Dr. Mary Claire Haver joins Stacy for a robust discussion about the reality of menopause, and shares her top exercise and nutrition tips, as well as her toolkit philosophy - techniques that she’s incorporated into her own life that she can apply as she ages to maintain a healthy lifestyle.
From Season 2. Lightly edited for clarity .
Stacy London (00:12) You're known for the Galveston Diet, for nutrition and exercise and weight gain and stress reduction, which I do want to talk to you about. But I think it's interesting that you realized there were so many people asking other questions related to menopause. If I understand correctly, there are 34 common symptoms, but over 100 potential issues that can happen during this phase — and nobody knows that frozen shoulder might be related to some sort of hormonal change. Is that really what you found?
Mary Claire Haver (00:56) Yes. Every single organ system in our bodies has estrogen, progesterone, and testosterone receptors, and when those levels start tanking, we see changes. Each of our expressions of perimenopause and menopause is individual — so where you might have had mental health changes and frozen shoulder, I had hot flashes, night sweats, and skin changes. It's really hard for medical providers to know all of these things, because we're not taught — there's such a lack of education and focus around menopause care outside of the hot flash. Women are left feeling like they're crazy. They don't understand what's happening to their bodies.
Stacy London (01:42) Let's talk a little bit about actionable items. I understand there's such a varied range of experiences, as you've said — one person's menopause is not going to be the same as another person's. I wanted to ask about this idea that, without any changes in diet and exercise, people in menopause and perimenopause gain about three to five pounds. Is that a solid three to five pounds, or is that per year? Because I feel like I've seen a lot of people with more weight gain than even that.
Mary Claire Haver (02:11) So that's on average pretty much a year — about three pounds a year is the average weight gain. A lot of the older studies said it probably has more to do with aging, because the trajectory of weight gain doesn't seem to change with the menopause transition — you just take a 50, 55, 60 year old and the weight is going up. What is changing, and what's important for people to understand, is your body composition — where and how you deposit fat, how much muscle you have — starts changing dramatically with the menopause transition. And that correlates with more than just annoying weight gain that's cosmetically distressing; it's a health risk. Having a few extra curves, or a little more of an inch you can pinch, may not be something you're happy with, but it isn't that dangerous. What's dangerous is the new fat that gets deposited around our internal organs. In medicine we call that visceral fat; in layman's terms it's usually called belly fat, and it's the fat that's driven by hormone change — cortisol, lack of sleep, decreasing estrogen levels, and, in some women, more testosterone activity due to changes in sex hormone-binding globulin. There are a lot of different reasons, and all of it is related to menopause.
Stacy London (03:24) So let's talk about nutrition. How can we leverage nutrition at this stage of our life? I really do feel like menopause is the last exit on the highway for us to safeguard our health for the rest of our lives — what our health span and longevity is going to look like. So I see this as a real opportunity. Let's talk about some of those action items — what can we do, nutrition-wise, to safeguard against some of these changes in our hormones?
Mary Claire Haver (03:54) So all those years we were counting calories — I did it too — we weren't looking at nutrition. In medical school, nutrition was like porn: you know it when you see it. I did not have a nutrition class. We learned about calories, protein, fat, carbohydrates, and some really extreme nutrition deficiencies like kwashiorkor or scurvy, but nothing about day-to-day nutrition and what is healthy.
Leaving calories aside for a minute — calories are important; if you eat too many, you're going to put on excess fat. But if that's not working for you anymore, let's take a look at your nutrition. Are you getting enough fiber? Fiber is one of the highest-quality, most underrated nutrients out there. The average American woman is getting about 12 grams of fiber in her diet per day, and she needs a minimum of 25. When you get adequate fiber — a combination of soluble and insoluble — which you're perfectly able to get through diet if you hustle, you're going to feed your gut microbiome (that's soluble fiber), slow the absorption of sugars out of your gut into the bloodstream, decrease your fasting insulin levels, and decrease inflammation.
Stacy London (05:00) Let's talk a little about that — I don't know the difference between soluble and insoluble fiber. What would be some examples, so that when somebody listens to this podcast, they can go grocery shopping afterward?
Mary Claire Haver (05:13) Soluble fiber is what dissolves in water — when you stir it up, you don't get precipitation at the bottom. It's dissolvable food for our gut microbiome; that's the prebiotic fiber. Insoluble fiber is the fiber that bulks the stool, pulls water in, and adds volume, helping move things more quickly through the gut. They each have jobs in our gut that are important, so if you choose a fiber supplement to get you over the edge — if you can't get it through food — you want one that has both.
Stacy London (05:50) When we talk about actual foods, are we talking about vegetables?
Mary Claire Haver (05:54) Legumes, nuts, and seeds tend to have some of the highest levels of fiber. Legumes are your beans — we all know there's tons of fiber in beans, a great source. I try to get some kind of bean or legume in my diet every day. Chia seeds, fabulous. Avocado, fabulous. Those are my top three, and they're things you should incorporate in your diet regularly if you love them and can tolerate them. Fruit, nuts, seeds, leafy greens — anything with a crunch, the crunch is fiber — have lots of fiber in them too.
Stacy London (06:31) That's wonderful, thank you — that's a really easy rule of thumb. And I love the idea of beans being in my diet every day. Beans, chia seeds, and what was your third one? Avocado, okay, great — two out of three I already have going for me, so I'm excited.
Let's shift gears and talk about exercise. One of the things I started to notice, especially when I was younger — going to the gym or seeing a trainer was, "I've got to lose 10 pounds, I've got to get thinner." That's sort of the Gen X mindset in some ways. But there was a point where I realized this wasn't going to be about aesthetics anymore — it was going to be about wanting to be able to walk when I'm 85, wanting to be stable enough not to fall when I'm older. And a lot of bone density changes happen after menopause. So talk to us about exercise and why it can be so important — what are the top three things you'd recommend as we're moving through perimenopause and postmenopause?
Mary Claire Haver (07:43) In my clinic, my patients aren't coming to me wanting to rock a bikini — though they wouldn't say no to that. They're looking at their mothers, their aunts, the older women in their family, and they're saying, "I don't want that. I'm scared. I want to be functional at 85. I want to be the fun grandma. I want to climb the mountains — and if I stay on the path I'm on, that's not going to happen for me."
So I'm like, okay, let's look at what you're doing now. If you're sedentary, we've got to get you up and walking regularly. If you're walking, let's pick up some weights. If you're going to the gym every day and feel like you're not getting the maximum out of it, you really should be doing resistance training, strength training, at least two to three times a week, hitting your upper body, lower body, and core. We should be doing balance work as well as stretching — all of these are so important. And then, of course, there's cardio. For forever, I was a Gen Xer — I did cardio to punish myself, to undo eating a cookie, or to get to a certain weight. Strong over skinny — strength is the goal of exercise now. Cardio keeps your heart strong, and that's important, but we have to do way less than we probably thought we had to do in order to keep that heart pumping and keep our longevity going for our cardiovascular health.
Stacy London (09:04) I'm curious about stretching — this is something I don't hear people talk about often enough when it comes to exercise. Can you explain why stretching is so important? We know stability is for balance so we don't fall, strength training is for bone density, cardio is for cardiac health — but stretching, I don't know that everybody understands the benefit of that.
Mary Claire Haver (09:28) One of the things we're discovering more and more about is the musculoskeletal syndrome of menopause. Estrogen receptors in the joint tissue and joint capsules are highly regulated in our premenopausal years, and when we take that estrogen away, it seems we're extremely affected. When we look at the data, women are having pain where they never had it before. They have no injury — they're having new joint pain, and for 20% of those women, it's the worst symptom of their menopause, absolutely devastating to them.
We don't just take menopause hormone therapy and think it's going to fix everything — everything's a toolkit. Part of the toolkit is stretching those joints and ligaments, because they're shortening and tightening, and we have to get in there and keep them limber. The lack of estrogen — even with HRT, there's no guarantee — is going to affect it. I've just seen women who are devastated by this.
Stacy London (10:31) The other part of this, before we talk about the toolkit — the big toolkit — is stress reduction. I read years ago in Scientific American that the lowest point of happiness in a woman's life is 45 to 55, and that's because it's the highest rate of depression, divorce, and decreased earning potential. And a doctor once said to me that all of this is being thrown at you when you're at your physiologically weakest to handle it.
So how do we manage the external stressors that are real in our lives — looking at our partner after 25 years and thinking, "Who are you? I don't want to be with you," or dealing with painful sex or loss of libido and struggling in that relationship? Those things are real. How do we take all of that, layered on top of being at our least physiologically able to handle it, and manage it in a way that actually benefits us?
Mary Claire Haver (11:30) I think first we have to educate that this is the time we're most physiologically vulnerable to mental health changes, and that it's tied to our hormones. Without hormone therapy, we see a higher risk of new mental health disorders, or existing ones worsening. So the therapeutic management that was working for you stops working as well as it did. Once women know, "Okay, this isn't just me — this is partly my hormones," something shifts.
What I see in my clinic, and in my patient population on social media, is people circling the wagons around themselves. They're putting up boundaries for the first time, prioritizing their own health and mental health, because they're realizing: if I don't do this, I'm not going to function, and I don't want to be like that. I want to be happy Mary Claire, functional Mary Claire. Prioritizing my family — the family I created, or whatever your inner circle is — they are my priority, and everybody else falls to the side. It's really kind of cool: people's give-a-damn factor just drops. [crosstalk] They're like, I'm coming first, because if I don't take care of me, no one else is going to.
I see it time and time again — in my own life, in my patients — and I constantly draw inspiration from other women in this menopause journey who are prioritizing themselves and reaping the benefits. No guilt, no shame. If I don't put on my own oxygen mask, I'm not going to be able to put it on for my children, my spouse, my parents.
Stacy London (13:21) When you talk about this toolkit in your book, what does that mean, and how should we interpret it?
Mary Claire Haver (13:28) When we approach "how am I going to live my healthiest, longest, best life," health doesn't operate in a vacuum — we have to approach multiple facets, and they all work together to keep us healthier. In the book, we look at each organ system and each symptom profile and how we can manage it, and you see so much overlap. If we increase fiber, that helps get your metabolic syndrome, diabetes control, and hypertension all better.
So in the toolkit, we look at nutrition — are you maximizing your nutrition, and what does that look like for you? What supplements might help with the symptoms you're having? We look at exercise — cardiovascular, strength training, stretching, and balance. We look at pharmacology — menopausal hormone therapy or other pharmaceuticals that might get you to the next level of function. We look at supplementation — where are there gaps in your nutrition, or certain supplements that might aid nutrition that's already good. We look at sleep optimization and stress reduction. And we look at community — where are your people? Who is going to support you through this journey, and how are you going to educate them so they can be a better partner to you?
Stacy London (14:38) That's also why the book is so good for everybody — you don't need to be going through perimenopause or be postmenopausal to get something from it. You can use it to help somebody who is going through it.
Dr. Haver, thank you so much for your insight and your time — but I want to go back through some of this to remind people what they can do when they leave this podcast.
First, in terms of nutrition: fiber is really important. The top things are legumes, beans, chia seeds, and avocado — put more of those into your diet. That's a good way to go.
In terms of exercise, we want to strength train. We also want to do things that help our stability so we don't fall, and cardio for cardiac health — but it doesn't have to be as much as we once thought. And we want to stretch, so our joints stay lubricated and we don't get the stiffness that happens during peri- and post-menopause.
And then, in terms of stress reduction, we really have to look at how we're going to prioritize ourselves, maybe for the first time in our lives, around all of these true stressors that are happening.
Maybe this is where we should end it — but what are some of the tools you use to reduce stress? Do you recommend meditation, cognitive behavioral therapy? What's been truly effective for you?
Mary Claire Haver (16:06) For me — and I practice meditation, which I never did before menopause; I thought it was woo-woo and I didn't have time for it, and I couldn't sit still — I do guided meditation with Headspace. There are other amazing apps, but that's the one I stumbled on and I like it. I also practice gratitude journaling — I try to visualize the things I'm grateful for, the wins in my life, the health of my children, the things going well, so I can focus on that and let go of the things that are negative. I put them in a balloon and imagine them floating away so they can't affect me. That doesn't work for everyone — I try to encourage each person to experiment and find out what works for them. It might be prayer, it might be baking — whatever it is where your mind can just let go. Find that time for you, however that looks, and prioritize taking five to ten minutes a day to do it, every single day.
Stacy London (17:11) You mentioned Headspace — I have to say I'm a big fan of Calm, another app. I'm not paid to say this at all, it's just that Harry Styles reads you a bedtime story and I'm really into that.
So again, with stress reduction: think about what gives you the most sense of relaxation, what lets you let go of some of the concerns and worries we're going to have to face every day. Whether that's baking or prayer or meditation — or maybe even exercise is part of that — something you can do for even five to ten minutes a day is really going to help with how menopause impacts you.
Dr. Haver, thank you so much for your time. I appreciate it so much, and thank you for giving us so many tips to get through this stage of life in a way that's joyful and meaningful for all of us.
Mary Claire Haver (18:04) You're so welcome.
