. I think, you know, normalizing this conversation, removing the stigma, it might make everyone go, oh, I mean, I didn't realize it in myself. You know, I thought it was grief -related and I was like, wait, when was my last period? When was oh, I think I'm in menopause.

1:02:31I mean, I was, and then I was like, oh, God, menopause, you know, even for myself, it was such a negative connotation. I had that sex in the city episode of my head when Samantha thought she was in menopause and how horrible it was for her and then turns out she wasn't and everything was better again. And I'm like, gosh, is this, you know, first of all, I applaud him for wanting to try to do something because so many, you think women don't understand what's going on. And so one bravo for wanting to be helpful to say it with love, say it gently, let's, and then find a provider or find a healthcare provider to go in and start the conversation.

1:03:13And I, one of my best visits with my patients are when their partners come and that the conversation is held together. And it really opens their minds, you know, to what's going on in her body and helps understand like what we can do therapeutically, what needs to be done at home. This is a special time for her. She's going to need extra help. We're going to get through this, you know, it doesn't have to destroy your sexual life or your relationship or whatever. It definitely can take a toll if left untreated. But, you know, bless him for doing it. Like we talked about a little bit earlier, you know, there's probably a fair amount of dissolutions of relationships because no one's talking about this process and what it could do to someone.

1:03:55This might be a really stupid question. But I'm no, I'm no, I'd ask a lot of stupid questions. Demen go through anything like this. So there's a lot of debate about manopause. The short answer is not really. We see men's testosterone level speak at about age 19, no shocker there. And then this very slow kind of down tick until they stabilize at about age 35 to 40 and then they stay stable for the rest of their lives. But there's a difference between in there's a big variation from man to man where the shape of the curve looks the same. But as far as normal men's range is from 236 to about a thousand.

1:04:42So there's a big, you know, man to man variation. And there is a lot of men who are supplementing when they come in on the low end and they're feeling a lot better. Now this is not my area of expertise. This is not, you know, I just read a lot of this research, you know, in testosterone and men are included in it. And so they are finding that they are having better cognition, feeling better, having more energy, etc. But there is no manopause. There are testicles don't stop working. I mean, it would be as if your testicles troubled up and died at 51. That's the equivalent. Gosh.

1:05:23I do have to say at the start of this conversation when you said if that was happening to men, the reaction would be different. I have to say I think I agree. I think that because it's one side of the population, I think it's kind of been overlooked over the last 10, 20, 30 years. But if it was men or both genders, I think it would be a different response. And so much of what women were going through in menopause were dismissed as psychological.

1:05:56And I've really had multiple times in their life, you know, it's all under head. We never said it's all in his head. That's not a thing on the words. You know, it's all under head was very much alive and well in my training and along a lot of my practice. I find myself now even having to pull myself back a little bit just because that was ingrained so much to always look for the psychological reason. I mean, women, a woman right now in 2023 is more likely to be prescribed in antidepressant for her menopause than hormone therapy. Multiple reasons for that. The way we were trained, the way we were taught to approach a woman's medical issues and also the fear, unfounded fear around the women's health initiative and what it did to, you know, physicians feeling confident about prescribing hormone therapy.

1:06:44Is there anything else that you do on a day -to -day basis in your life that we haven't talked about yet? Is there any sort of apps or tools? Yeah. So I really like head space. Another some good meditation apps. I really thought meditation was woo -woo and not anything that, you know, I would just sit there and my brain would be bouncing all over the place. But once I went through menopause and suffered so horribly from the mental side effects and the death, you know, all this happening at once to be with my brother's death, aging parents, teenage girls in the house, you know, and realized something's gotta give.

1:07:25And so I hired like a counselor, you know, I went to therapy and she recommended getting an app to help guide me through meditation and that has really turned the needle for me. Yeah. How? You know, carving out that it's just five or ten minutes in the morning to think of what I'm grateful for, focus on that gratitude, you know, and I love teaching that to patients and to my followers of really putting yourself first, you know, the thought of you have to put your own oxygen mask on first before you can go take care of your family and all the other things on your plate. And just giving my brain that time to just relax and let it flow and just let the thoughts, you know, and just focus on on me for that.

1:08:13That's really made a huge difference for me. What role to sleep playing on of this? So sleep disruption is massive, massive, massive in paramedicons and menopause. And when we don't sleep, we see everything. I tell patients, if you're not, that's the thing we need to work on first. We need to get you sleeping because nothing's going to work until your body is able to restore itself. That's when we, that's when we build muscle. That's when, you know, our brain resets. That's when our whole body, you know, and if you're having disrupted sleep and you're waking up at three in the morning and your brain is racing, I mean, everything is worse.

1:08:52Your cortisol level spike, your insulin resistance goes up. You're, you know, everything gets worse. And so when my patients come in, we focus on sleep first and nutrition pretty much. And if, if they're asleep, if their sleep disruption is due to hormones, then it's such an easy fix. I just give them the water they were drinking and they sleep again. Where the struggle is if someone's never been a good sleeper, then that's probably out of my area of expertise. I'm going to send them to a sleep medicine specialist. One of the things that we now see a correlation is a sleep apnea, even in a thin patient and menopause in women.

1:09:30We're seeing a big bump in the sleep apnea rates in women who are, they don't even have to have a weight problem. And what is sleep apnea? That's when, so sleep apnea is when you stop breathing. Are you snore quite a bit? You see the palate relaxes and you're not getting as much oxygen. You know, into the body and into the brain. It's a big health risk. And what is your personal sort of exercise regime? What do you do? So, you know, I came from the long, the 20 years of just trying to, I was exercising to be smaller. And now I'm moving to be stronger. And so now I'm doing resistance training. So I have a treadmill that I set up on an incline.

1:10:08And I do a lot of zoom calls there. I do lots of meetings there. So when I'm working from home and working on the Galveston Diet or the new book, I'm doing on my treadmill, but at an incline. So I'm really working on my legs. I will wear a weighted vest so that I'm getting the upper body. So I'm doing this for bone density. I'm doing a lot more lifting than I ever, ever, ever did in my life because I have a body scanner in my office. I have sarcopenia. I have a genetic low. I'm very thin. Individual is not blessed with a lot of muscle mass. And the fact that I focused on being thin for so long.

1:10:39And that was my social currency. As you know, I was, I was healthy. Probably I've lost that window of opportunity to gain more muscle easily in my 20s and 30s. So what I would tell my 35 year old self what I preached to my daughters is focused on being strong, not small. You know, muscles, strength of a skinny. And so the muscle mass that you develop now is going to serve you so much more than the lack of fat or this perceived lack of fat that you think you need. Don't worry about the curves that you have. That's natural. That's that's the way you're built. Let's get some muscle. And what about your diet?

1:11:17So what my personal eating window, what thing we talked about? Yeah, so I tend to, I break my fasted around noon -ish. Typically, if I'm hungry before, if I'm traveling or, you know, on a plane, I don't do all on a plane without food. And so what on a normal day when I'm like going to clinic and the night before is when my diet starts, I will pack up my meals and snacks that I'm going to take to the office with me when I see patients. And so I know what I've got. I'm doing, you know, I'm loading up on protein. I'm doing something green, some kind of a green veggie. I'm doing lots of fruit. I've got nuts and seeds.

1:11:52I eat nuts and seeds all day long for the anti -inflammatory benefits and for the healthy fats and for the fiber. And so I've got all that. So I'll break my fasted about noon. And then between patients, I'm constantly snacking. I'm really focusing on protein for myself. I don't have a way problem. And so I'm trying to get stronger. And so my protein needs have really increased. And so I'm sometimes doing a protein bar or a shake middle of the day to help with that. And then in the evening, now we're empty nesting. So it's just my husband and I. And so he, you know, we'll kind of discuss what do we have in the freezer?

1:12:28We'll pull out some salmon or, you know, we'll make some, I don't know, burgers or something. And, you know, we try to be protein centric. And then we're adding in like a beautiful salad, lots of avocado and chickpeas on the side. So, I think I covered it all. Yeah. So I'm typically done eating by 8 p .m. If it's an office day, I'll either exercise when I get back. I'm struggling to get up. I do a lot of great work in the morning. So I'll save my workout from when I get home from work. If you had a megaphone and you could speak to every woman right now, the 1 .2 billion that we talked about earlier that are in that peri menopausal, the menopausal phasal, postmenopausal.

1:13:13And you had to communicate one message to them. And I'm actually going to bring in everybody else as well, because although it's just those women I've mentioned, everyone around them in their life probably needs to hear somewhat similar message so they can play supporting roles in that individual struggle. What would you say down that menopause to those women and the loved ones? So my mantra is menopause is inevitable. Suffering is not. But you're going to have to advocate for yourself because society has failed us. Our medical system is built to fail the menopausal woman. And there is good help out there.

1:13:50You're going to have to do the leg work. I've got tons of resources on my website to help you. You know, lists of articles to print out and hand to your doctor system, you know, symptomatic sheets that you can like keep track journals that you can hand to your physician. Any way that I can help you advocate for yourself, because I can't be everyone's doctor, but that this is real. You're not crazy. This is happening. And there are lots of things that we can do, even non hormonal. Don't feel like if you're not a candidate for hormone therapy that you're stuck, you know, exercise, nutrition, other pharmacology, stress reduction, sleep.

1:14:25It's time to take care of yourself first so that you can have the best end of your life that you deserve. Q1 is often when businesses start implementing new systems and processes in hopes of creating efficiencies for the year ahead. And over the course of my career, I've learnt just how crucial having the right systems in places, one which has helped me across many of my investments is NetSuite. They're also a sponsor of this podcast. NetSuite is the number one cloud financial system through their streamlined platform. You'll find all of your accounting financial management inventory and HR in one place.

1:14:59Their technology has been a real game changer, especially for my team at Flight Studio. As over the last year, we've moved out of startup mode and into scale at mode. We no longer have to juggle multiple systems and having everything together has reduced the number of manual tasks and errors. Over 41 ,000 businesses have chosen to future proof their business with NetSuite. So if you'd like to learn how it can help your business, head to NetSuite .com slash Bartlett and free download the CFO's guide to AI and machine learning. That's NetSuite .com slash Bartlett. This episode is brought to you by Me Undies.

1:15:32While Me Undies can't totally help your love life this Valentine's Day, they can offer you insanely comfy undies and loungewear to buy or gift. Me Undies has so many awesome Valentine's Day prints and styles. Plus, you can match with your partner, friends or even your pets. This Valentine's Day give the gift that'll keep them thinking of you and score huge site white savings at meundies .com slash Spotify. That's meundies .com slash Spotify. Me Undies. Comfort from the outside in. You'll family have a history of health complications and illnesses, right? What is that history but also has that played into your overarching perspective about nutrition, the healthcare system, how it treats people.

1:16:14So my I'm one of eight children. I have six brothers and my oldest brother, Jeppe died when I was nine years old from acute lymphocytic leukemia. One of the most common forms of childhood leukemia. Now the curate is 95%. But at that time, he was put into remission and then he came out of remission in his late teens and died like a year and a half later. So my childhood was that that year and a half was all about trying to save him. And everything my family did of taking him to Memphis, which was so far from Louisiana where I grew up to St. Jude's Hospital, the last ditch effort to try to find another chemotherapy regimen, which he failed.

1:16:57And that kind of drove me. But you know, it was leukemia. It was childhood. It was one of those things. Fast forward to 20. He died in 2015. So 2010, my brother, I knew had HIV and had also contracted hepatitis. And he was doing great on his HIV meds. His counts were good. He was healthy functional. He'd been with the same partner for over 30 years. But then his liver was getting worse and worse and worse. He also struggled with alcoholism. And so that kind of combination was really hard to watch and love him through his choices. And he ultimately died in 2015. He had a stroke. And then I was able to go do his end of life care.

1:17:41And the first book I wrote, I talk about him in the book because in my rush to deliver his care, I forgot my own. And that's when I realized I was metaposal. It was through my grief process. I thought I was grieving. I were waking up all night. You're upset and your mental health and your brain fog is all because you're just grieving his death. And then my next brother, Jude, was diagnosed with stage 4, a suffigial cancer. Shortly, he was diagnosed when Bob died. And then he survived a few years. So Bob died at 56. And Jude died at 57. And I'm 55. And I don't, you know, I know a lot of it was lifestyle, but I still have those genetics.

1:18:32And I'm about to survive three of my six brothers. And out live. And I know that these choices that I make with my nutrition, my exercise, my sleep, my stress reduction, what I call the metaposal toolkit, you know, and my choice for HRT are all, I want to see my grandkids one day. If I'm looking, if to have any, I want to watch these women over -aids grow up and, you know, be the women they're meant to be. And that choice might get taken away from me if I'm not careful. So, you know, a lot of what I do and why I do it is because I have to. I may not get the choice.

1:19:12What incredibly important mission you're on and what incredible work you're doing, because there are, as we've talked about, there's been a group of people in society that haven't, have kind of been, I guess, dissolutioned, but they've also must have felt incredibly isolated in their experience and what they were going through. And it seems that there's been a real shift in recent times towards the conversation around menopause. And hopefully these conversations, if anything at all, will dismantle the stigma, which is often the first sort of all that needs to fall for people to be able to take action and have those conversations.

1:19:44And it's just speaking from my own experience, I didn't really understand what any of this stuff meant until I started doing this podcast. And I had the first couple of guests on and then someone said the word menopause to me and then we started having a conversation about it and I go, oh my gosh, like, you know, maybe when I was in school, someone should have told me about this phase of life. We talk about how to get a job, but it seems to fall off, you know, the education system seems to stop caring once we've had kids almost. That's what we're experiencing here as well. It's really, really crazy.

1:20:15And the work you're doing is so unbelievably necessary. And what I love about the way that you write and how you educate people is it's so science -based, but it's so accessible at the same time. That's always been my superpower, I think, is, and I realized that very quickly in my career was that I had this knack of being able to take something really complicated and break it down into terms that people could understand that, you know, most people would be able to grasp and walk away from. And you have nuance and empathy, which is the necessary ingredients when you're talking about subject matter like this, where everyone's symptoms are typically quite different from one another.

1:20:51And they all have different circumstances. We talked about other, you know, conditions and country indications that might be complicating things. And you seem to have a really wonderful empathetic view on all of those things and I've been appreciation that everyone's circumstances are entirely different. I'm excited and I'm really looking forward to having more conversations like this and learning more because although I am a 30 -year -old man, I have a partner that I love, I have a mother that I love, I have an older sister that I love, my sister is my partner's 30 as well, my sister's 36, my mom is 60, you know, nearly 60 now.

1:21:29I challenge you to have this conversation with her and ask her about her experience. I really applaud or the, and I don't know why they should say that got this far in this conversation and chose to listen and have an appreciation that the betterment of 50 % of our population who are going to go through something is the betterment of all of us. Exactly. And that they also have a role that they can play in being a support and encouraging and having the conversations that will bring down the stigma and the suffering of what is currently about 1 .2 billion people but will be 50 % of people in our population.

1:22:06So I highly recommend everybody goes and checks out both this book which is the Galveston Diet but also can we preorder the upcombo now? Yes, it's available for preorder wherever you buy books. And you'll think it'll be out in 2024 in... For sure, the latest May. The latest May I go and that's called the New Menopause so you can preorder that now wherever, wherever you get your books and that's the culmination of many decades of very, very hard work, very, very excited to read through that myself. And the Galveston Diet book is out now as well. It's been out for a little while. We have a closing tradition on this podcast where the last guest and also your websites are an incredible resource for all of the things you talk about right and your social channels etc.

1:22:48We have a closing tradition on this podcast where the last guest leaves a question for the next guest not knowing who they're leaving it for. And the question here is you get one last conversation with somebody you love, a child, maybe your husband, maybe someone else. What do you say to them in that conversation that maybe they haven't already heard? I love you.

1:23:21There's nothing more than love.

1:23:25I've done it three times from my dad too. My um, Bob and Jude were five years apart. My dad was shortly after Jude. You know, watching my parents bury three kids was a lot.

1:23:46Just love.

1:23:51Thank you. Welcome. Thank you so much. Do you need a podcast to listen to next? We've discovered that people who liked this episode also tend to absolutely love another recent episode we've done. So I've linked that episode in the description below. I know you'll enjoy it.

1:24:18Q1 is often when businesses start implementing new systems and processes in hopes of creating efficiencies for the year ahead. And over the course of my career, I've learnt just how crucial having the right systems in places, one which has helped me across many of my investments is NetSuite. They're also a sponsor of this podcast. NetSuite is the number one cloud financial system through their streamlined platform. You'll find all of your accounting financial management inventory and HR in one place. Their technology has been a real game changer, especially for my team at Flight Studio. As over the last year, we've moved out of startup mode and into scale at We no longer have to juggle multiple systems and having everything together has reduced the number of manual tasks and errors.

1:25:00Over 41 ,000 businesses have chosen to future proof their business with NetSuite. So if you'd like to learn how it can help your business, head to netsuite .com slash Bartlett and free download the CFO's guide to AI and machine learning. That's netsuite .com slash Bartlett.