Menopause: What to Know, What to Ask & What to Do – Mary Claire Haver, M.D. : 1015

You're listening to the Human Upgrade with Dave Asprey. Formerly bulletproof radio, A state of high performance. You're listening to the Human Upgrade with Dave Asprey. On today's show, we're going to talk about hormones. We're going to talk about menopause and what to do about it, what to ask and how it affects you. And if you're a guy listening to this, you could say, I think I'll skip to the next episode. And you could. However, I am just going to tell you that menopause is already screwing up your life. That's because if you're young, it's happening to your mom or your aunt or your grandmother and it's probably happening to your boss or your boss's boss. And if you are a woman who's pre menopausal, it probably is going to happen to you. And what you do now is going to affect how you feel in the future. It's going to make a really, really big difference. So with no further ado, let me introduce you to today's guest who is actually not named after a magazine, even though her name is Mary Claire Haver, who's a medical doctor. And she made it onto the show today because like a lot of my favorite hormone experts, she's a doctor. But the stuff didn't work. So she walked into the buzzsaw that can be menopause when you don't manage it correctly and had to deal with it. And these are always the best doctors. Like, oh my God, I had to learn a bunch of stuff that I didn't learn in medical school for my own uses. By the way, why am I a biohacker? I do the same thing. Because toxic mold is, and chronic fatigue syndrome and all the mitochondrial dysfunction, that stuff actually, it, it, it was such a big thing, you had to do it. So someone who has doctor training and is hacking themselves, these are the people you want to learn from the most. So she's a board certified OB GYN and she has a track record that I checked out about being curious and listening to patients. And not every doctor does that in the same way because of insurance companies and because of even sometimes regulations. So she's someone who hacked herself using a medical doctor's training. So, Mary Claire, welcome to the show.

Thank you. Thank you for having me.

Now, what happened? So tell me about your menopause experience.

Yeah, so I'm 54 years old and I am fully menopausal, but we're going to back up to about 2017.

I'm.

54 years old and I am fully menopausal, but we're going to back up to about 2017. I, through most of what I realized now was my perimenopause, I was actually on birth control pills for treatment of polycystic ovarian syndrome. So I kind of masked a lot of the symptoms. And at that point, and in late 2016, my oldest living brother died basically. And at that time, my, I was 49. My practitioner and I had decided time to come off of birth control pills and kind of see where you're at. And through his end of life care and you know, the immense depression that ensued after his death, I kind of forgot about that. So. So I ended up in full menopause and this incredible grief state all at the same time. And I was blaming the way I was feeling, the lack of sleep, the hot flashes, the fatigue, everything on grief and depression. And certainly it was playing a part of that. But then, and I was also gaining weight, but more than, and I've, I've not had, not had a weight problems, you know, in 20 years. And suddenly I was like. But I knew I was not eating the right things, I was exercising, I was just barely getting out of bed and going to work. And so six months after he passed away, you know, the depression starts lifting, the grief is getting better. And I look at my body and I'm like, all right, time to get back to it. Let's, let's get healthy again. And I went back to the old tricks that I used to do. You know, the working out, the severe calorie restriction, the 2A days at the gym, and I'd lose a couple of those pounds, but it was just popping right back on. And at the same time I was like, not sleeping, hot flashes, severe brain fog, getting in the car, and I can't even remember where I was going. That was new, all these new things. And joint pain. I was having severe hip pain and I was like, I was getting X ray and all this workup and no one, including myself, was saying, hey, this all is probably your menopause. So I got so frustrated, you know, with the weight gain. I remember my husband works overseas and he was leaving for a long trip. And I said, hey, when you get back, you're going to have the wife you deserve. I'm going to lose all this weight. No, no, no. And he said, honey, you know, you are beautiful. I don't care what size you are. He said, but what you're doing is not working. This is what you tell me what you tell the kids. You're a scientist. You got to figure this out. So then I was like, okay, challenge accepted. You know, I'm like, why isn't this the SECO thing that I've been taught my whole life, this law of thermodynamics that is infallible. That must work. Why is it not working for me and all of my patients who had complained of the exact same thing?

So you were telling. You were telling your patients, just work out more and eat less.

For 20 years. Yeah.

For 20 years. Have you, like, apologized for that?

Yeah, I mean, I apologize on social media. And, like, every patient who came back to me, I'm like, I am so sorry, you know, and sadly, it took happening.

Kudos.

So then I called up the PhD nutritionist at the university I was employed at, because I delivered everyone's baby. I was friends with everybody. It was a small academic community. I'm like, what the heck is going on here? And they're like, well, there's a lot going on with inflammation. We know there's some ties to menopause. Nutrition's gonna play a big role here. So they just sent me a bunch of articles, and I just went down the rabbit hole. So I. I had the obgyn. You know, there was just such a black hole of menopause information still, you know, but lots of nutrition information. And so I was just kind of putting things together and deciding, okay, I kind of like this fasting thing. There seems to be some. Some benefits to lowering inflammatory levels and bringing down insulin levels. Like, I was thinking of things totally differently than just calories in, calories out, you know, that I realized I'm more than just a simple machine. I'm very complex.

Hold on a second. Humans aren't meat robots.

Yeah.

Oh, my God. Who would have thought, right? So I should tell Elon.

So I. I was. There's Alpha Mega Alpha is an honor society for medical students, and I was in charge of the med students doing that. And so we had a guest speaker come in, and he was. Had started this medical nutrition, kind of like a master's for doctors in nutrition. And I was all over it. And so I enrolled in the program through Tulane Online, had to fly out to New Orleans to do these labs and stuff, and, you know, took about a year and a half to get through the curriculum and really learned so much about nutrition that was just, you know, lacking. And, like, I was pulling in my own menopause information and just kind of came up with my program. You know, based on that, based on research, personal experience, talking to patients. Then I just started talking about it on Facebook, and that's when it exploded. And people were like, whoa, what's going on here? Tell me more, tell me more. And as that grew, I got more and more questions just about menopause in general. And so what became me just talking about nutrition and menopause became me talking about everything. Menopause, which is kind of where we are today.

Now there's something that happens before menopause and perimenopause, and that's like our fertile years. My first book from about 12 years ago, took five years to write, and it was. It's called the Better Baby Book. It's a book on fertility and what do you do before and during pregnancy to have smarter, healthier babies? And it still stands the test of time today. People still buy the book and get pregnant magically without IVF and all that. And it's because my wife at the time, who was a medical doctor, the mother of my kids, she had PCOS and was infertile. You know, her medical colleagues at the hospital where she worked. Yeah, we ran all the tests like, you're not gonna have babies. And I'm like, yeah, we can hack that. So we did. But the birth control pill is a major contributor to problems. And, you know, PCOS is oftentimes fungal or it's a metabolic thing. Are you still recommending the birth control, like, hormonal birth control pill for. For patients?

So now most of my focus, I've. I've left traditional ob GYN practice and now I just focus on menopause care. And so in a very early perimenopausal patient who's symptomatic, occasionally I will. Because of cost insurance, a low dose birth control pill is a good option sometimes for them. But for most of my patients, I'm doing estradiol and micronized progesterone to support the gaps you know, that they've got, or try to stabilize them through transition and then keep them going into menopause.

Okay, got it. So. So you're, you're. Because you don't really deal a lot with women who are fertile. I just wanted this.

Not anymore.

Not anymore. One of the things that I just want to make really clear on the show, and I've said this lots of times, the abundance of evidence that I've seen is that the risks of hormonal birth control for women far outweigh the benefits almost always. But there are, there are certain cases where it just makes sense where it controls some other symptoms, but that the overuse of that I think is, is, it's, it's a crime against women. It's not for women. Birth control is necessary for women to, to have full rights and be healthy. The hormonal disruption that comes from that method of it seems like it's really causing an increase in risks. And we just don't tell people the, the changes in personality and their life that can happen as a result of it. So I just want to make that really clear, even though that's not what our topic is today, because you brought it up and it's in the context of perimenopause and menopause. If someone's been on birth control or the hormonal birth control most of their life and then they hit perimenopause, what would be different versus if they had their natural cycle and then hit, hit perimenopause, hit perimenopause.

So sometimes some of the bigger symptoms, like the hot flashes, the easily identifiable symptoms can be attenuated because you've stabilized their estrogen levels. In perimenopause. We see this in a normal menstrual cycle. For someone without PCOS or without any endocrinological disruption, you have a cycling, right? So our estrogen levels are kind of at baseline and then we ovulate and they peak and then they come back down and then progesterone kind of follows that faith. Days after ovulation, it peaks about seven days later. And then, and then we have a period and the whole thing starts all over again. So when we're in perimenopause, we begin to see the disruptions. Perimenopause is very much like PCOS in many, many ways. You know, I have a whole chart for PCOS patients that I show what you see in perimenopause, you know, side by side versus what you see in PCOS. And there's like 8 out of 10 boxes check the same as far as symptomatology, that they're going to have disrupted periods, you know, acne, change in body composition, weight gain in their midsection, you know, the apple shape rather than the pear, brain fog, some of the things that they might notice. Joint pain is something that's, that's new, that happens in menopause. We don't see as much in pcos and, and migraine headaches, like things that are inflammatory. So increasing of migraines or new onset migraines. Interesting enough, I just looked at this because I Did some research on mental health and it looks like depression, more than anxiety, seems to flare in perimenopause and it is a precursor for severe depression. So if you, if you were doing great and then you go into perimenopause, you get in your 30s and 40s and all of a sudden you're having a new onset depression without a big life event that would contribute to it. You know, that is something that should key you. This might be part of my perimenopausal journey.

Got it. So you said in, in your book that you think menopause is a, is a privilege.

Yeah. So, you know, if we're lucky enough, we, 100% of us, if we live long enough, are going to go through menopause. Okay. And I, you know, you talk about biohacking and personal, you know, I have, I'm one of eight, I'm one of eight siblings. So I have four older brothers and two younger brothers and a younger sister. Three of my older brothers have passed away. I don't have a surviving sibling past the age of 60. So I'm very, very focused, at least in my own health care on what can I do to limit, you know, to increase my lifespan and my health span as well. I want to be healthy, not just live forever. And so I, you know, personally can't take that for granted. So the point, sorry, the point of all that being the fact that I'm menopausal and really healthy because as you do, I check my own labs, I, I am very much on top of my own health and modifying as much as I can. If I make it to 60, it's an honor and a privilege. And I think by knowing what could happen to you, being able to recognize the symptoms, putting changes into place that will improve your quality of life and health through this journey, I think is going to go a long way. The first problem we have is not enough women are talking about it, know about it, understand what's happening to them, what could happen to them. And besides the, the symptoms, the hot flashes, the night sweats, the mood swings, all of that which is important and affects your quality of life. I'm talking about cardiovascular health, neurodegenerative disease, you know, mental health, these are things that we, it's looking like now that people are actually looking at the data. If we put these, you know, interventions into place, we could not have some of these long term health effects associated with menopause outside of just aging.

If I was a young woman and I had the means, I would actually Take some of my ovarian tissue and bank it so that when I hit menopause I could have it re implanted and do another 20 years without menopause. What do you think about that?

I think that's very interesting. You're the first person I've ever heard say that. But what I tell my patients in clinic is the best thing I could ever do for you is re implant your 25 year old ovaries and I can't do that.

I know there's a study and that's so funny.

I say that every day in clinic. Like the best treatment for you is to give you back your 25 year old ovaries and I can't. So here's the next best thing. Say that every day in clinic, like the best treatment for you is to give you back your 25 year old ovaries and I can't. So here's the next best thing. And now I'm like, that would be amazing.

But you can. They did it in the uk there's actually a trial of that where they've been doing it. And at least it was in animals. I don't know if they're doing it in people. I'm pretty sure that they are, but it works.

I think you just put it under the skin. I mean, so what's stopping us from doing this? I'm doing pancreases. I mean, you know, so.

And I don't know where they re implant it. But the bottom line is it seems like if, even though you would consider it to be a privilege, it's an inconvenient privilege. Even though you might come out the other side with wisdom. You could also just have wisdom and still have your period and have normal hormonal cycles in a body that thinks it's 25 again. Because the little mitochondria in the ovarian tissue, which is very dense in mitochondria, they're like, oh, hey guys, we're 25 again. And all the other mitochondria in the body are like, oh yeah. And then all of a sudden the youthfulness happens. And that's what they found in animals. So why not bank ovarian tissue? I mean, you could do that.

That would be amazing.

Well, okay, why aren't you doing it? You're no b gyn. You know how to pull that shit out. Like, I don't know how to do that stuff. I, I have scissors. I, I don't know how that works. But like you're a doctor.

It actually is a Good.

Pretty.

A pretty simple procedure. I mean, it's like. It would be laparoscopic, but you could totally do it.

Okay, so can I send my daughter?

I don't know of anyone who's doing it officially. I wouldn't know how to bank it, but let me. The fertility specialists who actually preserve that tissue.

We bank eggs, we bank sperm. We have freezers. I'm challenging you, Mary.

Yeah, that's. That is amazing. That would be amazing. I'll have to talk to my. I'm going to go down the rabbit hole with my fertility buddies.

Okay. You're good at rabbit holes. That's why I wanted you on this show, because I do the same thing. I've been down this rabbit hole, and it's. There's nothing stopping us other than maybe some regulator who's a politician. And those guys actually aren't in charge of us anymore. They haven't been for a long time. They just think they are. We just do what we want to do. That's why we're biohackers. Like, oh, a research chemical. Oh, no. Heaven forbid that I use that on myself because you wouldn't let me buy a medical grade one. That's the world we live in. So I'll fly to Thailand. I'll fly my family to Thailand, right? And, hey, you just turned 25, honey. I'm going to do you a favor that's going to give you an amazing life. A long time from now. Even I plan to be live that long, but maybe I won't be. Who knows? But let's do it. So let's open a clinic in Thailand or Mexico where everyone could go and bank their tissues and go to the beach.

That would be amazing. Yeah.

Yeah.

And then with like 45ish, you know, do some testing, kind of see where you're at. Reimplant and just.

And then, no, get another 20. Menopause young hormones for the rest of your life, at least. Maybe not the rest of your life, but for another entire adulthood.

20 years. Yeah.

Without all the weight gain and the brain fog and all the changes. It. It. It feels like that might be a really good use of time because there was a study also out of the UK that found that perimenopause was costing them billions of dollars every year and just lost productivity.

Oh, yeah. And misdiagnosis.

Yeah. So I. All right, this. This is your next big book. You know, the bank and beach book. That.

That's the new stuff I'm itching to.

All right. And. And it. It's funny. Cause I've talked about that. I think also with, I've had three other doctors who kind of had the same problem. Like, what's going on with menopause? What do I see in my patients? What am I seeing myself? Cynthia Thurlow, Anna Kabeca, and Suzanne Gilbert Lentz have been, I know other episodes where we've gone through this, but it feels like we're biohackers. And the time has come for a relatively inexpensive procedure. Was it a couple grand to do a laparoscopic surgery these days, I mean.

Especially in Mexico or Thailand.

Yeah. Where they have great medical care. And then you bank it, and banking is going to cost you a few hundred dollars a year. And then Magically you turn 45 and no menopause. Oh, my God, we have to do this. Okay. I'm signing me up for helping because I have, I have family, I have friends who need this. Okay. But it does feel like for the first time since I started the show 10 years ago, that people are really, really in the mass media. They're just way more open about perimenopause and menopause and even just anything I would do with sex and reproduction and women's body parts and all that than, than ever before. Why do you think that's happening?

I, I, I've asked on social media, you know, why is menopause having a moment? And they think it's a generational thing. Like, like I'm 54, so I forget what generate am I Gen Z X Boomer? I don't know. I'm somewhere on some cusp. But this next generation behind me is not willing to put up with it anymore. They're willing to be unmarried. They're willing to bring home the bacon. They're willing to not have children. They're willing to, like, break all of the norms. And they're not willing to be silent about suffering. You know, they're not putting up with, oh, you're just getting older. Oh, you're, you know, and so, and I think another thing that social media has done is allow people to have all these shared experiences with where they had no idea other people were going through the same thing. So it's really just kind of opened up the conversation. And then this next, you know, 30s, 20 plus, like my daughters who are 19 and 22 are going to be as prepared as possible for perimenopause. They're going to know exactly what's happening. And at that time, you know, it's 20 years from now, what their treatment Options are, and, you know, maybe they will bank their ovarian tissue for future use, you know, to keep them healthy and functional for much longer than they would be otherwise.

All right, and you're going to help?

I could, I could.

Let's talk about something that's going to be more likely to help listeners right now, and that's hormone replacement therapy. What's your take on it? Women replacement? You're a fan.

All right, I'm a fan, yeah.

What about all the risks? I mean, people talk about cardiovascular, breast cancer, dementia, stroke, all these bad things that might happen if you have a young person's health.

So if you, here's what the latest data has shown. The American Heart association just came out with a review. They looked at the whi, the Women's Health Study, the Nurses Study Framingham, and followed those patients out for 20 years. And they took two cohorts of people and they said, all right, starting young, starting healthy. There's something magical about estrogen being protective. If you start later, like late 50s, 60s, then it may exacerbate pre existing health conditions like Alzheimer's, dementia or cardiovascular disease. But if you start young at the very, you know, if you don't have an estrogen free interval, you know, a very small one, the women who were on hormone therapy in the form of estrogen plus or minus progesterone versus those who weren't, and we follow them, have less cardiovascular disease, less death from cardiovascular disease, less all cause mortality and less mortality from cancer. So that's what the late. It's, it's an issue of timing seems to be it. So as far as what kind to put in your body, I don't use, I don't recommend Premarin, which is from Pregnant Mary urine. I don't do synthetics. They do. It's, those are horrible people.

You don't need to do that to Premarin.

I know. I, I say, look, I have an ethical issue with this. I have great options for you that are completely, you know, I go with what your ovaries used to make, which is estradiol. That's my, that's my drug of choice. And so I have lots of options. I have, I usually stick to a transdermal option because oral will bump up the clotting factors. About seven out of a thousand women will have a blood clot on oral versus transdermal. So I usually go with the transdermal option. A patch of cream, you know, whatever her insurance will cover. Or, or if she's out of pocket, we get out the apps, and we start looking for the best affordable option for her. And then if she needs progesterone again, I'm trying to get as close to what the ovaries used to make. And that's going to be a micronized progesterone.

Do you find it offensive that insurance companies have anything to do with this?

Absolutely. Every day I fight this battle, and it makes me insane. The same with testing, the same with blood work. It's like, you know, they. I decide a patient needs XYZ tests based on my clinical experience and my level of expertise, and it is a battle. So in the clinic that I built for menopause, I don't take insurance. I try to keep the cost reasonable. I cover the labs with their visit costs, and then I have the freedom to order what I want to order. I also contract with a lab to get better pricing, you know, so. So I try to keep the costs down. But my patients are so happy because they're getting individualized care this way.

Yep. And there is. There's. There's so many connections between the insurance companies and. And big pharma, where that. That's why Premarin, which is horse, mare urine, that provably causes problems when women use it, that. That's still on the list. Cause it's covered by some insurance company somewhere.

Yeah.

So I'm getting a lot of questions from our live audience. And by the way, guys, if you're listening, you can go to daveasprey.com and you can sign up for the collective. You can be in the live audience and ask questions and all. And it's really fun because we have this whole community of people who are part of the collective, and a lot of them are asking. All right, Dave, Mary Claire just kind of dropped a bombshell there, saying that if you've been off of hormones after menopause, that maybe starting isn't a good idea. How long of a gap is too long?

So that's a great question, because we just don't. So when they looked at the whi, which was the original study, that kind of left a generation of women bereft because of flawed science. The average age in that study was, I believe, 62 or 63. And the. So they were starting women on hormone therapy. So the average age of menopause is 51. So. So more than half of these women had been menopausal for over 10 years. And so that's when I start counseling patients. Look, you know, they come in in their 60s, never been on never offered hormone therapy. You know, they come in, they're interested in the discussion. I'm like, okay, well, let's look at your risk factors. Let's get a calcium score. Let's, you know, talk about Alzheimer's and dementia. And is this run in your family? You know, because these were the diseases that seemed to get worse if there was a preexisting condition when they started the hormone therapy. So it's not for everyone. It is absolutely not for everyone. But every woman deserves a conversation about her individual risks, benefits, potential health goals. You know, what does she want out of this? So I today, this morning was at my exercise class. I do a workout with a bunch of ladies, and one of them is my patient. She said, hey, can I ask you something on the side? I said, yeah. So we went in another room. So she's a breast cancer survivor and she is in my menopause clinic. And she said, I just saw the oncologist and, you know, I had stage one cancer, lumpectomy, chemo, and they want to put me on whatever. You know, it's not tamoxifen. It's something new. And she said, I'm reading everything and the risks and benefits. And I said, well, what percentage chances is this going to decrease your risk of getting recurrence? And she said, I don't know. And I said, well, that's probably what you want to ask. And she said, I'm worried that my quality of life is going to be so poor from the side effects of this medication. I said, look, the oncologist's only concern usually is that you don't get cancer again. That's their job.

Even if you're locked in a prison, as long as you're in cancer, they win. Right?

And so your quality of life matters, your ability to sleep at night worried about getting recurrent cancer matters. You know, so it's all a balance. So I gave her a list of questions to ask, like, what is the percent? What am I gaining by this? What percentage? You know? And I said, for you, the risks of poor quality of life might outweigh any potential 1% chance decrease of recurrence. You know, think about it that way. And I don't think we're having those conversations with patients. We're all so worried about getting sued or the 1% that we're just missing the boat, that this is someone's life. You know, she's got to sleep at night. She's want to enjoy her sexual intercourse. I mean, it's going to take all everything out of her vagina and just leave nothing left, you know, so. So I think it's really important that the patient goes in armed with questions, you know, armed with information, asking the right questions to make sure she's getting, making the right decision for her and her quality of life. It's not cookie cutter for everyone.

It's not. So it sounds like the answer is that if someone's been menopausal for 10 years, the study showed a slight increase in potential risk, which, by the way, you could offset with some basic supplements like, oh, if your clotting factors go up, take some serrapeptase and there you go. Now you're clotting factors, factors go down, you have less fibrinogen because you took a cheap enzyme on an empty stomach that breaks up thrombin and fibrinogen, stuff like that. So then it comes down to, is quality of life higher when you're on hormonal replacement when you're in menopause, is.

It usually, yes, the quality of life is higher. Anytime you sleep better, especially if your sleep's disrupted, everything gets better. First thing I ask my patients is, how are you sleeping? Tell me about your sleep patterns, what's going on there? Because it's, you know, it's tied to so many things. And when I talk about the menopausal toolkit, you know, HRT is just one small part of what I counsel patients about. Now, again, I went back to school. I have a nutrition background now. You know, we talk about nutrition, we talk about exercise, we talk about stress reduction, we talk about sleep, we talk about possible other pharmaceuticals, and of course, we talk about supplementation. So it's all part, you know, it's like a tackle box and everything is important.

Many people out there are saying, oh, fasting doesn't work for perimenopause or for menopause. And I think it's because they're over fasting, right? Talk to me about fasting for perimenopause.

Yeah, for when I first got into the studies, when, when the nutritionists were throwing things at me, I was really looking at lowering and inflammation levels, you know, because perimenopause and menopause become a pro inflammatory state. And I'm like, what can we do with our world outside of medication to lower that naturally? And so many studies, you know, Mark Matson's work from the NIH on neuroinflammation, I mean, that he just, you know, he's this wonderful PhD. He doesn't make any money work for the NIH. And this was just his passion and I was so intrigued by it. So when I started looking at, you know, the very few studies that were done for women in menopause, it looks like a 168 seemed to be pretty much the magic window, you know, where you weren't starting to chew up protein, you know, chew up your muscle to get get amino acids going. It seemed to be enough to get the anti inflammatory benefits without moving into starvation. And so of course, you know, do I work 24 hour shifts at the hospital? Did I do a perfect 168 every day? No. Do I do one now? No. You know, so it's like most of the time I hit a 168 rough if I'm traveling or ill or whatever. I eat when I'm hungry, but my body's just used to it now and I'm enjoying all of the anti inflammatory benefits and hopefully some longevity as well.

It's really hard to know how much of the anti inflammatory effects of fasting are because you didn't eat inflammatory plants or man made chemicals or all the things that that we don't know are causing inflammation. But we do know that even if you eat low inflammation foods that still having an empty stomach works. In the Galveston diet. You talk about intermittent fasting, that's your main recommendation. And you have a list of inflammatory foods. People who know my work bulletproof diet was all about like here's the foods kind of stack ranked. Tell me your basic theory on what types of foods cause inflammation in the Galveston diet.

So there's things that disrupt your gut microbiome.

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So there's things that disrupt your gut microbiome. You know, there's things that those little bugs in there who need to be happy and well fed don't know what the hell to do with. And, you know, and there's things that actually cause direct inflammation on the lining of the mucosa. And so artificial colors, artificial flavors. I mean, I'm not talking the occasional, you know, snickers or, you know, handful of. But, you know, I'm talking about people who are consistently eating this on a regular basis.

Okay, so, so, so basically highly processed candy junk food with artificial colors and flavors.

Exactly. Advanced glycation end products. So when. When meats and things can be overcooked, those. Those have been shown to dang inflammatory and disrupt the gut microbiome.

Do you know how few people talk about that one? Burned meat is. Is something that. That's. That's part of the, like, cooking methods is part of the recommendations I made. Thank you for saying they had charred meat and charred veggies. Actually, both of them. The black stuff is really bad for you.

The black stuff can be harmful occasionally, fine. But I'm talking people who are like, smoking meat every week. I'm like, that stuff kind of. We weren't meant to eat it like that.

It's true, though. Smoking meats increases disruption of your microbiome, and it directly adds a lot of advanced glycation end products, as well as polycyclic aromatic chemicals that disrupt hormones. Bottom line is you probably don't want to actually smoke your meat. But I do use smoked salt. Right? So if you want smoky flavor, you can get it, because smoke on salt doesn't make those compounds. It's burning fat and burning protein that makes the negative compound. So you get the smoke flavor by burning wood with salt and adding the salt to your meat. And then you can even slow cook the meat so you still get your barbecue flavor. And so there are diehard people listening to this who barbecue. And like, I want to. I have a barbecue, too. And it. And it's like, it's Texas. Yeah. Right. So Just what about like some way to counteract that?

So, you know, filling your body with things that naturally flight inflammation, things with anthocyanins. You know, we in Galveston diet, we talk about eating the rainbow. Like every color of that natural fruit and vegetable has a compound in there, a phenol that is anti inflammatory. You know, naturally it's absorbed well into the bloodstream and it goes to work, you know, as an antioxidant doing whatever the hell it does inside. You know, that's a whole nother talk. So, you know, multiple. Filling your plate with as much variation of your fruits and veggies, of your legumes, of your whole grains that you can.

What is your take on like nightshade family and things like that.

So I haven't seen enough randomized controlled studies. I mean, I think a lot of that's in theory. And all the people that I trust are like, as long as you cook it, you're fine. You know, you'd have to eat, you know, the things raw to get the level of, I think whatever the derivative is, you know, to really be harmful. I love an eggplant. You know, I cook it well. It works for me. So. But there's also, you know, we're all different human beings with different microbiomes and different chemical makeups and different reactions. You sometimes need to do an elimination diet to figure out what your body's not reacting well to, you know, what's causing the bloating, what's causing. And I might be, I can eat all the dairy in the world, doesn't touch me. But, you know, 20% of the population is not that way. And so, you know, again, Galveston diet is not about restriction or you have to eat this or that. It's like just getting a different understanding nutrition wise on, you know, and, and, and allowing yourself to be who you are.

Yeah, I, I think you've, you've, you've nailed it. So you get intermittent fasting in there. That solves a huge number of problems and you avoid the obvious inflammatory foods for everyone. What I would call the kryptonite foods in, in the, the frameworks that I use. Okay, you've just now got like a 75% coverage and then you get the 25% people going. Well, a lot of my problems went away, but I still have X. And that's usually when you get into the realm. I just talked about where, you know, like nightshade lectins don't get destroyed by pressure cooking, but legumes do. And there's all These. These nuances. And it's funny, my son has the same genes for lectins I do. Each of us, we take one bite of potato, it's like neck pain and back pain and joint pain for a week. My daughter doesn't have it. She eats potatoes all the time. Like, it's black and white. But if you don't know. And I don't think everyone needs to avoid nightshades, but many more people than you'd think. So I'm glad you didn't include them, as you have to not eat them in the diet, in the Galveston Diet, because what you're doing here is going to get the vast majority. But when people come in still having problems saying it doesn't work. No, guys, the Galveston diet did work. It reduced inflammation, but you had other factors that were outside of it.

Other factors. And then we. That's when the work begins. We start, you know, really saying, all right, what is it with you and your body? You know, we just start checking the box off one by one.

And there's a third pillar. So in the Galveston Diet, you've got intermittent fasting for perimenopausal women. You've got avoid the common inflammatory foods. And then the third one, what's that?

So we call it fuel refocusing. It's kind of a catch all. You know, it's kind of where we do our coaching around the emotional aspect around looking at food as nutrition. So, you know, we talk about protein needs, we talk about healthy fat needs, we talk about net, you know, our. Our healthy carbohydrates and, you know, and in what proportion you should consider, you know, that. And then we talk about micronutrients, magnesium fiber, you know, how important they are, what they can help with, what a deficiency would look like, you know, and so really helps us kind of drill down to the nitty gritty for each. You know, we teach people how to track their nutrition in a different way. You know, the tracker my favorite was my daughter, she used in school is chronometer. You know, you can use lots of trackers, but have a really clean database for nutrition. I'm like, just track your magnesium for a week. See where you're landing. Are you getting enough? You know, that's a difficult one to do by blood test because it's an electrolyte and you just pee it out. You know, whole body magnesium is hard to measure. So I'm like, let's just see how much you're getting for the week. How much fiber are you getting? How much Omega 3s. What about your vitamin D? You know, and so it's looking at things, you know, at a more granular level and then seeing if you're maximizing that through nutrition. And then if you're not, then we talk about supplementation, or if you can't, if you don't have access, it's. You're allergic to fish, you, you know, whatever, then we start talking about supplements.

Ketosis for menopause. Yay or nay?

I don't track ketosis. We naturally go into it when we're fasting. There you go. Yeah. It's so it's not a goal for Galveston diet. It's inevitable. It just happens sometimes in the way that we do, and we welcome it. But it's not something that we're, like, peeing. I'm peeing on sticks. I'm not recommending that you track to make sure that you're in. Your body is going to go in and out. It's a normal part of it. We talk about if you're in ketosis for a long time, what you might feel, some things that you might be able to do to limit some of the side effects of when people go into keto early in the game, the keto flu or whatever. But, you know, because of the fasting, because we're kind of limiting carb. Not limiting, but, you know, because we're really paying attention to carbohydrates, ketosis is inevitable, and, you know, it's just a normal part of how our bodies fuel themselves.

So when people are following your recommendations and they're getting 16 hours without food, which basically means you eat dinner, don't have. Don't have a snack, and then eat a late breakfast. You got 16 hours.

Exactly.

Then magically, your ketones are up some and enough to get the metabolic.

You're burning fat for fuel, which is.

Yeah. It's not a keto diet, though, and it doesn't need to be. And I. I've been saying this for years. You can do it, but cycle in and out, and intermittent fasting is most of it. What about MCT oil? Maybe in coffee? I kind of know some stuff.

A lot of my patients come in and they're doing that and they really like it. And I don't. I'm like, okay, you do you. But I don't. I, you know, I'm a fasting purist, personally, so I'm, like, really, like, zoned into no, you know, nothing during my fast. I just have black coffee, water, tea. But we have a couple of recipes in our. In our cookbook that do use MCT oil. But we do. We say try to do it after you break your fast.

So I find it does. It really does increase fasting compliance, and it means people don't feel pain. And since it can't be stored as fat and it doesn't get processed in the liver, it's hard to argue that it's breaking the fast. But maybe. Maybe it is. If you're, you know, you redefine fasting, but I don't know. I think coffee breaks a fast if you're gonna do. By the way, this isn't a debate. I'm kind of teasing you for listeners. I define things in a fast as if it doesn't raise your insulin and blood sugar levels, and it doesn't raise mtor, which is a compound that protein and carbs turn on, which means go into growth mode. Then you're fasting, which is why you can have coffee, you can have prebiotic fiber, and you can even have fat in limited amounts, especially MCTs, that you're technically not breaking fast. And it sure is easier to fast that way. But you talked about some other stuff that I thought was intriguing and a little bit daring in a book, and this is something that biohackers who are listening to the show, and not everyone who listens is a biohacker, but there's lots of us. You talk about the stuff that most people have heard of, like insulin and leptin and ghrelin and cortisol, but then you go into cholecystokinin, which almost no one writes about. I think I have, like, a paragraph about it in my big diet book. And you talk about pancreatic peptide YY and glucagon, like peptide 1. Can you walk through some of these kind of fancy compounds that most biohackers don't know about and what they do in your gut and in your body.

So these are all, like the group of hormones, some better studied than others, that seem to control hunger and satiety very much like we have the best information for that on leptin and ghrelin. Those have been studied extensively. And so but it seems that, you know, cholecystokine and ppy, they also, you know, have similar properties as far as turning things on that drive our, you know, need to eat and turning things off that make us. Or turn things on that makes us feel full and happy. And so. And those are driven by the quality of your nutrition. So I put those in there. They're not Studied all that well, but it seems that getting protein with each meal, you know, getting fat with each meal, getting something complex with each, you know, each time you eat seems to help those hormones work for your benefit. If weight loss is your goal or staying full and, you know, staying healthy is your goal, I don't want to say all weight loss, it equals health. That is not, you know, what I'm here to, to propagate. But, but they all have a part. And there's more emerging research coming out now. GLP1 is being blown out of the water right now with all the GLP1 agonists out there. And I have first, my initial reaction to those medications being used for weight loss. I mean, I knew about them for type 2 diabetes, really kind of made me step back. But then I talked to some obesity medicine specialists and they have really kind of made me think differently about. Because, you know, obesity is such a complex problem. It's not just a function of overeating. It is. There's so many things that feed into it.

You know, what you said earlier is you don't want to say that weight loss equals health, but doesn't it in.

Obese people and obese people, as long as you're not sacrificing muscle to lose weight, as long as you're losing fat, you know, and as long as you're, you're doing it in a way that you can sustain for the rest of your life and you know, just the, the, the society we've created that weight loss at any cost is, is killing people and not making people healthier in the long run.

Lettuce and lettuce and aerobics is really, really, really harmful. Don't do that. I'm with you.

And I, I grew up in that generation, you know, literally lettuce and aerobics. I mean, that was me in college and a cigarette, you know, anything to be good. So, of course I've totally reversed my stance. And having family members and loved ones who've struggled with weight and realizing this is just not about simply about that they can't resist a plate of cookies. This is everything in their world leading to their failure, you know, what they feel is failure. And then helping, you know, I have one of the monitors in my office that measures visceral fat, that measures weight, muscle, that measures water. And so I'm really able to give them a better picture of their bodies outside of just what the scale or their BMI says. And I think that bmi, I agree with experts. It's a Terrible measure of health. And so now my whole focus for my health is I'm really focused on 20 years from now, if I'm lucky enough to be alive. You know, I want to be climbing that mountain. I want to be hopefully tossing up a grandbaby. I want to be, you know, doing the things and frail little Mary Claire, you know, I've got to stay strong.

I wanted to talk with you specifically about something I haven't covered on the show before. Neuropeptide Y. What does that do?

So neuropeptide Y seems to be driven by protein intake. And it works both, you know, if you're not having protein with each, like if you go without protein for a long period of time, the neuropeptide Y I believe, increases. And so that seems to drive more hunger when you're not really hungry, you know, when your calorie level is not.

And carb cravings.

Yes, and carb cravings. And so. So, you know, by getting that level where you in an optimal level for you, whatever that may be. And again, this is new and emerging. I just thought it was so interesting that the clinical quality of our nutrition affects these things that drive our cravings, you know, that push us to eat when we may not actually have low, you know, low energy needs and so or low energy and need to feed our body. And so it was just one of the newest ones. Like the most information I could find on it was just a few paragraphs, but I was like, I'm just going to add this guy in there.

You know, it's a. It's a cutting edge book because you did that. My understanding of neuropeptide Y is definitely. It increases your motivation to search for food and it gives you those carb cravings. And if you're getting likely 30 grams of protein, and that's probably a rough number, it may be higher than 30 grams for some people, depending on body weight and muscle and all that. But for most women, 30 grams is probably enough, and that's complete protein. Then you're less likely to have neuropeptide Y, which means you won't think about food as soon as you finish eating, which is what happens happened when I was a vegan for sure.

The studies that I saw were done using meat and so not. And not plant race. These were omnivores, you know, and they were measuring protein intake through that. And I think it was 30 per meal and 10 per snack. And so trying to hit that 70 to 80 range for women.

Why would you Snack. If you intermittent fast and know how to eat.

I pretty much eat throughout my entire eating window, but it's only eight hours.

Okay, got it.

So, so, so yeah, to get my 80 grams in, I have to just kind of keep at it.

It's actually a really good point. A lot of women, especially if you're not feeling hungry during perimenopausal, which can happen, you might not be getting enough protein if you're intermittent fasting just because, like, it's actually hard. God, three eggs? Really? You only eat three eggs twice in eight hours in order to get there? Yeah, we kind of do. Right, so the, the answer is steak, because steak is delicious.

So women tend to stack, and when you look at eating patterns, they'll have very little protein when they break their fast. Or if they're eating like the Western Standard Western, they'll have cereal or something heavy with carbs that they think is healthy, maybe a little yogurt for breakfast, lunch, they'll have a small little bit of protein. They kind of stack their evening meal with a lot of protein. But again, I mean, the research that I quote, you really can only process that 30 grams every couple of hours in a sitting, you know, and so, so try to get that 40 or 50 in with your evening meal. Like a big piece of steak, you know, is not your best bet. And I talk to our students about, you know, you really should try to spread that protein out throughout your eating window when you break your fast with each snack, you know, throughout the day. Instead of just like saving it up for that giant, you know, chicken breast.

At night, I'd be like, have a, have steak or chicken at lunch and dinner. And if you do snack between the two. But if you eat an adequate lunch, you probably won't. You're eating one is only eight hours. I mean, maybe, maybe you'd eat three times in there. But it, it, I find a lot of people don't, don't eat enough protein in there. And you, you recommend fatty fish. And I also have recommended fatty fish for a long time. And I stack ranked them with sockeye salmon is the least mercury and other toxins. But since that time, the amount of microplastics in the ocean has gone up a lot. And the amount of mercury has gone up and the amount of thallium has gone up. Although that's more of a kale issue than a fish issue. Are you concerned about the metal and plastic content of fish these days?

So my daughter, who's studying all this in college, is making me very Aware of it because, because I, you know, she talks a lot about, you know, there's farm raised versus, you know, the wild caught and what the potential differences are between the two. Yeah, I think as God intended it, it was an excellent way to eat. But the way that modern fishing practices have, have, you know, turned something that was really, really healthy into something that potentially could be not healthy for you.

And it may not be the fishing practice, it may be the burning of coal and the dumping of sewage in the ocean and really the use of microplastics and plastics everywhere. That's at the root of this. We got to get that stuff out of the ocean. And this goes off a little bit from our main topic. But right now it's safer for the long term environment to burn plastic in a high temperature incinerator than it is to let it degrade into small particles that will end up as part of your cells. And we just haven't faced that as a species. So we keep trying to do all this stuff. No, the plastic in the ocean, put it on a barge and burn it. And yes, there will be some chemical pollution that breaks down with sunlight and air over time. And it's not great. It's just better than letting the plastic itself be in our, in our bodies. So I, I am, I've moderated my fish consumption in favor of ruminant animals, basically cows and sheep and, and clean pigs when you can find them.

So are you supplementing with any of the Omega 3s or do you feel like you're getting enough?

But, and they have to be animal based or possibly some algae because the omega 3s from plants, they convert at a ratio of 45 to 1. You can't get enough omega 3s from olive oil or some kind of flax or whatever. So yeah, I take herring egg oil, which is best, or krill oil as my primary too. And those are low in microplastics just because of the nature of what they are.

Okay, interesting.

But it's a question for you, like in, in your audience with perimenopausal and menopausal women. Yes, you need the Omega 3s, but then it, like if you get the mercury, you know, how do we balance it out? I don't know the right answer. I take chlorella when I eat fish because it binds to mercury. But I, I'm just asking you as a doctor who sees a lot of people, what do you do? Because I don't really know.

Yeah, I try to stick to, to more things that are coming out of lakes, you know, as much as possible and locally caught. Luckily, I live on an island and you know, the fishermen are coming right up here. But I do recommend supplementation quite a bit for it.

Okay, so you tell people to take omega 3s, which is, which is really cool. Interestingly, earlier you mentioned Mark Matson and he's actually been on the show too in episode six 34.

I'm like a geeked out fan. He just changed my life and I just think he's incredible. Read all his papers.

It's incredible how much good research there is around all this stuff out there. So I'm always grateful to be able to shine a light on people who are are coming up with either easy ways to teach something or just new knowledge. And your Galveston diet book, I mean, you wrote it for a very specific audience. Women who are going into perimenopause and menopause. And you've got some really new cutting edge info in it which I think is really valuable, especially around these compounds that drive hunger. I know when I was obese I had actually less testosterone than my mom in my early 20s. And I had these profound cravings and, and obesity and feels when I talk with someone going through perimenopause who had control of her body. And all of a sudden it's like, I don't know why I gained this weight. I'm really frustrated. I've tried hormones, I've tried all these different things and I feel like your book is going to be really contributing to that, that set of knowledge because the fact that I had these cravings and sometimes I gave into them, it wasn't a moral weakness. And we're taught that it's just because it's a lack of discipline. It's not, it just isn't. It's biochemistry. It's a hardware problem and it's hackable. And when you do it, you can get through menopause. It just takes sometimes a monthly tuning and tweaking because the changes are so constant. And this is why so many of my friends who are going through perimenopause are dealing with it. And some just are lucky. They have few symptoms. The ones who have a lot of symptoms, they go really deep. I think if they'd have read your book at the start, it probably would have saved them a lot of adjustments, a lot of work. And so you've, you've done a great service to women. So thank you. Your website, galvestondiet.com correct. And thank you, Mary Claire, for being on the show.

Thanks for having me.

If you or someone in your life is either going through or about to go through perimenopause, it would be a really good idea to pick up the Galveston Diet and give it to them. And you do that because you if it's you, well, you should read it yourself. But the the women in your life, it happens, and usually they emerge at the other side with this weird thing called wisdom. But it can be a really, really painful and extended period. It doesn't have to be be. And it's not just painful and extended for the person who's directly affected. Everyone around them is affected too. Just like if you had a headache all the time and felt bad all the time, you wouldn't show up as the best version of yourself. So since this is treatable and it's largely avoidable, especially if you get set up for success ahead of time, that's why this book matters. And it's it's a very important topic. We need more of this in the world. So thanks again, Marie Claire guys. Buy the book. You're listening to the Human Upgrade with Dave Asprey.

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