Ep. 308 Dr. Mary Claire Haver: Weight Gain in Middle Age, Perimenopause and Inflammation

Today, I am honored to connect with Dr. Mary Claire Haver, a board-certified OBGYN who has dedicated her entire adult life to championing women’s health. 

Dr. Haver is the visionary creator of the Galveston Diet, the first and only nutrition program ever designed by a female OBGYN to cater to menopausal women. 

In our conversation today, Dr. Haver shares her background, and we discuss her new book, The Galveston Diet. We examine the glaring systemic gap where the health of middle-aged women remains undervalued and underfunded in research, and our discussion touches on various facets of women’s health, including perimenopausal symptoms, the distinction between chronological and endocrine aging, the scientific misconceptions surrounding weight gain and hormones, the advantages of intermittent fasting, inflammation, macros. We also get into the supplements Dr. Haver finds beneficial for women in middle age, in addition to dissecting the impact of non-nutritive sweeteners and the role of continuous glucose monitors.

“You have got to eat protein throughout the day because your body can only process 30-35 grams at a time, and then those amino acids will be stored as fat.”

– Dr. Mary Claire Haver

IN THIS EPISODE YOU WILL LEARN:

• Dr. Haver highlights various symptoms of perimenopause
• How menopause can increase health risks
• How muscle loss with aging can make women more insulin resistant and lead to cardiovascular changes
• How the hormonal changes that occur during perimenopause and menopause can impact weight management
• What are the benefits of intermittent fasting for perimenopausal women?
• How a combination of genetics and lifestyle factors can help women prepare for menopause and manage its symptoms
• How sugar, alcohol, and gluten impact inflammation, insulin levels, and blood sugar
• How a lack of protein and the wrong types of fats can lead to hunger and satiety issues and lead to muscle breakdown and weight gain in menopausal women
• Dr. Haver talks about her book, The Galveston Diet
• How do non-nutritive sweeteners impact the gut microbiome and blood sugar levels?
• The benefits of using a continuous glucose monitor to track blood sugar levels

Connect with Cynthia Thurlow

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• Submit your questions to support@cynthiathurlow.com

Connect with Dr. Mary Claire Haver

• Website
• Instagram
• TikTok
• YouTube
• Pre-order a copy of The Galveston Diet

Transcript:

Cynthia Thurlow: [00:00:03] Welcome to Everyday Wellness podcast. I’m your host, Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent, is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

[00:00:30] Today, I had the honor of connecting with Dr. Mary Claire Haver, who is a board-certified OB/GYN, who’s devoted her adult life to women’s health. She created the online program The Galveston Diet, and this is the first and only nutrition program in the world created by a female OB/GYN designed for women in menopause.

[00:00:46] Today, we spoke about her new book, The Galveston Diet, her background and how there’s been a systemic gap in where women of middle age are undervalued and research is underfunded. We spoke about perimenopausal symptoms, chronological versus endocrine aging, the flawed science around weight gain, hormones, the benefits of intermittent fasting, inflammation, macros, specific supplements that she finds beneficial to women in middle age, as well as the role of non-nutritive sweeteners and continuous glucose monitors. I hope you will enjoy this discussion as much as I did recording it.

[00:01:23] Well, welcome, Dr. Haver. It’s such a pleasure to have you on. I’ve been really looking forward to this conversation.

Dr. Mary Claire Haver: [00:01:31] So good to be here, thank you.

Cynthia Thurlow: [00:01:32] Absolutely, so it would be great to kind of start from the beginning. I would imagine that when you trained as an OB/GYN and I feel a lot of this because I used to think of menopause as a cliff. I was like, “It’s many years away, I don’t need to worry about it.” And I would imagine for you, as a young OB/GYN, kind of watching your patients go through that process, why do you think there’s a lack of education, emphasis for clinicians about this time in a woman’s life, and yet we spend 40% of our lives in perimenopause and menopause?

Dr. Mary Claire Haver: [00:02:03] I think it’s a systemic problem, and I actually didn’t recognize it as a significant gap in my education and training until I went through it and realized I didn’t have enough resources to help myself, let alone my patients. I hadn’t kept up with kind of the latest of what was going on. We have our board certification every year where we’re presented with the latest research articles and we have to do synopsis and answer some questions to make sure we’re keeping up. And I went back over the last several years and looked at how many of those articles were specific to menopause and it was maybe one out of 50 or 60 articles.

[00:02:43] And I think that menopause as a whole has been– it’s all part of women’s health, so I think women, women’s research has been undervalued, underutilized, underfunded, and then when it comes to menopause, just layer on top of that the bulk of my training for OB/GYN, which is all important stuff, I’m not knocking what I learned, more than 50% was obstetrics, helping people get pregnant, make sure they stay pregnant, guiding them through a healthy pregnancy, intervening if there’s a problem, delivering the baby, postpartum care, etc. And then the next, say 40% of our training was all lumped together as gynecology, which includes everything else, gynecologic surgery, oncology, pediatrics, and menopause is just a tiny little sliver of that training. They did a survey recently, I think it was Mayo Clinic, most OB/GYN residents getting out, the vast majority did not feel comfortable treating or discussing menopause with a patient.

Cynthia Thurlow: [00:03:43] Yeah, it’s interesting that I in cardiology kind of watched women transverse their 40s and I was a young NP in my 20s and I kept saying, “Gosh, there’s a lot going on with these women ” and then in their 50s. And this was in the time post Women’s Health Initiative where hormones were feared. And just watching women navigate the challenges of aging and trying to navigate cardiology in that realm. And of course, we were very pro Women’s Health Initiative and we were referring everyone back to their GYNs because we didn’t want to do anything related to that. But I just think about all the missed opportunities, and I think I reflect a great deal about my mom’s generation. My mom’s in her 70s and she was on HRT, and then post WHI was not on HRT. And I see a lot of my aunts really in many ways suffering because they’ve chronically inflamed oxidative stress, they are doing all the right things, but there’s been this reluctance to have the conversation about hormones as one example. And my mom said to me recently, “I really hope your generation gets it right for the rest of us, what my generation has gone through, it’s not replicated in your generation and subsequent generations to come.”

Dr. Mary Claire Haver: [00:04:56] Well, I think part of the systemic problem was– you’re lucky that your mother would even discuss this with you. There was so much taboo around discussing the subject. And one thing I’ve noticed as I’ve grown on social media is that I have people from every walk of life. I have celebrities, I have moms who are staying at home with six kids, all like sharing the same story over and over again blindsided by perimenopause and menopause, no one to talk to, feeling so alone. And social media has created this space where they realize, “Wait a minute, that’s me, I did that too.” And that the symptoms of perimenopause are very unique to the individual. Just because you have hot flashes doesn’t mean you’re not going to have joint pain or headaches or gastrointestinal changes. It’s a really wide variety of symptoms and very very difficult to diagnose if you don’t know what you’re doing.

Cynthia Thurlow: [00:05:50] Exactly. And that makes a lot of sense. And I think for many women, there’s this shame about talking about the aging process. They don’t want to talk about the fact that they’re no longer fertile or the changes they’re seeing in their bodies. And so maybe this is a good segue to talk about some of the symptoms of perimenopause, perhaps the ones that are not as common because there runs the gamut, there are so many, but I feel like a lot of, what I hear from, female patients is the weight loss resistance, if they’re having hot flashes. But I know there can be less common side effects that maybe people aren’t making a lot of, meaning, they’re just like, “Oh, I’m having changes in appetite.” And they just assume that this is just part of aging, this is all of that related. 

Dr. Mary Claire Haver: [00:06:33] It can be difficult to tease out what is chronologic aging and what is what we now call endocrine aging. And there can be some overlap between the two. We all know that 85% of women will have hot flashes, 85% of women will have sleep disturbances, almost 100% will have body composition changes, meaning, where you store fat. It turns out just the weight gain as far as what this number on the scale says, which you and I know, that means nothing. It doesn’t equate health, is more to do with muscle mass loss, sarcopenia, slowing down of your metabolism due to that, rather than what’s going on hormonally. But what menopause is doing is shunting fat now to the viscera, not so much to the subcutaneous tissue and that’s where the health risks come from. But as far as symptoms go, I like to take it in a top down–

[laughs]

[00:07:25] So, you are starting with the brain. We can have increasing headaches, migraines can get worse, new onset of neurodegenerative changes. So, Alzheimer’s and dementia, we start seeing an acceleration of those processes. Skin changes, dry skin, dry eyes, dry mouth, so dry mouth leads to dental changes, we see an increase of. I’ve talked to my friends in the dentistry world. Yes, cavities, root canals, all of that starts to accelerate at this age. More to do with menopause than to do just with aging. So, we have palpitations, there’s estrogen receptors on the sinoatrial node, so, we see disruptions in our heart rate. A woman will come to the ER with sweating and having rapid heart rate.

[00:08:10] She gets a million-dollar workup for heart attack and no one even discusses that this is probably how your menopause is presenting once they rule out, the other things which is important. So joint pain is another thing. Itchy ears is one thing that so many women– I have had that video went viral when I talked about itchy ears and menopause. Itchy in other places of your body, it’s mostly due to the dry skin, but really like joint and hip pain and increasing autoimmune disease, cardiovascular changes. We know that our lipid panels change with menopause and our risk for subsequent cardiovascular disease increases as well.

Cynthia Thurlow: [00:08:43] It’s really interesting that it’s a systemic thing. I think for many people they don’t realize we have estrogen and progesterone receptors and testosterone receptors. Systemically, it’s not just related to the genitourinary symptoms.

Dr. Mary Claire Haver: [00:08:57] Right.

Cynthia Thurlow: [00:08:57] And so, one thing that I think many women are surprised by and you touched on it is this muscle loss with aging that makes us more susceptible to becoming insulin resistant and this body composition changes. So obviously, menopause is a privilege. I know this is something you say in your book that understanding the aging process, it’s navigating these changes and trying to make peace in many ways with things that are ongoing in our bodies. So, kind of the conventional way that I was trained in and I’m sure you were trained in as well, is the science of weight gain is largely a calorie deficit or calorie surplus. How has that changed for you clinically as you’ve been navigating your own career path and then also perimenopause into menopause?

Dr. Mary Claire Haver: [00:09:41] I’ve had a lot of long conversations with obesity medicine specialists, and I’ve done a lot of reading in this area. And also when I went through my nutrition training, which I did in 2018, I learned, it just kind of ripped the Band-Aid off of everything that I thought I knew about “Why people are overweight?” And it’s a chronic disease and there’re so many factors that feed into this. We can’t just look at it and put the onus on the patient that she has a weight problem because she’s lazy or she’s not trying hard enough. Of course, my patients are all females, so this also applies to if you have any male listeners as well. And it just really opened my eyes to my own prejudice to my own because I before menopause other than pregnancy in the first couple of years of college really hadn’t struggled with a weight issue, so I was coming from a very privileged place of not understanding all of the factors that go into this.

[00:10:39] And all the hormones that are involved Insulin, cortisol, leptin, ghrelin, PYY, cholecystokinin, they all feed into our hunger, our satiety, our cravings, our emotions. Everything in their environment is “We live in an obesogenic environment.” The way food is presented, what healthy foods are available? Can you afford them? Do you have access? What kind of learning, training do you have to understand how these foods are going to affect your body? And just that our society and consumerism is trying to put a one size fits all, “Here’s the perfect diet for you or here’s the perfect supplement for you.” And it’s just we’re human beings and we’re very very individual. And so, what I try to do in my clinic is help my patients individualize this for them so they can be as healthy as possible.

Cynthia Thurlow: [00:11:25] I think it’s really important because the kind of conventional prevailing mantra in cardiology was, “Oh, just eat less and exercise more that will take care of it.” That’s the basic problem.

Dr. Mary Claire Haver: [00:11/ 30] OB/GYN, workout more eat less.

Cynthia Thurlow: [00:11:39] Yeah, and it’s interesting to me that my own perimenopause journey gave me great pause, much like you were stating, I never had a weight problem, lost weight after my pregnancies pretty easily. And then I hit the wall of perimenopause and all of a sudden, I was like, “Wait a minute, nothing that I used to know works and is not working. I’m doing all the things I’m supposed to be doing, nothing’s working.” And so that is what led me to eating less often, because I had been telling my patients, eat snacks and mini meals, and this is going to stoke your metabolism, and this is so important. And then all of a sudden, I was like, “Wait, time out.” The frequency at which we are eating in middle age, maybe we can get away with it in our 20s and 30s and teenagers. I have teenagers at home, and they have voracious appetites, but does not serve me at this stage of life.

[00:12:27] And it sounds like through your process, through this additional training, you went through that at some point, intermittent fasting became part of the discussion that you were having with your patients. How did you come to being a fan of intermittent fasting as a GYN? 

Dr. Mary Claire Haver: [00:12:42] Sure. I’d heard about it. So, when I started my own journey through this since 2017 and of course I’d heard about fasting. I think Fung’s book had come out by then, but I kind of dismissed it as a fad. I loved breakfast. I got up and ate as soon as I woke up in the morning, it was just a normal part of my day. But when I gained the weight through perimenopause and I went to the nutrition, like PhD nutritionist at the university I was employed at, I delivered their babies, we were all friends. And I said, “Hey, what’s going on?” And they kept pointing me to information about inflammation and aging.

[00:13:20] So, I kind of went down the rabbit hole and I stumbled onto Mark Mattson’s data, which you’re probably familiar with of neurodegenerative disease and inflammation, lowering systemic inflammation through the fasting process and I was absolutely fascinated, and I thought, “Well, let me give this a try” and see because everything I experimented on myself first before, and then I was just like, “Hey,” to my patients, “You want to try this little thing I’m working on?” and they were like “Yeah sure.” So, really it was just reading and looking at his references and reading those articles and just really seeing, “Okay, there’s some solid science here, it doesn’t seem to be harmful, and this may help.” And it was less about just weight loss and fat loss and more about lowering chronic inflammation levels so that you became more efficient as a human being and more resilient.

Cynthia Thurlow: [00:14:09] Yeah, it’s really interesting because it sounds like for me, it was around 2016, and Jason’s book was out. And I remember that was the book and I always give Jason credit. That was the book that gave me the courage to feel very comfortable as a clinician, starting to talk to my patients about it and then leaking into my business that I started all perimenopausal, menopausal women. And the one thing I always tell people is people come to intermittent fasting out of curiosity after a desire to change body composition, and they stay for all the other benefits, the cognitive improvement, the mental clarity, the having more energy. And you mentioned in the book you talk quite a bit about the neuroplasticity and BDNF, and so when you’re working with your patients and talking to them about fasting, what do you find to be the reasons why they continue doing it? I find for so many people, they just feel so much better. They’re like, “I had no idea that eating more frequently was contributing to why I had no energy.”

Dr. Mary Claire Haver: [00:15:04] Of all, we have three phases to our program and it’s the one that scares them the most if they’ve never tried it, because we were brought up in this culture of three meals a day and breakfast is the most important meal of the day. But actually once they get there, it is the easiest part of– the thing they can stick to the most. They go back to it first if they– life gets in the way, if they fall off the wagon, it’s the first thing they jump back into and they enjoy it. It’s not a big deal. They can do it on vacation. They can set their schedule around it. And they really think better. Like the brain fog that so many of us complain of in menopause seems to be so much better while you’re fasting, and that really keeps them sticking to it. 

Cynthia Thurlow: [00:15:53] Yeah. What is the more common reason or reasons why we have more inflammation and oxidative stress in middle age? What is mitigating that in your clinical opinion?

Dr. Mary Claire Haver: [00:16:03] So, there’s kind of two things that we talked about. There’s the chronologic aging, just the aging process. So, when you look at the longevity experts in all of their research, when they look at the actual DNA strands and how the telomeres are wrapped around the histones and how those start breaking down, that’s just part of the chronologic aging process. And I’m really excited to read some of those books and data as it comes out of things that we can mitigate nutritionally to slow that process down. We’re all going to die one day, we’re all aging, but can you live as healthy as possible without hurting, being able to think and take care of yourself for as long as possible, not being a burden on your family, which is my big goal.

[00:16:45] Well, there are three big things. The second of them is the endocrine aging for us, it’s menopause, okay? The drop in our testosterone, the drop in estrogen, the drops in progesterone, the Mr. Toad’s wild ride through perimenopause to the bottoming out to the less than 1% of the estrogen levels that we used to have in our normal reproductive cycles and how that dramatically affects the inflammation process.

[00:17:09] And third is the environment, our everything everything, our sleep patterns, our food choices, what’s available to us, the stress that we’re going through in our lives, pandemics, childbearing, kids leaving home, job changes, aging parents. All of that feeds into a negative feedback cycle for a lot of us.

Cynthia Thurlow: [00:17:30] Yeah, and it’s interesting. I actually interviewed Dr. Amy Killen a few weeks ago and she actually refers to menopause as a disease state, which was the first time I’d actually heard someone call it that. But she was explaining that so much changes in our bodies physiologically that maybe if we start referring to it as a disease state, it’ll get the attention it deserves to have.

Dr. Mary Claire Haver: [00:17:51] It deserves. So, if you take a woman who goes through menopause at 45 and you take a woman who goes through menopause at 55 and they’re identical twins, everything else is the same. The woman who went through menopause earlier is going to have a much higher risk of heart disease, of autoimmune disease, of Alzheimer’s, of dementia, of seven of the top ten leading causes of death, of cancer. She’s not going to live as long and not live as well. And so, yes, menopause is a natural process, but the later you are when you go through, the healthier you are. 

Cynthia Thurlow: [00:18:21] Yeah, it’s really interesting because I know the average age in the United States is 51 for menopause, but I’m seeing many of my girlfriends, thinner, people who are effectively privileged, they have the ability to do all the things to maintain their health going through at 47, 48, 49. I don’t know how to explain that per se, but it’s interesting that when I’m looking at research, it’ll sometimes say smokers sometimes go through earlier. Sometimes people that have more adipose tissue, more estrogen tissue, may go through a little later. I think so many variables whether or not it’s genetically mediated, environmental–

Dr. Mary Claire Haver: [00:18:56] There’s environment and genetics. So, they kind of play against each other definitely. Look at when your mom went through that’s going to give you some kind of idea. Of course, it’s not perfect, but if your mom went through at 45, you need to be on top of this. It’s going to come early for you, more than likely. And you can start changing nutrition, look at different supplementations so that you can set yourself up better than she was able to do for herself. And of course, hormone replacement therapy goes a long way, but it’s not perfect, it’s not the panacea for everything, but it is definitely– I spend so much time on social media just trying to educate people so that they can be informed enough to go and ask the right questions to their healthcare providers.

Cynthia Thurlow: [00:19:40] And I think that’s really important because I still find that– I was coming out in 2002, so young nurse practitioner and that was when WHI came out and there’s a whole generation of clinicians.

Dr. Mary Claire Haver: [00:19:52] This was when I was in training.

Cynthia Thurlow: [00:19:54] Yeah. A whole generation of clinicians who in many ways were fearful to prescribe patients who were fearful to take. And I feel like maybe the pendulum is swinging the other direction and I agree with you helping to educate people so they can work in conjunction with their healthcare provider to make the best decision for themselves and no one needs to suffer. I think that’s the big take-home message is just making sure people know there are options. When we’re talking about inflammation, I would be remiss if I didn’t talk about sugar and talk about alcohol and talk about things like gluten, which I know for many people can be– maybe they aren’t problematic in our 20s and 30s, but as we are getting older, our relationship with some of these more inflammatory substances can become problematic.

Dr. Mary Claire Haver: [00:20:36] Yes. So, definitely there are one-to-one correlations between the sugar, it’s the rapid rise of blood glucose leading to an insulin spike, that leads to the increasing inflammation levels. If we can slow down the absorption of sugars because they’re wrapped with fiber in handful of berries rather than in high fructose corn syrup, it’s a big difference. And I don’t want to vilify sugar as in general, but there’s a definite correlation between the amount of sugar in your diet, especially in the form of a simple sugar or high fructose corn syrup, and the inflammation levels. And it seems to be directly related to the rate of absorption and your insulin levels.

Cynthia Thurlow: [00:21:21] Yeah. It’s really interesting that when I’m talking to women about anti-inflammatory nutrition, which I know is another tenet of your book, The Galveston Diet, and really helping them understand the way that our body is processing different types of macronutrients, so protein, fat and carbohydrates, and understanding that changing our relationship with our carbohydrates is really critically important, we can’t eat as much, and sometimes we have to be really cognizant and careful and conscientious about what it is we are consuming. Green leafy vegetables, obviously they have carbohydrates are very different than having bread or pasta or rice, which is going to evoke a greater increase in blood sugar and then result in insulin secretion as well to bring your blood sugar back down.

Dr. Mary Claire Haver: [00:22:09] Hmm-mm. Exactly, having to– And I do a lot of education in the book trying to teach people about that process and giving them alternatives to enjoy that won’t be as deleterious to their blood sugar levels and the potential inflammatory increase.

Cynthia Thurlow: [00:22:25] Yeah, it’s really interesting. In the book you talk about– and I think for many people, they don’t understand we look at food labels for packaged foods, understanding net versus total carbohydrates. I actually think this is something that’s really important because I always say the processed food industry really is focused on trying to obscure the amount of carbohydrate we’re consuming, so they always focus on net versus total. And I always say total is– net is a cheat, you want to focus on total, it’s certainly very transparent. What are some of the tricks that you will help your patients with when they’re trying to lower their carbohydrate intake to be able to mitigate these blood sugar fluctuations that they’re experiencing?
Dr. Mary Claire Haver: [00:23:04] So, one of the things that we do is we talk about every meal and snack should have a combination of a healthy fat, a complex carbohydrate, and some kind of a healthy lean protein. And that combination seems to be the magic to make all– the fat and the fiber in the complex carb will slow the absorption of whatever sugars were naturally in the food, which is fine. The protein affects the other GI hormones in ways that decrease your satiety and make you feel fuller longer and decrease the carbohydrate cravings. And so typically, most women in the US eat very very little protein with breakfast. They usually have a carb oatmeal or cereal or toast or something. And then lunch is usually a salad with just a little bit of protein. And then they save their protein for dinner where they’ll have their piece of chicken or steak.

[00:23:59] And what I tell patients is like, “Look, you’ve got to eat protein throughout the day.” Your body only really can process 30, 35 grams, especially the older we get at a time. And then those amino acids will be stored as fat. And, so, your breakfast should have 20, 25, your snack should have 10, like each meal, and snack should at least have 20 for a meal and 10 for a snack if you’re dividing that out throughout the day. I mean, not try to stack all your protein for your one evening meal, and that will make all of those hormones work better together so you feel full, you’re not craving crazy things, you’re not having carb cravings, and making sure you’re getting the fats. Because we were all fat phobic [laughs] the way we were brought up. And I eat so much avocado now, 25-year-old me would be horrified by the amount of fat I eat in my diet a day. And I’m just chucking on nuts and avocado all day long.

Cynthia Thurlow: [00:24:52] Well, and it’s interesting because I think this is what leads to so much macro confusion. People were fearful of fat for a long time. Now we’re saying, eat the fat, it’s going to help with satiety, your tastebuds will be lit up. Now we’re working on the carbohydrate piece and I do find most, if not all, females eat too little protein, too much of the wrong types of fats, and too many carbohydrates. And once they start redistributing things, those satiety mechanisms that you’re alluding to do get triggered and then people are full. Like, I always say, if I eat enough animal-based protein, “I’m full.” I’m not thinking about dessert, I’m not thinking about anything else. I’m just comfortably full. But I think for many people, they’ve walked around it for so many years, eating too little fat, not enough protein, and they’re wondering why they’re hungry an hour or two after they eat a meal. And it has a lot to do with the lack of protein, the lack of healthy fats.

Dr. Mary Claire Haver: [00:25:46] Hmm-mm. Agree.

Cynthia Thurlow: [00:25:47] Yeah. And it’s interesting you allude to in the book, you were talking about some specific hormones, which I think are interesting in terms of the ones that are activated in the gastrointestinal tract that will help with satiety. I found this section in particular really interesting. Let’s talk a little bit about NPY and CCK and it’s almost like an alphabet soup, but I promise listeners you do a really nice job of explaining this in the book.

Dr. Mary Claire Haver: [00:26:13] So, these are hormones that are secreted in different areas of our gastrointestinal tract in response to what– they are sensors in our GI tract, in the stomach, in the small intestine, large intestine that are looking for protein, that are looking for fats, that are looking for carbs. And so, when it senses that those macronutrients are there, it will send signals to our brain saying, “Okay, we’re good.” And one of the most powerful triggers in a positive way that will make us not hungry, protein is one of them. And so, hormone PYY is one of the ones that is linked to our carb cravings. And so, getting enough protein throughout the day will turn that little signal to your brain off. Now, remember, all of these were evolutionarily put there to drive us to our next meal. Remember, we grew up as hunter-gatherers when food was not available 24/7, there was no McDonald’s, there was no Walmart. And so, all of our body was like, telling us to go find food so we don’t starve to death.
[00:27:25] And so given that the world has changed, we have to change the way we think about food. And like you said before, what we got away with in our 20s and 30s just isn’t working anymore. And so, learning about these hormones and how to make them work for you so that you’re not starving after the next meal and just wiping out the pantry because you don’t know what to do.

Cynthia Thurlow: [00:27:43] Yeah, it’s really interesting. There was a study done out of University of Sydney and it was talking about weight gain during the menopausal transition, evidence for protein leverage. And what’s interesting is they were talking about the physical changes, the phenotypic changes, the body weight gain, higher fat mass and less lean muscle mass. And so much of it was attributable to lower dietary protein intake, was associated with higher energy intake, meaning if you’re not hitting those protein macros or that protein threshold, your body will look for ways to get more food in and it’s probably going to be the wrong types of fats and too many of the processed carbs and lead to weight gain.

[00:28:23] So, it’s very interesting this low estrogen state with high FSH, the follicular stimulating hormone, it actually adversely impacts muscle breakdown. And so, if you’re not getting enough protein in your diet, it’ll actually lead you to eat more carbs and more of the wrong types of fat, so it’s amazing the way our bodies work to try to acclimate to these changes. But understanding that physiology explains why if your patients are eating these minuscule meals that are higher carb earlier in the day, and then they eat maybe a bigger meal at dinner, but then their body is just like, “I haven’t gotten enough food all day long, I’m just going to continue wanting to eat.” People are feeling the need to be in their pantry, they’re snacking, they’re eating more meals after their meals and not understanding why that’s happening.

Dr. Mary Claire Haver: [00:29:06] Right.

Cynthia Thurlow: [00:29:08] So, obviously, your book is The Galveston Diet, and it’s three key areas. We’ve touched on intermittent fasting. We’ve kind of alluded to the anti-inflammatory diet, but let’s talk about the book, because I think you’ve really done a nice compilation of putting together these strategies that you’ve worked on with your patients over the last several years.

Dr. Mary Claire Haver: [00:29:27] So, yeah. The first, we have three actions, what we call– so the first is intermittent fasting and when I introduce people to the program, I tell them, you have the rest of your life to figure this out. Don’t try to make all of these changes at once. Read the science, let it sink in, read it again, listen to it on audio. However, you learn– on our online program, I try to provide all the different resources because I know adult learners sometimes need to hear it, read it, see it, touch it, see it graphically, so we have all of that available online. And let the science sink in because just handing you a meal plan, sure you’ll do okay for six weeks until that meal plan goes away, and then you don’t understand why I asked you to make these changes that are going to benefit your health. So intermittent fasting is the first thing, and I’m like, conquer that, get that solid, set, normal part of your life before you ever move on to the next thing.

[00:30:15] So, the next phase we introduce our patients or our students to is the anti-inflammatory nutrition. Starting to think about which foods uniformly are inflammatory for everyone. Things like artificial colors, artificial flavors. Our gut microbiome does not know what to do with these artificial ingredients and it really causes gut disruption. We touch on that in the book as well. And then the things that really promote anti-inflammatory state. So leafy greens, vegetables, fruits, eating the rainbow is a big thing we talk about in The Galveston Diet. Like, the more colors you have, the more different micronutrients you have creating those colors. And each of those has an individual nutrient profile, so trying to eat a variety of foods, different colors, staying in the fruits, vegetables, lean meats, legumes, and why these foods and the properties in these foods make them anti-inflammatory. We talk about anthocyanins and the different chemicals in the foods that will helpfully decrease inflammation.

[00:31:23] Now there’re some foods that are pretty neutral that don’t promote inflammation, but they don’t really fight inflammation like a lot of the lean meats. They’re perfectly fine, but they’re not considered to be anti-inflammatory, but they’re not going to promote much inflammation if you eat them in moderation in the right ways.

[00:31:41] And then the third part is what we call fuel refocusing. And that’s when we do a really deep dive into macronutrients, micronutrients. We have a weight loss kind of macro settings that we offer. But then if you’re just coming here to be healthy and you don’t really have a weight issue, we have other macro goals that we set that we call our maintenance goals that they can kind of follow lifelong.

[00:32:05] And we talk a lot about the micronutrients. I talk a lot about fiber, magnesium and how a lot of us are deficient in these things and how to choose foods to increase those levels. And we talk about supplementation as well. And so, given my nutrition background, most of your nutrition should come from food. We should really only supplement when there is a gap. And we can have gaps for many reasons, we’re allergic, we’re intolerant to certain foods, we don’t have access, we live in a food desert, we don’t have enough money to afford to eat whatever. But supplements, whole foods should come first, your nutrition should come from food first and supplements, we just supplement any gaps that are there.

Cynthia Thurlow: [00:32:45] And do you have specific supplements that you like as a general recommendation?

Dr. Mary Claire Haver: [00:32:47] Yes.

Cynthia Thurlow: [00:32:49] Not asking you to say this is what everyone needs, but do you have specific supplements that you really like to utilize with your clients?

Dr. Mary Claire Haver: [00:32:54] Yeah, I do. So, the vast majority of us are deficient in the amount of fiber that we get in our diets per day. For a woman, it’s somewhere between 25 to 35 grams of fiber. I easily get 25 in my diet every day, again from the avocados, nuts, seeds, but I will supplement to hit 35. So, Galveston Diet does have a fiber supplement. I do supplement collagen. I don’t recommend it for everyone. And to be honest, I started collagen supplementation for vanity reasons. I was frustrated with the cellulite, and I had read some pretty good research on how appearance of cellulite can be improved with this certain collagen, so, I do use that. But just recently that same collagen has been found to help with osteoporosis. So now I feel better about myself that it has a medical indication.

[00:33:47] Omega-3 and vitamin D are another two that I quite often will recommend. A lot of people aren’t getting enough or don’t have access or don’t like it. Fatty fish, which is probably the best source of vitamin D out there as well as omega-3. We are covering our skin, we are trying to protect ourselves against skin cancer, and so we are not– about 80% of my patients are deficient in vitamin D, really really low and so I offer a lot of vitamin D supplementation as well.

[00:34:19] Magnesium is one that about 50% of us are deficient. However, there’s some medicinal properties when you go over. And so, for some people, it can help with sleep. And there’re multiple forms of mag out there, and it really depends on what you’re trying to achieve. And so, for the one that crosses the blood brain barrier the best– so, if I’m recommending for sleep, I’ll usually recommend a glycinate or an L-threonate to try to get the most, the highest bio-absorption and then across the blood brain barrier to work on the neurons.

Cynthia Thurlow: [00:34:49] Those are some really good suggestions. Where do non-nutritive sweeteners fall into your program? Whether it’s sucralose, aspartame, stevia, etc.

Dr. Mary Claire Haver: [00:34:59] So, the ones that are artificial like the aspartame in that family, I advise people to stay away from them. They really are gut disruptors. There’re lots of great research around that I fully believe. So, we stick to stevia and monk fruit for sweeteners in our recipes, but I tell them not to use those until they break the fast. They can stimulate and start an insulin response from the tongue receptor because they do stimulate the sweet receptor on the tongue, so we usually recommend not utilizing those until after you break your fast. Sucralose, it can be a GI disruptor. I’m kind of on the fence about that one. I don’t use it. Some of my followers really like it in a couple of recipes. I don’t feel strongly about that one, but other people have told me it gives them diarrhea.

Cynthia Thurlow: [00:35:45] It’s interesting because there was a study that came out in the fall talking about non-nutritive sweeteners. So, it was saccharin, which I don’t know where that’s used. Saccharin, stevia, sucralose, aspartame and the impact, this was in a rodent study, but it was looking at oral glucose tolerance and how disruptive it was in terms of the gut microbiome and blood sugar variability, which I found really interesting and it was just like a 28-day study. So, I completely agree with you that being careful about these non-nutritive sweeteners, being really conscientious about them, and certainly you probably get the same questions that I do. People say, “Does this break my fast?” And I always talk about the cephalic phase insulin response and I’m like, “if it’s sweet, don’t consume it in a fasted state” and assume that your body doesn’t think food is coming because even though it’s stevia and yes, I know your blood sugar, your glucometer, your CGM didn’t blip, that doesn’t mean that your body doesn’t perceive something is coming, something in the terms of food. Do you utilize any continuous glucose monitors or glucometers in your program or with your patients to help them kind of navigate food choices or stress?

Dr. Mary Claire Haver: [00:36:49] I haven’t yet. So, in my clinic, I have a body scanner, the InBody scanner, so I’m able to measure muscle mass, visceral fat mass, and we do a lot of discussion around that. I have a couple of patients who have gotten the online version of the continuous glucose monitors. It’s really hard for an OB/GYN to get insurance to pay for that outside of pregnancy, so they have to see a specialist and how–. So, some patients are just motivated and with their own money have gotten and I’ve helped them navigate, but it’s price restrictive for most people to be able to utilize that, so I don’t use it as a standard part of treating patients, but I encourage it. If they want to spend the money and that’s what they want to do, I’ll try to help guide them through it.

Cynthia Thurlow: [00:37:36] Yeah, it’s my hope as metabolic health kind of becomes a bigger and bigger topic for clinicians and patients, helping people understand, this is your N of 1, this is your body’s response to food, stress, poor quality sleep, exercise, and glucometers, I think, can sometimes bridge that gap because they’re so much less expensive. And I agree with you, I wish CGMs were covered by insurance companies, because to me, it’s so insightful, sometimes people don’t know that they are becoming more insulin resistant, and this can really be super helpful.

[00:38:09] Well, Dr. Haver, I want to be super respectful of your time. I know during a book launch you have a lot of media that’s stacked up. Please let my listeners know how to connect with you, where to get your book which goes on sale next week, which is so exciting?

Dr. Mary Claire Haver: [00:38:24] So, galvestondiet.com is our website. I am @drmaryclaire on Instagram and on TikTok, if they want to follow me. I do a lot of education around menopause, around nutrition. I do a lot of Q&As there. It’s so much fun for me to connect there. And on our website, if you’d like to come and visit me as a patient, if you’re in Texas, come on down to the Houston area, I’d love to see you, there’s a link there. And we have a YouTube channel as well, so we’re pretty much on all social media channels.

Cynthia Thurlow: [00:38:53] Wonderful.

Dr. Mary Claire Haver: [00:38:54] And the book link is on our website. It is available for preorder now if you’re willing to wait till January 10th.

Cynthia Thurlow: [00:38:57] Awesome. Well, it’s been such a pleasure connecting with you. Thanks for doing such great work and being an advocate for women.

Dr. Mary Claire Haver: [00:39:06] Thank you so much.