Dra. Mary Claire Haver denuncia negligencia médica en menopausia

Mary Claire Haver 医生谴责更年期医疗疏忽 雌激素下降加速了12亿女性慢性病的发展，而医疗系统却忽视激素治疗并过度开具抗抑郁药物。 Mary Claire Haver 医生揭示了传统医疗系统和社会如何因忽视或误诊更年期的影响，而忽视了超过12亿女性。通过对 WHI 等研究的批判性审查，她澄清了激素替代疗法（HRT）风险的迷思，并强调了保护心血管、大脑与骨骼健康的“机会窗口”。此外，内容还提供了基于抗炎饮食、间歇性禁食、力量训练以及补充膳食纤维或肌酸的科学应对策略。对话最后呼吁女性积极为自身健康发声，并强调更年期虽不可避免，但痛苦绝非必然。 全球有超过12亿女性正在经历更年期转型，约85%的女性深受相关症状困扰，但在现有医疗体系下仅有10.5%获得了针对性的主动治疗。 (0:00) 由于雌激素受体分布于人体几乎所有器官，激素水平骤降会引发冰冻肩、关节痛与认知衰退等全身性症状，传统的“少吃多动”卡路里法则难以应对内脏脂肪堆积与骨骼肌流失。 (7:05) 被称为“混乱区”的围绝经期可提前7至10年出现，而绝经后的前10年是开展激素替代疗法（HRT）的关键“机会窗口”，能够显著降低心血管疾病、糖尿病和认知障碍的患病风险。 (23:24) 2002年WHI研究对相对风险的片面解读引发了持续数十年的用药恐慌，实际上透皮贴剂、凝胶等非经口HRT给药方式可绕过肝脏代谢，不会增加血栓风险。 (45:23)

Dr. Mary Claire Haver argues that while menopause is an unavoidable biological milestone, its accompanying physical and cognitive suffering is needlessly exacerbated by systemic medical neglect, outdated research interpretations, and a failure to provide evidence-based hormonal and lifestyle interventions. Medical System Dismissal and Research Underfunding (16:28) According to 2023 FDA figures cited by Dr. Haver, 85% of midlife women report menopausal distress, yet only 10.5% receive active therapy. Dr. Haver observes that formal medical training largely overlooks menopause—her own four-year OB-GYN residency included only six hours on the topic—fostering clinical environments where complex complaints were historically dismissed with derogatory labels such as "whiny woman" or presumed to be purely psychological. Consequently, perimenopausal and menopausal patients presenting with fatigue, body aches, and mood shifts are statistically far more likely to be prescribed antidepressants than hormone replacement therapy (HRT). This clinical gap is reinforced by substantial research disparities. Dr. Haver reports that of the National Institutes of Health's approximately $55 billion research budget, roughly $15 billion is allocated to women's health, with the vast majority directed toward fertility and pregnancy. Menopause research receives approximately $15 million—about 0.03% of the total NIH budget—despite an estimated 1.2 billion women globally navigating the transition. Multi-System Pathology and Estrogen Withdrawal (7:05) Dr. Haver emphasizes that estrogen receptors are distributed throughout nearly every organ system, meaning hormonal depletion causes widespread physiological changes beyond vasomotor hot flashes. Over 70 documented symptoms accompany the transition, including frozen shoulder (adhesive capsulitis), arthralgia, vertigo, cognitive decline, and increased incidence of sleep apnea even among non-obese women. In the pelvic region, genitourinary syndrome of menopause (GSM) affects over 50% of postmenopausal women, leading to tissue thinning, painful intercourse, and recurrent urinary tract infections that represent an underrecognized cause of severe illness and mortality in older cohorts. The withdrawal of estrogen also accelerates musculoskeletal deterioration. Women reach peak bone density around age 35, after which estrogen loss destabilizes bone remodeling. Dr. Haver notes that 50% of women will suffer an osteoporotic fracture in their lifetime. For postmenopausal women who break a hip, first-year mortality reaches 30% even with surgical intervention, and rises to 70% without surgery. Re-evaluating Hormone Therapy and Delivery Routes (45:23) Dr. Haver asserts that widespread clinical hesitation surrounding HRT stems from the misinterpretation of the 1998 Women's Health Initiative (WHI) trial, which was halted in 2002. Public reporting highlighted a 25% relative risk increase in breast cancer among participants taking combined synthetic progestin and estrogen, obscuring that the absolute risk increase was only 1 additional case per 1,000 women annually (rising from 0.4% to 0.5%). Subsequent long-term WHI follow-up revealed that women on estrogen-only regimens experienced approximately a 20% reduced relative risk of breast cancer and a 40% reduction in relative mortality. Timing and administration routes remain critical clinical variables. Initiating HRT within a "window of opportunity"—during perimenopause or within 10 years of menopause onset—confers protective reductions in cardiovascular disease, type 2 diabetes, dementia, and all-cause mortality. Furthermore, Dr. Haver explains that non-oral transdermal and localized delivery methods (such as patches, gels, and rings) enter systemic circulation directly, bypassing hepatic first-pass metabolism and thereby avoiding the elevated blood clotting risks associated with oral estrogen. Localized vaginal estrogen provides targeted relief for GSM without significant systemic absorption. Muscle Retention, Metabolic Care, and Nutritional Strategy (33:01) Because estrogen serves as an endogenous anti-inflammatory agent, its decline triggers chronic low-grade inflammation, insulin resistance, and accelerated sarcopenia. Women lose an estimated 10% to 15% of total skeletal muscle mass within the first decade of menopause. Dr. Haver advises shifting away from caloric restriction and aesthetic thinness toward strength preservation, noting that skeletal muscle is the primary physiological sink for glucose disposal. She recommends progressive resistance training paired with daily creatine supplementation, which clinical research demonstrates significantly enhances lean muscle and strength gains over lifting alone. Nutritional interventions outlined in Dr. Haver's Galveston Diet emphasize adding nutrient density rather than restrictive dieting. Key benchmarks include restricting added sugars to under 25 grams daily and increasing dietary fiber from the typical 12 grams toward at least 25 grams per day. Soluble fiber feeds gut microbiota that synthesize short-chain fatty acids like butyrate, which correlate with lower cardiovascular and all-cause mortality. Dr. Haver also highlights that approximately 85% of menopausal patients exhibit vitamin D deficiencies, and she incorporates 16:8 intermittent fasting to encourage metabolic flexibility and reduce neuroinflammation. Dr. Haver concludes that while hormonal cessation is unavoidable, its debilitating symptoms are treatable through proactive self-advocacy, personalized hormone therapy, resistance training, and anti-inflammatory nutrition. However, systemic shortages of certified menopause practitioners, lingering provider fears from outdated WHI reporting, and an absence of FDA-approved female testosterone therapies remain unresolved structural obstacles to widespread care.

妇产科专家Mary Claire Haver博士指出，更年期是不可避免的生理过渡期，但女性承受的长期身心痛苦并非不可避免；现代医学由于认知偏见与过时研究的误导，普遍忽视了雌激素衰退引发的系统性病理改变，亟需通过科学的激素替代治疗与抗炎生活方式重塑中老年健康体系。 医疗系统的认知盲区与科研资金失衡 (16:28) 全球目前有超过12亿女性处于围绝经期、绝经期或绝经后期，每年新增约4700万人。然而在2023年，尽管85%的绝经期女性报告遭受相关症状困扰，仅有10.5%的人接受了主动治疗。传统医学教育严重偏向产科，Dr. Haver在其四年的住院医师规范化培训中，更年期相关课程仅有约6小时。临床医生因缺乏对复杂多器官症状的排查能力，往往习惯性将患者的疲劳、失眠、体重增加归咎为心理问题，甚至在非公开场合将这类患者贬称为“抱怨的女性（WW）”，导致更年期女性被开具抗抑郁药的几率远高于接受规范的激素治疗。 科研资金分配同样呈现出严重的生命阶段倾斜。在美国国立卫生研究院（NIH）约550亿美元的年度总预算中，女性健康研究获得约150亿美元，但资金压倒性地流向了生育和妊娠课题；绝经期健康研究仅获得约1500万美元，仅占NIH总预算的0.03%左右。Dr. Haver强调，这种长期的资源边缘化导致基层医疗严重缺乏获得认证的专业更年期医生，迫使大量女性不得不长途跋涉跨州寻找诊疗服务。 激素波动的生物学震荡与全身多系统症状 (9:13) 女性卵子储备在胎儿期5个月时达到峰值，30岁时降至约10%，40岁时仅剩约3%，平均在51岁（常见区间为45至55岁）耗尽，临床将连续12个月停止月经正式定义为绝经。然而在绝经前7至10年（最早始于35岁左右），女性便已进入围绝经期，Dr. Haver将其形容为充满波动的“混乱地带”。在此阶段，雌激素水平并非平缓下降，而是剧烈振荡，伴随睾酮持续减少，引发月经紊乱、肌肉流失与代谢失衡。与女性不同，男性睾酮在35至40岁间趋于平稳，睾丸功能不会在中年断崖式关闭，并不存在生理意义上的“男性更年期”。 由于雌激素受体广泛分布于人体几乎所有器官系统，其抗炎和保护特性的撤退会引发多达70种相关症状。绝经期是心血管疾病、胰岛素抵抗和突发胆固醇升高的独立危险因素。缺乏雌激素还会导致冻结肩（粘连性肩关节囊炎，常需长达2年康复）、全身关节痛、耳鸣、眩晕、脑雾，以及非肥胖人群中睡眠呼吸暂停的显著增加。此外，超过50%的绝经期女性会出现绝经期泌尿生殖综合征（GSM），组织萎缩导致的反复尿路感染若未获干预，甚至构成老年女性全身感染与死亡的重要隐患。 重估HRT安全性、给药途径与治疗窗口 (45:23) 长期以来公众对激素替代疗法（HRT）的恐慌，源于对1998年启动、2002年提前终止的妇女健康倡议（WHI）研究的片面解读。当时媒体将雌激素联合合成孕激素（Provera）组中乳腺癌年发病率从千分之4升至千分之5（绝对风险仅增加0.1%）夸大报道为25%的“相对风险增加”，引发全球停药潮。WHI长期的随访追踪数据显示，单用雌激素治疗的无子宫女性，其乳腺癌相对风险反而降低约20%，相关死亡率降低约40%。Dr. Haver解释，雌激素主要是刺激已有受体阳性肿瘤细胞的增殖，而非诱发健康细胞癌变。 HRT的效果关键在于“治疗窗口期”：在围绝经期或绝经后10年内开始治疗，能有效降低全因死亡率，并预防心血管疾病、糖尿病与骨质疏松；一旦超过该窗口，组织器官出现退行性硬化，预防效果便会丧失。给药途径同样直接影响安全性：口服雌激素会经过肝脏首过代谢，刺激凝血因子产生并增加血栓风险；经皮贴剂、凝胶、喷雾或阴道环等非口服制剂能绕过肝脏代谢，消除升高的血栓隐患。局部阴道雌激素由于不被全身吸收，甚至适用于乳腺癌康复者。针对性欲减退，补充睾酮可带来显著改善，但因缺乏FDA批准的女性专属制剂，目前多依赖专业配制药房超说明书使用。 应对慢性炎症与骨肌损耗的生活方式干预 (33:01) 雌激素与睾酮的骤降会加速全身低度慢性炎症，加剧细胞衰老。Dr. Haver在其倡导的Galveston Diet中提出，对抗该过程需从单纯计算热量转向抗炎营养干预：将每日添加糖严格限制在25克以内；将膳食纤维摄入量从当前女性平均的12克提升至25克以上，以供养肠道菌群生成具有心脑保护作用的短链脂肪酸（如丁酸盐）；纠正约85%更年期患者存在的维生素D缺乏。此外，循序渐进的16:8间歇性断食有助于提升代谢灵活性，通过利用酮体供能减轻神经炎症并稳定空腹胰岛素水平。 骨骼与肌肉构成统一的功能单元，绝经后头十年女性平均流失10%至15%的全身肌肉量，而峰值骨密度在35岁后便开始下滑。目前50%的女性一生中会遭遇骨质疏松性骨折，其中绝经后髋部骨折第一年内接受手术者的死亡率为30%，未手术者高达70%。Dr. Haver建议放弃单纯追求“减重变瘦”的高强度有氧运动，转向以保留骨量和骨骼肌为核心的抗阻力量训练，配合高蛋白饮食与每日肌酸补充，并优先纠正激素撤退导致的睡眠障碍，为身体修复和肌肉合成提供代谢基础。 Dr. Haver总结强调，尽管当前医疗体系在更年期诊疗培训、专科资源普及和女性专属药物审批上依然滞后，但女性绝不应被动承受长达数年的病痛折磨。面对系统性支持的不足，女性需要主动记录自身症状数据、掌握同行评审证据以积极进行自我健康倡导，并在专业医生评估下把握早期干预时机，综合运用HRT与生活方式管理来保障长期生命质量。

## Background 本期视频由 YouTube 频道 The Diary Of A CEO（主持人 Steven Bartlett）于 2023 年 12 月 18 日发布。视频简介指出，本期节目特邀著名妇产科专家 Mary Claire Haver 医生，深入探讨更年期与围绝经期症状、减重、运动及激素替代疗法（HRT）等关键健康议题。 ## TL;DR 妇产科专家 Mary Claire Haver 医生在访谈中揭露了更年期长期被主流医疗体系忽视与误解的残酷现状，指出全球有超过 12 亿女性正处于这一阶段，但高达 85% 的受困女性未能获得有效医疗支持。她深入剖析了从 35 岁左右即可悄然开启的围绝经期机制，破除了 2002 年 WHI 研究对激素替代疗法（HRT）造成的历史恐慌，并强调雌激素断崖式下跌对心血管、代谢与肌骨系统的实质性器质损伤。围绕抗炎营养（加尔维斯顿饮食）、充足膳食纤维与维生素 D、抗阻力量训练、优质睡眠管理及合理的激素替代，她为女性提供了一套科学的“更年期工具箱”，呼吁社会破除病耻感，赋权女性掌控下半生的健康福祉。 ## Atmosphere & style 整场对话在严谨的循证医学与深厚的人文共情之间取得绝佳平衡，既有对医疗体制系统性偏见与女性污名化的犀利揭露，也有真诚动人的情感流露。主持人的专注倾听与深刻发问，为 Haver 医生提供了从容倾诉的场域；当她谈及家族亲人相继离世的创伤与自身更年期觉醒时，现场氛围达到情感的高潮，沉重中带着极具感染力的生命韧性。整期播客节奏沉稳却充满力量，听来既是一堂震撼且解惑的健康通识课，也是一场对全社会中年女性身心困境的深情抚慰与强力赋权。 ## Bulletin - [00:00](https://www.youtube.com/watch?v=oQqcnYcKx68&t=0s) 全球约有12亿女性处于围绝经期或绝经期，高达85%的人承受明显症状困扰，但仅有10.5%获得了规范的临床治疗与针对性干预，医疗系统与科研资金长期存在严重漠视。 - [23:28](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1408s) 2002年妇女健康倡议（WHI）研究将每年每千人多出1例乳腺癌的微弱绝对风险误读并放大为25%的相对风险激增，引发全球恐慌并导致激素替代疗法（HRT）被边缘化整整一代人；实际上在围绝经期至绝经后10年的黄金窗口期启动HRT，能显著降低全因死亡率与心血管疾病风险。 - [07:05](https://www.youtube.com/watch?v=oQqcnYcKx68&t=425s) 雌激素是全身性强效抗炎激素且受体遍布各大器官，其断崖式下跌会直接引发神经精神异常、心血管硬化、冻结肩（五十肩）以及波及超半数女性的泌尿生殖系统综合征（GSM）。 - [43:28](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2608s) 更年期前十年女性骨骼肌流失可达10%至15%，大幅加剧胰岛素抵抗与骨质疏松；健身认知必须从过时的“追求苗条娇小”彻底转向抗阻力量训练与高蛋白抗炎营养，“追求力量远重于盲目消瘦”。 ## Key takeaways - [00:00](https://www.youtube.com/watch?v=oQqcnYcKx68&t=0s) 全球庞大的更年期群体正面临严重的医疗断层：全球超12亿女性处于更年期相关阶段，85%经历显著身心症状，但仅10.5%获得治疗，女性就医时被开具抗抑郁药的概率远高于激素替代疗法。 - [10:05](https://www.youtube.com/watch?v=oQqcnYcKx68&t=605s) 女性卵子储备在出生前即已定格并在30岁后加速枯竭，围绝经期往往在正式绝经前7至10年（早至35岁左右）便已悄然开始，体内激素进入剧烈波动的“混乱地带”。 - [15:20](https://www.youtube.com/watch?v=oQqcnYcKx68&t=920s) 传统医学教育在更年期与营养学上存在巨大盲区，四年住院医规培中更年期讲座累计仅约6小时，患者的多系统不适长期被医学界污名为“爱抱怨的女人（Whiny Woman）”或心理作用。 - [45:43](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2743s) WHI研究历史恐慌的真相在于受试者平均年龄偏大（63岁）及对乳腺癌数据的曲解宣传；事实上，单独使用雌激素的研究组乳腺癌相对死亡率反而下降了40%，雌激素本身并不诱发乳腺癌。 - [23:28](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1408s) 激素替代疗法具有关键的“10年黄金干预窗口”：在围绝经期或绝经后10年内开始治疗可显著降低全因死亡率与痴呆、心血管病风险；若延误时机，血管器质性病变定型后预防收益将大幅受限。 - [21:16](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1276s) 雌激素是全身核心抗炎分子，其撤退会引发“绝经期肌骨综合征”，导致肩关节囊无菌性炎性粘连与纤维化（五十肩），并加剧全身弥漫性慢性关节酸痛。 - [27:21](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1641s) 科研资源分配存在严重的年龄与生育偏见：美国国家卫生研究院（NIH）每年550亿美元预算中，女性健康预算多倾斜于妊娠与助孕，而关乎全球半数人口后半生健康的更年期研究仅占约0.03%。 - [30:57](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1857s) 更年期激素暴跌会对中枢神经造成剧烈冲击，诱发或恶化抑郁症、焦虑症、双相障碍及成人ADHD，围绝经期及时启动HRT可作为强有力的神经精神保护屏障。 - [33:59](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2039s) 抗炎饮食是更年期健康的基础支柱：应聚焦于添加糖低于25克、补充严重匮乏的维生素D，并将每日膳食纤维提升至25克以上，利用有益菌代谢生成的短链脂肪酸抵抗全身低度慢性炎症。 - [43:28](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2608s) 肌少症与骨折具有致命风险：全球约50%女性终生会发生骨质疏松性骨折，绝经后女性发生髋部骨折若未获手术一年内死亡率达70%，即使手术亦达30%，必须尽早强化肌骨储备。 - [51:42](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3102s) 给药途径决定代谢安全性：阴道局部雌激素不进入全身循环即可安全修复泌尿生殖系统黏膜；经皮全身制剂（贴片或凝胶）绕过肝脏首过效应，避免刺激凝血因子合成与血栓风险。 - [54:40](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3280s) 女性性健康障碍需精细鉴别与分型干预：包括关系冲突、唤起困难、高潮障碍、性交疼痛（GSM）及睾酮缺乏导致的性欲减退，不能草率归因于心理老化。 - [01:02:58](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3778s) 辟谣“男性更年期”概念：男性睾酮在35岁后处于平稳平台期，并无类似生理机制；女性绝经在生物学上的同等破坏力相当于“男性睾丸在51岁时瞬间坏死并彻底罢工”。 - [01:07:38](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4058s) 睡眠是更年期机能修复的第一优先级：雌激素骤降诱发凌晨惊醒与睡眠呼吸暂停，会导致皮质醇激增与胰岛素抵抗恶化，恢复深睡眠是所有生活方式干预生效的前提。 - [01:08:53](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4133s) 女性健身观念需彻底转轨为“追求力量，拒绝干瘦”：抗阻力量训练与肌酸补充是克服更年期肌少症的关键，充足的骨骼肌储备是下半生代谢与独立生活能力的护城河。 - [01:12:06](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4326s) “绝经是必然的，但痛苦绝非理所应当”：女性应携带症状记录与循证医学证据主动就医争取支持，通过抗炎膳食、力量锻炼、压力调节及个体化药物全面拥抱高质量晚年。 ## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=oQqcnYcKx68&t=0s) 沉默的流行病与被忽视的更年期危机 在当代社会中，更年期（Menopause）正影响着庞大的人群，但与之相关的医疗支持却极度匮乏。2023 年的数据显示，高达 85% 的女性正在经历更年期相关症状的困扰，然而其中仅有 10.5% 的人接受了针对性的治疗或干预。Mary Claire Haver 医生用了一个极具冲击力的比喻来形容这种断崖式的生理变化：“这就好比男性的睾丸在 51 岁时突然萎缩并彻底丧失功能，女性经历的正是同等量级的剧烈转变。” 更年期是每位女性生命中不可避免的自然生理阶段，但伴随而来的痛苦绝非理所应当。然而现实中，女性因更年期症状求医时，医生开具抗抑郁药的几率竟然远远高于开具激素替代疗法（HRT）。医学界目前已经归纳出多达 70 种更年期相关症状，从常见的脑雾（Brain Fog）、性功能改变、体重增加，到更为严峻的健康风险：包括抑郁症、焦虑症、双相情感障碍和 ADHD 的新发或恶化，以及心血管疾病、糖尿病发病率的激增，甚至是反复发作的尿路感染（UTI）——而后者往往是老年女性因败血症导致死亡的重要诱因之一。 面对肌肉量的断崖式流失，应对的核心在于及早将生活重心转向力量训练与抗炎营养，“追求力量远重于盲目追求消瘦”（Strength over skinny）。主持人 Steven Bartlett 强调，目前全球有超过 12 亿女性正处于更年期相关的生理阶段，这意味着社会中一半的人口都在承受其影响。不论是男性还是女性，大多数人都缺乏对这一过程的正确认知，许多正在经历围绝经期（Perimenopause，早至 30 多岁即可开始）以及四五十岁正处于绝经期的女性都在独自默默忍受。因此，这不仅是一堂女性的必修课，也是所有拥有母亲、伴侣或女儿的男性必须认真倾听的对话。 - **85%** 的女性报告有更年期症状，但仅有 **10.5%** 获得了针对性的治疗或医疗干预。 - 女性在更年期被开具抗抑郁药物的可能性，远高于获得标准激素替代疗法的可能性。 - 目前已分类的更年期相关症状多达 **70 种**，严重影响心血管、代谢、泌尿及精神神经系统。 - 全球有超过 **12 亿** 女性目前正受到更年期的直接影响。 --- ### [03:15](https://www.youtube.com/watch?v=oQqcnYcKx68&t=195s) 从妇产科医生到营养求索：医学教育的巨大盲区 谈及自己投身这一领域的初衷，Mary Claire Haver 医生回忆起自己最初踏入医学殿堂的经历。在医学院第三年的轮转培训中，原本钟情于外科手术的她，在妇产科（OBGYN）轮转并亲手接生第一个婴儿时，被那种强烈的多巴胺冲击、生命诞生的震撼与情感浪潮深深打动，认定这就是自己一生的使命。在完成为期 4 年的传统住院医师规范化培训后，她进入了私立诊所执业。然而 3 年后，出于对科学研究和教学的热忱，她选择重返大学医学院担任教职，过着接生、做宫颈抹片检查、指导避孕的典型妇产科医生生活。 转折发生在她步入 40 多岁、与自己的患者一同走向衰老之时。大批更年期患者涌入诊室，最集中的痛点就是不可逆转的体重骤增。患者们反复哭诉：“我什么都没改变，依然保持运动，饮食也没变，为什么肚子越来越大？”当时，Haver 医生脑海中唯一的答案依旧是医学界灌输了数十年的陈腐教条——“少吃多动，能量守恒（Calories In, Calories Out / CICO）”。但当她自己也迈入更年期并亲身体会到同样的挣扎时，她幡然醒悟：美国的医学教育在营养学上几乎一片空白，医学生在学校根本学不到营养学知识，住院医阶段同样缺乏对营养如何调控生理机能的系统训练。 为了解开腹部内脏脂肪堆积、皮下脂肪与骨骼肌流失背后的真相，Haver 医生毅然重返校园，进入杜兰大学（Tulane University）攻读烹饪医学（Culinary Medicine）。在那里，她被营养、系统性慢性炎症与衰老之间的密切联系所震撼，同时也震惊于主流医学竟然完全忽视了更年期在这一代谢转变中的核心地位。她将所学整合并为患者设计了一套综合干预方案，这便是日后《加尔维斯顿饮食》（The Galveston Diet）的雏形。在两个女儿的极力鼓励下，她开始将这些知识发布在社交媒体上，海量女性在评论区涌现，倾诉自己被传统医疗体系长期漠视、甚至被医生敷衍为“这全是你心理作用”的痛苦经历，这坚定了她彻底公开探讨更年期多器官系统衰退的决心。 ```mermaid flowchart TD accTitle: 更年期代谢变化与干预探索路径 accDescr: 展现医生从传统医学认知到深入研究营养、内脏脂肪及慢性炎症的过程 subgraph Traditional["传统医学局限"] A["传统妇产科实践与培训"] --> B["遇到更年期患者体重剧增"] B --> C["机械灌输 CICO 理论<br/>'少吃多动'"] end subgraph Breakdown["危机与觉醒"] C -.-> D["患者困境无解<br/>自身遭遇更年期危机"] D --> E["意识到医学营养教育缺失"] end subgraph Breakthrough["科学重构与方案"] E --> F["杜兰大学深造烹饪医学"] F --> G["探明内脏脂肪、炎症与衰老机制"] G --> H["创立 Galveston Diet<br/>推动社交媒体公开科普"] end ``` --- ### [07:05](https://www.youtube.com/watch?v=oQqcnYcKx68&t=425s) 全身雌激素受体与被低估的“围绝经期”时间线 许多人误以为更年期只影响一小部分特定年龄的人，但 Haver 医生指出，全球约三分之一的女性正处于围绝经期、绝经期或绝经后期。更年期不是一道选择题，而是每位女性生命中必然经历的生理转变。现代医学研究已经证实，人体的每一个器官系统都广泛分布着雌激素受体（Estrogen Receptors）。因此，当卵巢功能减退、体内雌激素水平断崖式下跌时，全身都会出现极其复杂且异质性的综合症状反应。 长期以来，公众和医学界往往将更年期局限在潮热（Hot flashes）、夜间盗汗、睡眠障碍和骨质疏松等典型表象上。然而，雌激素的撤退实质上是一场波及全身的多器官系统冲击：它直接牵动大脑功能与心理健康，造成皮肤胶原流失、肌肉骨骼疼痛、肾脏负担，甚至引发许多令人意想不到的症状，例如突发性眩晕（Vertigo）、耳鸣（Tinnitus）以及俗称五十肩的冻结肩（Frozen Shoulder）。每当她在社交平台上科普这些鲜为人知的非典型症状时，都会引发数以万计女性的强烈共鸣：“天啊，我终于知道自己到底怎么了，原来我不是疯了！”这种病情的确认与被理解，是对长年被误解为“无病呻吟”的女性最大的心理救赎。 在澄清发病时间线时，Haver 医生给出了明确的医学定义与年龄跨度： - **绝经（Menopause）的严格医学定义**：在没有任何其他病理原因的前提下，自最后一次月经来潮起算，整整连续 12 个月（1 年）未来月经，此时的平均年龄在美国和欧洲大部分地区为 **51 岁**（正常生理绝经年龄范围为 **45 至 55 岁**）。 - **围绝经期（Perimenopause）的实际跨度**：即卵巢功能开始减退、体内雌激素剧烈波动并开始出现自觉症状的过渡阶段，通常在正式绝经前的 **7 至 10 年** 就已经悄然拉开序幕。 这意味着，按照数学规律倒推，早在 **35 岁** 左右，身心机能正常的年轻女性就有可能开始经历围绝经期的早期生理变化。为了让大众彻底搞懂这一过程的根本原因，Haver 医生进一步以通俗的语言开始拆解男女生殖腺（Gonads）——即男性的睾丸与女性的卵巢——在制造遗传物质（精子与卵子）以及内分泌激素调控机制上的本质分歧。 ### [10:05](https://www.youtube.com/watch?v=oQqcnYcKx68&t=605s) 女性卵子储备的衰减与雌激素缺乏引发的全身症状 男性在经历青春期后直至生命终点，只要没有重大疾病，体内的遗传物质精子始终在源源不断地生成。与男性不同，女性的卵子早在母亲子宫内发育时就已经全部形成——当母亲怀孕5个月时，女婴体内的卵子数量便达到了一生中的顶峰。这些卵子在卵巢中处于休眠状态，直到青春期来临才被重新“唤醒”并开始排卵。在此之后，健康的女性便进入每月周期性的激素波动，周而复始。 然而，女性一生能使用的卵子储备从出生起就处于不可逆的消耗状态，无论是数量还是质量都在随岁月逐渐下降。到女性30岁时，其卵子储备量已骤降至出生时的10%左右；到了40岁，这一数值更是跌至仅剩3%左右。随着卵泡储备耗尽，维持周期性生理节律的激素涨落变得越来越吃力，月经周期开始紊乱，全身各个器官系统也相继亮起红灯。雌激素在人体大多数器官组织中扮演着极其强大的抗炎激素角色。当雌激素开始匮乏时，诸如“绝经期肌骨综合征”（Musculoskeletal Syndrome of Menopause）便悄然显现，引发五十肩（肩周炎）、关节痛以及全身弥漫性酸痛。许多临床医生至今仍只将更年期与潮热、盗汗或睡眠障碍挂钩，完全忽视了它对全身关节与组织的炎性影响。当这些被长期忽视的全身关联被揭开时，无数女性如释重负，庆幸自己终于被医学认可，而不是“自己疯了”。 - **男性与女性生殖细胞对比**：男性终生不断生成新精子；女性所有卵子在胎儿期（母体妊娠5个月）便已定格，绝经前不再新生。 - **卵子断崖式下降数据**：女性30岁时卵子储备仅剩出生时的约10%；40岁时仅剩约3%。 - **绝经期肌骨症状**：雌激素是全身强效的抗炎物质，其缺失直接导致肩周炎（frozen shoulder）、关节痛（arthralgias）和全身慢性酸痛。 --- ### [11:56](https://www.youtube.com/watch?v=oQqcnYcKx68&t=716s) 围绝经期的“混乱地带”与进化生物学视角 围绝经期（Perimenopause）是体内激素系统从有序走向失控的过渡阶段，被玛丽·克莱尔·哈弗医生形象地形容为“混乱地带”（zone of chaos）。过去规律、可预测的月经周期彻底失序：卵泡发育不良导致雌激素与孕激素波动极其诡异，月经周期可能变得极长，也可能频繁到两周一次；有些女性表现为经期推迟、跳过，而另一些人则会遭遇接近大出血般的惊人月经量。医生们习惯依据清晰的临床清单来诊断疾病，但围绝经期就像是在试图“给一头跑动的驴钉尾巴”一样充满变数——女性体内的雌激素可能会在数周内暴涨，然后骤降跌入低谷，导致患者在几个月里感觉完全正常，随后又突然全面崩溃。除了雌激素，女性体内的睾酮也在同步下降，直接导致肌肉量快速流失、性功能障碍、力量减弱，并对情绪与大脑认知能力产生显著打击。 从演化人类学的角度来看，这种现象尤为罕见。在整个自然界中，绝大多数哺乳动物直到死亡前夕都保留着排卵能力，真正经历绝经的物种寥寥无几，除了人类，目前仅发现于极少数鲸鱼种类以及某种长颈鹿。演化学界提出了著名的“祖母假说”（Grandmother Hypothesis），认为人类女性在一定年龄后停止生育具有演化优势，这样她们能够将精力转向抚育孙辈、提升整个族群的生存概率。但现代医学极大延长了人类的寿命和健康寿命，哈弗医生指出，在人类进化的大部分历史时期，绝大多数女性根本活不到55岁。现代女性在基因层面上“活得比原本的设计寿命更长”，因此不得不直接面对生殖激素彻底褪去后漫长的生理余波。 ```mermaid flowchart TD accTitle: 绝经演进全周期的三大阶段 accDescr: 展示围绝经期、绝经点与绝经后阶段的激素变化与临床特征 subgraph Phase1["围绝经期 (Perimenopause)"] A["卵子储备跌破警戒线<br/>(30岁剩10%，40岁剩3%)"] --> B["激素进入‘混乱地带’<br/>雌激素骤起骤落 / 睾酮下滑"] B --> C["症状显现：月经紊乱/暴崩、<br/>关节炎痛、肌肉流失、脑雾、性欲减退"] end subgraph Phase2["绝经时刻 (Menopause)"] C --> D["绝经确诊日<br/>(45岁以上连续12个月无月经)"] D --> E["手术或IUD无月经者：<br/>需结合血液激素检测判断"] end subgraph Phase3["绝经后期 (Postmenopause)"] E --> F["余生状态<br/>(潮热盗汗或缓解，但心血管/骨质/组织退行性病变持续线性恶化)"] end ``` --- ### [14:30](https://www.youtube.com/watch?v=oQqcnYcKx68&t=870s) 绝经定义：从“那一天”到不可逆的绝经后生命期 医学上所指的“绝经”（Menopause），在严格意义上其实仅仅代表人生中的某一天。这一天标志着卵巢排卵功能的永久终结——临床标准通常定义为：45岁以上的女性在无外力干扰下，连续12个月完全没有出现月经。然而在临床现实中，情况往往更为复杂。许多女性此前接受过子宫切除术、宫内节育器（IUD）置入或其他妇科手术，失去了通过月经出血判断绝经进程的生理指标，此时医生就必须依赖详细的血液生化检验来评估患者所处的激素状态。 绝经之后，女性便进入了漫长的“绝经后期”（Postmenopause），这代表了她们余生的全部阶段。尽管随着时间的推移，部分急性神经血管症状（如潮热、盗汗）以及严重的脑雾可能会在机体逐渐适应后有所减弱，但人体对雌激素的依赖并不会因此消失。若缺乏外源性雌激素替代支持，失去雌激素保护的心血管系统、骨骼密度、泌尿生殖系统与脑神经组织等，其退行性变和炎性退化将沿着极其冷酷的线性轨迹不可逆转地持续加剧，直至生命终结。 - **绝经的医学确诊条件**：年龄45岁以上且连续整整1年无月经来潮。 - **无月经参照系人群**：切除子宫或使用避孕环（IUD）导致闭经的女性，需依赖血液内分泌全套检测判定阶段。 - **后绝经期的不可逆陷阱**：潮热和脑雾可能自行好转，但骨质流失、血管僵硬与器官老化在缺乏雌激素干预下呈持续恶化趋势。 --- ### [15:20](https://www.youtube.com/watch?v=oQqcnYcKx68&t=920s) 医学体系对更年期女性的集体背叛与“抱怨女人”污名化 当代医疗系统乃至整个社会，在面对围绝经期与绝经期女性的健康诉求时交出了一份令人失望的答卷。主持人史蒂文·巴特利特提到，几天前一位拥有海量资源、平时为所有人提供答案的顶尖成功女性坐在同一张沙发上，唯独在面对更年期时束手无策，只能在互联网的海量矛盾信息中绝望摸索。哈弗医生毫无保留地认同这一点，并做出了诚恳的反思与剖析：她自己在接受了美国顶尖的医学住院医培训后，在长达15年的临床实践中，依然是一个“糟糕透顶的更年期医生”，因为她过去盲从于传统医学教育的条条框框，从未跳出既有的认知局限。 为了揭露医学界根深蒂固的系统性偏见，哈弗医生讲述了自己在做初级住院医师时的一段真实且令人羞愧的经历。妇产科培训体系严重向“产科”倾斜，而在妇科领域，小儿妇科与绝经管理全被混为一谈。在长达4年的住院医培训中，关于绝经的正式讲座累计仅有约6个小时。每当门诊遇到人到中年、深受各种症状折磨的女性——她们主诉乏力不适、长期失眠、体重莫名上升、浑身关节酸痛，带来一长串看似模糊的症状清单时，高年级的主治和住院医总会私下轻蔑地告诫低年级医生：“祝你好运，你手上又摊上了一个‘WW’。”所谓的“WW”，是医学同行之间口口相传的黑话代码，意为“爱抱怨的女人”（Whiny Woman）。这种将中年女性身体激素巨变贬低为神经质抱怨的做法，赤裸裸地暴露了医生在缺乏专业知识时的无能与逃避。 > “在妇科培训中，所有东西都被混为一谈。我们在整整四年的课程里，关于更年期的讲座加起来可能只有6个小时……我的高年级住院医会说：‘天哪，祝你好运，你手上摊上了一个 WW。’那是黑话，我们从不会写进病历，但人人都知道，WW 代表‘爱抱怨的女人’（Whiny Woman）。” --- ### [18:18](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1098s) WHI研究灾难性后果与85%女性面临的治疗断层 导致这种系统性医疗荒漠的核心诱因之一，是2002年被紧急叫停的美国妇女健康倡议（WHI, Women's Health Initiative）研究。哈弗医生恰好在2002年完成住院医培训，属于美国最后一批接受过传统激素替代疗法（HRT）正规培训的医生之一。随后，WHI研究由于存在严重的实验设计缺陷、新闻通报失实以及对数据统计结果的严重误读，在全球掀起了针对激素替代疗法的巨大恐慌，导致医学界一夜之间对激素治疗避之不及，直接“把地毯从整整一代医生和患者脚下抽走”。 尽管后续数十年的大规模复审与修正早已证实，针对绝大多数中年女性而言，规范的激素替代疗法不仅安全有效，更能切实拯救她们濒临崩溃的生活质量，但这一有效选项已经在常规医疗体系中被彻底边缘化。根据美国食品药品监督管理局（FDA）2023年的统计数据，有高达85%的更年期女性向医生明确主诉受到绝经期相关症状的严重困扰，然而在如此庞大的受困群体中，最终能够获得规范临床治疗的女性仅占可怜的10.5%。更令人深思的是，即便是身为专业医生的哈弗本人，过去也深受“只要保持苗条就等于绝对健康”的陈旧思维毒害，直到步入更年期身体全面亮起红灯，才彻底清醒地意识到现代医疗体系给广大女性挖下的巨大健康黑洞。 - **WHI研究的历史污点**：2002年WHI报告发布失实与误读，导致整整一代医生对激素替代疗法（HRT）形成病态恐惧并彻底停止开方。 - **医学共识的回正**：后续海量流行病学再分析证实，绝大多数女性在窗口期使用HRT是安全且极其有益的，但临床教育至今未能同步跟进。 - **巨大的临床治疗缺口（2023年FDA数据）**： - **85%** 的女性步入更年期后受到相关症状严重困扰并主动向医生求助。 - 仅有 **10.5%** 的女性实际获得了针对更年期症状的药物或医疗干预。 ### [19:52](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1192s) 医疗偏见与更年期根源：从多科就诊到精准干预 玛丽·克莱尔·哈弗（Dr. Mary Claire Haver）坦率地回顾了自己的职业生涯早期。她坦言，传统的医学训练体系中充斥着严重的“恐肥偏见”（fat-phobic bias），整个医疗系统对病人的体重问题普遍抱有先入为主的歧视。然而，当她深入钻研营养学与更年期医学，并真正静下心来倾听患者的声音时，她震惊地发现：绝大多数在更年期体重激增的女性根本没有做错任何事。她们依然坚持运动，维持着原先的饮食习惯，身体唯一的变量就是激素水平的剧烈震荡。然而，她们在一次又一次的就医过程中遭遇了彻底的漠视。 更令人触目惊心的是医疗系统的碎片化处置。许多女性带着一长串复杂的身体症状奔波就诊，其底层根源原本只有一个——更年期。但医生们各执一词、只见树木不见森林，结果导致患者被迫辗转于七八位甚至九位不同的专科医生之间，同时服用七八种针对不同表象的药物。哈弗医生指出，这本可以用一种合理的治疗方案从根源上化解；只要将她们缺失的激素补充到位，她们不仅能重拾充沛的生命活力，还能以从容优雅的姿态自然老去。 - **医疗体制的深层盲区**：将更年期激素撤退引发的代谢与神经症状拆解为孤立疾病，导致严重的多重用药与过度医疗。 - **患者遭受的系统性忽视**：女性的生活习惯毫无过错，却常被轻描淡写地贴上“管不住嘴、迈不开腿”的刻板标签。 --- ### [21:16](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1276s) 潜藏的器质性风暴：心血管、代谢紊乱与“五十肩” 更年期绝非只是情绪波动或体重秤上的数字变化，它会带来具有器质性危害、甚至缩短寿命的实质性健康后果。哈弗医生强调，大量严谨的研究证实，更年期是独立于自然衰老之外的重大健康危险因素。随着雌激素水平崩塌，女性患心血管疾病的风险呈指数级上升，胰岛素抵抗迅速恶化，糖尿病的隐患骤增。大量女性步入三四十岁时，在没有任何生活方式改变的前提下，体检单上的胆固醇指标毫无预兆地飙升，皮肤、牙齿、内耳平衡机制（导致严重的眩晕）亦接连发生病变。 其中最普遍却极少被正确关联的并发症之一便是“五十肩”（冻结肩，Adhesive Capsulitis）。哈弗医生解释道，雌激素在女性的骨骼、关节和肌肉中起着至关重要的抗炎作用。一旦失去这种保护，肩关节周围包裹骨骼与肌腱连接处的关节囊便会发生严重的无菌性炎症、粘连与纤维化包裹。患者的生活自理能力遭受重创，甚至连抬手扣内衣文胸或与朋友合影时举起手臂都无法做到，且往往需要长达两年的艰苦理疗才能逐渐松解。哈弗医生在社交媒体上公布这一临床数据后，收到了上万条惊呼“原来我也是这样”的留言。她强调，向大众揭示这些机制的核心价值在于打消女性内心的自我苛责——这绝非她们的个人过失，而是激素骤降引发的深层全身性炎症反应。 --- ### [23:28](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1408s) 激素替代疗法的“黄金窗口”与全因死亡率的降低 谈及更年期是否会缩短未治疗女性的预期寿命时，哈弗医生给出了肯定的答复：现有的大型观察性研究以及著名的妇女健康倡议（WHI）试验后续数据均表明，接受激素替代疗法（HRT，亦称更年期激素疗法 MHT）的女性具有显著更低的全因死亡率（lower all-cause mortality）。然而，享受这种保护效应存在一个至关重要的“治疗机会窗口”——必须在围绝经期（Perimenopause）或绝经发生后的头10年内开始干预。这是降低心血管疾病、2型糖尿病以及阿尔茨海默病等认知衰退风险的黄金期；若错过这个阶段，随着动脉粥样硬化等器质性病变定型，雌激素的保护作用将大幅缩水，因为“雌激素更擅长预防，而非亡羊补牢的治疗”。 ```mermaid flowchart TD accTitle: 激素替代疗法干预时间窗口与临床获益 accDescr: 对比早期在围绝经期或绝经10年内启动HRT的全身预防保护，与延误时机后的获益丧失。 subgraph Window["黄金干预窗口（围绝经期至绝经10年内）"] A["激素水平下降早期"] --> B["适时启动 HRT / MHT"] B --> C["系统性心血管保护"] B --> D["维持胰岛素敏感性与代谢平衡"] B --> E["显著降低全因死亡率与痴呆风险"] end subgraph Missed["延误窗口期（绝经10年之后）"] F["长期缺乏雌激素抗炎保护"] --> G["器质性损伤已定型"] G --> H["失去预防性代谢与血管保护优势"] end ``` 这种医学证据让哈弗医生正在医学院就读的女儿深受触动。女儿甚至直言：“妈妈，我绝不会让自己体内缺少雌激素，我从围绝经期就要开始补充，绝不做激素断档的女人。”哈弗医生建议，女性应从30岁尾声开始密切关注自身生理指标与微妙体征。大多数女性都能敏锐察觉到身体的异样——也许是睡眠障碍、不明原因的骨关节酸痛，或是消化道微生态与情绪状态的悄然改变。人体几乎没有任何一个器官系统能够脱离性激素受体独立运作。 - **用药黄金期**：围绝经期至绝经后10年内，超过此期限心血管与神经保护效益将大幅减弱。 - **全因死亡率收益**：早期启动正规HRT治疗，全因死亡率显著下降。 - **个体化启动信号**：30岁后期开始排查，不必等到完全停经才寻求干预。 --- ### [25:36](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1536s) 关系危机与情绪觉醒：更年期如何重塑亲密关系与女性边界 更年期不仅是生理的剧变，更是人际关系与社会角色的严峻考验。主持人史蒂文·巴特利特（Steven Bartlett）指出，身处风暴中心的女性往往深知自己状态异常，但周遭的伴侣和家人却毫无常识，甚至将其误判为严重的精神疾病。巴特利特回忆起自己身边的一位长辈，当时性情大变，周围所有人都以为她患上了双相情感障碍（Bipolar Disorder），如今复盘才意识到那完全是更年期的典型折射。这种由于缺乏理解带来的情感鸿沟，往往成为婚姻破裂的催化剂。 然而，哈弗医生敏锐地观察到了这一危机背后的正面觉醒。在漫长的社会化驯化中，女性习惯了包揽人际关系中的所有无形付出——既要承担全部的情绪劳动（emotional labor），又要操持繁琐的家庭组织协调。进入更年期后，女性在生理重负下已竭尽全力勉力维持生存，这反而赋予了她们毅然划清界限的勇气：“我受够了，我不会再独自承担这一切，伴侣必须承担起自己应尽的那一份。”哈弗医生的一位离婚律师患者甚至指出，当今有相当大比例的离婚诉讼背后都隐现着更年期的身影：这既是因为女性终于开始重新排列人生优先顺序，也是因为她们在这一脆弱转折期未能获得伴侣应有的支撑。 --- ### [27:21](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1641s) 全方位工具箱与科研不平等：更年期为何仅获0.03%的研究资金？ 要打破这一困局，首要任务是在社会层面彻底打破沉默。哈弗医生强烈呼吁每位女性向女儿、侄女、儿子以及身边的伴侣讲述更年期的真相，使之成为日常公共对话的一部分，消除病耻感与孤立感。同时，医疗体系必须提供全维度的干预“工具箱”。哈弗医生明确澄清，激素替代疗法并非包治百病的唯一神药，它必须与生活方式干预紧密结合：优先保障深层睡眠，配合认知行为疗法（CBT），并彻底改变两性对运动的陈旧认知。哈弗医生这一代女性过去被过时的健美操文化规训，一味追求“纤瘦与娇小”，而如今必须将重心转向力量训练与骨骼肌构建。因为肌肉储备直接决定了衰老过程中的功能独立性与寿命长短，而更年期雌激素与睾酮的剧降正加速分解肌肉单元，加剧骨质疏松的发生。 ``` 女性健康整体科研经费分布格局（美国国家卫生研究院 NIH 示例）： 全院总预算：约 550 亿美元 ├── 女性健康总预算：约 150 亿美元（占比 ~27%） │ ├── 生育力、助孕与妊娠相关研究：占据绝对多数比例 │ └── 更年期相关研究：约 1,500 万美元（仅占女性健康预算约 0.1%，全院总预算约 0.03%） ``` 谈及更年期在医学界长期被边缘化的深层根源，哈弗医生直指背后的年龄歧视与生育偏见。女性的衰老在主流社会语境中长期伴随着羞耻感，而更年期更是叠加了“丧失生育能力”的标签。她揭露了令人震惊的科研拨款数据：在美国国家卫生研究院（NIH）每年约550亿美元的研究预算中，用于女性健康的经费约为150亿美元，但绝大部分被倾注到了备孕、保胎与辅助生殖领域；而覆盖全球半数人口晚年健康质量的更年期课题，仅仅分到了约1,500万美元——仅占NIH总预算的大约0.03%。哈弗医生愤慨地发问：难道女性一旦脱离了育龄阶段，她们的生命与尊严就不再具备同等的价值了吗？ ### [29:44](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1784s) 庞大却被忽视的更年期群体与医疗误区 更年期并非小众议题，而是一场席卷全球女性的普遍经历。据估计，到当年年底，全球处于围绝经期和绝经期的女性人数将达到惊人的 12 亿，并且每年以约 4700 万新入人群的规模持续递增。然而，面对如此庞大的群体，医疗体制与社会认知却存在巨大的脱节。高达 85% 的女性走进诊所向医生求助时，往往被草草打发，带着满腹疑问失望而归；甚至只有 10% 的人能够与医生真正探讨激素替代疗法（HRT）。更严重的是，受当年妇女健康倡议（Women's Health Initiative, WHI）研究被错误解读与夸大宣传的深远影响，绝大多数女性至今仍深陷“雌激素会导致乳腺癌”的恐慌之中。尽管该研究后来已被全面推翻、修正与澄清，证实雌激素致癌纯属误导，但由此造成的恐惧阴影依然让无数女性抗拒本可以拯救健康的关键干预手段。 - **12 亿女性**：预计当年年底全球处于围绝经期或绝经期的女性总数。 - **4700 万**：每年全球新进入围绝经或绝经阶段的女性人数。 - **85%**：向医疗机构寻求帮助却被忽视或未能解决问题的绝经期女性比例。 - **10%**：就诊时能与医生探讨激素替代疗法（HRT）的女性比例。 - **WHI 研究破除**：所谓“雌激素直接导致乳腺癌”的结论已被医学界驳回与纠偏。 --- ### [30:57](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1857s) 更年期对女性心理健康的严重冲击 更年期带来的神经与精神冲击远超许多人的预期。随着激素水平剧烈波动，抑郁症、焦虑症、双相情感障碍以及成人 ADHD（注意力缺陷多动障碍）要么初次发病，要么在原有基础上剧烈恶化。许多长期依赖 SSRI 类抗抑郁药且病情平稳的女性会突然发现药物失效，不得不调高剂量。虽然医学界目前并不主张将雌激素替代疗法作为治疗抑郁症的单一首选方案，但大量研究已经证实，它是极其强大的辅助治疗工具。如果女性在围绝经期早期就开始进行激素替代治疗，甚至能有效预防绝经期新发抑郁症的产生。在极端情况下，激素骤降还与自杀倾向密切相关；数据显示，美国围绝经期与绝经期的白人女性中，自杀率出现了非常明显的上升趋势。 ```mermaid flowchart TD accTitle: 围绝经期与绝经期激素骤降对精神健康的影响路径 accDescr: 展示围绝经期雌激素下降如何诱发或加重神经精神疾病及干预措施 subgraph Hormonal_Decline["激素剧烈波动与衰退"] A["围绝经期/绝经期<br/>雌激素与睾酮骤降"] end subgraph Psychiatric_Impact["神经精神健康改变"] B1["原有精神疾病加重<br/>(SSRI 抗抑郁药反应钝化)"] B2["新发神经精神障碍<br/>(抑郁、焦虑、双相、ADHD)"] B3["自杀风险上升<br/>(特定人群出现显著峰值)"] end subgraph Clinical_Intervention["临床辅助干预"] C["围绝经期及早介入 HRT<br/>作为强大辅助方案与预防屏障"] end A --> B1 A --> B2 A --> B3 C -. 预防与缓解.-> B1 C -. 降低新发率.-> B2 ``` --- ### [32:15](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1935s) 炎症机制：雌激素为何是天然的“抗炎保护伞” 要理解更年期身体机能的滑坡，首先必须认清急性炎症与慢性炎症的本质区别。急性炎症是人类赖以生存的防御本能：当脚踝扭伤或遭遇病毒感染时，受损组织会释放化学信使，调集白细胞与红细胞前往前线清除病原并促进愈合，伴随的红肿与疼痛正是身体迫使我们休养的生理机制。然而，慢性炎症则是一种隐蔽且持续低度的“水面下燃烧”，与自身免疫疾病紧密相关。人体衰老本身会伴随慢性炎症，但绝经期女性由于雌激素和睾酮的断崖式跌落，体内的慢性炎症水平会发生爆发式增长。 雌激素在人体内扮演着强效抗炎激素的角色。失去了雌激素，就如同“直接掀掉了覆在身上的抗炎保护毯”，身体内部的系统性炎症骤增，导致生理年龄急剧加速老化。因此，对抗系统性炎症成为了加尔维斯顿饮食法（The Galveston Diet）的核心支柱，通过抗炎营养学来重新筑起女性被削弱的健康防线。 --- ### [33:59](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2039s) 抗炎营养基石：控糖、补充维生素 D 与充足膳食纤维 在探讨如何构建抗炎饮食时，核心原则应该是“多做加法而非盲目节食”，避免过度限制引发进食障碍。除了将每日添加糖摄入严格控制在 25 克以下，绝大多数人极易忽略的两个关键因素是膳食纤维与维生素 D。临床上大约 85% 的更年期女性都存在严重的维生素 D 缺乏症，而不仅仅是轻微偏低。现代人涂抹防晒霜、长期居于室内面对屏幕，加上衰老导致肠道对维生素 D 的吸收效率大幅减退。作为一种兼具激素活性的关键微量营养素，大脑等核心器官布满了维生素 D 受体，其长期匮乏与高血压、中风、糖尿病等女性十大死因中的七种疾病密切挂钩，也会恶化心理健康。 在膳食纤维方面，大部分绝经期女性每天仅摄入约 12 克，远低于 25 克的最低建议门槛。膳食纤维的价值主要体现在以下几个维度： - **平稳血糖与胰岛素**：延缓葡萄糖进入血液的速度，降低长期的胰岛素水平波动。 - **不可溶性纤维（Insoluble Fiber）**：在补剂中沉淀在杯底的部分，能在肠道内吸收水分，加速粪便在结肠中的蠕动排出。 - **可溶性纤维（Soluble Fiber）**：溶解在水中使液体变浑浊的部分，是肠道微生物菌群的核心“养料”（益生元）。充足的可溶性纤维能让补充人造益生元变得毫无必要。 - **生成有益短链脂肪酸**：健康菌群发酵纤维产生的丁酸盐等代谢物进入血液循环，已被证实能显著降低冠状动脉疾病、痴呆症和各类慢性病风险。 - **常见富含纤维的日常食物**：牛油果、奇亚籽、坚果、各类浆果、苹果、芦笋、芹菜以及十字花科蔬菜（其脆韧口感正来源于丰富的植物纤维，而精瘦肉类则几乎不含纤维）。 在更年期健康的“工具箱”中，即便激素疗法备受瞩目，抗炎营养学也始终必须摆在首要位置——脱离了扎实的营养基石，再多的激素补充也是无源之水。 --- ### [37:32](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2252s) 间歇性禁食的抗炎价值与循序渐进的“六周适应法” 关于禁食（Fasting），它并不适用于所有人，也不是专为减重而生的工具；实际上，关于间歇性禁食减重效果的科学数据尚有争议，若在进食窗口内暴饮暴食，禁食的所有好处都会被瞬间抵消。然而，禁食在改善全身系统性炎症、神经炎症以及降低基础胰岛素水平方面，拥有极为坚实的实证数据支撑。 在指导患者和学员时，推荐采用基于神经生物学家马克·马特森（Mark Mattson）研究的 16:8 间歇性禁食法，即连续禁食 16 小时，将进食时间浓缩在 8 小时窗口内。不过禁食节奏因人而异，无论是 14 小时还是 15 小时禁食，都可以作为起步阶梯。对于初次尝试的人，最忌讳从第一天起就硬撑 16 个小时不吃东西，而应该给自己预留大约 6 周的适应期： - **微调推迟窗口**：若以往习惯早晨 6:00 吃早餐，可先将进餐时间推迟至 6:15。 - **建立生理适应**：在 6:15 进餐并保持三到四天，直到身体完全适应、晨间不再感到饥饿。 - **递增延长时间**：每次以 15 分钟为单位逐步后移早餐时间（例如递进至 6:30、6:45）。 - **数周平稳过渡**：通过这种循序渐进的方式持续数周，到第五周左右，身体便能在无痛苦的状态下自然过渡到延后开餐的 16:8 节律。 ### [39:07](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2347s) 间歇性禁食的个人实践、大脑认知与进化视角 玛丽·克莱尔·哈弗（Dr. Mary Claire Haver）医生回顾了自己刚开始尝试间歇性禁食时的经历。当时她还在医院工作，某天中午她惊讶地发现自己居然熬过了整个早晨，忍不住惊呼：“天哪，我居然撑到了中午，而且感觉一点也不糟糕！”从那时起，她开始有意识地让身体逐步适应这种节奏。自2014或2015年起，禁食已经彻底融入她的日常生活，成为一件无需刻意考虑的自然习惯。当被问及禁食带来的直观感受时，她坦言自己的生活方式中包含很多健康干预，很难单独归因，但在禁食状态下，大脑的思维清晰度会有质的飞跃。她的大部分学术研究、高效工作以及在社交媒体上与粉丝的交流互动，几乎全是在清晨禁食期间完成的。她笑称粉丝经常看到她穿着睡衣、端着一杯黑咖啡录视频，因为只要早上学到了令人兴奋的新知识，她就迫不及待地想要分享出去；而一旦打破禁食吃了东西，神经突触的反应速度似乎就变慢了。 主持人史蒂芬·巴特利特（Steven Bartlett）从进化生物学的角度探讨了禁食的合理性。现代社会普遍认为人类“必须按部就班地吃早、中、晚三餐”，但这在很大程度上只是一种社会建构，并没有足够强大的科学依据作为支撑。在远古的狩猎采集时代，食物并非全天候触手可及，人类祖先在饥饿状态下必须保持高度机敏与专注的头脑才能外出捕猎成功。哈弗医生十分认同这一点，并指出禁食并非适合所有人——例如容易诱发进食障碍（eating disorder）的群体、糖尿病患者或低血糖患者就不应轻易尝试，但绝大多数普通人完全可以从中受益。 从代谢机制来看，虽然葡萄糖是身体偏好的基础燃料，但大脑在利用酮体作为燃料时往往运作得更加高效。动物迷宫实验表明，处于空腹禁食状态的动物往往能更快穿过迷宫、学习能力也更强，而吃饱后的动物则表现得更懒散。哈弗医生特别提到了著名神经科学家马克·马特森（Mark Mattson）关于阿尔茨海默病与痴呆症的研究：在生酮饮食概念风靡之前，科学界就早已发现人体利用酮体供能是一种极其正常的生理现象。当我们在夜间睡眠时，身体会先消耗血液中的葡萄糖，接着通过肝脏糖原分解和糖异生耗尽储存糖原，随后自然切换到燃烧脂肪并产生酮体的模式。不过哈弗医生也补充道，对于市场上流行的外源性生酮补剂，目前并没有针对绝经期女性的临床文献能证明其有效性，因此她个人从未尝试过。 ```mermaid flowchart TD accTitle: 代谢能量与认知状态转换流程 accDescr: 展示从进食状态向禁食状态过渡时体内的代谢物转换过程及对认知表现的影响 subgraph FedState ["进餐后状态"] A["摄入常规食物"] --> B["优先利用血液葡萄糖"] B --> C["突触兴奋度下降 / 饱腹后慵懒"] end subgraph FastingState ["空腹禁食期"] D["消耗血液葡萄糖"] --> E["耗尽肝糖原与糖异生储备"] E --> F["启动脂肪氧化分解"] F --> G["生成内源性酮体"] G --> H["大脑以酮体为高效燃料"] H --> I["思维敏锐度提升 / 认知清晰"] end C -. "禁食适应".-> D ``` --- ### [41:58](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2518s) 加尔维斯顿饮食的“营养重聚焦”与蛋白质和肌酸的价值 谈到其著名的“加尔维斯顿饮食”（Galveston Diet）三大支柱中的第三项——“营养重聚焦”（Fuel Refocus），哈弗医生指出，这代表着彻底摆脱单纯计算卡路里的过时观念，转而深层关注宏量营养素与微量营养素的配比。女性在步入更年期后，极易缺乏维生素D、镁以及膳食纤维等关键元素。与其每天焦虑地算计摄入了多少大卡热量，不如将精力聚焦在今天是否摄入了足量的维生素D和优质纤维。 哈弗医生坦率地反思了自己最初撰写《加尔维斯顿饮食》时的设定。当时该计划的核心目标是减重，因此采用了高健康脂肪、低碳水化合物以及占比20%蛋白质的宏量比例。但如果现在让她重写这本书，她会做出关键调整——大幅提高蛋白质的摄入比例。近年的临床与科研进展让她深刻意识到，充足的蛋白质摄入对维持肌肉质量具有决定性意义。此外，她正在大力倡导补充肌酸（Creatine）。许多高质量研究显示，在65岁及以上的老年群体中，肌酸补充剂与抗阻力量训练相结合，能够帮助绝经后女性实现更显著的肌肉体积增长与力量提升。 --- ### [43:28](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2608s) 肌肉流失、骨质疏松与绝经期骨折的致命威胁 在更年期的健康管理中，肌肉质量绝非仅仅关乎外表体态，而是决定生命健康走向的核心枢纽。随着自然衰老与绝经期雌激素断崖式下跌的双重夹击，女性在进入更年期的前十年内，可能会流失高达10%到15%的宝贵肌肉。骨骼肌是人体调节血糖和代谢的核心组织，肌肉质量的高低直接决定了机体抵抗胰岛素抵抗的能力，同时也决定了身体的基础功能表现以及跌倒时的自我保护和复原能力。 更鲜为人知的是，人体肌肉与骨骼在生理上构成了一个不可分割的“肌骨单元”（Musculoskeletal unit）。当肌肉量大幅萎缩时，骨质疏松的发生率将急剧飙升。哈弗医生列举了一组触目惊心的临床现实： - 全球约有 **50% 的女性** 在去世前会经历一次由于骨质疏松导致的骨折。 - 女性骨密度在 **35岁左右** 达到终身顶峰，随后随着衰老缓慢减退；而一旦绝经，骨量流失便会呈断崖式加速。 - 绝经后女性一旦跌倒发生髋部骨折（Hip fracture），**即使接受了手术治疗，仍有高达 30% 的患者会在第一年内死亡**；而如果**未能接受手术，一年的死亡率更是高达 70%**。 - 在那漫长而煎熬的一年中，患者将承受极其残酷的剧痛、彻底丧失行动能力，生活质量跌入深渊。 哈弗医生极其痛心地强调，这一切悲剧绝大多数是“完全可以预防的”。通过及早介入激素替代疗法、坚持抗阻力量训练、摄入足量的高质量蛋白质与肌酸，并确保体内拥有充足的维生素D水平，更年期女性完全能够保护自己的肌骨健康，从而终生免于陷入致命骨折的绝境。 --- ### [45:43](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2743s) 激素替代疗法与妇女健康倡议（WHI）研究的恐慌真相 谈到预防绝经期退行性疾病的关键手段，话题自然落在了备受争议的激素替代疗法（Hormone Replacement Therapy, HRT）上。公众长期以来对该疗法充满抗拒，主要源于一项曾引发全球震动的著名医学研究——妇女健康倡议（Women's Health Initiative, WHI）。哈弗医生在节目中对这一历史事件进行了剥茧抽丝的还原。 该研究始于1998年。当时美国国立卫生研究院（NIH）迎来了一位新的女性院长，女性健康科研终于获得了史无前例的重金资助，大量女性争先恐后地报名参与。最初，大量观察性研究已经反复表明，接受激素治疗的女性因心血管疾病死亡的风险、心肌梗死等动脉粥样硬化性心脏病的发生率，乃至全因死亡率都大幅降低。为了提供随机对照试验（RCT）的金标准证据，WHI 应运而生。但为了能尽快看到心血管事件的终点发生，研究招募的受试者**平均年龄高达63岁**——这远高于女性刚步入更年期的实际年龄。 试验将受试者分为两大阵营： 1. **子宫完整的女性**：体内拥有子宫的女性，在接受雌激素治疗时必须同时联用孕激素（Progestin，当时试验使用的是人工合成孕激素 Provera），因为单一无对抗的雌激素刺激会导致子宫内膜异常增生，诱发子宫内膜癌； 2. **已切除子宫的女性**：因无子宫病变隐患，仅需接受单一雌激素治疗。 在联用雌激素与人工孕激素的研究组中，追踪两年后研究人员观察到乳腺癌风险出现了轻微上升。然而，科研团队在向公众呈现数据时偷换了“绝对风险”与“相对风险”的界限： - **绝对风险**：从安慰剂组的 **每年每千人中4人患病**，上升到药物组的 **每年每千人中5人患病**，即每年每治疗1000名女性，仅多出1例乳腺癌病例。 - **相对风险**：从4例到5例，在统计学上换算成了 **25% 的相对风险激增**。 正是这个被严重放大、脱离临床语境的“25%”，彻底引爆了全球舆论。研究人员随后在华盛顿特区著名的水门饭店（Watergate Hotel）举行了声势浩大的全球新闻发布会。在互联网尚未普及的年代，世界各大主流媒体几乎以通栏头条同步宣称“雌激素致癌”，导致这一带有严重偏颇的恐慌叙事在几十年间深深刻入全球医患两端的脑海，彻底耽误了整整一代更年期女性本该享受的健康保护。 ### [48:47](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2927s) 雌激素与乳腺癌的真实关系及被误读的医学观念 在著名的妇女健康倡议（WHI）研究中，“仅使用雌激素”（estrogen-only）的试验组实际上多持续了数年，因为只接受雌激素治疗的女性不仅没有出现乳腺癌风险增加，其乳腺癌相对风险反而下降了约 20%，相对死亡率更是显著下降了 40%。Haver 医生澄清道，雌激素会滋养已有的乳腺癌细胞，但它本身并不会“导致”乳腺癌。人体内雌激素水平最高的阶段是怀孕期，然而在妊娠期间被确诊乳腺癌的情况极其罕见。健康乳腺细胞本身就分布着雌激素受体，所谓“雌激素受体阳性（ER+）”仅意味着乳腺细胞在癌变突变后依然保留了原有的雌激素受体，医学上恰恰可以利用这些受体作为靶点来进行针对性治疗。 尽管当年的研究结论早已被医学界逐步修正，多项后续跟进研究也证实了其安全性，但整个医学界的传统思维定式仍未扭转。即使作为一名资深妇产科医生，Haver 医生坦言自己过去受到的训练也是“开最低剂量、用最短时间”，并且仅将其保留给那些使用其他任何方法都无法缓解潮热症状的极少数患者——当时医学界狭隘地将更年期完全等同于血管舒缩症状（如潮热、盗汗）。 ```mermaid flowchart TD accTitle: 雌激素与乳腺癌机制及局部/全身给药路径 accDescr: 图表展示了雌激素的作用机制，以及局部与全身给药途径的区别与肝脏代谢差异。 subgraph Mechanism["病理机制澄清"] A["健康乳腺细胞 (含受体)"] -->|细胞突变| B["癌细胞保留雌激素受体"] C["外源雌激素"] -.->|滋养/非诱发| B B -->|提供治疗靶点| D["受体靶向治疗"] end subgraph Administration["给药途径与代谢差异"] E["局部给药 (阴道乳膏/片剂)"] -->|无全身吸收| F["改善泌尿生殖系统综合征 (GSM)"] G["口服给药 (吞服)"] -->|经肠道直达肝门静脉| H["首过效应: 凝血因子波动/血栓风险"] I["经皮给药 (贴片/凝胶/皮下植入)"] -->|绕过肝脏代谢| J["维持激素水平且不增加血栓风险"] end ``` ### [49:58](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2998s) 阴道局部雌激素与更年期泌尿生殖系统综合征（GSM） 在更年期女性中，超过 50% 的人会遭遇“更年期泌尿生殖系统综合征”（Genitourinary Syndrome of Menopause, GSM）。女性的膀胱、阴道以及骨盆底各组织都富含密集的雌激素受体。一旦雌激素匮乏，这些组织就会变得极其薄弱、失去弹性，进而引发频繁复发的尿路感染（UTI）。对于绝经后女性而言，反复发生的严重尿路感染往往可能诱发败血症，是老年女性的主要致死原因之一。 治疗并预防该综合征最有效的方法就是使用阴道局部雌激素。这种局部疗法极其安全，即便是乳腺癌患者也可以放心使用。然而，由于普遍的激素恐惧症，这项本可以彻底改变生活质量的治疗手段被强行从无数患者的备选方案中剔除，导致大量女性在毫无必要的情况下长期默默忍受性交剧痛、阴道干涩和反复感染的折磨。 - **局部治疗类比**：局部雌激素（如乳膏、阴道栓剂或阴道环）类似于治疗皮疹的外用可的松软膏，其活性成分不会被全身大量吸收，仅在局部组织发挥作用。 - **全身治疗区别**：全身性激素替代疗法（HRT）则旨在全面保护脑部、骨骼和心血管等系统，实现由内而外的整体调节。 ### [51:42](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3102s) 给药途径的差异：口服药与经皮吸收的肝脏首过效应 荷尔蒙替代疗法的首选给药形式在不同国家存在明显差异。在英国，全科医生（GP）通常首选外用凝胶（gel）或乳膏（cream）；而在美国，非口服形式中最普遍的是经皮贴片（patch），此外还有口服药片、阴道环以及皮下埋植颗粒（pellets）。 选择给药途径时必须考虑药代动力学的关键差异： - **口服雌激素的局限**：口服进入胃肠道的药物会通过门静脉系统直接进入肝脏进行代谢（首过效应）。这种高浓度激素对肝脏的冲击，若为睾酮可能引起肝毒性，若为雌激素则会刺激肝脏合成更多凝血因子，从而显著增加深静脉血栓和肺栓塞的潜在风险。 - **经皮制剂的安全优势**：贴片、凝胶或皮下埋植等经皮方式能够绕过肝门静脉循环，直接进入全身血液循环，因此不会导致血栓风险上升，极其适合本身有血栓家族史或高危倾向的女性。 ### [52:53](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3173s) 荷尔蒙替代疗法的副作用与个性化调试 天下没有免费的午餐，HRT 同样存在需要密切监测的副作用。完整的更年期激素疗法涉及三类主要激素：雌激素、雄激素（睾酮、DHEA、雄烯二酮）以及孕激素（Haver 医生倾向于开具天然微粉化黄体酮/Progesterone，而非合成孕激素/Progestins）。在用药过程中需要注意以下生理反应： - **头痛与偏头痛**：雌激素水平波动可能诱发头痛或加重原有的偏头痛，这类患者往往需要从极低剂量开始谨慎滴定。 - **突破性阴道出血**：约 40% 接受绝经期激素治疗的女性会出现阴道点滴出血。这绝不意味着卵巢“起死回生”恢复了月经，而是萎缩的子宫内膜组织受到激素刺激所产生的自限性剥脱。出血通常会在数月内自行停止；若持续时间过长，医生会安排超声检查以排除子宫内膜息肉等器质性病变。 - **贴片胶黏剂过敏**：大约 10% 的女性会对经皮贴片的背胶成分过敏导致皮肤红肿瘙痒，此时需要灵活更换为无刺激的凝胶或喷雾制剂。 ### [54:40](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3280s) 初诊评估流程与女性性健康五大维度 当一名深陷困扰的女性走进诊室时，Haver 医生首先会倾听患者叙述自己的经历，随后展开系统的鉴别诊断检查： 1. **全面血液排查**：不仅评估性激素水平以区分绝经前期与绝经后期（特别是针对切除子宫的患者），更重点筛查甲状腺功能（甲减常表现为极易与更年期混淆的疲劳、夜间盗汗与体重增加）、自身免疫疾病（如类风湿性关节炎）、维生素 D 水平、电解质以及基础血常规。 2. **女性性功能障碍的五大诱因**： | 功能障碍类型 | 临床特点与机制 | 应对方案与干预手段 | |:--- |:--- |:--- | | **关系障碍** | 伴侣关系不融洽、缺乏支持或情感冲突 | 药物无法解决，需借助心理疏导与伴侣沟通 | | **唤起障碍** | 生理唤起困难、局部充血充液不足（类似男性勃起问题） | 可考虑使用局部阴道伟哥（外用西地那非等制剂） | | **高潮障碍** | 无法达到性高潮；约 10% 的女性终身从未体验过性高潮 | 普遍缺乏社会重视，需专业性治疗与医学支持 | | **性欲减退** | 伴侣关系融洽但完全丧失主动发起或亲密的渴望 | 补充低剂量睾酮，或评估使用 Addyi、Vyleesi 等药物 | | **性交疼痛 (GSM)** | 阴道黏膜萎缩、干涩变薄引发严重疼痛 | 阴道局部雌激素软膏/栓剂修复组织弹性 | 针对终身无高潮的普遍现象，Haver 医生直言：“想象一下，如果有 10% 的男性终身无法达到高潮，这绝对会被列为国家紧急事件，美国甚至会削减军费预算来全力攻克这个难题。” 谈到性欲衰退时，女性体内睾酮的缺乏常被忽视。然而美国食品药品监督管理局（FDA）至今仍未批准任何专供女性使用的睾酮制剂，医生通常必须依靠专业配制药房（compounding pharmacy）进行定制调配，而无法直接通过普通药房和常规医保获取。 随后，Haver 医生引入了一位名为 Michael 的亲近患者案例：她初次就诊时带着更年期非常典型的复合困境——体重超重、长期失眠以及日趋严重的脑雾现象。 ### [57:56](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3476s) 患者康复范例：逆转关节剧痛与身体成分重塑 玛丽·克莱尔·哈弗医生（Dr. Mary Claire Haver）分享了一位令她印象极为深刻的患者案例。这位女士不仅饱受全身大关节酸痛与各种更年期不适的折磨，而且尽管非常深爱自己的丈夫，性欲却几乎完全丧失。哈弗医生为她制定了个性化的营养方案，患者也聘请了私人教练、走进健身房认真开始抗阻力量训练，并同步启动了激素替代疗法（HRT）。哈弗医生在诊所中使用 InBody 人体成分分析仪进行精准监测，结果令人惊叹：该患者不仅减掉了约 60 磅（约 27.2 公斤）的体脂，还增加了约 10 磅（约 4.5 公斤）的肌肉，完全不是单纯看体重秤数字的变化。 如今这位患者在社交媒体上成了哈弗医生的坚定支持者，身体感觉极佳，与丈夫重获了渴望已久的亲密生活，各方面都处于蓬勃生机的状态。然而，最让这位患者感到愤怒和遗憾的，是自己竟然白白忍受了那么久的痛苦才寻求帮助，以及此前根本找不到懂更年期的专业医生——她当时是特意从圣安东尼奥驱车三个半小时才赶到哈弗医生的诊所就医。 - **体成分改善**：通过抗阻训练与激素治疗，减掉约 60 磅脂肪，净增约 10 磅骨骼肌。 - **求医阻碍**：患者在本地无法获得有效诊疗，单程驱车 3.5 小时跨城求医。 --- ### [59:15](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3555s) 更年期医疗资源匮乏与患者推荐网络 哈弗医生两年前创办了自己的更年期专科诊所，候诊名单如今“比演播室的墙还要长”，甚至经常有全美各地的女性专程坐飞机赶来问诊。这虽令她感到荣幸与感激，但同时也折射出极其荒谬的医疗现状：女性在自己的家门口居然找不到合格的更年期医疗服务，不得不搭乘飞机跨州求医。 为了打破这种地域壁垒，哈弗医生在自己的官网上建立了一个经患者口碑推荐的医生名录，团队负责核实医生资质与真实联系方式；同时她也积极推荐北美更年期学会（原 NAMS，现已更名为 The Menopause Society）官网上认证的更年期专科医生列表，帮助无法亲自前往她诊所的女性就近找到能给予科学支持的医疗人员。 ```mermaid flowchart TD accTitle: 更年期医疗求助与资源分流路径 accDescr: 展示患者在本地医疗资源缺失情况下寻找专业更年期支持的解决路径 subgraph LocalIssue["现实困境"] A["更年期综合征困扰"] --> B["本地基层医疗缺乏专业支持"] B --> C["患者跨城甚至乘飞机异地求医"] end subgraph Solutions["专业资源渠道"] D["哈弗医生官网患者推荐名单"] E["绝经学会官方认证专科医生名录<br/>(The Menopause Society)"] end C -.-> D C -.-> E ``` --- ### [01:00:06](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3606s) 伴侣的介入艺术：如何以爱与尊重打破更年期耻感 主持人史蒂芬·巴特利特（Steven Bartlett）提到自己收到过一封来自听众丈夫的长信。这位男士在节目中了解了更年期知识后非常想帮助妻子，却陷入两难：男性伴侣既不敢贸然指着妻子说“我觉得你更年期了”，生怕冒犯对方，又不忍心坐视不理、无所作为。史蒂芬借此请教，伴侣究竟该在何时、以何种方式介入？ 哈弗医生指出，更年期的迹象往往始于一些细微而难以捉摸的变化——妻子的情绪反应与往常不同、心理韧性明显下降、处理日常压力的状态不再如从前。介入的关键在于彻底破除社会对“更年期”这一词汇的污名化与羞耻感。很多女性在听到这个词时会情绪爆发，是因为潜意识里将更年期等同于衰老和枯萎；就连哈弗医生自己当年经期停滞时，脑海里浮现的也是美剧《欲望都市》（*Sex and the City*）中萨曼莎（Samantha）误以为自己绝经时的崩溃桥段。 对于想要施以援手的男士，哈弗医生的核心建议是： - **表达善意与理解**：首先要赞赏伴侣主动分担的意愿，“带着爱意、温柔地去沟通”（"Say it with love. Say it gently."），而不是以审判或诊断的姿态。 - **共同迈出求医第一步**：协助寻找专业的医疗机构，并陪同妻子一起走进诊室。哈弗医生表示，她门诊中效果最好的问诊往往是伴侣双方共同出席的场景。 - **协同管理预期**：让伴侣明确知晓女性体内正在发生的剧烈生理变化，明确居家生活需要哪些分担与照料，共同建立信心，避免缺乏沟通导致亲密关系乃至婚姻破裂。 --- ### [01:02:58](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3778s) 彻底辟谣“男性更年期”：睾酮曲线与卵巢衰退的生物学真相 当被问及“男性是否也会经历类似更年期的过程”时，哈弗医生给出了非常干脆的回答：“简而言之，并不会。”（"The short answer is not really."） 她解释称，男女两性的性激素分泌规律存在本质上的生物学差异：男性的睾酮水平通常在 19 岁左右达到峰值，随后开始极为缓慢地下滑，大约在 35 至 40 岁之间达到一个平稳期，并在余生的大部分时间里维持相对恒定的平台期。尽管健康男性的正常睾酮参考范围跨度极大（约 236 至 1000 ng/dL），部分处于低区间的男性在接受睾酮补充后确实会改善认知、精力和情绪，但这与女性更年期完全不可同日而语。 - **器官命运的根本区别**：男性绝不存在生理意义上的“男性更年期”（"There is no manopause"）。男性的睾丸不会突然罢工；而女性更年期在生理上的对等冲击，相当于“男性的睾丸在 51 岁时彻底萎缩坏死并停止一切功能”。 --- ### [01:04:23](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3863s) 医学界的厌女偏见与“全是她胡思乱想”的误诊怪圈 史蒂芬感慨道，如果在 51 岁时身体机能骤然崩溃、器官停止运作的是男性，医学界和社会公众的反应绝不可能像现在这样冷漠。哈弗医生对此深表赞同，并尖锐地指出了医疗体制长久以来的系统性性别偏见：千百年来，女性在更年期所承受的身心痛苦，往往被轻描淡写地归结为“神经质”或心理障碍。 在临床培训与巡房期间，医护人员口中频繁出现“全是她脑子里胡思乱想”（"it's all in her head"），而医学界绝不会对男性患者轻易使用这套推脱之词。甚至到 2023 年的今天，这种根深蒂固的偏见依然存在——数据表明，一名更年期女性被医生开具抗抑郁药物的可能性，依然远远高于被开具科学的激素替代疗法。这种扭曲的医疗决策，一方面源于医学院对女性生理转变教育的长期缺失，另一方面则归咎于当年“妇女健康倡议”（Women's Health Initiative, WHI）研究所引发的非理性恐惧，导致整整一代临床医生对激素疗法谈虎色变。 --- ### [01:05:47](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3947s) 应对日常压力的解药：正念冥想与筑牢睡眠基石 在谈及个人日常身心调适的工具时，哈弗医生透露自己过去曾对冥想嗤之以鼻，认为那不过是故弄玄虚的“玄学”（"woo-woo"），自己坐在那里只会思绪乱飞。然而，当更年期症状与生活重压集中爆发——亲兄弟意外离世的剧烈悲痛、赡养年迈父母的责任、家中正值青春期的女儿们，再加上更年期激素暴跌带来的精神反噬，她意识到自己到了濒临崩溃的边缘。 在心理咨询师的引导下，哈弗医生开始使用 Headspace 等引导式冥想 App，每天清晨抽出 5 到 10 分钟专注于感恩练习。她强调，女性必须学会“先给自己戴好氧气面罩”（"put your own oxygen mask on first"），只有先关照好自己的大脑与心灵，才有能力去照顾家庭和应对多重社会责任。 此外，哈弗医生将睡眠列为更年期管理中压倒一切的首要任务： - **睡眠障碍的普遍性**：围绝经期和绝经期激素波动引发的睡眠剥夺极其严重且普遍。 - **干预的优先顺序**：哈弗医生在门诊中总是对患者强调，睡眠问题必须最先解决；如果无法恢复深度睡眠，身体系统无法修复，其他任何营养、运动或治疗手段都难以真正发挥成效。 ### [01:07:38](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4058s) 睡眠障碍与更年期阻塞性睡眠呼吸暂停 玛丽·克莱尔·哈弗（Dr. Mary Claire Haver）强调，睡眠是人体自我修复的核心环节——肌肉在睡眠中得以合成，大脑在此期间完成重启，全身系统借此恢复平衡。如果一名女性在更年期遭遇严重的睡眠障碍，常常会在凌晨三点惊醒，大脑飞速运转且无法再入睡，体内的生理指标就会迅速恶化：皮质醇（压力激素）水平激增，胰岛素抵抗急剧加剧，导致健康陷入恶性循环。因此，在她的诊所里，接诊患者后的第一优先级永远是调整“睡眠与营养”。 主持人史蒂芬·巴特利特（Steven Bartlett）插话表示，改善睡眠向来是“说起来容易做起来难”。哈弗医生回应道，如果是由于雌激素下降引起的更年期睡眠障碍，治疗其实非常简单且立竿见影，“就像把她们之前缺失的水分重新注入体内一样”，只要补充激素，她们很快就能重新安睡。然而，真正的难点在于那些长期以来睡眠质量就不佳的患者，这往往超出了妇科内分泌的范畴，需要转诊至专业的睡眠医学科。此外，研究显示更年期与睡眠呼吸暂停（Sleep Apnea）之间存在显著关联。令人担忧的是，这种呼吸暂停不仅发生在肥胖人群中，在更年期女性中，即便身材非常苗条的患者，其发病率也出现了大幅攀升。 - **睡眠呼吸暂停的病理表现**：睡眠时软腭松弛下垂，导致呼吸短暂停止或严重打鼾，严重阻碍氧气进入大脑和身体各器官，带来长期的健康和心血管风险。 - **临床干预策略**：首先甄别睡眠障碍是否由更年期激素剧变诱发；若属于激素原因，激素替代治疗可迅速见效；长期慢性失眠则需结合睡眠专科治疗。 ```mermaid flowchart TD accTitle: 睡眠紊乱对身体恶性循环的影响及应对 accDescr: 更年期雌激素骤降引发失眠，导致生理紊乱，需通过针对性治疗打破恶性循环。 subgraph S1["激素失衡与睡眠崩溃"] A["更年期雌激素水平骤降"] --> B["凌晨3点惊醒 / 大脑飞速运转"] B --> C["皮质醇激增 & 胰岛素抵抗恶化"] end subgraph S2["诊疗干预路径"] C --> D{"失眠成因鉴别"} D -- "激素源性睡眠障碍" --> E["激素替代疗法: 快速恢复修复机制"] D -- "非激素慢性失眠 / 呼吸暂停" --> F["睡眠医学专科转诊 & 气道监测"] end ``` ### [01:08:53](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4133s) 运动观念重塑：从“追求纤瘦”转向“追求力量” 谈及个人的日常健身计划时，哈弗医生坦承自己在过去的二十年里完全陷入了“为了变瘦、变小而运动”的思维定势中。如今，她的锻炼目标彻底转变为“为了变得更强壮而运动”，抗阻力量训练成为了核心。哈弗医生分享了她居家办公与工作的独特习惯：她在办公室配备了一台设置在坡度模式下的跑步机，在撰写《加尔维斯顿饮食》（The Galveston Diet）或新书、进行 Zoom 线上会议与团队探讨时，她都会在带有坡度的跑步机上一边步行一边工作，以此深度锻炼腿部肌肉；同时，她还会穿上一件负重背心（Weighted Vest），通过负重对上半身施加刺激，以此预防骨质流失并增强骨密度。 哈弗医生直言，自己通过诊所内的身体成分扫描仪确诊患有肌少症（Sarcopenia）。从基因层面看，她属于天生体型清瘦、肌肉量较低的体质。早年她一直将“苗条清瘦”视为健康的象征和融入社会的资本，这种认知让她错失了在20岁和30岁这一黄金年龄段轻松增肌的最佳时机。现在，她常常把这些经验告诫给自己的两个女儿，并希望穿越时空告诉35岁的自己：“专注于让自己变得强壮，而不是变得娇小；肌肉力量远比骨感纤细更重要。”她鼓励女性不要过度焦虑自己身上天然的曲线和所谓的脂肪，把精力投入到肌肉构建上，因为现在积累的肌肉储备将成为下半生最坚实的健康护盾。 - **工作与力量训练结合**：利用斜坡跑步机办公以强化下肢力量，搭配负重背心增强骨骼负荷，刺激骨密度提升。 - **给年轻女性的核心建议**：“追求力量，拒绝干瘦”（Muscle strength over skinny），肌肉质量对中老年机能维持与代谢保护具有决定性作用。 ### [01:10:19](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4219s) 哈弗医生的日常饮食法则：抗炎、高蛋白与间歇性禁食 在饮食作息方面，哈弗医生践行间歇性禁食，她的进食窗口通常从中午12点左右开始。除了在乘飞机等特殊旅行场景下需要提前进食外，在正常的门诊工作日，她的饮食筹备往往在前一天晚上就已开始。她会亲自准备好次日带往诊所的全部正餐与零食，确保营养构成完全由自己掌控。她的餐盘中包含大量优质蛋白质、深绿色蔬菜、新鲜水果，以及坚果与植物种子。哈弗医生透露自己整天都在吃各类坚果和种子，利用其中丰富的健康脂肪、膳食纤维和抗炎营养素来维持机体活力。 由于自身没有减重需求，当前的核心目标是克服肌少症、增强肌力，因此她对蛋白质摄入量的要求显著提高。在接诊间隙，除了坚果类零食外，她常会在午后饮用蛋白奶昔或食用蛋白棒进行补充。晚间的饮食则主要由她和丈夫共同商定——随着孩子长大离家，夫妻俩进入了“空巢”阶段，晚餐通常围绕高蛋白核心展开，比如从冰箱拿出三文鱼煎烤，或是制作高品质肉饼，旁边再搭配一份由大量牛油果、鹰嘴豆和绿叶菜组成的丰富沙拉。她通常严格将进食时间控制在晚上8点之前结束。由于早晨是她专注力最高、工作产出最优质的时段，她很难在清晨兼顾健身房，因此通常将力量训练安排在下班回到家后的傍晚进行。 - **进食时间窗口**：约中午12:00开餐，晚上20:00前结束进餐（大致维持16:8断食节奏）。 - **抗炎与蛋白配比**：坚果与植物种子贯穿全天，补充 Omega-3、纤维素与微量元素；午间补充蛋白棒/奶昔；晚餐主打三文鱼等优质蛋白搭配牛油果鹰嘴豆沙拉。 ### [01:12:06](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4326s) 致全球12亿女性与家属：“绝经是必然的，痛苦却不是” 史蒂芬向哈弗医生提问：如果给她一个可以向全球12亿正处于围绝经期、绝经期或绝经后女性，以及她们身边的家人与伴侣发声的扩音器，她最想传达的核心信息是什么？哈弗医生毫不犹豫地给出了自己的箴言：“绝经是不可避免的，但痛苦绝非必然（Menopause is inevitable. Suffering is not）。” 哈弗医生情绪凝重地指出，社会和现行的医疗体系在很大程度上辜负了更年期女性，医疗体制的设计并未给予这一群体应有的关照与支持，导致无数女性在迷茫中承受折磨。正因如此，女性必须学会为自己的身体健康主动争取权益（Advocate for yourself）。哈弗医生在个人网站上提供了大量可供免费下载的工具包，包括能够直接打印出来递交给全科医生的权威科研文献列表、更年期症状跟踪评估表和健康日志等。她坚定地向所有受更年期困扰的女性呼吁：“这些痛苦都是真实存在的，你们没有疯，这正在切实地发生。”即使某些女性因身体原因不适合接受激素替代疗法，也绝不要感到绝望与孤立无援——抗阻运动、精准抗炎营养、非激素靶向药物、压力管理和睡眠改善等综合干预手段同样能够带来实质性的改善。她呼吁女性在这个阶段务必学会将自己的身心健康置于首位，去拥抱理应拥有的高质量下半生。 - **核心主张**：打破“更年期必须忍受折磨”的错误社会观念，正视身体变化带来的病理反应。 - **自我赋权行动工具**：携带系统记录的症状追踪表与最新临床医学论文就医，主动与医生沟通治疗方案。 - **多元治疗矩阵**：非激素候选人群可借助抗阻运动、膳食抗炎、神经调节药物与睡眠干预重塑身心状态。 ### [01:13:36](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4416s) 商业公告与赞助：Flight Fund 与 Huel 营养升级 在此处节目中插播了史蒂芬·巴特利特的商业投资项目与播客赞助内容。史蒂芬首先介绍了他在2023年成立的私募股权基金“Flight Fund”，该基金旨在投资全球最具潜力的初创企业，致力于成为欧洲表现最佳的高成长基金之一，挖掘下一批欧洲独角兽。目前该基金不仅汇聚了欧洲众多成功的创新创业者作为投资人，同时也向具有高成长潜力的企业创始人开放融资路演通道，合格投资人亦可通过官方网站申请参与。史蒂芬随后宣读了合规风险提示：该基金受英国金融行为监管局（FCA）监管，私募股权属于高风险投资，仅适用于成熟专业投资者，投资资本存在损失风险。 紧接着，史蒂芬作为代餐营养品牌 Huel 的早期投资人与合作伙伴，介绍了由他亲自挑选配置的“Steven Bundle”定制产品组合。该组合包含高蛋白规格的“Black Edition”海盐焦糖口味代餐粉（每罐提供17次份量）以及定制摇摇杯。史蒂芬特别披露了一段此前从未公开的经历：多年前 Huel 首次推出蛋白营养棒时，口感体验欠佳，因此他多年来从未在播客中推荐过该品类；但过去两到三年间，Huel 研发团队对全营养棒进行了彻底的配方重构，全新推出的巧克力焦糖味全营养棒品质惊艳，深受其团队成员喜爱，甚至在工作台上一经拆封就会被一抢而空。听众可通过节目简介中的专属链接获取上述产品。 ### [01:15:50](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4550s) 家族病史的阴影：从个人经历反思医疗系统与营养学 广告结束后，访谈重回深入的人生对话。史蒂芬指出，哈弗医生的家族有着复杂的重大疾病与健康并发症史，并询问这段沉重的家庭过往是如何深刻重塑了她对现代医疗体系、临床营养学以及慢性病防治的宏观认知的。 哈弗医生深情回顾了自己的家庭背景：她在一个庞大的家庭中长大，是八个孩子中的一员，拥有六个兄弟。她的大哥所经历的健康危机与病痛折磨，成为了她人生观与医学职业生涯的重大转折点，也直接促使她重新审视传统医学在预防、生活方式干预以及代谢管理领域的严重缺失…… ### [01:16:10](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4570s) 家族逝去之痛与绝经期自我觉醒 Mary Claire Haver 医生坦陈了深植于自己人生中的家庭悲剧与健康隐患。当她年仅 9 岁时，哥哥 Jep 因急性淋巴细胞白血病（ALL）不幸离世。尽管如今该病的治愈率高达 95%，但在当时，Jep 在经历缓解期后又在十几岁晚期复发，仅仅一年半后就离开了人世。那一年半的童年时光全家都在拼命奔波，甚至不远万里从家乡路易斯安那州赶往孟菲斯的圣犹达儿童研究医院（St. Jude Children's Research Hospital）尝试最后一线化疗方案，但最终依旧无力回天。 悲剧在数十年后再次降临。2010 年前后，她的另一位哥哥 Bob 虽常年携带艾滋病毒（HIV），但在抗病毒药物控制下指标一直保持得很好，与伴侣携手走过了 30 多年，然而他同时患有肝炎与严重的酗酒问题。眼看着哥哥在酒精与肝衰竭的泥潭中挣扎，Mary Claire 承受着巨大的心痛。2015 年 Bob 突发中风，Mary Claire 全程陪伴并承担了他的临终关怀。在那段极度悲痛的时光中，由于全身心照顾哥哥而彻底忽略了自身，她开始整夜失眠、情绪崩溃、脑雾严重。她起初不断在心理上“精神内耗/自我煤气灯”（gaslit myself），以为所有症状纯粹是亲人离世带来的悲恸，直到后来才恍然大悟：自己其实已经正式步入了更年期。 随后，另一个哥哥 Jude 在 Bob 去世前后被确诊为食管癌晚期，苦撑数年后也遗憾撒手人寰。Bob 走时 56 岁，Jude 走时 57 岁，而 Mary Claire 此时已 55 岁。在六个兄弟中，她即将活过其中的三位。面对沉重的家族遗传与疾病阴影，她清醒地意识到虽然哥哥们的遭遇与生活方式有关，但相同的基因依然流淌在自己体内。正因如此，她必须严格执行营养配餐、力量训练、充足睡眠、压力管理以及激素替代疗法（HRT）这套“更年期工具箱”（menopause toolkit）。她动情地表示，自己拼尽全力健康生活，是因为她无比渴望活着看到自己的女儿们长大成人、展现自我，并期待着未来能抱上孙辈，"我之所以做这一切，是因为我必须这么做，因为如果我不谨慎，这个选择权随时会被夺走。" ### [01:19:02](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4742s) 打破更年期社会污名与科普赋能 主持人 Steven Bartlett 对 Mary Claire 的使命与工作表达了由衷的敬佩。他指出，长久以来更年期女性在社会中被边缘化，经历着无尽的幻灭与孤独，而当下关于更年期的大规模公开讨论，正是打破社会长期污名化这堵“第一道高墙”的关键开端。Steven 坦言，自己在创办播客并与相关医学嘉宾交谈前，对更年期几乎一无所知；学校教育教人如何工作、如何生儿育女，但一旦生育阶段结束，整个社会和教育系统似乎就彻底对女性的后续生命阶段弃之不顾。 Steven 盛赞 Mary Claire 的独特能力在于不仅兼具严谨的科学基石，更具有极高的通俗可读性，并且充满共情与细致入微的关怀（nuance and empathy）。更年期千人千面，每个女性的症状、合并症与禁忌症都截然不同，而 Mary Claire 始终能够设身处地为患者着想。Mary Claire 回应称，将晦涩难懂的医学机理转化为大众一听就懂的常识，正是她在职业生涯中发现的“超能力”。 作为一名 30 岁的男性，Steven 表示自己身边有深爱的伴侣（30岁）、姐姐（36岁）以及年近 60 岁的母亲。Mary Claire 随即鼓励他主动去和母亲聊聊更年期的真实感受。Steven 强调，全球正有约 12 亿女性处于这一阶段，更年期最终会波及全人类 50% 的人口，所有能坚持听到这里的男性都值得赞赏——因为改善这 50% 人口的健康福祉，就是改善整个社会的福祉，男性同样应当承担起倾听、支持与打破偏见的角色。 - **推荐著作与资源**： - 《加尔维斯顿饮食》（The Galveston Diet）：已正式出版，专注于抗炎饮食与体重代谢管理。 - 《新更年期》（The New Menopause）：凝聚了 Mary Claire 数十年临床心血的集大成之作，开放全网预售，预计于 2024 年 5 月正式面世。 - 官方网站与社交媒体平台：提供大量科学且免费的更年期健康资讯。 ### [01:22:19](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4939s) 终极之问与节目尾声 依照播客的固定传统，上一位匿名嘉宾给 Mary Claire 留下了一个深刻的问题：“如果你能与你所爱的人——无论是孩子、丈夫还是其他人——进行最后一次对话，你会对他们说些什么以前未曾听过的话？” Mary Claire 几乎没有犹豫，眼中含泪给出了最纯粹的回答：“我爱你（I love you）。”在历经父亲离世，以及眼睁睁看着双亲先后埋葬了 Jep、Bob 和 Jude 三个孩子之后，她深感生命的终点唯有爱最为永恒，"除了爱，别无其他。" ```mermaid flowchart TD accTitle: 更年期综合干预与长寿生活路径 accDescr: 展示从认知觉醒、健康工具箱应用到最终长寿愿景的闭环流程 subgraph Awareness["认知与社会支持"] A["破除更年期污名化"] --> B["理解个体差异与共情倾听"] B --> C["伴侣与家庭全方位支持"] end subgraph Toolkit["更年期工具箱 (Menopause Toolkit)"] D["抗炎营养饮食 (Galveston Diet)"] E["抗阻力量训练与肌量维持"] F["优质睡眠与昼夜节律"] G["科学压力管理"] H["合理应用激素替代疗法 (HRT)"] end subgraph Outcome["长寿与健康目标 (Healthspan)"] I["抵抗家族遗传易感风险"] J["改善脑雾/失眠等围绝经期症状"] K["见证下一代成长与孙辈天伦"] end Awareness --> Toolkit Toolkit --> Outcome ``` 访谈结束后，Steven Bartlett 带来了赞助商 Eight Sleep 智能温控床垫的分享。他谈到优化睡眠是他提升日常创造力、改善情绪状态的关键抓手，而适宜且能够随夜间自然节律波动的温度（入睡微凉、夜深更冷、清晨回暖）正是深度睡眠不可或缺的物理条件。最后，Steven 推荐听众继续收听往期备受好评的医学深度对谈。 ## Notable quotes > [00:00](https://www.youtube.com/watch?v=oQqcnYcKx68&t=0s) 这就好比男性的睾丸在 51 岁时突然萎缩并彻底丧失功能，女性经历的正是同等量级的剧烈转变。 — Mary Claire Haver > [15:20](https://www.youtube.com/watch?v=oQqcnYcKx68&t=920s) 在妇科培训中，所有东西都被混为一谈。我们在整整四年的课程里，关于更年期的讲座加起来可能只有6个小时……我的高年级住院医会说：‘天哪，祝你好运，你手上摊上了一个 WW。’那是黑话，我们从不会写进病历，但人人都知道，WW 代表‘爱抱怨的女人’（Whiny Woman）。 — Mary Claire Haver > [23:28](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1408s) 妈妈，我绝不会让自己体内缺少雌激素，我从围绝经期就要开始补充，绝不做激素断档的女人。 — Mary Claire Haver的女儿 > [25:36](https://www.youtube.com/watch?v=oQqcnYcKx68&t=1536s) 我受够了，我不会再独自承担这一切，伴侣必须承担起自己应尽的那一份。 — Mary Claire Haver > [39:07](https://www.youtube.com/watch?v=oQqcnYcKx68&t=2347s) 天哪，我居然撑到了中午，而且感觉一点也不糟糕！ — Mary Claire Haver > [54:40](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3280s) 想象一下，如果有 10% 的男性终身无法达到高潮，这绝对会被列为国家紧急事件，美国甚至会削减军费预算来全力攻克这个难题。 — Mary Claire Haver > [01:00:06](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3606s) Say it with love. Say it gently. — Mary Claire Haver > [01:02:58](https://www.youtube.com/watch?v=oQqcnYcKx68&t=3778s) 简而言之，并不会。（The short answer is not really.） — Mary Claire Haver > [01:08:53](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4133s) 专注于让自己变得强壮，而不是变得娇小；肌肉力量远比骨感纤细更重要。 — Mary Claire Haver > [01:12:06](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4326s) 绝经是不可避免的，但痛苦绝非必然（Menopause is inevitable. Suffering is not）。 — Mary Claire Haver > [01:12:06](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4326s) 这些痛苦都是真实存在的，你们没有疯，这正在切实地发生。 — Mary Claire Haver > [01:16:10](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4570s) 我之所以做这一切，是因为我必须这么做，因为如果我不谨慎，这个选择权随时会被夺走。 — Mary Claire Haver > [01:22:19](https://www.youtube.com/watch?v=oQqcnYcKx68&t=4939s) 我爱你（I love you）。除了爱，别无其他。 — Mary Claire Haver ## Mentioned Mary Claire Haver, Steven Bartlett, The Galveston Diet, The New Menopause, 杜兰大学 (Tulane University), 美国国家卫生研究院 (NIH), 美国妇女健康倡议 (WHI / Women's Health Initiative), 美国食品药品监督管理局 (FDA), 北美更年期学会 (The Menopause Society / NAMS), 马克·马特森 (Mark Mattson), 圣犹达儿童研究医院 (St. Jude Children's Research Hospital), Flight Fund, Huel, Eight Sleep, Headspace, InBody, Addyi, Vyleesi, Provera ## Video description Menopause symptoms, perimenopausal symptoms, weight loss, exercise, hormone replacement therapy. If you enjoyed this, you will LOVE this conversation with Dr Mindy Pelz: https://www.youtube.com/watch?v=e2mQOGzHtQc 00:00 Intro 02:56 Your mission 07:05 The Crazy Effects Of Menopause On Women's Bodies & Their Mental Health 09:13 What Is Menopause & It's Symptoms? 15:00 Women With Menopause Are Being Let Down By Our Medical System & Society 19:03 Are You Skeptical About The Medical System? 20:39 The Health Consequences Of Menopause 27:00 How Can We Give Women The Support They Need? 31:54 What Is Inflammation? 35:01 The Importance Of Fiber In Our Diets 37:12 Fasting 41:38 Fuel Refocus 43:05 The Importance Of Building Muscle Mass 45:23 Does Hormone Therapy Cause Cancer? 52:33 The Side Effects Of Hormone Therapy 54:16 How To Help Women With Menopause 55:21 The Link Between Sex & Menopause 57:12 A Story About One Of Your Patients 59:45 Advice For Men 01:02:38 Do Men Experience Anything Similar? 01:06:58 Sleep Disruption 01:08:33 The Perfect Exercises During Menopause 01:09:58 Your Diet 01:13:17 Ads 01:15:30 A History In Your Family Of Why This Is So Important To You 01:18:43 Your New Book 01:22:19 The Last Guest's Question Follow Mary Claire Haver: Instagram: https://bit.ly/3TtYGrv TikTok: https://bit.ly/3v9U3sq Pre-Order Dr Mary’s new book here: https://amzn.to/41tQtW8 The Galveston Diet: https://amzn.to/3v7g9fu Flightfund: https://flightfund.com/ The Conversation Cards: https://bit.ly/4amtNew Watch the episodes on Youtube - https://g2ul0.app.link/3kxINCANKsb My new book! 'The 33 Laws Of Business & Life' is out now: https://smarturl.it/DOACbook Follow me: Instagram: http://bit.ly/3nIkGAZ Twitter: http://bit.ly/3ztHuHm Linkedin: https://bit.ly/41Fl95Q Telegram: http://bit.ly/3nJYxST Sponsors: Huel: https://try.huel.com/steven-bartlett Eight Sleep: https://www.eightsleep.com/uk/steven/ CODE: STEVEN [Source](https://www.youtube.com/watch?v=oQqcnYcKx68)

[0:00] Mary Claire Haver: 这就好比男性的睾丸在 51 岁时突然萎缩并彻底丧失功能，女性经历的正是同等量级的剧烈转变。 [15:20] Mary Claire Haver: 在妇科培训中，所有东西都被混为一谈。我们在整整四年的课程里，关于更年期的讲座加起来可能只有6个小时……我的高年级住院医会说：‘天哪，祝你好运，你手上摊上了一个 WW。’那是黑话，我们从不会写进病历，但人人都知道，WW 代表‘爱抱怨的女人’（Whiny Woman）。 [23:28] Mary Claire Haver的女儿: 妈妈，我绝不会让自己体内缺少雌激素，我从围绝经期就要开始补充，绝不做激素断档的女人。 [25:36] Mary Claire Haver: 我受够了，我不会再独自承担这一切，伴侣必须承担起自己应尽的那一份。 [39:07] Mary Claire Haver: 天哪，我居然撑到了中午，而且感觉一点也不糟糕！ [54:40] Mary Claire Haver: 想象一下，如果有 10% 的男性终身无法达到高潮，这绝对会被列为国家紧急事件，美国甚至会削减军费预算来全力攻克这个难题。 [60:06] Mary Claire Haver: Say it with love. Say it gently. [62:58] Mary Claire Haver: 简而言之，并不会。（The short answer is not really.） [68:53] Mary Claire Haver: 专注于让自己变得强壮，而不是变得娇小；肌肉力量远比骨感纤细更重要。 [72:06] Mary Claire Haver: 绝经是不可避免的，但痛苦绝非必然（Menopause is inevitable. Suffering is not）。 [72:06] Mary Claire Haver: 这些痛苦都是真实存在的，你们没有疯，这正在切实地发生。 [76:10] Mary Claire Haver: 我之所以做这一切，是因为我必须这么做，因为如果我不谨慎，这个选择权随时会被夺走。 [82:19] Mary Claire Haver: 我爱你（I love you）。除了爱，别无其他。

[2:56] Dr. Mary Claire Haver: I was just going with the script that had been handed to me for years that calories in, calories out is the only way... I decided to go back to school to learn more about nutrition because I felt that there was a big piece missing here. [37:12] Dr. Mary Claire Haver: I used to break my fast about 6:00 in the morning before I exercised... I pushed that window to 6:15 and I did that for three or four days until it felt normal, natural... then I moved it to 6:30 and I just kept bumping that window out... by week five, I remember sitting at my desk... 'Oh my god, I made it. It's noon and I don't feel bad.' [65:47] Dr. Mary Claire Haver: The thought of you have to put your own oxygen mask on first before you can go take care of your family... [72:05] Dr. Mary Claire Haver: My mantra is menopause is inevitable. Suffering is not. But you're going to have to advocate for yourself because society has failed us.

[0:00] In 2023, 85% women are complaining of [0:02] menopausal symptoms, 10.5% are receiving [0:05] treatment or therapy. I mean, it would [0:06] be as if your testicles traveled up and [0:08] died at 51. That's the equivalent. [0:10] Let's get started. Dr. Mary Claire Haver [0:13] renowned menopause expert [0:15] with more than 2 million followers [0:17] helping countless women through their [0:19] menopause experiences. Menopause is [0:21] inevitable, suffering is not. But, a [0:23] woman is more likely to be prescribed an [0:25] antidepressant for her menopause than [0:27] hormone therapy. Women by the thousands [0:29] are like, "Oh my god, I had no idea." [0:31] That's when I realized no one's talking [0:32] about this. So, here's their laundry [0:34] list of symptoms. We've categorized [0:36] about 70. So, there's brain fog, changes [0:39] in her sexual function [0:40] weight gain But, here's the scary [0:42] things, and the studies have been done. [0:44] We see either a new onset or worsening [0:46] of depression, anxiety, bipolar, ADHD, [0:49] risk for cardiovascular disease and [0:51] diabetes increases, recurrent urinary [0:53] tract infections, which is a major cause [0:55] of death for women. They're suffering in [0:57] silence, and I was one of those women. I [0:59] want to see my grandkids one day. I want [1:01] to watch these women I've raised grow up [1:04] and, you know, be the women they're [1:05] meant to be, and that choice might get [1:08] taken away from me if I'm not careful. [1:13] But, there's lots of things that we can [1:15] do. For example, we see a dramatic loss [1:17] of muscle mass. Focus on strength [1:19] training. This is going to determine [1:21] your longevity as you age. Strength over [1:23] skinny. [1:23] What about your diet? [1:25] I developed a program for my patients, [1:27] and it's not rocket science. It's [1:29] Whether you're a man or a woman, [1:32] menopause is going to affect you because [1:35] it's going to affect 50% of our society. [1:39] And there is 1.2 [1:41] billion women being affected by [1:43] menopause right now. And whether you're [1:45] a man or a woman, most of us don't have [1:49] the answers. How do we help? How do we [1:52] talk about it? What is it? How does it [1:55] affect the human body? If you're in a [1:58] relationship with a woman that's in [2:00] perimenopause, which can start at 30 up [2:02] to a woman that is currently going [2:04] through menopause in her 40s or 50s or [2:07] 60s, what should you do to support her? [2:10] What can she do to support herself? This [2:13] subject of menopause has exploded in [2:16] public conversation, thankfully. But, [2:19] there's still so many unanswered [2:20] questions. And that's why today I [2:23] invited one of the leading voices on [2:26] menopause globally onto my show. Even as [2:29] a man that won't go through menopause [2:30] myself, but has a partner and a mom that [2:33] certainly will, there's something that [2:36] everyone can learn from this. And I [2:38] implore all men who maybe clicked on [2:40] this episode or was sent this link to [2:42] listen. [2:43] Please, just listen. [2:46] Because you can learn something, too. [2:49] And for everybody new to this channel, [2:51] can you do me a favor? If you like what [2:52] we do here, you like the guests we have [2:54] on, and you like the show that we bring [2:55] to you, can you hit the subscribe [2:56] button? It is the single thing and the [2:58] only thing I'll ever ask of you. I would [3:00] love you to join us on this journey, and [3:02] if you do, I will repay you, and that is [3:05] a promise. Do we have a deal? [3:07] Thank you. [3:15] Dr. Mary Claire Haver, [3:18] why do you do what you do? [3:21] You know, I started out in medicine [3:23] the way most people do. You know, I [3:25] wanted to help people. [3:27] And in our training and school, we get [3:30] to have a little taste of all the [3:31] different specialties. And my very last [3:34] rotation in my third year was OBGYN. And [3:38] I really liked surgery. I really liked [3:41] some of the surgical subspecialties, so [3:43] I thought that would be my path. But [3:45] then, when I delivered my first baby and [3:47] all of that rush of emotion and dopamine [3:49] and how beautiful that whole process [3:51] was, I knew that that was going to be my [3:53] calling. [3:54] And so I did the traditional 4-year [3:58] residency and loved it and really did [4:01] well and went into private practice. Um [4:04] after about 3 years of doing the private [4:09] practice route, I realized I missed [4:10] being in academics. I wanted that [4:13] ability to do research and be around [4:15] students and teach as well as take care [4:16] of patients. So, I went back [4:18] on as faculty. And everything was going [4:21] great. I was very successful. I was, you [4:23] know, doing pap smears and babies and [4:25] birth control and all the things a [4:27] traditional OBGYN does, and then I was [4:30] aging as my patients were aging, too. [4:33] And when I got to my 40s, I realized [4:37] that there was a big gap in my education [4:40] and knowledge around menopause. So, I [4:43] started researching. Most of my patients [4:46] were coming in, the pain point was [4:48] weight gain. And they were like, "I'm [4:50] not doing anything different. I'm [4:53] working out. I haven't changed my diet." [4:55] And that little voice in my head was [4:57] like, [4:58] "Work out more, eat less." You know, we [5:00] tend to move less. We tend I was just [5:02] going with the script that had been [5:03] handed to me [5:04] for years that calories in, calories out [5:07] is the only way. And, you know, in [5:10] medicine in the US, we have very little [5:12] background in nutrition. We learn [5:14] nothing in medical school, very little [5:15] in residency as far as what nutrition [5:18] actually is and how it can affect our [5:20] bodies. And so, [5:23] I started struggling with my own [5:24] menopause. My patients were all [5:26] struggling, and I decided to go back to [5:28] school to learn more about nutrition [5:30] because I felt that there was a big [5:31] piece missing here because this weight [5:33] gain was mostly centered around the [5:35] midsection, and I was learning about [5:37] visceral fat and subcutaneous fat and [5:39] the differences and what's going on with [5:40] our muscle mass, and I'm like, "There's [5:42] a much bigger picture here than just [5:44] calories in, calories out." [5:46] So, in my I enrolled at Tulane [5:49] University in their culinary medicine [5:51] program, and just my mind was blown by [5:54] how much I didn't know as far as [5:57] nutrition and inflammation and aging and [5:59] how it all affects, but where was this [6:01] menopause piece? [6:02] And [6:03] so I took everything I learned and I [6:06] developed a little program for my [6:07] patients, [6:09] um which became the Galveston diet, and [6:11] it really was just a passion project for [6:12] me. And then I started talking about it [6:15] on social media and realized that as my [6:19] social media presence grew and the [6:21] conversation got bigger and bigger, that [6:23] there were so many women suffering. [6:26] Probably the majority of women in [6:27] menopause were suffering not just from [6:29] weight gain, but from musculoskeletal [6:31] issues, mental health, brain fog, you [6:34] know, skin changes, hair changes, nail [6:36] changes, and I just kept doing deeper [6:38] and deeper dives and realizing no one's [6:40] talking about this. No one's talking [6:42] about the multi-organ system, you know, [6:45] failure that a lot of women are going [6:47] through, and they're suffering in [6:49] silence, and physicians aren't helping. [6:51] We're not trained. And so, I thought And [6:54] my It's really my kids who I have two [6:56] daughters. One's 23, she's in medical [6:58] school right now, and she's um she's [7:00] actually here with us. And then, um the [7:02] other is 20, and [7:04] they were like, "Mom, you've you've got [7:06] the social media presence. You really [7:08] need to use it for good." And that's [7:10] kind of where that conversation exploded [7:13] for me on social media and where I [7:15] realized by reading the comments [7:17] what a much bigger pic you know, what [7:20] was really happening in the menopause [7:22] world and how we need to bring it to the [7:24] forefront. [7:25] For people that don't understand [7:26] menopause, [7:27] Mhm. um they might think it's that it's [7:29] a small issue affecting a small group of [7:32] people. But, how many women are are [7:34] affected currently by perimenopause, [7:36] menopause, and postmenopause? [7:38] Sure. So, right now, about a third of [7:41] the female population of the world is in [7:43] peri, full, or postmenopause. [7:46] Um [7:48] you do not It's not optional. All of us [7:51] go through it. And because we have such [7:53] individual expressions of how it affects [7:55] our bodies, what we know now is that [7:58] there are estrogen receptors in every [8:00] organ system of our body. And when those [8:02] levels start declining, we see a very [8:05] wide variety of a spectrum of of [8:07] syndrome where it used to just be [8:09] thought it was a few hot flashes and [8:10] some night sweats. Maybe your sleep's [8:12] disrupted. Your genital urinary system [8:15] is going to take a hit. Um your bones [8:17] are going to get weaker. But, what we [8:19] know now is how much it's affecting our [8:21] mental health, our capabilities, our [8:23] skin, our bones, our kidneys, you know, [8:25] vertigo, tinnitus, frozen shoulder. [8:27] Anytime I post about those on social [8:29] media, [8:30] the internet explodes. And women by the [8:33] thousands are like, "Oh my god, I had no [8:34] idea." You know, and just the validation [8:36] piece was so huge for them to make [8:39] because they've been dismissed for so [8:40] long and told it's all in their head. [8:42] And if we think about from sort of peri [8:44] to postmenopause, what is that sort of [8:46] typical And I know that's a tricky word [8:48] to use, but what is the [8:51] ab sort of average typical age range? [8:53] And then also, what is the sort of more [8:55] um [8:56] possible age range? So, it could start [8:58] between this age and this age. So, it In [9:00] the US and in most of Europe, the [9:01] average age of menopause, which means 1 [9:03] year after your last menstrual period, [9:06] is 51. [9:07] Perimenopause, which is when your body [9:10] recognizing recognizes there's some [9:12] declining estrogen levels and you're [9:13] beginning to be symptomatic, can start 7 [9:16] to 10 years before that. So, normal [9:18] menopause is still 45 to 55. Mhm. And [9:22] so, if you do the math and back that up [9:24] 7 to 10 years, it is completely [9:26] reasonable for a 35-year-old woman to [9:28] begin to experience some of the symptoms [9:31] of perimenopause. [9:32] So, let's start with what is it? Um and [9:36] I would love you to explain this to me [9:37] like I'm a 10-year-old. [9:38] Okay. [9:39] Because I'm sure there's a lot of people [9:40] that are both men and women that aren't [9:42] fully So, we're going to talk about [9:43] gonads, right? [9:44] What's gonads? Gonads are um where our [9:48] So, in men, it's the testes and where [9:51] you're making your genetic material to, [9:53] Okay. you know, [9:54] uh where you're making sperm, right? And [9:56] in a female, it's going to be ovaries, [9:59] her ovaries. So, the difference big [10:01] differences between male and female and [10:03] how that process happens is that [10:05] males make their genetic material fresh [10:08] constantly. The minute they go through [10:09] puberty until basically they die unless [10:11] they have some medical issue. [10:13] Females on the other hand, our eggs [10:15] develop while we're in utero in our [10:17] mothers. So, while we're in the womb, [10:20] we're she's 5 months pregnant with us, [10:22] we have our maximum eggs that we're ever [10:24] going to have. And those are meant to [10:26] last us until we go through menopause. [10:29] And so, they lay dormant until we go [10:30] through puberty and then they wake up [10:32] again and we start ovulating. So, we [10:34] have this monthly in a healthy person [10:37] cyclical, you know, hormones rise and [10:39] ebb and flow with our cycles each month. [10:42] We have a period, you get pregnant, you [10:43] don't get pregnant, and the whole [10:44] process starts over again. [10:46] Well, because we're born with that egg [10:48] supply, through time we're decreasing [10:50] the amount [10:52] and the quality of those eggs. So, when [10:54] a woman hits the age of 30, [10:58] um she is down to about 10% of the egg [11:01] supply that she had at birth. And when [11:03] she's 40, it's down to about 3%. [11:08] And so, and it gets harder and harder [11:10] for that ebb and flow of the natural [11:12] hormones to do its job and we start [11:15] seeing fluctuations in her periods and [11:17] then organ systems that are beginning to [11:20] notice the lack of estrogen. Estrogen is [11:22] a really powerful anti-inflammatory [11:24] hormone in most of our body systems. So, [11:27] the musculoskeletal syndrome of [11:28] menopause is really starting to be [11:30] talked about quite a bit now and we're [11:32] looking at things like frozen shoulder, [11:35] arthralgias, generalized aches and [11:37] pains, and most physicians aren't aware [11:40] of this. You know, most know about hot [11:41] flashes and night sweats and sleep [11:43] disruption, but now that we're really [11:46] opening the conversation as to how many [11:48] organ systems are affected, we are [11:50] seeing people coming out of the woodwork [11:53] just so happy to know that they're not [11:54] crazy and they're being validated. [11:56] And what's happening at these sort of [11:58] three stages? So, we have the [11:59] perimenopausal stage, which is, from [12:01] what I've understood there, when [12:02] estrogen levels start to drop. Right. [12:04] So, we start seeing [12:06] disruptions in the force. So, instead of [12:08] that nice monthly estrogen surge with [12:11] ovulation and then the progesterone goes [12:13] up, we start the elongation sometimes or [12:16] they even get closer together. I call it [12:17] the zone of chaos. What used to be a [12:19] very reproducible, dependable system [12:23] starts failing. So, some women will have [12:25] irregular periods, meaning they're [12:26] spacing out, they're skipping periods. [12:28] Others will have really heavy periods [12:30] like like, you know, hemorrhagic almost. [12:34] Um and again, individual um [12:37] the way the body reacts to this is very [12:39] individualized from patient to patient. [12:41] Doctors love [12:43] something that follows a list, a [12:45] checklist, right? You know, we have all [12:47] these complicated things we have to [12:48] learn and we have these checklists, but [12:50] menopause, it's like pinning the tail on [12:52] a moving donkey. And in perimenopause, [12:54] the it's very, very chaotic. Estrogen [12:56] surges, then it goes away for a while. [12:58] Like a woman in perimenopause can feel [13:00] completely fine for a few months, [13:01] everything goes haywire, then she's fine [13:03] again, you know, and not only is her [13:06] estrogen declining, her testosterone is [13:08] declining as well. So, we're seeing loss [13:10] of muscle mass, we're seeing changes in [13:12] her sexual function, [13:14] we're seeing decreased strength, you [13:15] know, there's some some really good [13:17] studies showing how testosterone also [13:19] affects our mental health and our [13:21] cognition as well. [13:23] Why does this happen? [13:25] From this a sort of like an evolutionary [13:26] or So, the anthropologists have looked [13:29] at this heavily and there's we're only [13:31] there's only a couple of species in the [13:33] world that go through menopause. Humans [13:35] are one. There's a species couple of [13:37] species of whales and I think they've [13:39] now discovered one of the giraffes [13:41] species of giraffes can do it, but the [13:43] by and large, most mammals will [13:47] die while they're still ovulating. You [13:49] know, like they're not going to go [13:50] through a menopause. [13:52] Um [13:53] and so, there's something called the [13:54] grandmother hypothesis where there was [13:57] an evolutionary advantage for women to [13:59] survive if she stopped the ability to [14:01] have children at some point. Now again, [14:03] you have to temper this with [14:06] humans have prolonged their lifespan and [14:08] their healthspan because of modern [14:10] medicine. So, [14:11] probably when we evolved, we weren't [14:13] living this long. You know, a woman my [14:15] age was pretty rare. I'm 55. And so, you [14:19] know, it it's hard to say. I think we [14:21] have outlived how we were genetically [14:24] built. And so, we're living longer and [14:26] being forced to like deal with the [14:28] consequences of that. So, so then the [14:30] next stage is menopause. Mhm. Um [14:33] So, menopause itself is really that it's [14:37] just really one day in your life. It's [14:38] when you can throw the hammer down and [14:40] say, "I'm never going to ovulate again. [14:42] I'm done." And so, if a woman's over the [14:43] age of 45 and she hasn't had a period [14:45] for a year, that's the definition. Okay? [14:48] Now, it gets confusing because what if [14:51] she's had a hysterectomy or doesn't [14:53] bleed because of a surgery or an IUD or [14:55] something? Well, then we can't use her [14:57] periods to help judge and that's where [14:58] we start doing blood work to see, you [15:00] know, where she is in her menopause [15:02] journey. And then postmenopause is the [15:04] rest of your life. [15:06] You know, the hot flashes might go away. [15:08] Night sweats might go away. [15:10] Brain fog might get better, but pretty [15:12] much everything else is going to [15:14] continue to progress in a very linear [15:16] fashion until you die without estrogen [15:18] replacement. [15:20] To put it lightly, you seem somewhat [15:21] dissatisfied with the current set of [15:24] answers that [15:25] um the medical field, but just society [15:28] at large are offering for women in [15:31] the sort of peri- and post- and [15:32] menopausal phase of their life. And I've [15:35] sat here with a lot of women who are [15:37] experiencing menopause [15:40] at one stage or the other and they also [15:42] seem to be at a loss for answers. Mhm. [15:46] Um I was sat here two days ago with um a [15:49] very, very successful woman who, [15:52] you know, has all the resources in the [15:53] world and she basically can and and this [15:55] is someone that has all the answers. [15:57] People come to her because she has the [15:58] answers. And the one thing she doesn't [16:00] seem to have answers on, in her own [16:01] words, in her life at the moment, is [16:03] menopause. She's rummaging around the [16:05] internet, Googling things, finding [16:06] contradictory information. And when you [16:08] sat down, you you you had that same [16:10] energy like you feel like women have [16:12] been, dare I say, let down by a system. [16:16] I think the medical system is letting [16:17] them down. I think society is letting [16:19] them down. Our our value and our worth [16:22] in medicine, [16:24] you know, I came through this wonderful [16:25] training program. I'm very proud of what [16:27] I learned. I'm very proud of the care [16:28] that I gave except [16:31] I was a horrible menopause provider for [16:32] probably 15 years. [16:35] I knew what I knew. [16:36] I relied on my training and I didn't [16:39] look outside of the traditional confines [16:41] of training. [16:43] This is such a systemic problem [16:46] that [16:47] I mean, I'm going to tell you a story [16:49] and this is this is true [16:51] and it's embarrassing, but I think it [16:52] needs to be said cuz I think it really [16:54] highlights [16:57] how women are treated in medicine. [16:59] Um [17:01] When I was in training, we had these [17:03] upper level residents. So, we have a [17:04] hierarchy where you have different years [17:06] of training. So, I was in the early [17:07] years, maybe my first year, and we had [17:08] these clinics that we would run [17:10] um to take care of patients. And so, [17:13] we have obstetrics and we have [17:14] gynecology as like divisions in our [17:16] training. So, [17:18] in gynecology, everything gets lumped [17:19] together. Pediatrics, menopause. We had [17:22] no specific menopause clinic. I maybe [17:24] got 6 hours of lecture in a 4-year [17:26] curriculum. [17:28] And so, we'd have these women coming in [17:29] in midlife and they had multiple [17:31] complaints. [17:33] They didn't feel good, they weren't [17:34] sleeping, they were gaining some weight, [17:36] they were, you know, aching, that, you [17:39] know, just this laundry list of things [17:40] that were a little on the vague side. [17:42] And [17:44] my upper levels [17:46] would say, "Oh gosh, good luck with [17:48] that. You've got a WW [17:50] on your hands." [17:52] And that was code. We never wrote that [17:53] in the chart. This was not taught to me [17:55] by faculty. This was just kind of a [17:57] handed down in the lore of training. And [17:59] a WW was a whiny woman. [18:02] And that was code. And now [18:06] I know that she was perimenopausal [18:09] suffering from her list of symptoms of [18:11] now which we've categorized about [18:13] they're they're they were frustrated [18:15] because they they didn't think they [18:17] could help her. Now, remember the [18:18] Women's Health Initiative, [18:20] which was a study that was supposed to [18:21] do a lot of good for women. It was [18:23] originally designed [18:25] um and it was stopped in 2002. That was [18:27] the end of my training program was 2002. [18:29] So, I'm I come from one of the last [18:32] groups of physicians in the US that were [18:34] ever trained in hormone replacement [18:36] therapy and then it the rug was pulled [18:37] out from under us. [18:39] So, the WHI, there were mistakes, there [18:42] was misinformation in the reporting, [18:44] and there was uh misinterpretation of [18:47] the results. All of that has been walked [18:49] back, re-looked at. We know that for the [18:51] vast majority of women, hormone [18:53] replacement therapy is safe and [18:55] effective and can give a woman her life [18:57] back um if she chooses to take it. But [19:00] that option has been taken off the table [19:04] for the vast majority of women. And [19:06] recently, I just saw the numbers, [19:08] 85% of women will come in complaining of [19:11] what we know now, this was in 2023, [19:14] FDA looked at the numbers, [19:16] 85% women are complaining of menopausal [19:18] symptoms. [19:19] 10.5% are receiving treatment or therapy [19:22] today. [19:24] Is there something in you that feels [19:26] somewhat, [19:27] even though you're a doctor, somewhat [19:29] let down by the medical system [19:31] um or skeptical about the medical system [19:34] for personal reasons? I [19:36] Yeah. I I'm one of those women. You [19:39] know, I thought I'd be one of those [19:41] girlies who would just breeze through [19:43] menopause because I was thin. [19:45] And I was, you know, thin meant healthy. [19:47] I still, you know, that mentality was [19:50] alive and well when I trained and [19:52] through most of my practice. I I came [19:54] through a very fat phobic, you know, uh [19:58] training [19:59] and medicine as a as a whole is very, [20:04] um, [20:04] biased against weight people's weight. [20:07] And [20:09] so [20:10] now that I've done a deep dive into [20:12] nutrition and done a deep dive into [20:14] menopause and really sat there and [20:16] listened to patients [20:18] and realized that, you know women who [20:21] were gaining weight with menopause, you [20:22] know, they've done nothing different. [20:24] They're still exercising. They're eating [20:25] the same. The only thing that's changed [20:27] for them [20:28] is their hormones. [20:30] And they're being categorically [20:31] dismissed at multiple doctor's visits or [20:33] worse [20:35] here's their laundry list of symptoms. [20:36] The root cause is menopause, but it's [20:38] not recognized. [20:40] And one medication could have taken care [20:42] of everything, but they're going to [20:43] seven, eight, nine different specialists [20:45] on seven, eight, nine different [20:46] medications to handle each symptom. [20:48] Whereas all they needed [20:50] was just to get her hormones back and [20:53] she would feel amazing and be able to, [20:55] you know, age the way she should. [20:58] When we talk about the potential [21:01] um [21:02] health implications of women that are [21:04] going through menopause, it's not just [21:06] WW. Right. It's much more, um [21:10] That's how she feels though. And that's [21:13] how she's categorized probably by people [21:15] around her. [21:16] But the there's real health consequences [21:19] and life altering health consequences, [21:21] life span reducing health consequences. [21:23] Yes. What are those? So, we know that a [21:27] woman's risk and and the studies have [21:29] been done. It's not just aging. Of [21:31] course, aging plays into this, but when [21:33] you add in menopause as an independent [21:34] risk factor, her risk for cardiovascular [21:37] disease increases. [21:39] Her risk of diabetes increases. Her [21:42] insulin resistance starts going haywire [21:44] immediately. [21:46] Your your listeners and your, you know, [21:48] people who watch on YouTube will be [21:49] shocked. I'm going to say, "How many of [21:52] their cholesterol levels shot up in [21:54] their 30s and 40s with no changes in [21:56] diet and exercise?" [21:58] You know, we see cholesterol levels [21:59] changing skin, hair, teeth, the dental [22:03] changes, the inner ear changes, the [22:06] vertigo is incredible, the frozen [22:09] shoulder is legion. Um What's frozen [22:12] shoulder? Frozen shoulder is an adhesive [22:14] capsulitis of the shoulder joint. And it [22:18] is very common in menopause. So, [22:22] estrogen has this amazing [22:23] anti-inflammatory effect, especially in [22:26] our bones and joints and muscles. And [22:28] frozen shoulder is super common and it [22:30] takes about 2 years of therapy to get it [22:33] to break up. So, the capsule that is [22:35] right over the bone where the muscles [22:36] attach becomes encapsulated and adhesed [22:40] and stuck. And so, you have to get in [22:42] there and break it up and do lots of [22:43] training. So, like a woman wouldn't be [22:44] able to reach behind her back to do her [22:46] bra. [22:47] She that's one of the things or you go [22:48] to take a picture with your girlfriends [22:50] and you can't [22:51] put your arm or you can't lift your arm [22:53] above here. [22:55] That's one of the one of the studies [22:58] that I, you know, presented. A lot of [22:59] the stuff I do on social, I'll present [23:01] the studies because I like to I like to [23:02] have data. And, you know, I'll get [23:05] 10,000 comments [23:07] on, "Oh my god, that happened to me. [23:08] That happened to me. That happened to [23:09] me." Not that I can fix it [23:12] but at least they know [23:14] this is something that it's not your [23:16] fault. You didn't do anything. Your just [23:18] estrogen levels dropped, which led to [23:20] increasing inflammation in those joints. [23:22] And have they seen that there's a a [23:24] reduction in life span in women that go [23:27] through menopause that aren't treated in [23:28] a certain way? So, we know that, um, [23:31] women on HRT have a lower all cause [23:34] mortality. What's HRT? Hormone [23:36] replacement therapy or menopause hormone [23:38] therapy. So, in the studies that have [23:40] been done, the observational studies and [23:43] in the WHI, women who were on hormones [23:47] um, especially beginning early in their [23:49] menopause. Okay? So, estrogen [23:52] there is a window of opportunity for [23:54] reduction of some of this burden of [23:56] disease and it is very in starting in [23:58] perimenopause or within the first 10 [24:00] years of your menopause. [24:01] That's the sweet spot for being able to [24:04] decrease your risk of diabetes, decrease [24:07] your risk of cardiovascular disease and [24:09] dementia. [24:10] When we go beyond that, we start losing [24:12] those benefits because estrogen is [24:14] better at prevention than cure. [24:17] And so, my my medical school daughter [24:20] was like, "Mom, I'm never going to be [24:22] without estrogen. I'm going to start in [24:23] perimenopause. Like I'm not going to be [24:25] one of those women who's ever off [24:27] estrogen." Of course, she's my daughter [24:28] and listens to me on social media all [24:30] day. So, she's a little biased, but she [24:33] says, "Why why can't we get to that [24:34] point where we have no gaps in our [24:37] estrogen supply? We just support [24:39] starting in perimenopause, you know, [24:41] offer it to all women. Not all women [24:42] will choose it and I support that, but, [24:45] you know, we're not having the [24:45] conversation and they're not being given [24:47] the choice." So, what age would you your [24:50] daughter would you advise her to start [24:52] at [24:53] hormone replacement therapy if she so [24:55] chooses? So, I would say, um, we start [24:58] checking levels and we start looking [25:01] probably in late 30s. Certainly if she [25:02] starts having any symptoms out of the [25:04] normal, you know, she's living her best [25:07] life, you know, doing all the right [25:09] things for her health and all of a [25:10] sudden she's not sleeping well or she's [25:12] having aches and pains or she's [25:13] noticing, you know, changes in her body. [25:15] Most women can tell you [25:17] "Something was wrong. I couldn't put my [25:19] finger on it, but I knew that something [25:21] in something in me had changed and I [25:23] wasn't responding to things the same [25:24] way. You know, their mental health had [25:26] changed or, you know, the way their gut [25:29] had changed, their gut health." You [25:31] know, just just there's barely an organ [25:33] system that's not affected by this. [25:36] I sometimes wonder cuz, you know, [25:37] there's the person going through it and [25:39] then there's those around them. [25:41] And they might know themselves that [25:43] something's wrong, the person that's [25:44] going through perimenopause or [25:45] menopause, but the people around them [25:48] won't understand typically Mhm. what's [25:50] going on with that person. So, they'll [25:51] they might do their old WW thing, that's [25:53] a, you know [25:54] or they might label them something else. [25:56] They might misdiagnose it as another [25:57] man's health predicament. I remember a [26:00] woman in my life who when whose behavior [26:02] changed around this age and I didn't [26:04] know about perimenopause or menopause. [26:06] It's in hindsight now that I look back [26:08] and go, "Oh my god, [26:10] everyone around this person thought they [26:11] had bipolar or something." [26:13] Right. I mean [26:15] it it [26:17] it's probably contributing to divorce [26:19] rates, maybe in a good way. You know, at [26:21] this time [26:22] I I one of the positive things I see [26:24] about menopause is that [26:27] women are [26:29] cutting the things in their life that [26:30] don't make sense anymore. They're not [26:32] putting up with [26:34] you know, as a society we tend to take [26:37] on everyone's burden and um, you know, [26:40] take on the emotional labor in a lot of [26:41] relationships, take on the [26:42] organizational labor. And I see because [26:46] they're struggling so much with just [26:48] staying afloat, they're able to just [26:50] quickly say, "No, I'm not doing this [26:52] anymore. You know, you need to pick up [26:55] whichever relationship they're in. [26:57] You need to pick up your your end of the [26:58] bargain here. You know, I can't do all [27:01] of that organizational labor, the [27:02] emotional labor. And I've I have a [27:05] patient who's a divorce attorney and she [27:06] said, "I really think a significant [27:08] percentage is of this divorce is [27:12] menopause and either they're [27:14] prioritizing what's important to them or [27:17] they're not getting the support that [27:18] they need." [27:19] And [27:21] How can we give them the support that [27:22] they need? So, I think it's important [27:25] that we talk about it. I encourage every [27:27] single patient I have, all my followers [27:30] on social media, tell your story. [27:32] Tell your story to anyone who will [27:34] listen. Tell your daughters. Tell your [27:36] nieces. Tell your sons. Tell your loved [27:38] ones. Like make this a normal part of [27:41] the conversation so that we see it [27:43] coming, we understand what might happen [27:46] and that no one feels crazy and alone [27:48] when they're going through it. [27:50] And then we need to do a much better job [27:52] in our medical system of providing [27:54] support for these women in whatever way [27:56] they need it. Be it hormones, non [27:58] hormones [28:00] cognitive behavioral therapy, you know, [28:02] there's lots of things that we can do. [28:03] Not just hormone therapy is not the cure [28:05] all for everything. We have to support [28:07] the whole toolkit, right? We have to [28:09] prioritize our sleep. [28:11] Get the exercise that we need. Focus on [28:13] strength training when a lot of us in my [28:15] generation never did that. We were [28:16] aerobics, you know, focused on being [28:19] thin and small. It's time to be strong. [28:22] You know, this muscle mass that you have [28:24] is going to determine your longevity and [28:25] your functionality as you age and [28:28] menopause is, you know, that loss of [28:30] estrogen and testosterone is tearing our [28:33] muscle units apart, which is leading to [28:35] osteoporosis as well. I want to go [28:37] through that whole toolkit, um, [28:39] but I also want to just before we move [28:41] there [28:42] understand why women [28:45] don't sometimes communicate that they're [28:48] going through perimenopause or [28:49] menopause. What is the Is there a stigma [28:51] associated with talking about it? Yeah, [28:53] I think there's shame and stigma [28:54] associated with aging, with females [28:57] aging and then you're you're layering on [28:59] this loss of fertility. And in the [29:01] medical field, when you look at funding [29:04] in the US for research studies women's [29:07] health, like I think it's 55 billion in [29:08] the National Institutes of Health in the [29:10] US, you know, for all research studies. [29:12] And that's outside of what pharma is [29:14] funding. And women's health gets about [29:18] 15 billion. And the majority of that is [29:22] spent on getting people pregnant keeping [29:25] them pregnant [29:26] you know, and fertility issues. [29:28] Menopause gets, I think, 15 million. [29:31] Jesus Christ. Yeah. It's like .03% [29:35] if I did the math correctly [29:37] of [29:39] all [29:40] you know, are we not as important as we [29:42] were when we were fertile? Do our lives [29:44] not matter? [29:47] It's ridiculous to me. When we can [29:49] intervene and help and how give these [29:51] women a longer life and a better quality [29:53] of life. And how many women is that? I [29:55] know we said a as a fraction earlier on [29:57] or a percentage, but that's like I think [29:59] in your book I read it's 1.2 billion [30:01] women by the end of this year. [30:03] Yeah. [30:04] And there's what, 47 million new [30:06] entrants [30:07] into this sort of perimenopausal [30:09] postmenopausal [30:11] category every year? [30:13] 1.2 billion. Billion. Right. And how And [30:16] so many of them [30:18] have no education at their fingertips, [30:20] have nowhere to turn, [30:22] are, you know, 85% are going in to their [30:24] health care provider's office [30:25] complaining, "Help me." And being turned [30:28] away and leaving with more questions [30:30] than answers and only 10% are even [30:32] having the discussion for hormone [30:33] replacement therapy. And then if they're [30:35] given it, they're so terrified because [30:37] of the misrepresentation of the Women's [30:38] Health Initiative, they're convinced [30:40] they're going to get cancer. [30:42] And that that study's been completely [30:44] dismantled and walked back. We have good [30:46] information that came out of that study, [30:47] but, you know, the the the the thought [30:50] that estrogen causes breast cancer is [30:52] the worst thing that came out of that [30:54] study because it's not true. [30:57] The mental health implications is what I [30:58] really want to get into the the hormone [31:00] replacement therapy and all that stuff, [31:01] but the mental health implications for [31:03] women. Do we see an increase in [31:06] depression and those and the [31:07] consequences of depression, I guess? [31:09] Depression, anxiety, bipolar, um the [31:12] entire spectrum, ADHD. So, we see either [31:15] a new onset [31:17] or worsening of disease. So, I'm telling [31:20] my patients or I'm telling people on [31:21] social media, you may have done fine and [31:23] done well with your depression on your [31:25] SSRI. Don't be shocked if it is no [31:29] longer working at that level. You either [31:32] have to increase the dose. So, no one [31:34] right now is advocating for primary [31:37] therapy of depression to be estrogen [31:40] replacement, but we do know from the [31:42] studies that it is a very powerful [31:45] adjunctive tool. [31:46] And that it can be preventative for new [31:48] onset depression if you start in [31:49] perimenopause. Women who start hormone [31:51] therapy in perimenopause have a lower [31:53] incidence of new onset depression in [31:55] their menopause. Suicidality? [31:58] So, I've looked at these numbers and [32:01] COVID's kind of skewing things cuz we [32:03] did see increased suicide rates, but we [32:05] definitely see an uptick especially in [32:07] Caucasian women, not so much in women of [32:09] color in the US in the perimenopausal [32:13] menopause time frame. [32:15] Inflammation. Mhm. What is What is [32:17] inflammation? Sure. [32:19] So, inflammation, [32:20] there's there's it's there's chronic [32:23] inflammation and there's acute [32:24] inflammation. So, acute inflammation is [32:26] what we need to survive. [32:28] It is the body's reaction to a foreign [32:31] invader basically or to an injury or an [32:33] illness. So, you twist your ankle, [32:35] right? And so, we injure that tissue, [32:38] these chemical messengers are spread [32:40] from the injured tissue which basically [32:42] tells our immune system, "Send blood [32:44] that way. Send the the, you know, white [32:47] cells and the red cells and you know, [32:48] all the cells that are going to fight [32:49] and heal this. You're going to swell, [32:51] you're going to have pain that's going [32:52] to keep you off of that joint so that it [32:54] can heal, right? So, acute inflammation [32:57] also happens when we get viruses and [32:59] other illnesses. [33:01] Chronic inflammation is this low-grade [33:03] kind of under the radar inflammation [33:05] that's happening in the background. So, [33:06] autoimmune disease is a lot of chronic [33:09] inflammation, but we also see aging [33:12] itself, you know, we can't change the [33:13] fact we're aging, but menopause [33:16] dramatically increases the amount of [33:18] chronic inflammation that a female will [33:21] go through just based on the lack of [33:23] estrogen and testosterone in her body. [33:25] I'm trying to figure out why the lack of [33:26] estrogen [33:28] and the drop in estrogen causes [33:29] inflammation. So, it turns out estrogen [33:31] is a really powerful anti-inflammatory [33:33] hormone. So, we're just like removing [33:35] that protective blanket and now you're [33:37] you're just aging faster because of it. [33:41] Ah, okay. So, we need to make sure that [33:43] we reduce inflammation by any means [33:45] necessary. And that was the sort of the [33:47] one of it was the second component of [33:49] the Galveston diet, anti-inflammatory [33:51] nutrition. If I wanted to have a low [33:53] inflammation diet, you said there about [33:54] the sugar. Is there anything else that [33:56] I've got to be aware of or avoid or [33:58] choose in a supermarket? [33:59] Sure. So, I try to teach the principles [34:02] in the form of let's add things in [34:03] rather than restrict because [34:05] then we get into eating disorders and [34:07] so, what keeping tabs on your added [34:09] sugars, keeping those less than 25, but [34:11] fiber. And that's one thing most people [34:14] are not paying attention to. How much [34:15] fiber are you getting in your diet per [34:16] day? And most women are getting about 12 [34:19] g per day and the minimum we should be [34:22] getting is 25. Vitamin D is another huge [34:26] one. About 85% of my patients and women [34:28] in menopause are vitamin D deficient, [34:30] not just low, I mean deficient. We are [34:33] protecting our skin against sun damage, [34:35] of course. We're staying indoors more, [34:37] we're on our screens all the time, but [34:39] we're also our gut's changing and our [34:40] ability to absorb vitamin D is [34:42] decreasing. So, making sure that you are [34:45] checking your vitamin D levels regularly [34:47] and supplementing when you need to or [34:48] eating foods rich in vitamin D. That's [34:50] another one. And does vitamin D reduce [34:52] inflammation? Yes. Okay. So, vitamin D [34:54] is a it's a it's a vitamin, but it's [34:56] also a hormone and it has multiple [34:58] functions in the body. And so, vitamin D [35:00] deficiencies are linked to lots of [35:02] chronic diseases. You're more likely to [35:04] have hypertension, diabetes, stroke, you [35:06] know, all of the top seven of 10 causes [35:08] of death in women. And so, keeping those [35:12] low it's also mental health, you know, [35:14] it lots of vitamin D receptors in the [35:15] brain. And so, you know, first thing I [35:18] do is check a vitamin D level on my [35:19] patients when they come in. So, many of [35:21] my nutrition-based or medical or doctors [35:24] that I've spoken to on this show have [35:26] spoken about fiber especially in the [35:27] last like 6 months. [35:29] You know, people [35:30] historically speak a lot about protein [35:32] and all these kinds of things, but for [35:33] some reason everyone seems to be talking [35:35] about fiber all of a sudden. [35:37] So, fiber does lots of things for us. It [35:39] slows down the absorption of glucose [35:43] into the bloodstream. Ah. So, that keeps [35:45] our insulin levels lower over time. [35:48] It feeds our gut microbiome, soluble [35:49] fiber. So, there's two types of fiber. [35:51] There's soluble and insoluble. So, [35:52] insoluble is what kind of when you mix [35:54] up a fiber supplement, you see the stuff [35:56] precipitate down to the bottom. That's [35:58] the insoluble fiber. That's what pulls [35:59] water into the gut and kind of moves [36:01] things quicker through the colon. [36:03] Soluble fiber dissolves in water. That's [36:05] the cloudy part. That is the food for [36:07] our gut microbiome. That is the [36:09] prebiotic. You don't need a prebiotic if [36:11] you're getting enough fiber in your diet [36:14] per day. [36:15] And so, keeping that gut microbiome fed [36:17] and healthy and happy is going to do a [36:19] multitude of things. Like that kind of [36:21] data is exploding right now in the [36:22] research world as to where the gut [36:25] microbiome, how to keep it healthy and [36:27] what organ system it affects. [36:29] Um our our gut microbes make these [36:31] things called oxybutyrates which are [36:33] then absorbed into the bloodstream and [36:35] and people who have high levels of [36:36] oxybutyrates are actually healthier and [36:38] have less coronary artery disease, less [36:40] dementia, less less everything. So, it [36:42] really nutrition, when I talk about the [36:44] menopause toolkit, [36:46] hormone therapy is just one very small [36:48] part of the puzzle, but nutrition should [36:50] always be first. Like it doesn't matter [36:52] how many hormones you take if you're not [36:53] covering your your nutritional bases the [36:55] way you should. [36:56] And what are some sort of fiber-dense or [36:58] fiber-rich foods that are in, you know, [37:01] every supermarket? Avocado, [37:04] chia seeds, nuts, berries, [37:07] your cruciferous vegetables, things that [37:09] are crunchy, that's fiber. That's making [37:10] the crunch. Apples, you know, um there's [37:13] so many. Don't find much fiber in uh [37:16] lean meats or any. So, it's going to be [37:19] your fruits and veggies [37:20] and seeds and nuts. Asparagus, tomato, [37:22] spinach, celery. Uh asparagus, celery, [37:25] yes. Tomato, not so much. Just think of [37:28] things that, you know, the crunch is [37:29] usually from the fiber. Mhm. Okay. [37:32] Fasting. Mhm. [37:35] I'm a fan. It's not for everyone. [37:37] It's not a great way to lose weight. The [37:38] data on weight loss is conflicting at [37:41] best. You can eat a lot of things that [37:44] will undo the goodness of fasting in [37:45] your eating window if you're not [37:46] careful. [37:47] And so, [37:49] um [37:50] the there's good data though on [37:52] neuroinflammation and fasting and on [37:54] systemic inflammation and fasting. So, I [37:57] recommend fasting for the systemic [37:58] inflammatory benefits. And we do see [38:01] some really nice lowering of insulin [38:03] levels overall from fasting. [38:06] There's so many different types of [38:07] fasting people talk about. [38:09] So, when I'm teaching fasting to my [38:11] students or to my patients, I recommend [38:14] the 16:8. So, that's where Mark [38:16] Mattson's data. So, that's 16 hours of [38:18] fasting in a row followed by about an [38:20] 8-hour eating window. Now, for other, [38:23] you know, again, it's individualized. [38:25] Some people do great with a 14-hour [38:27] fast, you know, the 15-hour fast. 16 is [38:29] just kind of something to shoot for. And [38:31] if someone's going to consider [38:33] incorporating fasting into their life, [38:34] give yourself about a 6-week [38:37] trial, you know, don't just try to go 16 [38:40] hours without food if you've never done [38:41] it before. Your body will adapt. And so, [38:44] the advice I got and what I do and what [38:46] I teach now, [38:48] so, I used to break my fast about 6:00 [38:49] in the morning before I exercised. So, I [38:51] pushed that window to 6:15 and I did [38:53] that for, you know, three or four days [38:55] until it felt normal, natural, I wasn't [38:57] hungry. Then I moved it to 6:30 and then [38:59] I just kept bumping that window out in [39:01] 15-minute increments [39:03] over weeks and by week five, I remember [39:05] sitting at my desk and I have my lunch [39:07] ready to go and I was still at the [39:09] hospital at the time and saying, "Oh my [39:11] god, I made it. It's noon and I don't [39:13] feel bad, you know, like So, I had just [39:16] slowly slowly let my body adapt and [39:18] adjust and then I've been fasting, gosh, [39:20] since 2015, probably 2014. [39:23] And [39:25] and it's just a normal natural part of [39:26] my life. I don't even think about it [39:28] anymore. Have you noticed any effects of [39:30] that? You know, I do so many things. [39:32] Yes, it's hard to tell. And so, it's [39:33] hard to tell, but initially, I do find [39:36] when I'm fasting, the clarity of my [39:38] thought is much better. I get much more [39:40] work done. It's when I do my best [39:41] research. It's when I do my best [39:43] communicating with my followers is in [39:45] the morning. You'll often if you follow [39:46] me on social, I'm always in my pajamas [39:48] with a cup of coffee um before while I'm [39:50] getting ready for work cuz I just get so [39:51] excited about something I learn and I [39:53] want to share it with everyone. And so I [39:55] do find that once I break my fast the [39:57] synapses tend to not work as quickly for [39:59] me. I was thinking about this through [40:01] like an evolutionary lens why fasting [40:04] makes sense and why this sort of [40:05] narrative that we're meant to have [40:07] breakfast, lunch, and dinner. You know, [40:09] maybe breakfast at That's a social [40:10] construct. There's really not great [40:13] science. Now, there are humans that will [40:15] do better by eating more meals more [40:17] frequently and that's why I say [40:18] fasting's not for everyone especially if [40:20] it triggers an eating disorder. If you [40:22] have diabetes or you have, you know, [40:24] hypoglycemia, fasting may not be for you [40:26] but most people can do it successfully. [40:28] And so I really encourage people to [40:29] experiment with it and see how they do. [40:31] I was wondering if I was trying to think [40:33] through like an evolutionary framework [40:35] and I was thinking about how in our [40:37] hunter-gatherer past [40:39] Mhm. [40:39] we would have Meals were not available [40:41] 24/7. [40:42] Yeah. And we would have needed like a [40:43] really focused brain to go out on the [40:45] hunt. So this explains why when we're [40:47] like hungry our brain's working better. [40:49] It almost seems like there's more I [40:51] don't know oxygen or nutrients in the [40:53] brain. [40:54] tends to work better using the ketones [40:56] for fuel than uh glucose. So the glucose [40:59] is the preferred fuel in the body, you [41:01] know. And um but but when they did [41:04] studies, they were animal studies so [41:05] take this with a grain of salt but you [41:07] know, when they did the mazes, you know, [41:09] the animals tended to get through the [41:11] maze quicker and learn quicker when they [41:13] were fasted rather than after they were [41:14] fed. They're a little lazier. [41:17] Ketones you can also use ketones as an [41:19] energy source if you use the keto diet. [41:20] You can. You can. Um but I think, you [41:23] know, [41:24] when Mattson and and that those [41:27] researchers were doing their work their [41:29] research in Alzheimer's and dementia, [41:31] you know, there was no keto diet. They [41:33] were just knowing that people were [41:35] utilizing ketones for fuel which is a [41:37] normal natural process. We sleep. And so [41:39] we burn through the glucose in our [41:40] bloodstream then we burn up what's in [41:42] our liver in the you know, [41:43] gluconeogenesis and then it switches to [41:46] fat to burn for fuel. [41:48] And so um now there's people who like to [41:51] take exogenous ketones. I've I've never [41:53] experimented with that. I don't, you [41:55] know, that's I don't have any literature [41:56] menopause to support that use. [41:58] And the third component of the Galveston [42:00] diet is this idea of fuel refocus. [42:03] Right. So that's looking at, you know, [42:07] food [42:08] uh we're looking at the macro and [42:09] micronutrients. So I'm really going hard [42:12] on fiber and vitamin D and magnesium and [42:14] things that we tend to as a gender be [42:18] deficient in especially with menopause. [42:20] So I'm really trying to highlight those [42:22] things to make sure instead of counting [42:24] calories, let's see how much vitamin D [42:26] you're getting every day. Let's see how [42:27] much fiber you're getting every day. [42:29] And is there a certain sort of ratio of [42:31] foods that we should be having in terms [42:33] of So I originally developed Galveston [42:35] diet for weight loss, you know, um [42:39] but if I had to write it over again. So [42:40] I went really heavy on fats, you know, [42:42] healthy fats, lower on carbohydrates and [42:45] 20% protein. Um but I think if, you [42:49] know, doing it again the way I'm [42:51] counseling my patients now is I'm going [42:53] much higher on protein. What I've [42:55] learned since that book was written was [42:58] how important protein intake is to [43:00] maintaining muscle mass. I'm also [43:02] talking a lot about creatine. Um and and [43:05] there's some nice studies done in in the [43:07] we call it the elderly 65-year-olds and [43:11] and above I'm 9 years from that right [43:13] now and so and how creatine [43:15] supplementation just creatine [43:17] supplementation on its own well combined [43:19] with weight lifting we're seeing bigger [43:20] gains in the menopausal patient. [43:23] Postmenopausal patient, yeah. [43:24] Bigger gains in muscle [43:26] Bigger muscle mass and strength. Yeah, I [43:28] was going to ask you about this whole [43:29] muscle mass um point. Why is muscle mass [43:31] so sort of pertinent to this [43:32] conversation? So what we're Well, what [43:33] we know in menopause is that, you know, [43:36] aging combined with menopause we see a [43:38] dramatic loss of muscle mass with the [43:42] menopause process. And so in that first [43:45] 10 years of menopause we could lose up [43:46] to 10 sometimes 15% of our muscle mass. [43:50] And that muscle mass is going to [43:51] determine your resistance to sugars. So [43:54] your insulin resistance is really tied [43:56] to your muscle mass. Your functionality, [43:59] your ability to recover from a fall. Um [44:02] and the other thing is what most people [44:04] don't understand is the musculoskeletal [44:06] unit acts as one. [44:08] So when we have low muscle mass, you are [44:10] dramatically increasing your risk of [44:12] osteoporosis. Now right now, this might [44:14] shock you but 50% [44:17] of females [44:18] will have an osteoporotic fracture [44:20] before they die. [44:21] And this is almost completely [44:23] preventable. [44:25] What is an osteopathic fracture? [44:28] is when we lose the density of our bones [44:32] through So estrogen So all of our life [44:34] we remodel our bones, right? We chew up [44:36] bone and we lay down new bone. And so we [44:39] reach our maximum bone density as [44:40] females at about age 35 and then it [44:43] slowly starts to decline through the [44:45] aging process. And then when we get to [44:46] menopause, it dramatically we see a just [44:50] massive loss of bone. [44:52] So this loss of bone makes the bone [44:54] weaker and much more likely to fracture [44:57] when it when we fall. And so [45:00] if you fall and break your hip [45:03] in menopause [45:06] 30% of women with surgery will die in [45:09] the first year. [45:11] 70% will die without surgery. [45:14] And that year is marked by horrific pain [45:19] and not being able to move and just [45:21] really really miserable people. And so [45:24] and so much of this is preventable. [45:27] Going on hormone therapy, getting [45:29] adequate exercise, doing the resistance [45:31] training, eating the protein, adding in [45:32] the creatine, making sure you're getting [45:34] enough vitamin D is going to be huge at [45:36] protecting our my population from this [45:39] happening as we age. We can prevent the [45:41] majority of this. [45:43] I want to talk specifically then about [45:44] this hormone replacement therapy you [45:45] mentioned there. There's you also [45:47] referenced the study previously which [45:49] sort of scared people. Yes, the Women's [45:51] Health Initiative, yeah. [45:54] And that study suggested that there was [45:56] an increase in breast cancer if someone [45:58] did hormone replacement therapy. [46:00] So let's break it down. Um originally [46:01] the study was designed to see if we knew [46:03] it from observational studies was [46:06] hormone replacement therapy going to [46:08] truly be protective for cardiovascular [46:10] disease. That was the function of the [46:11] study [46:12] in women who took it versus women who [46:14] did not. We knew from observational [46:15] studies that yes, they had a much lower [46:17] risk of death from cardiovascular [46:19] disease and and all cause mortality as [46:22] meaning death from any cause as well as [46:25] um heart disease in itself. Okay, [46:27] atherosclerotic heart disease. [46:29] So [46:31] but that's observational. The way to [46:33] prove these things is to do a randomized [46:35] controlled study versus placebo. So [46:38] finally finally This is 1998. Women were [46:41] getting money. Like there was a new [46:43] female head of the National Institutes [46:44] of Health. They were funding this study. [46:47] This was so exciting. Women were lining [46:48] up in droves to sign up for it but [46:50] because the end game was to prove [46:53] whether or not it was protective for for [46:54] cardiovascular disease, the average age [46:57] of the patient was 63 years old. [47:00] So that they could see if it was going [47:02] to affect heart disease because women [47:03] tend to get that in their 60s and 70s, [47:05] right? [47:07] So [47:08] they recruit, they develop develop two [47:10] groups. We have women with uteruses and [47:12] women without women who had had [47:13] hysterectomies or were born without [47:15] uteruses. And so each of them had a [47:17] placebo arm and then a medication arm. [47:19] When you don't have a uterus, you don't [47:22] absolutely have to have progesterone. [47:24] When you have a uterus, it's required to [47:26] give a woman progesterone as well or [47:28] progestin as well to protect the lining [47:31] of the uterus from the estrogen. [47:33] Unopposed estrogen can cause endometrial [47:35] cancer but we can negate that by giving [47:37] her progesterone. You following me? So [47:39] we have an estrogen only arm and an [47:42] estrogen and progesterone arm and they [47:43] each have a placebo. So off we go. Let's [47:45] take our meds. Let's take our placebo [47:47] and let's start measuring. [47:49] What they saw in the estrogen plus [47:51] progesterone arm after 2 years was a [47:53] very slight increased risk of breast [47:56] cancer versus placebo. [47:59] Now, you have to understand there's a [48:00] difference between absolute risk and [48:03] relative risk. [48:05] So the relative risk went from So the [48:07] absolute risk went from four out of a [48:09] thousand women per year [48:11] to five out of a thousand women per [48:13] year. So one out of a thousand women [48:15] treated in the estrogen and progestin [48:17] arm [48:18] developed breast cancer where over [48:20] placebo. [48:21] That is a 25% relative risk increase. [48:25] Mhm. And that is the that is the [48:27] statistic that set the world on fire. [48:30] So the researchers held a huge press [48:32] conference at the Watergate Hotel in DC. [48:36] Every major news outlet with This is [48:37] before the internet and and announced [48:40] that estrogen causes breast cancer. Now [48:42] remember, these women were on estrogen [48:44] plus the progestin which is called [48:45] Provera. [48:47] The estrogen only arm continued for a [48:49] few more years because the women on [48:51] estrogen only not only did they not see [48:54] an increased risk of breast cancer, they [48:55] had a I think it was a 20% decreased [48:58] risk of breast cancer. Relative? Re of [49:01] Yeah, relative risk. And the relative [49:04] mortality went down 40%. So and we think [49:08] it's because estrogen feeds a breast [49:11] cancer cell but it doesn't cause breast [49:13] cancer. We are highest levels of [49:15] estrogen are in pregnancy and it's so [49:17] rare to ever be diagnosed with breast [49:19] cancer. And a healthy breast cell has [49:21] estrogen receptors and all that estrogen [49:23] receptor positive means is that that [49:24] breast cancer cell went from healthy to [49:26] cancer through a mutation but retained [49:29] its estrogen receptors. And so we can [49:31] use those receptors against the cancer [49:33] cell to treat the breast cancer. So that [49:37] study has been walked back. Multiple [49:38] studies have been done, but like the the [49:41] whole mindset has not changed. Myself, [49:44] as an OB/GYN, was still the lowest dose [49:48] for the shortest amount of time and only [49:49] in women where absolutely nothing else [49:51] is helping her hot flashes. Menopause [49:53] was defined by the vasomotor symptoms. [49:56] That's it. [49:58] You know, vaginal estrogen, which is [50:00] just putting estrogen locally in the [50:02] vagina. So, one of the biggest things we [50:04] see in a huge amount of patients, like [50:06] well over 50%, is something we call [50:08] genital urinary syndrome of menopause. [50:11] And it is the bladder, the vagina, and [50:14] all of the tissue in between all has a [50:16] lot of estrogen receptors. And we take [50:18] the estrogen away, that tissue becomes [50:20] very thin, we lose elasticity, we see [50:23] recurrent urinary tract infections. The [50:26] most likely treatment to help a woman in [50:30] menopause with recurrent urinary tract [50:32] infections, which is a major cause of [50:34] death for women, [50:35] is vaginal estrogen. And it's safe for [50:37] everyone, even with breast cancer. And [50:39] so, even that option is taken off the [50:41] table for so many women who are [50:43] suffering needlessly with horrible, [50:45] painful intercourse, [50:47] dryness, you know, recurrent UTIs. And [50:50] it's just such a simple thing to help a [50:52] woman and fix, and they're not being [50:54] offered that treatment. Is vaginal [50:56] estrogen the only form of administering [50:58] estrogen? So, we have No. So, when we [51:01] look at hormone replacement therapy, we [51:03] have [51:04] oral and non-oral medication. We have [51:05] like steroids is a good way to think of [51:07] it. So, say you have a rash and you go [51:09] to your pharmacy and you pick up a you [51:11] know, cortisone cream. That's That's [51:13] local therapy, right? So, vaginal [51:15] estrogen cream, there's pills, there's [51:17] there's different ways to put it in the [51:18] vagina, but that's considered local [51:20] therapy. It's not absorbed systemically. [51:22] We're just treating it kind of at the [51:23] moment. Systemic therapy is when it's [51:26] treating everything, our brains, our [51:28] bones, our genitourinary, so you know, [51:30] from the inside out. And so, you can [51:32] adjust it. There's creams, there's [51:34] patches, there's rings, there's pellets [51:36] that are now available. There's multiple [51:38] ways to get this medication into your [51:40] body. [51:42] And what's the most popular form of [51:45] administering administering [51:47] hormone replacement therapy? [51:48] So, it depends on the country. So, in [51:49] the UK, it tends to be a gel or a cream, [51:52] which is where most GPs, if you can get [51:55] one that will follow the guidelines and [51:56] prescribe it. I think it's the most [51:58] easiest pharmacologic option to get in [52:00] the UK. In the US, it tends to be the [52:03] patch for the non-oral form. We also [52:05] have pills available as well. There's a [52:07] caveat with estrogen pills. There's [52:09] something whenever we ingest anything, [52:11] food, medication, goes into our stomach, [52:13] into the intestines, and then it gets [52:15] picked up by the portal hepatic [52:17] circulation, the liver. And so, the the [52:19] portal vein goes straight to the liver [52:21] for processing. And when that bump of [52:23] estrogen or testosterone, typically, [52:25] hits the liver, we see some problems [52:27] with And for for testosterone, it's [52:29] liver toxicity, and for estrogen, we see [52:31] bumps in our clotting factor. And so, [52:33] you'll see a lot of women who are [52:34] terrified of hormone therapy because of [52:36] this potential risk of blood clots. They [52:38] either have a genetic risk of blood [52:40] clots, or a gene, or they've had a clot [52:42] in the past. But if they avoid oral [52:44] estrogen and go with a non-oral form, [52:46] like the patch or the ring or or even a [52:48] pellet, then we bypass the liver, and we [52:51] don't have the increased risk of [52:52] clotting. [52:53] Are there any other side effects? You [52:54] know, in life, there's no such thing as [52:55] Of course. [52:56] free lunch. [52:57] And so, um [52:59] it [53:01] estrogen, so we have to look at each. [53:03] So, when we look at hormone replacement [53:04] therapy, we have our estrogens, we have [53:06] our androgens, which would be [53:07] testosterone, [53:09] DHEA, and androstenedione, and then we [53:12] have our progesterone, which is uh the [53:14] bioidentical form progesterone. There [53:16] are synthetic progestins available, but [53:18] I tend to just prescribe the [53:19] progesterone. And so, each of them has [53:21] issues that may happen. So, with [53:23] estrogen, [53:24] you can see headaches. So, that's kind [53:26] of a red flag for us. We worry. We can [53:29] see migraines getting worse, so those [53:31] are patients you have to be really [53:32] careful with going low dose. Um you can [53:35] see unexplained So, 40% of patients on [53:38] menopausal hormone therapy will have [53:41] vaginal bleeding. [53:42] Doesn't mean it's a period. We have not [53:44] woken your ovaries up, they're gone. We [53:46] are just stimulating that tissue um in [53:48] the lining of the uterus, and it's [53:49] bleeding a little bit. It's usually [53:51] self-limited. It can go away on its own. [53:53] If it persists past several months, [53:54] we'll get ultrasounds to make sure we're [53:56] not missing a polyp or something there. [53:58] But um it's it's one of the things I [53:59] warn my patients about. So, things I [54:02] worry about, you know, headaches, some [54:04] women, depending on the formulation. So, [54:05] for the patch, it has an adhesive, [54:07] right, to get it to stick to your skin. [54:09] And there's a probably 10% of women will [54:11] have some kind of an allergic reaction [54:13] to the adhesive. So, then we have to [54:14] look for alternative forms. So, [54:16] thankfully, there are multiple forms on [54:18] the market. And for patients, we have to [54:21] do some trial and error to find out not [54:23] only which formulation's going to work [54:24] best for her, but also what dosing is [54:26] going to work best for her. So, if I was [54:28] a menopausal woman and I came to you and [54:30] I said, I need help. You get I mean, you [54:32] must get thousands of messages like [54:33] that. [54:34] Thousands of messages a week, probably. [54:36] And you know, [54:37] I walked into your practice, where would [54:40] you start with me? So, I start by [54:43] letting you tell your story. I tell my [54:45] story, and it's a typical story that you [54:47] hear. [54:47] Right. Yeah. What happens next? [54:49] Symptoms. So, I will we'll get blood [54:51] work. Sometimes I'm getting hormones to [54:53] see if if I'm not clear where she is in [54:56] her journey, I may get blood work to [54:57] help me define if she's peri- or [54:59] postmenopausal, especially if she's had [55:01] a hysterectomy. [55:02] Um I'll get a lot of blood work around [55:05] checking her thyroid. A lot of things [55:06] look like menopause, right? So, you [55:09] know, fatigue and night sweats, that [55:11] might be hypothyroidism. Weight gain, [55:13] hypothyroidism. Autoimmune disease, all [55:15] this rheumatoid arthritis. I want to [55:17] make sure I'm not missing something else [55:19] that looks a lot like perimenopause. So, [55:21] I'm doing blood work around that. [55:22] Nutrition deficiencies, vitamin D, [55:24] her basic labs for her blood count and [55:26] her electrolytes. I'm I'm doing this [55:28] full panel, okay? [55:30] But then I'm beginning to treat [55:31] immediately. And so, we have a [55:33] discussion around her sexual wellness. [55:35] Is she struggling with desire? Then [55:38] we'll have a discussion around [55:39] testosterone. Um [55:41] So, I'm struggling. I've got my desire's [55:42] gone. Okay. So, it's very common. So, [55:45] when we talk about female sexual [55:47] function, there's kind of five buckets [55:48] why a woman would be suffering or not [55:50] happy, okay? One is a relationship [55:52] disorder, and no amount of medication [55:54] really helps with that. So, we want to [55:56] make sure she's in a good place with her [55:57] relationship, supportive partner, all [55:58] that. So, we we have a discussion about [56:00] that. Then there's an arousal disorder, [56:02] where that's what most men are treated [56:05] for when they talk about libido issues. [56:06] It's really nothing's wrong here. [56:09] They're struggling to maintain an [56:10] erection. And so, we use Viagra and [56:12] those type of medications for that. For [56:14] So, if a woman has an arousal disorder, [56:16] vaginal Viagra can be helpful for that. [56:18] So, we we talk about that. We talk about [56:20] orgasmic disorders. Some women have [56:22] About 10% of women will never have an [56:25] orgasm in their life. [56:27] Imagine if that was 10% of men. I think [56:29] it would be a national emergency. I [56:31] think there would be, you know, [56:33] we would divert military funding in the [56:34] US to get this fixed. And it's just [56:37] something we don't talk about or offer [56:38] much help. And so, then that leaves [56:41] desire. So, most women who are in secure [56:43] relationships, love their partner, miss [56:46] that part of the intimacy that they used [56:47] to have, that desire to initiate, that [56:49] desire, yes, this seems like a good [56:51] idea. That goes away with menopause a [56:53] lot. And so, for those women, [56:55] testosterone might be helpful, or [56:57] there's a couple of FDA-approved [56:58] medications as well, Addyi and Vyleesi. [57:00] And so, we have talked about costs and, [57:03] you know, how to get it prescribed. And, [57:05] you know, testosterone, there's no [57:07] FDA-approved option for women. So, quite [57:09] often I will have to compound that [57:11] medication for them at a local [57:13] compounding pharmacy versus going to [57:16] Duane Reade or a CVS or a Walgreens to [57:18] pick it up using their insurance. [57:20] So, I know that you that you're coming [57:22] from the UK, our health systems, you [57:23] know, are a little bit different. But [57:25] because my reach is so large now, I try [57:26] to include, you know, all the different [57:28] health systems when I'm talking about [57:30] your options. Give me a case study of a [57:33] patient that walked into your door and [57:35] Gosh, you know, I have Okay, I had a a [57:38] patient who [57:40] came in [57:41] and [57:42] uh [57:43] her name is Michael. [57:45] And she didn't mind me saying it cuz [57:47] we're really good friends. And she came [57:50] in and typical, overweight, not [57:53] sleeping, some brain fog issues, some [57:56] major joints aching, aches and pains, [57:59] all the things. [58:00] And um [58:02] sweetest woman, absolutely adored her [58:04] husband, you know, like um but was [58:07] struggling with desire as well. So, we [58:09] started her, you know, I developed a [58:11] nutrition plan for her. She hired a [58:13] personal trainer. She got to the gym. [58:16] She got serious about, you know, [58:17] lifting. [58:18] Um she started on hormone therapy, and [58:21] she is my biggest cheerleader, you know, [58:23] on social because she's constantly She's [58:25] lost probably about 60 lbs of body fat [58:28] cuz we get to measure her. So, in my [58:30] clinic, I have a in-body scanner where I [58:32] can measure muscle mass and visceral [58:34] fat. So, it's not just the number on the [58:35] scale. I'm able to tell them. So, she's [58:37] probably gained maybe 10 lbs of muscle, [58:41] lost a tremendous amount of fat. She [58:43] feels amazing. She has this beautiful, [58:46] you know, she's back to her intimacy [58:48] level that she desired so much before. [58:50] She is absolutely thriving on all [58:52] aspects, and she's constantly sharing [58:54] her studies her her story online so that [58:56] other women can learn that they don't [58:58] have to suffer as well. And she just [59:00] can't believe [59:01] the thing that makes her angry is that [59:03] she [59:04] didn't come sooner, and that she [59:06] suffered for so long without looking for [59:10] help. And she couldn't find it. She came [59:11] from San Antonio, which is about a 3 and [59:13] 1/2 hour drive to come and see me. [59:15] So, here's the scary thing for me, or [59:17] it's honorable. I have patients, so I [59:19] have this menopause clinic I started 2 [59:20] years ago. And I have a waiting list [59:23] that's longer than this wall. And women [59:26] are flying in regularly to come and see [59:28] me, which is such an honor, and I'm so [59:30] grateful that they trust me. But it's [59:32] ridiculous that they can't find [59:34] menopause care [59:36] in their backyard. You know, that they [59:38] have to get on a plane to come and see [59:40] me because they cannot find care [59:42] wherever they are. So, I've started a a [59:45] a list of providers on my website that [59:47] my followers recommend where they found [59:49] good menopause care. They write a [59:50] testimonial and we just compile them and [59:52] we just look online to make sure it's a [59:54] real doctor and they have a phone number [59:55] that works. You know, um and then the [59:57] the North American Menopause Society, [59:58] now called NAMS, um now called The [60:01] Menopause Society, they rebranded, has a [60:03] list of certified providers on their [60:04] website as well. [60:06] I got an email sent to me after [60:08] listening to one of the episodes on this [60:09] podcast from what appears to be a very [60:12] helpless husband. It was a very very [60:14] very long email and they'd said that one [60:16] of the conversations we'd had on this [60:17] podcast about menopause at one point had [60:20] really helped them, but the key question [60:22] that remained for that person was [60:24] when does a supporting partner [60:28] know how and really at what point to [60:31] help? Because, you know, [60:33] no male partner wants to turn around to [60:35] their wife and go, "I think you've got [60:36] menopause." and starts diagnosing them. [60:39] But they also don't want to just sit [60:40] back and be quiet. [60:42] I think [60:45] you [60:47] it's usually begins with something you [60:50] can't quite put your finger on. [60:52] She's reacting differently. She's not as [60:55] resilient as she used to be. She's not [60:59] managing situations the same way. And [61:04] I think once we start taking the shame [61:07] and the stigma out, him suggesting that [61:09] perhaps this is menopause will not cause [61:12] her to fly off the handle. I think, you [61:16] know, normalizing this conversation, [61:17] removing the stigma, it might make [61:20] everyone go, "Oh, I mean, I didn't [61:22] realize it in myself." You know, I [61:24] thought it was grief related and and I [61:27] was like, "Wait, when was my last [61:28] period? [61:29] When was my last period?" [61:31] Uh [61:32] Oh. [61:33] I think I'm in menopause. I mean, I was [61:34] And then I was like, "Oh god, [61:36] menopause." You know, even for myself it [61:38] was such a negative connotation. I had [61:41] that Sex and the City episode in my head [61:42] when Samantha thought she was in [61:43] menopause and how horrible it was for [61:45] her and then [61:47] it turns out she wasn't and everything [61:48] was better again and I'm like, "Gosh, is [61:51] this [61:52] You know, first of all, I applaud him [61:54] for wanting to try to do something [61:56] because so many, you think women don't [61:59] understand what's going on. And so, [62:03] uh one bravo for wanting to be helpful. [62:05] Two, [62:06] say it with love. Say it gently. Let's [62:09] and then find a provider or find a [62:12] healthcare provider to go in and start [62:15] the conversation. And I one of my best [62:17] my best visits with my patients are when [62:19] their partners come. [62:21] And that the conversation is held [62:23] together. [62:24] And it really opens their minds, you [62:27] know, to what's going on in her body and [62:28] helps understand like what we can do [62:30] therapeutically, what needs to be done [62:32] at home. This is a special time for her. [62:34] She's going to need extra help. We're [62:36] going to get through this. You know, it [62:37] doesn't have to destroy your sexual life [62:40] or your relationship or whatever. It [62:42] definitely can take a toll if left [62:43] untreated. But you know, bless him for [62:47] doing it. Like we talked about a little [62:48] bit earlier, you know, there's probably [62:51] a fair amount of dissolutions of [62:52] relationships because no one's talking [62:55] about this process and what it could do [62:57] to someone. [62:58] This might be a really stupid question. [63:00] Um but I'm no [63:03] I'm no uh I don't ask a lot of stupid [63:04] questions. [63:06] Do men go through anything like this? [63:09] So, there's a lot of debate about [63:10] menopause. Um [63:12] the short answer is not really. [63:15] We see [63:17] men's testosterone levels peak at about [63:19] age 19 or so or there and then this very [63:22] slow kind of down tick until they [63:25] stabilize at about age 35 to 40 and then [63:28] they stay stable for the rest of their [63:29] lives. But there's a difference between [63:33] in there's a big variation from man to [63:35] man [63:36] where the curve the shape of the curve [63:38] looks the same. [63:39] But as far as [63:41] normal men's range is from 236 to about [63:44] a thousand. So, there's a big, you know, [63:47] man to man variation. [63:49] And there is a lot of men who are [63:52] supplementing when they come in on the [63:53] low end and they're feeling a lot [63:55] better. Now, this is not my area of [63:57] expertise. This is not, you know, I just [64:00] read a lot of this research, you know, [64:02] on testosterone and men are included in [64:03] it and so they are finding that they are [64:06] having better cognition, feeling better, [64:08] having more energy, etc. [64:11] But there is no manopause. [64:13] Their testicles don't stop working. I [64:15] mean, it would be as if your testicles [64:18] shriveled up and died at 51. That's the [64:20] equivalent. [64:23] Gosh. [64:27] I do have to say [64:29] at the start of this conversation when [64:30] you said if that was happening to men [64:34] the reaction would be different. I have [64:36] to say I think I agree. [64:39] I think that because it's one side of [64:41] the population, I think it's kind of [64:43] been overlooked over the last 10, 20, 30 [64:45] years. Mhm. Um but if it was [64:48] And men or both genders, I think it [64:49] would be a different response. And so [64:51] much [64:52] of what women were going through in [64:54] menopause were dismissed as [64:55] psychological. [64:57] Mhm. [64:59] And I really had multiple times in their [65:01] life, you know, it's all in her head. We [65:03] never said it's all in his head. That's [65:05] not a thing on the wards. You know, it's [65:07] all in her head was very much alive and [65:09] well in my training and a long a lot of [65:12] my practice. I I find myself now [65:14] even having to pull myself back a little [65:16] bit just because that was ingrained so [65:18] much to always look for the [65:19] psychological reason. I mean, women A [65:20] woman right now in 2023 is more likely [65:23] to be prescribed an antidepressant for [65:26] her menopause [65:27] than [65:28] hormone therapy. [65:32] Multiple reasons for that. The way we [65:33] were trained, the way we were taught to [65:35] to approach a woman's medical issues and [65:38] also the fear uh unfounded fear around [65:41] the Women's Health Initiative and what [65:42] it did to [65:43] you know, physicians feeling confident [65:44] about prescribing hormone therapy. [65:47] Is there anything else that you do on a [65:48] day-to-day basis in your life that um [65:52] you we haven't talked about yet? Is [65:54] there any sort of apps or tools [65:57] I really like Headspace. I know there's [65:59] some good meditation apps. I really [66:01] thought meditation was woo-woo and [66:04] not [66:07] anything that, you know, I I would just [66:09] sit there and and my brain would be [66:11] bouncing all over the place. But once I [66:13] went through menopause and suffered so [66:15] horribly from the mental [66:18] side effects and the death, you know, [66:19] all of this happening at once uh to me [66:22] with my brother's death, aging parents, [66:23] teenage girls in the house, you know, [66:26] and realized something's got to give. [66:28] And so, I hired like a counselor, you [66:30] know, I went to therapy. And she [66:33] recommended um [66:35] getting an app to help guide me through [66:37] meditation and that has really turned [66:39] the needle for me. Really? Yeah. How? [66:42] I you know, carving out that it's just 5 [66:44] or 10 minutes in the morning to [66:48] think of what I'm grateful for, focus on [66:50] that gratitude, you know, and I love [66:53] teaching that to patients and to my [66:54] followers of of really putting yourself [66:57] first, you know, the thought of you have [66:58] to put your own oxygen mask on first [67:00] before you can go take care of your [67:02] family and all the other things on your [67:03] plate. [67:04] And just [67:06] giving my brain that time to just relax [67:08] and let it flow and just let the [67:10] thoughts, you know, [67:12] and just focus on on me for that. That's [67:16] really made a huge difference for me. [67:18] What role does sleep play in all of [67:19] this? [67:20] So, sleep disruption is massive massive [67:23] massive in perimenopause and menopause. [67:26] And [67:27] when we don't sleep we see everything. I [67:31] I tell patients if you're not That's the [67:33] thing we need to work on first. We need [67:35] to get you sleeping because nothing's [67:36] going to work until your body is able to [67:38] restore itself. That's when we That's [67:40] when we build muscle. That's when, you [67:43] know, our our brain resets. That's when [67:46] our our whole body, you know, and if [67:48] you're having disrupted sleep [67:51] and you're waking up at 3:00 in the [67:52] morning and your brain is racing, I [67:54] mean, everything is worse. Your cortisol [67:56] levels spike, your insulin resistance [67:57] goes up, your, you know, everything gets [67:59] worse. And so, when my patients come in, [68:02] we focus on sleep first [68:05] and nutrition pretty much. And if Easier [68:07] said than done though, right? Sleep. [68:09] If the estro [68:10] if their sleep disruption is due to [68:13] hormones, then it's such an easy fix. I [68:16] just give them back the water they were [68:17] drinking and they sleep again. Where the [68:20] struggle is if someone's never been a [68:21] good sleeper, then that's probably out [68:24] of my area of expertise. I'm going to [68:25] send them to a sleep medicine [68:26] specialist. One of the things that we [68:28] now see a correlation is a sleep apnea [68:31] even in a thin patient in menopause in [68:33] women. [68:34] We're seeing a big bump in the sleep [68:36] apnea rates in women who are um [68:38] they don't even have to have a weight [68:39] problem. [68:41] And what is sleep apnea? That's when [68:42] people [68:42] So, sleep apnea is when you stop [68:43] breathing [68:44] um or you snore quite a bit. You you see [68:46] the palate relaxes and you're not [68:48] getting as much oxygen, you know, into [68:50] the body and into the brain. [68:52] It's a big health risk. And what is your [68:53] personal sort of exercise regime? What [68:56] do you So, you know, I came from the [68:57] long [68:59] the 20 years of just trying I was [69:00] exercising to be smaller. Mhm. [69:03] And now I'm I'm moving to be stronger. [69:05] And so, now I'm doing resistance [69:07] training. So, I have a treadmill that I [69:09] set up on an incline. [69:11] Um and I do a lot of Zoom calls there. I [69:13] do lots of meetings there. So, when I'm [69:15] working from home and and working on the [69:17] Galveston diet or the new book, I'm [69:18] doing on my treadmill but at an incline. [69:20] So, I'm really working on my legs. I [69:22] will wear a weighted vest so that I'm [69:24] getting the upper body. So, I'm doing [69:25] this for bone density. [69:27] Um, I'm doing a lot more lifting than I [69:29] ever ever ever did in my life because I [69:31] have a body scanner in my office. I have [69:33] sarcopenia. I have a genetic low I'm [69:35] very thin individual was not blessed [69:37] with a lot of muscle mass and the fact [69:40] that I focused on being thin for so long [69:42] and that was my social currency is you [69:44] know I was thin I was healthy. [69:46] Probably I've lost you know I lost that [69:48] that window of opportunity to gain more [69:50] muscle easily in my 20s and 30s. So what [69:52] I what I would tell my 35-year-old self [69:54] what I preach to my daughters is [69:57] focus on being strong, not small. [69:59] You know, muscle strength over skinny. [70:02] And so the muscle mass that you develop [70:05] now is going to serve you so much more [70:07] than the lack of fat or this perceived [70:09] lack of fat that you think you need. [70:11] Um, [70:12] don't worry about the curves that you [70:13] have. That's that's natural. That's [70:14] that's the way you're built. Let's get [70:16] some muscle. [70:18] And what about your diet? [70:20] So what my personal [70:22] Yeah, yeah, yeah. Eating eating window I [70:24] think you talked about. So I tend to um [70:27] I break my fast at around noonish [70:29] typically. If I'm hungry before if I'm [70:31] traveling or you know on a plane I don't [70:33] do well on a plane without food. And so [70:35] but on a normal day when I'm like going [70:37] to clinic and the night before is when [70:39] my diet starts. I will pack up my meals [70:42] and snacks that I'm going to take to the [70:43] office with me when I see patients. And [70:45] so I know what I've got. I'm doing you [70:48] know I'm loading up on protein. I'm [70:50] doing something green, some kind of a [70:52] green veggie. I'm doing lots of fruit. [70:54] I've got nuts and seeds. I eat nuts and [70:57] seeds all day long um for the [71:00] anti-inflammatory benefits and for the [71:02] healthy fats and for the fiber. And so [71:04] I've got all that. So I break my fast at [71:06] about noon and then between patients I'm [71:08] constantly snacking. I'm really focusing [71:11] on protein for myself. I don't have a [71:12] weight problem. Um and so I'm trying to [71:15] get stronger and so my protein needs [71:17] have really increased and so I'm [71:19] sometimes doing a protein bar or a shake [71:22] middle of the day um to help with that [71:24] and then in the evening now we're empty [71:26] nesting so it's just my husband and I. [71:28] And so he you know we'll kind of discuss [71:30] what do we have in the freezer or we'll [71:32] pull out some salmon or you know we'll [71:34] we'll make some I don't know uh [71:37] burgers or something and um you know we [71:40] try to be protein centric and then we're [71:41] adding in like a beautiful salad with [71:43] lots of avocado and chickpeas [71:45] um [71:46] on the side. So I think I covered it [71:49] all. Yeah. So I'm typically done eating [71:51] by 8:00 p.m. [71:52] Um [71:54] if it's an office day I'll either [71:56] exercise when I get back. I'm struggling [71:58] to get up I do a lot of great work in [72:00] the morning so it's hard for me to get [72:01] to the gym and the office. So I'll save [72:03] my workout for when I get home from [72:05] work. If if you had a a megaphone and [72:06] you could speak to every woman [72:08] right now the 1.2 billion [72:11] that we talked about earlier that are in [72:12] that perimenopausal or or the menopausal [72:14] phase or postmenopausal and you had to [72:17] communicate one message them. I'm [72:18] actually going to bring in everybody [72:20] else as well because although it's just [72:21] those women I've mentioned [72:24] everyone around them in their life [72:25] probably needs to hear some somewhat [72:27] similar message so they can play [72:28] supporting roles in that individual [72:30] struggle. [72:31] What would you say down that menopause [72:33] to those women and the the loved ones? [72:36] So my mantra is menopause is inevitable. [72:39] Suffering is not. [72:41] But you're going to have to advocate for [72:43] yourself because society has failed us. [72:47] Our medical system is is built to fail [72:50] the menopausal woman. And there is good [72:52] help out there. You're going to have to [72:53] do the legwork. I've got tons of [72:55] resources on my website to help you. [72:57] You know, list of articles to print out [73:00] and hand to your doctor, system you know [73:02] um [73:03] uh symptomatic sheets that you can like [73:05] keep track journals that you can hand to [73:06] your physician. [73:08] Um any way that I can help you advocate [73:10] for yourself cuz I can't be everyone's [73:11] doctor. But that this is real. You're [73:13] not crazy. [73:15] This is happening and there are lots of [73:17] things that we can do even non-hormonal. [73:19] Don't feel like if you're not a [73:20] candidate for hormone therapy that [73:22] you're stuck. You know, exercise, [73:24] nutrition, other pharmacology, stress [73:27] reduction, sleep. It's time to take care [73:29] of yourself first so that you can have [73:32] the best end of your life that you [73:34] deserve. [73:36] In 2023 I launched my very own private [73:40] equity fund called Flight Fund and since [73:42] then we've invested in some of the most [73:44] promising companies in the world. My [73:46] objective is to make this the best [73:48] performing fund in Europe with a focus [73:50] on high growth companies that I believe [73:52] will be the next European unicorns. The [73:54] current investors in the fund who have [73:56] joined me on this journey are some of [73:58] Europe's most successful and innovative [74:00] entrepreneurs and I'm excited to [74:02] announce that today as a founder of a [74:04] company you can pitch your company to us [74:08] or if you are an investor you can also [74:11] now apply to invest with us. Head to [74:15] flightfund.com [74:17] to gain an understanding of the fund's [74:18] mission, the remarkable companies we [74:20] proudly support and to get in touch with [74:22] me and my team. Legal disclaimer. Flight [74:24] Fund is regulated by the FCA so please [74:26] remember that investing in the fund is [74:28] for sophisticated investors only. Don't [74:30] invest unless you're prepared to lose [74:31] all of the money you invest. This is a [74:33] high risk investment and you are [74:34] unlikely to be protected if something [74:36] goes wrong. There is no guarantee that [74:38] the investment objectives will be [74:39] achieved and as with all private equity [74:41] investments all of the investment [74:43] capital is at risk. This communication [74:44] is for information purposes only and [74:47] should not be taken as investment advice [74:48] or a financial promotion. As you guys [74:50] know I'm a big fan of Huel. I'm an [74:52] investor in the company and they sponsor [74:53] this podcast. And what I've done for you [74:55] I put together what I call the Huel [74:57] Steven Bundle which is a selection of my [75:00] favorite products from Huel including [75:01] the black edition salted caramel flavor [75:04] which is super high in protein and has [75:06] 17 servings per container. My favorite [75:08] Huel bottle here which comes with my [75:10] bundle and also the brand new and very [75:12] exciting Huel complete nutrition bars. [75:15] This is chocolate caramel. You can see [75:17] from the empty box in front of me that [75:19] I've eaten most of them right? Me and my [75:20] team here. If you leave these on the [75:22] counter for 5 seconds they'll go. I'm [75:23] going to say something I've never said. [75:25] When Huel first made their bar many many [75:27] years ago I tried it and I didn't like [75:29] it. So I've never talked about it on [75:30] this podcast. They've spent roughly the [75:32] last two to three years making a brand [75:34] new bar which I absolutely love and [75:36] that's why I now talk about it because [75:38] it's a product that I eat. If you want [75:39] to order them yourself and get started [75:41] on your Huel journey the link is in the [75:43] description below. In this podcast [75:45] episode wherever you're listening to it [75:46] there'll be a Steven's bundle link and [75:48] check it out. Back to the episode. [75:50] Your family have a history of health [75:53] complications and illnesses, right? [75:55] Yeah. What is that history but also has [75:56] that played into your overarching [75:58] perspective about [76:00] nutrition Yeah. the health care system, [76:02] how it treats people? [76:04] So my I'm one of eight children. I have [76:07] six brothers and um my oldest brother [76:10] Jep died when I was 9 years old from [76:13] acute lymphocytic leukemia, one of the [76:15] most common forms of childhood leukemia. [76:17] Now the cure rate is 95% [76:20] and but at the time he was put into [76:22] remission and then he came out of [76:25] remission in his late teens and died [76:27] like a year and a half later. [76:29] So my childhood was [76:31] that that year and a half was all about [76:33] trying to save him. [76:35] And everything my family did of taking [76:37] him to Memphis which was so far from [76:39] Louisiana where I grew up to St. Jude's [76:41] Hospital [76:42] the last ditch effort to try to you know [76:44] find another chemotherapy regimen which [76:46] he failed and that kind of kind of drove [76:48] me but you know it was it was leukemia. [76:50] It was childhood. It was one of those [76:52] things. [76:53] Fast forward to 20 [76:56] He died in 2015 so 2010 my brother I [76:59] knew had HIV and um had also contracted [77:02] hepatitis. [77:03] And he was doing great on his HIV meds. [77:06] Um his counts were good. He was healthy, [77:08] functional. He'd been with the same [77:09] partner for over 30 years. But then his [77:12] his liver was getting worse and worse [77:13] and worse. [77:14] He also struggled with alcoholism and so [77:17] that kind of combination [77:19] was really hard to watch and love him [77:22] through his choices, you know. And uh he [77:25] ultimately died in 2015. He had a stroke [77:27] and then I was able to go do his end of [77:30] life care. And the first book I wrote um [77:33] I talk about him in the book because [77:36] in my rush to deliver his care I forgot [77:39] my own and that's when I realized I was [77:41] menopausal was through my grief process. [77:43] I thought I was grieving. I gaslit [77:45] myself. [77:46] Like no no no you're not sleeping. [77:47] You're you're waking up all night. [77:48] You're you know upset and your mental [77:50] health and your brain fog is all because [77:52] you're just grieving his death. [77:54] And then um my next brother Jude uh was [77:58] diagnosed with stage four esophageal [78:00] cancer. [78:01] Um [78:02] shortly [78:04] uh he was diagnosed when Bob died and [78:06] then he survived a few years. Um so [78:10] Bob died at 56 [78:12] and Jude died at 57 and I'm 55. [78:16] And [78:17] I don't you know I know a lot of it was [78:20] lifestyle but I still have those [78:21] genetics and I'm about to survive three [78:23] of my six brothers. [78:25] And um [78:27] out through outlive. And I know that [78:30] these choices that I make with my [78:31] nutrition, my exercise, my sleep, my [78:33] stress reduction, what I call the [78:34] menopause toolkit, you know, and my [78:36] choice for HRT [78:38] are all I want to see my grandkids one [78:40] day. If if I'm lucky enough to have any [78:42] I want to watch these women I've raised [78:45] grow up and you know be the women [78:46] they're meant to be and that choice [78:48] might get taken away from me if I'm not [78:50] careful. So you know a lot of what I do [78:54] and why I do it is [78:56] because I have to. I may not get the [78:58] choice. [79:02] What an incredibly important mission [79:04] you're on and what incredible work [79:06] you're doing. Um [79:08] because there are as we've talked about [79:10] there's been a a group of people in [79:11] society that have [79:13] kind of been I guess disillusioned but [79:14] they've also must have felt incredibly [79:16] isolated in their experience and what [79:18] they were going through. And it seems [79:20] that there's been a real shift in recent [79:22] times towards the conversation around [79:24] menopause and hopefully these [79:25] conversations if anything at all will [79:27] dismantle the stigma which is often the [79:29] first sort of wall that needs to fall [79:31] for people to be able to take action and [79:33] have those conversations. [79:34] And it just speaking from my own [79:36] experience, I didn't really understand [79:37] what any of this stuff meant until I [79:38] started doing this podcast and I had the [79:40] first couple of guests on and then [79:41] someone said the word menopause to me [79:43] and then we started having a [79:44] conversation about it. And I go, "Oh my [79:46] gosh, like you know, maybe when I was in [79:49] school someone should have told me about [79:51] this phase of life. We talk about how to [79:53] get a job, but it seems to [79:56] fall off, you know, the education system [79:58] seems to stop caring once we've had kids [80:00] almost. That's what we're experiencing [80:02] here as well. [80:04] It's really really crazy and the work [80:05] you're doing is so unbelievably [80:06] necessary and what I love about the way [80:08] that you you write and how you educate [80:10] people is it's so science-based but it's [80:13] so accessible at the same time. That's [80:15] always been my superpower, I think, is [80:17] and I realized that very quickly in my [80:19] career was that I had this knack of [80:22] being able to take something really [80:23] complicated and break it down into terms [80:26] that people could understand. Mhm. That, [80:28] you know, most people would be able to [80:30] grasp and walk away from. And you have [80:33] nuance and empathy which is the [80:34] necessary ingredients when you're [80:36] talking about subject matter like this [80:37] where everyone's symptoms are typically [80:39] quite different from one another and [80:41] they will have different circumstances. [80:42] We talked about other, you know, [80:44] conditions and contraindications that [80:46] might be complicating things. Um [80:49] and you seem to have a really wonderful [80:51] empathetic view on all of those things [80:53] and a real appreciation that everyone's [80:55] circumstances are entirely different. Um [80:57] I'm excited and I'm really looking [80:59] forward to having more conversations [81:00] like this and learning more because [81:02] although I am a 30-year-old man, [81:05] I have a partner that I love. Mhm. Um I [81:08] have a mother that I love. I have an [81:09] older sister that I love. My sister is [81:11] my partner is 30 as well. My sister is [81:13] 36. My mom is [81:15] 60 now. [81:18] Nearly 60 now. I I challenge you to have [81:20] this conversation with her and ask her [81:22] about her experience. [81:23] I really applaud all the and I don't [81:26] know whether I should say this or not, [81:27] but I really applaud all the men that [81:32] got to this far in this conversation and [81:33] chose to listen and have an appreciation [81:35] that [81:36] the betterment of 50% of our population [81:38] who are going to go through something is [81:39] the betterment of all of us. Exactly. Um [81:42] and that they also have a role that they [81:43] can play in being a support and [81:46] encouraging and having the conversations [81:48] that will bring down the stigma and and [81:51] the suffering of what is currently about [81:52] 1.2 billion people but will be 50% of [81:54] people in our population. So, [81:57] I highly recommend everybody goes and [81:59] checks out both this book which is the [82:02] Galveston Diet but also can we pre-order [82:04] the upcoming book now? [82:05] Yeah, it's available for pre-order [82:07] wherever you buy books. And you'll think [82:09] it'll be out in 2024 in [82:11] For sure. And [82:12] the latest May. The latest May, okay. [82:15] And that's called the New Menopause so [82:16] you can pre-order that now wherever [82:19] wherever um you get your books and [82:21] that's the culmination of many decades [82:23] of very very hard work. So, I'm very [82:25] very excited to read through that myself [82:26] and the Galveston Diet book is out now [82:28] as well. It's been out for a little [82:29] while. Um we have a closing tradition on [82:31] this podcast with the last guest and [82:32] also your website is an incredible [82:34] resource for all of this all of the [82:35] things you talk about, right, and your [82:36] social channels, etc. [82:39] We have a closing tradition on this [82:40] podcast where the last guest leaves a [82:41] question for the next guest not knowing [82:42] who they're leaving it for. [82:43] And the question here is [82:48] you get one last conversation [82:50] with somebody you love, a child, maybe [82:53] your husband, maybe someone else. [82:56] What you say to them in that [82:57] conversation [82:59] that maybe they haven't already heard? [83:03] I love you. [83:11] There's nothing more than love. [83:16] I've had done it [83:19] three times with my dad, too. My um [83:24] Bob and Jude were five years apart. My [83:27] dad was shortly after Jude. You know, [83:29] and watching my parents bury three kids [83:31] was a lot. [83:33] Um [83:36] just love. [83:42] Thank you. You're welcome. [83:43] Thank you so much. [83:47] Quick one, I discovered a product which [83:49] has changed my life called Eight Sleep [83:51] and they are now a podcast sponsor. You [83:53] guys have probably figured out by now [83:54] that I'm pretty obsessed with optimizing [83:55] my health and specifically my sleep and [83:58] I think my sleep has been a bit of a [83:59] personal revelation for me, the [84:00] importance of it and how much it [84:02] correlates to how I feel every day, how [84:04] creative I am, my mood and everything [84:06] that seems to matter to me. One of the [84:08] controllables to have better sleep is [84:10] temperature. If the room's too hot, you [84:12] won't sleep. Your body needs a certain [84:14] temperature to sleep but not only that, [84:16] it needs that temperature to kind of [84:18] fluctuate through the night starting [84:20] cool, getting colder and then heating up [84:22] again which is a reflection of nature [84:24] and how our ancestors would have lived [84:25] before central heating and duvets and [84:27] air conditioning and all this stuff. [84:29] Highly recommend Eight Sleep. I've [84:30] spoken to the founder, I understand [84:32] their mission, I believe in it, they're [84:33] good people. This is one of those [84:35] products where once you've tried it, you [84:37] never go back. Go to savings and ring in [84:40] the most wonderful time of night. Eight [84:42] Sleep currently ships within the UK, [84:44] USA, Canada [84:47] and select countries in the EU and [84:49] Australia. [84:51] Do you need a podcast to listen to next? [84:54] We've discovered that people who liked [84:55] this episode also tend to absolutely [84:58] love another recent episode we've done. [85:00] So, I've linked that episode in the [85:02] description below. I know you'll enjoy [85:04] it.