TAMING WEIGHT GAIN, MENOPAUSE, AND INFLAMMATION WITH DR. MARY CLAIRE HAVER, THE GALVESTON DIET

Part 1

Mary Claire Haver  00:00

And that is what medicine tells us is that simply it's a matter of willpower. And even I think of the paternalistic things that I've read in textbooks about, well, you know, women are gaining weight at this age because they are so stressed out from these difficult lives and they're just not happy and so they're turning to food for solace. And I'm like, what?

Sarah Milken  00:26

Hey, peeps, welcome to the flexible neurotic podcast. I'm your host, Dr. Sarah Milken. Yeah, you heard that right. I'm a real PhD doctor. Long, long ago, like last fucking year. I was sitting in the midlife funk wondering, was this it for me? That day, I realized I needed to get off my ass and start my midlife remix. I dusted off my PhD wipe the menopause, sweat off my forehead, grabbed my golden shovel and started digging deep to all my midlife bitches. It's not just luck, coffee and hormones that get you through your midlife remix. It's action steps. Let's do this. Hi, peeps. This is the next episode of The flexible neurotic podcast and I'm Dr. Sarah Milken V flexible neurotic. Today I have a chat that I have been looking forward to that is going to help us tame menopause, weight gain and inflammation in midlife. This guest is a board-certified OBGYN, menopause normalizer and Problem Solver she changed her focus of her whole gynecology practice to be menopause care and became a social media superstar and Instagram and tick tock with 2 million followers. I am sure her college-age daughters are really enjoying the midlife Vijay gone public and viral just as much as mine are. On top of being a board-certified OBGYN. She is also certified culinary medicine specialist from Tulane University, author of the new book The galvus and diet that hit number one in January sold out on Amazon. I couldn't even get one. She had to send me one and then my Amazon copy finally came so I might have to give away the extra copy. She has helped almost 100,000 women lose weight, get in shape, lower inflammation, inflammation, be happier increased longevity, and manage menopause with her online Galveston subscriber program. Her name is Dr. Mary Claire. Hey, Eva. I know oh my gosh, I'm so happy to have you here.

Mary Claire Haver  02:39

My Well, it's wonderful to be here.

Sarah Milken  02:41

We're like both in green with glasses on. We're like having a little bit of a vibe here. So the intention for this episode is to dig deep with our golden chip shovels into why weight gain is not a willpower problem in midlife as Mary Claire says it's a hormone problem, and about 7000 other things related to menopause, belly fat nutrition supplements and hormone treatment. Okay, before we get into it, I just want to tell listeners like a brief little snapshot of you. And then I'm going to have you dive in. You are a walking example of how to turn life pain points into your own why or purpose in life, you yourself have lost three brothers and a father to various diseases. When one of your brothers passed away, you went into a depression, you came off birth control pills that you've been on your whole life, and found yourself in menopause, eating and gaining weight, brain fog and a mess. And you didn't even know it was menopause, and you're an OB GYN yourself. You started calorie restricting, doing two workouts a day and telling your patients to exercise more and eat less just like you did. And now you look back on that after you've created this platform and you're like, What the fuck can you give us? I'm glad you're loving. Can you give us a quick snapshot of what happened from there when your husband said Mary Claire, you're a scientist figure this out.

Mary Claire Haver  04:10

So I've been banging my literal head and body and nutrition against the wall, you know, in an effort to lose this depression, menopausal, you know, mess that I had gotten myself into. And I kind of went back to the tricks that had always worked for me in the past, you know, after having babies or you know, big vacations, I would work out more, eat less and that is lettuce and aerobics. Right. Lettuce and aerobics. Yeah, I mean, I was. I was, you know, my mindset was, and this is before this whole journey, healthiest that. And it was kind of, you know, it's embarrassing to say but it was kind of how I defined some of my self worth was what the scale said, how I looked at my scrubs, you know, I kind of had that skinny privilege. You know, for most of my life outside of Pregnancy in the college wait. And then here I was absolutely flabbergasted that no matter what I did, I could not shake the weight. And it was coming on in different places. I never had it before, you know, in my gut and in my abdomen. So when my husband was like, Hey, you're obsessed, and your kids are watching, we got a, you know, the girls are watching you. Yeah, be very upset about this. And, you know, restricting more and more at mealtimes and working out multiple times a day and weighing yourself multiple times a day, like this isn't, you know, this isn't this isn't you. And so that was kind of the wake up call. And being still type A and very, very crazy. I, you know, decide, well, I'm going to double down in another direction. And so I reached out to the PhD nutritionist that were employed at the university that I worked at, and they did a lot of research in the elderly and protein. And I had delivered all their babies, like we knew each other, you know, across the academic spectrum. So these are friends. And so I was like, What is going on with menopause? Why are all of my patients complaining and now it's happening to me, and I cannot I'm really struggling to get this off. And I promise you I am working. And they said, well, there's definitely a one to 1.5 pound weight gain starting at age 35, no matter what a woman does, okay. And but what's happening with menopause, regardless of where her menopausal statuses, so if you were an identical twin and say twin a had her ovaries removed surgically for pre cancer or something, and twin B went through menopause naturally at 55. So we have 45 and 55. Menopause in identical human beings, they will gain weight at the same rack rate. But what's happening in the younger person who goes through menopause is her body composition is changing much faster and much more dramatically, meaning she is losing muscle at a much faster rate. And she's depositing fat at a much higher rate. So a lot of us, you know, or fret when we lose muscle that controls our basal metabolic rate. And so this is all the research that I'm diving into and learning I'm like, No one told me this, no one talked about this, like, Where else can I go with this? And how do we what changes can we do to reverse this and they started pointing me in the direction of inflammation, you we know that chronic inflammation starts skyrocketing along you know, we're along with these changes, we're losing muscle as inflammation goes up, and we're gaining fat in new places as inflammation goes up. And if we can attenuate this chronic inflammation, we can, you know, it looks like we can start attenuating those body composition changes and the weight kind of comes off. So I was like, Okay, I'm in how do we do that? What pill do I need? Well, there's no pill, got to do the work at work, but you're not working in the right way. So before I was calories in calories out, only paying attention to you know, low fat, whatever. Nutrition was like porn in medical school, you know what, when you see it, and, you know, like, like, that's how you define it. You know, when things are healthy, like we don't have to sit here and teach you well, that turns out to be the biggest fallacy I've ever just because something says healthy on the package or low fat or low calorie, natural, organic, natural, organic does not mean that it is good for you. And it's you know, stop defining things as good and bad. So, at the same time, my daughter becomes shortly after my daughter goes into the nutrition science program in a university and college. And so you want to be held accountable for stuff, have your child go into something that you're trying to create, ah,

Sarah Milken  08:33

and daughter too

Mary Claire Haver  08:35

call you out on every single thing, like you tried to present. And so she's coming. So anyway, she is really totally to the line. And it really helped me stay evidence-based and not, you know, follow trends. And so I started looking at what how we could lower inflammation with nutrition and I got so interested in and I'm like, you know, there's a huge gap in my knowledge here. What can I do? And so I kind of toyed with do I get a Master's like is that possible with my schedule? I was still working as a full-time OB GYN and running the residency program. Wow. And so then there was a speaker at AOA. AOA is alpha omega alpha, and it's the honor society for medical school. And so I was one of the

Sarah Milken  09:15

of course you were super nerd

Mary Claire Haver  09:19

So we had a speaker come in from Tulane, and he was the head of this culinary medicine program and I didn't know what that was. And turns out it's a medical nutrition.

Sarah Milken  09:28

I know it sounds like you're going to be a chef in France. 

Mary Claire Haver  09:30

so we did work in kitchens to learn cooking techniques. It was really a cool, it was like medicine, and we had registered dieticians and we had chefs and we had, you know, people who were physicians, but so interested in nutrition, it was kind of melding all three of these things together where we could practically sit down with patients and talk about how to prepare meals that are healthy, how to, it's really the best thing I've ever done. So I'm taking these courses, my brains exploding, and I'm putting this little plan together and I had just so I could tell my patients, I start utilizing the changes in myself. Body Composition starts going back to what it used to be pre-menopause and the weight comes off. And I was like, whoa, whoa, whoa, this is working. So of course, my girlfriend's want to know

Sarah Milken  10:13

wait, were you on? Were you on? I know you had come off birth control pills. Were you on HRT at the time?

Mary Claire Haver  10:19

Probably at the same time. That was changing my nutrition. I went back I started on HRT, yeah. Okay, so I wasn't willing to not sleep for that long.

Sarah Milken  10:27

Yeah, exactly. Fucking raging lunatic.

Mary Claire Haver  10:32

You know, the Maelstrom was spinning, you know, in both my nutritional you know, just hiatus I took you know, for my grief process. And so like, the fog is lifting from depression. I'm like, this isn't depression, this menopause. This this? Oh, my God. So I got on HRT, I started making the nutritional changes and everything kind of started working the the the hamster wheel I was on stopped and started spinning the other way. And so I started sharing it with my patients, I started sharing it with my girlfriends with people in town, and it just kind of grew organically on its own. And then I took it to social media, just out of curiosity, because I wanted to test out a few things. And I was asking for my followers, you know, had little groups I would make and be of 100 people volunteers to try the program and give me feedback. And so that's kind of how I did that for a year, I gave it away for free, not ever intending to make it a business or write a book or anything. But I was just experimenting. And it just kind of exploded on social media from there. So what initially began as a conversation about nutrition and menopause blew up over four or five years into just menopause one on one. And so as people would ask me more questions on social about, well, what about this, this condition and these symptoms, I just start going down more rabbit holes for menopause specific. And I'm like, wait a minute. We're not doing this whole thing, right? I mean, yes, nutrition is a huge part of it. But you know, I was totally not prescribing HRT, because I was terrified to give someone cancer. Right. Yeah, based on all that, though. None of my continuing education, medical education articles were about the safety of hormone replacement therapy and the debunking of the debate, you know, the Women's Health Initiative? Yeah, I mean, that was all a discovery for me in the last five years, and a lot of practitioners feel the same way. I did, you know, back then. So I was a terrible menopause provider, pre 2018

Sarah Milken  12:26

well, uou talk a lot about the fact that when you go to medical school, and you're there for at least four years, there is not a menopause training or real nutrition module. So you go out on your own as an OBGYN. And you said, a third of your patients are having, you know, not just yours, but a third of a guy knows patients are going to have menopausal symptoms, and they're not armed to deal with it, unless they're taking it upon themselves, like you to do the work and the research to get all the current information.

Mary Claire Haver  13:01

That's it, there's a huge gap. When you look at a couple of things that I realized, you know, every year I have to recertify for the American Board of Obstetrics and Gynecology. And so it's a I voluntarily do it every year. And there's a series of articles that we read, And we read about 30 articles we answer, we answer questions about the article. And I went back over the last several years, and I looked at how many articles were directly menopause specific. And over the last three to four years. I think we had two. Wow, who added probably 120. And so and then I said, Well, let me do this. Let me go to PubMed, which is like a repository built by the National Institutes of Health, for medical, like, not quasi like real research, you know, things that are peer-reviewed. And I typed in the word pregnancy, important stuff. I mean, I know everything about pregnancy, by the way,

Sarah Milken  13:48

that's great for menopausal women.

Mary Claire Haver  13:51

So I you know, I thought and there were 1.1 million articles, I just just did the search term pregnancy. And I said, All right, let me just type in menopause. And there were 94,000 articles. And that 10 to one-ish ratio held over the last 10 years. So we are just not as a society as a medical institution, as OB-GYN at you know, treating menopause with what it deserves. If you go and read anything in the last five years on menopause, every single article ends with we need more research. We need more research. We need more research. And you know, we're getting there. But I mean, we had to debunk What happened 22 years Yeah, with the Women's Health Initiative, and we're just coming out of the darkness from that. So we have a whole generation of women who have been we've shortened their lives. We've decreased their quality of life. We've increased their risk of heart disease all from not

Sarah Milken  14:46

dementia. How about dementia and high-risk? You know, what's really interesting is my mom, she's 74 and she starts she was always on birth control pills like me like a birth control pill addict. I know Some people hate them, but my body and her body, we just love them. It just works for us. So she started getting a few hot flashes. And she said to her doctor, like, I'm not doing this. And he said, and you know, he obviously referenced that study, and it was very taboo. And she said, you know, what, my quality of life is much more important to me than feeling like this. And she was like a renegade at the time. So she actually started the hormone replacement when she was 42, when it was very taboo, which I think is kind of interesting. And, you know, it's like, now she at least is gonna get the benefits from all of that.

Mary Claire Haver  15:39

Yes, so my mom as well put her foot down and insisted, and I mean, thank God,

Sarah Milken  15:46

I mean, thank God, because we already have so much muscle loss and bone loss just from aging in general. And especially now, after three years of sitting on our butts during the pandemic, I'm just like, oh my god, any sort of extra safeguard that we could have is critical, 

Mary Claire Haver  16:04

it's critical, and muscle mass, as you're saying, you know, I'm just now coming to understand the importance of muscle and that if you know, the muscle you go into menopause with is a huge determinant on how you're going to do, you know, as far as longevity, quality of life, and, you know, your risk of osteoporosis and fracture. I mean, if you fracture your hip, you have a 50% chance of death in 5 years

Sarah Milken  16:32

I know I have yours. And I'm crazy. You're like, how is that even possible?

Mary Claire Haver  16:38

So you know, so it's like, and the, you know, the body you have today, the health you have today was set 20 years ago with the choices you were making back then. And like, that's what I tell my patients, you know, if I'm not, here's your HRT one and done, you know, menopause care, as all of health care should be a toolkit and nutrition should be first exercise should be second, pharmacology is a possible third, not everyone needs or desires or wants her as a candidate for hormone therapy, we have nonhormonal options to help us stay healthy. Supplementation might be something that could be helpful for you, depending on gaps in your nutrition. But you know, you don't swallow a handful of supplements, and go through the drive-thru and think that you're negating a choice, you know, you that's not how supplements work. They're meant to supplement a healthy diet, where there are gaps, or potential medicinal benefits, and stress reduction and sleep. We cannot you know, all of those things work together to give us our healthiest lives.

Sarah Milken  17:34

I know you have the menopause toolkit. And what's interesting is a lot of us know this information, or we keep hearing about it, but it's kind of bridging that gap between knowing and actually doing, and how do we break it down into smaller little sort of steps? Because it all seems so overwhelming. You're like, oh, yeah, so sleep really well. And then I'm supposed to lift heavy weights three times a week, and but I'm also supposed to do aerobic exercise to keep my heart healthy. It's like so many things.

Mary Claire Haver  18:03

So I am, you know, I do break it down for my patients. And I give them very attainable goals, kind of where they are with this exercise, where they are with nutrition, and we kind of build from a platform of where they're starting at, you know, no one comes to me very few wanting to like, Look rock a bikini. That's not why they're there. They're there. Because they see what's coming down the road. They're looking at their mother's health they're looking at, they're looking at their family, you know, and they are terrified. They don't want that life. They don't want to plague their children with their own illness. So like, you know, they're why they're having to suffer because their parents are suffering from chronic health diseases. And they're like, I don't want my kids to feel about me the way I feel about my parents. What steps can I take today, to hopefully avoid this in the future? And that's the conversation we have. 

Sarah Milken  18:55

Yeah, I think it's really interesting. I've read something somewhere where I think it would be yours and my, like, kind of college-age teenage kids that will be the first generation that have intentionally worked out and exercised for their whole lives.

Mary Claire Haver  19:12

And that is my kids. I mean, yeah, like, it's so kind of interesting. And it's not about being skinny for them. 

Sarah Milken  19:19

Totally. I agree with you. Yeah. Like my daughter is like, I'm going to Pilates and then I'm doing this and and then I'm doing that and she's not obsessed with it from a weight perspective. It's like, this is just what she does. Whereas my mindset is like fuck, why do I have to do this? You know what I mean?

Mary Claire Haver  19:36

Like, every day, skincare,

Sarah Milken  19:39

oh my god, the TikTok skincare routine with the puffy headband shoot me. I'm like, What is going on here? She facetimes me from the bathroom. And she's on her 97 Step. I'm like, I'm only on five. What's happening here? I'm 48 and you're 16 It's so funny. Now I want to say that I've heard you say that a Third of female, the third of the female population having menopausal symptoms, and how crazy that is, if they are not getting treatment, only a fraction of that third are actually getting the treatment that they need.

Mary Claire Haver  20:15

Yeah. So, you know, in my training, and I think it still holds today I was, as of 2018, I was still a program director. So I knew exactly what the American Board of OB Gen required us to teach the residents, you know, who were going to become OB GYN for the rest of their lives. And perimenopause was a name just tossed out. But there was absolutely zero education around diagnosing it, treating it, there was no treatment for perimenopause, I happen to have this really awesome professor who had a wife I think, who had a tough period menopause. And he had started and I would come out in the hallway, and he would tell me about patients who are really suffering and perimenopause. And I'd be like, why, you know, and he was treating them with birth control pills and how much better they were doing, how much they felt, you know, they were sleeping. And so that was really the first time and it was only because I happened to have someone who had a personal interest in it, and was becoming the go to person in our town to help with Peri menopausal symptoms, and I just was like, move menopause, it's like, well, you know, if she's willing to like die from breast cancer, then you know, then go ahead and treat her but other than that look for any other thing to give her other than estrogen. And another place that we really were not focused was the general urinary syndrome of menopause. So people with recurrent UTIs vaginal atrophy, I mean, we should be putting vaginal estrogen in the water. You know, like, it should get

Sarah Milken  21:56

that I'm glad you brought that up, because that would have been a whole other episode. And I actually had to like, take it out of this phone. But since you brought it up, I think that there are a lot of women who are taking systemic Astra estrogen with the patch or whatever. But they're also doing the vaginal estrogen thing. And some women who are not as much caught up or know the information on this yet are like, wait, what do you mean? Why? Why would you be doing both isn't the systemic hormone the estrogen that's coming through the patch supposed to resolve all the vagina issues.

Mary Claire Haver  22:29

So maybe, but the thing that works the best and fastest is vaginal. So I have patients who I'm starting them on both at the same time, they've been they've been, you know, estrogen free from their ovaries dying, you know, X amount of years, and they have horrific vaginal atrophy as well. So I'm starting him on systemic and vaginal, you may be able to wean yourself down off of this vaginal estrogen or go to once a week or something, but it's going to take several weeks, you know, the latest data, I read three to six months of vaginal estrogen treatment to get your vagina bladder, whatever, you know, that whole area back up to speed to where you were in a pre menopausal state.

Sarah Milken  23:10

What I think is interesting, too, is because I was talking about it with my doctors, you actually have to do it for two weeks straight. I rebuild it up every night loading or Yeah, the loading goes before you move to the twice a week. But some of the doctors don't know that. Because even my mom was like, What are you talking about? And I'm like, Wait, your doctor didn't tell you that. And so she did it the way I told her to do it. And she was like, Sarah, oh my god, I was like, Yeah, see, I told you. I'm a gynecologist now after this podcast.

Mary Claire Haver  23:40

And the other thing is, vaginal estrogen has never ever, ever been shown to increase the risk of blood clots or breast cancer, even people who are currently being treated for breast cancer can safely vaginal estrogen. And if nothing gets taken away from this podcast, it is that find someone who's knows what they're doing is up to date on the research do not suffer, you will not spur on your breast cancer. But if you want to remain sexually active and have a normal functioning pelvic floor, then you're gonna need some vaginal estrogen even on Tamoxifen.

Sarah Milken  24:16

Now, what are your thoughts on like using the cream versus like it's called a IMVEXXY

Mary Claire Haver  24:21

IMVEXXY. There's no generic, you know, estradiol works for everyone. And so, you know, there's this theoretical that vaccine might be a little bit safer because it's like a SERMs selective estrogen

Sarah Milken  24:35

 and that's just that's the pill you kind of slide in.

Mary Claire Haver  24:38

 Yeah, there's pills. There's creams. There's a vaginal rain that why have the maxi sitting in my bathroom staring at me. So it is like it's like a Mercedes versus a Honda. Supposedly, it's a little safer. But again, estradiol plain vaginal, generic estrogen cream has never been shown to be dangerous in any form. And so why pay more, you know, total liner? 

Sarah Milken  25:01

Yeah, I'll use my designer vagina vagina pills for until they're over and then I'll go back to the regular will go back. Yeah, exactly, whatever. Now, why do French women? Why do 75% of French women? Why are they all on HRT but not us?

Mary Claire Haver  25:21

So that number has dropped a little bit in recent years. But they didn't really believe the whi, you know, wasn't their country that did the data and also, they weren't on. So the whi was only done with Premarin and prempro. You know, plus placebo. So that's conjugated equine estrogen. I don't think that was available in France. So women on hormone therapy, there were treated with other forms, estradiol, different suggestions. And so then they have a, I guess, lower tolerance to suffering.

Sarah Milken  26:04

So interesting. I'm like families have vital, they must have really juicy vaginas. They must have really good bones and they get to drink their red wine and they're croissants, right? They know where it's at. Okay, so I want to get into the Galveston diet book, the Galveston the name. I know people like wait, what is that? It's just It's named after your hometown. Right?

Mary Claire Haver  26:27

Right. So I chose to live here. So it's where I've raised my kids. We've, we've lived in and out of here since 98. Okay. And so you know, my people are calling it the Mary Claire plan that this plan that plan, and they're like, You need a name. And so one thing I would do differently was never call it a diet, because it really is a lifestyle. But in medicine, a diet is a pattern of eating, I don't say are you on a diet? I say what is your diet, you know, with patients? And I was thinking Mediterranean diet, you know, yeah, no one has any problem with that, you know, because it's more about a pattern of eating. Now, Galveston is a big resort town. People laugh.

Sarah Milken  27:07

Oh, sort of sort of like the South Beach diet, I guess. So got it.

Mary Claire Haver  27:12

So um, but I've gotten a lot of pushback from calling it a diet, you know, people who were like, I'm scared for my children to see the book on my nightstand because I don't want them to think I'm buying into toxic diet culture, which I totally understand. But I just named it after the town that we live in that we let my you know, our kids grew up here. And I just thought, Okay,

Sarah Milken  27:34

it's good enough for me. And I think you explain in the book so well, that it's not a diet, because it's not a temporary solution. It's not like a one week cleanse, you're basically saying, this is a lifetime lifestyle. Yes. And you explain that very clearly in the book. And the subtitle of your book is The Doctor develop patient proven plan to burn fat, fat, and tame your hormonal symptoms? So getting into the toolkit? I know I want to ask you 15,000 hormone questions just for me personally, but I'm gonna stick to the Galveston diet right now and bring you back another time. The three pillars of the Galveston diet are one intermittent fasting to avoiding inflammatory foods and three fuel refocusing with protein, healthy fats, and food for nutrients. You say that body weight and composition and mid life is not about willpower, it's about hormones. All of us can take a deep breath and not feel so shitty about ourselves that somehow people think that we're just eating cupcakes all day.

Mary Claire Haver  28:38

Right? And that is what society tells us. That is what medicine tells us is that simply it's a matter of willpower. And even I think of the paternalistic things that I've read in textbooks about well, you know, women are gaining weight at this age because they are so stressed out from these difficult lives and they're just not happy and so they're turning to food for solace. And I'm like, What? No, I've read that and okay, and get an A on my tests. I gotta memorize this. You know, lifestyle choice, she's just having a difficult lifestyle and taking it out on food. And actually felt like that was what had happened to me. I mean, I definitely was not on a good nutritional plan when I you know, after my brother died, I was on the goldfish crackers and wine diet. Oh, good. And you know anything to just stuff processed carbohydrates. I'm a salt not a sweet person, honestly, Pringles popcorn, I was just, you know, and rinsing it down with wine just to numb the pain of you know, the grief but, um, so but you know, looking at a woman I mean, and I for years had patients tell me, I'm doing the things I am telling you and they would grab their tummies in the middle and shake them at me, you know, in their little paper gowns. What is this? And I would just be like, Oh, we, you know, we tend to park a little closer to the building, take the stairs. I mean, I could just shoot myself when I think about the things that I said to patients. And if any of my former patients from 1015 years ago are out there listening, I'm sorry,

Sarah Milken  30:20

no, we do the best we know at the time and look at all you're doing now and kind of like retraining us with the with the real narrative. And I think to say to women, yeah, it is happening. It's not your imagination. And it's not because you don't have the willpower. It's because your hormones have gone ballistic, but and not but and there are these things that you can do about it. You're not just saying, okay, just sit with it. Menopause is a natural thing. Just sit with it. You're like, here's some solutions. And you go step by step. You talk about a study, a huge study in 2020, from the American Journal of Clinical Nutrition. And you said it was authored by a leading obesity scientist. And they basically stated that which was going against everything before is that obesity is not an energy balance disorder, but rather a hormonal disorder that dictates fat storage and metabolism, regardless of how many calories you eat.

Mary Claire Haver  31:20

That's it moly, exactly. I know this upsets personal trainers, I know this upsets people who've made a lot of money off of the calories in calories out, you know, dictum, and not to say that calories don't have a role here.

Sarah Milken  31:36

They do. Yeah, it doesn't mean you can eat cupcakes all day long, right? 

Mary Claire Haver  31:37

And so, you know, but insulin, cortisol, leptin, ghrelin hormone, PP y GLP. One that's a real hormone in our body. Yeah, that's the agonists that are so popular right now. You know, all of these hormones work together. So we have this certain level of homeostasis that most of us enjoy. Now, I'm not talking about people who've dealt with lifelong weight issues. This is the people who have new kind of onset in midlife. And they, you know, you kind of were maintaining your balance, you were homeostatic, with your way, everything was fine. You know, you had your tricks. You know, when you occasionally things went off the rails, you got right back on, you had a baby, then you got the weight off, and then and then all of a sudden, you get to midlife and those same, you know what's changing. And so 

Sarah Milken  32:23

been in three Jean sizes this year. You know what I mean? Like I put them on before, I never tried clothes on before a trip, but we did went on a two week college tour last year. And I was like, I'm just gonna try my jeans on and I was like, oh my god, they don't close. What the fuck. I've been wearing leggings so long. I didn't know my jeans didn't close. But I just like folded them up. I bought a few pairs of the next size up. But now I can wear my old jeans again that I wore, you know, six months ago. It's just so weird.

Mary Claire Haver  32:55

It is weird. So all of these hormones start you know, under the influence of what's happening with estrogen and androgen with our sex hormones. They start not being able to do the job that they used to do, it all kind of works together, you know, independent of aging. Menopause is marked by an increase in blood sugar, insulin resistance, cortisol levels, you know, disrupted sleep, you know, all of these things, start making all of the hormones that control our weight and where and how we store fat work against us.

Sarah Milken  33:27

Oh, I have my bloodwork done. I'm like a house on fire.

Mary Claire Haver  33:35

Yeah, all right. glycerides, independent of age. So yeah, I had a

Sarah Milken  33:40

I had I have I'm on the statin for high cholesterol but I've had high cholesterol since I was in college. I weighed 100 pounds in college and ate no carbs. And my cholesterol was two. Yeah, my cholesterol was to add that I also think it was part of like that whole like PCOS whole situation that I always face. But I just feel like I like the way you explain it because you say that the combination of hormones with carbs with declining estrogen is like the perfect clusterfuck of the storm to find new fat around our tummies and the bat wings, I guess. Right,

Mary Claire Haver  34:19

mostly Tommy's bat wings are and a lot of that's collagen like, oh, we lose 30% of our skin collagen through the menopause transition. And there's not a woman alive is going to escape this.

Sarah Milken  34:32

Oh my gosh, I love it. It's such a nightmare. Okay, so the first pillar of the Galveston diet is intermittent fasting. Intermittent Fasting is such a thing.

Mary Claire Haver  34:43

So, you know, there are things that intermittent fasting can do and things that intermittent fasting does not do and I've seen claims of you know, miraculous, you know, going from morbid obesity to underweight. Look you. We talked about intermittent fasting in terms of lowering inflammation Um, there's some great research around autophagy kind of, you know, when you're in the fasted state your your cells clean out the junk proteins and kind of poop them out, you know, and they go in the bloodstream, you filtered them out through the liver and the kidneys. And so, also people who fat intermittent fast, have lower insulin levels and lower glucose levels. And so you know, kind of using that as a tool to lower inflammation and insulin is directly correlative to increasing inflammation levels, and visceral fat deposition. So getting those levels to come down is only going to work in your favor, it's not a great way on its own to lose weight, you can eat a lot of things that are going to undermine the anti inflammatory benefits of fasting in your eating window. So that's why we don't just fast there's some beautiful research out there done in menopausal women and fasting that look, you know, amazing. And so people call me out. No, you shouldn't ask the menopause is gonna mess up your hormones, multiple article, I'm always pulling receipts on yeah,

Sarah Milken  35:57

that's, that's the best part about what you do is you're taking real peer reviewed, reviewed research that you're finding on PubMed or whatever. It's not just like some random guy did in the basement of his house. And you're like this was these studies are done on menopausal women, not on 14 year olds. Yeah, it's, it makes sense. And you take all these research articles and make them so accessible into these sort of like five step nuggets that are so helpful.

Mary Claire Haver  36:26

So I still get a lot of hate. Yeah, because I think we're threatening an industry, you know, with these kind of radical, like, obesity is not your fault, you know, that we have to think our way out of this box that we've gotten into 30% of our population is obese, you know, it can't be just like 30% of the human population is not having willpower, that's just not the way humanity works. And so but there's the multibillion dollar industry built on, this is your fault, you need to work harder, you no doubt about it. And so a lot of people are threatened and they are there is so much misinformation out there. And speaking of I did a tick tock today, because my Instagram feed was literally one menopause miracle cure after the other and they're all just trash. And I was like, I screenshotted every one it was like every other post was in menopause and menopause add you know, take this pill do this thing. This is going to cure your menopause, no more aches and pains. So that out with one pill on like nine out works, by the way. Yeah. And so it's just their, their marketers have realized there's a pain point, and that women are starting to talk about it. So they're trying to capitalize, you know, with the sale of products promising to cure menopause. At the same time, you know, you're never getting out of menopause, once you're menopausal. It's forever, there's no way to at this point, we do not know how to reconstruct the ovaries, you basically replace all of the healthy ovarian tissue with fibrosis, and that you can't bring that back. That's like permanent scar tissue in the ovaries. And so we have to deal with these health consequences of this zero estrogen level for the rest of our lives. And like this book is all about what we can do from a lifestyle standpoint to try to improve our and optimize our health.

Sarah Milken  38:12

And I love how you say that menopause is natural, but that doesn't mean we don't treat it. When you say erectile function is natural. And we fucking Neopia I mean, it's so good. Yeah, you and I are with these glasses on. It's like if I had to do this podcast without them, I'd be like, yeah, legally blind. Yeah. And that, yeah, totally. And that's the thing. It's like, if there are treatments out there that can help you. I'm all for it. Now, with intermittent fasting. It the research is basically showing that obviously, there's a million different ways to fast. But we're not going to go into all of that. But the most typical one that you adhere to, and most of your patients and clients adhere to is the 16 8. Oh, will you explain that?

Mary Claire Haver  38:57

So it is time restricted feeding is the proper like nomenclature. 

Sarah Milken  39:02

It sounds like you're feeding birds or something. Yeah. 

Mary Claire Haver  39:05

So basically, you limit your you know, we all have an eating window, right? We sleep. So when no one eats when they're sleeping, unless you're having some kind of continuous feed, you know, right. It's in a very small subset of people who can't eat food and the normal way so they have to have it pumped into their stomach. And so they'll do that overnight. But most of us were fasting while we sleep and we have a time period before we go to bed where we're not eating and probably a little bit of time period in the morning so most people will fast naturally without thinking about it for 12 hours. And so it by shortening that, that window of feeding and lengthening the time that you're not eating, we seem to have some pretty good anti inflammatory and medicinal benefits by utilizing that

Sarah Milken  39:52

do you think like people give up because they're not seeing weight loss like this rapid weight loss or like, oh, it's not working

Mary Claire Haver  39:59

to fasting and thinking you're going to have this massive weight loss is a fallacy. We're not we're doing it for health, not for the scale. So and, and it's a tricky slope. I mean, you have to maintain your muscle mass. So one of the things we coach constantly in our program is we have to make sure you're getting enough protein in that window. Because people like, what about a 24? hour fast? What about this fat that fast, I'm like, you start running into your body, cat catabolism, you know, catabolic ly consuming its muscles to generate those amino acids that it needs. So we have to make sure that you are getting adequate protein in your eating window. And I like daily intermittent fasting, because it's a habit. And it's a habit that most of the students in my patients actually find the easiest part of the program to stick to long term. 

Sarah Milken  40:44

And I like you also say in your book that you can be flexible about it. It's like if you have your daughter's graduation and the dinners at 730, like dinner, yeah, have dinner, you're not going to die. It's like just, it's just like a lifestyle that you do when you can and other times that you can't do it and you just move on from there. Exactly. Now in terms of tricks for sort of sticking to it, you talk about hydration, you talk about sleep, and that's because why, 

Mary Claire Haver  41:15

you know a lot of you can when you're not eating you tend to not drink and so dehydration is just going to undermine any progress that you have just dehydration will lead to hunger, and you know, leptin and ghrelin hormones that control your hunger and satiety. So staying hydrated throughout your fasting period, because you're going to sleep through aiders, hopefully eight hours of that. So you've got to make sure you're pushing fluids. Now, for my menopausal patients. I'm like, you may want to cut that drinking window out a couple of hours before

Sarah Milken  41:42

trust me. I know I love people to drink these like calming tonics before bed.

Mary Claire Haver  41:46

I'm like, I'm like, I'll be up at three and

Sarah Milken  41:48

I'm like, I'm I already opened three. You know what I mean? Like, I can't be up three times.

Mary Claire Haver  41:54

So I make sure that in that morning fasted period for me, my window that works for me is 12 to eight I eat I break my fast around noon, like today was 11 because we have this podcasts. And so, you know, I didn't want to go into starvation or feel jittery. Yeah, now we're early. No big deal. And then but you know, really put in I do work out in the morning as well, typically. So

Sarah Milken  42:15

does that work for you to work out with no food.

Mary Claire Haver  42:17

So when I coach people through becoming fast adapted, it's it's a process and I would say give yourself five to six weeks to get there. So just slowly push out your eating window, especially if you exercise in the morning, you know, so what I did was okay, I used to eat at like 630. And so then I went to 645 for four or five days until that felt okay and normal. And then I went to seven for five days, and then 715 and I just kept nudging that window out over several days until I got to noon. And by doing that, my body didn't go into shock. I was able to continue my workouts, you know. So just giving yourself the gift of time and patience to become fasting adapted is going to make it a lot easier for you

Sarah Milken  42:58

drink coffee, right? Black coffee, yeah, black coffee, and if you do the whole Dave Asprey thing, I can't remember if you put the MCT oil that doesn't break a fast, right, 

Mary Claire Haver  43:08

according to Dave, but you know, I follow the studies done by the fat, you know, done by Mark Max, right, did the research on neuro degeneration and so you want your body to make its own ketones, so you don't need to take exogenous ketones. There's no need for that. And you the MCT oil kind of speeds up the production of ketones, but I'm a fasting purist, I teach my students to be fasting periods we have no we tried it, we shoot for no calories during the fast if you want to add MCT or different things. We're going to do that in our eating window.

Sarah Milken  43:42

I drink my black coffee for the first time before my colonoscopy. I was like, Oh, I forgot what that tasted like. Because after I put my creamer and my stevia and all the other crap in it, it's like wow, but I guess it's just getting used to it. It is now the second pillar of the Galveston diet is anti inflammatory foods. And I would love for you to tell us what the research shows of why we care about anti inflammatory foods in midlife and what they're going to do for us.

Mary Claire Haver  44:13

So anti inflammatory foods are basically fruits, vegetables, legumes, nuts, seeds, lean meats, okay? Meats can get a little tricky, you know, but mostly lean fresh wood. 

Sarah Milken  44:27

If you're not eating, they're like eat a bazillion grams of protein. But like if you're not if you're going to a restaurant, you're not getting organic, grass fed steak. Right so the time

Mary Claire Haver  44:39

you know we hopefully you're not going to a restaurant every night of your life, right? That's your life a lot harder to be healthy. It just

Sarah Milken  44:46

unless you're my kids ordering Chipotle? Yeah.

Mary Claire Haver  44:50

So um, you know, we all get into social situations where we can't make the choice we would make at home. You just do your best. So my go to at a restaurant is is some kind of usually I don't cook a lot of fish at home, because my kids didn't like it as much now that I'm empty nesting, I can have all the fish I want. It's great. But like when we go out, I would usually that would be my time to order fish or shellfish. And I would do you know, lots of veggies or a big salad and I would be absolutely happy as a clam. What month my trip up is Mexican. So I love Texas, Texas. Next is mu. And so I have to get creative to stay on top.

Sarah Milken  45:30

Oh, god, is that like a once a week thing? 

Mary Claire Haver  45:34

Um, so yeah, we had a Thursday night fat bunch of families who would all meet for Mexican and so I had to get good about doing like a taco salad, no shell, or just getting, you know, trying to make the best choice possible. So and then talking to, you know, the restaurant newest and knew basically what I wanted occasionally knowing

Sarah Milken  45:55

that you are just knowing that you are high maintenance, no biggie. Go ahead, you know,

Mary Claire Haver  45:59

sometimes I get the nachos. It's, it's real life. Yeah. And so I enjoy them, and I eat them all up. And then I'm like, okay, the rest of the week, we're gonna make some better choices, or I'm gonna, or I'm not gonna feel good.

Sarah Milken  46:11

Oh, my God, that's for sure. So in terms of in your book, you talk about how the oil there sort of random weird oils that we're eating the vegetable oils of corn oil, this soybean oil. And you also talk about this idea of the Omega six versus omega three, will you explain that?

Mary Claire Haver  46:30

So back when I was originally researching for the program, there was a lot of of theoretical data that came out about Omega six and Omega three ratios. So in the agrarian diet, like like, when we were, you know, we typically had equal amounts of omega six and Omega three and what we ate and then as industrialization came on our omega six intake because of Cornwell mostly and processed foods increased dramatically, and there were some pretty good researchers that theoretically thought that, that increasing Omega six versus them, and then we stopped eating is things rich in Omega three flax nuts, and fatty fish. And so that's just not part of most western diets. And so they felt like this was an important part of why we are suffering from chronic inflammation that is increasing, and leading to obesity. And so we kind of went with that now, my daughter this year, that's kind of been debunked a little bit. I mean, no one wants to sit there and you know, just inhale corner oil. But it doesn't seem to be as inflammatory as possible, we still recommend a diet rich in omega threes, because there's, you know, when you're eating diets that are naturally rich in omega, like the Mediterranean diet is very rich and omega three fatty acids, and you tend to be healthier, but demonizing some of these oils, you know, can be problematic.

Sarah Milken  47:57

Yeah. Because if you order that salad, they're like, oh, it's made was seed oil, or whatever. And you're like, okay, but like, this is as healthy as I'm getting right now. I can't prepare every single family,

Mary Claire Haver  48:08

the data is in human studies, it's not really playing out, it was a great theory. But once it was really tested in humans, it doesn't seem to have as dramatic as an effect. 

Sarah Milken  48:17

don't eat vegetable oil day, but move on. Now, another key part of your your platform, and for the galvus and diet is you talk about tracking, and it's not tracking to make yourself fucking crazy and be on the scale and Oh, my God, and how much do I weigh and all of that, tell us what your thought process with the macro tracking?

Mary Claire Haver  48:36

You don't know what you don't know. And so there's some key things like when I have a patient come in, who has elevated levels of visceral fat, and I can actually have a special monitor that I can measure that in my office is that the InBody that's the InBody. And so I'm like there are specific research, there is specific research that with nutritional recommendations that have actually worked in menopausal when I'm a

Sarah Milken  48:59

skinny fat person.

Mary Claire Haver  49:03

enough fiber in your diet, like the only way to know how much fiber you're getting is to pay attention. And these trackers just kind of make it easy. And so you know, I don't track every single day anymore. I kind of know my you we all kind of eat the same thing. And so when I find myself not feeling well, or going off plan, then I'll kind of get back into tracking to get myself back. But it's more of an experiment and like what are you really eating what nutrition is in your food it really is meant to be an eye opener for you to start paying attention. You know, I need stuff. rich in magnesium, I'm not getting nearly enough magnesium and it's better everything is always better to come from food than from a supplement and so on. People get so frustrated they're like foods, I can't I magnesium supplements and eat whatever. Yeah, like snow, how it works, what kind of foods would be good and magnesium.

Sarah Milken  49:51

So pumpkin

Mary Claire Haver  49:53

seeds are very rich in magnesium. A lot of the leafy greens have a tremendous amount of magnesium, but also in these Foods. So I have this Fab Four challenge on our website. And it was one of my biggest tic tock videos ever. Well, I'm like, Look, if you're struggling and you're counting calories, this is not working, just do this experiment with me track for nutrients for a week and just eat your normal stuff and see where you fall with these nutrients. And it was fiber, magnesium, Omega three and vitamin D. And so people were like, oh my god, I had no idea that I was so deficient in all four of these nutrients. I'm like, so the next week, fight to put food in your diet to get those up to the FDA recommended amounts, nothing more. And then tell me how you feel. And people were like, This is a mirror

Sarah Milken  50:36

Oh my God,

Mary Claire Haver  50:37

I didn't count a single calorie. I just tried to get foods rich and these things because these foods also have other vitamins, minerals, nutrients, fiber, I mean, they all cross react to make you healthier, and to get those enough nutrients. And you're kind of avoiding some of the processed foods because those nutrients are found in both

Sarah Milken  50:56

Yeah. And like you said, I think once you figure out the five or six things that you like, personally, then it just becomes part of your day, like you're working all day. So I'm sure like at your desk, there's like a pumpkin seed bag. And there's a nut bag. Yeah. See, there you are right now with oh, she has toothpicks in raspberries and blackberries. And being a walnuts. I eat so many walnuts that my doctor was like Sarah, you have really high alpha lipoic acid. Are you eating walnuts? And I was like, Yeah, you want in my oatmeal every day. And she's like, Oh, your husband doesn't eat walnuts, obviously. And I was like, Yeah, and he's cortisol is normal. Mine's on fire. Like what's happening here? I can't handle it. Now let's talk about the inflammation as it relates to cognitive decline and Alzheimer's and the inflammatory foods. I mean, I read this statistic the other day that said that 75% of people with Alzheimer's don't even have one or both of the genes for it. That it's literally lifestyle. Yeah, that is astounding.

Mary Claire Haver  52:03

So one of the biggest eye openers for me when I started down the research rabbit hole. When I say research, I am reading other people's research. I was not in the lab doing the research.

Sarah Milken  52:15

Yeah, but your part is just as important because you're taking it and breaking it down and making it digestible for people like us.

Mary Claire Haver  52:24

And that it was I thought everyone with Alzheimer's had a genetic like you, you know, I didn't realize that so much of so many chronic conditions was a lifestyle. I mean, I knew heart disease, and I knew, you know, but I knew some diabetes type one for sure. But type two is almost always lifestyle. And, um, you have a predisposition. But so but you know, that's, I did a survey on social media, and I said, What scares you about getting old. And for me, it's cancer because of my brothers. And and everyone said, the loss of ability to take care of myself like that I can't think or I can't move. So it was you know, Parkinson's, ALS, Alzheimer's, dementia, you know, something where you're going to be a burden on your family and not be able to care for yourself as you ah, they that terrified them. So then I started reading more on there, like, what can we do to decrease these risks? And so I started going down the rabbit hole, I'm like, Oh, my God, nutrition and Alzheimer's, nutrition and dementia. Like I didn't know, no one taught us that. I mean, you know, like porn eat a healthy diet. Yeah, it's so but like, people who eat according to these certain patterns have a much lower risk, including exercise of these diseases, and like Amgen, known 20 years ago that you could have avoided, you know, being unable to care for yourself and being institutionalized or your fate, you know, being a burden on your family and locked in a room somewhere. Yeah, just by making a few easy nutritional changes and incorporating some exercise. Wouldn't you have done it?

Sarah Milken  54:00

Yeah, I know. And now the thing is, we're getting all this information now. And it's going to be interesting to see how many of us can listen to and come to the call, and actually do the work? Because it is a lot of work. There are so many things that we have to do. But what's so interesting about it is it's it's a theme I talk about in this podcast a lot. It's self responsibility, no one's coming to save you. The information is there people like you are disseminating this disseminating this amazing information. And it's up to us to take it and actually make these micro changes in our actual lives.

Mary Claire Haver  54:40

Well, and I think our that our kids generation is building this into their lives now. Like they're not going to be hard. They're not going to think it's there. It's just always what they've done. 

Sarah Milken  54:51

Oh my God My son goes to the gym, he doesn't care if he has a runny nose. He doesn't care if he has a stomachache, and then he goes then he goes to baseball practice after and I'm like why I'd be like taking a nap, my nose is running, you know, it's just, it's such a different thing. It's amazing. Now I listen to you speak about supplements and the Galveston diet. And I know that my listeners are like me and they really want specifics. So I want to like get really granular with you for a second find out your medicine cabinet, the Mary Claire 411 I know you start talking about collagen and fiber, tell me why we need them how you do it, you mix it together the whole thing and the brand. So it's your brand right?

Mary Claire Haver  55:36

four supplements that I've created. And it was for myself, my patients my followers. One is fiber. Now that being said, you should get the majority of your fiber from food. And the fiber we created has not only psyllium husk which is in most fibers, that's kind of the bulk of what most fibers like Metamucil is made from I wanted to make it palatable because fiber is really hard to get down. So we added a little bit of natural orange flavor and a little bit of stevia and monk fruit just to make it drinkable and so make it enjoyable. Then we added amaranth keen Wah, we added different grains because I wanted like a full spectrum of different fiber sources because you have soluble and insoluble fiber and they both have important jobs. Soluble fiber is what mixes in water and dissolves and that's what feeds our gut microbiome insoluble fiber just absorbs water stays in the gut and kind of moves things through quicker you know when you've had a high fiber diet you know the next day or and so, so, so we developed that the college how many grams of fiber or in should be getting so this for your female listeners should be getting a minimum of 25 grams per day but you can push to 35 I

Sarah Milken  56:55

know I want to know how you get it to 35

Mary Claire Haver  56:58

so I my big trick is that I get 25 with my nutrition so you know I probably an avocado a day,

Sarah Milken  57:05

how many grams and and avocado no about 12 So about half of my fiber comes from I'm about to eat an avocado today. So that's a really good trick. Just eat it with a spoon with salt and pepper some

Mary Claire Haver  57:18

days I'll put it in the South last night I made an extended salad through the avocado in there

Sarah Milken  57:21

if i could have the fiber with one avocado, I could totally do that. I love that. Okay, everyone's gonna go buy avocados right now. Okay, 

Mary Claire Haver  57:31

other supplements that we created one was the well we didn't create we co branded with a company called Sparkle is the collagen. Now I originally started sparkle because I didn't like the way my cellulite looked. And I found some research I found intriguing. My teaching the kids were teasing me when we're trying on bathing suits and stuff. So you know, cellulite on a thin person is no prettier than with some meat behind it. So it's like, you know, hanging off a bone and yeah, I know well, so um, and it also helped with wrinkles. So I'm like, well, it's not gonna hurt me and it's a decent source of protein. Let me try this stuff. And I immediately loved it turns out collagen also was really helpful for osteoporosis. So now I'm putting in my oatmeal to my vanity, my vanity. So for me like I'm lazy, I have these big 30 ounce cups, and I mix my fiber and collagen after a break my fast in the big cup and I just sip at it all afternoon. I also take we have an Omega three and vitamin D combo. It's it's sold out because we've reformulated coming out mid March it's we're doing double the vitamin D with vitamin K and omega three fatty acid combo.

Sarah Milken  58:39

You read my mind that's actually on my little list here. It was going to ask you about vitamin D and Vitamin K because most people don't talk about the k

Mary Claire Haver  58:50

 And we made the decision to reformulate we're just of course everything in the world lags in production. Yeah. So we are supposed to be mid February and we ran out of our supply. You know, the book kind of drove more people coming to the website and more people buying the supplements. Yeah, did March. They promised us march 17. We will be back in stock with our new formulation, which is 4000. I use vitamin D with the vitamin K and the omega three fatty acids.

Sarah Milken  59:17

Amazing and how much Omega three do you have in it?

Mary Claire Haver  59:20

So it's about two grams. So that's a lot.

Sarah Milken  59:23

That's good.

Mary Claire Haver  59:24

It is derived from fish or sardines actually, but ya

Sarah Milken  59:27

know that so how many do you have to take to get the vitamin D and the Omega?

Mary Claire Haver  59:31

They're tiny. I don't have them in here. So they're it's four capsules in? Do you take four at the same time? Or do you just I put them all in a little bowl and I take them throughout the afternoon?

Sarah Milken  59:43

Got it. Okay. No, I love that. You said that because I just interviewed someone else and she's looking at different research and seeing how cognitive decline and muscle building a lot of the research is showing you can have up to four grams a day So she takes two grams in the morning and two grams at night, I guess. Yeah, of her omega. So I thought that and she bases her stuff on research too, which I thought was kind of interesting.

Mary Claire Haver  1:00:09

So I'm pretty good about salmon I'm eating 

Sarah Milken  1:00:13

Oh, see, I'm not a big salmon lover.

Mary Claire Haver  1:00:15

i'll eat twice a week. So I figure between my dad probably getting it blacks want, you know, I'm, I'm probably there.

Sarah Milken  1:00:22

 and the vitamin D situation is interesting, because I was really low a few years ago, and my doctor gave me a prescription for 50,000. And I had to take 150 1000 pill once a week, just to get me to the minimum threshold, because like, as you say, the 4000 is a maintenance dose isn't. So how do you get your patients who have a very low vitamin D

Mary Claire Haver  1:00:47

exactly the same, we do a 50,000 once a week prescription. Now you have to be careful, Vitamin D is fat soluble, so you can become toxic. So Oh, my mind actually got too high. Okay, 80% of my patients are vitamin D severely deficient. It is just the What's your range that you like? Because I know, I know, the machine spits out your report, and it says like above 20 or 30, or something is fine. Now, most longevity experts, I'm a big Peter OTF fan. No agree that 60 or above is what you want to shoot. Oh, so I tried to get it between 60 and 100.

Sarah Milken  1:01:24

Got it? And how often do you have to check that like if you're taking, if you're taking it regularly give them

Mary Claire Haver  1:01:30

the weekly loading dose for 12 weeks, and then we'll recheck and kind of see where we're at. And then they're doing maintenance dosing the day they're not taking the 50,000. And then we see kind of where they're at. And we may have to adjust. I have you know, there's just some people who are poor absorbers, or just genetically this is you're always going to struggle. And so some of them I have them on 10,000 a day, but that's rare. Yeah, my vision, you know, that is not something I would just give somebody off the street,

Sarah Milken  1:01:58

right? So if somebody is low, they should say to their doctors, Hey, can I take the 50,000 once a week, for however many weeks remains, I think that's interesting to know, because a lot of us will just go to the market and buy a vitamin D off the shelf. But unless you're loaded up, you may not be moving anywhere, right? And I don't feel like enough people are talking about that. Okay, let's talk about probiotics. I saw this whole thing with you. And you have two different kinds of probiotics when you travel with one that's in your refrigerator, break it down for us, and why do we need them?

Mary Claire Haver  1:02:30

Um, well, if you're eating something rich and probiotics every day, so if you're eating sauerkraut, kimchi, miso, Kim Bucha. Now our yogurt, you know, unflavored plain yogurt, because the additives can kind of kill off that the spores, then you're probably fine. You know, but it's funny. Most of the studies in nutrition are done with food not not so much with that. But like the patterns of eating are done with what they ate, you know, they do a dietary recall and whatever. But the studies and menopausal women were done with probiotic supplementation, not eating foods rich and probiotics, which is unusual. And so it's important because our gut microbiome is everything. And we are learning more and more about it every day. 10 years ago, I would have said you were insane. This was woowoo. And it's just you know, but turns out, this is a thing. And we totally misunderstood the importance of what's going on in our gut. And so, women in menopause, who were obese and overweight who had hypertension were treated with a probiotic supplement versus placebo, I think for 12 weeks, and the plus the probiotic group, they both lost weight and they were also placed on calorie restriction. They both lost weight, but the probiotic lost more belly fat. So they were doing the DEXA scans and measuring their visceral fat, and their blood pressure got better. And so more than the other group and so, you know, studies are more and more studies are being done showing the health benefits of making sure how much

Sarah Milken  1:03:58

do you need? There's like Zillow, BillyOh, there's not

Mary Claire Haver  1:04:01

been like, clearly you need to do because there's so many options. So when you're shopping for a probiotic billions is better. You want something with a lot in there. Now there's a lot of raging debate over encapsulated, which is like the spore form versus live cultures. So when I'm home because some people say, well, the stomach acid destroys the bacteria, but most of the probiotics found in food or life, and so they're getting to our gut, you know, it's happening, our gut microbiome comes from food. And so that kind of shoots that argument out of the water, but when I travel, so this the raw meaning the non encapsulated has to be refrigerated and that's a little tough with travel. So when I travel and I take my little pillbox, I will pack the encapsulated but when I'm home or at the office and I'm bringing my lunch to work with patients I will pack the raw and this throw it in the fridge you know

Sarah Milken  1:04:53

what brand, what brand do you use that's refrigerated and

Mary Claire Haver  1:04:58

what brands so what works for me Me and I'm no I don't sell these I have no affiliation with this company is the Garden of Life The Women's 85 billion raw is what I've been said. And do you take it on an empty stomach doesn't matter. Oh, no, I can't take anything on an empty stomach. Okay, so all my supplements I take after a break my fast

Sarah Milken  1:05:15

got it. Okay. And then the one that you travel with is called What?

Mary Claire Haver  1:05:20

The same. It's the garden. Same brand. It's just it has like 35 billion. It's not quite as

Sarah Milken  1:05:27

it's the one that doesn't have to be refrigerated. refrigerated. Yeah. Okay, got it. It's shelf stable. Now. Okay, we talked about vitamin D. And you also talked about tumeric? Yeah. Tumeric. So what's the deal with that?

Mary Claire Haver  1:05:41

So, um, I have all the research on our web, all this stuff I have on my website with all the medical articles, you could

Sarah Milken  1:05:48

be in your website for four days, by the way, honestly,

Mary Claire Haver  1:05:52

like you give everything away. 

Sarah Milken  1:05:54

I know, I know

Mary Claire Haver  1:05:55

know. I'm doing my thing

Sarah Milken  1:05:56

financially.

Mary Claire Haver  1:05:57

So, um, so the turmeric, hot flashes, for sure. And, and joint pain, you know, are the two most compelling reasons. So when I have a patient who's coming in with joint pain with you know, osteoarthritic pain with you know, that's worsened and menopause, I'm like, you probably should try this. And, you know, I think it's great for hot flashes. And it that has some other you know, benefits are not as strong. It's kind of studies not not as strong, but you know, maybe helpful, so I'm not going to like make these bold medical claims, but we know that it decreases hot flashes and for sure helps with osteoarthritic pain and what brand do you like and what dosage mine? No, okay, that we have? Yeah, we came out with a turmeric and it is turmeric is kind of tough, because it's very low. bioavailability the way yeah, there's so much like na on the curcumin, you know, in the tumeric. Sport it. I mean on the the Yeah. So we combine it with Pep piperine which is the active ingredient, black pepper to now helps increase the absorption.

Sarah Milken  1:06:59

Got it. Okay, now there were two more supplements in your little toolkit, man. Yeah, magnesium, tell us your deal with magnesium.

Mary Claire Haver  1:07:10

So there are multiple forms of magnesium and they all so confusing, really. So depends on what you're trying to treat. If you're deficient, there's several that will work to get your blood levels up. Okay. There's some like mag, oxide that work in the gut, they don't absorb very well into the bloodstream, they stay in the gut and they can induce a bowel movement, we use certain forms of mag to induce diarrhea for colonoscopy, you know, like, it just depends on what the mag is bound to and where it's going to react. There's one particular one called magnesium el Theron eight, that seems to be the one that crosses the blood brain barrier, the best. So when a patient is struggling with mental health issues, sleep, you know, anxiety, anything to do in the in the brain, I will recommend that as a trial to see if it's going to be helpful for them. So that's what I take I take you take you take the life extensions brand? I do. I do. Yeah. No, I don't sell them. I don't.

Sarah Milken  1:08:07

But are you are Did you say you were coming out with it also.

Mary Claire Haver  1:08:10

So we got into talks with Maggie life extension to do a partnership like we do with sparkle, but it kind of fell through. And we're literally we're flying by the seat of our pants. The business is just so crazy right now. And I just don't have time to go through all these contracts. Oh, my God, I understand from them. I don't get any money from them. But it's

Sarah Milken  1:08:30

okay, now is there any other magnesium that's like a big hitter that we should think about glycinate

Mary Claire Haver  1:08:35

is really good for if you have low blood levels, and it's tough because some of these minerals and vitamins are water soluble. So literally, our blood levels change on a minute to minute basis. And so there's not it's a difficult to tell if your like overall Max storage level is low, because it's stored in bones and no one's going to do a bone biopsy. So just like a one time blood level of magnesium is not really telling you the full picture. It's different than vitamin A, K, D and E, which I never check any level. But you know, I checked D all the time, that's fat soluble. So when you're looking at a blood level of D, you're looking at a picture of her over the last several weeks, you're really getting a feel for like what she's doing. You know, and there's and so but things that are waterbase you're just paying them out every day. And so it's hard to get toxic on these to me you can but it's hard through food to get toxic on Mac or calcium or something like that. You really have to work at that. If you have functioning kidneys, it's almost impossible. Now if I put an IV in you, I can kill you with calcium fluoride,

Sarah Milken  1:09:35

but do that during this college process that I'm in.

Mary Claire Haver  1:09:38

But you really for most of those, it's hard to tell we know just looking at nutritional profiles and did you know dietary recall that probably half of Americans are only getting 50% of the magnesium. 

Sarah Milken  1:09:54

There were two that we should take the L PHE. Na will help you sleep and when like depression anxiety can be right and D and glycinate would be another good kind of full service one

Mary Claire Haver  1:10:07

and some people take two depending on who they're you know who they're seeing where they're taking one specifically at night to treat sleep and then they're taking another one in the morning to kind of bring their blood levels up. Now, I don't I rarely recommend that

Sarah Milken  1:10:20

does the L fi and eight one that you take at night, 

Mary Claire Haver  1:10:23

so I take it in the late afternoon. So I have my little bowl and I know that those are white and I kind of shove them over to the side.

Sarah Milken  1:10:29

Oh my god, you're like You're like the medicine lady. Yeah, like all your my husband makes fun of me is like you have all these like weird baggies like you've turned into like your grandmother. Like all these baggies in your purse.

Mary Claire Haver  1:10:42

I have that seven day travel day. I'm like, they don't all fit in this little box. I'm taking too much stuff like my diets not on point like they have to fit in here.

Sarah Milken  1:10:51

Hey, peeps, it's me again. I listen to this episode with Dr. Mary Claire, Havre, board certified OBGYN menopause normalizer and Problem Solver writer of the Galveston diet, so I could summarize the golden nuggets for you to have actionable items to start using today. I know that when I listen to a long episode with my midlife brain, I'm like, oh my god, I love that. But then I can't even fucking remember the specifics. This is why I come back and do a golden nugget summary. There are so many golden nuggets from my conversation with Mary Claire that we decided to make it two parts. So after this episode, there's Part Two that's already out. So go and listen to that one after this one. In part one of this episode we discussed the first two pillars of Mary Claire's Galveston diet, or she likes to call it the lifestyle protocol. This diet is intended it's not even a diet this protocol is intended to be a way of life for menopausal women in midlife and covers nutrition, exercise and supplements that you can take to set yourself up for success in midlife and menopause. Golden Nugget number one will power verse hormones and the menopause toolkit in midlife, bodyweight and composition is not about willpower. It's about hormones. Mary Claire stress that medicine has told us that weight management is still about willpower. But the truth is that menopause is marked by an increase in blood sugar, insulin resistance and CO high cortisol levels that are making our hormones that control our weight go ballistic and work against us. Although menopause is natural, that doesn't mean we don't treat it there are solutions. Dr. Mary Claire haber has put together a very helpful toolkit for menopause that consists of nutrition exercises, pharmaceuticals when necessary supplements stress reduction and sleep all of which can help with menopausal symptoms and just the clusterfuck of midlife. Golden Nugget number two, the first pillar of the Galveston diet is intermittent fasting. Mary Claire emphasizes that intermittent fasting is a great tool for not only lowering inflammation and clearing toxins, but also lowering insulin and glucose levels in the body. When we hear the term internet mitten fasting we usually think of weight loss and weight management and it does help with that sometimes, but for menopausal women, it's not the best when it's the only tool you're utilizing. Mid lifers will see the best results with weight loss when intermittent fasting is used in combination with other healthy lifestyle practices, remembering protein, fiber and hydration, keeping it flowing while maintaining muscle mass and menopause and perimenopause, Golden Nugget number three, the second pillar of the Galveston diet is anti inflammatory foods. Yep, I said it a large portion of the Galveston diet is about keeping inflammation low because this is a leading factor that contributes to obesity and cognitive decline. anti inflammatory foods that should be included in your diet are fruits, vegetables, legumes, nuts, seeds and lean meats. Something to look out for is the oils that are used in the foods we eat particularly processed foods. Foods that are heavy in Omega six oils should be eaten sparingly because of how they contribute to inflammation. So the general rule of thumb Omega three is your bestie. That's like what's found in salmon, Golden Nugget number four supplements, supplements supplements, supplements can be very helpful in terms of adding to your routine. They have so many medical benefits and help with stress management and sleep. Knowing which supplements you should be adding will largely depend on any nutritional gaps that you have in your diet. Regularly tracking your food intake is a great way to determine any nutritional gaps you're experiencing and what supplements you should start introducing. It's not about counting calories, it's about using an app app to track your food for a few days or a few weeks to really see what you're getting like Do you have enough magnesium? Are you eating enough things? Mary Claire recommends magnesium probiotics fiber vitamin D tumeric, which I learned is super helpful for reducing hot flashes, peeps, the golden nuggets or endless from this conversation. They were riffing. Don't forget to go listen to part two of my episode with Dr. Mary Claire, which is out now just clicked on the next episode where we dive deeper into the Galveston diet and the importance of exercise in midlife. The gold is dripping off these nuggets, grab it, use it, there are three things you can do first, subscribe to the podcast. Yes, subscriptions matter. Second, share it with some friends who liked midlife shit. And third, write an apple review. writing reviews is fucking annoying. It's an extra step. But guess what? It really helps the podcast grow. And you know I'm a one man band doing this whole thing so any help I can get is so appreciated. You think your little review doesn't matter but it does. If you went to a show and everyone said my clap doesn't matter. There will be no clapping. We all matter. See me you know I always respond. I'm the only one on my Instagram. Oh, and of course follow me on my instagram at flexible neurotic da love you talk soon

Part 2

Sarah Milken  00:04

Hey peeps, welcome to the flexible neurotic podcast. I'm your host Dr. Sarah Milken. Yeah, you heard that right. I'm a real PhD doctor. Long, long ago like last fucking year. I was sitting in the midlife pump wondering, was this it for me? That day I realized I needed to get off my ass and start my midlife remix. I dusted off my PhD wipe the menopause, sweat off my forehead, grabbed my golden shit shovel and started digging deep to all my midlife bitches. It's not just love coffee and hormones that get you through your midlife remix. It's action steps. Let's do this. Hey, peeps, welcome back to part two of my discussion and amazing chat with Dr. Mary Claire hay fever, the menopause normalizer and problem solver. In this episode, we discuss the third pillar of the Galveston diet her best selling book and the lifestyle protocol for midlife and menopausal women. We talk about protein, how the heck to calculate how much you need in your midlife and the importance of exercise. Why we absolutely need it. How much weight training do we need to do? What do we do with the weights? And I learned like what not to do for midlife muffin top. We wrap up part two by going over key measurements for midlife, body composition ratios of muscle to fat for the female metabolic health issues and how these ratios can give you crucial information about your midlife health. And remember, if you haven't heard part one, you're missing out, you got to go listen to that. Okay, now, pillar number three of the Galveston diet is the fuel refocus, you say that you meet many women who are addicted to carbs, especially ones in short, high in sugar. That's me, you know, there's a reason

Mary Claire Haver  02:01

for that there are multiple things that in when I talk about carbs, I don't want to lump all carbs together. I'm talking about you know, things with added sugars, processed carbohydrates versus fruits and bet you know, fruits, right, but yeah, but there are starchy vegetables and other vegetables. Yeah, like you gave me a choice of eating broccoli or sweet potatoes. 

Sarah Milken  02:19

I'm picking sweet potatoes

Mary Claire Haver  02:21

yeah, yeah, so um, but you know, if I gave you a choice between a table full of sugar, and a cup of sweet potatoes, the sweet potatoes are going to have fiber, minerals, nutrients are going to do a lot different to your body than what that table sugar is going to do. And so what people are addicted to is not the sweet potato, it's the quick fix, you know, and sugar fix from processed carbohydrates and added sugars and food. So they both the World Health Organization and the American Heart Association have come out and said, Look, we're eating way too much added sugars, it's on the labels, now we need to limit those, a woman should limit those to no more than 25 grams a day. So I'm not saying you never get the cookie or you never have anything. But you know, women who who who have diets, less than 25 grams of added sugars average per day, are a lot healthier, have much less diabetes, much less hot flashes, you know, just do better overall.

Sarah Milken  03:15

And I also think you also talk about the idea that a lot of us are trying to jump to stevia or fake sweeteners. 

Mary Claire Haver  03:24

And you're not getting rid of the addiction for those of you who are out there addicted to sugar. You know, it's that quick fix of the brain, right? Any addiction is Oh, yeah, you're on like a dopamine search. So it's the sweet receptor on the tongue, you know, you're stimulating that so I tell people during their fast to not do stevia and not do monkfruit You know, and to really limit those because you're not training your brain to get that fix from without it.

Sarah Milken  03:52

Okay, now you talk about macros, and we talked about that with the tracker. Oh, we never talked about which trackers you'd like on the app on the App Store.

Mary Claire Haver  04:01

Again, my daughter is the one the one I recommend and that we've partnered with, because they load up all of our, you know, meal plans and stuff in their database is chronometer CRM, meaty, er, that is the one that most universities use in the dietetics programs. And so as my daughter who turned me on to it, I was doing my fitness pal or something when those are okay, but they were really built for calorie counting or keto most of the ones commercially available. chronometer was built to have a clean pristine database for nutrition, thought you can do keto you can track the other stuff on there, but that's not what they built it. And they're very, very particular about what is in the database and that it is accurate nutritional information. So their database goes a lot deeper for micronutrients and do they charge How much do they charge you for there is a free version you can absolutely do the opposite diet with the free version. But if you want the bells and whistles and the ease and the access to the Galveston diet, you know, database then you Great to the gold.

Sarah Milken  05:00

Do you become a member of your platform? And then you kind of hook into the Galveston diet?

Mary Claire Haver  05:06

Yeah. Got it? Yeah. So they have a guy with a diet setting that you can just switch it, switch it.

Sarah Milken  05:12

Oh, fantastic. So just to remind everyone in terms the word macros is basically meaning your protein, carbs,

Mary Claire Haver  05:19

carbs, and fat red, those are macronutrients, and then vitamins and minerals and everything else, alcohol is all micronutrients. Well, I'll call them actually a nutrient there's nothing about as I keep telling myself every day,

Sarah Milken  05:31

yeah, you write that the average American diet is 50% calories from carbs, 15% from protein and 35%, from fat, but on the galvus and diet, what's the breakdown,

Mary Claire Haver  05:44

so if you're, if you need weight loss, then we shift that quite a bit. Um, people like to see results. And so we do a 70% Fat 20 We want to make sure you're getting those protein goals, so 20% protein, and then we want to do about a 10% carbs. And that's really about on training your body away from using sugar as a tool and food and so once you get closer to your goal, we switch those closer to you know, there's really 50 You probably shouldn't be 20% protein no matter what but and we sweet we trade out the fat for more carbs adding back in more fruit adding back in we're you know more high do the sweet potatoes and you know, the starchy veggies that we love. And as the weight comes off, now you can absolutely do the maintenance program from day one and be healthy. And a lot of people do that not everyone has a weight problem. And so you can absolutely just go straight to maintenance and be healthy. 

Sarah Milken  06:48

Like me where it's not really a weight issue. It's a more inflammation, insulin resistance. 

Mary Claire Haver  06:55

So there's a module for that read out. Yes. So you know, we a lot of people do the fasting, some people can't do fasting because of hypoglycemia, or it triggers an eating disorder. I mean, there's these three arms can be followed altogether, and they do work synergistically together. Or they can you can just pick and choose what works for you. Now,

Sarah Milken  07:13

are you assigned to an individual coach, like how does it work within your system

Mary Claire Haver  07:18

we have a coaching option within our online, you know, it's an online option, where you go and and is basically we have, we have a set of coaches who are paid to guide people through the program. And so you can jump in at any time it runs constantly. And it kind of runs on a week to week basis where the first week covers the first arm of the program. The second week covers the second arm of the program. The third week covers the the you know, fuel refocusing. And in the fourth week is like putting it all together. menu options, tricks, tips, you know, from our coaches in the whole thing repeats. So to give people and there's a community there, you can you know, ask questions, get your questions answered. But that is a subscription to get into that. But you can cancel.

Sarah Milken  08:04

That's probably why you have so many women doing it because it's like so straightforward. So in your version, the ideal scenario would be 70% healthy fats 20% lean protein and 10% carbs

Mary Claire Haver  08:18

in the weight loss portion. That's not what I follow. I don't have weight to lose. And so you know, we go a 40

Sarah Milken  08:25

But you did you did it? Well, yeah, I

Mary Claire Haver  08:27

did. That's what I started with. But you know, I haven't followed that. And they just Yeah, so I now do a 4040 20 Roughly for me to manage it.

Sarah Milken  08:36

4040 20 Okay, so just I'm sure a lot of us know this, but healthy fats from your perspective and your research. 

Mary Claire Haver  08:43

So I don't want to be restrictive. But there's something magical about eating more unsaturated fat than saturated fat. Saturated fat in moderation is fine. But if the majority of your fats are coming from butter and bacon, you are going to suffer from inflammation. We know that okay, eating you know, we want to eat the rainbow and the Galveston diet. We want to eat a wide variety of things. We don't demonize one food group over another is not what we're trying to do. But there are patterns of eating that make people more healthy, you can just eat whatever you feel like and expect to have the same results. And so healthy fats are you know, the majority of your fats more than half should come from now should come from nuts, seeds, you know from nature versus animal fats,

Sarah Milken  09:36

right so like avocado oil, coconut oil, all of seeds.

Mary Claire Haver  09:42

Coconut oil is one of the saturated fats that comes from nature but you know that in moderation is fine as well. I like keeping like to put it all over their bodies. I know.

Sarah Milken  09:51

Oh, I know. I just talked about that in one of my in like one of my Instagram reels and people were like, really and I go Yeah, Sherry Ah told me that you take a bath you know three times a week for 20 minutes and you know unrefined raw coconut oil I'm like whoa you get you get your parts going now what's the deal was starchy versus non starchy vegetables.

Mary Claire Haver  10:18

So it's just that part is really educational, but there are veggies such you know, the sweet potatoes the carom as the you know beets and things that are more higher in carbohydrates. And so it's becoming aware of that, especially in the weight loss phase of choosing things that are less starchy to keep your carbohydrates in check, and then adding those back in as you get to the weight that you want.

Sarah Milken  10:42

Got it. Okay, now, the protein thing I know we touched on a little bit, but there's so much information out there. And my question to you is there's so many people on social media and just in the media in general talking about how we should be eating one gram of protein per pound of body weight. So if you weigh 135 pounds,

Mary Claire Haver  11:01

it's actually one so it's one to 1.5 so for menopausal women that's all I take care of now, you should be having one to 1.5 grams of protein for every kilogram of lean body weight. Oh,

Sarah Milken  11:15

how do I do that man? Oh, math.

Mary Claire Haver  11:16

Yeah, so say you are so 2.2 is the so say you're you know X amount of pounds but in kilograms. You are 100 kilograms. I'm just to make the math the you should be eating 100 to 150 grams of protein. If if that is your kilogram weight now that's a lot of weight for a woman that's unusual, but it might be if you have a lot of muscle mass so you want to hang on to your muscle there is never going to be too much muscle in your body.

Sarah Milken  11:46

Okay, wait yeah, there's Pete it from my small midlife brand repeats I think we're the ratio and 1.5

Mary Claire Haver  11:51

grams of protein for every kilogram of lean body mass not pound okay.

Sarah Milken  12:01

So I have to figure out what my kill and lean body

Mary Claire Haver  12:04

mass is basically your goal weight when were you rocking the house? You know? When did you feel your best? Are you back in the envelope?

Sarah Milken  12:12

Got it I mean college probably the end of college maybe not the beginning of college the end of college when I got my shit more more my shit together. Now in terms of packing and all that protein in an eight hour feeding window Mary Claire, holy moly. On packing in hydration on packing in fiber on packing and protein. How do you shove it all down

Mary Claire Haver  12:40

there's data showing that you know, like for leptin and ghrelin and some of the gut hormones, they're very sensitive to protein levels as they hit the gut. So it's really important that every single meal and snack that you have in your window has a significant source of protein. So in Galison diet, we shoot for 25 to 30 grams are meal and then we eat generally two big meals a day and then a couple of snacks. And about 10 to 15 Maybe in a snack.

Sarah Milken  13:10

Interesting. So what would be a sample snack for you that would hit the protein? The one you just had where it was like walnuts and the walnuts and fruit

Mary Claire Haver  13:20

on it right now? Yeah, um, a lot of the nut butters are really easy grab and go Piper which

Sarah Milken  13:26

which ones have less sugar or no added sugar package?

Mary Claire Haver  13:30

flip them around. There are you know every almond nut cashew, whatever floats your boat. You know, nuts are a really nice source of protein if you're not allergic

Sarah Milken  13:38

now, do you ever find that people eating really high end mats? Well, they're really high in calories. And so I was scared of them forever. That I say hi, and nuts, nuts high in calorie, high calories,

Mary Claire Haver  13:51

eating too many nuts. So yeah, I mean, yeah, I mean, calories do count. I mean, if you eat 5000 calories a day, most likely, and you're not running marathon every day, you're gonna you store that excess calories as fat that is a thing. Now, you'll probably store it in the subcutaneous, rather if it's nuts, rather than in the intra abdominal cavity as much. But, you know,

Sarah Milken  14:11

we you that you know, we don't say count calories and galvus and diet, but when the occasional student is struggling, often they are loading up on nuts. And so my husband said the other day, he's like, I realized I'm eating really well. But I feel like my handful of nuts might be bigger than what it should be. I'm like, Would you like me to pre bag them for you? So how many almonds would you be eating 10? Or is it like full?

Mary Claire Haver  14:39

Well, quarter cup is generally like where I know, you know what the measurements are. And for me a quarter cup I can now just eyeball what I'm doing. So I mean, this was it's probably about 1010 halves of these walnuts, you know, and probably 12 or 15. Almonds are a little bit smaller and more Compact.

Sarah Milken  15:01

Now you also talk about I think it was on the Dave Asprey podcast when I was listening to you, you say that a lot of women do this protein stacking thing, and how it doesn't really work out for us. What is that? And how do we avoid that

Mary Claire Haver  15:14

though, if you look at the traditional Western diet, and the way most women tend to eat, they'll have toast or something for breakfast, oatmeal, they'll have maybe a salad or something for lunch, and then they'll they'll eat their big protein, you know, their steak or their chicken breast or something in the evening, and they're not good at distributing that protein out throughout the day. And so, studies in like that most of these studies were done in the elderly, but by dividing out that protein into more even, you know, 3010 30, you know, batches throughout the day actually keeps you satiated longer makes your gut hormones work for you better, so you're not as hungry, you know, since satiety signals to your brain. So it's another way to kind of trick yourself into, you know, having those hormones work for you. And you're just not starving, you know, after a snack of processed sugar

Sarah Milken  16:06

 And that's the story of my life. 

16:07

Now, what about this whole idea about animal protein versus like powdered protein? So that is your body? No, there so I think your brain knows because the chewing Yeah, all of that sends signals back to the brain. I don't use a protein powder very often.

Sarah Milken  16:29

But a collagen powder is sort of like a protien powder, right?

Mary Claire Haver  16:31

Yeah, so yeah, one scoop of my collagen powder has five grams of protein. So I do generally two scoops. And so that's 10 that's my snack, you know, I count that as my, the protein part of my snatch. And so, you know, but I'm also eating stuff with it. So it's like I'm chewing my brain is getting all these signals that I'm satiated and full. But I've seen you know, some of the protein supplements out there. You know, if you're if you choose to be vegan or vegetarian, there are health benefits to that compared to the Western diet. Yes, yes. Yes. So you have to remember, you're you're comparing it to the worst way to eat in the US that's leading to all the chronic diseases. So yeah, vegan, vegetarian is healthier. And actually you'll have less hot flashes and all the things not so much that you're avoiding meat in as much you know.

Sarah Milken  17:19

I get it

Mary Claire Haver  17:20

kind of meat you're eating. But they really struggle with protein. I have patients who come in who are vegan or vegetarian, they are so low muscle, that chronic deprivation of protein, it's hard to get into, you really have to focus, they're coming in low muscle 

Sarah Milken  17:35

and a lot of it is dairy too, because I'm finding that like, I want to like amp up my eggs. So I mix it with cottage cheese to scramble them. And I love that it like doubles or triples the protein but I'm like, Oh my God, how much dairy am I eating over the course of the day?

Mary Claire Haver  17:53

Dairy is inflammatory in two sets of people. It's not inflammatory for everyone. I don't care. There's no study to prove that okay, dairy, people across the world eat dairy. And it should not be the main source of what you eat. But if you have an allergy to milk protein, absolutely. And you should know that a lot of kids have it but they outgrow it. Okay, yeah, my son or if you are lactose intolerant, and that means you your body does not make the enzyme that breaks down lactose. Now Parmesan has hardly any lactose. So most people who are lactose intolerant can enjoy a little Parmesan is like a little shaving or you know treat or as an accoutrement to a meal without ever having any kind of issue with it. I'm Cajun, we can have as much dairy is good. 

Sarah Milken  18:37

But what about bloating? Like I don't seem to have that. But my daughter is like, oh, whenever I have like dairy yogurt, I just feel like oooughh

Mary Claire Haver  18:44

She may have some lactose intolerance and she inherited from her father. So

Sarah Milken  18:49

just blame him for everything. In terms of the meat thing I was asking because I've listened to Dr. Mark Hyman talk about how the amino acids that come from animal proteins are so good for us and how you can get the same things from my elders.

Mary Claire Haver  19:05

So they're complete proteins. And meaning they have just about every amino acid we're supposed to have. And in all all of the amino acids that are required for us to eat to be healthy our bodies can make a couple of them generate them on our own, but but a lot of them are we have to get them through our diet. And so some of the powders, the whey based powders struggle with getting a complete, you know, complete protein, meaning that covers every single essential amino acid that we need.

Sarah Milken  19:38

It's just so hard because it's like we're talking about eating animal protein, but again, it goes back to that thing where you know, not everyone can afford to buy like the most amazing Organic Farm raised chicken antibiotic free you know what I mean? It gets to a point where it's like eat the protein, eat the protein, but like if I bought all organic meats from My son, I'd probably spend $60 a day. You know what I mean? If you think about it.

Mary Claire Haver  20:05

So, you know, my daughter talks a lot about that in their nutrition studies, they talk about, you know, food deserts and not vilifying food groups, because that is all people can afford. And like, how can we work with people in different environments to help them stay healthy? With what they can afford? Yeah. And so, you know,

Sarah Milken  20:25

it's like, not milk. It's like, not feel so great. nut milks are great, but it's like $9 for the bottle.

Mary Claire Haver  20:33

And are you going to die if you you know, yeah. Oh, brutal, heavy cream in your coffee.

Sarah Milken  20:42

So what is her What is the the research that she's found, say to do just to eat the non organic chicken?

Mary Claire Haver  20:48

Yeah. Yeah, eat the chicken, whatever. 

Sarah Milken  20:52

What program is she in?

Mary Claire Haver  20:54

So she's at Louisiana State University and the it's in the Department of Agriculture, but it is the nutrition science department. Most of the graduates from there go straight into a registered dietitian program, which is an additional 18 to 22 months of training, and then they become certified like you have to have a bachelor's then it's basically a master's and you're in hospital training, but she decided to apply to medical school and got in so she Oh, my gosh, she didn't she started medical school in July. Wow. Congratulations. With a nutrition science degree. I go, babe, you got a leg up on everybody in there.

Sarah Milken  21:30

That's so cool. So your program that you did it to lay in you can't do as an undergrad?

Mary Claire Haver  21:35

No, it's only for physicians, nurse practitioners, pharmacists, like advanced level practitioners. Not it not our regular BSN. 

Sarah Milken  21:45

I wonder if they'll I wonder if they'll create one because it seems like there'll be such demand for that right now.

Mary Claire Haver  21:50

So it's mostly online. I had to fly to New Orleans to do like several hours of lab stuff. And then I went to San Antonio for another one to to check all the boxes to get my breakfast.

Sarah Milken  22:01

That's very cool. Very cool. Okay, in terms of exercise, and the galvus and diet and exercise in midlife women. What are you doing? What are you recommending? How do you get the weight lifting high enough? 

Mary Claire Haver  22:15

So you, first of all, you have to get it out of your head that we are exercising to be skinny, stop. Just skinny is not healthy. Stop, stop, stop, stop, stop. That is a fallacy. And there are way better ways to lose weight, we move our bodies to have strong bones and muscles and strong minds and strong hearts. So cardiovascular activity keeps your brain strong. And your heart strong resistance training through strength training keeps your muscles strong and whatever way that brings you joy. And so if that's Zumba, if that's hit, if it's I am not going to sit here and tell a woman that she is ruining her cortisol and doing it that is a bronchus bunch of BS really. And like I mean, 

Sarah Milken  22:57

I don't want to do HIIT training, I'm way too lazy for

Mary Claire Haver  23:00

Then don't! do something else. But you must do resistance training. Or you are going to lose muscle. And if that is you know, but you. The other thing is that you've got it for us as women at this point of our lives, you must include balanced training, it is so important because we are falling and breaking like crazy. And so balance training and stretching cardio and strength. I mean, there's no way around it. And if you can get all four, then fine. So I usually, you know, prescribe 115 minutes of cardiovascular exercise a week. And I give him a heart rate soon. I don't care how you move your body do you do

Sarah Milken  23:33

you are like just have sex all day.

Mary Claire Haver  23:36

That's zone two. That's a long time. And yeah. So you want to do 530 minute sessions or 345 minutes sessions a week, at least three sessions, however you defined it

Sarah Milken  23:48

can you define zone 2 for everyone, is it's like the zone two

Mary Claire Haver  23:50

is the heart rate zone where you are not at your aerobic capacity. It's like you can talk through it. And so you're you're working but you can still have a conversation through it. So you know, rule of thumb for the back of the envelope is to 20 minus your age. And it's 60 to 75% of that. Now like my Apple Watch tells me what zone I'm in.

Sarah Milken  24:12

Yeah, I can't wear an Apple watch because I can't see them. And I feel like I'm going to accidentally like text someone and be talking I have no idea. That's the way too complicated

Mary Claire Haver  24:25

and then so I'll calculate it out for my patients and I'll give them a little target heart rate to try to do cardio and then strength training at least twice a week and the goal of strength training is to get stronger. So if you've been working out with the same eight pound weights for the you're not doing your body service, you need to

Sarah Milken  24:41

I know that's what that's the kind of hard part about it is unless you have a trainer like what's going to take you from the eight pound dumbbell to the 20 pound dumbbell

Mary Claire Haver  24:51

so, fortunately there's a million options online 

Sarah Milken  24:53

yeah, I know it's doing it, again. It just comes back to doing it

Mary Claire Haver  24:58

and if you don't you you're not going to be as healthy as you could be because your body is trying as hard as it can to just poop muscle out and get rid of it

Sarah Milken  25:05

oh my gosh. Now will you explain everyone I did a really big episode with Dr. Rocio Salas. I think you know her that she Yeah, she's like an endocrinologist and obesity expert. And she's the one who we did a whole episode on female metabolic health and the weight loss and diabetes, diabetes drugs. And I know you said that at first, you were like, Oh my God, why are people taking this to lose weight? But then you kind of like change your tune a little bit. So who in your practice? Or who do you think is a candidate for that versus doing just strictly the Galveston diet?

Mary Claire Haver  25:44

So I Yeah, totally changed my song. I was like, what I mean, I heard of those medications, but they were for diabetes. And then, you know, the whole thing blew up on the internet. Well, across my feed came these obesity medicine specialists like her. And I reached out to them offline and was like, Okay, help me here, I'm doing something wrong, because you look like a reasonable human being who really cares about your patients? And you're saying, and they know the research, just like you do? Yeah. So that's why I learned from that, nothing I learned in school, I mean, it was calories in calories out, you're fat, because you're lazy, you know. And so it totally took like, I knew that that wasn't right. But like seeing it in a, in someone with chronic morbid obesity, who basically we could change their life forever, and the quality of their life and their outcomes and potentially avoid surgery, or some people have both, you know, do the medication and do have surgery, you know, like, like, I have no business judging another human being. And I was coming from a place of judgment before. And you know, and realizing from their education and training, some of who've had obesity in their own lives, others who've never had a weight problem, and just where they're coming from as as providers and human beings sounded a lot like me treating menopause, but just so I just sat at their feet and listened to them for weeks. Yeah, like, Okay, I got it, 

Sarah Milken  27:02

now you're ready to any of your patients take it is that something you have probably in

Mary Claire Haver  27:07

my clinic, you know, I see. Probably 15 patients a week, I don't, you know, I have a very part time schedule. And so I probably have four or five total right now. Now, again, I've only started prescribing it comfortably in the last four months. And so these are people who are doing everything nutritionally doing Galveston diet, and are still kind of struggling. And so we've agreed, let's go ahead and add this, we went through the risks, the benefits and see how they're doing. And it's a very long ramp up to get to a therapeutic dose, because it has side effects for some of these patients. So I'm still kind of when they and because I have a muscle measure where they're coming in every month to get their muscle. So we're really focusing on getting enough protein, letting go of the scale as a measurement of health, you know, and in not sacrificing muscle to get to that number on the scale.

Sarah Milken  27:58

Now, what numbers on the InBody? Are you particularly interested in, like, give me a sample person.

Mary Claire Haver  28:04

So I really like looking at the visceral fat level. And so being able to counsel a patient around even with normal weight, you know, the skinny fat people around visceral fat I also zero in on the muscle mass. And what we can do so like for people who come in who are sarcopenia, or have like, you know, less than 90% muscle mass for someone their age, we have a long talk around how what can we do to avoid you breaking in 20 years,

Sarah Milken  28:32

so you shouldn't be so the numbers you shouldn't be less than 90%.

Mary Claire Haver  28:37

So I at 90%, I start the conversation at 80%. I'm like, full stop, like, this is our number one priority is putting on muscle, you know, because you are and typically when people are coming in, they're morbidly obese, their muscles have to work so much harder to just their daily activities that fortunately, muscle mass is not an issue for them. And so I mean, that's my theory actually don't know the data. And I know there are people who have low sarcopenia and obesity, especially in the elderly, and so on. That's there just so metabolically high risk, but if I can intervene with them, so I'm on giving them more protein recommendations in clinic, I can't do this, if unless I see them. Yeah, but in clinic there, I'm going to maybe 25% protein instead of 20 I'm giving them a little more carbs to help because they really need those carbs if they're doing that much weight training. So it's like I'm in clinic, I'm really able to, you know, nuance it for them to get their best health

Sarah Milken  29:35

now. So if the average woman that's coming into your office, what is their embodied what is their in body look like?

Mary Claire Haver  29:44

So typically, they are, you know, overweight, they have elevated body fat mass, most of my patients have normal to really good muscle mass, not all I'm able to break down where their muscle is so so one of the red flags So what we see is that if they have really great upper body, muscle and core, but their legs are 15 to 20% behind that means they've been sedentary through them, not realizing it. And so we talk around workarounds for improving their muscle strength in their legs, you know, you want to be symmetrical with your muscle and not have this bionic upper body and then your legs are dwindling away

Sarah Milken  30:23

But is it the DEXA scan that shows you all the intricacies of the DEXA will

Mary Claire Haver  30:26

give you really good visceral fat levels, but it won't show muscle mass. The inbody, you know, is correlative for fat levels to the DEXA. I mean, in a Dex is $60,000. And it's a giant machine, you have to lay down in it right. And so it wouldn't fit my office,

Sarah Milken  30:42

I've done it with with my mammogram. 

Mary Claire Haver  30:44

Okay, the next best thing is is the InBody. And I got the medical grade one, the 770

Sarah Milken  30:50

Okay, so we should be looking at that. And I know we have to wrap up, but you talk about body circumference and calculating waist-to-hip-ratio 

Mary Claire Haver  30:57

a nice, like a back of the envelope, really easy way to kind of guesstimate your visceral fat level is the waist hip ratio. So it's measuring the smallest part of your waist divided by the widest part of your hips, like around your butt. And so less than point seven, you most likely don't have elevated levels of visceral fat greater than one, like if your waist is the same size or bigger than your hips. Most likely, you do have some visceral fat issues. It's not perfect. But you know, not everyone can afford the CT scan the MRI, the DEXA, you know, or have access to an MRI. So it's it's how we have our students track their progress outside of the scale is with monitoring their waist hip ratio over time.

Sarah Milken  31:36

Yeah. And on page 54, you have a chart on your book that shows the low, moderate high, because you also say that the waist to hip ratio can can can predict cardiovascular disease, hypertension, diabetes, gallbladder disease, and even cancer. And the good news is you can reduce it. Yeah, the muscle part is going to be the hardest thing for me, I think to actually like build more. And you also say to take a photo of yourself, which I'm like, Oh my God, I don't know if I want to. I don't know if I want to do that. Now I just want to say you have taken a huge pain point in midlife weight gain inflammation and insulin resistance and created a life changing platform for millions of midlife women. Kudos to you and thank you on behalf of all of us. I mean really amazing. Before we wrap up, I want to ask you, Mary Claire, what is your one piece of advice for midlife women trying to get their weight and menopause in order,

Mary Claire Haver  32:33

I would say probably something you've never thought of is is track your fiber intake, if nothing else, and then fight to use nutrition, Whole Foods to get that fiber intake up to 25 grams minimum per day. And if you're not doing that, you're gonna see a huge difference in your health immediately.

Sarah Milken  32:51

Wow, I have loved talking to you and picking your brain and asking all the questions that US midlife women have on our minds regarding midlife and menopausal waking inflammation and the amazing tool of the Galveston diet and lifestyle. If listeners want to find you and stalk you, where can they find you

Mary Claire Haver  33:11

everywhere, so diet.com And then on social, it's Dr. Marie Claire. So on Instagram and Tiktok it's Dr. Marie Claire on Facebook. It's Mary Claire Haber, MD. So if you just Google me you can find

Sarah Milken  33:25

like do you might have to do some tick tock tutorials. You could do like a whole platform on that

Mary Claire Haver  33:31

I teach my kids that I have a PhD in tick tock you do.

Sarah Milken  33:33

How did you learn all that? Summerland wall and see what sticks? Oh my God, I want to thank you Dr. Mary Claire haber for saying yes. And being a new friend of mine and the flexible neurotic podcast. You're so welcome. Thank you. Thank you. Thank you. Hey, peeps, it's me again. I listened to this episode with Dr. Mary Claire. Hey, ver board certified OBGYN menopause normalizer and Problem Solver so I could summarize the golden nuggets for you to have actionable items to start using today. I know that when I listen to a long podcast episode my my midlife brain is like oh my god, I love that. But then I can't even fucking remember the specifics. This is why I come back and do a golden nugget summary. In part two of this episode, Mary Claire and I covered the third pillar of the Galveston diet in the importance of exercise in midlife and building muscle mass. We wrap up by talking about the key measurements for midlife weight, and what they can tell you about your weight, the muscle to fat ratio, Golden Nugget number one, the third pillar of the Galveston diet is the fuel refocus. It's important that we're getting protein in when we are choosing foods that fuel us. As tempting as it is to grab the sugars. They're addictive. And what we think is a refuel is really just a quick and temporary dopamine fix for our brains, not to mention that women with less than 25 grams of sugar per day in their diets. Are a lot healthier and experience fewer hot flashes, our diet should be 70% Lean fat 20% protein 10% carbs and menopausal women should be getting 25 to 30 grams of protein per meal. And that's not even including snacks. Golden Nugget number two, exercise in midlife is crucial. I know we often associate exercise with weight loss, but we really need to move our bodies to stay strong both physically and mentally. I was fascinated to find out that muscle mass that we go into with menopause is just a huge huge determinant of our longevity and quality of life. So resistance training and strength training are crucial parts of your exercise routine in midlife for longevity. Find an exercise you enjoy, make that part of your midlife routine and make sure you keep cranking up the weights. Golden Nugget number three, the importance of our hip to waist ratio and the InBody scale. The hip to waist ratio can help you guesstimate your visceral fat ratio. To do this, you would measure the smallest part of your waist with one of those fabric soft tape measures that you would get at the tailor and divided by the widest part of your hips around your butt. For reference less than point seven means that you likely don't have elevated visceral fat, but greater than one is an indicator of visceral fat issues. I mean, who even fucking knew you can get the same information about visceral fat from a machine the brand is called an in a body scale i n g o d y. There's an at home version you can buy an Amazon or whatever, and many gyms and some doctors offices have it. And this machine measures body composition. The end body again can be at home or at a doctor's office. Usually the commercial ones are a little bit more specific and detailed but at this point anything is helpful. Like I said my conversation with Dr. Mary Claire was filled with mid-life golden nuggets. And if you missed part one, go back and listen to part one. It's juicy, it's supplements. It's all the things if you haven't listened go back. The gold is dripping off these nuggets. Grab it use it. There's three things you can do. First, subscribe to the podcast. Yes, it matters. Second, share it with some friends who like midlife shit. And third, write an apple review. writing reviews is kind of annoying and an extra step. But guess what? It really helps the podcast grow. You think your little review will matter but it does. If you went to a show when everyone said my clap doesn't matter, then there would be no clapping. You all matter. DM me, you know I always respond. I'm the only person in my Instagram oh and of course, follow my Instagram with the flexible neurotic da love you talk soon