Brain Fog and Menopause

Hi everybody. For those of you just joining, my name is Dr. Mary Claire Haver. I am a board-certified obstetrician gynecologist. I'm also the creator and founder of the Galveston Diet. I am also a certified nutritionist.

So I am here today. I got a lot of questions today about brain fog, so I wanted to come on today specifically to answer any questions about brain fog and talk about what is some of the latest research that has come out, um, concerning brain fog and menopause.

Um, so I was, um, as always, I go to PubMed and, um, to look up what the latest studies show. And it was kind of shocking to me, as a lot of things are in menopause, that there were actually, um, studies actually proving that women suffer from brain fog and menopause. And this just really upsets me. Now that I'm a woman who has multiple conditions related to menopause, why did we have to do a study to prove that women are suffering from brain fog? Why do we need a study to prove this? Why can't we just listen to our patients and take them at their face value and absolutely believe them? Why is it that when someone complains of something subjective, that especially for women, we have to do a study to prove that this is actually a problem before we start investigating ways, you know, the causes of it and ways to alleviate the suffering that women are going through?

And I use this analogy because this happens in gynecologic pain. Right now, the call for anyone even discussing gynecologic pain on the OB/GYN circuit is, "We need more studies." And my point of this is, at this point, studies to prove subjective experiences becomes unethical. Why can't we just listen to our patients and, and then try to find, you know, causes and solutions to what they're going through?

For example, pain associated with vasectomy. Okay, there was no study ever done to prove that a man has pain during a vasectomy. None. No study. The expert opinion? No. So the, the American Neurological Society, you AUS, AUS has a statement clearly everywhere in all of their written literature that says a man can have X, Y, and Z as pain medication options for his vasectomy. He can go to the OR, you know, all fine. There was no study done to prove this. There was no study done to look at what protocol of pain control would be best for a man. They're just like, "Look, throw everything out and make sure he's comfortable and be done with it." We don't have the same thing for gynecologic procedures. We do not have standardized methods of pain control for gynecologic procedures. And there's, I have a paper written on this. There are many, many reasons why this is happening. One is the fallacy that the cervix doesn't have very many nerve endings and is impervious to pain. And others, um, others just misogynistic, paternalistic. I hate using those words, but they absolutely are necessary here.

So when I looked at the data on brain fog to come to you to give you solutions, I was, uh, shocked by the number of studies that were done just to prove that you were actually having brain fog. Like, instead of going for the solution or going for the cause, simply multiple studies, multiple, were done to prove that what women are saying is actually happening, is actually happening. Why can we not believe our gender from the get-go? How many of you? I have hundreds of thousands of comments on multiple videos of women complaining of menopause symptoms. Okay? But yet science and medicine still feels like they have to do studies to prove that these things are actually happening. This is a problem. There is not an equivalent, that I know of, on the man's side of things, okay? On the male reproductive health, okay? There is not a, you know, men say that they hurt, you don't have to do a study to prove it. Yes, you hurt. Let's get you some pain medicine. Yes, you're having brain fog. Let's figure out why. Not, "Oh, we need to do a study to see if," especially when it's related to perimenopause and menopause.

So, by the way, there are multiple studies proving with evidence from Harvard. Harvard, why did you have to do a study proving that a woman has brain fog? Why can't you listen to the woman who's telling you she's having difficulty concentrating and remembering and realize that she's in perimenopause and just go from there? Why does this have to happen like this? Why does this have to happen?

So, so all the studies are saying, "Why, yes, these things are real. These things are real. You are having forgetfulness, difficulty concentrating, and thinking clearly." Okay? Um, all right. Let me go back to, um, scholarly. Okay. So, cognition, mood, and sleep in the menopausal transition. So there seems to be a relationship between how, what your quality of sleep is, as well as going through menopause and brain fog. That they're, you're in this little treadmill and it's feeding back in and, obviously, feeding back in and on each other. So there is a deterioration of the hypothalamic pituitary axis, and that women suffer these symptoms and the syndrome, and these three things seem to be related.

So, um, okay. So sleep, sleep, sleep, sleep, sleep, sleep. Making sure you're getting good quality sleep. My, um, so we're talking about brain fog, okay? And I have, this is expensive, but some of you may have watches or things that do it. This tracks the quality of my sleep and it gives me suggestions as to things when I don't have great sleep, how I can improve them. I suffered miserably with sleep disruption during my perimenopause and menopause. Hormone replacement therapy was very, very helpful for me. I tried everything. I tried Benadryl. I tried sleeping pills. I tried, um, you know. So a combination of hormone replacement therapy, relaxation techniques, meditation, good sleep hygiene. There's not going to be one thing. Everyone's like, "What vitamin can I take for this? What one thing can I do for that?" You guys, your body is undergoing a tsunami of hormonal changes. You have to fight back with a tsunami of lifestyle changes to combat it. I'm sorry, there's not one thing. There's not one magic. If you don't want to suffer in your perimenopause and menopause, you have got to open up Pandora's box of your armamentarium of multiple things that you can do to change. And I'm going to go through some here. Okay.

So we know that when your sleep's disrupted, your brain's not going to function. Okay? So I had to fix my sleep to help my brain fog. And how did I do that? Sleep hygiene. Turning off electronics. Not taking electronics to bed. I have a whole blog at galvestondiet.com on sleep hygiene where you can, um, oh, a finger heart. Thank you, guys. Um, so if you're just joining me, sorry, I get all these notifications from TikTok. Everyone double tap the screen to like this video. Um, you can power tap, which means tap a whole lot. A little heart will pop up under my name and it goes across the screen. And then you give me a little, um, a shower of hearts. If you would like to, please place any questions in the question box down here below and feel free to share this video with someone who you feel like it would be helpful for.

So we're going to talk about some ways to improve your sleep. So I have a whole blog on sleep hygiene. Please go check it out at galvestondiet.com. Magnesium. So we know that people who have a magnesium deficiency have trouble sleeping. But magnesium and super physiologic doses, meaning you're not quick to create, you're not correcting a deficit, you're actually going higher than the recommended daily amount, can be medicinal. Okay? But there's certain types of magnesium which are better for this than others. My favorite, the one that has been proven to cross the blood-brain barrier, that means get into the brain easier and faster, is called magnesium L-threonate. Someone type it out. Magnesium L-threonate. M-A-G-L-dash-T-H-R-E-N-O-A-T-E. I get it from Amazon. I'm actually formulating for Galveston Diet, but it's not, it's not going to be here until the end of the year. It takes forever to do this stuff. But please consider magnesium. Um, it's really, in, in the dose is recommended on the bottle. I take, I think, 340 milligrams per day. Um, I think I keep selling it out on Amazon. But magnesium L-threonate is going to be your best bet, um, to try it. It's not going to work for everyone, but it will work for several of you to help with sleep. Sleep gets better, brain fog can get better.

If you are a good candidate for hormone replacement therapy, you should consider it. The earlier the better. The earlier you start hormone replacement therapy, like in perimenopause, the better you are going to do long term. The better you're going to do with sleep. The better you can do with brain fog. The better you're going to do with colorectal cancer. The better you're going to do with chronic disease. The better you're going to do with any and everything. Now, remember, if you have questions, you guys keep coming. Thank you, thank you, thank you. Share and like this video as much as possible and hit the interact button to drop your questions there. And then, of course, share this video by hitting that, um, the, uh, share button down there below.

So, um, everybody wants to know, "Blood levels, do, why isn't my doctor testing my blood? Why am I not getting my blood levels tested?" Okay, I'll tell you why. And listen up, ladies. We do not, as an OB/GYN profession, have a good blood test for perimenopause. We are excellent at diagnosing post-menopause, but perimenopause, no, no. Why? Because your levels fluctuate on a day-to-day, minute-to-minute basis. Okay? Now, they trend down over time in perimenopause, but they are fluctuating today. So it just depends on what time of the day you're having your blood drawn. It may look completely normal. It doesn't mean that your function is normal. A normal blood test does not mean that you're not suffering. Let me say this again. A normal blood test only means that you're falling in a certain range. It does not mean that it's not pathologic and you are not suffering. Okay? We don't diagnose perimenopause with a blood test. We don't diagnose perimenopause with a blood test. If my level is 50 and your level is 50, our journeys are completely different. A level doesn't mean anything. We treat your symptoms. The earlier the better. Okay? The earlier the better. Okay, we get it. I guess I was getting a little too dramatic there.

So brain fog. All right. So sleep is one big thing. What, uh, what else can we do? Um, hormone replacement therapy can be helpful with brain fog. The menopause transition and cognition during the middle. Okay. Remember, so are you having memory problems? Are you having difficulty concentrating? Are you getting in the car and you can't remember where you're going? Can you not remember where you put your keys? I want to see some likes, some high fives, some whatever. I want to see what's going on with you. Are you having these symptoms? Are you? Yes, yes, yes, yes, yes. Okay, give me a bunch of likes. Like the heck out of this. Um, and thank you for the gifts. Thank you so much. Um, if you are having it, well, 60% of you have it in perimenopause. And if you're, this could be the only symptom of your perimenopause. If you think you might be going through perimenopause, take the perimenopause quiz. It's at the link in bio here at Dr. Mary Claire, at the top of my TikTok page. Um, lose keys. Sleep is the worst part. Okay. So try magnesium. Magnesium L-threonate is one easy over-the-counter way. Do not rely on sedatives. They're good for the short term, not good for the long term. Magnesium L-threonate is my favorite. Um, is HRT pushing off what is inevitably happening? Girl, HRT is making you healthier. If you're a good candidate, stop thinking you're putting off the inevitable. What are you putting off? You're getting healthier. Women who go on HRT live longer, live healthier, longer lives. So I, you're just putting off dying. Okay, fine. If you don't care when you die or how, you know, I don't care when I die as much. I don't because my, I have three dead brothers who are older than me. Okay? Three dead, dead, really dead. Cancer, cancer, and, uh, liver failure. True, true life here. So I'm not so concerned about when I die. I'm concerned how I die. I want the best quality of life. I do not want to live the last 10 years [ __ ] miserable like my brothers did and like my parents are. My dad died last year as well. So it's been a rough couple of years. And I know I get very passionate about this, but it's the truth. And I'm trying to take everything that I've learned and gained and share it with you so you don't have to suffer. My whole goal is to alleviate suffering. Alleviate suffering through nutrition, through exercise, through possible supplementation if there's a gap in your nutrition, and through hormone replacement therapy if you're a good candidate. Okay. The four pillars of good health in perimenopause and menopause. Okay. HRT, hormone replacement therapy. Hormone replacement therapy. There are a lot of things that you can do. Nutrition should always come first. Absolutely always come first. If you're looking for a good program, Galveston Diet, a little plug there. Go check us out at galvestondiet.com or up here at the link. But other than that, guys, I was blindsided when I did my nutrition certification. Nutrition to me was like porn. You know, when good nutrition, you know, when you see it. They didn't teach me jack about it in medical school or residency. Okay? It was mind-blowing to me when I, 18 months of graduate-level coursework in nutrition, and I was like, "We are doing this wrong." Locale is not the way. Counting calories is not the way. Anti-inflammatory nutrition is the way. And I have student after student after student is seeing dramatic reduction not only in brain fog and, okay, number two things. So I said magnesium. Theory. Intermittent fasting is fantastic for brain fog. If nothing else, intermittent fasting is, let me say it again, fantastic for brain fog. It is combative. It lowers inflammation levels. It lowers neuroinflammatory levels. Okay? It does. So, um, higher brain levels of estradiol are are correlated with increased performance and memory issues, memory tasks in the studies. Okay? So I recommend a daily intermittent fast. Um, it's part of the Galveston Diet. You can go check that out. I teach a 16:8, roughly 16:8 in our program. You don't have to get it perfect every day, but it is what I use. Um, magnesium L-threonate. Somebody type it out for those of you. I wish I could like put a sticker or something in here. Can I? Let's see. Can I put a sticker? No. Okay. Is my favorite one that I like. All right. Full of menopause. You fasted. All right. If you have comments, drop them here in the comment section below. So yes, your brain fog is real. And it just pisses me off. Y'all, please go back and like my last TikTok. So I did this kind of funny TikTok about brain fog and just saying, "Oh, the studies are showing that women are actually having brain fog. Did you think we were lying? Did you think we were not telling the truth when we come to the doctor and we're like, 'I can't remember a goddamn thing'?" Now, for some of you, it might be dementia and Alzheimer's. Okay? But probably it's just perimenopause. That your brain does not function as well when you're going through decreasing estrogen levels. It is proven, proven, proven, proven. Okay. Other things can help support your function and memory. Sleep, as I talked about earlier. Hormone replacement therapy. Magnesium L-threonate can be very, very helpful, especially with sleep. Intermittent fasting can be amazing. Exercise can do wonders. Okay? And keeping your brain stimulated. Doing word puzzles, doing, you know, cognitive tests, doing whatever it is, just not sitting there and doing passive things. Reading, not just watching TV. Keeping your brain HRT, as hormone replacement therapy, as active as, as possible. So no, you ain't crazy. It's brain fog. It's real. And it's most likely related to your estrogen levels declining in perimenopause and menopause. Mamas out there, aunties, anybody with a younger uterus, carrying person in your life, talk to them about this. Nor. Okay. And then, oh my god, the [ __ ] article I read was like, "We're trying to normalize brain fog and menopause." Okay, normalizing it does two things. One, yes, we start talking about it and we realize we're not alone. But normalizing it to say that it's normal isn't okay. Because normal doesn't mean you're not suffering. Normal doesn't mean that you have an ability to change this in your favor. Doctors are, you know, our healthcare system. I hate to blame doctors because we're just robots now doing what we're told. The healthcare system is basically using normal as a way to blow us off, as a way to just say, "Everybody else is going through it. Suck it up, buttercup." And it doesn't have to be that way. There are things that we can do. Oh, thank you, Rudy. Thank you. Thank you. Thank you for my heart. Um, HRT is an option. It is not a panacea. It is not the be-all, end-all. It is one cog in the wheel of your Pandora's box of things that you need to do to stay healthy as you age as a woman. Okay? It's never going to be just one thing. You cannot stay on the path if you were suffering. If you were suffering perimenopause and menopause, brain fog, night sweats, mood swings, decreased sexual feelings, headaches, aches, pains, digestive issues, you name it. I want to see your symptoms down below. Let me see it. Let me see it. Let me see it. Okay. You cannot keep doing what you're doing and expect a big change. And you can't just do one thing. When patients come to me at Mary Claire Wellness in my clinic in Houston, I go through a complicated treatment plan, including nutrition, exercise, possible supplements, prescriptions, you know, mindful wellness, all of it. It's got to be a complete change in how you are living your life and utilizing every tool you can in your, in your toolbox, or you're not getting the maximum benefit. I cannot tell you, "Do one thing." Everybody wants to hit the easy button. I know, I know, I know. And I wanted it to. Okay? But yes, I am on HRT. That is my personal choice. I also have dramatically changed my nutrition. Check out Galveston Diet. I exercise on a regular basis. I'm very specific about my exercise for because I have sarcopenia. I am under muscle. I've had it my whole life. I'm fighting to hang on to my muscles so I can remain functional and lift those potential. No, no pressure, Catherine and Madeline, but lift those potential grandchildren. And, and my little, I call her my niece, um, Miss Birdie, who's, lord, she is a chunk and she's 18 months. And girl, I was picking her up the other day. This is our nanny's daughter, who I adore. So, all right. So fasting and hair loss and severe anxiety. I'm reading through the symptoms. Brain fog, incontinence around your period, bloating, weight gain, aches, anxiety. Oh my god. Having complete hysterectomy and freaking out about menopause. Why are you having your ovaries out? Why? If you're having a complete menopause, pre-menopausal, think hard about keeping your ovaries. Okay? You are more likely to die from a menopause-related complication than from ovarian cancer. Okay? You are more likely to die from early menopause, a complication secondary to that, than you are from ovarian cancer. I, hopefully, you guys are hearing that in the back. The earlier you go through menopause, naturally or surgically, the higher your risk of everything. Everything, absolutely everything. What age should you start thinking maybe it's pre-menopause? At least 35. 35 is when it starts. Okay? Remember, the average age of menopause is 51. Normal is 45 to 55, meaning your period stops. The decline in estrogen, hallmarking the beginning of perimenopause, starts 7 to 10 years before that. Do the math. 10 years minus 45 is 35. So at 35, we all should start thinking, "Am I there? Am I getting there yet?" Monitoring your symptoms, looking to see if there's a pattern. And remember, these symptoms can wax and wane over time. It is not, I'm sorry, um, uh, it's not about so much joint pain. The Galveston Diet has so much info. They should get it. I do. Y'all, the Galveston Diet is not just meal plans. It is a comprehensive educational about menopause, perimenopause, hormones, leptin, things, hormones that make you hungry, hormones that make you full, hormones that control your hunger and satiety, hormones that control cortisol. I mean, cortisol is a hormone. You know, vitamin D, all of it. All of it. All of it. All of it. It is extensive. It takes about 28 days to get through it, but it is meant to be a tremendous lifestyle change. Tammy, thank you for the rose. That is so sweet. I really, really appreciate it. Um, you can't do hormones. You don't know if you're feeling medical history and you don't know if there's cancer. I'm telling you guys, you're, that is not enough to not be a candidate for hormones. Your risk of dying from a menopause-related disease is higher. Oh, thank you, thank you. Than any cancer. Than any cancer. Thank you for the crown. Thank you for the crown. That was so sweet. Um, uh, your wife is 36 weeks, spotting, pelvic, and has back pain. Get off TikTok and call the doctor immediately. She might be in labor now. Okay? Not okay. Now. Um, let's see. What are you dying from? Heart disease. Number one killer in women is a heart attack. Heart disease dramatically increases AF during perimenopause and menopause. Risk of heart disease regardless of your age. Completely menopause-related. Estrogen is cardio-protective. Yeah. Okay. Diabetes, stroke, colorectal cancer, all of the above.

Um, okay, I'm going to the questions. Four hours of sleep, hot flashes, and crying. Okay. So you are, God bless you, in the perimenopausal, menopausal tsunami. Okay? Everything's crashing down. You're in this negative feedback cycle. So you're, you're not getting enough sleep. Your hot flashes are disrupting your life. You're crying all the time. Your emotional ability is through the roof. All of this is feeding into each other. On top of that, your cortisol levels are rising, which is making your inflammation levels rise, which is making you drive more fat to the abdomen. I will bet my medical degree and my license that you have visceral fat. That all of this is leading to increased deposition of visceral fat. So we got to back this up. The first thing, the first thing we got to figure out what you need to sleep. Okay? It might be hormone replacement therapy. Sleep hygiene. Please go check out my blog on sleep hygiene at galvestondiet.com. Um, sleep will fix so many things. Hot flashes, almost 100% of the time, are fixed with hormone replacement therapy. Okay. On hormone replacement therapy, you should be terrified. This is real [ __ ] and we're just like, "I go, it's normal. Welcome to 50. Welcome to getting older. Oh, you're a woman now, stop complaining." I'm like, "[ __ ] it, no. I'm not. I'm not. I'm here for you. And I am going to change me and a few other good women change the face of menopause." Okay? If you have to be on Tamoxifen, God bless you. All right. There are, you have got to maximize. I talked about Pandora's box. Your armamentarium. Okay? You have your sword, you have your mace, you have your, uh, helmet, you have your, what's that thing that round thing? Your shield. You know, you have all these things you're using to combat menopause. You got your sword taken away. Okay? Not your fault. Not your fault at all. Then you have to maximize all the other things. Nutrition, exercise, supplements, other potential prescriptions. You need a partner in this menopause journey, especially if you are on Tamoxifen, because it is so much harder for you. So much harder for you. But yes, absolutely, there is help. You just have to find the right provider. So any of you who have the world's most kick-ass menopause provider, please, please, from the bottom of my heart, I am begging you. I have a database. I am building of excellent menopause providers. Again, go to Dr. Mary Claire Haver. Everybody, double tap the screen to like this video real quick. Everyone, double tap, double tap, double tap. This will help drive the algorithm. Um, and please refer them at galvestondiet.com or at the top of my TikTok page. There is a blog, a link in bio. Click on that and you can go and refer your favorite physician. Please, please, please. We will verify that they're actually legit, put them into our database. We're building it as we speak. As we speak. Okay. Um, everybody, double tap, double tap, double tap. Um, oh, 24,000 likes. Thank you, thank you, thank you, thank you so much. Um, we're really getting there. Okay. Uh, I'm looking at questions. Okay. Um, you're 70 and you're still on an estrogen patch. Is that okay? Basically, when I have patients, the North American Menopause Society, American College of OB/GYN, don't have a lot of data to prove that, um, staying on hormone replacement therapy over the age of 60 is a good idea or is improving your health. But the studies just haven't been done. So they're reluctant to recommend it. It is done on a case-by-case basis. So if you are happy with your physician, you know what your risks are, you feel better on the medicine, your quality of life is improved, that is a personal decision between you and your healthcare provider. But I fully support that if that is what you want, if that is what one of my patients wants and she understands her risks. So, but feels that her quality of life is, is, um, how do you know if you're in perimenopause? It is a diagnosis of exclusion. It is not a blood test. Let me say this again. Perimenopause is a diagnosis of exclusion, not a blood test. We don't have a good blood test for perimenopause because the levels fluctuate on a day-to-day basis. I have, so it's, it's a, you have to, uh, there is a validated perimenopausal scoring system. Go here, Dr. Mary Claire. Go to the link at the top of my TikTok page. And I have a menopause quiz that will tell you the likelihood that the symptoms that you have are related to perimenopause. It's free. You put in your email, it will send you a ton of information for you all about perimenopause and menopause, medications you can consider, things to talk to your doctor about, lab tests to ask for, all there for you. Okay? And it's free. So check it out at the link in bio at the top of my TikTok page. Okay. Um, and, and certainly if you're over 40, I would say that number approaches 100%. For those of you who are going to, so drop your questions in the question box in the interact button there below, guys. Minimum hours for fasting. So I followed the research from Mark Mattson, done at the National Institutes of Health. The studies that I follow and that I, I based my Galveston Diet on were from these studies. And I have them all listed in the Galveston Diet. If you want to go and click on the medical references. Um, I also at the bottom of our website have all, a bunch of medical references listed, just to let you guys know that I'm legit. But I practice the 16:8. It seems about 16 hours on a daily fast seems to be the magic where you're gonna, Matt's an M-A-T-T-S-O-N, where you're gonna maximize the benefit without running into issues with chewing up muscle for fuel. Okay? You're just in the fat-burning zone and not a muscle-burning zone, which is what we worry about. Remember, weight loss at any cost is not the way. When you do longer fasts, you burn more muscle. And so yes, the scale is lower, but you're undermining your progress because you are artificially losing, you're losing muscle. How can you treat visceral fat? Girl, you have come to the right place. This is my favorite conversation in the world. I am the queen of getting people, getting rid of visceral fat. I actually have a machine at Mary Claire Wellness where I can measure your visceral fat. I have some very tough conversations with patients, very eye-opening, very mind-blowing. And we talk about specific nutritional things. Again, I have a blog about all of this with all the recommendations for visceral fat. So what is visceral fat? Visceral fat is, okay, there's basically two compartments for fat in your body. One is subcutaneous fat. That is the fat that gives us curves. You can pinch and she gives us cellulite. We don't like it. It's not metabolically dangerous. It causes wear and tear in our joints. It makes it harder for us to exercise and move around. But it does not pump out any hormonal factors into our body. Visceral fat is different. So the latest research is showing that visceral fat, which is the fat inside of our abdomen, you can have skinny arms and legs and a giant belly. Okay? That makes you look pregnant. That is usually visceral fat. It's not bloating. The fat does not go down. Okay? It's like that hard belly when it's very large, like the man with the beer belly. That is visceral fat. Okay? That fat is metabolically active. It is meta, it is what causes your waist-hip ratio to change. Okay? Meaning it pumps out inflammatory cytokines, which are linked to hypertension, diabetes, stroke, all of the seven of the top 10 leading causes of death in women linked to increasing amounts of visceral fat. And visceral fat deposition dramatically increases beginning with two years before your period stops. Proven. Okay? So all these 25-year-old buck trainers who are like, "Fat is fat. Fat doesn't know a calorie's a calorie." Y'all, just turn them off. Follow their workouts, fine, whatever. But do not listen to what they're telling you to eat because it's [ __ ] crazy. So what can you do to decrease visceral fat? All right. Number one, make sure you're getting enough fiber in your diet. The average American is getting less than 50% of the recommended daily amount. For a woman, it is 25 grams. For a man, it is 32 grams per day. Okay? The majority of your fiber should come from food, not supplements. I get 25 a day roughly through food and I supplement an additional 10 because of my family history of colon cancer. Okay? So I am getting 25 through, I'm getting it through nuts, seeds, legumes, avocado, you know, healthy nutritious sources, mostly plant-based because that's where fiber comes from. And, um, and then I supplement with the Galveston Diet fiber. You can check it out at shop.galvestondiet.com. Again, the link is up here. Oh, we're up to like 40,000 likes. Everybody, double tap the screen. Um, uh, okay. All right. So number, so number one, fiber. Number two, probiotics. Women who, um, were taking probiotic supplements had lower visceral fat than those who weren't. Now, you absolutely can get probiotics through food. Um, you can get it through sauerkraut. Drop your favorite, um, uh, probiotic-rich food in the thing. You can get it through sauerkraut, yogurt. Um, but a lot of yogurts are really unhealthy. They have so many additives and added sugar. I would not recommend. Zero out of 10. But I just, the yogurt at our house is Fage plain Greek strained for higher protein yogurt. The end. Chinese pickles, kimchi. Yes. Sauerkraut. Kombucha is another. Okay. And then, uh, number three is aerobic exercise. Aerobic activity has been shown to, uh, decrease. Another sneaky one is one avocado a day. They did a really cool study where they looked at, they provided meals to patients and what the meal, the only difference in the meal is that one, they were equal calorimetrically, the same, but one had an avocado a day and the other one didn't. Okay? So they had the same amount of protein, fat, calories. It's just the only thing different was an avocado. And the avocado group lost weight, had decreased visceral fat, and they lowered their blood pressure. Go [ __ ] figure. So guess who eats avocado a day? Me. And I love them. They're delicious. So if you love avocados, it's like the greatest, greatest news of all time. It'll decrease your amount of visceral fat. Um, let's see. Aerobic activity, avocado a day, probiotics, fiber. Go check out the blog at galvestondiet.com. It is called Menopausal Belly Fat. Easy, easy, easy, easy. And go check out the Galveston Diet at galvestondiet.com. Oh, and we have a TikTok sale. TikTok 15 is TikTok 15 is the code to save 15% on all things Galveston Diet. Um, okay, so let's go to questions. Um, how do you do a waist-hip ratio? Okay, that's a good one. Um, all right. So waist-hip ratio. Let me take off my lab coat and show you guys. Okay, waist-hip ratio. I'm in my workout clothes. Ugh. All right. How do you do it? This is me, real me. Let me see if I can get the thing to stay up here. No. Okay. So you want to go where you are the smallest here. Okay? So some people, if you don't, if you're just a boxer, you go out, pick your belly button. For me, it's kind of high. I have a weird waist. Okay, I have a high waist under my ribs. This is the smallest part of me. Okay? So you want the smallest part. It doesn't matter centimeters or inches. The waist circumference. So you measure this. And then the hip circumference. Let me pull this guy back up. Is the widest part of you, where your butt goes out. So wherever this biggest measurement is, where the part of your butt sticks out. So your waist divided by your hip. Okay? It's going to give you a ratio. All right. It's going to give you a ratio. The waist divided by the hip. The smallest part of your waist divided by hip. Okay? Write this stuff down. If you are less than 0.85, 0.85 for a woman, you're doing pretty good. Okay? You probably don't have a significant amount of visceral fat. If you are above that, and definitely above one, if you are wider at your waist than you are at your hips, you are most likely having visceral fat. Now, if you bloat a lot, or you know, do it first thing in the morning when you're not bloated, just, you know, I know there's a lot of bias here. People like, "What if I'm guys, it's better than your BMI for a measurement of health." Okay? So if you got a big ass, good for you. It works in your favor. That's why the pears are healthier than the apples. Okay. Oh, can you hear me? You still have audio? Okay. So your waist-hip ratio should be 0.85 or less. 0.85 or less. Everybody's going to run, go get a tape measure and figure this out. It is mind-blowing. It is mind-blowing how that is. Okay. Um, all right. Let's see. Who is a good candidate for hormone replacement therapy? I'm better at telling you who should avoid hormone replacement therapy. If you have had an estrogen-related blood clot, that is kind of controversial, though. A lot of studies are coming out showing that because the doses of postmenopausal hormone replacement therapy are so low, you probably can go ahead and take it. But talk to your doctor about that. If you have had a stroke or any kind of thrombotic event related to estrogen, you know, definitely you have to have a conversation. If you have personally had estrogen receptor positive breast cancer, no. Okay? You are not a candidate. We don't want to grow any potential cancer cells that got left behind after your treatment. Number three, if you have a primary first-degree relative or a known cancer syndrome that is estrogen-sensitive, no. If you have active liver disease where your body doesn't process estrogen correctly, no. If you have known cardiovascular disease, no. Okay? That's pretty much it. Everybody else, this could be a candidate. All right. Let's see. Um, I have a whole giant long YouTube about. I have a whole giant long YouTube about menopausal hair loss. Please go check it out at my YouTube channel. There is, oh my god, we're at 54,000 likes. All right, everybody, take a stop. So if you're just joining me, so many of you come in and out. I am Dr. Mary Claire Haver. I am the creator and founder of the Galveston Diet. I'm also a board-certified obstetrician gynecologist, as well as a certified nutritionist. And I have married my two passions of menopause and health and women and nutrition to create this safe space for all of us to learn about menopause. So all right, thinning and hair loss. Go check out. It's too much. There's too much there. But I have it all in my YouTube video on menopausal hair loss. Go check it out on my YouTube channel. There is a link at the top of my TikTok page. So I'd love for all of you all to go check it out because I talk about different things you can try for treatment and what I use. So which is Rogaine. Um, all right. Um, I don't like the term "balance hormones." I think balancing hormones has become a marketing term. It's not a medical term. When I'm talking to another OB/GYN and I'm like, "Her hormones aren't balanced." That is not anything we talk about in medicine. Okay? That has become a marketing term to make you feel like something's wrong with you that you need a solution to. Now, I call things like, "Mrs. Smith is suffering from perimenopause. I think she needs hormone replacement therapy to level her out while through this transition." Those are words that I would use. And these are the words I use with you. Be careful because there are a lot of charlatans out there who are preying on you because of the lack of knowledge and education around perimenopause. They're offering you miracle cures and balancing treatments when we don't know what the [ __ ] they're doing. Okay? And they're just taking your money with false promises. So be very, very, very careful. I don't love using "balancing hormones." Okay. Um, let's see. Thoughts on bioidentical hormones? Okay, it's just another form of hormone replacement therapy. So when we talk about, let's just talk about estrogen. Okay? When we talk about estrogen, the very first estrogen that was kind of created in, in the setting that was commercially available was conjugated equine estrogens, or something under the brand name Premarin. Um, Premarin came from the term pregnant mare. I know there's a lot of ethical things around that. I don't prescribe Premarin anymore. It was very, very popular when I was in training. I was taught to prescribe it all the time. And so that is considered to be, it is natural because it's coming from pregnant mare urine, which is a natural source. So it, but it's not bioidentical. Bioidentical means it looks just like the estrogen, the estradiol, that your ovaries would create. Um, then their next kind of phase was, um, ethinyl estradiol, which is synthetic. It's made in the lab. Um, it works fine. It binds to the receptors. It does all the things. Um, but it's kind of gotten a bad rap because it, um, is not bioidentical. And so the third thing is bioidentical, meaning it looks exactly like. Now, it could be said that bioidentical could be synthetic or it could be plant-based. It just depends on how they make it. And so, and so there's all this like, again, uh, people who are preying on you as not understanding how hormones work and desperate, desperate to get some help and just grasping at anybody who will offer to help you. And someone like, "Oh, do this bioidentical. It's so much safer. It's so much better." It's never been proven to be safer. Now, the studies with breast cancer were with Premarin, which is why I avoid it. But I don't know if bioidentical is any safer. We don't have studies showing that. Okay? It was not the one used in the study, but that doesn't make it safer. An estrogen receptor is an estrogen receptor. It's going to get stimulated. Batch. It happens. Trust me. Your oncologist is taking you off of all estrogen. Your oncologist is not giving you bioidentical because it's not that much safer. Think about it. If it was really safer, then people with breast cancer could take it. They're not. It's estrogen. Okay? So, um, estrogen hormone replacement therapy is good for the heart. Is good for the heart. Is good for the heart. Go right now and Google estradiol and heart disease scholarly and pull up the latest scholarly articles that are just look up menopause and heart disease and look at what declining estrogen levels do to your heart disease risks. Okay? I don't know who's telling you this stuff. It's completely bunkus. It is absolutely fantastic for heart health. And women who are on HRT suffer less from heart disease than others. Okay? So, um, bioidentical? Yes, I prescribe them. Not right. I mean, I, I give patients the option. They can be very expensive. I try to, you know, if a patient, it's, you know, it's fancy, it's designer. But if she can't afford it or has to like not go on vacation or enjoy time with the family or go out to dinner because she's got to pay for her hormones, it's not working. So we're going to go with another option that isn't as fancy or designer, but she can afford. It's like driving a Honda versus driving a Porsche. You're going to get to where you're going. It just may not be as luxurious. Okay? So I try to pay attention to what my patient's whole life needs, including her budget. Okay. Um, let's see. Libido is in [ __ ] show is [ __ ] now, sorry, in menopause. Suggestions? That's complicated. So I have a couple of blogs about this. But here's a doctor I would follow. Um, I would watch, listen to this podcast. You Are Not Broken. You Are Not Broken. Somebody type it out for me for Dr. Kelly Casperson. Kelly Casperson. You Are Not Broken. She does everything to do with sexual wellness with women. She's a urologist. She's a female urologist who has devoted her life and studies to learning about women and sexual function. And she is fan freaking tastic. And you will love her. Um, she has so much great information. Go back and listen to the old podcasts. She's coming out with a book soon. I adore her. I've learned so much from her and been able to share some of the information with her. And she's got tons of ideas. Okay? Um, but it's real. It's very, very complicated. Um, is hormone replacement dangerous? No. Not having hormone replacement therapy is more dangerous than having it. Okay? No, it's not dangerous for most women at all. Okay? Not having it, suffering, suffering being a person you don't recognize, not being able to sleep, not being able to function in your relationships, not having any sex drive, not having increased your body dysmorphia in your image, everything is just, just jacked. Okay? Is hormone replacement therapy going to fix all that? Not all of it, but a lot of it. So what's more dangerous? A quality of life that's in the [ __ ] or a 0.00 something percent increased chance of breast cancer? It's not dangerous. Menopause is dangerous. Menopause is pathological. And you don't have to suffer. Um, uh, full hysterectomy at age 30. Should you be on treatment? I cannot believe that your physician did not discuss hormone replacement therapy with you so young. This is malpractice. And I would turn them into your state medical board. That is ridiculous. Um, I do. Okay. Um, yes, hormone replacement therapy is safe if you have had human papillomavirus. Absolutely. There's no issues there. Um, [Music] You have menopause because of your cancer. Okay. Why? Why did I start hormone replacement therapy? Because I don't want to die. I want to live as healthy as possible. Well, my night sweats and, and disruptive sleep were just [ __ ] horrific. But the more that I've learned about the medical benefits, the long-term health benefits of hormone replacement therapy, am I getting off? Okay. Why am I staying on hormone replacement therapy? Because I want to live a quality of life that is kicking [ __ ] ass when I'm 80. I don't want to be decrepit with low muscle mass and low ability to function and hurting all the time and not being able to enjoy my relationships or my grandchildren. That is not, that is not anything I want. So hormone replacement therapy is one of the many things that I am doing to improve my health for the long term. Let's see. I'm reading the questions, guys. Um, I do a few online consultations, but only in Texas. You can learn more about my clinic at maryclairewellness.com. Again, there's a link up here at Dr. Mary Claire. Oh, we're at 62,000 likes. Let's get to 100,000. This will be fun. If you were in the state of Texas, I am licensed to practice medicine on you. You can absolutely get everything.

for free off the website. Join the Galveston Diet. Enjoy all the nutritional perks. Learn everything I can teach you online.

Um, absolutely. You do not have to be in Texas if you want to come and see me as a patient and develop a personal doctor-patient relationship. You must be in Texas at the time of the visit. I cannot practice medicine in another state. Now, I have patients fly to see me all the time. About 20% of my patients come from out of state, but again, that is a long journey. I understand if you can't make it. My clinic is in Friendswood, Texas. You can learn more about it. Again, the link is up here at Dr. Mary Claire. If you go to the top of my TikTok page, click on the link in bio, and you will see information there about how to find me and my clinic or make an appointment to come and see me.

Um, yes, heart palpitations are very, very, very common in perimenopause. Yes, you're not crazy. Your palpitations, which weren't there a few years ago and just kind of popped up all of a sudden, the sinoatrial node has estrogen receptors on it, and when estrogen levels begin to drop and go and start bonking around, it can directly affect your SA node, which can lead to palpitations.

Oh, I have tons of patients who drive in from San Antonio. Yeah, no problem. Um, let's see. Um, good fiber for people with IBS? That's trial and error. That is, you know, irritable bowel syndrome can be a tough one, and I'm like, you just have to try to see what's going to work for you, and you may not be able to take it all, all at once.

Um, okay, I'm reading the questions. Hang on. You should be working with a reproductive endocrinologist if you had menopause at 21, premature ovarian failure, or you lost your ovaries due to tumors or something. You should be working hand in hand, hand in hand with a reproductive endocrinologist because your risk of heart disease and problems is dramatic. Um, and it's a shame that you were kind of turned out to the pasture without no. You, this should be something. It's like having diabetes that you just know everything about it.

Um, no, there's no equal alternative to hormone replacement therapy. Nothing works as better as hormone replacement therapy than hormone replacement therapy.

Um, okay, so, um, I want, let's see. Uh, oh, perimenopause can make you feel like you're dying. Absolutely. Now, if you don't know if you're in perimenopause, if you're new and you're joining, you think, oh my god, this could be me. Take our perimenopause quiz. It is a validated scoring system. There is no great blood test to determine perimenopause. It is up here at Dr. Mary Claire. Go to the top of the page, click on the link in bio, and scroll down until you see perimenopause and click on that. That will take you to our perimenopause quiz. It will give you a score that will tell you the likelihood that your constellation of symptoms is related to perimenopause. It will then ask for your email and we'll give you a [ __ ] ton of information all about perimenopause and what you can do about it, medications to ask, things to ask your doctor, etc.

Okay, patients just love this. So if you're just joining me, everyone double tap the screen to like the video. Um, please feel free to share this video with someone that you feel like, um, it would be helpful for. And, um, if you have questions, drop them in the question and keep commenting and giving me your, um, giving me your, um, questions down in the question box and sharing this with someone.

How far are we scheduling out appointments? We're booked out solid till about mid-May right now. So about a month in advance. It's not too bad. It's not too bad. Oh my god, we're at 72,000 likes, 72 shares. Thank you guys. Thank you, thank you, thank you. This helps keep me relevant on the platform.

Um, okay, why do you have so much joint pain and muscle pain? Now, I can't promise you 100%, but if you're noticing an increase and you're in your late 30s to early 40s, this could be perimenopausally related. We see a dramatic increase in muscle and joint pain. Okay, and in arthritis. And so there are a lot of things that you can do about it. Hormone replacement therapy, medication, um, nutritional changes. All information is available in the Galveston Diet.

Let's see. Um, not really. Do certain vitamins help with brain fog? There's no, other than magnesium. I mean, certainly if you have a deficiency, correcting any deficiency can be helpful, like vitamin D or magnesium. Yes, but you know, just most, you know, the only way to know if you're deficient is for certain vitamins as a blood test. For others, it's to track your nutrition, and my favorite tracker is Chronometer. It is a nutrition database. So you track it for a week and see kind of where you're falling low, and those are the things that you want to supplement. There are multiple forms of magnesium. So if you're taking one that hurts your stomach, you want to try a different formulation.

Um, your doctor suggested, why did your doctor suggest that you stop hormone replacement therapy? Why? Um, if you're happy on it and your quality of life is excellent, you are going to go right back to where you were when you get off.

Um, let's see. Asking for your wife, is HRT safe? It depends on the patient, but for the vast majority of patients, yes, HRT is very safe.

Um, okay, I've got to jump off and, um, go take my supplements. It's time, uh, and mix up my fiber and my collagen drink. Um, if you want to learn more about my favorite supplements, check out. I have two or three blogs about it at GalvestonDiet.com. If you want to look at our supplements, it's shop.GalvestonDiet.com. Everybody double tap the screen on your way out to like the video.

Um, I do not believe in an age to stop HRT. No. I'm reading some questions real quick. Um, and we will chat again soon.