Dhru Purohit Show - Why Women Are More Likely To Develop Alzheimer’s and How to Prevent It with Dr. Lisa Mosconi

Episode Date: October 24, 2022

This episode is brought to you by InsideTracker and AquaTru. Two out of every three Alzheimer’s patients are women. Today, Alzheimer’s is as real a threat to women’s health as breast cancer is. A 45-year-old woman has a one-in-five chance of developing Alzheimer’s during her remaining life, while a man of the same age only has a one-in-ten chance. What happens to women, and not to men, in midlife that could potentially trigger an Alzheimer’s predisposition, and that could potentially initiate Alzheimer’s? On today’s mini-episode, Dhru sits down with Dr. Lisa Mosconi to talk about the research on why women represent two-thirds of the Alzheimer’s population. They discuss what happens to a woman’s brain when she goes through menopause and the connection to Alzheimer’s disease. They also talk about how to care for women’s brains, how to prevent dementia, and the groundbreaking research that Dr. Mosconi and her team are conducting at the Alzheimer’s Prevention Clinic.  Dr. Mosconi is the director of the Women’s Brain Initiative and associate director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College, where she serves as an associate professor of neuroscience in neurology and radiology. In addition, she is an adjunct faculty member at the NYU Department of Psychiatry and the author of Brain Food and The XX Brain.    In this episode we dive into:   -The statistics on Alzheimer's disease, and its impact on women -The early changes we are seeing in the female brain midlife -What happens to a woman's brain when she goes through menopause -The impact of diet on our hormones and brain health -What women can do to prevent dementia   Listen to the full episode here.   For more on Dr. Lisa Mosconi, follow her on Instagram @dr_mosconi and through her website, lisamosconi.com. Learn more about The Women’s Brain Initiative here. You can find her book, The XX Brain: The Groundbreaking Science Empowering Women to Maximize Cognitive Health and Prevent Alzheimer’s Disease, here. This episode is brought to you by InsideTracker and AquaTru. InsideTracker provides detailed nutrition and lifestyle guidance based on your individual needs. Right now, they’re offering my podcast community 20% off. Just go to insidetracker.com/DHRU to get your discount and try it out for yourself. AquaTru is the primary water filter I use at home and in my office. Right now, they are offering my community an amazing deal. Get $150 off your filter at drhyman.com/filter today. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hi everyone, Drew Prode here with another mini episode for you with Dr. Lisa Mascone. If you haven't heard about her, she is one of the foremost experts and researchers on brain health, but especially the intersection of women and brain health. And on today's mini episode, we're going to be talking about a few things at that intersection from Dr. Mascone's best-selling book, The XX Brain. Specifically, we're going to be chatting about the following items. the statistics on Alzheimer's disease and its impact on women. We're going to be talking about the early changes we are seeing in the female brain

midlife through Dr. Moscone's research. She's going to be chatting about what happens to a woman's brain when she's going through menopause and how that's such a central time for setting up the future of brain health. She's also going to be talking about the impact of diet on hormones and brain health. And lastly, she's going to chat about what women's. can do to prevent dementia and reduce their risk of Alzheimer's. You know, the thing is, there are biological differences between men and women, and more and more researchers are getting funding and getting attention when it comes to women's health and looking at those intricacies

and those differences that aren't there. If we don't know and acknowledge those differences, primarily because women have an infradian rhythm and their hormonal system, which is much more complicated than men's, they have unique needs that are there. So that's what Dr. Mascone's research is all about if you care about reducing your risk of Alzheimer's disease, preventing dementia, and being in your optimal, hormonal, and brain health throughout your life, this episode, this mini episode, is absolutely for you. So tell us what do we know about the stats around Alzheimer's and when it comes to the gender divide. Right. So Alzheimer's disease is the most common form of dementia on the planet, affecting close to 6 million people in the United States alone.

But almost two-thirds of all these people are actually women. So for every man suffering from Alzheimer's, there are two women. And that's on top of the higher risk of anxiety and depression, or multiple sclerosis, or meningiomas, like you mentioned, which are the most common brain tumors. Women are also much more likely to die of a stroke. If a stroke takes place, we're more likely to have aneurysms as we go through menopause, especially. And Alzheimer's is just, it's enormous. There are so many people with Alzheimer's.

And if we don't find a solution, then the rates of Alzheimer's disease are going to triple by the year 2050 with a projected 15 million patients in the United States alone, which is, for context, the populations of New York, Chicago and Los Angeles, together. So it's an enormous amount of people and two-thirds of all those people might end up being women. Yeah, you said before in a talk that I watched in preparation this interview, you say just because we're living longer, it doesn't necessarily mean that we're always living healthier. Yes. And that's actually also the problem we have in Alzheimer's disease. And for many years, I was trying to study this gender disparity in Alzheimer's and people would just say

to me, well, you know, that's just because women live longer, right? So Alzheimer's disease is a disease of old age and women live longer. So it goes without saying that you get Alzheimer's more. And that's the end of it. Right. That was the conclusion that was accepted in science for long time. For a really long time. And things are starting to change dramatically, finally, in part because we now understand that Alzheimer's is not a disease of old age. So we associate Alzheimer's with the elderly because the symptoms of Alzheimer's emerge when people are older, usually in their 70s. But in reality, Alzheimer's disease starts with negative changes in the brain,

years, if not decades, prior to clinical symptoms. So we started to look at that midlife. Midlife seems to be when this brain changes really start taking place. And so since my background is in brain imaging, I have a PhD in neuroscience, but also in nuclear medicine. So, So I do brain scans for a living physically. And in my lab and with the Women's Brain Initiative, we do brain scans on all of our participants. And we started going younger and younger. When I started, we were looking at patients who were like 65, maybe 70. And then I was like, well, you know, we have to really start looking at people who are like in their 40s.

And so now we have hundreds and hundreds of participants who are like 40 to 65, for example. And we did brain scans on all of them. and then we compared the brains of men and women, and we showed that women's brains in midlife look much more Alzheimer-ish than men's brains, which means, in other words, that women, with a predisposition to Alzheimer's disease, start developing Alzheimer's earlier than men do.

What are some of the ways that men's and women's brains might be different and how that impacts what diseases we get in our later years? Yes, that's a really good question. And I just want to mention that there are a lot of pop-sciety, hand-wavy theories on how women's brains are different from men's brains. And I just want to be very, very clear that from a scientist's perspective, there is no evidence of a gendered brain.

So I just want to put it out there because I got this question a few times. Men are from Mars. Right. Girls are from Venus. This is something that leaves me obviously like, whoa, I don't know about any of that. However. Totally. And it's not even like the brain is, there's not like a male brain and then a women's brain. It's how the body interacts with the brain.

Thank you. Yes. So what's really important is that we're different systems. We're wired a little bit differently. And that starts from the very moment of conception. So if you are female meaning, if you have two X chromosomes, which has nothing to do with gender, gender identities, just really to use a word that we're using. clinical practice, if you have two X chromosomes technically, you're a female, and if you have an X and the Y, you're male, and so is your brain, right? What's interesting is that the X chromosome is bigger than the Y chromosome. It has like 1,098 genes, whereas the Y chromosome only has 78. So if you are a double X, you have a thousand more genes to start with, and many are involved in reproduction and fertility, but others are really involved in brain health. And it's really important to know that because your DNA is what really makes your hormones.

And hormones are one of the very first factors that matter for the sexual differentiation of the brain. So as the little brain is maturing, if you have more androgens flowing in your bloodstream and in your cells, then you're going to have more of a male brain. whereas if you have the XX and more estrogens, you're going to develop a female brain. So the architecture of the brain is very similar, but the functionality is slightly different just because of this, to start with. And this, you're not even born at that point.

You're still inside your mom's belly and you're just growing a brain. And once the child is born, then the difference is obviously become even more pronounced because of all the interactions with the environment and all. the things that happen to girls and boys, right, all the way through adolescence, and then the biggest events in a woman's life, being pregnancy, being pregnant and getting a child, has profound effects on your body and your brain as well, and then going through menopause, which is quite a shock to this finely tuned system. And these are all neuroendocrine transition stages.

means that your brain and your endocrine system, your hormones, are both in transition at the same time. And we now understand that this transition states are very important for brain health, especially in women. So let's go to that example that you were sharing before because it used to be thought that, okay, because women are living longer, that's why they're experiencing some of these diseases like Alzheimer's. And then in a lot of the research that's out there, including the work that you did,

you're saying that in midlife is when we're starting to see some of the earliest changes in the brain. So what are some of the earliest changes? Let's talk about the female brain for a second. What are some of the early changes? I want to see it? Yeah, I would love to see it. Okay, fantastic. So you pass me your phone. I'm looking at the difference. Everybody that's listening on the podcast of explain what we have on the left and what we have on the right.

So these are positron emission tomography scans or PET scans, which is a nuclear medicine technique. in which we use radioactive isotopes that go up in the brain and look at brain energy levels. And that's literally a map or a visual of how well the brain is metabolizing glucose to produce energy. And the brain to the left belongs to a woman who was 43 years old when we scanned her the first time, and she was pre-menopausal then. And that brain is exactly what you want your brain to look like when you're 43. What are you in your 40s? Really nice and bright with a lot of red, right?

Everywhere in the brain is very symmetrical and it's quite red and yellow. The other brain is the same woman just seven, eight years later after she went through menopause. And I think you can see quite easily how the red turned yellow, basically green on the outside of the brain. That's a 30% drop in brain energy levels. And this is not just that one woman. This is the average. It's what happens to most women as they go through menopause. And interestingly enough, this does not happen to a man of the same age.

Right. The man's brain looks more like the skin to the left and remains that way throughout midlife. Unless, of course, there's always exceptions. But on average, brain men's brain energy. levels are nice and high and pretty much consistent throughout midlife. Whereas for women, there's a very marked change during the menopause transition. And we'll include the image in the show notes. And obviously for those that are watching on YouTube, you can slid, we'll splice it in. Patrick will throw it in the mix. So let's talk about that because this is a perfect example of

what changes over time. So what happened from one scan to the next? What is happening in the postmenopausal state for women that is leading to less efficient ability to work and produce through energy in the day. Well, a lot of things happen. The most impactful of which is that estradial levels plummet. Estradial is the most potent form of estrogen and is the number one hormone that we lose during menopause. Now, why is that important? Because we think of estrogen or testosterone. testosterone is sex hormones, but in reality, these hormones have a very important function in the brain. They're not just involved with reproduction or having kids. They also serve a number of functions that have everything to do with brain energy. Estradion, in particular, is a neurotoprotative

hormone, and we call it a must-of-regulator in the female brain. So it's really involved in a number of functions, starting with energy production, but also in growth, plasticity, and even immunity. It really supports the immune system. So it's kind of a superpower that this hormone has, if you will. And once you lose it, the brain loses a very strong ally. Right. It's like this hormone is energizing the brain, is keeping the brain young and plastic. And once you lose it, what can happen is that your neurons slow down because they lose

energy levels and start aging faster. And studies have shown that this process can even lead to the formation of amyloid plaques or Alzheimer's plaques in women's brains as we go through menopause. And what's something that is important to clarify is that we associate menopause with the ovaries, right? We think of menopause is something that makes you infertile. Like you can't have kids anymore, so it's your ovaries shutting down and retiring. But when women tell you that they're having hot flashes or night sweats or insomnia or depression or anxiety or brain fog or memory lapses, those symptoms don't start in the ovaries. They start in the brain. They're neurological symptoms. We're just not used to thinking about them as such. And this is really important for two reasons. Number one, because menopause doesn't happen when you're old. Menopause can happen any age between 35 and 60.

And the earlier you go through menopause, the more severe these changes can be, the harder on your body and brain, the estrogen loss can be. So it's really important to start the conversation when women are younger, not when you are in menopause, because this is what we do. You wait until you are in menopause, and then the doctor tells you, well, you know, these issues you'd be having, you're in menopause, surprise. And then you're like, oh, what do I do now? No, right?

There's no understanding of why you have the symptoms that you're having, and there's very little understanding of what to do about it. So it's really important, I think, to just talk about it. Also for men, you know, to just know, these things happen to women they're not just complaining or making it up. Of course. No, it's not, of course. No, of course they're not making it up, is what I'm saying.

Can you believe instead how many people think? Yes, yes, so people think that they're making it up or it's this, that. they're of course they're not making up something is actually happening in the body and if you have a loved one your wife your mother a cousin family friend whatever it might be this is why it's so important to be for men to be part of the conversation too yes so part of that conversation and the work that you're focused on is is prevention and part of prevention is understanding what are the factors that make it more likely to have us have a worse state versus not a worse state so in that instance of menopause and in that instance of estrogen plummeting and not being in the body, what are the factors that contribute to that?

There are quite a few factors. Some are genetic, of course, and at this point in time, we can't really do much about that. Age is another factor. Most women go through menopause in their early 50s, but it can also be earlier often because of medical interventions. For example, a hysterectomy and or an ophrectomy, which is the surgical removal of the uterus and or the ovaries. And unfortunately, there is evidence that having the uterus, and more so the ovaries removed before menopause correlates with a higher risk of dementia in women, which is something that you're not usually told before that happens to you. And I just want to be clear, I'm not saying that women should decline.

the procedures or avoid the procedures that they need them. But I think we really need to better understand what happens to our brains as we go through menopause, natural or medical, and how to protect her brains in the process. And also something I was reading is done in the United States. One in every nine women has the uterus removed at some point in her life, which is a lot of women. And the number one reason for that is not something terrifying,

Like something they have to do. But it's fibroids. Fibroids. You know, perhaps modern medicine could come up with some better solutions than just removing your organs. Well, we know the impact of an anti-inflammatory diet and lowering sugar and how that could potentially be something that could help with that. Yes. There are quite a few. So lifestyle is another factor that plays a role in definitely hormonal.

health, but also menopause and how and when and how you go through menopause. So let's expand on the lifestyle because it's one of the things that we can actually control. Yes, exactly. It's something that we can do. So you had given this example of the people in your scans that were eating the Western diet versus not. Let's start off first with the lifestyle aspect of diet. What do we know about diet and its impact on hormones?

Right. So what we know about diet is that the foods we eat really have an impact on the health of our brains. And they think as a society we're more comfortable with the notion that we feed our bodies and that the foods and diets that we choose will have an impact perhaps on our choice of clothing or our waists and muscles, but we're less aware that we're also feeding our brains. and that the nutrients that we put in our bodies will probably have an effect inside their heads as well. And I think it's really important to acknowledge the fact that foods also have an effect on hormones. There's a strong correlation between diets like you mentioned right now and hormonal health to many different levels,

whether obesity, diabetes, insulin resistance, thyroid disease, but also menopausal symptoms. So we really need to eat to optimize our health, not just the way we look, but also the way we think. And as a scientist who is really involved in women's health, I went through the research that's been done specifically in women, because we know that men and women need somewhat different diets, because we have different hormones, we have different muscle fibers, to some extent. I mean, we're not different beings, obviously. but there are some differences that could potentially explain

why women crave chocolate more sometimes. And different ages too. When you're young and you're a woman who's in her prime of fertility you need a different, you might have different requirements. More chocolate. But it's true. More iron, more protein.

Sure. I've even heard like a lot of women who are young in like, you know, like let's say 25, like in the 25 to like 40 year old age and are still, they want to have kids, they haven't had kids yet, and they try and like an extreme keto where they cut out all carbohydrates. Typically, we've gotten a lot of women that say, okay, it doesn't work the same way for me as it might work for a man, especially as a man like at our clinic at the

ultra wellness center. So there's so many areas where even though we are similar, we're all human beings, that we do have to personalize things appropriately for women. Yes. And men. Yes, for sure. And we'll respond to diets very differently, also depending on the menstrual cycle, honestly, which is something that many diets just don't consider. So in the first part of the cycle, when your estrogen is really high, your metabolic activity is higher. So you can definitely tolerate more carbs, for example. In the second part of the cycle, where the estrogen goes down and the progesterone goes up, then you're going to need three times the same kind of stimulant, for example, to feel the same effect,

which is when women have a tendency to perhaps overdo it a little bit with the chocolate. So there are a few physiological things that one needs to take into account. And I think the research is pointing to, well, the research has pointed to the Mediterranean diet as a diet that seems to be really supportive of women's health. And I would say, I would argue that perhaps it's not just the diet as much as the lifestyle, that is really lower stress. more consistent, low-intensity physical activity, but you just keep your body moving all the time,

and the food is definitely higher quality than in other societies, like when you go to the way and read and there's donuts everywhere. So it's perhaps a lifestyle that it seems to be more conducive to improve women's health. But it is interesting that the Mediterranean diet contains foods that are quite rich in estrogens in the form of phytocetrogens or estrogens from plants. So what's interesting is that estrogen is the most ancient of hormones. So it can really go across species.

So the estrogen that a plant makes has a similar effect in a woman's body as our own estrogens. Which is really nice. I think the nature works all together and that we can get hormones from a plant and just, they become part of our own hormonal system, I think is quite nice. And, of course, there are some phytoestrogens that have been associated with some health risks like soy. Soy is perhaps the richest source of phytoestrogens, but many people have allergies to soy. And the soy that we have in the United States is very often genetically modified or very highly

polluted, so it's perhaps not the best choice. But then there are other foods like flax seeds. They're a great source of estrogens from plants, sesame seeds, chickpeas, most legumes, as well as dried apricots for some reasons, and the number of fruits. And also dark chocolate contains a form of phytoestrogen that is potentially biologically active in a woman's body.

So we know the Mediterranean diet, and we'll come and want to talk about a few more things with the Mediterranean diet. Okay. Going back to some of the factors inside a diet, But one of the things that we've definitely seen an increase of as diets all around the world have become more westernized, even in places like Italy and Europe and other places, everybody's sort of following the unfortunate trend that the United States has set is we've seen a massive influx of

sugar into a lot more fruits. So what do we know about sugar and how it plays into a role with the items that you're talking about? Well, so refined sugar wears out your pancreas, right? It really decreases your insulin sensitivity and increases your risk of insulin resistance. And insulin being a hormone works in balance with all your other hormones. So if you have hormonal imbalances, whether thyroid disease or insulin resistance, pre-diabetes, that might also impact your sex hormones and your reproductive functionality. So I think in general, I don't know if it's just sugar, but there's a lot of evidence that processed food is really not good news for health in general, but also especially for women's health. And there's this incredible study with 100,000, over 100,000 people that came out in the British Medical Journal, shown how consistent consumption of processed food is associated with an increased risk of cancer of all types of cancers.

but also over 12% higher risk of cancer or breast cancer for postmenopause of women. Whereas there's another really big study showing that regular consumption of fish, especially fatty fish, and also legumes, is associated with a later onset of menopause. So anything that can delay the onset of menopause, I think, is beneficial to women. So when men or women come to you and talk to you about, Okay, now I know the stats. Right. Women are more likely for X, Y, and Z

and all the things that we talked about at the beginning of the podcast. Yes. And we know lifestyle factors contribute. And we know that they show up as early as our 40s, right? Like later 30s, 40s. What are some of the things that you tell? Let's focus on women because that's what, you know, the angle is. And for the men that love them and are in their lives,

what are the things that are the highest return that you have them start to focus on at that age to impact the likelihood of Alzheimer's and other degenerative brain diseases or brain tumors that might come later down in life? When you start off at the top in terms of like, like, you usually prioritize this first and then and this next. I'm sure they all matter. Yes, so I'm going to show you this very quickly. What I usually tell them is this. There's a sentence in Latin that I'm sure you're familiar with is men's sanana, incorporate sano, which means a healthy mind in a healthy body.

And if you use, if you take just the beginning, mens sana, then you have M for mental stimulation. E for exercise, N for nutrition, S for sleep. We have another S for stress, A for avoiding toxins, another N for networks, and the final A for medical assessments. And this is part of your eight-step plan that you put together. Can you explain what that's called? It's called the well-nourished brain. Oh, the eight steps to a well-nourished brain.

Yes. That's the same thing as what you were talking about. Yes, it is the same thing. Well, just a coincidence, they both have eight steps. I think the eight steps is more like the diet. Okay, got me, got it. Yeah, there are eight things that one can do to optimize their diets. Let's talk about this one first.

These are eight things that people can actually do. And what I always say to our patients is that it's up to them to decide which one is most important to them. Because we have some patients who are super healthy in terms of their diet and exercise levels, but they're so stressed out. They're just, they're shaking when they come to. the office, they're under so much stress, they can't sleep a night. So for them, stress reduction and sleep management are really the absolute priorities. So I think it's really important to see, check these eight things, and what are you doing okay already, and what is not so great,

and how can you make it better? Yes, what's missing in your life at this point, and then let's try to address those. If I had to just choose three, My top three would be number one diet because we all, almost all of us, we eat three times a day. So we have three chances every day to really make. How can you make it better? Yes, what's missing in your life? Exercise, number two, there's a ton of evidence that keeping your body going really also helps your brain, staying young and healthier and makes it more resilient.

And for women in particular, there is literature, there's research done specifically in women. And it did show, like you were saying, that age plays a big role in hormonal health as well. So when women are pre-manopause, their muscles, their energy levels, everything is more conducive to a higher level of intensity in terms of exercise. You don't have to do it, but you could. whereas after menopause is a little bit more difficult to really engage in high-intensity activities. And so many women just feel so bad about it. And they almost beat themselves up. So part of what I'm trying to do is to just say, it's okay.

It's not about having a standard. It's not about following trends. It's really about what works for you and your body and your mind at this stage in your life. If you can't do spinning, it's okay. Just find something else that you like to do it, but do it consistently. So what research has shown is that consistency is really key, rather than intense bursts of activity, and then it takes you three weeks to recover

because your hormones are not there to help you out, and maybe you're so stressed that your cortisol is up to the roof and your adrenaline doesn't make your sleep. Just try to find an exercise that really helps you feel at your best. So that would be my number two. And number three would be stress reduction. And that's a big word. Which one?

Which one? It's a simple word, but it's a big topic. It's a huge one, yes. Because part of what you were saying before is that part of what may be influencing, kind of like the research in the blue zones, could be influencing the Mediterranean diet and how impactful it is, is just the Mediterranean lifestyle as a whole. Yeah.

So when you work with the women in New York, at Cornell who are asking for the recommendations that are out there where you're talking at different places and forums to audiences and the topic of stress reduction comes up. How do we create a little miniature Italy in our own lifestyle and embrace that? What have you been the things that you've seen that are most impactful for people when it comes to stress reduction? I think it depends on why you're stressed, right?

There are many people in New York are stressed because of work. we all work very long hours. We have very little time for self-care. And I think there's research showing how for women also holding full-time jobs and having a family and raising small kids and taking care of the elderly parents and trying to perform as well as a man in the same position while being paid less. there are a lot of psychological stressors as well that really seem to peak when women are in the ages of 25 to 45, according to, I don't remember which norm is entering the CDC, the Center for Disease Control and Prevention. There's also evidence that women tend to suffer more stress, the men, or at least they internalize stress perhaps more, or have more symptoms because of the same levels of stress. And I think it's in part that women don't have a lot of time

to really take care of themselves. Perhaps we're not good in making the time. But as a new mom, I can totally relate to that. They used to exercise very consistently and that now I really had to plan for it. You know, you just don't have that hour and a half that you just, oh, I'll just drop off at the gym.

No, no more. Now you go to the playground. It's a really difficult, you know, it's a different life that you have at some point. And it's a beautiful life. It's just really important, I think, to find ways to reduce stress that work for every individual woman. And everybody's different in many ways. Yoga is something that works for a lot of people. Meditation has been shown in clinical trials to really reduce cortisol levels in stress.

women including those going through menopause. So it's a good thing to know. Green time over screen time. You know, you're doing this kind of weekends without social media or try not to check your email before bedtime. Try to really optimize your sleep, trying to sleep longer if you need to or at least to sleep better so that you're not disrupted. So the book, The X-X-Sprane is coming out, March 10th. And what's your hope for the book for people that are out there? Like, who is really the person that you want to pick up this book? Any woman, really, any woman. My hope for this book is really to empower women to better understand their brains

and to really take control of their health, especially their brain health. And the reason I wrote the book is really to take the research out of the lab and out of the clinic and make it actionable for people. So I divided the book into three different parts. The first part is really the research that we've been talking about. And I think it's so important to understand what's been done so far and why women's brains have been neglected and what we all should do as women to avoid that from happening again and to actually have research that is specifically focused on our brains.

Because we need more. It can't be just a few scientists here and there. It should really be all research able to look. differences between the genders. And then the second part is the testing. I really clarify which numbers you need to know about yourself. You have to know your numbers and which numbers are really important in terms of prevention and treatment in case you do have something that needs treating. And then the last part is what you can do. And I think the question I get the most is about hormonal therapy. Should I take hormones? Or I took hormones. Was the other mistake?

They always say, it depends. It really depends. I need to have a lot of information on a woman to be really able to advise her. And that's when I think having a doctor that you really trust and respect and work well with is so important. But in the book, I have a number of tests that one can take directly in the book to identify, at the very least, the things that concern the greatest symptoms, perhaps the greatest risks. for you as a person. And then I even have like, because I'm a scientist, of course, where they have diagrams. Yeah.

Like flow charts that lead you to a solution. Like, do you have half flashes? Yes or not. Are you eligible to take this medication, right? And then there's a table that shows you if you are eligible or not. Yes or not. You have these symptoms. Yes or not.

And it keeps going until you have a solution. Yeah. You're not eligible for hormonal therapy, try therapy, SSRI or SNRIs or S&RIs or try a gabapentin or try it, da-da, which is really closer to this precision medicine approach that we use at the clinic and the women's brain initiative where we look at each person's individual risk factors and we try to personalize the solution. And of course, that's just one chapter in a book and it's just the first step. But I think it really answers a lot of questions.

Like if you're older than X number of years and you went through men, seven years ago. Should you be on hormones? Probably not. You know. And then let's look at other things that you can do. And then there's the whole lifestyle. Because we have to be all of us as human beings. We have to be the CEO of our health. And then we have to find the right implement. You have to find the right doctor, the right person, the right therapist that's there. But if you're not informed, it's hard to ask good questions. And really reading books like this is a great way to get more informed so you know what's out there.