[Angela Foster]
What about belly fat? This is so super common.

[Dr Mary Claire Haver]
Mm-hmm. Oh, yeah, so that's what brought me to to my knees what's I've had thin privilege most of my life and You know all of a sudden this new body composition change so new accumulation of belly fat. I mean, this is a Expected biological consequence of hormonal chaos if you do nothing different expect That's it So there's very few women who can get through menopause without this happening now is it inevitable?

No, there's a stuff we can do absolutely, you know, and and it's more than cosmetic, right? No one wants a big tummy because the way we were socialised that we all should look like 14 year olds But actually the intra-abdominal fat is metabolically dangerous. And so in our clinic, we have a body composition scanner So every single patient leaves my office knowing how much muscle mass she has how much total body fat and how much visceral fat?

She has we don't even talk about her weight.

[Angela Foster]
We don't care what she weighs And what have you found are the best ways to shift the visceral fat?

[Dr Mary Claire Haver]
Yeah, so that's that was the evolution of the Albertson diet and so anti-inflammatory nutrition is huge So really really focussing on whole grains Legumes seeds nuts plants, you know heavily plant-based as close to nature as we can get it Avoiding processed foods avoiding simple carbohydrates as much as possible not counting fruits and vegetables That's that's God's fruit, you know That's God's sugar and that's that's usually fine because it comes with vitamins minerals nutrients fibre right very very different than heavily processed foods where all the nutrients have been stripped away and they're adding chemicals and all these things that kind of disrupt the way we're really supposed to eat making sure we're getting enough protein that that really seems to turn the needle and Healthy fats can be amazing for satiety and helping people stay full longer.

[Angela Foster]
What about bloating? This is another abdominal symptom.

[Dr Mary Claire Haver]
So great great question. So bloating is the presence of too much gas Liquid or solid in the gut. That's all it is.

Okay, too much air too much water too much solid and That usually happens, you know, if you nothing in your diet has changed, but you're all of a sudden having bloating Then Your gut microbiome has changed and we know this like Zoe The Zoe team out of the UK like collected stool samples on a bajillion women all through the menopause transition and they saw the body the composition changes of the stool like the decrease in the amount of healthy back to you know, healthy gut bugs and Decrease in the the profile So instead of having this like really robust profile with lots and lots of different healthy bugs You get really tight. And so are the gut microbiome approaches that of a man? So we have a very different gut microbiome premenopausal and then we become more manlike and so, you know, we're really starting to understand the function of the gut microbiome and The gut bugs that produce these chemical and neuromodulators that go back into the bloodstream and do all this positive stuff And so we see loss of that across the menopause transition also in perimenopause how we reprocess oestrogen So the oestrogen metabolites will get excreted through the liver into the bile and then into the colon and then the gut bugs will like Reconstitute it back into estriol and send it back up the pipe It's really really fascinating and so you know when I have a patient who comes in with bloating the first thing we do is look at their diet and

[Angela Foster]
When you do you think you can fix it with diet alone? Or do you sometimes need to add things like probiotics?

[Dr Mary Claire Haver]
I try diet first and like loading up on fibre and multiple sources of fibre loading up on Antioxidants and you know all the things that keep you know Both both soluble and insoluble fibre all the things that keep the gut microbiome happy and the water intake sleep is important Stress reduction. That's all important like lowering those cortisol levels.

[Angela Foster]
And so and then We'll add a probiotic if if we feel like it might be helpful If it's needed and what about when we're looking at stress resiliency, you mentioned that looking at women's HRV Do you see changes in things like their resting heart rate their heart rate variability?

[Dr Mary Claire Haver]
It's funny because I'm gonna have Kristen Holmes who's like knows more about HRV than anybody in the country in the world and so we're gonna be talking about this across because they track, you know, and they have all the data across menopause and My patients who wear the trackers. I don't I took my ring off to do weights I just got out of the gym and and since I was like, I left it downstairs and so We do see changes. Yes.

We need more data To really kind of suss out what it is, you know for me the HRV Alcohol kills it for me Like if I drink within six hours of bedtime my HRV tanks almost every time and that that seems to me the most predictable thing now if I Have my tea and I do my red light therapy and I do my sauna blanket I don't have a sauna here, but you know have a little blankie thing I can get under it really makes a big difference for my HRV

[Angela Foster]
So a lot of this from what you're saying can be addressed naturally through changes in diet through changes in movement stress resiliency sleep What about when we look at supplements are there specific supplements that you find helpful with perimenopause or women, you know?

[Dr Mary Claire Haver]
And full disclosure I sell supplements. So take this with a grain of salt. There are no supplements that cure menopause.

Let me be clear Okay, I've seen all these advertisements get your sexy back get your life back all this stuff When I talk about supplements supplements don't Fix an unhealthy diet, right? You can't like eat a bunch of processed food go through the drive-thru, you know Get your Whataburger, which is my drug of choice here in Texas and then take a handful of supplements and they're gonna somehow negate each Other that's not how it works supplement are meant to supplement a healthy diet. Okay, so when I'm approaching supplements It's usually from a nutritional standpoint with a patient.

All right, how much fibre are you getting per day? Is that a struggle for you? we might need to add a little bit of a fibre supplement to get you over the hump and that probably the best data on Supplements is on fibre, you know as far as Women in the US and I'm assuming it's the same Get about 8 to 10 grammes of fibre per day.

But for maximum gut health, we're looking at 35 25 for women and for cardiovascular health is actually 32 to 35 So my goal is 35 grammes a day And so I do a little bit of a fibre supplement in my shake which I this is my ritual To help me get over the hump, right? Is she getting enough vitamin D about 80% of my patients are deficient in vitamin D. That's something we can measure and Very easily and it's just hard to absorb.

It's harder as we get older We're staying out of the Sun to protect our skin You know and it depends on where you live if you're not in an area with a lot of sunlight and so And vitamin D is critical to multiple body functions And so that's quite often something we'll recommend our vitamin D supplement also has vitamin K to increase absorption and omega-3 fatty acids which you know, we don't have a Deficiency, but it just really really is a powerful antioxidant and anti-inflammatory Then we look at things like creatine.

Okay creatine. I mean if you eat 12 chicken breasts today, you can get Up creatine. We just don't store it as well as we get older It's an age-related decline in our month, you know I am constantly in the gym trying to stay strong so that I avoid the nursing home that my mother and grandmother needed You know because of their frailty with age like for years, right?

And so Creatine is helping me with muscle recovery. And you know, there is some data to suggest. It's great for brain health I also have you know, I recommend quite often a protein supplement if women are struggling to get enough protein in their diet we Tumeric for patients who are struggling with inflammation and menopausal women has shown to be helpful We looked at some studies that were done on a certain type of collagen for bone health and skin health And so that's another thing you might consider. So it's not like I'm like rolling out a bucket You know or a wheelbarrow full of supplements and saying here you go. It's like what are your goals?

What are we missing if she's getting enough fibre in her diet from food? We're good. You don't need this extra stuff, you know And so I do like the studies on co-enzyme q10 for heart health for women specifically But you know if she's sedentary and smokes co-q10s not gonna do anything And so, you know, you really have to like this is goes on top of the healthy lifestyle as like a sprinkle Which is why they're supplemental.

[Angela Foster]
Yeah, absolutely What made you write the new perimenopause after writing new menopause patients asked me to you know They're like what about us?

[Dr Mary Claire Haver]
And so now the postmenopausal patients are like hey I'm like, let me birth this baby before I get pregnant with the next one And so the new perimenopause is not the waiting room for menopause. It is its own Completely distinct biological transition. It's very very different because of the brain Symptoms that are happening that really calm down in postmenopausal, you know in the menopause and so it deserved its own book

Dr. Mary Claire Haver, a board-certified obstetrician-gyneacologist, explores the physical and biological shifts women experience during perimenopause and menopause. She discusses the common issue of visceral belly fat and its health implications, emphasising the importance of an anti-inflammatory diet rich in fibre and whole foods over a weight-centric focus. 

Dr. Haver also addresses digestive changes like bloating, linked to a shifting gut microbiome, and offers guidance on essential supplements such as Vitamin D, fibre, and creatine to support long-term health and muscle maintenance.

WHAT YOU’LL LEARN
- The biological cause of belly fat: Understand how hormonal fluctuations during menopause lead to a natural shift in body composition and the accumulation of visceral fat.

- How the gut microbiome changes: Discover the relationship between menopause and digestive symptoms like bloating as the gut's bacterial profile begins to shift.

- Dietary strategies for hormonal health: Learn the benefits of an anti-inflammatory, plant-based diet and the specific role of fibre in managing menopausal symptoms.

- The role of key supplements: Identify which supplements, like Vitamin D, magnesium, and creatine, can effectively support health goals when paired with a balanced lifestyle.