Build Strength, Live Longer: The Menopause Longevity Blueprint with Dr. Vonda Wright

What if weak bones and muscle loss aren't just "normal aging" but the result of decades of misinformation? In this episode double board-certified orthopedic surgeon Dr. Vonda Wright joins Dr. Mary Claire Haver to shatter the myth that frailty, fractures, and decline are inevitable for women in midlife. Dr. Wright explains why women can lose up to 20% of their bone mass in just five years after menopause—and more importantly, what we can do to prevent it. She reveals how stress, inadequate nutrition, and neglecting strength training and hormonal health create the very outcomes we've been taught to accept as unavoidable. From the "musculoskeletal syndrome of menopause" that affects 70-80% of women (yet most doctors never discuss) to the science of building bones through strategic lifting, Dr. Wright provides the blueprint for aging with power instead of resignation. This episode also covers: -Why your bones are master communicators affecting your brain, metabolism, and more -The real story behind frozen shoulder and why it happens to women in perimenopause -How to lift weights for longevity -Why many women are diagnosed with osteoporosis only after they break something, when it's already too late -How estrogen loss drives chronic inflammation -Why nutrition, specifically foods that are rich in calcium, are better than calcium supplements to help strengthen bones Dr. Wright also shares her personal journey through perimenopause as an athlete and surgeon, and why she wrote her latest New York Times bestselling book Unbreakable. Guest links: Dr. Vonda Wright https://www.surgeon.drvondawright.com/about Dr. Vonda Wright https://www.instagram.com/drvondawright/ (Instagram) Articles Longitudinal changes in bone mineral density during perimenopausal transition: the Vietnam Osteoporosis Study https://pubmed.ncbi.nlm.nih.gov/37106043/ (Osteoporosis International) Osteoporosis Due to Hormone Imbalance: An Overview of the Effects of Estrogen Deficiency and Glucocorticoid Overuse on Bone Turnover https://www.mdpi.com/1422-0067/23/3/1376 (International Journal of Molecular Sciences) The musculoskeletal syndrome of menopause https://www.tandfonline.com/doi/full/10.1080/13697137.2024.2380363 (Climacteric) Bone remodeling: an operational process ensuring survival and bone mechanical competence https://www.nature.com/articles/s41413-022-00219-8 (Bone Research) Biological basis of bone strength: anatomy, physiology and measurement https://pmc.ncbi.nlm.nih.gov/articles/PMC7493450/?utm (J Musculoskelet Neuronal Interact) Stem Cells for the Regeneration of Tendon and Ligament: A Perspective https://pmc.ncbi.nlm.nih.gov/articles/PMC7691853/ (International Journal of Stem Cells) Peak bone mineral density in Vietnamese women https://pubmed.ncbi.nlm.nih.gov/20234855/ (Archives of Osteoporosis) Sarcopenia: revised European consensus on definition and diagnosis https://academic.oup.com/ageing/article/48/1/16/5126243 (Age and Ageing) Sarcopenia https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31138-9/abstract(The Lancet) The Conceptual Definition of Sarcopenia: Delphi Consensus from the Global Leadership Initiative in Sarcopenia (GLIS) https://academic.oup.com/ageing/article/53/3/afae052/7633681 (Age and Ageing) Sarcopenia definition, diagnosis and treatmen ...

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Mary Claire Haver?

  Buy smart, drive for less, and trade for more. That's Toyota affordability, and it all starts with a great deal from your local Toyota dealer. Make a smart buy on an all-wheel-drive Camry, Corolla Cross, or get a Corolla sedan, packed with the latest features, advanced tech, and head-turning style. Take a test drive in two of Toyota's most popular SUVs, the spacious, family-friendly Grand Highlander and adventure-ready RAV4. And with so many hybrid and plug-in hybrid models available across the lineup, plus efficient all-electrics like the BZ, BZ Woodland, and all-wheel-drive CHR, you can drive your way and skip the pump. And long after you leave the lot, your Toyota keeps delivering,

• 0:44Dr. Mary Claire Haver?

  with legendary resale value built on a reputation for quality and reliability. So when it's time for your next Toyota, you could trade in for more. From a great deal today, to a great value tomorrow. A Toyota is right for you. Shop toyota.com for deals and details, or stop by your local Toyota dealer today. Toyota, let's go places.

• 1:08Speaker 01

  I contend that although we certainly undergo some life-stage changes, what we call "normal aging" is actually "normal aging" for stressed-out, undernourished people who are not intentionally building muscle, not attending to their hormonal health, and not prioritizing mobility. Aging to frailty only seems "normal" because modern life has made it so and threatens to rob us of our vitality. It's why most of us spend a quarter of our lives deteriorating from chronic diseases that encompass what we now understand as Sedentary Death Syndrome.

• 1:45Dr. Mary Claire Haver?

  The views and opinions expressed on UnPaused are those of the talent and the guests alone, and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.

• 2:12Dr. Mary Claire Haver?

  Both my grandmother and my mother had osteoporosis and fractures. So I always assumed it was inevitable for me, too. I knew menopause hormone therapy would give me an edge, but I honestly thought weak bones and multiple fractures as I aged would just be my destiny. I see older women every day who were clearly becoming frail, bent over, moving stiffly, faces showing pain with every step. Recently, on a flight, I noticed an elderly woman traveling with her family. She was very weak and had trouble balancing and had to be guided just to walk. And it was clear she was living with dementia. I could even see through her pants that she was wearing a diaper. Her family tended to her with such love and care.

• 2:55Dr. Mary Claire Haver?

  And I thought, my God, she's so loved and so well cared for, thank goodness. But I couldn't help wondering what the last 10 years of her life had looked like. Was this long, difficult end of life slog inevitable? Is this what we're all destined for? Or can we change the way we think about aging, frailty, and independence? The first time I heard our guest, Dr. Vonda Wright, speak was at a menopause conference. I had never heard anyone talk specifically about aging for women. She told stories of women coming into the ER with a hip fracture who also had heart trouble or incontinence. And they would look at her and say, "I wasn't always like this." Hearing her speak stopped me in my tracks.

• 3:40Dr. Mary Claire Haver?

  She wasn't calm or detached about the way women age. She was furious. Furious that so many women are funneled down a path towards frailty, osteoporosis, and muscle loss, when so much of it is preventable. Up until that moment, I had only heard osteoporosis and sarcopenia discussed as inevitabilities, something you diagnose, accept, and manage with treatment, almost never as something you could actually prevent. Dr. Wright shattered that narrative for me. She said, "No, this doesn't have to happen. Here are the steps." She showed me that osteoporosis is largely preventable, that frailty doesn't have to define the latter decades of a woman's life.

• 4:25Dr. Mary Claire Haver?

  And hearing her say that completely changed the way I think, the way I practice medicine, and the way I counsel both my patients and my followers. I call this stretch of life the minnow span. And we need to talk about it openly, urgently, and with solutions. Because aging looks very different for women than it does for men. And if we understand the difference, we can change the trajectory. I'm Dr. Mary Claire Haver, a board-certified obstetrician and gynecologist, and certified menopause practitioner, and also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to UnPaused, the podcast where we cut through the silence

• 5:08Dr. Mary Claire Haver?

  and talk about what it really takes for women to thrive in the second half of life. Joining me today is Dr. Vonda Wright, a double-board certified orthopedic surgeon, internationally recognized researcher and sports physician with more than two decades of experience dedicated to high-performance orthopedics, aging, and women's health. She is the author of bestselling guides like Younger in Eight Weeks, Fitness After Forty, and her latest New York Times bestseller, Unbreakable: A Woman's Guide to Aging with Power. Millions of women experience debilitating fractures every year from osteoporosis. And yet, it's still framed as inevitable aging rather than a preventable, diagnosable condition.

• 5:52Dr. Mary Claire Haver?

  One out of two women will suffer an osteoporotic fracture after the age of 50 versus 20% of men. Most women have no idea that they can lose up to 20% of their bone mass in the first five years after menopause. And as bone mass decreases, fracture risk increases. As I told you, Dr. Wright's mission is to educate women and help them navigate midlife with clarity. That begins with seeing menopause not only as the moment when your periods stop, it's the life stage many of us will enter for the next 45 years, and one we can meet with strength and resilience.

• 6:29Dr. Mary Claire Haver?

  Why did you leave nursing? Why orthopedic surgery?

• 6:32Speaker 01

  I know, orthopedic surgery of all the things. I was fortunate to progress really rapidly in nursing. Smart kids in my generation were directed only a few pathways. There weren't that many. There was like, you should be a doctor, teacher, nurse. And I come from a really small town in Kansas. So of course I said, okay, I'll be a doctor, even though nobody in my family was a doctor. And my, my parents were the first in their family to go to college. I get to college where I made it through freshman year. Organic chemistry then comes in front of me. And on the second organic chemistry test, I failed it. And I'd never failed anything in my entire life. And so I didn't know what to do with that. The end of the story is by the end of the year I had a B. But by then I had decided that I couldn't be a doctor.

• 7:17Speaker 01

  And no one told me that that was just bad thinking, right? So right after college, I have a degree in biology. There were such a shortage of nurses that in three years I got another bachelor's degree and a master's degree in cancer nursing and started working on a cancer floor at 23 years old. But because I had the capacity to learn really quickly, I progressed really quickly in that job and I was promoted. And suddenly I was 27 thinking, I think I've learned what I'm going to learn from this career. So do I do a PhD? Do I go into the business of nursing? Or do I finally go into medicine? And I decided in the end that I need to take care of people and I need to do research.

• 8:01Speaker 01

  And being a doctor allows me to do both. It'd been 11 years since I took organic and all those things because I hadn't taken my MCAT.

• 8:08Dr. Mary Claire Haver?

  Yeah.

• 8:08Speaker 01

  So I went back and I took all those things and went to medical school only for some reason to decide to do a surgical residency, which dumped me out of my training at almost 40.

• 8:21Dr. Mary Claire Haver?

  So how old were you when you started medical school?

• 8:23Speaker 01

  28.

• 8:24Dr. Mary Claire Haver?

  So there's not a lot of female orthopedic surgeons. I knew two, I think, on through all my training and they were badasses. Why on earth, Vonda, would you pick something there? You're automatically an outsider.

• 8:37Speaker 01

  I mean, I knew that there weren't many women, but I didn't realize that it could be a problem. And I'm going to tell you for sure, it never became a problem until I was an attending. Only when I was attending did I feel the difference in opportunity, the difference in acceptance of my work, the difference in salary. In my residency, I think we were well supported. This was an anomaly and amazing, but out of 46 residents, there were eight women, which is unheard of. I never knew in residency it was going to be a problem. And plus, I was a nurse and I was a cancer nurse and I wasn't about to be pushed around.

• 9:13Dr. Mary Claire Haver?

  Yeah.

• 9:13Speaker 01

  But not until I got to my attending ship, did I see the differences that still exist today, even though when I trained, there were 3% women and now there are 6% or 7% women. We're not at critical mass.

• 9:27Dr. Mary Claire Haver?

  Let's pivot a little bit. I want to hear about your own experience at midlife. You've talked about this before. So you're getting tossed out of your training residency and newly minted.

• 9:37Speaker 01

  Yeah.

• 9:38Dr. Mary Claire Haver?

  At around 40.

• 9:39Speaker 01

  Yeah.

• 9:39Dr. Mary Claire Haver?

  And what was that like for you?

• 9:41Speaker 01

  What, to be that old, married, old?

• 9:44Speaker 01

  You know, 40.

• 9:45Dr. Mary Claire Haver?

  Being in the best shape of your life.

• 9:46Speaker 01

  I was. 40 was amazing. I lived in New York, 38, 39. I moved back to Pittsburgh where I took a faculty job at 40. But you live in New York and you walk everywhere and you have access to amazing food. And I started racing in the park and training for triathlon. And I was single at that time, so I had, I could work out twice a day if I wanted. So I entered my attending ship at 40 in the best shape of my life, as I describe it. I decided to have a baby. So I had a child when my dear friends, the OBs call us geriatric. But I exit that. And what I've become aware of, Mary Claire, is that, okay, baby at 40, I breastfed till

• 10:29Speaker 01

  almost 42. I think I went right into perimenopause because the chaos of pregnancy, then the resumption of your estrogen, weirdo.

• 10:38Dr. Mary Claire Haver?

  They go back to work. I can't imagine what your cortisol levels were doing.

• 10:41Speaker 01

  Oh, six weeks. And I was the head doctor for the University of Pittsburgh football team. So I was leaving my newborn to go take care of 150 football players, which is my job. But the cortisol, crazy, right? So I don't, I think I went right from one hormonal stage to the other, but I didn't know it. I had no idea what was happening. You're gonna laugh at this. I've said this out loud sometimes. I wasn't sleeping. I had a new baby, but different kind of not sleeping, hot flashes. I lost my nouns. And I thought that I was getting dementia. So I'd started looking it up online. I started having heart palpitations. I call my friend, the cardiologist, to do a stress test. And then I couldn't get out of bed, right? Triathlete training person couldn't get out of bed because of

• 11:26Speaker 01

  the musculoskeletal syndrome of menopause. But here's the, here's the wackiest thing and just shows that I got no education on this in medical school. I was an athlete my whole life and had a lot of amenorrhea. If I was just that kind of athlete.

• 11:38Dr. Mary Claire Haver?

  Yep.

• 11:39Speaker 01

  And low body fat for months. And I'm like, yes, because then you don't have to mess with it. Little did I know, that was damaging my bones. And I didn't know.

• 11:48Dr. Mary Claire Haver?

  You were robbing your body of estrogen.

• 11:49Speaker 01

  Yes. So I get to perimenopause and I start having heavy raging periods. And do you know what I said to myself, Mary Claire? I said, oh, my God, I'm finally a woman. Because all the other girls had, I never had real periods. Isn't that ironic? But then when I entered this place where I describe it as feeling like I was gonna die, out of control, like. I've never not been in control. I'm a surgeon, right? It's my job to be in control, but my old body was revolting against me out of control. Makes me sad. I'm about crying. Like, I figured it out. I did a deep dive. I became an expert in what I could. I read the

• 12:31Speaker 01

  books, right? I was not going to leave a stone unturned. But it makes me upset about all the women I meet right now who still don't know what perimenopause is.

• 12:40Dr. Mary Claire Haver?

  Yeah.

• 12:41Speaker 01

  I mean, I had all the resources in the world and I still didn't know.

• 12:44Dr. Mary Claire Haver?

  Same. I was the expert.

• 12:46Speaker 01

  That's right. You're an OB-GYN program director.

• 12:48Dr. Mary Claire Haver?

  I could not diagnose myself. I gaslit myself for six months and I was actually fully menopausal by that point. But I'd never had regular periods and I was blaming stress and, you know, my brother's death and all the things. And after like month six, I was like, oh, my God, I might be in menopause.

• 13:06Speaker 01

  I know.

• 13:06Dr. Mary Claire Haver?

  Like, like, and I felt like a chapter of my life was ending. Why did you write Unbreakable?

• 13:12Speaker 01

  It's interesting. Unbreakable is actually how I treat women. This is not theoretical. It's not something that I had to make up to write a book. It's actually my approach to women. And so I felt like I was seeing enough women. I had a system that I was using. And the need was so great, Mary Claire. I mean, not everybody is going to read the papers we published in academic journals. My group published this paper on the musculoskeletal syndrome of menopause and inclimacteric. So I'd like to raise my hand and say, that was God's gift to papers, but it wasn't. It was a good paper. That tells me the need was so great that women are dying out there and need information, right? It's the same response,

• 13:57Speaker 01

  you know, that you get from the new menopause, right? Women are dying. They need information. And that made me think, okay, Mary Claire's written this seminal book on menopause. A lot of our friends have written great books on menopause and I'm going to write the book that tells them now what.

• 14:14Dr. Mary Claire Haver?

  Now what?

• 14:15Speaker 01

  What do you do next? And so that's what Unbreakable is, but it's more than just physical resilience. But when we close the back cover of the book, I'm hoping that women close. The cover on hopelessness and emerge with this great hope that their future can be unbreakable if they step in front of it.

• 14:33Dr. Mary Claire Haver?

  There's a couple of paragraphs early on that really strike me as probably two of the most important paragraphs in this book, and I would like you to read them for me. I don't think I can do them justice.

• 14:44Speaker 01

  Oh, you're so sweet. Okay. I contend that although we certainly undergo some life stage changes that we call, what we call normal aging is actually normal aging for stressed out, undernourished people who are not intentionally building muscle, not attending to their hormonal health, and not prioritizing mobility. Aging to frailty only seems normal because modern life has made it so and threatens to rob us of our vitality. It's why most of us spend a quarter of our lives deteriorating from chronic diseases that encompass what we now understand as sedentary death syndrome.

• 15:28Dr. Mary Claire Haver?

  Let's dig in. The bone I had at 30 is not the bone I have at 57.

• 15:33Speaker 01

  No, it is not. In fact, that was two and a half bones ago.

• 15:37Dr. Mary Claire Haver?

  So explain that to me. Talk to me about how bone is made, how it turns over. Like, what is the process of our bones?

• 15:43Speaker 01

  If we think of bones at all. The only time I contend that people think of bones is when Aunt Mary breaks one.

• 15:50Dr. Mary Claire Haver?

  Or Mama.

• 15:50Speaker 01

  Or Mama. But the reality is, bones are not just a structural I-beam that our muscle is attached to. It is a structural I-beam, and thank God, because if muscle weren't attached to it, muscle would just be a heaping pile of metabolic tissues steaming. It wouldn't have the form and function. We would not locomote. But bone, my friend, is the incubator of all of our baby blood cells. We make all of our immune system in our pelvis and long bones.

• 16:18Dr. Mary Claire Haver?

  In the bone marrow.

• 16:19Speaker 01

  It is the storehouse for all of the minerals that our body needs to function, from our brain to our muscles. So, structure, it is storehouse, it is incubator, it is endocrine organ secreting hormones that move to almost every other. Other body part and do things like help you build a better brain.

• 16:39Dr. Mary Claire Haver?

  Walk me through a little bit of that. You've always said that bones are a master communicator.

• 16:44Speaker 01

  They are.

• 16:44Dr. Mary Claire Haver?

  So for our listeners, what does that mean?

• 16:47Speaker 01

  Yeah.

• 16:48Dr. Mary Claire Haver?

  So they make, bones make hormones?

• 16:49Speaker 01

  They do. They make many kinds. I love to talk about two in particular. One called osteocalcin and one called LCN2. Osteocalcin is secreted by the bone. It can cross the blood brain barrier and stimulate your brain to produce its own growth hormone called brain derived neurotrophic factor, which helps you build a better brain. Your bones do that, right? It goes to your pancreas. The pancreas is responsible for secreting the hormone insulin, which helps us with our blood sugar and without the function of the pancreas. And so bone sends osteocalcin to the pancreas. It sends it to the muscle to help with glucose metabolism.

• 17:32Speaker 01

  If you're a man, it sends it to your testicles to help you make testosterone. And we think bones are just structural. They are talking all the time. Bones also secrete this other hormone called LCN2, which is directly influencing the feeling of satiety or feeling full after a meal.

• 17:52Dr. Mary Claire Haver?

  Whoa.

• 17:52Speaker 01

  I know.

• 17:53Dr. Mary Claire Haver?

  GLP-1.

• 17:54Speaker 01

  Exactly. And I had that same reaction that when I first read about it, like, what? But, but it makes so much sense. If our bones are the storehouses of minerals, if they're involved in glucose metabolism, why wouldn't bones also be interested in influencing when we're full? The system just works together. So when I say bones are the master communicators, they're talking all the time to every other tissue. It's just that we don't know how to listen to them.

• 18:25Dr. Mary Claire Haver?

  Okay.

• 18:25Speaker 01

  We're not good bone listeners. When you asked me the question of the bones you had at 30 are not the same bones you have today, that is because not only are they master communicators, but they're constantly renewing. The way bone is made, which is important in menopause, is there's a cell type called an osteoclast. Which digs bone out.

• 18:47Dr. Mary Claire Haver?

  I think of it as Pac-Man.

• 18:48Speaker 01

  That's right. That's like, maybe that's why I do this with my hand when I talk about it. It creates an acidic environment. So all the minerals and vitamins are removed from bone. So your body can use them. Well, your body's not going to leave itself full of holes. Coming up behind it is the osteoblast, which fills these little holes. When we have enough estrogen is a balance because our bones are constantly remodeling. That's the key word. Every 10 years, we, we essentially have a new set of bones. But the problem happens when for some reason we are not balanced and we're breaking down more bone than we are building.

• 19:26Dr. Mary Claire Haver?

  And that happens in menopause?

• 19:28Speaker 01

  It happens. One of the reasons it happens is in menopause. One of the main reasons is because estrogen is a critical controller of the osteoclast. So this Pac-Man is partially controlled by estrogen. So without that, we're eating more bone than we're laying down.

• 19:45Dr. Mary Claire Haver?

  You can lay down.

• 19:45Speaker 01

  Yes.

• 19:46Dr. Mary Claire Haver?

  What is peak bone mass? What does that mean?

• 19:49Speaker 01

  So peak bone mass is the bone mineral density. It's a measure of how much mineralization is in the bone. We reach the peak, we say 30, but it probably happens between 17 and about 25. And so I get a lot of young women, their peak bone mass is osteopenic.

• 20:08Dr. Mary Claire Haver?

  Wow.

• 20:09Speaker 01

  Because I test almost everybody that comes in to me. And if I catch it in their twenties, then we do a big job of trying to get you to a better peak bone mass. But that being said, I catch a young, a lot of young women in their early 30s, definitely in their early 40s, who don't have amazing bone mineral density. So you're starting this decline

• 20:32Dr. Mary Claire Haver?

  Okay.

• 20:33Speaker 01

  From a lower starting point. We want to start this decline from as high as we can because we are going to decline due to natural aging and then this catastrophic loss of estrogen.

• 20:44Dr. Mary Claire Haver?

  Let's talk about muscles and tendons for a little bit.

• 20:46Speaker 01

  Here's the thing. Muscle, tendon, ligament, bone, fat, annulus, the discs in our spine, they all come from the same kind of stem cell. They're all cousins. They all speak the same hormonal language. So they're all interacting. They're all talking together all the time. So that's why we can build better bone through the, through the action of muscle.

• 21:08Dr. Mary Claire Haver?

  Yeah. That musculoskeletal unit always works together.

• 21:12Speaker 01

  Exactly.

• 21:13Dr. Mary Claire Haver?

  So, strong muscles usually mean stronger bones.

• 21:15Speaker 01

  Better bones.

• 21:16Dr. Mary Claire Haver?

  Okay. So what is, so we talked about peak bone density. What is low bone density?

• 21:21Speaker 01

  Yeah. So the most common way to measure bone mineralization, bone density is through this test called a DEXA scan. It uses x-ray to tell us about our, our, how much bone we have. So the top of the bell curve, the zero point, the average is the bone density of a healthy 30-year-old woman. When you get your DEXA scan, any positive number is fantastic. That means you have bone density more than a healthy 30-year-old. But at minus one, we start calling that bone osteopenic.

• 21:53Dr. Mary Claire Haver?

  Okay.

• 21:54Speaker 01

  Which means it's getting weak. If we continue to lose bone and our T-score declines to minus 2.5, which is two and a half, two and a half standard deviations below average. So that's osteoporosis. One in about two women will get osteoporosis, about 40 to 50%. And if you do, you have a 50% chance of fracturing. So it, it makes your fracture risk much, much higher. And you wouldn't even care about that until you fracture. And then it's all anybody in your family can think about. Definitely all you're thinking about.

• 22:31Dr. Mary Claire Haver?

  When do you order a DEXA? Or when do you recommend?

• 22:33Speaker 01

  I order DEXA on everybody.

• 22:35Dr. Mary Claire Haver?

  Same.

• 22:35Speaker 01

  I think, just like we get our mammograms at 40, I think we should have our screening test by 40.

• 22:41Dr. Mary Claire Haver?

  You should have a baseline.

• 22:42Speaker 01

  Let's just figure it out, whether it's REMS, whether it's DEXA, just find one. In fact, we should probably do it at 35, when we have a little bit of estrogen still circulating.

• 22:52Dr. Mary Claire Haver?

  To see what's your, your, your peak.

• 22:53Speaker 01

  Your baseline. And if you're already low, then you really gotta get after it. Cause you're still probably producing some estrogen.

• 22:59Dr. Mary Claire Haver?

  Walk us through bone loss over time. Like, what is the process?

• 23:04Speaker 01

  What is bone do, right? So we're building peak bone density, if we're building peak bone density to 30. And then we stabilize for a while.

• 23:13Dr. Mary Claire Haver?

  Okay.

• 23:13Speaker 01

  And then, just like men, we start to lose bone density about 1% per year in a slow steady decline. And men just continue like that. Men get osteoporosis, 2 million men in this country have osteoporosis, but they have this slow steady decline, nobody notices. For women in perimenopause, when estrogen walks out the door, as I like to say, and never looks back, that girlfriend of ours, we start to rapidly lose bone density between 2 and 3% a year, such that in the 5 to 7 years surrounding the end of perimenopause to menopause, we can lose 15 to 20% of our bone density, and most of us never know it.

• 23:54Dr. Mary Claire Haver?

  Have no idea.

• 23:55Speaker 01

  No idea. It's a shock when people, even women who are doing all the right things, will lose bone density because of the loss of estrogen. So that's what happens. So men and women do not age the same when it comes to bones.

• 24:09Dr. Mary Claire Haver?

  Now, what role, we talked about estrogen, does the other 2 hormones involved, you know, coming from the ovaries, progesterone and testosterone, have any play in this?

• 24:19Speaker 01

  Yeah, testosterone has a bigger role than progesterone. I mean, and the reality is, these things need to be worked out. We don't, we don't know all the answers, like, how does progesterone affect it? How can we use the supplemental progesterone that some of us take at night? But because not enough research has been done. We know testosterone plays a big role in bone density, in both men and women, but not as big as estrogen does.

• 24:44Dr. Mary Claire Haver?

  As estrogen does. What is sarcopenia?

• 24:47Speaker 01

  Yeah, so sarcopenia, translated means a low muscle.

• 24:52Dr. Mary Claire Haver?

  Okay.

• 24:52Speaker 01

  Loss, sarc, muscle, pina, less, like osteopenia, sarcopenia. But it is not just about your total pounds of muscle. It is a functional definition. You want to be 45% muscle or more, actually. But it's functional, meaning can you sit to stand? How fast can you walk? Because the concept of sarcopenia has to do with function. Do we have enough muscle mass to function? Do we have enough strength in the muscle we have? To get up off the floor or to walk fast enough to be safe. It's not running, but it's it's not the slow crawl we see some people do as they age.

• 25:33Dr. Mary Claire Haver?

  What is frozen shoulder?

• 25:35Speaker 01

  One of the most audible musculoskeletal symptoms of menopause has to do with our shoulders. And it's not because suddenly your shoulder is bad for you. Estrogen walks away, we become highly inflamed everywhere. The shoulder is very susceptible. So the shoulder on the inside, you see it on the outside with skin and then muscle. And then inside of that, there's this layer called the capsule. The capsule will become so inflamed that overnight you wake up and your shoulder is killing you. And you didn't bump into the door, nothing happened. You're like, I don't know what happened. So like most women, you try to wait it out. You're like, I got this, I've suffered a little. And so women come to me in a relatively short amount of time and their arms will no longer move.

• 26:20Speaker 01

  They're excruciating and they can't get their arm up and they certainly can't hook their bra.

• 26:24Dr. Mary Claire Haver?

  I shared one of your videos on frozen shoulder years ago now. And it was absolutely viral. The comments in the thousands and thousands of women. Oh, my God, no one's ever said this. I can't, I've had this. And one of the hallmarks I see is that women struggle to put their, you know, we always love to take our group photos.

• 26:47Speaker 01

  All right, oh, can't put their arms around each other.

• 26:49Dr. Mary Claire Haver?

  Put their arms around. How would you know maybe if you had frozen shoulder? Like if someone is like sitting at home listening to this.

• 26:55Speaker 01

  Are you in your perimenopausal years? Did your shoulder start hurting out of nowhere? Like you didn't hit it, there was no obvious injury. Can you suddenly not reach behind your back or reach out to the side? Those are the two motions that go first. And suddenly you can't put your bra on it from the back. You gotta scoot it around in the front. Those are clues. This also happens in people with uncontrolled diabetes. So if you don't have diabetes, like where is this coming from? Here's the thing, though. The medical term is called adhesive capsulitis. We orthopods have known about this for centuries. In fact, it's sometimes described in the conclusions of papers tends to happen in middle aged women. With nobody then taking the next step to say, well, why could that be?

• 27:40Speaker 01

  What's a common? So bless their hearts. I have to say about my orthopedic peers whom I love, I do. But most of them, 94% of them were born without the benefit of ovaries. So they're never gonna know. But they don't experience.

• 27:55Dr. Mary Claire Haver?

  True.

• 27:55Speaker 01

  All they know is that women show up in midlife, their shoulders don't work, and then it's going to take two years to defrost.

• 28:02Dr. Mary Claire Haver?

  Oh, my gosh.

• 28:02Speaker 01

  Oh, my gosh.

• 28:09Dr. Mary Claire Haver?

  So you wrote a paper that changed my life called the

• 28:13Speaker 01

  The Musculoskeletal Syndrome of Menopause.

• 28:16Dr. Mary Claire Haver?

  And I was so excited for this because I, as you probably in medical school, got one hour of menopause.

• 28:24Speaker 01

  Oh, I don't even remember.

• 28:25Dr. Mary Claire Haver?

  Maybe. And then in my OB-GYN residency, which was four years of 100-plus hour weeks, I had six scheduled lectures on menopause. Six hours in four years. And I was taught hot flashes, basomotor symptom. I was taught some vaginal dryness, atrophy. I was taught the bones would begin to deteriorate. And sucks to be a woman for that. And there's not much we can do about it. You know, until she's diagnosed with osteoporosis, then we give her all these meds. I was never taught estrogen's effects, the loss of estrogen's effects on the musculoskeletal systems. For our listeners, walk us through what the musculoskeletal syndrome of menopause is.

• 29:06Speaker 01

  The musculoskeletal syndrome of menopause, which affects about 70 to 80% of all women. So think of all the women with hot flashes. Equal numbers have one of these, right? Every musculoskeletal tissue, muscle, tendon, ligament, bone, cartilage, which is the smoother, the nice lining of the end of the knee. Fat is a musculoskeletal tissue. We have stem cells, the discs in our back, all of those, which are cousins, have estrogen, alpha and beta receptors on them. So I always hold up my hand like a little basket because estrogen fits in there and then all the good things happen. Lack of estrogen in these tissues manifest as total body pain. It's called arthralgia.

• 29:49Speaker 01

  I think we throw every woman under the bus and call her fibromyalgia when actually it's untreated arthralgia of the musculoskeletal syndrome of menopause. So total body pain, I had this. I'm an athlete. It was disabling. I mean, not so much that I couldn't work, but I had trouble getting out of bed. Number one, frozen shoulder, both due to inflammation. We have tendonitis.

• 30:14Speaker 01

  How about tennis elbow, golfer's elbow, Achilles tendon, patellar tendon? All your tendons hurt for no reason. On the bottom of your foot, it hurts. Your plantar fascia hurts. Women have a rapid increase of arthritis, which is loss of cartilage after 50. Before 50, men have more arthritis. After 50, women rapidly develop arthritis. I see this all the time in my clinic. It's because, again, estrogen, alpha and beta receptors are critical for maintaining cartilage, the matrix. Cartilage is a matrix, and without it, it just crumbles. And we wear down our cartilage, which is irreplaceable.

• 30:56Speaker 01

  We get one set for a lifetime. All of these things happen for the same reason. Estrogen decline.

• 31:03Dr. Mary Claire Haver?

  You often talk about meeting women for the first time in the emergency room when they're shattered, broken, fractured, as a orthopedic surgeon.

• 31:11Speaker 01

  Yeah.

• 31:11Dr. Mary Claire Haver?

  Where should they have met you first?

• 31:13Speaker 01

  The youngest, big fracture, life-changing fracture, not an ankle, not a wrist. The woman was 47, 57. I write about her in my book. And I met her in the emergency room, and I had probably met her in the gym. We went to the same gym because she was doing everything she thought she could possibly do. She was, because you know why her motivation was? She was not going to age like her mother, who was frail and overweight. And so she was doing everything she thought Dr. Google would want her to do. She was lifting, but she was starving because she still believed that she could only be this big. Right? So if we're going to work that hard, we need to feed ourselves that hard.

• 31:55Speaker 01

  But what I do, what you're referring to is when I meet women in the emergency room or on the floor because she has a hip fracture, it's the first time she's ever thought about her bones. And she's forced to because fractures are excruciating. Finally, these bones that you think are silent are screaming so painful that you know in hospitals how the beds are kind of slick because they're plastic beds and people slide down to the end of the bed and they need to be pulled up in bed, but they won't let you touch them because it's too painful.

• 32:27Dr. Mary Claire Haver?

  So much pain.

• 32:27Speaker 01

  They're in so much pain. But here's the reality, and I've gotten not afraid to say these things out loud. You know that when I go to the bedside, she has been incontinent. And she's usually laying there, not because of bad nursing care, but because she's a constant incontinence because she's just lost her bladder control and we've done nothing about her pelvic floor or her prolapsed bladder. And often when I'm trying to clear her for surgery, which we go through a certain procedure, do lab tests, she has a UTI. In fact, maybe she got dizzy and fell down because of her chronic UTIs, which we know is a thing. Then what happens now in the hospital is the medical doctor will come and clear her

• 33:09Speaker 01

  heart for surgery. It takes about 45 minutes to fix a hip, but the heart has to be healthy enough. But many women have not been treated with estrogen, only four or five percent, right? So they have microvascular heart disease that they may not even know about, and it's difficult to clear their hearts. And then finally-

• 33:30Dr. Mary Claire Haver?

  Meaning clear their hearts for listeners.

• 33:32Speaker 01

  To prime their hearts for surgery.

• 33:34Dr. Mary Claire Haver?

  That they're not, they're going to survive the surgery.

• 33:36Speaker 01

  That they're going to survive anesthesia. Thank you for clarifying that because it's a stress to undergo surgery and anesthesia. It's like running a race. You don't want somebody to have a heart attack on the table. But the other thing, Mary Claire, is that either the stress of the incident, or they've already got early Alzheimer's, they're not coherent, their brains are not functioning. The way they would want them to. So we've got all these things that frankly, my friend, we could have prevented had we gotten a hold of women when they were 35.

• 34:09Dr. Mary Claire Haver?

  So Mama is 88.

• 34:12Speaker 01

  Yes.

• 34:13Dr. Mary Claire Haver?

  And she has never had a bone density scan in her life. And no one ever, ever, ever, ever talked to her about her bones.

• 34:23Speaker 01

  Hmm.

• 34:24Dr. Mary Claire Haver?

  Her mother laid in a bed, incontinent, with severe dementia.

• 34:29Speaker 01

  Mm-hmm.

• 34:30Dr. Mary Claire Haver?

  And had broken, not a hip, but broke ribs, broke shoulder, arm, you know, multiple falls.

• 34:37Speaker 01

  Yeah.

• 34:37Dr. Mary Claire Haver?

  And spent probably the last good three to five years in a bed, hallucinating, incontinent, yelling out, you know.

• 34:47Speaker 01

  Not how she wanted to be.

• 34:49Dr. Mary Claire Haver?

  And my mother, no one ever talked to her about what Mama could do to prevent this. Not even me. Now, I tried to help her with vaginal estrogen. My mother's had struggles with incontinence since I was a child. Mama is now, has Alzheimer's.

• 35:04Speaker 01

  Yes.

• 35:05Dr. Mary Claire Haver?

  Is in a facilitated living facility. And on New Year's night.

• 35:10Speaker 01

  Yes.

• 35:10Dr. Mary Claire Haver?

  Fell, looking for my father.

• 35:12Speaker 01

  Oh.

• 35:13Dr. Mary Claire Haver?

  Who passed away six years ago, hallucinated, thought she heard his voice. Fell, shattered her hip, got taken to the ER, passed clearance for heart. Survived the surgery.

• 35:25Speaker 01

  Yes.

• 35:26Dr. Mary Claire Haver?

  It is eight months post-op and she is just now walking with a walker. She has been rolling around in a wheelchair, scooting herself around since then. And we finally got the right physical therapist in to really.

• 35:37Speaker 01

  Wow.

• 35:37Dr. Mary Claire Haver?

  Get her up and get her motivated. And no one is talking to these women.

• 35:41Speaker 01

  Nobody.

• 35:42Dr. Mary Claire Haver?

  About prevention, about this doesn't have to happen. She's exactly walking the path my grandmother did.

• 35:48Speaker 01

  Mm-hmm.

• 35:49Dr. Mary Claire Haver?

  And I am refusing.

• 35:50Speaker 01

  I know.

• 35:51Dr. Mary Claire Haver?

  For this. I'm changing the legacy for my daughters.

• 35:54Speaker 01

  Yes, you are. There is no way you'll let that happen.

• 35:57Dr. Mary Claire Haver?

  So yeah, we're going to talk about how we're gonna how, you know, what we can do about that. What part does inflammation play in all this?

• 36:05Speaker 01

  I'm so glad you asked that.

• 36:07Dr. Mary Claire Haver?

  Because it's not just one thing. It's not just menopause. It's not just calcium intake.

• 36:10Speaker 01

  The second chapter of the whole book is all about the science behind aging because I just don't want people to walk away thinking, just get on another exercise program or another diet. That is so not what you and I are talking about. One of the things we talk about is this concept of inflamaging.

• 36:26Dr. Mary Claire Haver?

  Mm hmm.

• 36:27Speaker 01

  It is chronic inflammatory processes in your body that never stop. Now, let's clarify. Inflammation is a normal bodily process. When you twist your ankle and it gets hot and red and it swells up protective because your body is rushing to the scene. It is dumping growth factor. It is creating inflammatory cytokines to heal and to clean up the mess so that you can return to life. When we do not turn off our inflammatory processes, either because we're chronically stressed, which increases our cortisol levels, which and increases all these inflammatory cytokines that we just normally produce. They never

• 37:08Speaker 01

  get taken care of. We enter a state of inflamaging, which is one of the motivators for all of our chronic disease, whether it's your heart disease, whether it's your diabetes, whether it's your sarcopenia and your bone density, because both bone and muscle are critically sensitive to inflammatory cytokines. When they are present all the time, they can increase loss of bone because they give osteoclasts, the bone eating cells, the advantage. So high inflammation, more loss of bone. The same for muscle mass.

• 37:49Dr. Mary Claire Haver?

  Okay.

• 37:49Speaker 01

  High levels of these inflammatory cytokines make us weaker, make us recover from muscle injuries slower.

• 37:59Speaker 01

  Such that there are lots of studies that go way deep into the mechanisms of this, but we know that in some studies in women, that when they measure these levels in the blood, they can correlate it to significant decreases in muscle mass and recovery. So this is not just theoretical. We know this happens. And so, why do we become so inflamed? Because estrogen is a potent anti-inflammatory.

• 38:27Dr. Mary Claire Haver?

  I remember reading the data on blood inflammatory markers and some researchers, thank God, who were tracking them across the lifespan, specifically in women and seeing this dramatic uptick somewhere around 45 on average. And some other researchers said, hmm, I wonder if this is menopause. And they started looking at animal studies and then, then human studies and just how menopause itself, just from the loss of estrogen, changes in progesterone, you know, becomes a pro-inflammatory state. I was floored by that.

• 39:01Speaker 01

  Exactly right. When women say, oh, I didn't have menopause. I didn't have night sweats, brain fog. I didn't feel bad. Or you know what? I just had it a little.

• 39:11Dr. Mary Claire Haver?

  Or I'm done with all that.

• 39:12Speaker 01

  Oh, I'm done. Well, okay. That just comes from the fact that we need to educate women continually to say that you may not feel it, but it's happening.

• 39:22Dr. Mary Claire Haver?

  It's happening.

• 39:23Speaker 01

  It is happening.

• 39:24Dr. Mary Claire Haver?

  Yeah, that loss of estrogen will follow you in every life system for the rest of your life.

• 39:28Speaker 01

  That's right.

• 39:29Dr. Mary Claire Haver?

  Okay, talk to me about vitamin D and calcium. We hear a lot about that on social media and this, one of the things I was taught in residency.

• 39:37Speaker 01

  So you know, we talk a lot about, about those things in terms of building bone density, but we forget that vitamin D is critical for brain health and immune function and gut absorption.

• 39:48Dr. Mary Claire Haver?

  Calcium supplements, and correct me if I'm wrong, have never been shown to decrease the risk of osteoporotic fracture.

• 39:53Speaker 01

  We need it from our food. It's not hard to accumulate 1,800 milligrams. Definitely not hard for 1,200. Cause a cup of yogurt has about 300 milligrams of calcium. Salmon with bones in it, sardines, but you know, who wants to eat those? But prunes and bok choy, there's just so many choices. That I'd rather people try to get it from their food.

• 40:16Dr. Mary Claire Haver?

  The way I counsel my patients is these foods that are rich in calcium are also rich in so many other things that are wonderful for you.

• 40:23Speaker 01

  Great health.

• 40:24Dr. Mary Claire Haver?

  So it's always better from food. So earlier, we talked about that one in two women after the age of 50 can expect to have an osteoporotic fracture. And that's our reality. However, in my clinic, I am recommending DEXA scan. So let's go get your bone density checked. Often, insurance won't pay for it until the age of 65. Or if she has some severe risk factor. But even in that setting, I feel like that is too late. When my patients are diagnosed with low bone density, they are devastated.

• 40:58Speaker 01

  Yeah.

• 40:59Dr. Mary Claire Haver?

  They cannot believe it. How do you counsel those patients in your clinic?

• 41:04Speaker 01

  They feel disappointed, ashamed, frightened. And then we don't just leave the conversation there. I think a DEXA scan number alone is useless until unless you give a patient or a woman a plan. And so we go through all the things we know that will help build better bone. And we know that we can stabilize or build better bone.

• 41:26Dr. Mary Claire Haver?

  What are those things?

• 41:26Speaker 01

  Every woman is a sentient being and gets to make her hormone decision. But I insist that she makes it based on facts, not fear. And so every day, I recommend, well, I recommend your book. So I say, if you want all the world's data on the safety of your hormones, you're going to read Estrogen Matters. If you want to know what's about to happen to you, you read The New Menopause. If you know how good sex can be at this age, you read You Are Not Broken. And then, of course, I recommend Now Here's Your Plan Unbreakable. But as I explain to them, I say, you must make your hormone decision because and then I explain the role of estrogen on bone. It's going to be harder to get in front of this if we don't.

• 42:10Speaker 01

  But if you don't want to, well, what else are we going to do? We are going to learn to lift heavy weights. We are going to put down the manby pamby five pound weights that we lift 30 times to failure. And we are going to take the six or nine months to work up to. Lifting the hex bar that you lift when you deadlift, right? To lift heavy because it is that which is going to exert the most pulling force against your bone. We're going to jump around like a crazy person. I want people to jump 20 jumps a day, not just straight up and down, not landing lightly. I want you to thud on the floor because we need to generate four times body weight.

• 42:51Speaker 01

  You can do that. Walking generates about 1.2 times body weight. Running two to three times, but we want a thud on the floor. And that takes jumping from a height of about eight inches. If you cannot do that because your knees hurt too much, well, NASA uses rebounders or little trampolines. We can't use it as an excuse. We just have to do the best we can because lifting, jumping, plus or minus estrogen, plus nutrition, high in protein can help you stabilize and rebuild bone. And so of those things, the best data is from estrogen and lifting. Women always ask me, especially online, but I'm either I'm afraid or I have osteoporosis.

• 43:36Speaker 01

  I can't lift.

• 43:37Dr. Mary Claire Haver?

  I see a lot. Anytime I post about lifting exercises, the comments are always full with, but what if, but what if, you know, I have osteoporosis already? Am I going to fracture? I have a herniated disc. I have arthritis. You know, a lot of women are already dealing with conditions that are going to make these things harder.

• 43:55Speaker 01

  But you know, the irony is so, so Dr. Beck, who's from New Zealand, I believe, did a big study called the Lift More and under supervision, we must be taught to lift heavy. We don't want to get hurt. In her protocol, you're lifting to failure in five reps times five sets. That is heavy and nobody broke and everybody built bones. No injuries. And so, yes, it can be done.

• 44:22Dr. Mary Claire Haver?

  And they all had osteoporosis.

• 44:23Speaker 01

  Oh, they were, that's entry to the study was osteoporosis. What the irony about what you just said is people think that they can't lift because they have arthritis or they can't jump because they have arthritis. When I get someone coming to me for arthritis, I don't start with the medical interventions. I start with, we are going to make you strong as a bull because your butt core and hip strength will act as shock absorbers against the impact of your weight on your knees because regular activity exerts.

• 44:54Speaker 01

  You know, seven to nine times body weight on your joints. So if we don't want them to pound together, we have to build better muscle, right? Isn't, people are so shocked when I say that. We're going to make you strong first before we start doing all the medical stuff. But that's an approach that maybe they haven't heard.

• 45:11Dr. Mary Claire Haver?

  Yeah.

• 45:11Speaker 01

  At their standard doctors, because you're right, we silo things. But the reality is, if we want to treat the whole person, that person needs to be strong.

• 45:20Dr. Mary Claire Haver?

  Can you talk about some of the pharmaceuticals that have been developed to treat osteoporosis? And when would you begin those?

• 45:25Speaker 01

  So there's several categories. The most, the most common one that people are familiar with are the bisphosphonates, Fosamax. And then now there's a new category of monoclonal antibodies that work on, there's a receptor on the osteoclast that it blocks. Those medications are offered to women when they have the diagnosis of osteoporosis, which is a T score of minus 2.5. But do you know, nearly to a woman that I see, they've all said to me, I have osteoporosis, my doctor wanted to put me on a bisphosphonate to rescue my bones, and I don't want it because of the side effects.

• 46:07Dr. Mary Claire Haver?

  Yeah.

• 46:07Speaker 01

  Well, that's understandable, because some of them are very terrifying sounding. But here's the reality, Mary Claire, we were talking about the women I treat and your own mama. If you get a hip fracture, 70% of all hip fractures are in women, 30% of the time you die in the first year. From that moment.

• 46:27Dr. Mary Claire Haver?

  Even after surgery?

• 46:28Speaker 01

  Even after surgery, from the complications, whether it's a UTI, sedentary living, bed sores, dementia, not being mobile, you lose 9% of your muscle mass laying in bed for a week or more. These things add up in already frail people, right? 30%, you hit the floor. Those people who survive, 50% will never get to go back home because they're, they can't get around, right? To live independently, you must be able to get up and down from a chair and do ADLs.

• 46:59Dr. Mary Claire Haver?

  This is why we care about fracture.

• 47:01Speaker 01

  Absolutely. No one would care unless the devastating outcomes of it.

• 47:07Dr. Mary Claire Haver?

  So what most women don't realize is most women are not offered any screening for osteoporosis currently.

• 47:14Speaker 01

  Right.

• 47:15Dr. Mary Claire Haver?

  They just kind of get skipped and most people are diagnosed with their osteoporosis at the time of fracture.

• 47:22Speaker 01

  You can buy a DEXA scan without a prescription. You can Google "DEXA scan near me." If you don't want a DEXA scan, there's a new technology using ultrasound called a REM scanner, right? It's not as common in the United States as it is in the UK or Australia, but it's coming. And it uses ultrasound, not even x-rays, to tell you bone quality because whether or not you fracture has more to do with the quality of your bone.

• 47:50Dr. Mary Claire Haver?

  Right.

• 47:51Speaker 01

  Than how much mineral you have in it. Because what, what people don't know about bones either is that every time you take a step, if this is your femur, your leg bone, your thigh bone, it bends a little, it bends a little. And your body, knowing that, perceiving that, will build the strongest bone where you have the most bending. So the ultrasound type predictor will tell you the quality of your bone. But either one of these things, listen, can be purchased. So if you've got a clinician who just won't do it, then you can buy it yourself by saving up your Starbucks money. So do it just because we both told you to do it.

• 48:29Dr. Mary Claire Haver?

  Mm-hmm.

• 48:30Speaker 01

  But if that's not enough for you, think about these things. Is your mother shrinking?

• 48:34Dr. Mary Claire Haver?

  Yeah.

• 48:35Speaker 01

  My mother has shrunk so much. She used to be my height. And now she's about down here, right? I can look over her head.

• 48:42Dr. Mary Claire Haver?

  Why are they shrinking?

• 48:43Speaker 01

  Because the vertebral bodies in our spine, the our our spine, our spinal cord is surrounded by an armor of bone. And they are like blocks, literally blocks. They sit one on top of each other. And as we lose bone, they they collapse and shrink. So we lose height. So is your mother shrinking? Are you shrinking? Did you smoke when you were young? Because it was so cool. Smoking and nicotine is bone poison. Or did you have a an illness when you were little? Like asthma, where you had to take a lot of steroids chronically? Or do you have an autoimmune disease? All of these things, and many more frankly, are risk factors for osteoporosis. Or how about this, Mary Claire? What if you're like me?

• 49:26Speaker 01

  You're a young athlete and you never had periods. Or maybe you had periods, but you were an athlete and never fed yourself. So all of these things could make you at risk for osteoporosis. And if you're identifying with any of these things, go get yourself a scan.

• 49:44Dr. Mary Claire Haver?

  So when should women begin to think about being proactive or just begin to be proactive about protecting their bones?

• 49:51Speaker 01

  How about during our fertility periods? I start talking about this and I have to be very careful with the way I phrase this. But to build a baby, you're going to use at least 500 milligrams of calcium from your bones every single day. So I mean, we're building a baby from ourselves, right? So either we're eating enough or we're taking it from ourselves. So there is a real entity called osteoporosis of pregnancy. Now, here's the good news. Our bodies are built to renew that. But only if you eat post pregnancy. Many women are so focused on getting back in their genes that they don't eat. Or I may have used my breastfeeding period of life to get back to my original weight because I'm thinking, oh.

• 50:36Speaker 01

  I'm gonna lose weight by doing this.

• 50:37Dr. Mary Claire Haver?

  Yeah, 500 calories a day out the breast.

• 50:39Speaker 01

  Yes. That was such bad thinking.

• 50:42Dr. Mary Claire Haver?

  Yeah.

• 50:42Speaker 01

  I didn't know at that point. Let's say you're breastfeeding. That requires about 500 milligrams of calcium, which we're gonna take from our bones. Now, hear me, audience, when I say, it's not that I'm anti-breastfeeding. I breastfed for as long as my daughter would let me, right? Over a year. But unless you know that you're gonna lose your bone, you can end up osteopenic or osteoporotic just from something so natural. So mothers and lactating mothers need to be really conscientious about getting enough of great nutrition to rebuild. Historically, women would have baby after baby after baby. And now what I see millennial women doing is because they're waiting a long time to have children.

• 51:24Dr. Mary Claire Haver?

  Yeah.

• 51:24Speaker 01

  They're getting their babies done because before they become midlife, right? And then maybe you don't have enough time to rebuild. So it worries me that teenagers aren't building enough bone. It worries me that young mothers don't know that they need to rebuild their bones. And then if they're like me, they go straight from postpartum to perimenopause.

• 51:43Dr. Mary Claire Haver?

  Yeah.

• 51:44Speaker 01

  That is a lot.

• 51:44Dr. Mary Claire Haver?

  They never get a chance because we lose 30% in perimenopause.

• 51:47Speaker 01

  That's right.

• 51:48Dr. Mary Claire Haver?

  So yeah, they never have that chance to rebuild.

• 51:56Dr. Mary Claire Haver?

  So conventional wisdom, conventional medical advice that my mother and likely my grandmother got was to always fight to be in a smaller body. What is this, you know, this constant workout? You know, cardio, eat less, cardio, eat less. Because if you're this size, then you're healthy. How much of this epidemic, and I believe that we are living in an epidemic of frailty?

• 52:22Speaker 01

  Right now, we are.

• 52:23Dr. Mary Claire Haver?

  Sarcopenia and osteoporosis for our women in that last decade. You know, how much of can we lay at the feet of? We've been telling women the wrong thing.

• 52:33Speaker 01

  I think we need to redefine what healthy is because you say all-

• 52:37Dr. Mary Claire Haver?

  All my mom knew.

• 52:38Speaker 01

  Was little.

• 52:39Dr. Mary Claire Haver?

  Little and skinny. To this day, with her dementia, I walk in the room and she comments on my size.

• 52:44Speaker 01

  Does she?

• 52:45Dr. Mary Claire Haver?

  You're looking nice and thin today, honey. Thanks, Mom.

• 52:48Speaker 01

  Well, you know what? That is what she was taught. I cannot get my 86-year-old father to only compliment how I look. In fact, I got a little nasty with him. Bless his heart. It's just, I said, Daddy, I am smart, but I- That is the generation they grew up in. So here's what I see happening. Tell me if you think so our really elderly, your parent, your mother, my parents and the baby boomers. I don't know if we'll ever get it through their head that it's okay to take up space. The Xers like us, we were raised like that. I was raised like that where it's an aesthetic.

• 53:29Speaker 01

  I mean, you got to ask yourself, it was, were we taught that really because skinny is healthy? Or were we taught that because in the world we were raised, there's an aesthetic of attractiveness?

• 53:40Dr. Mary Claire Haver?

  Yeah.

• 53:41Speaker 01

  That has to do with your size. But I am very hopeful that the millennials or definitely the generation of my 17 year old or your daughters, uh, older than my 17 year old will value their strength versus their thinness.

• 53:58Dr. Mary Claire Haver?

  So when I think about my exercise patterns throughout my life, um, when I was younger, my daughter's age, I moved my body to be thin.

• 54:07Speaker 01

  Yeah.

• 54:08Dr. Mary Claire Haver?

  So I did it for aesthetics purely.

• 54:10Speaker 01

  Yeah.

• 54:11Dr. Mary Claire Haver?

  Um, and I, I thought that was healthy. And then when my thirties and forties, I, I moved my body for performance. I got into racing, marathons, triathlons with my girlfriends. It really was a social thing to do and, and we were healthy and we, we look good.

• 54:26Speaker 01

  Yeah, of course.

• 54:27Dr. Mary Claire Haver?

  Now, this morning I'm in the gym and I am moving my body for longevity.

• 54:33Speaker 01

  Yeah, that's right.

• 54:33Dr. Mary Claire Haver?

  What is your vision of that? What does moving your body for longevity mean?

• 54:37Speaker 01

  When I think of longevity, when we talk about women's longevity, all of us that are working together towards this are trying to reframe the narrative. For men, longevity, living longer is longevity and glorified.

• 54:54Dr. Mary Claire Haver?

  Yeah.

• 54:54Speaker 01

  In every press.

• 54:55Dr. Mary Claire Haver?

  Women win. When we just talk about longevity.

• 54:58Speaker 01

  We win. We win. Living six years longer anyway, but we suffer longer.

• 55:02Dr. Mary Claire Haver?

  Yeah.

• 55:03Speaker 01

  Because we've spent our life on anti-aging. The superficial, and it's not the inside out anti-aging. It's the superficial, do we look young enough? Are we little enough, right? So we're reframing that to women living longer. Well, what, how do you want to live longer? I talk about in Unbreakable, what it means to me is I want to do what I want, when I want it, how I want it. I want to only ask for help if I want to ask for help, not because I can't help myself. So if you want to be independent, if you want to have the kind of relationships that fill your soul when you're older, it takes daily work now on all the kinds of things.

• 55:47Speaker 01

  You know, you went to the gym at five o'clock this morning. You, nutrition is a huge part of your practice in your life, right? There is the daily investment of your health. That's the only way to get there. Because what happens if we just leave time to itself? Well, we don't answer the time bombs of aging. We don't build the kinds of shields that you're building from a lifestyle, and we're going to become frail.

• 56:09Dr. Mary Claire Haver?

  I don't want to burden my children. They will step up. I know my girls, you know, if I need help, they're going to, they're going to come in and do it, or find a really nice nursing home for me, you know, if, if they can't take care of me. But God, I don't want to do that to them.

• 56:24Speaker 01

  You don't want to.

• 56:25Dr. Mary Claire Haver?

  I want to die like my grandfather. He drove a truck the day he died.

• 56:28Speaker 01

  Oh, my gosh.

• 56:29Dr. Mary Claire Haver?

  You know, he drove a truck, went out about his business in his 90s. He probably should not have been driving, by the way. But he lived out in the country on a farm.

• 56:36Speaker 01

  They all do it.

• 56:37Dr. Mary Claire Haver?

  He got home, had a massive heart attack, and it was over.

• 56:40Speaker 01

  Me too. I want to die like Queen Elizabeth, who on Tuesday, met the Prime Minister of Great Britain, and on Thursday, just didn't wake up.

• 56:48Dr. Mary Claire Haver?

  Yeah.

• 56:49Speaker 01

  That's what I, I mean, if I get to choose.

• 56:51Dr. Mary Claire Haver?

  If I could pick. What about the difference between lifespan and health span? And I think, you know, all this talk about anti-aging, longevity, and all the wellness bros saying they want to live to 120. I do not want to live to 120. If it means I'm not going to have my loved ones, you know, if they die before me, I am not interested in that. And I don't have a single patient who tells me I want to live forever.

• 57:13Speaker 01

  Yeah.

• 57:15Dr. Mary Claire Haver?

  They all say, well, fix my hot flashes, give me my life back. Okay, now then we sit down and say, let's talk about your mom.

• 57:23Speaker 01

  Mm hmm.

• 57:23Dr. Mary Claire Haver?

  Let's talk about your grandmother, the women in your family, how they age. What are we looking at over the next 30 years? If you're lucky enough, if you run the cancer gauntlet.

• 57:30Speaker 01

  Mm hmm.

• 57:30Dr. Mary Claire Haver?

  And, you know, we're going to decrease that risk too with all of the exact same changes.

• 57:34Speaker 01

  Same things.

• 57:35Dr. Mary Claire Haver?

  And they're like, I don't want to be a burden.

• 57:39Speaker 01

  Women say that to me in my office. And then I'm like, great, because here's the plan we're going to start. And we start building a blueprint together. And one of two things happens. Either they are all for it and they're like, tell, tell me how to do this. Set me up with a trainer, like they are all action.

• 57:56Dr. Mary Claire Haver?

  Mm hmm.

• 57:56Speaker 01

  Or this is what happens. Okay, well, I can't give up my sugar. Okay, and so there becomes an excuse for everything. And to which I say two things. Number one, you can't out excuse me because I've been doing this 30 years. I have an answer for every excuse. And they kind of chuckle when I say that. But number two, if you don't want to burden your children, then you better get active right now. Because that's what's going to happen. Either they're going to have to make a hard financial decision about who's paying for the nursing home, which can cost $7,000, $15,000 a month.

• 58:32Dr. Mary Claire Haver?

  A month.

• 58:32Speaker 01

  Yeah, and eat up your life savings. Or you're going to move in with somebody like my parents do, which we made that choice, right?

• 58:40Dr. Mary Claire Haver?

  Right.

• 58:41Speaker 01

  So it's one of those two things. So, so either stop making excuses, take the action you need, or just know you're going to burden somebody.

• 58:51Dr. Mary Claire Haver?

  When do you order a DEXA? Or when do you recommend?

• 58:54Speaker 01

  I order DEXA on everybody.

• 58:56Dr. Mary Claire Haver?

  Same.

• 58:56Speaker 01

  I think, just like we get our mammograms at 40, I think we should have our screening tests by 40.

• 59:03Dr. Mary Claire Haver?

  You should have a baseline.

• 59:04Speaker 01

  Let's just figure it out, whether it's REMS, whether it's DEXA, just find one. In fact, We should probably do it at 35 when we have a little bit of estrogen still circulating.

• 59:14Dr. Mary Claire Haver?

  To see what your, your, your peak.

• 59:15Speaker 01

  Your baseline. And if you're already low, then you really got to get after it. Cause you're still probably producing some estrogen.

• 59:22Dr. Mary Claire Haver?

  Do you have another way to measure body composition? Like, do you have one of the impedance scales in your office?

• 59:28Speaker 01

  Yeah, I like, well, we have in bodies in our facility. Yeah.

• 59:31Dr. Mary Claire Haver?

  Yeah.

• 59:32Speaker 01

  I like those. I mean, I think, I don't, do you know the data? I don't know how accurate they are. I mean, they're close enough.

• 59:38Dr. Mary Claire Haver?

  They're close enough.

• 59:39Speaker 01

  We're actually looking for trends.

• 59:41Dr. Mary Claire Haver?

  Right.

• 59:41Speaker 01

  More than absolute numbers. Yeah.

• 59:43Dr. Mary Claire Haver?

  So, and for our listeners, when we talk about body composition, we're talking about not just their bone density like we would get on a DEXA. But these scales in our office do not give us bone density. But what they do give us is they can tell us how much muscle, where the muscle is. So I can look at muscle mass, especially for my GLP-1 patients. I want to know their baseline and where we're heading throughout their treatment. It also tells us where the fat is, what type of fat is it visceral fat, which is around our organs? Or is it subcutaneous fat, which actually is not that harmful?

• 1:00:14Speaker 01

  No.

• 1:00:14Dr. Mary Claire Haver?

  So, yeah. Curves are good. Curves are healthy. Curves in a pre-menopausal woman, meaning subcutaneous fat out of her skin, especially in the hips and thighs, is actually protective.

• 1:00:25Speaker 01

  Is, uh huh.

• 1:00:26Dr. Mary Claire Haver?

  For your bones and cardiovascular disease, because you have to carry around a little bit heavier body than someone like me who didn't, wasn't blessed with wonderful curves.

• 1:00:35Speaker 01

  Yes, there's benefits of all body types.

• 1:00:37Dr. Mary Claire Haver?

  Why is insurance company, and I, I think it's gatekeeping a little bit. Um, is the decision to not have bone density, and this is based on, you know, it's not an insurance company making an independent, they're going off of guidelines. Where do you think the guidelines are, are wrong, or, you know, are, are underserving women here?

• 1:00:54Speaker 01

  Well, if we're working in a disease care model, then you set the guideline for when you've got the highest probability of picking up the most disease. So it's post 20 years post-menopausal, right? So it's 65. That's prob, I don't know how they were established, but probably that's what the thinking was. We're going to treat osteoporosis with drugs.

• 1:01:16Dr. Mary Claire Haver?

  Mm-hmm. Right.

• 1:01:17Speaker 01

  And is their, their T-score likely to be low enough? Well, it's actually bad thinking. Uh, 65, right?

• 1:01:25Dr. Mary Claire Haver?

  Right.

• 1:01:26Speaker 01

  Or in Australia, 70, interestingly. Okay, if you're in a disease care model, okay, I can see why you did that, although I know that 30-year-olds are osteoporotic, 40-year-olds. But if you're in a preventive care model, like we are for breast cancer, you're gonna do it much earlier because we know interventions, the longer you're preventing, the less likely. Meaning, the Endocrine Society data show that you need to be on estrogen optimization for 10 years to have the biggest effect on fracture risk. Not started at 65, when you have a bad DEXA scan, but it's better if you start earlier to give your bones all that runway.

• 1:02:12Speaker 01

  So that's why I think is, is we're working in a disease care model. Let's got osteoporosis, well, we've got a drug for that. Let's give you the drug. We wouldn't give you the drug if you didn't have the diagnosis, so why check?

• 1:02:23Dr. Mary Claire Haver?

  And estrogen is FDA-approved, and most women don't know this. Most doctors don't know this.

• 1:02:29Speaker 01

  Or the

• 1:02:30Dr. Mary Claire Haver?

  Prevention.

• 1:02:31Speaker 01

  Prevention.

• 1:02:32Dr. Mary Claire Haver?

  Of osteoporosis.

• 1:02:33Speaker 01

  That's right. Yes.

• 1:02:34Dr. Mary Claire Haver?

  It's the only drug approved for the prevention of osteoporosis is estrogen.

• 1:02:40Speaker 01

  That's right. And the other reason I think women don't get them is, is it's not thought about in most medical circles, right?

• 1:02:50Dr. Mary Claire Haver?

  In OB-GYN, it is in our guidelines to discuss osteoporosis and to recommend, like, it was one of our little checkboxes, so I can say in mine, but most women stop coming to me when they're done having babies.

• 1:03:03Speaker 01

  Yeah.

• 1:03:03Dr. Mary Claire Haver?

  You know, they, when I was doing traditional general OB-GYN gynecologist practice, they weren't, they were like, I'm done having kids, I'm just gonna go to my internist or my family medicine doctor. And I think we, as a medical specialty, or, you know, all, all of medicine, is really dropping the ball, especially for prevention in women.

• 1:03:22Speaker 01

  Well, the whole medical system is a disease care model. There's never the whole person care.

• 1:03:28Dr. Mary Claire Haver?

  Let's pivot.

• 1:03:31Dr. Mary Claire Haver?

  I love that you're trained in orthopedic surgery. Because you were trained to treat both men and women.

• 1:03:38Speaker 01

  Yes.

• 1:03:38Dr. Mary Claire Haver?

  I don't have that privilege.

• 1:03:39Speaker 01

  I still do.

• 1:03:40Dr. Mary Claire Haver?

  So I only, the only penis I saw were baby boys at birth. And I did a few circumcisions and then gave up on that practice.

• 1:03:47Speaker 01

  Yeah.

• 1:03:47Dr. Mary Claire Haver?

  And then my husband's is the only one I have to tend to now. When I talk to orthopedic surgeons, especially females, when I talk to our female urology friends.

• 1:03:55Speaker 01

  Yeah.

• 1:03:56Dr. Mary Claire Haver?

  People who came up through the system and treat both genders. It's shocking to them when they get out into practice and they realize the bias against women.

• 1:04:04Speaker 01

  Mm hmm.

• 1:04:05Dr. Mary Claire Haver?

  That is built into the system. So in my education, we had a term called WW or WWW, which was whiny women or whiny white women. And I talk about it in the book and I always give lectures on it. Basically, a woman in her 40s would come in with multiple vague complaints.

• 1:04:21Speaker 01

  Mm hmm.

• 1:04:22Dr. Mary Claire Haver?

  And we couldn't figure out what it was. Turns out it was probably perimenopause, some multi-system effect that she was having that we couldn't figure out. And the urologists, you know, our friends, our.

• 1:04:34Speaker 01

  Dr. Casperson and Dr. Rubin.

• 1:04:36Dr. Mary Claire Haver?

  Dr. Rubin would said, hey, wait a minute. These patients are coming in with the same complaints. Sexual dysfunction, you know, things hurt or aren't working down there. And the men, you just go all in. You rush in to fix the problem and you give them the medication. And the women were getting pats on the head and coconut oil or, you know, and just said, you got this, babe. Do you see the same thing?

• 1:05:01Speaker 01

  Yes, because, and I may have historically been guilty of it.

• 1:05:07Speaker 01

  Because when a man comes in in midlife, dragging around and multiple tendon issues.

• 1:05:16Dr. Mary Claire Haver?

  Mm hmm.

• 1:05:17Speaker 01

  Like everything hurts, multiple tendons or rupturing tendons.

• 1:05:23Speaker 01

  I test his testosterone. And then I send them off to get some testosterone, even because in men, the physiology is different, but obviously. I'm encouraging my millennial sons to get their testosterone checked in their youth, they're in their mid 30s, because that's how we know what to correct back to. Because even if a guy in midlife rupturing all his tendons, feels terrible, moping around, moody as heck, has testosterone that is between 250 and a thousand something, which is normal. If he used to be 800 in his youth and he's now 300, that's a big delta. But we're sending that guy off to get some testosterone because God forbid,

• 1:06:08Speaker 01

  we let anybody feel like that. But when women come in and have multiple things going on, they're accused it's all in their head.

• 1:06:17Dr. Mary Claire Haver?

  Yeah, they get a psychiatric referral.

• 1:06:19Speaker 01

  Or maybe they're labeled with fibromyalgia.

• 1:06:24Speaker 01

  And I don't believe that everybody I say that comes in and wears that diagnosis has something like that. I think it's untreated perimenopause that affects the musculoskeletal system. So now, there is parity in my clinic. But when I have queried my Instagram following, what have orthopedic surgeons said to you?

• 1:06:45Dr. Mary Claire Haver?

  What did they say?

• 1:06:46Speaker 01

  And it is appalling.

• 1:06:49Speaker 01

  It is appalling, the blaming, the dismissive, the you're just getting old, there's nothing wrong with you, it's in your head. Have you talked to your whoever about it? The musculoskeletal system is at least eight to 10, depending how granular you want to get. Whole organ systems, muscle, tendon, ligament. How can we just ignore that, right? So I'm this much encouraged, this much, you can even see the space here, because I can't.

• 1:07:23Speaker 01

  Attract the attention of my own peers to publish these things in our own literature, to do grand rounds at our departments, except I have to shout out Mount Sinai, which is led by a woman. We did this two years ago. The International Cartilage Research Society just called me to say, I think we're missing something. We need to, we need these researchers to learn about perimenopause. So we're sneaking in a talk to their whole assembly. It is a slow drip that needs to be a roaring conversation.

• 1:07:58Dr. Mary Claire Haver?

  Right. You and I both, and I'm, I'm back on as adjunct faculty, come from this academic world. And it's really, that's where the magic happens. That's where the guidelines happen. The guidelines are what insurance decides what, what they, what they will and won't pay for. That's who gets screened for certain things. And I just want all the listeners to understand, from new research to a guideline changing, on average, right now, is 17 years.

• 1:08:27Speaker 01

  Oh, my God, that is a generation of people.

• 1:08:29Dr. Mary Claire Haver?

  17 years, on average. Now that, one of, one of the beautiful things about the internet, good and bad, is that now, regular people, smart people, women who can make decisions for themselves, actually have access to some of the medical journal articles. And they're coming in, asking better questions. But, you know, we have this whole force of wonderful physicians who do care, who just weren't trained.

• 1:08:54Speaker 01

  Of course.

• 1:08:55Dr. Mary Claire Haver?

  And so where do you see, you know, what, what is a stopgap for this? These Gen Xers are not taking it. They're not having it. You know, my Gen X patients are like, absolutely not. I'm not going to live like this. Fix me. But I can't, you can't be the doctor for everyone. I can't be the doctor for everyone. Where can they go now? Like, like, where can someone find better help?

• 1:09:14Speaker 01

  Yes. So I require women to be responsible for themselves.

• 1:09:19Speaker 01

  So they must become educated.

• 1:09:21Dr. Mary Claire Haver?

  Mm hmm.

• 1:09:22Speaker 01

  So that's why I recommend the bevy of books that I discussed with you.

• 1:09:28Speaker 01

  You must get the information for yourself. Number one, number two, you can go the regular path. You can go to your primary care of your OB and have this educated discussion. And if they're not caught up with you, if they blow you off, it is okay to keep them as your disease care person.

• 1:09:48Dr. Mary Claire Haver?

  Yeah.

• 1:09:48Speaker 01

  But you must not stop there. So many women who write to me, they're like, my doctor said no, so I just stopped. That's not the answer. Seek out somebody who knows. So where do you find that person? Well, you're right. I can only see so many patients. You can only.

• 1:10:04Speaker 01

  There are many telehealth companies now that are staffed by legitimate clinicians who can expand the database. But in order to get in front of this, it has to start being taught in medical schools.

• 1:10:20Dr. Mary Claire Haver?

  Now for a midi pause sponsored by midi health. If you're in midlife and feeling bloated, sluggish, or frustrated that the same diet you've always followed suddenly isn't working, you're not imagining it. As estrogen levels drop, we lose some of estrogen's protective effect on metabolism, heart health, and gut function. This shift can mean slower digestion, rising cholesterol, more insulin resistance, and potentially more belly fat. This is where getting enough fiber becomes critical. I recommend women get 25 to 30 grams of fiber per day, and it doesn't have to be complicated. Simply add a tablespoon or two of chia, flax, or hemp to your meals.

• 1:11:02Dr. Mary Claire Haver?

  Include lentils, beans, berries, avocados, whole grains, and other fruits and vegetables into your daily menu. If you fall short, don't worry. Supplement the gap with a high-quality fiber supplement. Remember, this isn't about dieting. It's about supporting your body's changing needs. Menopause is a biological transition, not a decline. When we understand how nutrition supports it, we can all thrive. So if you could design midlife care for women, what would that look like?

• 1:11:34Speaker 01

  Well, what it will look like is.

• 1:11:38Speaker 01

  From the minute you, if you decide to have children, or the minute you are done having children, you would automatically go into a holistic program, a whole woman preventive care

• 1:11:54Dr. Mary Claire Haver?

  Yeah.

• 1:11:54Speaker 01

  model that includes education, that includes annual labs, that includes exercise, teaching.

• 1:12:04Dr. Mary Claire Haver?

  So I think the takeaway here is we have to take our prevention into our own hands.

• 1:12:10Speaker 01

  We're responsible.

• 1:12:12Dr. Mary Claire Haver?

  Yeah. You can't count on the medical system.

• 1:12:15Speaker 01

  Nor should you.

• 1:12:16Dr. Mary Claire Haver?

  To, you know, be really an active partner in your prevention of disease.

• 1:12:21Speaker 01

  Right, prevention is on us.

• 1:12:23Dr. Mary Claire Haver?

  How much protein do you shoot for in a day?

• 1:12:25Speaker 01

  Me, I shoot for 130 because that's a good weight for me. I'm, I'm short, but I'm really muscly. So I, that's what I need to take in a day. And it's not that much volume of food when you consider that a cup of Greek yogurt is 25 to 30. Your morning shake has 55 grams of protein, for God's sake, right? And you drink it.

• 1:12:46Dr. Mary Claire Haver?

  Try to knock it out.

• 1:12:47Speaker 01

  You do. So people think you have to eat this tremendous volume of food. You don't actually to get in that much.

• 1:12:54Dr. Mary Claire Haver?

  And I find when you're focusing on protein, when you're eating that much, the other stuff tends to just fall to the side. I mean, I'm eating complex carbohydrates. I'm eating plenty of healthy fats, you know, and I'm, I'm really focusing on protein and fiber.

• 1:13:08Speaker 01

  Yes.

• 1:13:09Dr. Mary Claire Haver?

  Are my top two goals. And I hear, I, my daughter loves to make TikToks about meals she makes. And she's like, here's my high protein, high fiber. I'm like, poor baby.

• 1:13:18Speaker 01

  You did the right thing. You did the right thing. But I, and I know you focus on fiber and I love to help people understand that I am not anti-carb. I am anti simple carb and sugar because fiber often comes as car is carbs.

• 1:13:34Dr. Mary Claire Haver?

  Right.

• 1:13:35Speaker 01

  Right?

• 1:13:35Dr. Mary Claire Haver?

  Things rich in fiber.

• 1:13:36Speaker 01

  Rich in fiber are.

• 1:13:37Dr. Mary Claire Haver?

  Complex carbohydrates.

• 1:13:39Speaker 01

  That's right. So I'm not anti carb. It's not a war against carbs. It's just who you let in. And it has to be high fiber.

• 1:13:46Dr. Mary Claire Haver?

  What does a adequate workout program look like? How many days in the gym? How long should you be in the gym?

• 1:13:51Speaker 01

  So it's not about time. It's about time under tension, which means how many reps you're doing and how many sets you're doing. So no matter what kind of lifting you're doing, you need to lift to failure, meaning by the end of the set, you can't lift it anymore. So if you want to lift for hypert- for endurance, you're going to lift a little tiny weight 30 times. That does not interest me in old age. If you want to build big muscles like bodybuilders, then you're going to lift medium reps. For women, that's like 10 to 15 for four sets or so. And that's what's going to stimulate enough damage that you're going to build muscle. But in midlife and beyond, I teach people to lift for strength and power.

• 1:14:36Speaker 01

  Strength so that we can do what we want to do when we want to do it. And power, meaning lifting over time so that we don't fall down. That we can move quick enough to not have a fatal fall. Right? So strength and power take a different kind of lifting. Strength, lifting for strength is lower reps,

• 1:15:00Speaker 01

  higher weights. I've been treating people for 30 years. I know people want very specific instructions.

• 1:15:06Dr. Mary Claire Haver?

  Yeah.

• 1:15:06Speaker 01

  So my last lifting program, which is the one I published, was four reps, four sets.

• 1:15:11Dr. Mary Claire Haver?

  Okay. And that's all in the book?

• 1:15:13Speaker 01

  It's all in there. So what that means is when I'm doing a bench press, I can do four reps. I may be able to squeeze out five, but I'm not doing six without the bar coming down because I'm lifting to failure. And then I'm going to completely, I'm going to recover for two or three minutes before my next set. But this type of lifting will build our strength. And then, once we're really good at it, and it might take us six months, nine months, a year, then we can add speed, meaning it'll take us three seconds to go down in a squat, and then we spring up in one second. That speed work helps us build the power we need to age without falling down. And so it sounds complex.

• 1:15:56Speaker 01

  It's not really, once you learn, this is a great time to hire a trainer for a short period of time. Don't get another purse, get a trainer. That's what I say in the holidays. But to get great benefit, you can do it as little as twice a week. I'd rather you do it four times a week, and it doesn't take that long. You can pound out a complex set in about a half an hour.

• 1:16:19Dr. Mary Claire Haver?

  I've seen you talk about certain tests, certain milestones that women should meet. And the gym bros love to talk about this. I posted a video of myself doing pushups.

• 1:16:31Speaker 01

  You sure did.

• 1:16:32Dr. Mary Claire Haver?

  When you talked about a woman should be able to do 11 pushups, and I got, it went viral, not because I was doing 11 pushups, because every personal trainer in America jumped in about my form, which needed some work. But, okay, so we've got the 11 pushup test.

• 1:16:47Speaker 01

  Dude, don't worry about it.

• 1:16:48Dr. Mary Claire Haver?

  Yes. What else is there?

• 1:16:51Speaker 01

  I want to clarify why we even do things like that. Because the response I got, whether it was the pushups challenge, or the sit to stand tat challenge, meaning can you get up and down off the ground without using your hands or your knees, or there's a pistol squat, anything, anything. The point is not, or I'll say it another way, 90, more than 90% of the time, women responded like you do. They're like, can I do this? I'm going to try to do this. I'm going to get better at this. Let's challenge ourselves. Let's be positive about the future. There were a small percentage of women and gym

• 1:17:30Speaker 01

  bros who came on and said things like, why are you shaming women? Why are you isolating and excluding people? To which I say, why do you expect so little from women? Why do you think that we can't do hard things? Because we birth the babies in this world, right? We do hard things already. We figure it out. So when I do those kinds of challenges, it's aspirational because there is a line called the frailty line, where your VO2 max, your fitness is so low, you can't get up from a chair by yourself. That is the day you have to be moved into assisted living, whether it's with your kid or in a home.

• 1:18:14Speaker 01

  Because you can't get up from a chair yourself. Nobody wants to pass that line.

• 1:18:19Dr. Mary Claire Haver?

  No.

• 1:18:19Speaker 01

  And we can build that. So that's the purpose of all these tests. Whether it's pushups, which tells you what your upper body strength is, what your core is, whether it's grip strength. It's testing your grip strength online, which we have all done, is not about how strong your hand is in squeezing a tennis ball. It is a measure of your total body strength, such that if you have a decrease in 5 kilograms of grip strength, it infers an increase in all-cause mortality of 16%. It's big. It's not about squeezing a tennis ball. It's about your total body strength. That's what those are for.

• 1:18:54Dr. Mary Claire Haver?

  Well, I've loved having you on today.

• 1:18:57Speaker 01

  Thank you so much.

• 1:18:57Dr. Mary Claire Haver?

  I have a few questions I kind of ask everyone. What is the best part of this stage of your life right now?

• 1:19:07Speaker 01

  I may have come to this late in my life, but this is the most authentic I've ever been. People are surprised when they meet me. They're like, "Oh, you're just the same as you are online." I'm like, "There's only one me." The most authentic, the most confident, because I think that we learn from the memory of our successes. And I have figured out a lot of stuff in my life, and I know I can figure anything out. I've said this to you before. Because I am in a male field, I have more professional support now. And...

• 1:19:43Speaker 01

  I don't even know the right word to say camaraderie, collegiate, whatever than I have ever had. And from that, I mean, it's you, it's the extended group of people that we

• 1:19:55Dr. Mary Claire Haver?

  The menopause.

• 1:19:56Speaker 01

  It's the menopause. It's the five of us that talk every day. That enables me to go further, faster, harder. And I've never had that before.

• 1:20:06Dr. Mary Claire Haver?

  Wonderful. What are your non-negotiables? Like, how do you take care of you?

• 1:20:10Speaker 01

  Yeah.

• 1:20:10Dr. Mary Claire Haver?

  What does Vonda do? W, you know, we have a thing in the menopause is what would Vonda do?

• 1:20:14Speaker 01

  Oh, my gosh, you guys.

• 1:20:15Dr. Mary Claire Haver?

  Because she's our, our touchstone.

• 1:20:17Speaker 01

  A lifestyle person.

• 1:20:18Dr. Mary Claire Haver?

  Like, none of us want to end up in a nursing home. So you are my nursing home prevention program.

• 1:20:22Speaker 01

  Oh, my gosh. Well, if that's the truth, then you're going to be in bed at the same time every night, and you're going to get up at the same time every day when you can, because you are not going to compromise on your sleep, which is completely restorative. And that includes anything that might muck it up.

• 1:20:38Dr. Mary Claire Haver?

  Alcohol.

• 1:20:39Speaker 01

  Alcohol.

• 1:20:40Dr. Mary Claire Haver?

  Drama.

• 1:20:41Speaker 01

  Eating too late, stress at night. I am not compromising on that, number one. Number two, I, at this point, eating the way I eat is just the way I eat. It's not a burden, it's not a diet, it's a lifestyle with the protein, with the fiber, with the knowing what I'm eating. It doesn't mean that I don't occasionally have sugar, but it's not how I used to live, which was always having sugar, right?

• 1:21:09Dr. Mary Claire Haver?

  Yeah.

• 1:21:09Speaker 01

  Non-negotiable. And then, and then it's lifting weights. Whether, you know, when I'm traveling, it's very hard. So sometimes it's just pushups on the, in the hotel room or anything I can fit in. You know what I like people to remember as we've just laid out a bunch of things to do, right? Do this, do that. And it can be overwhelming. But we have to return to, what do we value? And why do we even want to do this? But the number one reason has to be because you believe that you are worth it. You believe that you are worth the daily investment of your health, not because your children need you, not because something else, you as a person.

• 1:21:55Speaker 01

  Have value and worth, and you are worth the work.

• 1:21:58Dr. Mary Claire Haver?

  What I'm finding in menopause and with my patients, with myself, with my girlfriends, is that they are, something about menopause kind of crystallizes that acknowledgement that if I don't do this, no one's coming to save me.

• 1:22:15Speaker 01

  There's no hero.

• 1:22:17Dr. Mary Claire Haver?

  You have to be the hero of your own story. You have to be the CEO of your own healthcare. Thank you so much for joining me. I've told you this before, but you've changed my life. You've changed my patients' lives. You've changed the way I practice medicine. And I could not be more grateful for you joining us today on UnPaused and for your, your support through all of this. It's my privilege.

• 1:22:43Dr. Mary Claire Haver?

  As a reminder to our audience, her book Unbreakable is available now and listeners can also check out her podcast, Hot for Your Health, wherever they get their podcasts and follow her on Instagram, @DrVondaWright. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at DrMaryClaire and get the honest, accurate information on health, fitness, and navigating midlife at thepauselife.com. If you're loving this podcast, be sure to click Follow on your favorite podcast app so you never miss an episode. UnPaused is presented by Odyssey in collaboration with Pod People. I'm your host, Dr. Mary Claire Haver. And be sure to share the show

• 1:23:24Dr. Mary Claire Haver?

  with the women you love. We would be so grateful. You can also find full episodes on YouTube at DrMaryClaire. The views and opinions expressed on UnPaused are those of the talent and the guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.