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Intro

in 2023 85% of women are complaining of menopausal symptoms 10.5% are receiving treatment or therapy I mean it would be

as if your testicles shoveled up in diet at 51 that's the equivalent let's get started Dr Mary CLA Haver renowned

menopause expert with more than 2 million followers helping countless women through their menopause

experiences menopause is inevitable suffering is not but a woman is more likely to be prescribed an

anti-depressant for her menopause than hormone therapy women by the thousands are like oh my God I had no idea that's

when I realized no one's talking about this so here's their laundry list of symptoms we've categorized about 70 so

there's brain fog changes in her sexual function weight gain but here's the scary things and the studies have been

done we see either a new onset or worsening of depression anxiety bipolar

ADHD risk for cardiovascular disease and diabetes increases recurrent urinary tract infections which is a major cause

of death for women they're suffering in silence and I was one of those women I want to see my grandkids one day I want

to watch these women I've raised grow up and you know be the women they're meant to be and that choice might get taken

away from me if I'm not careful but there's lots of things that

we can do for example we see a dramatic loss of muscle mass focus on strength training this is going to determine your

longevity as you age strength over skinny what about your diet I developed a program for my patients and it's not

rocket science it's whether you're a man or a woman menopause is going to affect you because

it's going to affect 50% of our society and there is

1.2 billion women being affected by menopause right now and whether you're a man or a woman most of us don't have the

answers how do we help how do we talk about it what is it how does it affect

the human body if you're in a relationship with a woman that's in per menopause which can start at 30 up to a

woman that is currently going through menopause in her 40s or 50s or 60s what

should you do to support her what can she do to support herself this subject

of menopause has exploded in public conversation thankfully but there's

still so many unanswered questions and that's why today I invited one of the

leading voices on menopause globally onto my show even as a man that won't go

through menopause myself but has a partner and a mom that certainly will

there's something that everyone can learn from this and I implore all men who maybe clicked on this episode or

were sent this link to listen please just listen because you can learn

something too and for everybody new to this channel can you do me a favor if you like what we do here you like the

guests we have on and you like the show that we bring to you can you hit the Subscribe button it is the single thing and the only thing I'll ever ask you you

Your mission

I would love you to join us on this journey and if you do I will repay you and that is a promise do we have a deal

thank [Music]

you Dr Mary CLA Haver why' you do what you

do you know I started out in medicine the way most people do I wanted

to help people and in our training in school we get to have a little taste of

all the different Specialties and my very last rotation in my third year was

OBGYN and I really liked surgery I really liked some of the surgical sub

Specialties so I thought that would be my path but then when I delivered my first baby and all that Rush of emotion

and dopamine and how beautiful that whole process was I knew that that was going to be my calling and so I did the

traditional four-year residency and loved it and really did well and went

into private practice um after about three years of doing the Private

Practice route I realized I missed being an academics I wanted that ability to do

research and be around students and teach as well as take care of patients so I went back on his faculty and

everything was going great I was very successful I was you know doing psmears and babies and birth control and all the

things the traditional OB gen does and then I was aging as my patients were

aging too and when I got to my 40s I

realized that there was a big gap in my education and knowledge around menopause

so I started researching most of my patients were coming in the pain point was weight gain and they were like I'm

not doing anything different I'm working out I haven't changed my diet and that

little voice in my head was like work out more less you know we tend to move less we tend I was just going

with the script that had been handed to me for years that calories in calories out is the only way and you know in

medicine in the US we have very little background in nutrition we learn nothing in medical school very little in

residency as far as what nutrition actually is and how it can affect our

bodies and so I started struggling with my own menopause my patients were all

struggling and I decided to go back to school to learn more about nutrition because I felt that there was a big piece missing here because this weight

gain was mostly centered around the midsection and I was learning about viseral fat and subcutaneous fat and the

differences and what's going on with our muscle mass and I'm like there's a much bigger picture here than just calories

in calories out so in my I enrolled at tulan University in their culinary

medicine program and just my mind was blown by how much I didn't know as far

as nutrition and inflammation and aging and and how it all affects but where was this menopause piece and so I took

everything I learned and I developed a little program for my patients um which became the Galviston diet and it really

was just a passion project for me and then I started talking about it on social media and realized that as my

social media presence grew and the conversation got bigger and bigger that there were so many women suffering

probably the majority of women in menopause were suffering not just from weight G pain but from muscular skeletal

issues mental health brain fog you know skin Changes hair changes nail changes

and I just kept doing deeper and deeper Dives and realizing no one's talking about this no one's talking about the

multi-organ system you know failure that a lot of women are going through and

they're suffering in silence and Physicians aren't helping we're not trained and so I thought and my it's

really my kids who I have two daughters one's 23 she's in medical school right now and she's um she's actually here

with us and then um the other is 20 and they were like Mom you've you've got the

The Crazy Effects Of Menopause On Women's Bodies & Their Mental Health

social media presence you really need to use it for good and that's kind of where

that conversation exploded for me on social media and where I realized by reading the comments what a much bigger P you know

what was really happening in the menopause world and how we need to bring it to the Forefront for people that

don't understand menopause um they might think it's that it's a small issue affecting a small group of

people but how many women are are affected currently by per menopause menopause and postmenopause sure so

right now about a third of the female population of the world is in Perry full

or postmenopause um you do not it's not optional all of us go through it and

because we have such individual expressions of how it affects our bodies what we know now is that there are

estrogen receptors in every organ system of our body and when those levels start declining we see

a very wide variety of a spectrum of of syndrome where it used to just be thought it was a few hot flashes and

some night sweats maybe your sleep's disrupted your genital urinary system is

going to take a hit um your bones are going to get weaker but what we know now is how much it's affecting our mental

health our capabilities our skin our bones our kidneys you know vertigo ttis

frozen shoulder anytime I post about those on social media the internet explodes and women by the thousands are

like oh my God I had no idea you know and just the validation piece was so huge for them to make because they've

been dismissed for so long and told it's all in their head and if we think about from sort of Perry to postmenopause what

is that sort of typical and I know that's a tricky word to use but what is the a sort of average typical age range

and then also what is the sort of more um possible age range so it could start

between this age and this age so in the US and in most of Europe the average age of menopause which means one year after

your last menstrual period is 51 par menopause which is when your body

recognizing recognizes there's some declining estrogen levels and you're beginning to be symptomatic can start 7

What Is Menopause & It's Symptoms?

to 10 years before that so normal menopause is still 45 to 55 MH and so if

you do the math and back that up 7 to 10 years it is completely reasonable for a 35-year-old woman to be begin to

experience some of the symptoms of per menopause so let's start with what is it

um and I would love you to explain this to me like I'm a 10-year-old okay because I'm sure there's a lot of people that are both men and women that aren't

fle so we're going to talk about gonads right what's goads gonads are um where

our so in men it's the testes okay and where you're making your genetic material to you know where you're making

sperm right and in a female it's going to be ovaries M her ovaries so the

difference big differences between male and female and how that process happens is that males make their genetic

material fresh constantly the minute they go through puberty until basically they die unless they have some medical

issue females on the other hand our eggs develop while we're in utero and our

mothers so while we're in the womb we're she's five months pregnant with us we have our maximum eggs that we're ever

going to have and those are meant to last us until we go through menopause and so they lay dormant until we go

through puberty and then they wake up again and we start ovulating so we have this monthly and a healthy person

cyclical you know hormones rise and EB and flow with our cycles each month we have a period you get pregnant you don't

get pregnant the whole process starts over again well because we're born with that egg supply through time we're

decreasing the amount and the quality of those eggs so when a woman hits the age

of 30 um she she is down to about 10% of the egg supply that she had at Birth and

when she's 40 it's down to about 3% and so and it gets harder and harder

for that EB and flow of the natural hormones to do its job and we start seeing fluctuations in her periods and

then organ systems that are beginning to notice the lack of estrogen estrogen is a really powerful anti-inflammatory

hormone and most of our body system so the muscular Skeletor syndrome of menopause is really starting to be

talked about quite a bit now and we're looking at things like frozen shoulder aralas generalized aches and pains and

most Physicians aren't aware of this you know most know about hot flashes and night sweats and sleep disruption but

now that we're really opening the conversation as to how many organ systems are affected we are seeing

people coming out of the woodwork just so happy to know that they're not crazy and they're being validated and what's

happening at these sort of three stages so so we have the per menopausal stage which is from what I've understood there

when estrogen levels start to drop right so we start seeing disruptions in the

force so instead of that nice monthly estrogen surge with ovulation and then the progesterone goes up we start the

elongation sometimes or they even get closer together I call it the zone of chaos what used to be a very

reproducible dependable system starts failing so some women will have irregular periods meaning they're

spacing out they skipping periods other will have really heavy periods like like

you know hemorrhagic almost um and again individual um the way the body reacts to

this is very individualized from Patient to Patient doctors love something that follows a list a

checklist right you know we have all these complicated things we have to learn and we have these checklists but

menopause it's like pinning the tail on a moving donkey and in per menopause the it's very very chaotic estrogen surges

then it goes away for a while like a woman and per menopause can feel completely fine for a few months everything goes Haywire then she's fine

again you know and not only is her estrogen declining her testosterone is declining as well so we're seeing loss

of muscle mass we're seeing changes in her sexual function we're seeing decreased strength you know there's some

some really good studies showing how testosterone also affects our mental health and our cognition as well why

does this happen from a sort of like an evolutionary or so the anthropologist

have looked at this heavily and there's we're there's only a couple of species in the world that go through menopause

humans are one there's a species couple of species of whales and I think they've now discovered one of the giraffes

species of giraffes can do it but the by and large most mammals will die while

they're still ovulating you know like they're not going to go through a menopause um and so there's something

called the grandmother hypothesis where there was an evolutionary Advantage for women to survive if she stopped the

ability to have children at some point now again you have to temper this with

humans have prolonged their lifespan and their health span because of modern medicine so probably when we evolved we

weren't living this long you know a woman my age was pretty rare I'm 55 and

so you know it it's hard to say I think we have outlived how we were genetically

built and so we're living longer and being forced to like deal with the consequences of that so so then the next

stage is menopause MH and so menopause itself is really that it's just really

one day in your life it's when you can throw the hammer down and say I'm never going to ovulate again I'm done and so

if a woman's over the age of 45 and she hasn't had a period for a year that's the definition okay now it gets

confusing because what if she's had a hysterectomy or doesn't bleed because of a surgery or an IUD or something well

then we can't use her periods to help judge and that's where we start doing blood work to see you know where she is

Women With Menopause Are Being Let Down By Our Medical System & Society

in her menopause journey and then postmenopause is the rest of your life you know the hot flashes might go away

night sweats might go away brain fog might get better but pretty much everything else is going to continue to

progress in a very linear fashion until you die without estrogen replacement to

put it lightly you seem somewhat dissatisfied with the current set of answers that um the medical field but

just Society at Large are offering for women in the sort of per and post and

menopausal phase of their life and I've sat here with a lot of women who are experiencing menopause at one stage or

the other and they also seem to be at a loss for answers um I was sat here two days ago

with um a very very successful woman who you know has all the resources in the world and she basically and and this is

someone that has all the answers people come to her because she has has the answers and the one thing she doesn't seem to have answers on in her own words

in her life at the moment is menopause she's rummaging around the internet Googling things finding contradictory

information and when you sat down you you you had that same energy like you feel like women have been dare I say let

down by a system I think the medical system is letting them down I think Society is letting them down our our

value and our worth in medicine you know I came through this wonderful training program

I'm very proud of what I learned I'm very proud of the care that I gave except I was a horrible menopause

provider for probably 15 years I knew what I knew I relied on my training and

I didn't look outside of the traditional confines of training this is such a systemic problem

that I mean I'm going to tell you a story and this is this is true and it's embarrassing but I think it needs to be

said because I think it really highlights how women are treated in

medicine um when I was in training we had these upper level residents so we

have a hierarchy where you have different years of training so I was in the early years maybe my first year and we had these clinics that we would run

um to take care of patients and so we have Obstetrics and we have Gynecology as like divisions in our training so in

Gynecology everything gets lumped together Pediatrics menopause we had no specific menopause Clinic I maybe got

six hours of lecture in a four-year curriculum and so have these women coming in in midlife and they had

multiple complaints they didn't feel good they weren't sleeping they were gaining some weight they were you know

aching they you know just this laundry list of things that were a little on the vague side

and my upper levels would say oh gosh good luck with that you've got a ww on

your hands and that was code we never wrote that in the chart this was not taught to me by faculty this was just

kind of a handed down in the lure of training and a ww was a whiny

woman and that was code and now I know that she was Perry menopausal suffering

from her list of symptoms of now which we've categorized about 70

and they're they they were frustrated because they they didn't think they could help her now remember the Women's

Health Initiative which was a study that was supposed to do a lot of good for women it was originally designed um and

it was stopped in 2002 that was the end of my training program was 2002 so I'm I

come from one of the last groups of physicians in the US that were ever trained in hormone replacement therapy

and then it the rug was pulled out from under us so the Whi there were mistakes

there was misinformation in the reporting and there was a misinterpretation of the results all of

that has been walked back relooked at we know that for the vast majority of women hormone replacement therapy is safe and

effective and can give a woman her life back um if she chooses to take it but that option has been taken off the table

Are You Skeptical About The Medical System?

for the vast majority of women recently I just saw the numbers 85% of women will

come in with complaining of what we know now this was in 2023 FDA looked at the

numbers 85% of women are complaining of menopausal symptoms 10.5% are receiving

treatment or therapy today is there something in you that feels somewhat even though you're doctor

somewhat let down by the medical system um or skeptical about the medical system

for personal reasons I yeah I I'm one of those women you know I thought I'd be

one of those girlies who would just Breeze through menopause because I was thin and I was you know thin meant

healthy I still you know that mentality was alive and well when I trained and through most of my practice I I I came

through a very fat phobic you know uh training and medicine as a as a whole is

very um biased against weight people's weight and

so now that I've done a deep dive into nutrition and done a deep dive into menopause and really sat there and

listened to patients and realized that you know women who were gaining weight

with menopause you they've done nothing different they're still exercising they're eating the same the only thing that's changed for them is their

hormones and they're being categorically dismissed at multiple doctor's visits or Worse here's their laundry list of

symptoms the root cause is menopause but it's not recognized and one medication could have

The Health Consequences Of Menopause

taken care of everything but they're going to seven eight nine different Specialists on seven eight nine different medications to handle each

symptom whereas all they needed was just to get her hormones back and she would

feel amazing and be able to you know age the way she should when we talk about

the potential um Health implications of women that are going through menopause

it's not just ww right it's much more um

that's how she feels though and that's how she's categorized probably by people around her but the There's real Health

consequences and life altering Health consequences lifespan reducing Health consequences yes what are those so we

know that a woman's r and and the studies have been done it's not just aging of course aging plays into this

but when you add in menopause as an independent risk factor her risk for cardiovascular disease

increases her risk of diabetes increases her insulin resistance starts going

haywire immediately your your listeners and your you know people who watch on

YouTube will be shocked I'm going to say how many of their cholesterol levels shot up in their 30s and 40s with no

changes in diet and exercise you know we see cholesterol levels changing skin

hair teeth the dental changes the inner ear changes the vertigo is incredible

the frozen shoulder is Legion um whato frozen shoulder frozen shoulder is an

adhesive capsulitis of the shoulder joint and it is very common in menopause

so estrogen has this amazing anti-inflammatory effect especially in our bones and joints and muscles and

frozen shoulder is super common and it takes about 2 years of therapy to get it to break up so the capsule that is right

over the bone where the muscles attach becomes encapsulated and adhesed and stuck and so you have to get in there

and break it up and do lots of training so like a woman wouldn't be able to reach behind her back to do her bra she

that's one of the things or you go to take a picture with your girlfriends and you can't put your arm or you can't lift

your arm above here that's one of the one of the studies that I you know presented a lot

of the stuff I do on social I'll present the studies because I like to I like to have data and you know I'll get 10,000

comments on oh my God that happened to me that happened to me that happened to me not that I can fix it but at least

they know this is something that it's not your fault you didn't do anything your just estrogen levels dropped which

led to increasing inflammation in those joints and is have they seen that there's a a reduction in lifespan in

women that go through menopause that aren't treated in a certain way so we know that um women on HRT have a lower

all cause mortality what's HRT hormone replacement therapy or menopause hormone

therapy so in the studies that have been done the observational studies and in the Whi women who were on

hormones um especially beginning early in their menopause okay so

estrogen there is a win of opportunity for reduction of some of this burden of disease and it is very in starting in

per menopause or within the first 10 years of your menopause that's the sweet spot for being able to decrease your

risk of diabetes decrease your risk of cardiovascular disease and dementia when

we go beyond that we start losing those benefits because estrogen is better at prevention than cure and so my my

medical school daughter was like Mom I'm never going to be without estrogen I'm going to start in Perry menopause like

I'm not going to be one of those women who's ever off estrogen of course she's my daughter and listens to me on social

media all day so she's a little biased but she says why why can't we get to that point where we have no gaps in our

estrogen Supply we just support all starting in Perry menopause you know offer it to all women not all women will

choose it and I support that but you know we're not having the conversation and they're not being given the choice

so what age with your daughter would you advise her to start uh hormone

replacement therapy if she so chooses so I would say um we start checking levels

and we start looking probably in late 30s certainly if she starts having any symptoms out of the normal you know

she's living her best life you know doing all the right things for her health and all of a sudden she's not

sleeping well or she's having aches and pains or she's noticing you know changes in her body most women can tell you

something was wrong I couldn't put my finger on it but I knew that something in something in me had changed and I

wasn't responding to things the same way you know their mental health had changed or you know the way their gut had

changed their gut health you know just just there's barely an organ system that's not affected by this I sometimes

wonder because you know there's the person going through it and then there's those around them and they might know

themselves that something's wrong the person that's going through per menopause or menopause but the people around them won't understand typically

what's going on with that person so they'll they might do their old ww thing that's you know or they might label them

something else they might misdiagnose it as another man Health predicament I remember a woman in my life who went

whose Behavior changed around this age and I didn't know about per menopause or menopur 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 it

it's probably contributing to divorce rates maybe in a good way you know at this time I I one of the positive things

I see about menopause is that when women are cutting the things in their life

that don't make sense anymore they're not putting up with you know as a society we tend to take on everyone's

burden and um you know take on the emotional labor in 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 whichever relationship they're in you you need to

pick up your your end of the bargain here you know I can't do all of the organizational labor the emotional labor

How Can We Give Women The Support They Need?

and I've I have a patient who's a divorce attorney and she said I really think a significant percentage is of

this divorce is menopause and 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 in whatever way they need it hormones non-

hormones cognitive behavioral therapy you know there's lots of things that we can do not 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 go through that whole to toolkit um but I also want to just before we move there understand why women don't

sometimes communicate that they're going through per menopause or menopause what is the is there a stigma Associated we

talking about it yeah I think there's shame and stigma associated with aging with Fe females aging and then you're

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 and 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 F you know are we not as important as we were when we were fertile does do our lives not

matter it's ridiculous to me when we can intervene and help and have give these

women a longer life and a better quality of life and how many women is that I know we said it as a fraction earlier on

or a percentage but that's like I think in your book I read it's 1.2 billion women by the end of this year yeah and

there's what 47 million new entrance into the sort of per menopausal

postmenopausal category every year 1.2 billion billion right and H and so many

of them have no education at their fingertips have nowhere to turn are you

know 85% are going in to their Healthcare provider's 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 Women's Health Initiative they're

convinced they're going to get cancer and that that study's been completely dismantled and walked back we have good

information that came out of that study but you know the the pro 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 the hormone replacement therapy and all that stuff but the mental health um implications for women do we see an

increase in depression and those and the consequences of depression I guess depression anxiety bipolar um 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 don'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 an very powerful adjunctive tool and that it can be preventative for new onset depression if

you start in Perry menopause women who start hormone therapy and per menopause have a lower incidence of new on set

What Is Inflammation?

depression in their menopause suicide it so I've looked at these numbers and

it CO's kind of skewing things because we did see increased suicide rates but we definitely see an uptick uh

especially in Caucasian women not so much in women of color uh in the US in the per menopause and menopause time

frame inflammation what is what is inflammation sure so inflammation um

there's there's it's 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 uh chemical Messengers are spread from the injured tissue which basically tells our immune system sin

blood that way send the the you know white cells and the red cells and you know 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 so acute

inflammation also happens when we get viruses and other illnesses chronic inflammation is this lowgrade 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 um and the droing estrogen

causes inflammation so it turns out estrogen is a really powerful anti-inflammatory hormone so we're just

like removing that protective blanket and now you're you're just aging faster

because of it ah 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 galison 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 or

choose in a supermarket sure so I try to teach the principles in the form of let's add things in rather than restrict

because then we get into eating disorders and so what 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 so 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 it's it's a vitamin but it's also a hor hormone and it has

multiple functions in the body and so vitamin D deficiencies are linked to lots of chronic diseases you're more

The Importance Of Fiber In Our Diets

likely to have hypertension diabetes stroke you know all of the top seven of 10 causes of death in women and so

keeping those low 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 so many of my nutrition based or medical

or doctors that I've spoken to on this show have spoken about five 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 uh 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 that's the insoluble fiber that's what pulls water into the

gut and kind of moves things quicker through the colon soluble 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 how to keep it healthy and what organ system it affects um our our

gut microbes make these things called oxy butat which are then absorbed into the bloodstream and and people who have

high levels of oxybate are actually healthier and have less coronary artery disease less dementia less less

everything so 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 your

nutritional basis the way you should and what are some sort of fiber dense or fiber rich foods that are in you know

every Supermarket avocado chia seeds nuts berries your cruciferous vegetables

things that are crunchy that's fiber that's making the crunch apples you know um there's so many don't find much fiber

Fasting

in uh lean meats uh or any so it's going to be your fruits and veggies and seeds

and nuts asparagus tomato spinach celery uh asparagus celery yes tomato nuts so

much just think of things that you know the crunch is usually from the fiber okay fasting MH I'm a fan it's not

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 in your eating window if you're not careful and so um the there's good

data though on neuroinflammation and fasting and on systemic inflammation and fasting so 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 168 so that's

where Mark matson's data so that's 16 hours of fasting in a row followed by about an 8 Hour eating window now for

other you know again it's individualized some people do with a 14-hour fast you

know a 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 6:00 in the morning before I exercised so I pushed that

window to 615 and I did that for you know 3 or 4 days until it felt normal now natural I wasn't hungry then I moved

it to 6:30 and then I just kept bumping that window out in 15minute 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 um and it's just a normal natural part of my life I 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 it's 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 um 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 I was thinking about this too like an evolutionary lens why fasting

makes sense and why this sort of narrative that we're meant to have breakfast lunch and dinner you know

maybe breakfast I don't 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 I

was wondering if I always try and think through like an evolutionary framework and I was thinking about how in our

hunter gatherer past we would have meals were not available 24/7 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

brain's working better it almost seems like there's more I don't know oxygen or nutrients in the brain the brain tends

to work better using the keton Tes for fuel than uh glucose though though glucose is the preferred fuel in the

body you know and um but but when they did studies they were animal studies so

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 were a little lazier ketones

you can also use ketones as an energy source if you use the keto diet you can you can um but I think you know when

Matson and 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

Fuel Refocus

we sleep and so we burn through the glucose in our bloodstream then we burn up what's in our liver in the you know

glucan Genesis and then it switches to Fat to burn for fuel and so um now

there's people who like to take exogenous ketones I've I've never experimented with that I don't you know

that's I don't have any literature menopause to support that use and the third component of the galston diet is

this idea of fuel refocus right so that's looking at you know

food we're looking at the macro and micronutrients 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

so I'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 certain sort of ratio of

foods that we should be having in terms of that's I originally developed Galviston diet for weight loss you know

um but if I had to write it over again so I went really heavy on fats you know healthy fats lower on carbohydrates and

20% protein um 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 what 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 um and and there's some nice

The Importance Of Building Muscle Mass

studies done in in the we call it the elderly 65y olds and and above which I'm

nine years from that right now and so and how creatine supplementation just creatine supplementation on its own well

combined with weightlifting we're seeing bigger gains in the mopal patient post menop pulle patient yeah bigger gains in

muscle mass and strength yeah I was going to ask you about this whole muscle mass um Point why is muscle mass so sort of perent to this conversation so what

we're well what we know in menopause is that you know aging combined with a 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 um and the other thing is what most people

don't understand is the muscular skeletal unit acts as one so 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 osteop paic 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 up bone we lay down new 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 and then when we get to menopause it

dramatically we see it just massive 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

Does Hormone Therapy Cause Cancer?

getting adequate exercise doing the resistance training eating the protein adding in the creatine making sure

you're getting enough enough vitamin D is going to be huge at protecting our my population from this happening as we age

we can prevent the majority of this I want to talk specifically then about this hormone replacement therapy you mentioned there there's you also

referenced a study previously which sort of scared people yes the Women's Health Initiative

yeah and that study suggests Ed that there was an increase in breast cancer if someone did hormone replacement

therapy so let's break it down um 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 we knew from observational studies that yes they had a much lower

risk of death from cardiovascular disease and and all cause mortality as meaning death from many cause as well as

um heart disease in itself okay aosc orotic 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 in droves to sign up for it but

because the endgame was to prove whether or not it was protective for cardiovascular disease disease the

average age of the patient was 63 years old so 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 Dev

develop two groups we have women with uteruses and women without women who had had hysterectomies or were born without uteruses and so each of them had a

placebo arm and then a medication arm when you don't have a uterus you don't absolutely have to have progesterone

when you have a uterus it's required to give a woman progesterone as well or progestin as well to protect the lining

of the uterus from the estrogen unopposed estrogen can cause IND demetrial cancer but we can negate that

by giving her progesterone you following me so we have an estrogen only arm and

an estrogen and progesterone arm and they each have a placebo so off we go let's take our meds let's take our Placebo and let's start measuring what

they saw in the estrogen plus progesterone arm after 2 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 relative risk went from 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 Norm develop breast cancer where over

Placebo that is a 25% relative risk increase m and that is the 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 and announced

that estrogen causes breast cancer now remember these women were on estrogen plus the progestin which is called

pra 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 they had a I think it was a 20% decrease

risk of breast cancer relative of yeah relative risk yeah and 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 our highest levels of estrogen are in pregnancy and it's so rare to ever be

diagnosed with breast cancer and a healthy breast cell 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 the whole mindset has not changed myself as an

Oben was still the lowest dose for the shortest amount of time and only in women where absolutely nothing else is

helping her hot flashes menopause was defined by the vasil motor SYM 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 we lose elasticity we

see recurrent urinary tract infection 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 is taken off the table

for so many women who are suffering needlessly with horrible painful intercourse dryness you know recurrent

UTI and it's just such a simple thing to help a woman and fix and they're not being offered that treatment is vaginal

estrogen the only form of administering estrogen so we have no so when we look

at hormone replacement therapy we have um 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 our general urinary you know from the inside out and so you can ingest 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 uh hormone 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 in the US it tends to be the patch for the nonoral form we also

have pills available as well there'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 up by the portal hepatic

circulation the liver and so the 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

for testosterone it's liver toxicity and for estrogen we see bumps in our clotting factor and so you'll see a lot

The Side Effects Of Hormone Therapy

of women who are terrified of hormone therapy because of this potential risk of blood clots they either have a genetic risk of blood clots or a gene or

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 or even a pellet then we bypass the liver and we don't have the increased risk of clotting are there any other

side effects you know in life there's no such thing as a of free lunch and so um

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 um DHEA and andrine diione

and then we have our progesterone which is uh the bioidentical form progesterone there are synthetic progestin available

but I tend to just prescribe the progesterone and so each of them has issues that might happen so with

estrogen you can see headaches so that's kind of a red flag for us we worry you

can see migraines getting worse so those are patients you have to be really careful with going low dose um 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 um in the lining of the uterus and it's bleeding a little bit it's usually self-limited it can go away

on its own if it persists past several months we'll get Ultra ounds to make sure we're not missing a pup or something there but um it's it's one of

the things I 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 a 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

How To Help Women With Menopause

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's going to work best for her but also what dosing is going to work best for her so if I was a

menopausal woman and I came to you and I said I need help you get I mean you must get thousands of messages like that

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 what happens next symptoms so I will will 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 Perry or postmenopausal especially if she's had a hysterectomy um I'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 like Perry menopause so I'm doing blood work around that

The Link Between Sex & Menopause

nutrition deficiencies vitamin D um basic labs for her blood count and her electrolytes I'm 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 is

she struggling with desire then we'll have a discussion around testosterone um

so I'm struggling I've got my desires 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 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 it's really nothing's wrong here they're struggling to

maintain an erection and so we use Viagra and those type of medications for that for so if a woman has an arousal

disorder vaginal Viagra can be helpful for that so we we talk about that we talk about orgasmic disorders some women

have NE 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 much help and so then that leaves desire so 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 this seems like a good idea that goes away with menopause a lot and so so for those

women testosterone might be helpful or there's a couple of FDA approved medications as well Addie and VII and so

we have talks 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 cound that medication for them at a local compounding pharmacy versus

A Story About One Of Your Patients

going to uh Dwayne Reed or a CVS or Walgreens to pick it up using their

insurance so I know that that you're coming from the ukuk 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

gosh you know I had okay I had a patient who came in and uh her name is Michael

and she 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 a Jo joints aching aches and pains all the things

and um sweetest woman absolutely adored her husband you know like um but was

struggling with desire as well so 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 M 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 inbody scanner where

I can measure muscle mass and visceral fat so it's not just the number on the scale I'm able to tell them so she's

probably G gained maybe 10 pounds of muscle lost a tremendous amount of fat

she 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 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 I have patient so I have this menopause Clinic I started two years ago and 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 a a list of providers

Advice For Men

on my website that my followers recommend them where they found good menopause care they write a testimonial and we just compile them and we just

look online to make sure it's a real doctor and they have a phone number that works you know um and then the the North American minapa society now called nams

I mean now called the mopa society they rebranded has a list of certified providers on their website as well I 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 had 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 I think you it's usually begins with

something you can't quite put 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 this 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 thought it was grief related and and I was like wait

when was my last Peri when was my last period oh I think I'm in menopause I

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 in my head when Samantha thought she was in menopause and how horrible it was for her and then turns out she wasn't and

everything was better again and I'm like gosh is this you know first of all I

applaud him 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

two 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 and I one of my be 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

Do Men Experience Anything Similar?

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 this might be a really stupid

question um but I know I'm no uh I ask a lot of stupid

questions Dem men go through anything like this so there's a lot of debate about menopause um the short answer is

not really we see men's testosterone levels Peak at

about age 19 no shocker there and then this very slow kind of downtick 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 curve the shape of the curve looks the same but as far as

normal men's range is from 236 to about a thousand so 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 in 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 on 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 manop pause their testicles don't stop working I mean it

would be as if your testicles shriveled up and died at 51 that's the

equivalent gosh I 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

um but if it was and Men or both genders I think it would be a different response and so much of what women were going

through a menopause were dismissed as psychological and really had multiple

times in their life you know it's all in her head we never said it's all in his head that's not a thing on the warts you

know it's all in her head was very much alive and well in my training and a long a lot of my practice I I find myself now

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 an anti-depressant for

her menopause than hormone

therapy multiple reasons for that the way we were trained the way we were taught to 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 is there anything else

that you do on a day-to-day basis in your life that um we haven't talked about yet is is

there any sort of apps or tools so I really like headspace I know there's

some good meditation apps I really thought meditation was woow woo and

not anything that you know I I would just sit there and and my brain would be bouncing all over the place but once I

went through menopause and suffered so horribly from the mental side effects

and the death you know all this happening at once uh to me with my brother's death aging parents teenage

girls in the house you know and realize something's got to give and so I hired

like a counselor you I went to therapy and she recommended um getting an app to

help guide me through meditation and that has really turned the needle for me really yeah how you know carving out

that it's just five or 10 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 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

Sleep Disruption

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 that's really made a

huge difference for me what role does sleep play in all of this so sleep disruption is massive massive massive

in per menopause 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

our brain resets that's when our our whole body you know and if you're having disrupted

sleep and you're waking up at 3: in the morning and your brain is raised say I mean everything is worse your cortisol

levels spike your insulin resistance goes up your you know everything gets worse and so when my patients come in we

focus on sleep first and nutrition pretty much and if easier said than done

though right sleep if the EST if their sleep disruption is due to hormones then

it's such an easy fix I just give them back 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 we're seeing a big bump in the sleep apnea rates in women who are um they don't even have to have

The Perfect Exercises During Menopause

a weight problem and what is sleep apnea that's when so sleep apnea is when you stop breathing um or you snore quite a

bit you you see the pallet relaxes and you were 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 are you do so you know I came from the

long the 20 years of just trying I was exercising to be smaller MH and now I'm

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 um and I do a lot of Zoom calls there I do lots of meetings there so

when I'm working from home and and working on the galison diet or the new book I'm doing it on my treadmill but at an incline so I'm really working on my

legs I will wear a weighted vest so that I'm getting the upper body so I'm doing this for bone density um I'm doing a lot

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 was not blessed with a lot of muscle mass and the fact that I focused on being

thin for so long and that was my social currency is you know I was thin I was healthy probably I've lo you know I lost

that that window of opportunity to gain more muscle easily in my 20s and 30s so what I what I would would tell my

35-year-old self what I preached to my daughters is focus on being strong not small you know muscles strength over

Your Diet

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 um don't worry about the curves

that you have that's that's natural that's that's the way you're built let's get some muscle and what about your diet so what

my personal window think you told about yeah so I tend to um I break my fast at

around noonish typically if I'm hungry before if I'm traveling or you know on a plane I I don't do well on a plane

without food and so but on a normal day when I'm like going to clinic and the night before is when my diet starts I

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 I eat nuts and seeds all day long um 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

fast at about noon and then between patients I'm constantly snacking I'm really focusing on protein for myself I

don't have a weight problem um 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 um 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 we'll pull out some salmon or you know we'll we'll make some I don't

know uh burgers or something and um you know we try to be protein Centric and

then we're adding in like a beautiful salad with lots of avocado and chickpeas um on the side so I think I

covered it all yeah so I'm typically done eating by 8:00 p.m. um

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 it's hard for me to get to the gym and the office so I'll save my workout for when I get home from work

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 per menopausal or the menopausal phase or postmenopausal and 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 s 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 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 is built to fail the

menopausal woman and there is good help out there you're going to have to do the leg work I've got tons of resources on

my website to help you you know lists of Articles to print out and hand to your doctor system you know um uh symptomatic

sheets that you can like keep track journals that you can hand to your physician um 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

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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 it's time to take care of yourself first so that you can have the best end

of your life that you deserve in 2023 I launched my very owned

private Equity Fund called flight fund and since then we've invested in some of the most promising companies in the

world my objective is to make this the best performing Fund in Europe with a focus on high growth companies that I

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funds Mission the remarkable companies we proudly support and to get in touch with me and my team legal disclaimer

flight fund is regulated by the FCA so please remember that investing in the fund is for sophisticated investors only

don't invest unless you're prepared to lose all of the money you invest this is a high-risk investment and you are unlikely to be protected if something

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Investments all of the investment capital is at risk this communication is for information purposes only and should

not to be taken as investment advice or a financial promotion as you guys know I'm a big fan of hu I'm an investor in

the company and they sponsor this podcast and what I've done for you I put together what I call the hu Steven

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A History In Your Family Of Why This Is So Important To You

I absolutely love and that's why I now talk about it because it's a product that I eat if you want to order them yourself and get started on your hu

Journey the link is in the description below in this podcast episode wherever you're listening to it there'll be a

stev bundle link and check it out back to the episode your family have a history of Health complications and

illnesses right yeah what is that history but also has that played into your overarching perspective about

nutrition the Health Care System how it treats people so my I'm one of eight

children I have six brothers and um my oldest brother Jeep died when I was 9

years old from acute lymp esthetic leukemia one of the most common forms of childhood leukemia now the Cure rate is

95% and but at the time he was put into remiss and then he came out of remission in his

late teens and died like a year and a half later so my childhood was but 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 you know find another

chemotherapy regimen which he failed and that kind of kind of drove me but you know it was 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 um had also contracted hepatitis and he was

doing great on his HIV meds um his counts were good he was healthy functional he'd been with the same

partner for over 30 years but then his 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 choice es you know and uh he ultimately died in 2015 he had

a stroke and then I was able to go to his end of life care and the first book

I wrote um 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 menopausal was through my grief process I thought I was grieving I

gaslit myself like no no no you're not sleeping you're you're waking up all night you're you know upset your mental

health and your brain fog is all because you're just gri geving his death and then um my next brother Jude uh was

diagnosed with stage four esophageal cancer um

shortly uh he was diagnosed when Bob died and then he survived a few years um

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 and I'm about to survive three of my six brothers and um out outli and

I know that these choices that I make with my nutrition my exercise my sleep my stress reduction what I call the menopause toolkit you know and my choice

for HRT are all I want to see my grandkids one day if if I'm lucky enough

to have any I want to watch these women I've raised grow up and you know be the women they're meant to be and that

Your New Book

choice might get taken away from me if I'm not careful so you know a lot lot of

what I do and why I do it is because I have to I may not get the

choice what an incredibly important Mission you're on and what incredible work you're doing

um because there are as we've talked about there's been a group of people in society that haven't have kind of been I

guess disillusioned but they've also must have felt incredibly isolated in their experience and what they were going through and it seems that there's

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 and 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 like 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 and the work you're doing is so unbelievably necessary and what I love about the way that you you write and how you educate

people is it so science-based but it's so accessible at the same time that's always been my superpower I think is and

I 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 MH 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 and they will have different circumstances we talked

about other you know conditions and contraindications that might be complicating things um and you seem to

have a really wonderful empathetic view on all of those things and an appreciation everyone's circumstances

entirely different um I'm excited and I'm really looking forward to having more conversations like this and learning more because although I am a

30-year-old man I have a partner that I love um 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 now nearly 60

now I um I challenge you to have this conversation with her and ask her about her experience I really applaud all the

and I don't know whether I should say this or not but I really applaud all the men that got this far in this

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 um 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 and the suffering of what is currently about 1.

.2 billion people but will be 50% of people in our population so I highly

recommend everybody goes and checks out both this book which is the Galveston diet but also can we pre-order the

upcoming book now yeah it's available for pre-order wherever you buy books and you'll think it'll be out in 2024 in for

sure um the latest May the latest May okay and that's called the new menopause so you can pre-order that now wherever

The Last Guest's Question

wherever um you get your books and that's the culmination of many decades of very very hard work so I'm 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 um

we have a closing tradition on this podcast where the last guest and also your website's an incredible resource for all of this all of the things you

talk about right and your social channels Etc we 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 you say to them in that

conversation that maybe they haven't already had I love

you there's nothing more than love I've had done

it three times my dad too my um

Bob and Jude were five years apart and my dad was shortly after Jude you know

I'm watching my parents bar three kids was a lot

um just

love thank you you're welcome thank you so

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