Episode 370: Dr. Mary Claire Haver: Why Every Woman Needs to Lift, Tips for Menopause, Maximizing Semaglutide, and More

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I'm a big believer in strength training and lifting heavy, especially as you age.

I know you talk about that as well in your book.

What can you tell us on the research that you've done of

how strength training and menopause or as you age, the importance of those two are together?

So most women peak at their muscle mass at about age 30, and then we have an age-related decline in muscle mass.

And in order to overcome that natural progression, we have to work harder and harder and harder every single year, or we're just going to have to give up that, you know.

And so, as we're living longer than men, we're becoming more and more frail in those years.

And so, when you look at long-term care homes, 66% are female, 33% are male.

And the most likely reasons a woman is going to be admitted is for dementia.

And then for frailty, she can't get off the toilet, she can't, you know, lift her legs, she can't get off the floor.

If she falls, she can't pick herself up.

And so, this is the end result, or she's fallen and broken, you know, a bone and can't take care of herself.

All of this is pretty much avoidable.

But, you know, my generation, our generation, I was a cardio queen.

I ran, I, everything was about sitting to be thin.

Like my whole focus for movement was to be skinny, okay, which I had skinny privilege.

I ran marathons.

I did all this stuff, you know, super proud of that.

But God, if I could go back and talk to that girl, pick up some freaking weight, you know, because I chipped away at my bone and muscle strength to be thin.

I never looked at nutrition outside of calories.

You know, I tried to eat healthy.

I didn't know what that was till I went back to school.

They didn't teach us that in medical school, just, you know, don't eat french fries.

Okay.

So, um, but for movement, two to three days a week of progressive load resistance training that scares the hell out of women because they've never done it.

They don't know how, but it is so important.

So, when they did studies on elderly women, which is 65 plus, okay, I am eight years away from that or nine.

How old are you?

55.

Oh, you look great though.

So, almost 56.

So they were looking at vibratory training, putting them, they put them in 10% weighted vests.

They had them start lifting.

They were doing deadlifts.

These women were making major gains in their 70s and 80s for muscle mass and bone strength and osteoporosis.

And I'm like, okay, osteoporosis prevention program.

Let's go.

There's great studies on collagen.

There's great studies on wearing a weighted vest.

I wear one all the time now when I'm walking the dog, when I'm doing housework, when I'm, you know, walking on my treadmill, which I do a lot of work on my walking guest, but I put the weighted vest on to do it because I'm cheating the system I'm just you know I'm never gonna be obese that is not in my genetics it wouldn't be a lot of hard I could do it

yeah

so but you know for me it's avoiding the frailty card and I want to be 90 and playing on the floor with my grandkids yeah your great grandkids would you know I want to be climbing a mountain I don't want to be able to walk her like my mother at 85 yeah you could barely get around she can't get in and out of the tub we're trying to figure out converting her bathroom right now she sits on on the toilet and does a sponge bath.

That is the best she can do right now.

Wow.

You know, and that I know, no.

So

I'm doing squats like nobody's business right now because this is my mother.

So these are the things I talk to my patients about.

They're not coming in saying I want a bikini body.

We're, you know, those ships have sailed.

And it'd be great.

I mean, who doesn't want that?

But they're like, look, I'm looking at my future.

I'm looking at my aunts.

I'm looking at my mom's.

What plan can I get on right now?

What habits can I change?

What do I need to focus on so that I can be healthy and vibrant as long as possible and not 10 years of horrible morbidity, not being everything in pain, breaking hips, breaking, you know?

So women, 50% of women will have an osteoporotic fracture before they die.

Yeah.

Men don't do that.

Yeah.

You know, like

very few men.

So it happens, but it's rare.

And so I want to be like a man.

I want to die like a man.

They just die.

They live and die.

We have a protracted, horrible last 10 years of our life, completely dependent on others.

And that doesn't have to be like that.

So this is what we talk about when we talk about menopause care.

And this, we're talking for straight training is being, is, is an essential piece of it.

Do you think that cardio, because cardio is known to break down muscle mass, right?

I think, I think you need a walk, a brisk walk, a brisk walk with a weighted vest.

I stopped running.

It's not good for my knees.

You know, I might do a few sprints just to get my VO2 max going, but you know, a few sprints here and there, a little bit of Tabata.

You don't have to go crazy, you know, but like if you're on the couch, get up and walk, baby.

That's it.

Yeah.

Just walk forward.

The weighted vest is what I've done to my patients.

I love it.

If you, okay, all right, you're walking.

Good.

Grab a weighted vest.

Let's get some hand weights.

Let's, you know, let's work.

You have to meet the patients where they are.

And, you know, saying you need to do three days of resistance training.

She's going to run out of my office screaming.

But, you know, she's like, hey, I'm walking every day.

This used to work for me.

It's not working anymore.

I measure their muscle mass in clinic.

I have an in-body scanner.

So I'm doing visceral fat, muscle mass.

You know, I really can look at their insides and be like, okay, here's the path you're on right now.

Here's what we can do to reverse this.

Yeah, I'm a big believer in strength training for your bone density, for the way to weight advest is amazing.

Then now the cardiovascular data, you know, women are much less, much more likely to decrease their risk of cardiovascular disease by like 20 to 50% if they strength train.

Yeah, absolutely.

More than men.

Like they can do less strength training and have more benefits than a man.

They can.

They will have more cardiovascular benefits with less work.

Oh, I love that.

Yeah.

Okay, let's talk about semiglutide and the, you know, semiglutide, the GLP-1.

Yeah.

Is there a benefit for going on something like that, like the Ozempics of the world, if you are gaining belly fat from menopause or for perimenopause?

So most of my patients, you know, again, I usually defer to people who have training in obesity medicine.

You know, I don't have, unless my patients are obese, and especially patients with lifelong obesity, and they've done everything, they've done every diet, you know, this is a whole mind, you know, it's more than just mindset for so many patients, but I do think that there's a place, I have a handful of patients on it.

We monitor them very closely.

Before they leave the office, they know they're coming back every six weeks.

We're monitoring their muscle mass.

We talk about acceptable muscle mass loss.

We talk about protein intake.

Like going to

the long-term success of you being on semaglutide, where you're going to end up healthier in the long run is really dependent on the doctor who gives it to you and how they take care of you and monitoring you.

Weight loss at any cost is rarely sustainable and rarely better for your health long term.

And the reason why I'm even asking you this question is because we're talking so much about muscle mass, right?

And keeping, you know, know, lean muscle mass on your body, it breaks down your,

when you lose weight, you're losing fat and muscle.

If you severely calorically restrict half of what you lose is muscle, which is why so many people yo-yo, because muscle is what controls our basal metabolic rate.

So you've lost 10 pounds, five of its muscle.

You immediately put on another 10 pounds, you know, you go back, but you've gained 10 pounds of fat and you could never get that muscle back without eating all the protein and doing all the resistance training.

So this is semaglutide is a tool in your toolbox to be healthy.

You cannot ignore the value of nutrition, of movement and the right, you know, doing the right movement, you know, just getting your shots and not eating is not going to serve you long term.

But also when you get off, I mean, you're the doctor.

I'd like to ask you, once you get off of it, your appetite, I would imagine, rebounds.

If you don't change your habits and you go back to your old habits, you're going to gain the weight back.

How do you change your habits?

It's not a, it's not a habit for, it's not about habits.

It's about making, it's turning off like your, your hunger.

I'm seeing something different.

So my patients are using that food noise going away, that time that they now have in their day as a time to, we talk about this, you know, how they're going to, this is a multifactorial disease.

And we talk about habit changing.

Is it successful for everyone?

No.

But I've seen some beautiful results.

And when the patients come in and they've held on to their muscle mass and they see that visceral fat going down, they're watching their cholesterol go down.

And semaglutine plus HRT, they lose 30% more weight, by the way.

Really?

More fat.

Yes.

Wow.

Women, menopausal women on semaglutide lose X amount.

Women on semaglutide plus HRT lose 30% more.

Wow.

I'm signing up.

And they're more likely to keep it off because you're more likely to maintain your muscle mass if you have your hormones on board, including estrogen.