Huberman LabHow to Navigate Menopause & Perimenopause for Maximum Health & Vitality | Dr. Mary Claire Haver
EVERY SPOKEN WORD
150 min read · 30,257 words- 0:00 – 2:04
Dr. Mary Claire Haver
- AHAndrew Huberman
(instrumental music) Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Mary Claire Haver. Dr. Mary Claire Haver is a board-certified OB-GYN and an expert in perimenopause, menopause, and all aspects of female-specific health. During today's episode, Dr. Haver explains exactly what perimenopause and menopause represent in terms of their underlying psychology and biology and the specific actions that all women can and should take in order to navigate these stages in optimal health. She also describes the things that all women should know and do long before perimenopause arrives in order to best navigate perimenopause and menopause once they arrive. We discuss specific nutritional practices, supplementation practices, as well as conversations that you should have with your mother and with your physician, in particular your OB-GYN, not just as perimenopause and menopause approach, but at every developmental stage. A fair amount of our discussion centers around hormone replacement therapy, not just for estrogen, but for testosterone in women as well, and the many misconceptions and controversies that exist around hormone replacement therapy for menopause. Dr. Haver explains how the specific timing in which hormone therapy is initiated plays a key role in whether or not the hormone therapy is beneficial for women or not. And of course, today's discussion gets into ways to offset some of the more common difficulties associated with menopause, including sleep issues, hot flashes, inflammation, and more. By the end of today's episode, you will have a clear picture from Dr. Marie Claire Haver about what perimenopause and menopause actually represent, the best way to approach perimenopause and menopause, and the various considerations around hormone therapy and lifestyle choices that can allow any woman to approach the years of perimenopause and menopause and beyond with the utmost vitality and
- 2:04 – 6:26
Sponsors: AeroPress, Eight Sleep & BetterHelp
- AHAndrew Huberman
wellness. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is AeroPress. AeroPress is like a French press, but a French press that always brews the perfect cup of coffee, meaning no bitterness and excellent taste. AeroPress achieves the perfect cup of coffee because it uses a very short contact time between the hot water and the coffee. The entire thing takes only about three minutes. I started using an AeroPress over 10 years ago. I first learned about it from a guy named Alan Adler. He's a former Stanford engineer and inventor. He developed the Aerobie Frisbee, which I believe still holds the Guinness Book of World Records for the furthest thrown object. In any event, I'm a big fan of Adler's inventions. So when I heard he developed a coffee maker, the AeroPress, I tried it and I found that indeed it makes the best possible-tasting cup of coffee. And I'm not alone in my love of the AeroPress coffee maker. With over 55,000 five-star reviews, AeroPress is the best-reviewed coffee press in the world. AeroPress also just released a new AeroPress tumbler that makes brewing coffee when traveling or anywhere incredibly easy. This new AeroPress Go Plus is incredible. It's super compact, easy to clean, and you can use it anywhere. All you need is hot water and some coffee. And again, it's very easy to clean up. Also, with Father's Day coming up, it makes for a terrific Father's Day gift. If you'd like to try AeroPress, you can go to aeropress.com/huberman, get 20% off. AeroPress currently ships in the USA, Canada, and to over 60 other countries around the world. Again, that's aeropress.com/huberman. Today's episode is also brought to us by Eight Sleep. Eight Sleep makes smart mattress covers with cooling, heating, and sleep-tracking capacity. Now, I've spoken many times before on this podcast about the critical need for us to get adequate amounts of quality sleep each night. One of the best ways to ensure a great night's sleep is to control the temperature of your sleeping environment, and that's because in order to fall and stay deeply asleep, your body temperature actually has to drop by about one to three degrees. And in order to wake up feeling refreshed and energized, your body temperature actually has to increase by about one to three degrees. Eight Sleep makes it incredibly easy to control the temperature of your sleeping environment by allowing you to program the temperature of your mattress cover at the beginning, middle, and end of the night. Eight Sleep also tracks your sleep with very high precision. It will tell you how much slow-wave sleep you're getting, how much rapid eye movement sleep you're getting, each of which is critical for different aspects of physical and emotional recovery during sleep, and that allows you to dial in the exact temperature parameters to really ensure that you get the best possible night's sleep. I've been sleeping on an Eight Sleep mattress cover for well over three years now and it has completely transformed my sleep for the better. Eight Sleep recently launched their newest generation pod cover, the Pod 4 Ultra. The Pod 4 Ultra has improved cooling and heating capacity, higher-fidelity sleep tracking technology, and it also has snoring detection that, remarkably, will automatically lift your head a few degrees to improve your airflow and stop your snoring. If you'd like to try an Eight Sleep mattress cover, you can go to eightsleep.com/huberman to save $350 off their Pod 4 Ultra. Eight Sleep currently ships to the USA, Canada, UK, select countries in the EU, and Australia. Again, that's eightsleep.com/huberman. Today's episode is also brought to us by BetterHelp. BetterHelp offers professional therapy with a licensed therapist carried out completely online. I've been going to therapy for over 30 years. Initially, I didnDelighted
- 6:26 – 9:50
Menopause, Age of Onset
- AHAndrew Huberman
to have you here and to learn about menopause and other aspects of women's health. There's a lot happening in this area right now-
- MHDr. Mary Claire Haver
Yeah.
- AHAndrew Huberman
... and you are at the center of what I understand is a new direction for the understanding and treatment of menopause-
- MHDr. Mary Claire Haver
That's what we hope.
- AHAndrew Huberman
... and related themes, like perimenopause-
- MHDr. Mary Claire Haver
Yeah.
- AHAndrew Huberman
... and the many important aspects of female health that stem from it, like cardiovascular disease, osteoporosis-
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
... and so on. So we will get into all of that today, but just to kick things off, how do we define menopause?
- MHDr. Mary Claire Haver
So the medical definition of menopause, which I have a huge problem with, is one year after the final menstrual period. And the reason why I have a problem with it is not everyone has a menstrual period. What if you've had a hysterectomy? What if you have an IUD? What if you've had an ablation or something that's suppressing your periods, PCOS? So for a lot of women, and even clinicians, they are struggling to, like, find that diagnosis because it doesn't fit everything. What it represents is something much bigger. Menopause is also one day of your life. It is that one day exactly one year after your last period. But it represents the end of your ovarian function. Some of us call it ovarian failure, ovarian senescence, but basically, what separates males and females is... Many things separate us, but in my world, um, we are born with all of our eggs. We have 1 to 2 million at birth. By the time we're 30, most of us are down to about 10%, maybe 120,000. By the time we're 40, we're down to 3% of our egg supply, and the quality is declining as well. So menopause is when you have no more eggs left and therefore no more sex hormone or very little sex hormone production from the ovaries. So estradiol levels will decline less than 1% of your reproductive years. Your progesterone levels will decline as well. Testosterone declines for sure, but we have other ways to produce it so it's somewhere 50% or less than your healthiest years.
- AHAndrew Huberman
So is it fair to say that we need a redefinition of what menopause is?
- MHDr. Mary Claire Haver
I think so. I think defining it as the presence or absence of a period is a mistake.
- AHAndrew Huberman
Is there any consensus about the, quote unquote, "typical" age of onset for menopause, and is it changing? You know, I hear a lot about how the onset of puberty is shifting earlier-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... in females, and given that puberty, at least by some definitions, relates to the onset of menses, uh, one could imagine that menopause would be shifting earlier as well.
- MHDr. Mary Claire Haver
So the things that determine when we have puberty or not are different than the things that determine when we run out of eggs. Um, right now in the US, it's the average age of that one year after your cycle, so menopause, that one day, is about 51 to 52 years old. However, normal is still 45 to 55 and there's a big variation. You know, that curve's pretty wide.
- AHAndrew Huberman
Mm-hmm.
- MHDr. Mary Claire Haver
Um, perimenopause begins 7 to 10 years before that last menstrual period.
- 9:50 – 14:42
Perimenopause, Hormones & “Zone of Chaos”
- MHDr. Mary Claire Haver
- AHAndrew Huberman
Wow. Okay. And I say wow because, um, it's the first time I've ever heard a, a specific number tacked to this word-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... perimenopause. Maybe we could talk a little bit about perimenopause-
- MHDr. Mary Claire Haver
Sure.
- AHAndrew Huberman
... since it sounds like it represents a transition phase-
- MHDr. Mary Claire Haver
Yeah.
- AHAndrew Huberman
... into, uh, official menopause-
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
... um, however one chooses to define that. What are some of the, I don't know if I should call them symptoms-
- MHDr. Mary Claire Haver
Sure.
- AHAndrew Huberman
... or I should, uh, just-
- MHDr. Mary Claire Haver
Well, let me, let me do, let me walk you through the endocrinology-
- AHAndrew Huberman
Mm-hmm.
- MHDr. Mary Claire Haver
... and then we can go through symptoms so you understand.
- AHAndrew Huberman
Great.
- MHDr. Mary Claire Haver
So in a normal, healthy menstrual cycle before menopause ever becomes an issue, the female hormone cycle is a very EKG-like reproducible monthly rise and fall of estrogen, progesterone, and then the brain hormones LH, FSH, and then GNRH. So the way it works is our brain in the hypothalamus, um, is sensing for, has a little sensor in the blood looking for estradiol levels, and when they get low, it sends GNRH down to the pituitary saying, "Hey, tell the ovaries to start trying to ovulate so we can get more estrogen on board." The process of ovulation is what drives up our estrogen levels, okay? So pituitary sends out this pulses of LH and FSH, which then lead to ovulation. When we reach, in perimenopause, the beginning of perimenopause, that critical level of egg supply, those signals don't work as well. We start becoming resistant to the LH and FSH pulsatile surges. So the brain's like, "Hey, I told you we need more estradiol." And the pituitary is like, "I sent the signal." And the brain's like, "Send more." So we get much higher pulses of FSH, and then finally the ovary kind of, ugh, is able to get that egg out, but sometimes it's delayed. So we have the timing of that monthly predictable cycle goes awry. Sometimes the periods are closer together, sometimes they're further apart, but also the estrogen and progesterone levels start changing dramatically. We see much higher surges of estradiol than we ever had in our preproductive years and then much lower levels underneath. So we end up with this very volatile curve and not predictable at all. We call it, in our world, the zone of chaos. So it is literal hormonal chaos. What used to look like this, you know, every month is now...... just, just insane and very, very, very unpredictable. That is why we don't have a good blood test in perimenopause to make the diagnosis. Those of us in the menar- menaverse use symptoms, usually, to make the diagnosis and we rule out other conditions that might overlap. So perimenopause, basically critical threshold. It's a downward trend overall of estradiol, but it is a very chaotic, you know, race till you flat line and bottom out.
- AHAndrew Huberman
I see. So for those listening, um, your description of the, um, kind of the amplitude of the-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... estrogen surge, it gets much greater-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... in this perimenopause phase. You also mentioned that follicle stimulating hormone, which comes from the pituitary, has to be or somehow is upregulated in this phase because-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... I don't know, is it that the receptors for FSH are somehow not responsive, or ... At the level of the ovary, do we know what's happening to the ovary? Is it obviously the signal's getting there, it's not effective, so then the brain is kicking out more FSH?
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
Is it that the ovary is some-
- MHDr. Mary Claire Haver
So the egg quality-
- AHAndrew Huberman
Mm-hmm.
- MHDr. Mary Claire Haver
... is poor, and then around each germ cell is the theca lutein cells, which is actually where the estradi- the, the whole pathway going from, you know, actually testosterone's converted to estradiol.
- AHAndrew Huberman
Mm-hmm.
- 14:42 – 20:04
Perimenopause, Estrogen & Mental Health
- AHAndrew Huberman
for women who are in the age range of perimenopause-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... or, or who are thinking about this, are there things that they can do in order to either upregulate the sensitivity of the ovary to FSH or to somehow prolong this period of perimenopause? Um, and I should also say, what are some reasons why they would want to do that? Um, you know-
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
... obviously this is part of the, um, of the arc of maturation-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... of the female reproductive axis, but of course, that alone is not a reason to not try and, um, I guess we say optimize it for one's wellbeing.
- MHDr. Mary Claire Haver
So we don't know. When you ... Uh, the best way I can highlight why we don't know or, or where the dollars are going for research, you know, we go to PubMed and you type in the word pregnancy, 1.1 million articles come up. Type in the word menopause, it's down to 97,000.
- AHAndrew Huberman
Really?
- MHDr. Mary Claire Haver
You type in the word perimenopause, and I checked this, like, two weeks ago, and it was, like, 6,400 and something.
- AHAndrew Huberman
Wow.
- MHDr. Mary Claire Haver
Yeah.
- AHAndrew Huberman
That is surprising.
- MHDr. Mary Claire Haver
So-
- AHAndrew Huberman
Or maybe it shouldn't be surprising given what we were just talking about in terms of, um-
- MHDr. Mary Claire Haver
So as far as, like, why those cells are becoming resistant and what's happening at the level of the receptor, I think we need a lot more research in this area. I think it's starting to happen because women are realizing there's a demand now, because the older you are when you go through menopause, the healthier you are for cardiometabolic disease. It's the loss of estrogen that accelerates our path to those diseases.
- AHAndrew Huberman
So are there clinical signs of perimenopause-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... that either directly or indirectly relate to these bigger surges in FSH-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... and these larger amplitude, um, estrogen, uh, surges?
- MHDr. Mary Claire Haver
The, the two best documented and studied are mental health changes. Um, the brain does not like the chaos of ... And, and the neurotransmitters are very, very sensitive to estrogen and progesterone and even testosterone. And so we see aberrations in serotonin, in norepinephrine, and in dopamine as the levels start becoming chaotic. So we have at least a 40% increase of mental health disorders inc- no- and SSRI use doubles across the menopause transition, across perimenopause. And now the data is showing that women who are given hormone therapy in their perimenopause have a lower incidence of new onset depression. And now the neuroscientists are saying, "Hey, for these women who are developing depression in perimenopause, giving them estrogen is better than an SSRI. They're going to have a better outcome."
- AHAndrew Huberman
Yeah, I think most people don't realize how rich the brain and rest of the nervous system are with hormone receptors, in particular estrogen receptors and, as you mentioned, testosterone receptors as well, androgen receptors.
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
Um, and the often direct relationship between estrogen and the neuromodulators such as serotonin, dopamine, epinephrine, acetylcholine.
- MHDr. Mary Claire Haver
And GABA for, for-
- AHAndrew Huberman
Yeah.
- MHDr. Mary Claire Haver
... um, progesterone.
- AHAndrew Huberman
Mm-hmm. Yeah. It's, it's interesting during neural development, which is kind of where I started off, which was, um, neural embryonic development, the hormones exert, you know, these widespread roles in defining even which neurons will express certain neurotransmitters. And then somehow the field of neuroscience has only recently gotten on board the idea that, um, this intimate relationship between hormones and neurotransmitters is something to consider in essentially every aspect of, of brain health.
- MHDr. Mary Claire Haver
Right.
- 20:04 – 25:26
Perimenopause Symptoms; Tool: Lifestyle Factors & Ovarian Health
- MHDr. Mary Claire Haver
similar.
- AHAndrew Huberman
I know we're going to get into actionable tools-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... uh, later as it relates to menopause, but as long as we're discussing this phase of perimenopause-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... uh, what are some of the basic things-
- MHDr. Mary Claire Haver
Sure.
- AHAndrew Huberman
... that women could, A, pay attention to?
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
We don't want to make people hypervigilant to the point of anxiety.
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
But, but, um, certainly given the frequency and given the implications, um, s- it's important for them to pay attention to this phase. And then, some of the things that they can do to, you know, either behaviorally or perhaps through other tools offset, um, some of these changes.
- MHDr. Mary Claire Haver
Sure. Uh, dysfunctional uterine bleeding, um, which is abnormal periods. So, and again, nothing's off the table. It could be heavy periods, menorrhagia, too frequent, too few, skipping. It's really, really chaotic. And, but a lot of women are suffering horribly from really debilitating periods, either through the volume of blood loss or they're having, you know, cramps and, you know, really, and so 90% (laughs) of us will have that s- as a symptom. Um, fatigue is a huge one. A lot of them, the symptoms are kind of vague, you know, and can be attributed to a lot of other things. In our, in my what we call the Menopausy Chat Group, you know, we have a lot of theories about a lot of conditions like fibromyalgia and the irritable bladder syndromes and that probably just perimenopause and menopause, and doctors didn't know how to put th- you know, make that diagnosis. And so, you know, musculoskeletal system takes a huge hit through the transition, so all of a sudden you have no injury and you're having hip pain, joint pain, back pain, with, you know, you go to the doctor and you get an X-ray or you do whatever workup and they can't find anything wrong. Palpitations are huge. It is a vasomotor symptom. So along with hot flashes, palpitations, so a woman will walk into the emergency rooms sweating profusely, horrible palpitations, she's anxiety, and they'll tell her she's having a panic attack. You know, um, they'll work her up, you know, everything's negative, and just say, "Well, it's a panic attack. Go home." And no one knew to connect the dots and figure out that this woman was in her menopause transition and this is how her body was expressing it. It's complicated because we have sex hormone receptors, as you do, in every organ system of our body, and when these levels start going chaotic, it can present in so many different ways. And so when the patients come to me, I'm doing blood work, not a lot of hormone levels 'cause they're not super helpful, but I am doing thyroid workups and autoimmune workups and looking for r- um, nutritional deficiencies and anemia and different things because I don't want to miss those things and just pin everything on perimenopause.
- AHAndrew Huberman
Are there lifestyle factors that can-
- MHDr. Mary Claire Haver
Yes.
- AHAndrew Huberman
... offset some of this?
- MHDr. Mary Claire Haver
It's not a perfect correlation-
- AHAndrew Huberman
Mm-hmm.
- MHDr. Mary Claire Haver
... but the healthier you are, so anti-inflammatory diet, you know, Mediterranean-esque, Alvesson diet-esque, you know, nutrition pattern, um, regular exercise, good sleep habits, you know, all the pillars of health, the healthier you are when you hit perimenopause, the better the course is going to be for you. They're looking at extending the life of the ovary with pharmacology. We know what can shut it down faster, so we have kind of a genetic predetermined age of when you're gonna lose all your eggs, but we can speed that up. So if you smoke, you're gonna go through menopause sooner than your twin would have if she didn't smoke, okay? If you don't have children and you ovulate regularly, then the more you ovulate, the faster you run through your egg supply. Okay?
- AHAndrew Huberman
Interesting. I, I wasn't aware of those data. That's, uh, I don't know that most people are aware of those data.
- MHDr. Mary Claire Haver
No. If you have a hysterectomy and you leave your ovaries behind, I didn't kn- I didn't ever counsel my patients about this. You lose four years off the life of your ovaries. If you have a tubal ligation, you lose a- lose a year and a half. Huge genetic disparities, so African Americans tend to go through a year and a half sooner, and then there's Caucasians in the middle and then Asian fam- tend to go through later and they're not sure why. You know, a year or two years. So, there are, if you have chemotherapy, if you have surgery, if you have any inflammatory process in the abdomen, irritable bowel or endometriosis, you are going to lose some of the life of the ovary.
- AHAndrew Huberman
You mentioned smoking. Are there any data on vaping?
- MHDr. Mary Claire Haver
Not yet. I haven't seen any. There might be out there, I just haven't seen it yet.
- AHAndrew Huberman
No, I'm, I'm guessing, uh, if they're out there, they're not, um, prominent or you would've seen them. I'm curious about vaping because a lot of people are vaping instead of smoking.
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
And hopefully people are neither vaping nor smoking because it seems that, we had an expert on vaping on the podcast recently from Stanford and it seems that, um-There's nothing great about it.
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
And there may be some things really bad about it, but was just curious, given that a number of young women, and men for that matter, are vaping nowadays-
- MHDr. Mary Claire Haver
I think we probably need-
- AHAndrew Huberman
... who, and where smoking rates have gone way, way down.
- 25:26 – 29:42
Early Menopause, Premature Ovarian Failure; Estrogen Therapy
- AHAndrew Huberman
it. So you mentioned, um, rough ages for onset of, uh, menopause, um, 51, but anywhere from 45 to 55.
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
And that perimenopause, uh, is defined as a period about seven years prior to that?
- MHDr. Mary Claire Haver
Seven to 10, yeah.
- AHAndrew Huberman
Okay. Um, what's the earliest you've ever had a patient come in who entered menopause? What's the latest you've ever seen?
- MHDr. Mary Claire Haver
My personal-
- AHAndrew Huberman
Yeah.
- MHDr. Mary Claire Haver
... patient, 27, and she came in just a couple months ago. So she had a special condition we call premature ovarian failure.
- AHAndrew Huberman
Okay.
- MHDr. Mary Claire Haver
And she had found me on social media and wanted to come just to make sure she was doing everything right. And so early menopause is defined as between the ages of 40 and 45, and then premature menopause, or pre- premature ovarian insufficiency, it's not a complete failure for most women, but it is very, very low, is any time before the age of 40. So this patient kind of got kicked around for two years, went to her doctor, no periods, horrible hot flashes. Again, she was 25, and it was not on his radar, and he never tested her for menopause, and it took her, you know, 18 months to get the diagnosis. And so the longer your body is away from estrogen, the higher the risk factor. And it's been all over the news this week, where we know that untreated premature ovarian insufficiency has a earlier death. So they have higher cardiovascular disease, diabetes, stroke, all because estrogen is so protective and they have to go so long without it. We can back, negate most of those risks by giving her aggressive hormone therapy early. So she came in to make sure she was on the right dose (laughs) because in premature ovarian failure, we don't want to give them menopause hormone therapy doses. They're too low. We want to get her more like she would have, which is three to four times the amount of estrogen as a reproductive-aged woman. And so, and she wanted to have a period so she would seem like her friends. You know, it was an emotional thing for her, which I totally respect. And so, um, so we were doing cyclical progesterone for her so that she would have a withdrawal bleed and feel like she was normal.
- AHAndrew Huberman
Basic question, but I, I'm curious, so I'll ask. Um, given that levels of estrogen change so much-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... naturally-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... during the course of the, um, ovulation cycle, menstrual cycle, um, with estrogen therapy, is it a constant dose or it's modulated by-
- MHDr. Mary Claire Haver
Yeah.
- AHAndrew Huberman
... uh, week to week or day to day?
- MHDr. Mary Claire Haver
Good question. So there are some formula, so, and when we look at hormonal contraception, so the, the biggest difference between con- contraceptive doses and menopause hormone therapy doses, they're both based in estrogen and progesterone mostly, okay? The hormone therapy was developed to stop a hot flash. For decades, menopause was defined by the presence or absence of, you know, severe menopause was defined by hot flashes or not. They do, didn't, nothing else. And so they developed the formulations with enough estrogen to stop hot flashes. Birth control was developed to stop ovulation. You don't ovulate, you don't get pregnant. And it's, but the difference between low dose birth control pill and higher dose menopause hormone therapy is not that far away. And so, um, that, a lot of people don't understand. Now, the types of estrogen we use in birth control are a little bit different. Most birth control is ethinyl estradiol, which is one of the synthetics. We have literally millions and millions of womens' year data on it. We know its safety profile. I think we're not counseling patients adequately about birth control as far as what it does to their testosterone and what it can do to, you know, "Oh, it's fine. It's safe. I took it for years." But I think we need to do a better job as a specialty on counseling women. But I do think it's a good medication. And then on menopause hormone therapy, you know, it's much lower dose. It does not suppress ovulation. So in perimenopause, it's a little bit of the Wild West. Which one we're gonna use? How high do we want to go? Do we need to suppress our ovulation because she's got acne or horrible periods or cramps or something where I want to suppress that ovulation to help her? Or can I give her menopause hormone therapy doses, which, in effect, think of the hypothalamus. I'm giving her just enough estrogen to calm the brain down and tell them everything's okay. We're not gonna get those big peaks and drops, and if she still ovulates, that's okay too.
- 29:42 – 31:31
Sponsor: AG1
- MHDr. Mary Claire Haver
- AHAndrew Huberman
As many of you know, I've been taking AG1 for more than 10 years now. So I'm delighted that they're sponsoring this podcast. To be clear, I don't take AG1 because they're a sponsor. Rather, they are a sponsor because I take AG1. In fact, I take AG1 once and often twice every single day, and I've done that since starting way back in 2012. There is so much conflicting information out there nowadays about what proper nutrition is. But here's where there seems to be a general consensus on. Whether you're an omnivore, a carnivore, a vegetarian, or a vegan, I think it's generally agreed that you should get most of your food from unprocessed or minimally processed sources, which allows you to eat enough, but not overeat, get plenty of vitamins and minerals, probiotics and micronutrients that we all need for physical and mental health. Now, I personally am an omnivore, and I strive to get most of my food from unprocessed or minimally processed sources.But the reason I still take AG1 once and often twice every day is that it ensures I get all of those vitamins, minerals, probiotics, et cetera, but it also has adaptogens to help me cope with stress. It's basically a nutritional insurance policy meant to augment, not replace, quality food. So by drinking a serving of AG1 in the morning and again in the afternoon or evening, I cover all of my foundational nutritional needs. And I, like so many other people that take AG1, report feeling much better in a number of important ways, such as energy levels, digestion, sleep, and more. So while many supplements out there are really directed towards obtaining one specific outcome, AG1 is foundational nutrition designed to support all aspects of wellbeing related to mental health and physical health. If you'd like to try AG1, you can go to drinkag1.com/huberman to claim a special offer. They'll give you five free travel packs with your order plus a year's supply of vitamin D3K2. Again, that's drinkag1.com/huberman.
- 31:31 – 38:18
Contraception, Transdermal, IUDs; Menopause Onset, Freezing Eggs
- AHAndrew Huberman
As long as we're on the topic of birth control, earlier you mentioned that the IUD, and presumably this is some form of the IUD, not necessarily copper IUD, can, um, disrupt or stop-
- MHDr. Mary Claire Haver
A period, mm-hmm.
- AHAndrew Huberman
... a, a period. Um, maybe we could talk a little bit about the different forms of birth control.
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
Um, IUD, um, as the pill, quote unquote-
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
... um, old term, but, um, uh, I think most people know what we're referring to when we say that. The ring-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... um, and, and on and on.
- MHDr. Mary Claire Haver
Sure.
- AHAndrew Huberman
Um, what is your stance on, on these different forms of birth control-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... as it relates to their safety? Um, you know, uh, I guess about a year and a half ago, I hosted a, um, a female physician guest on, on this podcast, and both sides of the, uh, birth control issue were touched on. Uh, one, the relationship to, um, potential, um, inhibition of certain forms of cancers, but then also the potential for certain side effects, maybe even cancers. And so it, you know, it seems like it can play out both ways-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... and this is a very heated topic.
- MHDr. Mary Claire Haver
Yeah.
- AHAndrew Huberman
Um, in fact, so much so that I learned that if one is going to post a clip of any of this on social media-
- MHDr. Mary Claire Haver
(laughs)
- AHAndrew Huberman
... it, it almost makes sense to have them-
- MHDr. Mary Claire Haver
It's very-
- AHAndrew Huberman
... in the same post because we actually did both of them. We, we d- did a post where it was more about the, the pros of birth control and then the cons of birth control-
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
... as, as stated through, um, the words of this very same clinician. Um, so we will be sure to, uh... If, so for anyone listening-
- MHDr. Mary Claire Haver
(laughs)
- AHAndrew Huberman
... whichever answer comes first, stay tuned for the next answer (laughs) because, um, my understanding is that it's not a black and white issue.
- MHDr. Mary Claire Haver
I think the best form of birth control is a vasectomy, and so much of contraception is dumped in a female's lap, you know, in a committed relationship. And I can't tell you the comments I've heard when, uh, w- a patient comes to me and she wants to get X, Y, and Z simply for contraception. She's absolutely perfectly healthy. There's nothing wrong with her. She just doesn't want to be pregnant. And I'm like, "Okay, you're done ha-" you know, she's completed her family. She's out, you know? And I'm like, "Tell your partner to get a vasectomy," oh, he won't do that, you know?
- AHAndrew Huberman
Mm.
- MHDr. Mary Claire Haver
So now all of the risk and the onus goes on her, and so we, we go through the options of surgical, like, you know, tubal ligation, um, which is basically blocking the tube. So when I, you know, talk to my teenagers, I'm like, "Here's how you not get pregnant. A, you don't have sex." Well, if that's not an option, then we have to either block the sperm, stop the egg from coming out, or stop the place where they communicate, which is the fallopian tube. And so when we look at the different forms of hormonal contraception, which are meant to stop ovulation, suppress ovulation, because they're telling the brain, "We have enough estrogen and progesterone onboard. Quiet down so it doesn't send those signals to the ovary," right? And so that can come in a pill form, a patch form, a ring form, and they each have their own pros, cons, risks, benefits. You know, transdermal has less risk of blood clots versus oral has a higher risk of blood clotting, any form of estrogen. So we talk about that. We look at their family history or if they have MTHFR, any of the clotting genes, you know, then we counsel directly versus the IUD. The IUDs create an, an inflammatory environment in the uterus that blocks and i- creates a plug in the cervix so that the sperm can't get through, and then if any do get through, it's a toxic environment in the uterine cavity for the sperm. So that's really how the I- those IUDs work.
- AHAndrew Huberman
Mm-hmm.
- MHDr. Mary Claire Haver
Some IUDs are coated with progesterone or progestin, not progesterone, a progestogen, and those end up decidualizing the endometrium so thinning that lining from that constant progesterone to the point where you stop bleeding. So a lot of my patients really loved that option of being amenorrheic, no periods, just for the convenience of it. But they were still ovulating in the background, so we're not suppressing their natural cycles, just their periods.
- 38:18 – 45:01
Women’s Health: Misconceptions & Research
- MHDr. Mary Claire Haver
- AHAndrew Huberman
Okay, just wanna make sure we're crystal clear for people.
- MHDr. Mary Claire Haver
(laughs)
- AHAndrew Huberman
You're being very clear, but I, I wanna make sure that I'm clear on it and then reiterate because this can be, um, uh, kind of tricky territory. I think there, there are a lot of assumptions about this stuff, and there's a lot of lore out there. What, why do you think that is? Is that because of the lack of solid research and communication in this area?
- MHDr. Mary Claire Haver
I think so.
- AHAndrew Huberman
Or, or is it something else? You know, I, I, I think that these are, um, tricky topics for, for, uh, discussion often because, uh, w- we hear all this stuff, like birth control pills disrupt one's ability to get pregnant when they come off or, or it, we just learned that it can delay the onset of perimenopause, which, by extension, means there's a greater window for pregnancy if one, um, thinks about it that way. But, uh, why do you think it's, it's so, um, such a tangled discussion out there?
- MHDr. Mary Claire Haver
I think just the way that society views pregnancy and female health, and you know, at least, you know, I live on the internet now. You know, this new life has brought me life on the internet and this, what the algorithms-
- AHAndrew Huberman
Welcome.
- MHDr. Mary Claire Haver
... are showing me. (laughs) Yeah.
- AHAndrew Huberman
(laughs) It's a very friendly... They... Everyone's super... No, it's-
- MHDr. Mary Claire Haver
Everyone loves you, every, yeah. (laughs)
- AHAndrew Huberman
It's a, it's a great... Listen, it's... What you're doing, um, is so important.
- MHDr. Mary Claire Haver
Yeah.
- AHAndrew Huberman
And, uh, I understand the, the statement behind that statement, I, I think. Um, but it's so important because it, people are getting the opportunity to learn about really critical public health-
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
... and female health issues, um, in a way that just was inaccessible before.
- MHDr. Mary Claire Haver
Yeah, it is. And I, I... It's good and bad. You know, there's a lot of lore and misinformation that's getting propagated, and I feel like as a specialty, you know, as a women's health specialist, we did this to ourselves. You know, we have not properly educated ourselves. We have not spent the money, the research, really, you know, championed women after reproduction. When you look at the dollars and, and the research and where it goes in women's health, I mean, women's health just gets a little sliver of all the NIH funding. When you look at all NIH funding and what goes to menopause, it's 0.03%.
- AHAndrew Huberman
Unbelievable.
- MHDr. Mary Claire Haver
Less than half a percent, and this is one-third of a woman's life. And when you look at... God, McKinsey & Company just, just published, um, a report where they pulled 680 studies on, like chronic diseases, diabetes, hypertension, cardiovascular disease, and they looked at how... They had... There were women included in the studies, but how many presented the data for the different sexes, like what happened in men versus what happened in women. It was only 50%-
- AHAndrew Huberman
Hmm.
- MHDr. Mary Claire Haver
... of the articles actually did sex-specific differences in how this medication affected this process or whatever. And then of the ones that did, 30% of women had poorer outcomes. And, and the other, and on the flip side, 10% of men had poorer outcomes. And these things aren't just being brought to light. So the, the lack of recognition of sex-specific differences in chronic disease and how menopause kind of plays into all that I think is where the future needs to go. So we deserve as much good health as everyone else, 'cause yes, we're living longer than men, but 20 to 25% of that life is in poorer health.
- AHAndrew Huberman
Wow, that's a, a really significant statement. I mean, I think that the National Institutes of Health has been terrific in establishing new institutes-
- MHDr. Mary Claire Haver
Yes.
- AHAndrew Huberman
... within it. Um, they even have a complementary health institute now.
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
There's the, the National Eye Institute. There's the, you know, cancer, urology. Um, is there a plan or one would hope for a dedicated institute for-
- MHDr. Mary Claire Haver
There's a-
- AHAndrew Huberman
... women's health?
- MHDr. Mary Claire Haver
... push.
- AHAndrew Huberman
Mm-hmm.
- 45:01 – 48:31
Tool: Diet, Preparing for Peri-/Menopause; Visceral Fat
- AHAndrew Huberman
- MHDr. Mary Claire Haver
(laughs)
- AHAndrew Huberman
Getting back to, um, kind of things that people can control-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... so for people who are heading into perimenopause-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... or who are in the perimenopause phase, um, aside from the, the typical things that we hear about, fortunately, a lot these days, like getting adequate sleep-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... um, getting exercise-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... um, nutrition, maybe we could touch a little bit on nutrition in a moment.
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
You mentioned Mediterranean diet, Galveston diet, um, things that are going to promote overall health.
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
Um, are there any things that people can do, maybe even take, that would improve, uh, their outcomes in this phase? Like I, I've heard of people, and b- I have no bias here or even knowledge-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... of the research on this, if there is any, of people taking, for instance, grape seed extract or people trying to do a number of things to reduce inflammation, kind of general themes around, um, self-care and wellness these days. But what are sort of the five or six that come to mind, um, perhaps as, like, the things that can move the levers in the right direction?
- MHDr. Mary Claire Haver
What I would tell my 35-year-old self, you know, who just kind of went into this obliviously and what I know now is, your diet is probably one of the most important things that determines your level of inflammation. And then estrogen is a really powerful anti-inflammatory hormone, and we lose that protection when we go th- we start losing it through the transition. So whatever you can do in the other areas, especially with nutrition, sleep, stress reduction, we need to do it. So fiber, we are not getting enough fiber in our diet. In the Western diet, I think it's most women are getting 10 to 12 grams per day, and we need at least 25. And the health benefits tend to max out around 30, 32 grams per day. So focusing on foods that are rich in fiber. Fiber's feeding the gut microbiome, slowing down glucose absorption, you know, glucose levels, uh, sugar absorption into the bloodstream. It is slowing down the rate of, you know, certain parts of transit and pulling more water into the gut, and, like, there's nothing bad about it, right? The foods that are rich in fiber have a lot of other stuff that's good for you too, cofactors, vitamins, minerals, nutrient- you know, just, they're just so healthful. Um, and then anthocyanins, you know, just find things that crunch, that are g- and get as many colors as you can, you know, green, red, purple, yellow. Every color represents a phytochemical that is going to be good for you in, uh, different areas of your body and try to keep it as varied as possible. Um, we're not getting enough protein, and I have to thank Dr. Gabrielle Lyon, you know, really helping me focus in on that. You know, when I first wrote Galveston Diet, to be honest and transparent, it was for weight loss. And, you know, I was frustrated with my weight gain, and I- that was the pain point my patients had, and that was my pain point. But I didn't realize it represented something much more sinister than, than just the way I looked, you know, the visceral fat gain. And so, uh, learning about visceral fat and what it really means, and that is, for your listeners, the fat that wraps around our internal organs. It's a very different fat than the subcutaneous fat. And, you know, a premenopausal woman, so we age matched and looked at visceral fat levels, measuring it with the, uh, um, DEXA scanners. You have a- about 8% of your fat is visceral as a premenopausal person, and then when you go through the transition, it's 23%-
- AHAndrew Huberman
Wow.
- MHDr. Mary Claire Haver
... with no changes in diet and exercise.
- AHAndrew Huberman
The, uh, visceral fat is not something that gets enough attention.
- MHDr. Mary Claire Haver
No.
- AHAndrew Huberman
I think everyone thinks about subcutaneous fat-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... because of its relationship to aesthetics.
- MHDr. Mary Claire Haver
It's cosmetically distressing, but really, yeah. Like ... (laughs)
- AHAndrew Huberman
Um, and one doesn't want too much of it for health reasons eith- either, but the-
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
... it's the, um, intraviseral fat that, at least by my understanding, is, is really, uh, the most problematic for-
- MHDr. Mary Claire Haver
Yes.
- 48:31 – 51:42
Tools: Body Composition, Muscle & Menopause, Protein Intake
- MHDr. Mary Claire Haver
...
- AHAndrew Huberman
I read that weight gain is one of the primary symptoms of menopause itself.
- MHDr. Mary Claire Haver
Yeah. So it's- you have to be careful how you think about that. When we, when we plot weight gain versus age, it's a very straightforward linear curve, and menopause does not seem to affect that. What is happening is a body composition change. We are losing muscle, and we are gaining...... visceral fat. And so, and you might be gaining some c- subcutaneous fat, but those are kind of the key things that are happening. And so that's really, when I'm counseling patients, what I'm focusing on. 'Cause I have a body scanner in my office where I can tell them what their level of visceral fat is and their muscle mass. And so we, bone and muscle, that musculoskeletal unit works together. And so we see this acceleration of muscle loss, which controls our basal metabolic rate, which determines our resistance to insulin, which, you know... So it's just, that's the l- eh, the organ of longevity. That's what I've learned from Dr. Lyon, you know, and everything we can do to hang onto it and build is so important. So protein, going back to the original point, protein intake is key. And women, by and large, are getting 50 to 60 grams of protein per day, and we really probably need 80, 100, 120 depending on our body composition.
- AHAndrew Huberman
Yeah, thanks for mentioning Dr. Gabrielle Lyon. She's doing what I view as just, just-
- MHDr. Mary Claire Haver
Beautiful work in the world.
- AHAndrew Huberman
Yeah, terrific work, really promoting women's health and health generally. I know she's now, I believe, is exploring, um, advanced training in, uh, in urology-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... for males as well.
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
And, um, so, you know, it's, um, it's, it's only fair to, to credit her with, with really expanding into these different areas, but especially this idea that we need, and women perhaps in particular, from what I understand of, um, she'll be on the podcast soon, so we'll get more of a, uh, of an understanding, at least one gram of quality protein per pound of lean body mass, maybe even per pound of body weight per day in order to optimize their, their health.
- MHDr. Mary Claire Haver
Yeah. She's, she's definitely on the higher end. You know, the WHI, the Women's Health Initiative, some of the, my favorite data, you know, it's not all bad, it's data, and was looking at frailty scores and protein intake in women. And what they found was women who were having 1.5 to 1.7, so basically it was the higher their protein intake, the less likely they were to be frail. The end. And it was, you know, they were reaching, it was kind of peaking out somewhere around 1.5 to 1.7 grams for kilogram of lean body mass. And most women are getting around, you know, the FDA recommends .8.
- AHAndrew Huberman
Wow. And source of protein, also important, high quality.
- MHDr. Mary Claire Haver
Right, right.
- AHAndrew Huberman
Yeah, yeah, yeah.
- MHDr. Mary Claire Haver
You need all the amino acids. Yeah.
- AHAndrew Huberman
Very interesting. Um, now that's in menopause, but presumably also-
- MHDr. Mary Claire Haver
So starting those habits in peri-
- AHAndrew Huberman
Mm-hmm.
- MHDr. Mary Claire Haver
... just getting that laid down and getting those habits laid down are gonna set you up for a much better post-menopause, a much healthier post-menopause. And we have to stop defining menopause by your hot flashes, you know? It may or may not make your hot flashes better, and we have great medications for that if it's disruptive. But I'm talking about your, your cardiometabolic disease risk.
- 51:42 – 58:22
Menopause: Genetics, Symptoms; Tools: Waist-to-Hip Ratio; Gut Microbiome
- MHDr. Mary Claire Haver
- AHAndrew Huberman
I meant to ask this earlier, so forgive me for, for leaping back briefly, but is there any value in knowing the age at which your mother-
- MHDr. Mary Claire Haver
Yes.
- AHAndrew Huberman
... went into menopause-
- MHDr. Mary Claire Haver
Tremendous genetic-
- AHAndrew Huberman
... as a metric-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... uh, or a sensor rather, uh, for, or a, as a window into whether or not you will go into menopause at more or less the same age?
- MHDr. Mary Claire Haver
Yes. There is a, of course it's not one-to-one. We get half of our DNA from our fathers. So, but I always ask, and there is a d- you know, acc- the latest data that looked at it, genetics is the biggest factor that determines when you're gonna go through menopause. So knowing when your mothers, your aunts, you know, went through and if there were any medical conditions associated with that is huge.
- AHAndrew Huberman
Okay, so now we're talking not so much about perimenopause, but also menopause itself.
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
What is the typical constellation of symptoms as one enters menopause? Like right at the beginning.
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
And then does that constellation of symptoms change as one is, you know, a year, two years, three years into menopause?
- MHDr. Mary Claire Haver
So it's almost 100% with body composition changes, like very, very close. You know, that visceral fat is tough to beat. It's beatable, but it takes a lot of work, you know?
- AHAndrew Huberman
Do people know if they have visceral fat? I mean, there's, there are scanning approaches to-
- MHDr. Mary Claire Haver
So-
- AHAndrew Huberman
... to look at it.
- MHDr. Mary Claire Haver
... gold, you know, of course the gold standard is a DEXA or even an MRI, but w- no one can afford that. So we have in, like what I have a- um, in my office is the InBody scanner. So it's electrical impedance scanner and it's, it's pretty good.
- AHAndrew Huberman
So you stand on the scale, hold the handles.
- MHDr. Mary Claire Haver
And we hold, I have the medical-
- AHAndrew Huberman
Okay.
- MHDr. Mary Claire Haver
... I have the highest grade one-
- AHAndrew Huberman
Mm-hmm.
- MHDr. Mary Claire Haver
... for my patients. Um, and most people doing what I do, you know, utilizing a body scanner, use that one. Um, but you can use the waist-to-hip ratio. And so the waist-to-hip ratio is a better measure of your risk of metabolic health than your weight or your BMI. So it's so simple. You take a tape measure and a calculator, or you can do it in your head, but you measure the smallest part of your waist, and if you don't have a small waist, if it goes out, then just use your belly button. Just use something you can measure again.
- AHAndrew Huberman
Are people sucking in or are they relaxed?
- MHDr. Mary Claire Haver
You should be relaxed.
- AHAndrew Huberman
Okay.
- MHDr. Mary Claire Haver
And I tell my patients, you know, "Do it first thing in the morning when your bladder's empty and you're not bloated and, you know."
- AHAndrew Huberman
Mm-hmm.
- 58:22 – 1:05:18
Galveston vs. Mediterranean Diet, Fasting, Tool: Building Muscle
- MHDr. Mary Claire Haver
- AHAndrew Huberman
What's the difference bet- between the Mediterranean diet and the Galveston diet?
- MHDr. Mary Claire Haver
So when I... So I w- got my culinary medicine certification. I was frus-
- AHAndrew Huberman
Culinary medicine?
- MHDr. Mary Claire Haver
Yeah. So I was frustrated in, when I was working, because I didn't know anything about nutrition and suddenly, like, everything I was trying to tell my patients was based on, like, the one lecture I got in medical school and, you know, good nutrition was like porn. You know it when you see it, you know, the Supreme Court definition of pornography. And so, you know, the best I'd ever gotten was the gestational diabetic diet and it was this Xeroxed things with, you know, I was in the deep ... I was in Texas so it had, like, tortillas and stuff on it and, and it had been copied so many times you could barely read it anymore and that was the diet we would ha- that was the only nutrition I'd ever, like, handed to a patient. And so I'm like, "Eat healthy." And so I'm like, "I gotta do better than this. I don't know enough." And so we had a guest speaker for AO- uh, Alpha Omega Alpha, which is the honor society for medical school and I was one of the advisors so ... And it was this guy, Tim Harlan, who had started this culinary medicine movement and it was basically nutrition for doctors (laughs) . And he developed this, like, online program and I had to go to New Orleans for a lab, in San Antonio for a lab, and work in kitchens where you were learning how to counsel patients, how to cook, and also basically, like, getting a little minor in nutrition. Um, so it was the best thing I've ever done.
- AHAndrew Huberman
Yeah. I was gonna say very cool what-
- MHDr. Mary Claire Haver
I mean, I learned about allergies and, like, all this stuff, you know, food allergies and things that I just didn't know and just basic nutritional principles like what it takes to build a healthy body and, and what ... You know, I knew about kwashiorkor and, like, severe deficiencies but not good basic nutrition.
- AHAndrew Huberman
Mm-hmm.
- MHDr. Mary Claire Haver
And so, you know, they talked heavily about Mediterranean and they talked a lot about the fad diets and stuff but, you know, the principles of the Mediterranean, I was like, "I want to teach this to my patients but they're not gonna eat a lot of, um, greek yogurt or they're probably not gonna eat a lot of feta." You know, like, "How can I kind of take these blocks and make it more Americanized?" So that was kind of like the brainchild for me around Galveston Diet was let me, like, create something and I really was into fasting at the time too so I was like, "Let me put this fasting thing together with, you know, good nutritional anti-inflammatory principles and talk about the things we know are probably you should, you know, not having a whole lot of, you know processed foods and high sugars and stuff and, and explain it in a way and how it's affecting their menopause and, like, how can she approach her nutrition?" And that's how Galveston Diet was born. It was for my patients and then I gave it to my girlfriends and then they started sharing it and I talked about it one day on Facebook and the world exploded.
- AHAndrew Huberman
In the best way.
- MHDr. Mary Claire Haver
In the best way. (laughs) Yeah. It led me here.
- AHAndrew Huberman
Right.
- MHDr. Mary Claire Haver
So-
- AHAndrew Huberman
Right. Um, and we all benefit. W- what is the evidence that-... fasting can be beneficial or detrimental-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... to, um, perimenopause and menopause.
- MHDr. Mary Claire Haver
Yeah. So, the jury's kind of still out on that one. I was a re- really liked the data that, you know, uh, I think it was Mark Mattson had done on neurodegenerative disease and, and using fasting as a tool there in lowering inflammation levels. So I was like, "This is amazing. This is great." Because so much about menopause is pro-inflammatory, you know?
- AHAndrew Huberman
I- is this intermittent fasting?
- MHDr. Mary Claire Haver
Intermittent fasting, yeah.
- AHAndrew Huberman
So time-restricted feeding?
- MHDr. Mary Claire Haver
So he was basically doing 16:8, you know?
- AHAndrew Huberman
Mm-hmm.
- MHDr. Mary Claire Haver
And, uh, you know, very scheduled intermittent fasting. And so, that was something I was coaching my followers about. You know, "Consider this. Try this. This would- might be something to help lower inflammation." I pulled back on that because it's really hard to get enough protein in for a lot of, of women, especially if they came in at 60 and now I'm telling them to double their protein, you know, and then giving them an eight-hour window to do it. They're like, "I'm walking around gnawing on a chicken breast all day."
- AHAndrew Huberman
Right.
- MHDr. Mary Claire Haver
You know?
- AHAndrew Huberman
Right, right.
- MHDr. Mary Claire Haver
This is hard. And-
- AHAndrew Huberman
Right. And m- metabolizing protein is its own work.
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
Okay.
- 1:05:18 – 1:06:29
Sponsor: InsideTracker
- MHDr. Mary Claire Haver
that.
- AHAndrew Huberman
I'd like to take a quick break and acknowledge our sponsor, InsideTracker. InsideTracker is a personalized nutrition platform that analyzes data from your blood and DNA to help you better understand your body and help you reach your health goals. Now, I've long been a believer in getting regular blood work done for the simple reason that many of the factors that impact your immediate and long-term health can only be analyzed from a quality blood test. Now, a major problem with a lot of blood tests out there is that you get information back about metabolic factors and hormones and lipids and so forth, but you don't know what to do with that information. With InsideTracker, they make it very easy to know what to do with those numbers because they have a personalized platform that allows you to see the levels of those metabolic factors, lipids, hormones, et cetera, and they give you specific directives that you can follow related to nutrition, behavioral modification, supplementation, and more that can help you bring those numbers into the ranges that are optimal for you. If you'd like to try InsideTracker, you can go to insidetracker.com/huberman to get 10% off their new membership program. InsideTracker membership offers significantly reduced prices on InsideTracker's comprehensive blood panels. Again, that's insidetracker.com/huberman to get 10%
- 1:06:29 – 1:15:36
Hot Flashes; Estrogen Hormone Replacement Therapy (HRT), Breast Cancer Risk & Cognition
- AHAndrew Huberman
off. So, um, what are some other symptoms of menopause? You, you, you mentioned body composition changes.
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
Uh, the one that we hear about the most, for s- some reason, I don't know, is hot flashes.
- MHDr. Mary Claire Haver
Yeah, so, so I think-
- AHAndrew Huberman
So, so maybe we could define-
- MHDr. Mary Claire Haver
... hot flashes, um ... So in medicine, we call it a vasomotor symptom. So we have a, a dysregulation of the thermoregulatory center in the hypothalamus, and that, that g-... the, the way- the thermostat gets reset, basically. And so what happens is we have this vasodilation of, it starts in the core typically for most women, somewhere in the chest/neck area, and you feel this heat. You know (laughs) , I can probably trigger one just by talking about it. Um, and it, it goes up into the neck and out into the extremities, and then you just start profusely sweating from all the blood vessels dilating, and then it can last minutes to a second. But for some women, it's preceded by sometimes palpitations, sometimes by this intense feeling of, of dysphoria, you know, this intense sadness feeling, and then it, and then it just kind of passes. But, you know, say you're, you know, wherever you are in your life, whatever you're doing, all of a sudden you're just, like, sweating profusely in the middle of some important area of your life, work, you know, whatever your jobs are in your life, and it's disruptive. If it happens at night, you don't sleep. And for some women, it's severe where they're having multiple ones a day.
- AHAndrew Huberman
And when, anytime you disrupt sleep, then daytime is far worse.
- MHDr. Mary Claire Haver
Yeah.
- AHAndrew Huberman
It, regulation of everything. Yeah.
- MHDr. Mary Claire Haver
You eat differently. You, yeah, you stress differently.
- AHAndrew Huberman
Yeah.
- MHDr. Mary Claire Haver
You, you know, everything changes, and so when my patients come in, the first questions we ask are sleep, and that's the first thing we work on is, is, you know, "What can we do to get your sleep better?"
- AHAndrew Huberman
What can be done for hot flashes, aside from the things that you've already described, to offset menopause and bring menopause itself?
- MHDr. Mary Claire Haver
So the goal, absolute gold standard is hormone therapy, is, like, giving your body back the estrogen, which will readjuv- get your serotonin levels back to where they were and leave that thermoregulatory center (laughs) alone so it's back to where it used to be.
- AHAndrew Huberman
Let's talk about hormone therapy.
- MHDr. Mary Claire Haver
Sure.
- AHAndrew Huberman
It's a bit of a controversial topic.
- MHDr. Mary Claire Haver
For no reason.
- AHAndrew Huberman
Yeah, I, I was gonna say, I don't know why. Um-
- MHDr. Mary Claire Haver
Yeah, it's demonized. It, it got such a bad rap, and we need to, to, it's just some of the, what was the worst misinformation campaign in the history of medicine.
- AHAndrew Huberman
Well, that's a bold statement, but I believe you. The, um, the way I understand it is that there was this large-scale hormone therapy trial.
- MHDr. Mary Claire Haver
Mm-hmm, mm-hmm.
- AHAndrew Huberman
Um, and the interpretation of that trial was something different than we now believe-
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
... um, as a medical community.
- MHDr. Mary Claire Haver
The initial... So it was really groundbreaking at the time. Aging women were finally being studied. We knew from observational data that women on hormone therapy, probably 40% of the population of females eligible were on HRT, okay? So very large amount. So the women who were given hormone therapy had lower incidents of cardiovascular disease, older ages of cardiovascular disease, lower death from cardiovascular disease. Some people argued that that was an artifact of healthier, wealthier women get HRT 'cause they go to the doctor, okay? So this is just because they're healthier that they have less cardiovascular disease, so let's prove it. What do you do that with? A randomized control trial. So flaws in the study, so they take, I think there were 11,000-ish women in the estrogen-only arm 'cause they'd had hysterectomy. So for your listeners, if you have a uterus and you're getting estrogen, you must have a progestogen with it to protect the lining of the uterus from endometrial cancer. As long as you give an adequate progestin, you're fine, okay? But if you don't have a uterus, progesterone is not mandatory. So the women who had had hysterectomy got estrogen only or placebo.
- AHAndrew Huberman
All right.
- MHDr. Mary Claire Haver
And the estrogen at the time was Premarin, which was the number one prescription for HRT at the time, so nothing weird about that, okay?
- AHAndrew Huberman
So it's just, um, synthetic estradiol?
- MHDr. Mary Claire Haver
Actually, no, uh, Premarin is, is... Premarin stands for pregnant mare urine. It is actually very natural. They take pregnant horses and extract the estrogens from their urine because they're pregnant and they're excreting a lot of it, and it was cheap and easy, and I have a lot of ethical issues about how they do that, but, and I don't prescribe it, but that's what was done at the time, so.
- 1:15:36 – 1:24:00
Estrogen HRT, Cardiovascular Disease, Blood Clotting; “Meno-posse”
- AHAndrew Huberman
I have to ask, when they announced this study at the Watergate Hotel of all places, um, and the conclusion that they put forth was that estrogen therapies can, um, increase rates of cancer-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... um, I have to wonder if that had something to do with what I understand is the sort of party line around cancers and breast cancers in particular, which is that you want to quote unquote "block" the estrogen receptor.
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
You want to get in there and put, give tamoxifen-
- MHDr. Mary Claire Haver
Mm-hmm.
- AHAndrew Huberman
... or nowadays I'm sure there are other drugs that are more effective to block the estrogen receptor. It all seems to, um, pile up on the side of a story that says, you know, estrogen and estrogen binding to the estrogen receptor is pro-cancerous-
- MHDr. Mary Claire Haver
Right.
- AHAndrew Huberman
... which obviously I think you're telling us, um, in a, in a indirect and direct way now and we'll go further into is simply not the case.
- MHDr. Mary Claire Haver
If you take a healthy breast cell and dump it in a Petri dish and then marinate it with some estrogen, it's not teratogen- I mean, it's not carcinogenic. Estrogen is not carcinogenic. We live with it our whole lives. If it was, in pregnancy, for those of us who are ever pregnant, when our estrogen levels skyrocket, we would see this in- uptick in breast cancer, and we don't.
- AHAndrew Huberman
In fact, I think there's some evidence, uh, for the opposite, that getting pregnant prior to age 40, is- is it true that that's protective against certain forms of-
- MHDr. Mary Claire Haver
It seems to be somewhat protective-
- AHAndrew Huberman
... breast cancer?
- MHDr. Mary Claire Haver
... for certain forms of breast cancer, yeah. So we have this whole generation of physicians who really weren't taught much about menopause, don't understand the protective benefits of estrogen and- and- and menopause's effect on metabolic disease, and they have this men- this mentality of estrogen is bad. And so a woman walks into her... Today, 2023, they looked at the data. She goes in to her doctor complaining of menopausal symptoms, which right now are still only recognized as general urinary syndrome menopause, hot flashes, night sweats, you know, the very cliché symptoms. Documents and the charts she's having, whatever. Only 10% are offered any therapy, and they're most likely four to one to be offered an antidepressant. That is where it stands today. That is what we are fighting against, is not every woman will choose HRT, but every woman deserves an informed conversation about it, and let her make her choice. You know, if you believe the WHI data, which there are some problems there, the risk is small, okay? But did you talk to her about cardiovascular disease and diabetes and insulin resistance and her cholesterol? Because those things go up through the menopause transition with no changes in diet and exercise, and those are all, you know, you're more... Even with a diagnosis of breast cancer, the most likely thing a woman is going to die from is cardiovascular disease, a heart attack or a stroke. So framing it like that I think is where we need to head, and the other thing is, you know, I was a great OB-GYN in so many areas of what I did. Why should this all be dumped in the lap of the poor busy OB-GYN who's running around the hospital doing Pap smears, trying to deliver babies, surgery, and all the things? Like, this should be required education for all, everyone in medical school. We are females, and we're not little men with breasts and uteruses. We react differently to medications, disease, disease burden, you know, and that's not been studied adequately, and that's where the, the push needs to go. It's bigger than just hot flashes.
Episode duration: 2:18:18
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