Dhru Purohit Show - Top Brain Expert Reveals Why Women Are More At Risk of Alzheimer’s & Cognitive Decline and What They Can Do to Prevent It with Dr. Lisa Mosconi

Episode Date: April 3, 2024

This episode is brought to you by BiOptimizers, Lumebox, and AquaTru. Women can spend up to 40% of their lives in menopause, and we know that they often experience changes in their mood, cognition, and overall brain health during this time. But these changes aren’t discussed openly or discussed with no helpful solutions, leaving women feeling hopeless, alone, or unsupported. Today’s guest is a brain researcher here to shed light on the changes during this time and what we can do to support women entering this phase.  Today, on the Dhru Purohit Show, Dhru sits down with Dr. Lisa Mosconi to discuss what happens to a woman’s brain when she goes through menopause and the connection to Alzheimer’s disease. Dr. Mosconi shares how to care for women’s brains during puberty, pregnancy, and menopause, how to prevent dementia and the lifestyle habits that can help women navigate the transition into menopause.  Lisa Mosconi, PhD, is an associate professor of neuroscience in neurology and radiology at Weill Cornell Medicine and the director of the Women’s Brain Initiative and the Alzheimer’s Prevention Clinic at Weill Cornell Medicine/NewYork-Presbyterian Hospital. She is also the New York Times bestselling author of The XX Brain and Brain Food.   In this episode, Dhru and Dr. Mosconi dive into (audio version / Apple Subscriber version): What happens to the brain during menopause (0:00:20 / 0:00:20) Research as validation for women’s experience (13:40 / 10:40) Brain changes during the 3Ps in a woman’s life (16:39 / 13:00) Life contentment during perimenopause and menopause (20:11 / 16:51) Epigenetic’s role in menopause (26:03 / 22:34) Lifestyle changes that are critical for optimal brain health (31:15 / 27:45) Three types of exercise for menopause and what they activate (37:34 / 33:32) What is menopause and when does perimenopause start (45:06 / 41:18) Lifestyle factors that cause the early onset of puberty (52:36 / 48:50) Environmental toxins that Dr. Mosconi removed from her home (57:30 / 53:35) Whole foods diet, fiber, and protein for optimal health (1:00:00 / 56:08) The research behind Hormone Replacement Therapy (1:21:32 / 1:17:22) Also mentioned in this episode: Dr. Mosconi’s Slideshow  The Menopause Brain Go to bioptimizers.com/dhru now and enter promo code DHRU10 to get 10% off any order and up to 2 travel-size bottles of Magnesium Breakthrough for a limited time. Lumebox is offering my community $260 off their FDA-approved portable Red Light device! That's over 40% off! Go to thelumebox.com/dhru and get your Red Light device.  AquaTru is a countertop reverse osmosis purifier with a four-stage filtration system that removes 15x more contaminants than the bestselling water filters out there. Go to dhrupurohit.com/filter/ and get $100 off when you try AquaTru for yourself. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Lisa Mascone, welcome back to the podcast. It's a pleasure to have you here. Thank you. Thank you for having me. Let's start off with the basics. You have a new book all about the menopause brain. Talk to us about that time in a woman's life. What is actually fundamentally going on in the brain? And I believe you also have some incredible scans that can help illustrate the message and really drive it home as well too. Yes. So my research, as you know, I'm on. I'm a brain scientist by training, and I do brain imaging or brain scans for relieving, and they usually focus on Alzheimer's disease, the risk of Alzheimer's and how to prevent

Alzheimer's disease, especially in women. And there was my research on cognitive aging and dementia that led me eventually to study menopause as a risk factor for Alzheimer's disease and cognitive aging in women. So this is an interesting connection. There was not really fully explored until we came along in some ways. There was a lot of preclinical research. But what was missing, I think, from the picture was a very clear illustration of how menopause can impact the brain as women go through it. So there was research showing what would happen, what can happen to women's brain.

brain health after the fact, right? So insofar as research had any interest, the menopause until 2017, it was always in terms of the outcomes. So menopause was seen more as an endpoint rather than a process. And for me, the question is what happens during, right? Can I catch any changes by looking at women's brains before, during, and after menopause. And to me, as a woman, besides a scientist, I was shocked to realize that it really had not been done. There was 2017. I come from a completely different line of research.

And I was like, okay, I understand that menopause is so important for women's brain health. What's been done already? How do we build up on it? And nothing had been done in terms of before and after. So I went to my team and they said, I realized that this is different. What we've been doing for the past 15 years, but we need to. We need to do it. And so we gathered, we enrolled a lot of women in the study and we started doing brain scans.

And we were able to map the neurological effects of menopause in women going through the menopause transition. So these are the brain scans. These are some of the brain scans that we've been, that we're done. So when we started, we had 60 women in the study, 20 premenopausal, 20 perimenopausal, which is the in between, 20 postmenopausal, and we compare them cross-sectionally, right? One woman against another woman. But the real question was, what happens to you as a woman, is you yourself transition from a reproductive to a non-reproductive state.

Is it just your ovaries that change? Does that really impact your brain? So, let me show you. Yes, yes. Well, we started gathering evidence, and now more and more investigators are trying to do the same, so we have more data, we have more information, which is really great. This is one of the very first patients who has been working with us for many years, because going through menopause takes a while.

By the way, most people think it's like overnight, absolutely not. It can take a decade to fully go through menopause. Now, we work with a woman, many women, but this is a patient who was 43 years old. Yeah, and we're looking at a scan of her brain right now. Yes. And she went through menopause a bit early,

and we can talk about that. Right, why some women do that. Yes. women, it's more delayed. Exactly what the range is. But the important thing is that we were able to map her transition in a reasonable amount of time, right, in like less than 10 years, which means she's been with us for 10 years at this point, and I've been doing this, whatever. This is 10 years in my life. But yes, so this is the type of brain scans that I specialize in. This is called the positive emission tomography or pet scan that looks at broadly brain

energy levels in the brain. We use a tracer that's called fluorid dioxide glucose, which maps the intracellular concentration of glucose, a simple sugar, in the brain. Why? Because the brain runs on glucose. So glucose is the primary energy source for the brain. So it's like the fuel that the brain utilizes to produce energy or ATP at the cellular level. So this kind of brain scans shows the speed at which the brain takes up glucose from the bloodstream and converts it to energy. So it's awesome, isn't it? It's great. It's amazing. Yes. And you want your brain to look really red when we're using this color scale. It's showing a positive usage of energy inside the brain. It shows that your neurons are hungry for energy and they're burning energy,

they're burning glucose efficiently, which is wonderful. It's a sign of a healthy brain. And you want your brain distribution to be mostly like this, so isometabolic, which means that the left side of the brain is as bright as the right. It's kind of symmetrical. In the top, which is called the frontal cortex, it's brighter, but almost as bright as the very bottom part there, which is the precunias, with the parietal cortex and posterior singular cortex. And then you want just little structures in the middle that looks like, I don't really know what it looks like, but the little butterfly shape in the middle, just the salamis, the basal ganglia, to also being really nice and bright.

So this is a wonderful looking brain. Yes. This brain has all those things. Yes, this brain has all these things. Yes, this is what you want your brain to look like when you're like in your 40s. So really nice and bright with a lot of red and a lot of yellow and a lot less green and blue. Okay. But then we're superimposing the after menopause scan on the before menopause scan so that we can

really see the change in the brain. And I think you can see how the red turns yellow and the yellow turns green and the whole scan, the whole brain turns greener. Yeah, there's a lot less red in the brain. It's like fading in a way and we're going to look the image so we can see it again. Right. So this is a boom, bright. Now you see it's really, really red, very activated.

And then pretty much the whole cortical mental declines in terms of energy utilization and production. So we can put them side by side. And remind us over what period of time was this? Yes. So the after was before age 50. So that may have been like less than seven years. Seven years.

So these are over a seven year period that transition slowly, slowly going from a lot of red to a lot of green, a lot of green, which is a 30% reduction in brain energy metabolism. That's a lot. Yes, it's significant, I would say, especially in seven years, right? Not all women show these changes. Not all women go through menopause in seven years. Usually it takes longer. But I think this is a really good example of what can happen, metabolically at least, and go through menopause. So there's no, I think it's obvious, that the after scan is different from the before scan,

which was taken by many as more conclusive evidence that menopause impacts the brain, right? Menopause changes the brain because really many clinicians still don't believe that. Many scientists do not believe that or are not aware of that. So I think that this was very helpful to many to see, oh, now we have evidence that I can actually discuss and talk about. There's something that I can see, that I can quantify and measure.

It's not just women's imagination. I don't know why we have to clarify that, but evidently we do. Yeah. So I always say our work is largely about validating what women have been saying for thousands of years and providing a good level of evidence that this is true. It's not just all in your head like many people believe. So we're legitimizing women's experiences for centuries, basically. And we're trying to raise awareness that this is not just something that happens in the brain

and stays in the brain. There's behavioral correlates. There's symptoms. There's medical risks that come from these changes. This episode is brought to you by bi-optimizers. You know, stress is inevitable in this modern world, but chronic stress comes with a whole host of challenges, including an increased risk for major diseases and ailments.

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$250 off your first diagnostic by visiting my lifeforce.com slash D.H.R.U. That's my lifeforce.com slash D.H.R.U to save $250 off your first diagnostic and optimize your health and longevity today. Yeah, this work is phenomenal. And just to kind of connect some of the dots there, in the book you say, this is not just about the ovaries. It's about the brain, which is how science looks. at it and medicine looked at it for many years is that simply this is a woman who is no longer reproductive and that's just about the ovaries. That's about it. And there's the lived experience of millions, billions of women over the years talking about how they notice their brain changing, their body feels, a whole host of different things, often a negative association with that time,

women sharing like, here's all the negative things that I'm experiencing that I previously wasn't experiencing, which we'll chat a little bit more about that. And it also lives in this context that, yes, this is the lived experience of modern woman that's there. And there could be conditions that are happening in the way that we live today that are magnifying what would be associated as some of the more symptomatic issues that women are going through during this phase of life. Is that accurate? Oh, it's perfect. Yes, it's completely accurate.

And thank you for saying that. I think as a society, we have missed pretty much 50% or half for what menopause really is. So menopause is a neuroendocrine transition, which means that your brain and your hormones are all in transition. Your reproductive organs are changing, and your brain is changing accordingly. But if you think about the way the menstrual and you're going to be a matter, you're going to be in transition. Menopause is perceived in society is all about fertility. So most people realize that, yeah, something is happening to the ovaries,

and then you're going to stop having a menstrual cycle. You won't no longer be able to have children. So menopause is usually seen as the end of fertility. And because in Western societies, most of the Western world really a woman's worth is usually associated with her ability to carry out a pregnancy and have children, that menopause is seen in the extreme negative as something that is a problem for women, that we need to either completely ignore and not talk about or heavily medicalize.

And I think it's really important that we get a clearer picture of menopause and isn't. And that really starts with understanding the connection between the brain and the reproductive system. And this is important not only for menopause, but for life, right? So I try to clarify in the book and in my talks and in my work also that we think of aging as a linear process, right? You're born and then you grow and then you age and this kind of linear over time and stable. That is not the case for men or for women. There are very specific transition states that accelerate growth and then accelerate in others that accelerate aging. So it's more like a step-bloader of sort.

And for women, there are three very important pivotal times, which I call the three peas, puberty, pregnancy, perimenopause, which is the transition to menopause. Can I talk more about it? Please, please. Let's jump into it. So I think it's so important to realize that we are born with a very important system in our bodies that connects the brain to the reproductive organs. We never talk about the system, but it's right there, and it's a strong driver of brain

health and longevity for both men and women, right? So we are born with a sort of gigantic system, that neurological system that connects the brain in women with the ovaries and the men, the brain with the testis. This is called the neuroendocrine system that connects the brain, your neurons, to your hormonal system, the endocrine system. And in women and men, this system is actually activated as we go through puberty. And that leads to a complete remodeling, as we all know, of the body from the neck down, but also of your brain. Your brain changes massively when all human beings go through puberty. We can talk about it if you like a little bit more because it's important to understand pregnancy and that menopause and women.

But then this same system is reactivated during pregnancy. Every time a woman goes through pregnancy is not just the body, the changes. You're not just having a baby. you are effectively remodeling your brain to prepare for motherhood. And we just really never acknowledge that is something that is worth being happy and proud of. And I would love to change the narrative around this as well. And then the system, however, this neuroendocrine system is shut down after menopause because you no longer need to have kids.

So this very elaborate and metabolically expensive system has no reason to be there anymore, so we're going to turn it down, which is a way more efficient way to live and move forward than just keep carrying all this infrastructure you no longer need. But that leads to another remodeling that in this case comes with some glitches, like the symptoms of menopause that everybody is concerned about, that so many women experience, over 80% of all women experience neurological symptoms during menopause, brain symptoms, they just don't realize that those symptoms come from the brain. So when women say that they're having heart flashes, night sweats, insomnia, depression,

anxiety, panic attacks, memory loss, forgetfulness, brain fog, those are all symptoms of menopause that do not start in the ovaries at all. they start from the brain. They're neurological symptoms. We're just not used to thinking about them as such. And therefore, we don't quite know how to address them properly. Because menopause means obeying territory, right? But half of this transition is actually neurological,

and there are no brain doctors involved. In fact, you also add to that inside of the book, you say that these symptoms in this transition in a woman's life is also associated with sort of, a negative sort of happiness index, right? Like they're, like that, I don't know exactly the proper term, but they report to feel not as content, not as sort of joyful during this period of time.

And then on the other side of it, you end up transitioning and feeling much better. Do you want to see it? Yes, please, let's do it. There it is. Describe this for the people that are listening. Yes. So these are quite a few studies that nobody's in.

to know about. They're mostly from Europe and some from the United States, where scientists have very creatively started thinking of menopause, not as a loss or as a medical issue, but it's something that has a reason to be. And it's the grandmother, the grandmother of ours as we were talking about before. But this is what the data shows, right? So before menopause, let's say your life satisfaction starts at whatever level on the y-axis, right? So it's pink, the pink line. For many women, life contentment and happiness takes a dip during period menopause, which is the transitional phase during which we start skipping periods, and all these symptoms can make the first appearance, and usually hide you hardest, the half-flashes, and the forgetfulness, the depressive symptoms, lack of sleep is a huge one, right? and life satisfaction goes down accordingly, which honestly is no wonder, I would say. Many women report not being as happy or having a hard time.

But what was striking to me is that once the transition is complete and we, basically, we merge into the postmenopausal stage, at some point, like two or three years, sometimes up to six years after the final menstrual period, life contentment resumes and it starts increasing. And at some point for many women, it would be even higher than it used to be before menopause. And what's important is the variability, right? So we have the pink line that shows the average change. But then we have a lot of variability, which is the pink to blue shadow behind, which really says if menopause was the same for all women,

we would have very little variability, right? But the variability is huge, also during period in menopause. It can range from the very top of the curve to not having any issues. Your life satisfaction pretty much remains the same to being extremely sad and depressed. And the outcomes are generally positive, but they're more positive for some women and not as positive for other women. So the question for me was why? what are the factors that can make menopause better for you? What are the factors that can help you or not?

How do we prepare? And how do we keep our brains healthy after the fact? So a lot of my research now is really focused on menopause and specifically hormonal transitions for women. And men, we're starting a program for men as well because, you know, not everybody really, realizes that men go through a sort of menopause too. It's called andropause, which is different, is more gradual and usually hits in the 70s and 80s, but it does happen. And there are hot flashes,

and there are sleep disturbances, and there are just forgetfulness and other concerns that I think are very important to investigate for men as well, and then address, of course. We're going to jump into a bunch of different things, but give us a little bit of a teaser of what are some of the possibilities, and we'll later in the interview, we'll break them down. What are some of the things that you found that would have some women to have a higher happiness index or feel like they have less symptoms? Yes. Everybody will have some symptoms that are there.

Give us a little bit of a teaser of what you found in your work. So there are many different factors. They range from genetics to medical conditions to lifestyle and mindset. So genetics are important. I'm a scientist, so I think that there's a genetic basis background for almost everything. And in menopause, there is a strong link, a genetic link in menopause that runs in the family. So a lot of women are like, okay, when am I going to go through menopause? Do I need to do a blood test?

Do I need to do some crazy tests to find out? And the answer is no, you need to ask your mom. your mother is your best source of information because there seems to be a genetic linkage. So if your mom went through menopause in her late 50s, chances are you're also going to go through menopause around the same age. If your mother had an early onset of menopause in the 30s or 40s, chances are that might happen to you too. So it's really important to get that sense. And if your mom had a really difficult menopause, then you, also may have a hard time, whereas if your mom breathes through menopause, then you can kind of

relax and say, okay, how can I make it better? So that's a good blueprint, which is not deterministic. There are factors. There's your own life that plays a huge role and can determine whether or not your menopause is going to be easier or more difficult earlier or, you know, the onset is going to be later on in life. So these are the other factors that we need exploring. Yeah, I'm sure the question for a lot of people that are familiar with the work of a lot of researchers like yourself that, you know, have been on this podcast, not necessarily that they're doing the same work, but they know that epigenetics plays a huge role. Right? Yes. And it sounds like it's not exactly clear that of how much, or let me ask you

actually, do we know how much is based on lifestyle, stress, mindset, and how much? much is based on genetics, are we not yet at that place? Because there's just no way that that's those, that research has been done yet. The research has not been done. And I, again, as a woman and the scientist, I'm profoundly offended that the research is so scarce. You know, women are half with the population. All women go through menopause, go willing. All women who live long enough go through menopause, which is the majority of women. And all women have brains. And the vast majority of women have brain symptoms during menopause. And we don't talk about it.

We don't do the research. In general, women's brain health remains one of the most underfunded, are under-researched, under-diagnosed and underserved fields of medicine. And when you go to the NIH, but can I talk to you about money? Because as a scientist, I think it really clarifies how little work has been done on menopause. So when you're a scientist and you want to do research on any topic, you apply for funding. Contrary to what people believe, we don't just do it work. You can't just come to the office and put your head in a scanner.

Right? Somebody has to pay for that. Does someone be me? I have to raise the funds to do the research, and all scientists have to do that. So the way you do it usually is that you go to the NIH website and you look for budget allocations. So this is the entire budget for national health care. How is it allocated? 10% goes to heart disease.

20% goes to Alzheimer's. 20% goes, this is random numbers, but it goes to cancer research. This match goes to women's health, which is great. Okay, so you have the whole budget. This is for women's health. Within women's health, there's aging, and within aging, there's menopause. And if you do the math, research on menopause has been allocated less than 0.08% of the entire budget for the past 15 years. So that gives you a sense of how low a priority disease and why there isn't a lot of studies that we can talk about yet.

Most of the studies are about reproduction and fertility and the reproductive aspects of menopause and how to study. top of super roses. And I'm hoping that brains will also be part of the future soon in a more, you know, in a bigger role, would play a bigger role. Is there anything that we can learn from different societies around the world when it comes to menopause, especially people that are living more what I would call indigenous or modern-day hunter-gatherer lives? Is there anything that we see about how menopause and the lived experience around it is today in our westernized world with ultra-processed foods and all these things, comparatively to how it might have been previously, especially in terms of the severity of symptoms, which is what a lot of women talk

about and share that is very difficult for them to go through. Yes. I think there's so much that we can learn, especially from eastern countries, because generally there's a much better attitude towards menopause than in Western societies. I think that we have demonized menopause in some ways, whereas other countries do not do that. And then, I thought it was so fascinating that correlates with better outcomes during menopause, like fewer symptoms, milder symptoms, no symptoms, or just a more positive outlook on this stage of life that most women spend over 30% of their time into, right? So most women spend over 30% of their life in a post-menopausal stage.

So why not looking at the positives of the transition and the good that can come from it? And one of the best analogies I have come across personally is a Native American saying about menopause that is more like another ring around the trio life, right? It's just beautiful. it's just one more dance, one more tune that we learn to dance to, it's something that you want to adjust and embrace because it comes and it stays and you want to make the most out of it. So how do we do that? I think there's a combination of things that help.

Some are pharmaceutical, but some are really lifestyle-based. What do you want to hear first? Let's start up with a lifestyle because I think that's where this podcast is. But again, the pharmaceutical interventions are so important. And there's a long history of them being well-intentioned, but having consequences of kind of scaring women to pursue some of those interventions. So we'll get to that second. Yes.

Let's go for the lifestyle. Yes. Let's go for the easier route first. I believe that lifestyle plays a crucial role in brain health overall. and you and I have talked about this before. And I think this is especially true when it comes to menopause as well as puberty and pregnancy. It really, the way you live your life and the choices you make have a huge impact on your health, not just your physical health, but your cognitive health and mental health as well.

And one reason for it that I like to discuss is that the brain is not like the other organs in the body. So most of our organs, the cells, most of our organs, regenerate continuously. There's a very rapid turnover. So if you look at your blood cells, they're constantly discarded and regenerated every three months. If you look at your hair, you lose hair very often, but then it regrows. Even the skeleton is renewed at a rate of 10% a year. So whatever change you make in your lifestyle, whether it's diet, exercise, stress reduction, you can see the effects very quickly because your body is optimized for change, not your brain.

Your brain is optimized for stability. So neurons do not regenerate. Some can grow over time, but most of the neurons we have are born with us and stay with us for life. So the best way to have a positive impact on your brain health is to be consistent, right? This is why quick fixes do not work from brain health. These three weeks magic plans that people try to sell, not happening when it comes to brain health. Because if you could change your brain in a matter of day, we would all be mad. Right?

We need to protect. It's good that your brain is stable. It's good that your brain is stable. But the changes then are long-lasting. So lifestyle practices that are done consistency, frequently enough for a long enough period of time, have the best chances of making a positive or negative impact on brain health. And some things work better than others. So for menopause, the number one most important thing that nobody should do is smoking.

Smoking is the number of the number of. one ovarian toxin that you can yourself introduce inside your body. And it's not just active smoking, it's passive smoking as well. And this starts young. It accumulates, right? The way that these neuroendocrine toxins works by bioaccumulation. So it's not a once in a while thing. Once you are exposed, the effects are long lasting and they tend to accumulate,

you know, variant tissue, breast tissue, fat tissue, brain tissue, and stay there for a long time. So this is something that we really should address because there are a lot of households where kids grow up and parents smoke or somebody else smokes. So it's really important to open the windows and make sure maybe there's an ear purifier in the house because it starts really, really young. And the changes that if you're exposed to cigarette smoke, tobacco smoke at a young age, this can actually have an impact on your reproductive life for life. Those are your menopause.

So that's the number one thing that I would say. Just be careful. And air purifiers everywhere. Just don't smoke or don't be around it. Yes. And those to make sure that people realize that there's an impact. Yes. It seems like smoking is on the decline in America, but then you go.

But vaping is up and that has its own issues. Anything chemical. But Europe. I know you're from Italy. I go to Italy. I go to visit Europe. And it still feels like a lot of people smoke there. Asia.

Yes. Yes. Lots of people to smoke. Yeah, they haven't gotten a memo. We need to translate this interview in other languages. Yes. But also, you know, there are a lot of people who maybe tried smoking at some point in life, like in high school and whatnot.

And it's important to know if you've ever smoked. If you smoked more than 100 cigarettes in your entire life, that is enough to have a negative impact on the way that you're going to go through menopause as a woman, and therefore on the way that your brain is going to start aging, starting in mid-life. So in that case, in my opinion, it's really important to consider antioxidants, either through the diet or the supplements, because that can offset the kind of damage that you're going to carry with you for a long time. I used to smoke in high school as every Italian person.

No, no, every Italian person, but the vast majority of your kids back then. And I regret it to this day. Yeah. Well, it's good that you're passing on the message. And it's good to know that even if somebody's listening today and it's like, oh my gosh, I was that person. I've smoked at least, you know, 100 cigarettes. Yes, which is not. It's five packs.

Yeah. Right. In your entire life. It's good that you've also mentioned that there's things that can be done. To offset. Yes. You know, mostly antioxidant, like vitamin C high doses. Glutididium, right? The master antioxidant, right? People can take it in something form and then diet. Yes, for sure. So that's one thing. So then exercise. It's a wonderful way

to reduce the number and severity of menopauseal symptoms. And I think by looking at the entire research so far, there are three types of exercise. that can really help with different things. So aerobic exercise is usually the go-to. If you want more bang for your buck, then you go for aerobic exercise. Aerobic? Aerobic. Yes.

Jumping, running. That's the biggest bang for the buck. Yes. Even more than strength training. It is considered to be the most effective type of activity because... For menopause or you're saying for the brain? For both. At this point, at least in the scientific community.

I don't know. I've heard a few debates. I've heard a few debates in the scientific community of, in particular, because there's such a shift in how our metabolic health changes as we age, which is one of the number one complaints that women have, which I want to ask you about, is that they start to notice fat deposits and body composition completely differently than how it was before. And I'm very curious about that. I know the women that are listening on the podcast are curious. But because such a big part of metabolism is maintaining lean muscle mass, which has its own benefits. Not that there's not benefits for aerobic, that women in particular, they tend to lose muscle

more so as they age. Sarcopenia becomes an issue. They no longer have the ability for the glucose sink that is muscle. And generally, there's this correlation with. lean muscle mass and brain size as we age is what I've heard. I don't know if there's any anything to that, that if we maintain, if we maintain our muscle mass, there's less brain shrinkage. Is there any truth to that? You could say no. There's some research. I think, you know, when you say, is there some truth? Sure. The question is, is it universally so,

is it replicable? How much research has been done? So when I say, aerobic exercise is probably the best researched type of exercise for brain health. What I mean is that there's been a lot of research done, including some clinical trials, and most studies do report positive effects. So it is a consistent positive effect. I would say that the effects of strength training on brain health have not been as widely researched. So we'll see. Yeah. I would say that it doesn't have to be a war. It's not one or the other, right? So why not doing both? Like you said, absolutely. So I was going to say, actually, the three types of exercise that seem to be really helpful for women's brain health and menopause are aerobic exercise, strength training and flexibility exercises. And they target different things. Is that flexibility means like stretching? Yoga, Pilates, Tai Chi, mind body.

exercises plus stretching and balance overall. These are all are really important, but they seem to be more effective for different things. So aerobic exercise is usually regarded as being very helpful for brain fog. For brain fog? Yes, and the memory lapses and the forgetfulness and just the energy and mental fatigue the many women experience. And why do you think that is? What's going on with aerobic exercises that it would counteract that?

Is it just simply come down to blood flow in the brain? Well, that is one component, but the point is that your brain is wired to respond to vigorous, but also modest, moderate intensity aerobic exercise in ways that are oxygen dependent. So, yes, there is an increase in blood flow that provides more nutrients and more readily available oxygen to your brain cells, which is very important. And at the same time, there are a few different things that are activated in the brain, also via estrogen-dependent pathways. So there are chemicals that are being released when we perform that kind of oxygen-inducing exercise

that are also beneficial on the way that estrogen binds to estrogen receptors in the brain. So you get help from two different passwords. in a way. And it also, you know, it reduces inflammation, it boosts immunity. So it has a lot of good positive effects. In fairly quickly, I would say, maybe that's what scientists mean when they say, if you really need a little boost, go for the run, because the effects can be fast. So why not, right? Also, what exercise does is that it supports thermal regulation throughout the body. So it helps stabilized body temperature that has been shown to help minimize half flashes and night sweats, which are usually one of the biggest concerns for women going through menopause. So let's say,

if your major concern is the hot flashes and the night sweats, which by the way happens when you're pregnant just for context, it's not just menopause. It happens as women just go through life. then activities that increase your heart rate seem to really be helpful. And it could be strength training as long as your heart is beating a little bit faster and it is a little bit flush into the cheeks, right? And you can talk as you go, but you would be challenged to maybe sing a song. That is the kind of range that seems to be working well for, at least for women's brain health in midlife.

then the strength training, which is helpful for metabolism throughout the body and improving insulin sensitivity and all these beautiful things that strength training can do for your muscles, but also it's been linked with better mood. So I think that is important to know that for women who are having trouble with depressive symptoms or anxiety or irritability, some women get really, really angry, they feel like an increasing rage. and hostility during menopause. And some women have very severe depression as well. So it's good to know that if you incorporate strength training in your workout, that may not only help your muscles and your metabolic activity, but also your mood.

So I think that's one more reason to look into that. It's one type of exercise that is beneficial, also to brain health. And then flexibility and balance, like yoga, Pilates, Tai Chi, martial arts, if you want to try or any kind of mind-body techniques are good, not just for balance and flexibility, but also for sleep and stress reduction. So I think, you know, you have choices, and then it's always a matter of making time and finding the kind of exercise that you really enjoy and that is sustainable for you to do. But that could be really helpful for menopause as well. So would the opposite statement be true? Could you universally say that,

hey, having a sedentary life is one of the worst things you could do to navigate this period of time of perimenopause into menopause and that it would exacerbate the symptoms. Yeah, it can make them worse. Yes, for sure. Also, you know, one thing we haven't talked about is what is menopause? Yeah, most people don't know. I find it really interesting when our patients come to us for their brain scans and neurological evaluations, they were like, so are you in menopause?

lot of people like, I have no idea. I can't quite tell it that means. Okay, let's see if I have it right from my understanding. Go. Is it, it's the time period between your last period and it has to be a year since your last period. Yes. And that is the classical definition. Is that accurate? Yes, it's accurate. So what is confusing about this definition is that it sort of implies that menopause is one day on the calendar. Right. And it doesn't take into account that that is the end of menopause. What menopause actually is, is a transition, is a process, it's a complex and dynamic

process that can take years up to decades. Yeah, decades. So a lot of people are thrown out, a lot of women feel a little bit, maybe blindsided by their bodies and let down by their brains and especially failed by their doctors who fail, who don't often always recognize the symptoms until you reach that milestone. And you're like, okay, I haven't had my period in 12 months or longer. They're like, oh, you're in period.

You're in menopause. Yay. Now I know what to do with you. But the 10 years prior, I usually kind of dismissed as, you know, it's midlife, maybe you're under stress. Maybe you should see a psychotherapist. Do you want some antidepressants? So it's important to clarify that there's a lot, it's a long time.

It takes a long time to go through. It can take a while to go through menopause. And all these things we're talking about are important to do before that time point, also after menopause, but also in the years leading up to menopause, because that's really when most people have a hard time, when the symptoms are most severe. So when you look at your wife or any woman's reproductive life from puberty through your, usually your 40s, once you have a regular menstrual cycle, that is your reproductive life or your premenopausal life. Then it will happen at some point. I don't know how much in detail you want me to go.

Stop me if it's too much. Go into detail. There's never too much. So at some point, your cycle will start changing slightly. it may become shorter or longer or heavier or lighter. That is the late premenopausal stage where many women start having trouble sleeping. It's something that happens. So I think it's important to talk about.

So they were all prepared. There will be nights when you just can't sleep. No matter what you do, you'll just look at the ceiling and wonder what is happening. Do I drink too much coffee? Do I have too much of my mind? it may be progesterone. It's not universally the case, but it may happen. So this is something good to know. Then you start missing your period, but it may just be like, okay, this month I didn't have my period, but then I have it again. And then I have it for six months, and then

I skip it again, right? That is the early perimenopausal phase. And it's important to notice this because it's usually a sign that you will start going through the actual transition within four to five years sometimes, sooner than that. So it's a little bit of a red flag. Like, you know, okay, now if I can, I really want to prepare because the late period of menopausal stage is really the killer for many, many women is when the symptoms hit hardest is when most women have a legit hard time. Then your last menstrual period arise. Then usually in the next one to six years, the symptoms start to go away and that is the early postmenopausal phase and then is the late postmenopausal phase in the rest of your life. So lifestyle interventions are important always, but especially

during the transition. So the early and late periodontopausal and early postmenopausal phase, which can take 10 years for some women. For some women, they could be like their mid-30s or late 30s, early 40s. So how you live your life then sets the tone for what's going to do. Yes. And you know what? Your healthy midlife is the best predictor as a woman of your health in old age and for the rest of your life. And how would you define health? If you would run through like a checklist, right, if somebody was saying, how is your health in midlife? What would be some of the things that you'd be looking at? Oh, we'd be looking at things like risk for cardiovascular disease and diabetes and metabolic damage and risk for dementia. So you want to avoid all chronic diseases, I would say. And that is

so whether or not you have a chronic disease. Yes. Whether or not you're pre-diabetic or diabetic. Yes. Whether or not you. Hypoedemia, right high fat levels in blood. Body composition, high fat. Body composition. But also in general, how you feel in your own skin, like, by the French say, to be antideopo. And also whether or not you feel like you have enough cognitive. power to really go through your days with ease. And I think this is a very good target, right? Because, I mean, health is wealth, but brain health is the ultimate treasure. I would say, and we all want our cognitive span to match our lifespan.

So these are things that are very important to do as soon as you can start. It's never too late to begin, but obviously the sooner you start taking. in charge of your health, the better the results that you will see throughout your life. So it's diet, exercise, sleep hygiene, stress reduction, avoiding toxins, social networking, intellectual stimulation, regular medical checkups. There are so many things that we can do. And sometimes, you know, sometimes medications can be helpful too. Before we go to the medications, remind us again of the three Ps.

Yes. Yes. So the three P is puberty, pregnancy, and perimenopause, which is the menopause transition. So one thing that we've seen because our, the classic sort of Michael Pollan quote, you know, our diet has changed more in the last 50 years and the last 5,000 years, is that especially in our Western societies, as we've seen that there is an abundance of young women that are entering into puberty much earlier. Yes. then would have typically been there in different societies. And our genetics don't change that fast as a species in a 50-year period of time.

So it seems to be very clearly that lifestyle factors, diet, and then especially in certain communities, environmental toxins, have been playing a role. Yeah. So naturally, a lot of women who listen to my podcast are asking the same things about perimenopause and metapause. And we touched on it a little bit, but I would love to just dig into it a little bit more, is that could some of the same things that are causing the brain and the body to change and leading to young women entering into puberty as early as six, seven, eight years old?

It's incredible. It's incredible and scary. It's tricky. It's tricky. They can't dress themselves yet. Yes. Could some of those same factors, environmental toxins, as well, it's tricky. well as lifestyle factors, could those be responsible why some women enter into menopause as an

earlier stage and also have significantly worse symptoms than other women? Yes, I believe the answer is yes. And of course, I would love to see more research on this topic, but there seems to be a clear, there seems to be a connection between certain aspects of one's lifestyle and outcomes with all the three peas, puberty, pregnancy, in menopause, they are related, and they kind of predict each other in a way. Like, you can get a sense of what your menopause is going to look like if you look at what your puberty was like and your pregnancy or more than one pregnancy. Diet is a factor.

I think there's more and more research showing that processed foods in particular are an issue for health overall. They're strongly correlated, like the standard American diet that is so rich in processed foods and fast foods and refined grains and refined sugar and poor fats and has been linked with almost every chronic disease under the sun from a higher risk of heart disease to diabetes, obesity and cancer. And now we also know that women who follow diets that are high in processed foods tend to have an earlier onset of menopause and more severe symptoms. as compared to women who eat more healthily, the standard reference group is like the Mediterranean-style diet,

but it's really a diets that focus on whole foods. Instead, the more vegetables and fruit, more fresh produce and lean protein and healthy fats, those women tend to experience menopause later, and they tend to have a gentler menopause as well. And then there's evidence that environmental toxins, especially the toxins that act as endocrine disruptors or xenostrogens, right? Those are toxins that we've released in the environment and in our food chain and in their household supplies that contain very specific chemicals that look like estrogen, but not quite. And they mimic the effects of estrogens, but like, it's like the evil tween, right? I look like it, but I'm going to mess up your entire house. And that's what happens to children and girls.

And then women who are consistently exposed to these xenoestrogens or neuroendocrine disruptors. Like plastic is a big one, cigarette smoke is another. big one, all the chemicals that are included in cigarettes besides tobacco. There are a lot of food additives and preservatives that have these effects. And a lot of chemicals that are constantly found in everything from fabric to detergents. Pfeas, all those chemicals that are fire retardants. Fire retardants and even, you know, cosmetics or cologne. Yes. So there seems to be a bad effect of the substances in reproductive health, starting from

infertility to endometriosis all the way to thyroid disease and some cancers and reproductive cancers have been linked to exposure to these substances. And it's so bad. And the American Academy of Pediatrics is now urging parents to avoid plastic for infants and young kids. Because like I was saying, before, these toxins work by bioaccumulation, so they build up in your tissues over time. And you don't notice until they reach a certain concentration, but it's really hard to get rid of them. They can stay in your system for decades on end. And women, obviously, girls as well, we have a higher proportion of body fat relative to men, and the substances accumulate in fat preferentially.

So it's even worse. And I think it's becoming a public health issue that we really need to be aware of. All to highlight the lessons that you talk about in your book, which are living a low-tox, non-toxic lifestyle. Yes. You know, I changed my entire house. Yeah, talk about some of the changes you made in your house. So we have to protect not only you, but your daughter's life. My daughter, yes.

When she was born, I really, I kind of started scrutinizing everything that we were doing. eat very, you know, we eat healthy and we are active and we're careful with their lifestyles. But they were like, no, no, no, no. We are going to be even more careful. So just no plastic in my kitchen anywhere. And sometimes it's a little bit like, oh my God, I had to wash this again. But everything is glass, ceramic, tin, iron. Yes, sometimes tin. But mostly glass, I would say, even wood, I bought this beautiful wood plates that nobody could break. She was lit her so she could make her only the snacks. And yes, that's one way.

And we use, I mean, I buy predominantly organic foods when I can, you know, within reason. But I try. And we're very careful with their food choices. In general, like, I would say I have hardly any packaged foods in my entire. house, even for Lily, my daughter's name is Lily. And I pack her lunchbox myself every day. We bake together on weekends so we can put, you know, we can bake goods in her lunchbox that we make in the house. So I know exactly what she eats, doesn't eat. And the other day, it was Halloween. And we went out with her friends and her friends, they all eat that kind of stuff, like key cats and, you know,

candy. Snickers. Snickers. Snickers. Sneaker bars. Yeah. And she was so like, what are those? And can I have one? Yes, you can have one, of course. But let's talk about the choices. Yeah, a little crazy.

But then also, you know, fabrics. You want to have regonic cotton bed sheets, for instance, or some natural fabrics if you can. It's a good investment, I think, and all these different household products. Right now you can find them, that they're affordable for the most part, especially in bulk, and they're healthier and gentler on your health and the health of the planet as well. So I think that's a good investment, at least

to my mind. Oh, yeah, I would 100% agree. Because we talk about diet and we're about to go into the pharmaceutical interventions that are there and some of the navigating around that. What's your diet? I eat, I would just call it clean. I was raised vegetarian. Oh, me too. And I think we talked about this a little bit last time. And then I was vegan for a few years. Me too. Yeah.

Oh, that is funny. Yes, yes. And there was this period of time in the U.S. where there was this movement. It was called like the raw food movement. Yes. Did you do that? So I did that for like, I did that for a little while as well too.

And the spirit was there of eating cleaner, finding better sources, other things. And I did it when I was pretty young. I think I became vegan at the age of 18. and then I stayed that way for about six, seven years. And what I noticed is like it was great because I wasn't eating, you know, at home my parents always cooked healthier vegetarian food. But I was a junk food vegetarian outside home. And I was, you know, I was drinking Mountain Dew because it's vegetarian.

And I'm eating Taco Bell because it's vegetarian. I wasn't necessarily eating a ton of vegetables. Right. And I got into the whole like fake meat craze and stuff. And then for a while, I had great energy, especially when I started to move towards adding actually more vegetables into my diet, like raw food in that whole world. And then right around the age of like my early 20s, like 24, 25, I started to notice like my brain power was not there.

And I started to notice too that I was already pretty skinny growing up being vegetarian and not prioritizing protein and I wasn't working out. I never really felt like it made a difference. I was really feeling like, oh man, like I really have no lean muscle mass and I want to add more of that there, you know, and fight for every amount that I can. And so I got introduced to a test. I have no affiliation with this company. Somebody said, you know, you should check your omega levels because a lot of vegetarians and vegans, their omega 369 ratio is completely off. I did this test. talked about on the podcast before, it's $100 called an omega-quant. It's a prick test. And I sent in my levels and my omega-3 fatty acids came in super deficient. And I thought, okay, this might be linked.

And omega-3s is one of the most studied interventions and aspects and correlates with longevity and brain health and pregnancy, mood. And I was going through, I wasn't clinically diagnosed with depression, but I would go through this, like, what I would call, like, depressive episodes. Yes. And I would feel like, just like this deep sense of the blues. And I thought, like, this is not me. Like, I have so much to be grateful for in life. And so I made the decision to start eating fish.

And I felt like immediately my brain turned on, like clockwork. Yes. And through that, I got through the rabbit hole. And then as I dug in further and I got into the world of functional and integrative medicine and meeting all these great practitioners, I realized like, oh, actually I don't do really well with a lot of grains and lentils. Like I feel digestively. Maybe it was because I was raised on, I was on a lot of antibiotics as a kid and my gut health was disrupted.

So I went towards more what I call like a cleaner paleo diet, right? Lean protein, fish, chicken, some beef here and there as well too. And just a lot of plant food as well. But staying away from too many grains because I didn't work well. for me. And that was kind of, that's my diet and that's still my diet today. Yeah. Yeah. How about you now? Have you gone beyond fish? Do you eat other proteins? Well, I don't, I don't eat meat. You don't eat meat. No, I don't eat meat. And is that like, is that like a moral thing? Yeah. Yeah. Yeah, I just, I don't mean. So my mom is a very straight vegetarian. Yes. Yeah, you mentioned

everyone time. I hope she doesn't listen to this. She's the kind of vegetarian who, if you do, eat meat, she looked at you like, oh, you know, and I grew up thinking, no, no, no, no, we can't do that. We just cannot do that. So I never comment on people's diets. Whatever it works for you is what works for you. For me, I just prefer to not eat meat for myself. I think I was, I'm too sensitive to it.

I just suffer. I don't know. Yeah, yeah. It is right it is. It's compassion, animal rights. And also, but then people are like, why don't you feel sorry for the fish? So then I feel like, well, you know, I have limits too. And I think because they've been consistently a vegetarian for most of my adult life,

the way that I'm able to keep being a vegetarian is to allow myself some flexibility. Of course. And that's, I'm not saying this is perfect, but it is what works for me. And actually, I mean, with how much we know about omega-3s, it might be perfect. So I was trying to really get all the omega-3s from the diet from plants. And then my daughter was born and I was really concerned. I'm the only person who cooks in the family. So I'm cooking for everyone and they don't have time to make different dinners or to really make sure that she's eating after the hemp seeds.

And so I figure it flexible is it's fine. Yeah. And just how important it is to your daughter's growing brain. Yeah. Yeah. So just I can't. I will say that one thing I've noticed, unless if you're, you're, you're, you know, vegetarian for religious reasons.

Like my mom comes from this tradition in India called the Jane tradition. They're strict vegetarians. A lot of them don't even eat eggs. Some of them are vegan. And then my dad comes from a more traditional like Hindu, Hindu background, which a lot of them are vegetarian too.

So unless if you're vegetarian for religious reasons, the number one reason that I've seen women stopped being strict vegetarian is because they get pregnant. And either in pregnancy, they're craves. certain foods. Oh my God. I woke up one morning craving a turkey burger. I had never had one in my life. I had no idea. We don't eat turkey in Italy. I never felt the need to eat a turkey burger in the United States. But my husband loved him. And so one morning I wake up and then thinking,

oh God, I wish I had a turkey burger. I thinking, what? What is happening? Then I said, well, it's just proximity. Right. He loves turkey burgers. He's grilling a turkey burger. And then day after day after day I was like I want turkey burgers and I was like we need to take a test and sure enough I was pregnant oh my gosh yes and all this baby wanted was turkey burgers the baby wants protein or maybe wants fuel so I had some during my pregnancy when I felt my body really also I was hemodiluted and so I was anemic I was getting anemic and it was a little tricky and so my husband went and booked a night out to Peter Luger.

I was like, this is my only chance. Yeah. You know, I have this theory, which is that you don't meet many women, if any, really, that are the most dogmatic about diets and food, right? And I think a big reason why. Often, yeah, sure, when men and women are younger, we are idealistic. We feel like everybody should be vegetarian, everybody should be this. I was that way in the past.

Yes. Not everybody feels that way. Some people, when they're dogmatic, when they're dogmatic, you think everybody should do this when you're younger. But as you always age, and especially for women, if you look at, especially in our world of wellness, a lot of the people that are the most never eat this food, don't do this, don't do that. They typically are all men, right? And why I feel that women are a little bit more flexible is that women's bodies are telling them because they're more in tune with it. They have to be because of their cycle, the connection, the reproductive connection, all the things that are there. Yes.

The brain-body connection that's there, which is all your work. So there's a sense of like, don't be too dogmatic about anything. Not that I'm saying that all women don't feel that way, but you don't see of the people that are out there saying you have to eat this way. You can only do this, unless of sometimes like the militant vegans, which, you know, my heart goes out to them. But, you know, that's a tough place to be. all to say that, you know, you asked me about my diet. Yes. I think our audience loves to hear from experts about how they've changed their mind over the years.

And also listen to their body because in addition to the growing research that's there, there's also the key component, which is the theme of this book, is paying attention to your body. Especially if you're a woman and not being felt that your how you feel is somehow wrong. or somehow shouldn't be addressed. So I appreciate that anecdote. And I hope your mom doesn't listen to the podcast, but if she does, I don't know. I'm sorry. We talked about it.

We talked about it. She's like, mom, don't say. So a couple of key principles that you want to leave people with on diet before we get into prescription interventions. Just, you know, you've already talked about sticking to whole foods. Yes, stick to whole foods. And for menopause, I would say it's really a few nutrients are very important. And these are antioxidants.

I'll just keep talking about antioxidants forever. But the point is that the brain is the most energetically expensive organ. And it does run on glucose, no matter what other people think. It runs on glucose. There are other energy sources as well, but at least through menopause, every time you burn glucose for energy, there is oxidative stress that's been produced. And if the amount of oxidated stress and free radicals exceeds your brain's ability to detoxify, which is not the trendy term necessarily, really the brain needs to get rid of these free radicals.

Medical detoxification. Medical, yes. The only way is to supplement from the diet. So you need to import antioxidants from your bloodstream. It's basically the only way to supply antioxidants to the brain. And it's a very important thing to do. because antioxidants just damage everything. They have a rusting effect to make yourselves age faster.

They impair metabolic reactions. They impair cellular reactions at all different levels. They'll age you. They'll age, yes. Yes, you can't see it. Hit them with the vanity, right? I mean, people do see it. People who eat ultra-pracist diet, they see it in their skin.

Yeah, yeah. I meant you can't see it in your brain that is aging, but you can trust the science that it is. So I think it's really important to focus on foods that have reached an antioxidants. And those are fruits and vegetables and some nuts and seeds, some whole grains as well. So it's one more reason to, you know, there's this way that people, this terminology people use now to go plant forward. Right. And I think it's a good way to think about it.

You want to up your consumption of produce, basically, fruit and vegetables. If you don't eat fruit, at least eat the vegetables. because they really are the best source we have, readily available antioxidants. Most people think blueberries, and blueberries are a wonderful thing to eat. There are other foods that provide even more antioxidants, like blackberries, if you like berries or goji berries,

or the Indian berries called Amla. Yes, is one of the most, you know, powerful foods in terms of antioxidant capacity. Artichokes, highest antioxidant capacity of all the veggies, as far as I know at least, goji berries, great source of vitamin C. Some little plums are also really good sources. And then lemon, orange, grapefruit, and leafy vegetables, cruciferous vegetables, all sorts of vegetables. Those are really important for brain health as well.

Also, they contain fiber. And fiber is important. not only for digestive health, for a healthy microbiome, but also to regulate estrogen levels. So fiber has a positive effect on this protein, this is called the sex hormone-binding globuli, that regulates the amount of free estrogen relative to bound estrogen, so it regulates endosate testosterone and other hormones, but it regulates bioavailability of these hormones in the bloodstream. So it's important to eat fiber for the reason as well.

And then there are very specific nutrients that provide nutrition for the good bacteria in the gut. They're called oligosaccharides. There are type of carbs that we don't really fully digest in the stomachs. So they land in the intestine almost untouched. And this is what this good bacteria that we have in our guts, the microbiome feeds on. And there's one interesting part of the microbiome that is called the estrobulum. that has been discovered recently that is a part of the microbiome that specifically helps to regulate estrogen levels in the bloodstream.

And, you know, you can damage these microbes by eating processed foods or not eating enough fiber in your diet and by taking antibiotics or by ingesting other chemicals that can disrupt your flora, your intestinal flora, Or you can keep them healthy by making healthy choices and eating enough fiber and drinking enough water and having enough for the antioxidants and anti-inflammatory foods as well. So there's one more reason to go plant forward, if you will, which it really can just come down to eating enough fruit and vegetables throughout today. Beautiful. I love that.

Thank you. Let's touch on one other thing that you write about in the book that's related to this. You know, you mentioned you're eating fish. Yeah. In your diet? Sometimes, sometimes, sometimes eating fish. I mean, I love fish. I'll be honest. I love it. Do you have a favorite type? Do you have a favorite type? Branzino. Branzino. You? Yeah, I love, I mean, I love a classic, you know, wild salmon. Yes. Yes.

Yes. Yes. You're in L.A. for a couple days, you know, doing interviews. If you haven't been, did you go to Air One the last time you were here? I did not. And actually is on my list. Okay. So if you go there for lunch, you can grab a wild salmon. they have there that they make. And sometimes they also have a wild cod as well too. Both are fantastic. It's a miso cod and a wild salmon. They cook it perfectly.

It's in their hot bar section. Okay. Thank you. So one of the things about, just to touch on it, is that as we talk more about, you know, people talk about plant-based or plant-forward or other things. Or just enough. I find a lot of people really resent the terminology. Like, you're telling me to go on one diet instead of another diet.

I'm like, no, no. We're just saying, focus on whole things. It says don't miss out on plant foods. Yes. Right. Don't miss out on plant foods. Have you also been following at all some of the recent sort of conversations about also, hey, look, don't, regardless of how you get it, whether it's from plants or whether it's

from animals, also make sure you don't miss out on the protein component. Have you been following any of those conversations that are there? No. Okay. Well, it's a big topic. But I'm sure it's a big topic. I mean, protein is important. Right.

There's no question. There's no question. I think what happens in social media is that maybe some people think that we need to eat a lot of protein. What would you say is a lot of protein? What's inadequate from what you've seen? Or is that not your wheelhouse? It's not my wheelhouse. It's the right amount of protein per person. But I think a precision medicine approach is important here, precision nutrition.

If you lift heavy, if you exercise a lot, if you just have a very physically active life, you need more protein. There's no question. If you don't, then there's a question of how much is enough and even how much is too much because you still need to metabolize it and process it out. So you don't want to, in general, you don't want to fatigue your liver in some ways. And I think then is trial and error. I mean, I have not been following the debate. Yeah, yeah.

Tell me. Well, one of the conversations around the protein component, not that I'm asking you to chime in on this, is that protein based on literature, and this is the work of a gentleman out of Illinois, Dr. Donald Lehman, protein is one of the most satiating things. So people are struggling with their weight, whether it's from plant protein or whether it's from animal protein. When you have a protein first approach of at least making sure that you hit certain macros that are there, it tends to quench hunger.

Oh, for sure. Right? So protein is very satiating. That would be one. And the second component would be basically like a lot of people, you know, a lot of people actually don't know where their body composition rest. They've never done a Dexas scan. Yeah. They've never done an in-body scan. And especially for men and women, but women in particular, you know, once you hit 40 and above, I think the statistics are you lose about over the next decade,

you can lose about 8 to 10% of your lean muscle mass in the body. Yes. And you get you get undermuscled and over fat. There's a friend of my. and Dr. Gabriel Lyon, who recently wrote a book about this. And so more just highlighting that, yes, we don't want to minimize plant food. We want to be plant forward and have the appropriate amount, but also in this sort of wellness trend that probably started in California, a lot of people thought they don't need any protein or that they're not getting adequate. And really, if you just look at your body composition, you're measuring your lean muscle mass. if you are not both stimulating your muscles through exercise, going back to the things you mentioned

before, especially the strain training and resistance training, and then if you're not adequately getting the appropriate amino acids, you will start to lose muscle mass, and that has all sorts of different impacts on the body, which it sounds like you agree on in general, and then people have to just, they have to dial that into their unique sort of stage in life and what they're going I think so, and it's hard to do it right, right? This hasn't really been formalized in science. Like how we know the minimum requirements. We know what is too much, yes. But then it's hard to really find the right amount for you. I think it's a trial and error and know yourself type process. But I mean, it's undeniable. The protein is important for health.

and then the source depends, right? Some people prefer maybe protein sources from vegetable foods, and there's plenty of options. I think one possible misunderstanding is that many people feel that plant-based foods do not have protein or don't have enough protein, and that if they don't eat animal foods, they would be protein deficient.

And that is not the case, there's protein in many plant foods. So I think it's important to have a balance as well and to know your choices and know your options. One type of food that I personally love that is quite rich in protein is spelt. It's a grain. We call it farro in Italy.

It's super tasty. And it's got more protein program than quinoa does. And I think it tastes better. So it's something, you know, something to consider. And then there are many other vegetable sources of protein as well that most people are just not aware of. Yeah, totally. Like a good rice and bean, you know, it's not, right, right. You're not going to be protein deficient.

And I think a lot of the most interesting research in the space talk about get away from animal, get away from plant. Just look at amino acids. Yeah, look at the composition. Look at the amino acids. Because total grams of protein doesn't necessarily mean anything. if the amino acids are not there. So as long as you're getting the appropriate amino acids, then you're good to go. You might be, have to navigate a little bit more if you're doing that being vegetarian or vegan. Yes, you need to pay more attention to your fats as well.

Yeah. You mentioned the omega three before. Yeah, for sure. I mean, you know, know yourself. I think we, this day and age, there are so many ways than one can find out. Yes. Right. And then you just tweak your diet based on your own nutrient or, you know. nutritional profile if you can. All right. We teased about it, but let's talk about prescription interventions. Let's talk about it. Give us the big picture on that and then we'll get into some of the details. Well, the reason I mentioned prescription meds is that there's a little bit of a movement right now to revamp HRT, hormone replacement therapy. And as with everything that's been shunned for a really long time and is having a comeback, now everybody's interested in hormones.

and some people may even downplay a little bit, some of the risks and side effects. So I think it's important to get the full picture and know what we're working with, what we know, what we don't know, what kind of research has been done, and what kind of research has not been done. It's important to know about things. And I, again, I specialize in brain health, so I'm going to stick with brain health when it comes to hormone replacement therapy. but so what we know about estrogen in particular is that it's a very versatile hormone and we think of

estrogen and testosterone progesterone is sex hormones but that is really kind of a mistake so the history is that estrogen was discovered in the 1930s by scientists who were studying reproduction and so they realized that this hormone was important for women's fertility and bang this they're they just named it as a sex hormone, and we've been stuck with that definition since, which was really an issue because in the 1960s, sorry, it was discovered that those same exact hormones that were so important for reproduction were also just as important for brain health. And so it turns out that estrogen has serves a number of roles and functionalities. They have nothing to do with having kids and everything to do.

with having a healthy brain. Right. So this has been missing for the future for a really, really long time. And it's a problem because the biggest clinical trials of hormone replacement therapy or estrogen replacement, which is the Women's Health Initiative, was launched before anyone had any clue

of what estrogen could and could not do for your brain. So in the 1990s, the NIH, the National Institute of Health, and other subdivisions launched this enormous clinical trial, they was testing hormones for prevention of cardiovascular disease, heart disease, and also prevention of dementia, among other things. And within just a few years, they had to stop the studies because it turned out that the hormones were doing exactly the opposite of what the scientists thought they would do.

So the risk of heart disease and stroke was actually increased. and so was the risk of breast cancer and the risk of dementia. Now, those results were inflated by the media, and that's how estrogen replacement therapy really came to have a bad rap, to the point that today in the United States, only 4% of all women going through menopause are being offered, or at least are being prescribed hormones for relief of the symptoms. And that is a bit of an issue because we do know now, years later, now that the research has been done,

and now that we do understand how estrogen and testosterone actually work in the brain, as well as the rest of the body, we do know that they can actually help during menopause and that they are safe to use for women who are eligible. So according to the North American menopause society and other professional societies, they specialize in menopause, taking hormones for relief of menopausal symptoms in women who are going through paramedopause or early postmenopause of women, as long as the symptoms are active and you are within 10 years of your final menstrual period, taking hormones is safe and well tolerated by most women, not all,

so you need to obviously check, and usually it can provide significant benefits and relief. So this is something to consider because so many women don't realize that, and we're stuck with the women's health initiative, and people think that hormone replacement therapy is some kind of poison that's going to give you cancer. So it's really important to have a clearer picture of what hormone replacement therapy can and cannot do for you, right? It's not a miracle. But there are benefits. So I think it's important to know when to use it, how to use it, what to use, and for how long. It's not a miracle, but I mean, just the women in my life that I know, you know. Oprah, she loves it. Yeah,

they actually felt like it was a miracle for them in many instances. So we don't want to underplate it as well. It made a massive difference for a lot of women. For a lot of women. Obviously, there's foundational health issues that are there. If somebody's not living a healthy life, et cetera, those things. But for the women that have a lot of that, and they went on it and just dialing it in with the right doctor, it was a game changer for them. For many women, not all. Not all.

I know a lot of women who would love to take hormones and they don't do well on hormones. But I would say that they're not in the majority. They're more like exceptions. How would somebody know if they do well or not do well? Would they just have to try it? You take it. Yeah. Yes.

It takes three months, more or less, to get a sense, whether or not. not it works for you. And if you have side effects or if you feel horrible on it, it just means, you know, I mean, you can try to change the formulation first. Of course, you can try to change the dose. But for some women, it just doesn't work. However, for many women, it does work. So I think it's worth considering and it's worth knowing that it is on the table for many women who are eligible and at the right age. We're studying hormone replacement therapy for brain fog as well and for Alzheimer's prevention, and I will show you what we found. Yeah, yeah.

So you're bringing up an image. I'm bringing up an image that was very well received. This is a study we just published. It was featured on CNN and the New York Times and the Wall Street Journal that shows that this is important to women, right? We need to know this information. This is the largest, to my knowledge, it's the largest meta-analysis or the effects of hormone replacement therapy, which is now called menopold.

hormone therapy on the risk of Alzheimer's disease and dementia. And this study included over six million women, I believe, globally from all over the world, and over 50 studies that looked at the effects of HRT use relative to risk of dementia later on in life. And the effects are quite interesting in that there are two factors that really matter. The type of hormones that you're taking and when you're taking them. So for women who do not have a uterus, usually we only prescribe estrogen, estrogen alone. For women who have a uterus, then you need to take a progesterone. It's got a progestogen in medicine, in medical terms, but it's effectively progesterone. So there are these two possibilities, only estrogen, estrogen and progesterone. And then you can take it when you should,

which is during menopause or right after the transition, or you can take it more than 10 years after the final menstrual period, which is not recommended, but is what a lot of studies did, like the women's health initiative. They were just testing the hormones of women who were more than 10 years post-menopausal, and they didn't know back then that there's a window of opportunity during which estrogen has positive and beneficial effects, but once the window closes, once it's too late and your system has been dismantled,

like we were saying before, at some point this neuroendocratres system shuts down, then reintroducing the estrogens may not be beneficial and can actually be harmful in some ways. So once you break it down and stratify by these parameters, you can say that this is estrogen only to the left. We're looking at graphs that summarized the results. And the left portion of the panel is what estrogen can do for you if you take it within 10 years of your final menstruate period, which is a 32% reduced risk of Alzheimer's disease and dementia later on in life. A 32% is a lot.

That's a lot. It's a good reduction. And it really goes back to what you were saying. The timing of it. The timing is important. Yes. Now, if you start taking the estrogens after this window of opportunity and this only estrogen, then the effect is overall neutral.

Doesn't really increase your risk of Alzheimer's, doesn't seem to lower it either. If you look at the estrogen and progestogen formulation, and these are mostly synthetic forms of progesterate, which means non-bi-identical. Non-bi-identical. Then if you take this combination therapy in midlife, less than 10 years from the last month's period, then there is a 23% risk reduction of Alzheimer's disease and dementia, which is just, still good and at least it's not harmful, right? The concern is always that the progesterone makes it worse. But if you take this combination more than 10 years post-menopause,

then there is a possible risk increase that was not significant, but it was present and needs to be further investigated. Like the tip of the curve is the Women's Health Initiative. Whereas studies that were done afterwards did not show such a big risk increase. And now we're trying to tease out what was actually driving those effects. And this seems to be the kind of progesterone that they were using that is no longer used in the United States. So bioidentical progesterone seems to be safer overall and bi identical estrogen also seems to be gentler on the system. So the key takeaways here, timing is a big portion. Timing is important. Getting involved earlier. Yes. And using biodentical hormones. If somebody has access to that

and finding a practitioner who can work with you, that's where you're going to get the biggest bang for the buck, whether you do estrogen only or estrogen progesterone. That's correct. Yeah, fascinating. It is fascinating. It is fascinating. Yes, I was quite happy when I saw these results.

This is one of my students, Matilda Neratini, which is one of our PhDs. Shout out to Matilda. Shout to Matilda. We'll link to this slide. If you're listening on audio, we can link to it so that people can view it online. That's great. This has all been fantastic.

I've been really enjoying this. conversation. I'm so glad. You know, it's really funny. My husband and my daughter, they all know everything about menopause and pregnancy and puberty. There's this little girl who's like eight and she'd go to her friends. It's like, oh my goodness, are you close to puberty? Because when it happens, your brain is going to rewire. You may have, you know, you may have trouble sleeping or you'll be feeling like you're cranky, in a bad mood, but it goes away, it goes away. And then you get a new brain. And I love it. Yeah, though. We need more of these conversations. And it was funny. before we started recording, I was like, oh, are you going to do a few podcasts you're here in

LA right now? Yes. And you were like, yeah, I'm going to be on your podcast. I'm going to be on Max, Max Lugavir, and Sean Stevenson. In the back of my head, I'm thinking, awesome. You know, these are three of the top help podcasts that are out there and all men that are hosting this conversation and featuring your incredible work. And we just need more of this.

Yes, we need more of this. We need men to be educated. We need women to be educated. Sometimes I have to stick up for the men because we often get accused of being, oh, men don't know anything about women's health. And my women friends, and I have two sisters. And I'm trying to female friends. They're like, it's not like we learned anything about women's health, right? Like ask us about the basics of things. Like, we didn't know any, nobody even was telling us about the intricacies of, you know, puberty until right until like

it happened. Until it happened. Right. So we all need education. I'm team human, right? Like we all need education on these topics. And one of the areas that I found going on this theme of education that I found the most sort of exciting in sort of the book is at the end of the book, you really start to tackle this question of so many women feel like, why is this happening to me? And larger in sort of the space of women who know that menopause and paramedanibanols will happen at some point in time. It's like, why do women go through this?

Right. It's this question of why. Like, why would we as a species be going through this and forcing women to experience this? And it just seems like unfair, if I would say anything. It's sort of unfair in the way that it's sometimes expressed. Yes. Why do women go through this? But that's culture.

Right? And once you get out of unfair, there's a sense of like curiosity of like, wait, why is this going on? And you tackle this in the book and you kind of hinted at a little bit earlier. And there could be a reason. a reason why women are going through this that is deeply linked to our evolution as a species and the longevity of the fact that we have made it this far as a species. Can you talk about that? Yes, this is something that I really loved about the research and looking into menopause. Because for anyone with ovaries, manopause is just something that happens and we take for granted.

but in reality, from a scientific perspective, menopause is a biological riddle. It's something the scientists have been spinning their wheels on for a really, really long time because it goes against the theory of evolution. And they will preempt that Darwin was not the kindest person to women in general. But it is the backbone of modern science, and menopause goes straight against it

because the idea of evolution is that you are, are only useful for as long as you're reproductively viable and you can pass on your genes to the next generations. So the fact that at some point women stop reproducing and don't die seems to go against this idea. And it led to some theories around menopause that is called a mismatch hypothesis that really dominated the understanding of menopause through the 90s, which is that menopause is a fluke. mistake. A mistake. So that somehow modern medicine helps women live longer than nature intended for them to live. And then this doctor, Dr. Hawkes came up and she said, no, no, no, let me give you a perfectly

alternative explanation that actually makes a lot more sense, which is called the grandmother hypothesis. It is lovely. She was working with the Hasda. But by the way, sorry to interrupt. What an incredible name. Dr. Hoax? Yes. Who's like unraveling the hoax that's been perpetrated on women? Yeah, that's a good point. Don't think about it.

Yes. So she basically came up with this alternative explanation, which makes a lot of sense both genetically and societally, which is that it makes more sense for women to stop reproducing as a certain age because the risk of dying or childbirth is higher the older you are in the risk of genetic mutations happening in the kids is also higher with age. So in a way, it is better for women to stop reproducing themselves and stay alive to help their own daughters, become mother and then take care of the grandchildren

because that enables their daughters or sons to have more kids. And so the shift switches from women being reproductive to women being productive, after menopause, which I think is a beautiful way to look at the impact of older individuals in society, not just women, men as well. Right. You know, grandpa's like great. But for women, I think it's important to realize that.

And what they added on top of this theory is that the women who were able to survive and live long enough to become grandmothers are those who were really physically fit at that point. So they had genes. They promoted. fitness, strength, and longevity that was then passed on to the dosers who would then follow into a similar pattern. And therefore, it is possible that grandmothers are one of the reasons that humans live as long as we do. I mean, that makes sense to me. It's a wonderful way to think about grandmothers. I love it. You know, the heroin's. Totally. Anybody that sees these traditional

societies and I'm very fortunate to, you know, both my grandmothers have passed, but I'm very fortunate to have spent a lot of time with both of them at a young age. Their influence on the family, like both my grandmothers at various times live with my family. And our, my dad's side of the family, especially he has seven brothers and sisters. They would fight to say, no, no, they're going to stay with us for a little while right now. And the kids would, we have such a deep, you know, affinity. And I recognize not everybody is in that situation. But when it works well, like you understand the influence of the matriarch and the patriarch, the divine matriarch, divine patriarch, and like this is what has kept our species there. So I'm not a scientist, but that makes

sense to me and I'm running with that theory now. Me too. It's such a better way to think about aging in general. I think as a society, we're so focused on the downsides and don't appreciate that really aging is a gift. And not many species are able to live as long as we do. in fact, something interesting about menopause is that most other females of other species just die. Yeah, they die. They don't have menopause. I'll learn that from your book. Exactly. There's only four species that go through menopause and live to tell the tale, right, which is very interesting. It's like killer whales. Yes. I love the analogy. Yeah. And some Asian elephants, some giraffes, another kind of whale, the normal, I believe, and another kind of whale, I don't remember. And then

there's one bug is the Japanese aphid. That is so funny. If you look at this little insect, she's all nice and pretty for menopause. And then when she hits the bug equivalent to menopause, basically sprouts spikes. It turns into a kind of little hedgehog. And you can't get near her. It's really like, I am done. I love that. And then women. Yeah. Yes. So I think there's something special about human menopause that we don't really appreciate. And I'll tell you one more thing that I thought was fascinating, which is that there are new neurological skills that are being developed with menopause, one of which being greater empathy and emotional mastery.

And I love this and I think we need to be aware that there's something to look forward to and really celebrate and appreciate, which is with men's. There is one part of the brain that's called the amygdala. This is very highly reactive in puberty and pregnancy, but then gets turned down so that you don't overreact to things that happen to you. Only in menopause, a very specific part of this structure is downregulated, but another one seems to be upregulated, which means the women after menopause are less reactive to things that are upsetting to me. negative sources of stimulation, but more reactive to things that are positive. And that seems to be working together with the prefrontal cortex, which is their impulse control and logical part of the brain, to kind of give you emotional stability.

And we call it emotional mastering, that you have a better grasp over your emotions, especially over negative emotions. So you're able to, like we were talking about, about, you know, life contentment before. There's a possible neurological explanation which lies in our biology. So you're turning down this part of your brain that makes you more aggressive and more reactive, which you need if you're a mother. Right. Right?

You have to fight and protect your kids. You're the mama bear instinct comes from there. And you get selectively turned down in menopause so you can be happier for longer. I mean, if you look at through history, especially like through the lens of like Joseph Campbell's work, a hero with a thousand faces, looking at mythology, you see through history and all the different, you know, spiritual fates and traditions, these different stories and fables where you have essentially, even in modern movies like The Matrix. Oh, yeah. You have the Oracle. Yes. Right?

You have the wisdom of the divine feminine, the grandmother that can see all understands and understands the unity of it all. kind of gives context and direction in a very sort of 30,000, 50,000 view of the world, the wisdom that comes from a life well lived. And there's a reason why these things are in our society, right? It's this recognition. Now, we might have forgotten it in our modern day world, but I think it's never too late to remember the power of that. And that being one of the things that comes along with this life transition is there's just this

to see things in a more contextual context. Yes. Yeah. Yeah. Dr. Mascone, this has been fantastic. This has been great. I always appreciate your work. Every time I get a chance to interview you, it's such a blast. Tell us about some of the work and how people can follow along, the lab, as well as some of the advocacy work that you do with different individuals like Maria Shriver, who's a friend of mine. And then, of course, just we mentioned. about the book and we'll link to it in the show notes so everybody can get a chance to pick it up. So if you could share a little bit more about that. Yes.

So I run the Alzheimer's Prevention Program, the Wal-Carnel Medicine, which is an entire clinical research program that spans from R&D to clinical practice. So we have three units. We have the Women's Brain Initiative, which is my clinical research component. Then we have a clinical trials unit where we test compounds for Alzheimer's Preachians' Prevention. that are specifically gathered towards women, women's brain health. And then there's the Alzheimer's Prevention Clinic, which we reopened about half a year ago, where we see patients in a real world clinical settings.

And if anybody is interested in working with us, we're open to enrollment, which is exciting. And to make things easier, this is how people can reach us that email over there. The Women's Brain Initiative WBI-B-I-Rash at Med-Cornell EDU. Advocacy. So, yes, we're doing a lot of work at the Alzheimer's Prevention Program. We have a lot of participants, which is amazing. And at the same time, we're trying to get the message out and take the information out of the lab and make it accessible and actionable to anyone who might benefit from it.

So I did write this book, which I'm very happy about. And Maria Shriver, who's, oh my gosh, she's like the ultimate superstar. And she's a good friend. And she wrote the foreword, which truly is a blessing. Actually, she wrote the foreword for the XX brain, which is the last time I was here to talk. Yeah.

And she graciously wrote the forward for the menopause brain. She's extremely interested in women's health. She really is a champion, a women's health, especially women's brain health. And she's now going for menopause, and that is wonderful. And she's been a wonderful supporter of our work. She has funded a couple of her published projects, like the HRT study that we just talked about.

And there's one project that was so hoping that I could talk to you about, but I can't yet because it's not published. Well, when it is published, you can come back. Yeah, so we'll love that because I think it's going to be really big. And they'll tell you when we're done here because I must tell you what it is. And yeah, so we're trying to really make sure the women have access to the information that we have as scientists and clinicians and people like Maria who can really translate the information and make it fun and accessible and also give it that kind of zest. You know, I can never do. She's amazing.

She opens her mouth and everybody's like, oh, I got it. So it's so wonderful that we get to. to work with her and her team and we're really, really blessed. And, of course, the NIH, they're also, I mean, we could not, we would not be here if it wasn't for the support of the National Institute of Health slash National Institute on Aging, which is where we apply for funds. And where people can find me on Instagram, Dr. Moscone, and on my website, which is easy, it's Lisa Moscone.com.

And I don't know. That's it. That's it. That's it. Well, the book is out. Or did the clinic. Come get your brain scanned. Yes, come get your brain scanned.

Check out a copy of the book. You come get your brain scan. I can come in and do it. Of course. All right. Let's do it. Yeah. I would love it too.

Yes, yes. She would love it. She would love it. Oh, good. Good. And then you know, you can put up the brain scans in your living room. Oh, hers is going to be superior to mine for sure. The book is out.

The menopause brain, new science empowers women to navigate the pivotal transition with knowledge and confidence. That's what you did in this interview for the listeners. You gave the knowledge, you gave the confidence. Lisa, thank you so much for being on the podcast. Thank you. Thank you for having me. Hi, everyone.

Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do to support this podcast is share it with a friend. share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on

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