Feel Better, Live More with Dr Rangan Chatterjee - Why Women Are More Likely to Develop Alzheimer’s with Dr Lisa Mosconi #129

Episode Date: October 28, 2020

Women's brain health remains one of the most under researched, under diagnosed and under undertreated fields of medicine. Women are twice as likely as men to develop Alzheimer’s and twice as likely to become anxious or depressed. They are four times more likely to suffer with headaches and migraines and they are more prone to brain tumours and strokes than men. Today’s guest says this is a clear indication of functional differences between female and male brains. And she’s made it her life’s work to learn more about it. Neuroscientist Dr Lisa Mosconi is director of the Women’s Brain Initiative and works at the Alzheimer’s Prevention Clinic at Weill Cornell Medical College, US, where she studies how genetics, lifestyle and nutrition shape brain health, particularly in women. Lisa describes her frustration at constantly being told by peers that the reason Alzheimer’s was more prevalent in women was simply because they live longer, and it’s a disease of ageing. We discuss her ground-breaking research that has exposed this bias, finding dementia brain changes can actually begin in midlife, triggered by declining oestrogen during perimenopause. Worrying as that might sound, this discovery will enable women to take control of their risk at a much earlier age. Lisa goes on to share plenty of practical, evidence-based advice to help you do that. I was really moved hearing Lisa talk about the beautiful changes that happen in the female brain during pregnancy and post-partum. It’s a new take on the idea of ‘Mummy brain’ and will be validating for all mothers out there to hear. She also gives a clear and candid explanation of how perimenopause alters brain function. So many of my patients in their 40s and 50s are scared by changes like forgetfulness, brain fog and anxiety. If that’s you or someone you know, Lisa’s insights and advice will be really empowering. I’m a passionate advocate for women’s health equality. Yet chatting with Lisa made me realise how much more work we all have to do to get topics like these out there and understood. This conversation is relevant to all of us, women and men alike. I hope it gets you thinking and talking more.  Show notes available at drchatterjee.com/129 Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

Women's brain health remains one of the most under-researched, under-diagnosed, under-treated fields of medicine and is really a direct consequence of the reductive understanding of what a woman is in the first place. And that I take personally and I find it incredibly offensive. For every man suffering from Alzheimer's, there are two women, which is something we never talk about, right? So we know that women have a higher risk of breast cancer, for sure, and breast cancer gets the pink ribbon, and everybody clearly understands breast cancer is a women's health issue. But a woman who's 60 years old is almost twice as likely to develop Alzheimer's disease in the rest of her life than she is to develop breast cancer. And nobody talks about Alzheimer's

disease as something that women should be concerned about or should know about. Hi, my name is Rangan Chasji. Welcome to Feel Better, Live More. My name is Rangan Chatterjee. Welcome to Feel Better, Live More. Hello and welcome to episode 129 of my podcast. I think you are going to really enjoy today's conversation. It's all about women's brains, but it's just as relevant to men as it is to women. You see, women's brain health remains one of the most under-researched, under-diagnosed, and under-treated fields of medicine. Women are twice as likely as men to develop Alzheimer's and twice as likely to become anxious or depressed. They're four times more likely to suffer with headaches and migraines, and they're more prone to brain tumours and strokes

than men. Now, my guest today says that this is a clear indication of functional differences between female and male brains, and she's made it her life's work to learn more about it. My guest is the neuroscientist and author of the brand new book, The Female Brain, Dr. Lisa Moscone. Lisa is director of the Women's Brain Initiative and works at the Alzheimer's Prevention Clinic at Weill Cornell Medical College in New York, where she studies how genetics, lifestyle, and nutrition shape brain health, particularly in women. Now, long-time listeners will remember Lisa. She appeared on the podcast way back on episode 18 when she spoke about the best foods to nourish your brain. If you've not heard that one, it's definitely well worth listening or re-listening

if you've forgotten what she's spoken about. But in our conversation today, Lisa describes her frustration at constantly being told by peers that the reason Alzheimer's was more prevalent in women was simply because they live longer than men. We discuss her groundbreaking research that has exposed this bias, finding that dementia brain changes can actually begin in midlife, triggered by declining estrogen levels during the perimenopause. Worrying as that might sound, this discovery will enable women to take control of their risk at a much earlier age. Lisa goes on to share plenty of practical evidence-based advice to help you do just that. I was really moved hearing Lisa talk about the beautiful changes that happen in the female brain during pregnancy and postpartum. It's a new and fresh take on the idea of mummy brain and I'm sure will be validating for all mothers out there to hear.

Lisa gives a clear and candid explanation of how the perimenopause alters brain function. Now many of my patients in their 40s and 50s are scared by changes like forgetfulness, brain fog and anxiety and if that's you or someone you know, Lisa's insights and advice will be really empowering. I'm a passionate advocate for women's health equality yet chatting with Lisa made me realise how much more work we all have to do to get topics like these out there and understood. As I said at the start, this conversation is relevant for all of us women and men alike and I hope it gets you thinking and talking more. Please note there was a significant delay in our Zoom connection when

recording so in some parts it seems as if we were interrupting each other, when in reality, we had no idea the other person was still talking. Now, without further ado, here is my conversation with the wonderful Dr. Lisa Mosconi. Dr Lisa Mosconi So I started looking at brains when I was 19 and one of the reasons that I was so passionate and so interested in women's brain health is that I have a family history of Alzheimer's disease it runs in my family and really hits the women in my family pretty hard. And so already back then, I was asking everyone, does it matter if you're a woman or a man? What

are the genetics of Alzheimer's? Is it worse if you're a woman? Does it affect women more than men and why? And back then there were no answers whatsoever and so I literally I dedicated my entire career to studying women's brain health is literally what I do for a living and everything else is more you know like a side dish I mean there's two strands for me that I'd love to pick up on one is about the ordering of your books then in terms of if this is the more natural one. It's surprising to me that you then, or it's interesting to me that you started writing a book on food and the brain. And I wonder if that's to do with, you know, the fact that food dominates everything, right? When we

talk about lifestyle, generally the conversation goes around food. We often neglect the stress, sleep, other factors. People like talking about food. So was it easier to get that entry point into writing a book in a way to sort of communicate your work to people? Was it easier through food than the brain? No, it was not was it was quite a thing also I'm a scientist I'm like 100% scientist so it was it's already hard enough for me to

just talk to non-academics and my work again is really about brain health and especially women's brain health. So it was quite interesting to me. I had the opportunity to write this book about diet and nutrition for the brain. And that was really a great time for me to do so because, you know, research comes and goes. The topics change. So when I started, I was looking at genetics, I was looking at DNA and the genetic factors that cause Alzheimer's that predispose to Alzheimer's disease. And that was a few years of my life. And then I started looking into lifestyle and nutrition and exercise, intellectual activity and sleep. And that was a few years of my life again of my research because research goes in cycles right

you have three years worth of funding five years worth of funding and so that was a great time for me to really focus on brain nutrition because number one i was teaching neuro nutrition at nyu yeah but a little while i was at nyu and then i moved to wild Cornell, where I am still associate director of the Alzheimer's Prevention Clinic, which was funded by Dr. Richard Isaacson, whom I know you know well. And that's really all about behavioral interventions that can minimize risk of dementia in people and also really just support cognitive health. But then I was able to go back to women's brains and I've been doing that since it is my passion is women's brain I think you can tell that when you read this book which is very passionate yeah your Italian passion is definitely coming through yeah but but it's it's it's such an important book it's such an important topic

yes and you mentioned already in this conversation a few times the female brain the female brain right and normally it's the male brain well i think that's i think we should start there already what what what is going on like because i think in my profession as a you know in medicine we very much have not been taught throughout our careers and even now when you talk to colleagues i'm not convinced that there is a widespread understanding that the female brain is different from the male brain yes i agree with you with you. There's marketing, right, where we are being presented as different beings, starting from very early on in life with pink and blue, Barbie and Lego. We are aware that there are behavioral tendencies, not differences,

but more like tendencies that have been totally exploited by the industry and marketing. But then I think it's really important to recognize that there are some differences between the female brain and the male brain that are not, they have nothing to do with like Mars and Venus, so to speak, because I get that a lot, mars and venus so to speak because i get that a lot but there are real biological differences that are really important for our health so i've been looking at brain scans forever as i mentioned and i can guarantee that there is no such thing as a gendered brain when people tell you i can look at two brains and tell you this is male, this is female, absolutely impossible. There's just no way to do that.

The differences are subtle and they're functional rather than structural. It's not the anatomy that is different. It's really the functionality of the brain. And what's really important and what my research has shown consistently, which I'm very happy about, is that our brains age differently. We think about aging as something that is quite linear, and that is pretty much the case in men. It's just great. It's a great thing. For women, it's more like a stepladder. There are some very important turning points that accelerate aging and slow down aging. Accelerate

aging, slow it down. And the scientists and as clinicians, we're just never told that this is the case. We're not told that we age differently and we're not told why that is the case. And one of the big answers that we have come up with is that our hormones are really key for brain aging, especially in women. Yeah, that is... It's a lot of information. Lisa, is so profound and so important. Because actually, if society is not aware of that, if scientists, if doctors are not aware of that, that we can start to put that bias in to how we talk to people, how as a doctor, I treat my patients you know that that that bias can infiltrate and actually I guess there's a broader philosophical point for me as I'm reading your book and you

sort of do cover this in your introduction you know actually what we're talking about on some level is a form of discrimination really isn't it yeah clearly so it starts with darwin you know the father of evolution and all modern theories of biology he was incredibly misogynist and he would say that women's brains are inherently inferior to men's brains and this is pretty much the framework the scientists were operating under for centuries just trying to prove that women's brains were not as good as men's brains and that was really based on observations of size so if you do compare a number of brains male and female brains female brains women's brains are, but that's because women are smaller than men on average, right? Their head size is smaller. So it makes sense that their

brains are also smaller. Once you account for head size, there's really not much difference in volume. What we do find is that there are very specific subtle differences in some parts of the brain that are also correlating with behavior which i think is really nice when we say for example that we know that women have better verbal memory than men this is related to some differences in the structural and functional cognitivity of the brain it is slightly different in women than in men. Can you explain verbal memory? Yes, verbal memory is the ability to remember verbal information. So if somebody tells you something, you as a woman remember it.

I'm laughing because we have this, you know, with my husband, I literally had to repeat the same thing five times before he actually pays attention to me um well he's a man right so his verbal memory is inferior to yours as a woman yeah it's not his fault right um but then it is true that men have better visual spatial abilities on average again this is not an absolute but better sense of direction for example and there's a lot of um debate over whether that is the case or not but it does seem to be to be true and it is also reasonable if you think about evolution right a long time ago our ancestors um used to go out hunting the male right the ancestors used to go out hunting.

The men used to go out hunting and needed to be able to go back home. Whereas the women would stay back and nurture the children and take care of the elderly. So it makes sense that those parts of the brain that are involved in direction finding would be more developed in men to some extent and those parts of the brain that are more about nurturing and raising a family might be a little bit more I'm not going to say developed because that's unkind to fathers were incredibly wonderful but they're just built a little bit differently in women. They're wired a little bit differently. I would say wired is a good word. Our brains are somewhat wired differently.

And that really starts from the moment of conception because our genes are different, right? Women are born with the XX genotype, which is also the title of my book, The XX Brain. Men are born with an X and a Y chromosome. And it's really interesting that these chromosomes are quite different. Like the X chromosome is so much bigger than the Y chromosome. It's got 1,098 genes as compared to the 78 genes in the Y chromosome. So women are literally born with 1,000 genes more than men,

So women are literally born with a thousand genes more than men, which are important for reproduction, but also for brain function. So from the moment we're born, our DNA is telling our brains as women that our brains really respond to reproductive organs in a very strong way. And that is really such an important underlying mechanism for our entire research on brain ageing because it's really the interactions between the brain and the reproductive organs that in many ways drive brain ageing in women. Yeah. You said before that for women as they age, there's often a stepwise change. With men,

it's more gradual. Are there key moments in life where these step changes start to happen? And if so, what are they? They are the three P's, puberty, pregnancy, perimenopause. So puberty is obviously common to both men and women, and is really the beginning of our life as adults, right? So the brain, from the moment of conception, the brain has been growing, growing, growing, growing, growing at light speed. But once we hit puberty there's a moment these are called neuroendocrine transition states and what the word means is that is a neurological system or brain

in their endocrine systems that are in transition together that something is changing you're maturing from a sexual perspective but so is your brain in ways that go above and beyond reproduction during puberty there's this explosion of hormonal power that in a very interesting way leads to the brain losing volume you would think the brain would explode as well instead it's exactly the opposite the brain says okay that's it you're not growing i need to specialize and so a number of synapses which had the connection between neurons are just being discarded because the brain doesn't need them anymore at that point you know how to lace up your shoes right you know how to ride a bike

you don't need to remember all the different little steps those neurons can go those connections can go in the brain gets smaller but more efficient and those those neurons that you have in your brain once you're an adolescent are pretty much all the neurons you'll have for the rest of your life. Your synapses will change, will grow, will get discarded, but your neurons pretty much are final. And then for men, things remain pretty stable over time. And I want to just clarify that these changes are mediated by our hormones. And we all know the hormones differ between men and women, right? Men have more androgens, like testosterone.

Women have more estrogens, like estradiol, which is the most potent of estrogens. And what's important is that these hormones are not just key for reproduction and fertility. They're also really incredibly important for brain function. They literally supercharge your brain so when the levels of these hormones are high your brain energy is also high yeah i mean it's it it's really profound because we you know in common parlance we often talk about our puberty and how people start you know obviously what it means for boys and girls often talk about our puberty and how people start, obviously what it means for boys and girls when they go through puberty.

We know about these different stages in life, but we often think about them through the lens of hormones. And even the general public will talk about it as hormonal changes. But we often don't make the link that hormones that are changing in our body also have an impact on our brain. And so I think what you're doing with your work is really, you know, almost getting that conversation up on a par saying, yes, it's hormones. You know it's hormones, but those hormones actually change the way your brain functions as well. Yes, those are the same hormones, and it's just not common knowledge, I find. Even with scientists, I studied neuroscience, I have a PhD in neuroscience and nuclear medicine, and not once did anyone mention hormones to me. Menopause, yeah, you know, we know that that happens to women, but how and why nobody seems to care about or really talk about.

So it's interesting for me that I literally work at the intersection between neurology, neuroscience, and women's health. And it's a really strange space to work in. There are many people who work in neuroscience and there are so many people who work in women's health, but they don't talk to each other. So if you go to a brain person like me, we understand the brain. We don't really understand the ovaries or reproductive systems. And then you go to an OBGYN or a women's health doctor and they don't fully understand how the brain works. Yeah.

So I think it's so important to have this conversation and make sure that people are aware that the brain is not an isolated organ, but rather that there's a constant communication going on between our brains and the reproductive organs every day over life. So the health of the ovaries for women and the health of the reproductive organs for men and women is so crucial for brain health and the other way around. Yeah, I mean, exactly. around. Yeah, I mean, exactly. I mean, I think one of the reasons I've always been drawn to your work and really, really connected with it is because you very much do see the body as a system. You know, that's one thing that I really like. It's very, very aligned with how I look at the human body as well. But you also, as you write about in your latest book you know you don't believe in this sort of

one-size-fits-all approach um which again is completely aligned with how i think and i think a lot of the tips towards the end of the book which are so practical i think it really helps people try and identify what are the right approaches for them, what they can experiment with to see if it works for them. So yeah, I think it's a super, super interesting point. And I've got to be honest, I think it's one of my frustrations with medicine is, you know, there's a lot within the profession I'm proud of. But actually, I do think on some things, we've got slightly off track, and've got very very microscopic through one lens looking at a particular organ without seeing the big picture and your work highlights that so beautifully

thank you i used to be very vertical in my work you know just one topic and go really really deep and i i find as you start going horizontal it's so much more interesting and so much more satisfying to really think about you as a person, not as a bunch of bits and pieces that magically work together. We are systems, like you said. And I think we, as a society, we have a tendency to think of our brains as not being part of the system. Whereas I think it's so important to understand that everything that happens in your body has an effect on your brain as well. So by taking care of your body, you take care of your brain and your cognition and your mood and your affect and your sleep and everything you need for life. Do you remember when exactly that changed for you and the reason I asked that Lisa is because you know I always talk about the fact

that I'm a clinician okay so I'm not a researcher so I've spent you know nearly 20 years seeing patients and so I always listen carefully I I observe what's happening, who's getting better, who's not getting better, what's going on, why did people come in with three or four different symptoms, and if I can, let's say, help them change various aspects of their lifestyle, all three or four of them start to get better as well. And you think, okay, hold on a minute, what's going on here. So my perspective that everything is connected comes very much from what I've seen with patients. You know, a lot of scientists, by nature, the scientific method, I guess, has to be slightly reductionist at certain times. So what happened to you? Do you remember that exact moment when you started to think less vertically and started to move out horizontally. I do, I do. And it was, in some ways, it was frustrating. So I was studying Alzheimer's disease, again, trying to understand what causes Alzheimer's disease. And this is particularly important

because Alzheimer's is the most common form of dementia on the planet, affecting almost 6 million patients in the United States alone. And a similar two-to-one ratio is found pretty much non-consciously. We have data for it, which means for every man suffering from Alzheimer's, there are two women, which is something we never talk about, right? So we know that women have a higher risk of breast cancer, We never talk about, right? So we know that women have a higher risk of breast cancer, for sure. And breast cancer gets the pink ribbon.

And everybody clearly understands breast cancer is a women's health issue. But a woman who's 60 years old is almost twice as likely to develop Alzheimer's disease in the rest of her life than she is to develop breast cancer. And nobody talks about Alzheimer's disease as something that women should be concerned about or should know about. And when I started working in this space, I would get so much pushback. The whole time, the whole time,

I was always, well, sweetheart, you know, the thing is, I always get this, sweetheart, you know, the condescending, yes, girl, but women live longer than men and alzheimer's disease is a disease of old age so it's inevitable the more women than men develop alzheimer's disease and it took a really long time for me and for other scientists to really prove that that is just a bias we We're just not thinking about it correctly. Number one, women don't live that much longer than men. But most importantly, Alzheimer's disease is

not a disease of old age. We tend to associate it with the elderly because the symptoms develop usually when people are like in their 70s. The average age at onset here in the united states is 71 years old but in truth alzheimer's disease starts with negative changes in the brain years if not decades prior to the cognitive symptoms it's a very insidious disease it's a silent disease that starts in midlife and accumulates over time. And then eventually the damage is so severe that you get clinical symptoms. And so the question changed to, given that Alzheimer's disease is a disease of midlife, of middle age, what happens in midlife only to women and not to men? It could potentially explain why more women than men have Alzheimer's

disease. And we just showed recently that what happens to women is that we tend to develop Alzheimer's plaques before men do, at an earlier age than men do, and specifically specifically during the transition to menopause. And that created chaos. We showed that. That was like a war. Because we never, ever talk about menopause as something that could be associated with Alzheimer's disease. We never talk about menopause as something that could potentially impact their brains, right?

Let alone increased risk of Alzheimer's in women. But that was a big deal. And for me, I was not expecting that, to be honest. So that was my aha moment. We have to shift gears here and just start completely from scratch. Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show. Now, if you're looking for something at this time of year to kickstart your health,

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Yeah, I mean, Lisa, as you sort of talk through that. It makes sense. It makes complete sense yes and i have i have a sort of whole different range of emotions um from anger to frustration to you know feeling this is very very unfair i guess i'm slightly clouded at the moment that my my elderly mum's not going through a great time at the moment uh with she lives, she lives by herself. She's falling a little bit. My brother and I helping out loads of trying to get things, uh, back on track, but, but, you know, occasionally I, I, I talked to my brother and go, Hey, is mum, is mum still kind of, you know,

have you noticed something? And then a few days later, she's better again. So like, you know have you noticed something and then a few days later she's better again so like you know it's and i'm too close to it to be objective but i guess the point i'm trying to get to is you think this research if you wound it back and let's say it was done 50 years ago or 100 years ago right yeah how many women's lives might have been changed? Many. Preemptive action could have been taken. And again, look, that's the nature of progress. That's the way the world goes.

I get that. But I do get this sense. And I think these things are particularly acute at the moment. As you mentioned in the book, the Me Too movement, we've seen this year with the sort of racial tensions in America and around the world. But there's that theme of discrimination and unfairness and trying to create a more equal society. And although you've written a health book to help women, actually, there's a political aspect to this as well there's a you know there really is it's about

equality and science about not looking through the world and i appreciate i'm a man saying this but you know a very male focused world it's about yeah but i think some everybody reacts this way men and women and nobody wants to treat women poorly. Nobody is aware that women have been discriminated in research. I think it doesn't take a scientist to denounce the fact that women's social, financial, and physical security remains inequitable. Not doing that. But it does take a scientist or a doctor to denounce the fact that women are also overlooked medically, where our needs go way too often unacknowledged and unaddressed, especially as

far as our brains are concerned. Women's brain health remains one of the most under-researched, under-diagnosed, under-treated fields of medicine. And it's really a direct consequence of the reductive understanding of what a woman is in the first place. And that I take personally, and I find it incredibly offensive. I talk about bikini medicine in the book, And I think it's an interesting term that really speaks to the fact that historically, medical professionals and scientists

truly believed that women were essentially smaller men with different reproductive organs. So from a medical standpoint, it was really like saying that the only thing that makes a woman a So from a medical standpoint, it was really like saying that the only thing that makes a woman a woman from a medical perspective is the reproductive organs, those parts of the body that you can cover under a bikini. And that means that women's health is inherently flawed and biased because all the attention is really about the reproductive organs.

You go to a women's health doctor, they'll draw blood to check your hormones, they'll do a pap test to check your cervix for cancer. If you're over 40, 42, you get a mammogram to make sure your breasts are okay. And that's great. We should. We should. We should take care of all. We should take advantage of all those tests.

Incredible progress. But nowhere in the conversation are our brains mentioned. And I just want to clarify for context that Alzheimer's is only, Alzheimer's disease is just one part of a much bigger picture where women are twice as likely as men to be diagnosed with an anxiety disorder or depression. We're three times more likely to develop an autoimmune disorder, including those that attack the brain, like multiple sclerosis. We're four times more likely to suffer, I'm going to underline suffer, from headaches and migraines. We're more likely, far more likely, to develop a meningioma, which is the most common form of

brain tumor, especially after menopause, and we're far more likely to die of a stroke. And still, when we talk about women's health, we very specifically do not talk about our brains. Yeah, absolutely, Lisa. And, you know, as you were going through those statistics, which I am sure will be brand new information for a lot of my listeners and viewers, you can't help but thinking, if men were much more at risk of these things, I suspect we would know about them. And, you know, I want to make clear that whoever's listening to this or watching this on YouTube right now, this is a conversation

that's relevant for all of us men and women your book actually lisa is relevant for men and women you know no but it is it's kind of men need to know this because they need to know that no i do as it is unapologetically for women but i think it's so important for all men to be aware of these facts right because it's never it's never about women without men it's never women against men or women instead of men it just that's not the point at least i think men will enjoy this book honestly right no because actually we've all got mothers, right? We may have daughters, we may have girlfriends, wives, friends, aunties. You know, it's not as if we live, you know, we live in our silos as just men. No, we kind of, I think a lot of us would be super interested in learning, wow, the female brain is different.

brain is different maybe this is going to help if men read it help them understand and have more maybe more compassion for what a partner or a female friend might be going through at a particular time of life do you know what i mean i think that's why it's so important for all of us yeah for sure i think especially like the chapter about pregnancy i think nobody knows that the brain changes during pregnancy i think nobody knows that the brain changes during perimenopause and that's actually i don't think i don't really think that most people know what perimenopause is let's go through it because you know this we'll never be able to cover the whole contents in this conversation but i there is such practical information so let's sort of go through you know what happens in pregnancy what happens in perimenopause and as a way we can use that and

then then maybe go into a lot of practical tips that people can use yeah yes so we talked about puberty and how the brain stabilizes after puberty and then with aging things change a little bit but slowly we can kind of hypothesize a linear decrease in synaptic density and whatnot that's especially in men because testosterone and androgens in general decline very slowly with age which is not to say that they don't change it's not to you know undervalue concerns as related to men's health the point i want to make is that the change for women is much more dramatic but let's say that a woman goes through pregnancy pregnancy is huge it's huge i have my little daughter and i look forward to a play date whenever we happen to be in the same country. Definitely.

And you did, Lisa, you may not remember this, on either our first Facebook Live or our first podcast, you offered to scan my brain next time in New York. And it's on my to-do list. And I promise you, next time in New York, I'll be calling you to say, please scan my brain. I want to know what's going on. Great. Yes, let's do it. That's wonderful. Because I do want to clarify what's going on great yes let's do it that's

wonderful because i i do want to clarify that we care very much about men's brains as well and actually in my research program which has grown exponentially in the past couple of years i'm very happy about it we have a program for women the program for men we're just starting so i'm very excited about that because men's brains have risks of other things. So we should be really addressing both and, you know, equality. I was saying before, there should be health care, like really good health care for both men and women, which is not the same as one health care for both. I really believe in gender medicine and specializing the fields also as far as our brains are concerned. That said, I'm going to go back to pregnancy. And as everybody knows, pregnancy is another explosion of hormones, right?

For the entire time that a woman is pregnant, there are things that are happening in the brain and in the body that are really driven by these hormonal surges. Our hormone levels literally balloon to 30 times what they're usually during a regular non-pregnant stage of life. But what is really interesting is what happens after giving birth. And studies using brain scans have shown that the brain shrinks once the baby is born.

And in some ways, then it grows back, which I find incredibly beautiful. And people are looking into that more and more right now. And there's a physiological explanation, which I'll give you in a second. And then there's a psychological behavioral explanation, which I find really adorable. The physiological explanation is that you have to give birth to a human being. So at some point, neutrogenesis, which is the birth and the growth and new synapses, stops. And when the baby is born, we actually find the reduction in brain volumes that is really correlated with the slowing down of the brain growing new cells. Because at that point, what you need to do as a mom, according to mother nature,

is kind of forget about yourself and take care of your baby. Once the baby is self-sufficient and you stop breastfeeding, and it's usually around nine, 12 months after birth, and it's usually around 9, 12 months after birth, neurogenesis kicks back in. And your neurons start growing again. And you go back to baseline, which is insane. If you think about all the things that we learn about the brain, at least I was told that the brain doesn't change.

Once you're a grown-up, you have one brain. You can lose parts of it, but pretty much the brain is stable, it's static. And it turns out it's not. It's very dynamic. It still retains plastic properties that are very evident in women as we go through these huge changes that impact the body and the brain. So that's in pregnancy. And I personally interpret that that and that could be incorrect as new moms really don't have time to worry about a lot of stuff right and your brain

reflects that like wearing high heels forget about it i don't need those neurons anymore right or where do they put my keys who knows a couple of months, you just kind of resign yourself to the fact that you're busy, you're undislept, you have a lot of stuff to do. And a lot of things just don't matter that much. At that point, a long time ago, when women were pregnant and, you know, we still lived in caves, all the focus had to be on the baby, making sure that the baby survives. Once the baby's fine, your brain goes back to being like, oh, you also, yeah, there's you too, mom.

Let's see if we can have another baby. And we start again. That was a long time ago. So this is pregnancy. And I think what's really fascinating is that the brain changes have been correlated with maternal attachment and with mother's ability to theory of mind to really understand the mental state of the baby and really making sure that you can support the growth of your infant. I know it's so beautiful. Isn't it beautiful? It's published in Nature.

I think it was a couple of years ago. It's published in Nature, I think it was a couple of years ago. It's just incredible. And brain scans are so crucial to really understanding how our brains work. I'm so fortunate that I get to do them pretty much daily. I mean, Lisa, I'm blown away by what you just told me. And there's a couple of things i want to comment on one of them is you know the term mummy brain or pregnancy brain right these things are out there in the vernacular in society but what i think you beautifully add to the conversation is

you're actually saying there is this is real right there are biological changes happening and and what it does is it makes it real for people i i can think now to so many friends or female patients who who will tell you things that are going on or say how they feel and we'll come to the menopause shortly and i have so many reports of stories that patients are saying like my you know my my mind feels a bit separate from my body now the sort of thing that unless you've been taught now i'd like to think i've been uh shown empathy to patients who said that i certainly hope i have but if you've not been taught that that you know you could easily be dismissed and so oh my god yes that's exactly why we're doing this work yeah and I'm sure there's women

listening to this right now who are going yeah yeah you don't say Dr. Chachi of course that's that's my life with my dogs for the last five ten years or whatever right I get that and I appreciate I'm a man trying to have this conversation but but I can only talk from my perspective. I think it's incredibly valuable to raise awareness. I also think when you, when you talk about that and the kind of evolutionary rationale for it, I think that, you know, you are, I think you were born in Italy. Is that right, Lisa? Yes. In Florence, New York. Right. So you're born in Italy, you live in America. And I've got friends who've moved out to America. And, you know, I think one of my friends, I think she went back to work maybe four weeks after having

a baby in America. I think so. Yeah. And you did. Okay. And so when we start to think about what's going on with the brain and then the pressures from society now on women. And you sort of feel that actually brains evolved in a different time for a different pace and a different style of living. Yet by not recognizing that the female brain is different, we're trying in many ways to force women in some level to live a kind of life potentially that's not in harmony with their biology which I find incredibly interesting and I wonder if you've had any experiences since the brain since the book came out with people in Scandinavia where women and men get a lot more paid maternity and paternity so in some ways are better able to allow nature to do what it wants to do do you see

what i'm getting at yes i i think it's a great point and yes to your point the experience of the postpartum period is very different depending well on sex that's a big difference it really is different objectively between new mothers and new fathers which is again not to say that is easy for new fathers absolutely not it's just that their brains are not changing yeah that was shown very clearly with the brain scans yes you're tired you sleep deprived you love this kid your life has changed but your brain has not and your body has not and maternity leave those four weeks that we get six if you're lucky is a joke it's not they were on vacation for four six weeks and then we're immediately ready to go back to work but regardless of that depending on where you are the symptoms are

different there are so many women with the mommy brain or the baby brain right after giving birth but it seems to be worse in countries like the united states where the stress is a little bit higher or probably a lot higher um in a societal from a societal perspective where you have so many perhaps so much pressure to just go right back to work you don't really have a lot of support either like i don't have family here i have to rely on babysitters i've never seen in my life so it is different it is different i think the severity or the impactfulness of the experience may be very different in different societies. The same with menopause. You know, when we know that as women approach the next phase, the next transition stage,

which is the perimenopause to menopause transition, we're all familiar with the fact that women experience things like hot flashes, or night sweats, or insomnia, depression, anxiety, the brain fog you mentioned before. As a society, we associate all these symptoms with the ovaries. But in reality, all of the symptoms start in the brain. Those are neurological symptoms, once again, that happen only to women not to men and they're really a symptom of the fact that your brain in over is the entire neuroendocrine system is in transition in pregnancy so many women will tell you i can't remember what i have for breakfast or i'm feeling tired and confused but then it goes away right And something similar happens during perimenopause and menopause

with the difference that you're older at that point, so the recovery time is longer. And we have shown that the brain, once again, changes during this phase of a woman's life. For many women, there are no symptoms, but for most women, there are symptoms. They need addressing and need, like you said before, compassion. Yeah.

Compassion goes a long way. It does. It may not change the structure of the brain, although I think there are some sites where it does start to change things physiologically. it does start to change things physiologically. But it is the most important step, I think, in trying to help anyone is a feeling of being heard that actually, okay, so you're feeling like that. Okay, let me try and figure out why that might be, which is what I think a lot of people, particularly women, don't often find they get. You know, you see this a lot around the menopause. It's very common that women will say, my doctor didn't understand, didn't take it seriously. And I think there's a wider point

there that I've been thinking about over the last couple of days, which is, you know, in the UK, we qualify pretty early as doctors. You know, you can, you know, I went to medical school within two or three weeks of my 18th birthday. And, you know, yeah, so you're coming out, you know, 22, 23, trying to help people. And you're like, what kind of life experience do I really have to really understand some of this complexity of someone's life? And I guess also, you know, the term you used before gender medicine, that's super interesting. I don't think I've heard that term before. And you think, well, as a guy, you know, you know, as a guy in my early mid twenties, did I really have

an understanding of women's issues? Could I relate, uh can i now i think you'd have to ask my wife if she'd agree that i can relate now but i think it's i mean it's really interesting to me that you know are is there certain structural things within the medical system as well meaning that women don't get the best care that they could do for sure also gender medicine is a really recent thing it's just happening because so many more scientists like myself and other doctors would just say, hello, we're not the same. Even just metabolically speaking, we're not the same. We metabolize drugs differently. always men and women lumped together. Drug efficacy is rarely tested separately in men and women, which is, again, an effect of this bikini medicine situation where we're assuming that if you have a drug that works for the heart,

the heart doesn't fit under a bikini, so the drug is probably working the same for men and women. Not taking into account that women's hearts are also working differently. They're also functionally different from men's hearts. We don't experience a heart attack the same way. Usually the common symptom, the pain in your chest and the left side and the shooting pain down the arm,

the Hollywood heart attack thing, that's predominantly male. Women feel like they have the arm, the Hollywood heart attack thing, that's predominantly male. Women feel like they have the flu, which led to so many women being undiagnosed in the middle of a heart attack. Women are seven times more likely than men to be discharged from the ER while having a heart attack because doctors just can't recognize this and doctors are not trained to recognize the symptoms of a heart attack in women wow yeah ambient the most common sleeping pill was given to men and women at the same dose and what happened was that women were definitely kind of overdosing because the metabolic activity is different. You know, the way we absorb the drugs is different.

And the reason that the dose was changed by gender was that insurance companies realized that all these women were having car accidents. And so they made it known that there was something about women. Women can't drive. These women just can't drive in the morning. And then it turns out that this is why they're why that's because they're over-medicated. And so that led to the FDA changing the dosage and cutting it in half for women. And this is again a consequence of the fact that women were excluded from research until 1993. For decades, the FDA said no women in research because of some issues that, do you know about thalidomide?

Yeah. Right. So there was, in the 1960s, this drug called thalidomide was being given to pregnant women because people didn't know that the drug would cause severe birth defects. It was really catastrophic for the pregnancies and for the babies who were born with severe malformations and disabilities and whatnot. And so the FDA took a cautionary stance and said, OK, from now on, women of childbearing age, which is, however, any woman from puberty through the endomenopause need to be excluded from experimental clinical trials to avoid this happening again. However, everybody

panicked and then women were just excluded from research, period. So then we have decades of medical research with no women in it. So all the knowledge we have are from studies in men. And the assumption is just that that's going to be good enough for women as well. And even now that we have men and women in research, it's mandatory now to enroll men and women for research. The vast majority of studies just lump them together and then use statistical procedures to remove the effects of sex and gender.

So we're still saying that women are indistinguishable from men, except there are some ovaries in there. Yeah. And it's much more difficult to do what we're doing, which is looking at men and women separately, because then you need twice the amount of patience, twice the amount of time, twice the amount of money. Yeah.

And you need to really want to do this because it's it's quite a thing yeah and and you know when you really follow that line of argument to its kind of obvious conclusion it's like well how many other fields in medicine have we made this mistake and you're highlighting it in the brain beautifully but what are we doing as you say with. But what are we doing, as you say, with the heart? What are we doing with mental health problems? What are we doing with all kinds of other problems where we might find some really clear explanations? Oh, this is why women have got so much more anxiety and depression, or this is why, you know, and so I guess all change has to start somewhere. You know, so that's that, you know, as a note of optimism, that's a good thing that things

are starting to change. If we go about some menopause a second, I really want to talk about oestrogen because when people think about hormones and they think about male and female hormones, I think people often think about testosterone as the male hormone and estrogen as the female hormone so what is estrogen and what goes on with it around the menopause and how does that affect our brains right so hormones sex hormones are broadly divided into androgens and testosterone is the most popular one and estrogens and we use the word estrogen to refer to three different hormones estradiol estrin and the other one i can't remember right now that is made only during pregnancy yeah and estradiol is 17 better estradiol, 17-betoestradiol is the most common, is the most potent form of estrogen and is the most common sex hormone in the brain.

And what is really important to know is that the brain evolves, in good part develops and matures in good part because of the action of estradiol, or let's just say estrogen, on very specific receptors so i want to mention that because it's important to just understand the physiology in that hormones work like a key that needs to get inside a lock so the hormones are the key and receptors are the lock when the hormones go in the brain and find the lock and open the lock, everything happens. Everything great happens. The brain activity goes up, brain energy levels go up. Basically, estrogen literally pushes neurons to burn glucose to make energy. So when your estrogens are high, your brain energy is high as well.

When your estrogens decline, which is the case during menopause, your neurons start slowing down and they start aging faster, which for some women has been associated with the early deposition of Alzheimer's plaques in the brain. For some women, not all. And this is a lot of my research. But also we talk about estradiol and estrogens in general, also progesterone, FSH, LH, all these so-called sex hormones have very important effects on the neuroplasticity of the brain. It can literally stimulate the growth of new dendrites from neurons, the new little branches that come out of the neurons, and synaptic connections are really supported by this plastic effect of the hormones. They're also involved with the immune system, for example. They're boosters for immune resilience, not just in the body, but also in the brain. So overall, what these hormones do, it has testosterone in men, androgens in men,

and estrogens in women. And also, there's a little bit of crossover, right? So men's brains and bodies contain a little bit of estrogens, and women's brains and body contain a little bit of androgens. But what all these hormones have in common is that they have like superpowers right so estrogen is the master regulator of the female brain it's like the orchestra conductor that just says okay immune system we need you over there we need more energy in the hippocampal formation because we need to make some memories there we need some more estrogen in the frontal cortex because you need to do something with the memorism forming. We need to grow more neurons in this part of your brain. So everything is orchestrated by your hormones. And unfortunately, women starting in midlife experience very strong

and very sharp declines in the levels of estradiol. And we start going through perimenopause which is a transitional phase between having a regular cycle and no longer having a cycle. So as you go from the pre-menopausal age to a post-menopausal stage there's this in between there's this confusing gray area called the perimenopause or the menopause transition that can last up to 10 years in some women where the frequency of your cycle or the severity of your cycle changes the duration frequency and length and you start having symptoms for some women their bodily symptoms like also pruritus vaginal dryness for other women they're really neurological symptoms that seem to be quite disruptive, like the brain fog and depression, anxiety, even forgetfulness.

A lot of women come to us because they're worried. They don't know if they're just having a rough year or is that something worse? Is it like Alzheimer's disease? Is it something? Do they have a neurological illness that they need to address? Yeah. a rough year or is that something worse this is like alzheimer's disease this is something do i have a neurological illness that i need to address yeah sometimes it's but the thing also that i want to mention is that all women go through menopause all of us right and the degree of disruption varies widely. But the fact remains that all women go through menopause. Right now on the planet, 850 million women have just entered menopause or are about to enter menopause.

850 million women. And the vast majority has no clue what's happening to them. Because we don't talk about it. And they're scared, they're concerned, they're worried, and they don't know what to do. So what should they do? What should they do? It's a great question. So that's the second part of the book that I really wanted to develop

because there are some solutions that are really based on science. And I didn't even know that there's a whole field there's a whole number of investigators that are looking specifically at things that can really improve and support cognitive health in women and also reduce the risk of dementia which is the focus of the book but it's not just about dementia it's about the anxiety the depression and everything else that we need to address. But also, can I just highlight what you said earlier, Lisa? Because I think it's a point that people often don't think about enough. You said that dementia is not a disease of old age.

That's right. It's so important for people to get that because I've spent a lot of time with Professor Dale Bredesen in California. I'm sure you've seen some of Dale's work and some of his research. And, you know, he's said on many occasions that, you know, Alzheimer's or other forms of dementia may be starting even 30 years before it shows up. Now, I'm not, you may or may not agree with that, but he has sort of said that the idea being that when you get symptoms is not when this starts. This starts a long way before. And therefore, there's an opportunity if we're aware of that, to start taking preemptive and preventive action, you know, in our 30s and our 40s and our 50s, not when we're

suddenly getting the diagnosis at the age of 72, let's say. So I want to just hammer home that the things in your book that are based absolutely in science in terms of what people can do, they're kind of relevant to everyone, particularly women, I would say no matter what your age, right? to everyone particularly women I would say no matter what your age right I agree with you I I completely agree on everything you said Alzheimer's disease is not like you you just all of a sudden catch a cold right it's not like tomorrow you go to the doctor and boom you have Alzheimer's disease there's something that's been happening in your brain for a really really long time that eventually leads to the symptoms which again speaks to how resilient the brain is how strong these brains we have are because they can literally fend off a whole amount of pathology and insults and problems for years and years and years and

your ability and your brain's cognitive reserve of reserve against these insults is really largely based on the way you live your life. There is a genetic component. Our DNA is part of whoever we are. Everything we are is involved in every bodily and neurological function. function however your medical report card and your lifestyle matter just as much for the vast majority of people like even in patients with genetically determined alzheimer's even for those very rare patients who carry genetic mutations that cause Alzheimer's at a young age, there's evidence that things like exercise can really delay the onset of dementia. And for the vast majority of the population, over 98% of people do not carry this genetic mutation.

So risk is really more about the interplay of factors like, sure, there are genetic risk factors. Your genes are important, but your lifestyle is just as important. Your environment is just as important. Your medical health is just as important. And those are the things that we need to take care of pretty much as soon as we're aware that they're important. It's not like you're 50 and today you have to take care of your brain

no it is this brain health should really be part of overall health we should really start thinking about their brains as our best friends yeah part of us that needs nurturing and supporting that is doing so much for us right so i think it's really important that we make choices that really support the brain and i i usually like to say that i encourage everyone to think of their brains more like a muscle right there are things that you can do to make your brain stronger you can exercise it properly you can feed it properly you can take care of it properly and your brain would perform so much better for you yeah at any age either at any age yeah i mean i want to sort of get into this lifestyle piece because there's so much that people can do uh particularly the bit on movement as well where

less might be more for for women which i found really interesting it's something i i've been thinking about for some time as well um before we do that, I wonder if we could deal with hormones and in particular HRT, which is obviously a very hot topic. It's a very divisive topic. From you as a neuroscientist looking through the lens of the brain and with all the work you've done, what are your views on hormones and how they can be used to help brain health? Before we get back to this week's episode, I just wanted to let you know that I am doing my very first national UK theatre tour. I am planning a really special evening where I share how you can break free from the habits that are holding you back and make meaningful changes in your life that truly last.

It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be. In my live event, I'm going to simplify health and together we're going to learn the skill of happiness, the secrets to optimal health, how to break free from the habits that are holding you back in your life, and I'm going to teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour and I can't wait to see you there. This episode is also brought to you by the Three Question Journal, the journal that I designed and created in partnership with Intelligent Change.

Now journaling is something that I've been recommending to my patients for years. It can help improve sleep, lead to better decision making, and reduce symptoms of anxiety and depression. It's also been shown to decrease emotional stress, make it easier to turn new behaviours into long-term habits, and improve our relationships. There are of course many different ways to journal, and as with most things, it's important that you find the method that works best for you. One method that you may want to consider is the one that I outline in the three question journal. In it, you will find a really simple and structured way of answering the three most impactful questions I believe that we can all ask ourselves every

morning and every evening. Answering these questions will take you less than five minutes, but the practice of answering them regularly will be transformative. Since the journal was published in January, I have received hundreds of messages from people telling me how much it has helped them and how much more in control of their lives they now feel. Now, if you already have a journal or you don't actually want to buy a journal, that is completely fine.

I go through in detail all of the questions within the three-question journal completely free on episode 413 of this podcast. But if you are keen to check it out, all you have to do is go to drchatterjee.com forward slash journal or click on the link in your podcast app. My views are that hormones are important. are important and that the field has not developed the way that one would hope, especially as far as our brains are concerned. And I could talk about this for days to just give you the full detailed picture, but I think the bottom line is that preventing Alzheimer's or minimizing the depression and anxiety is not the same as treating hot flashes right so we know that hormonal replacement therapy is very effective

at reducing minimizing and in some cases completely eliminating hot flashes for women who can tolerate the medication some women are not eligible for hormone therapy for menopause but most women are and that is something that has been shown to be successful for like HRT can really help with hot flashes with also cirrhosis with vaginal dryness especially for women who undergo a hysterectomy or oophorectomy, which is the surgical removal of the uterus and or the ovaries. Now, when it comes to brain health, things become really complicated because the research is just not there.

There have been clinical trials that looked at whether or not hormonal therapy could prevent dementia, right? And they showed that it cannot in women older than 65. So they were looking at women who were like 15 years post-menopause, and they were given hormones at that point, which is too late. It's just too late to start. Now, more recently, two very large clinical trials tested the efficacy of hormonal therapy in women who were a little bit younger, so within five years of menopause, and they showed no adverse effects, but also no benefit for cognition. And I would argue that that is, again, too late. We were talking about the lock and the key, the key and the lock analogy.

And the timeline is very important because what happens in physiology is that this system where the hormone locks to the receptor is really age dependent. locks to the receptor is really age dependent. What happens to the receptors is that if you don't have hormones blocking for a really long time, the receptor shuts down. It just closes. The lock is no longer a lock. It just turns into a piece of door. If you try to get the hormones, then nothing is ever going to happen. Right? Yeah.

You need to have plasticity. You need to have the hormones and the receptors. If the receptors said, okay, sorry, guys, too late, there's no point giving hormones. So what we're trying to do right now is to better clarify this window of opportunity for brain health. window of opportunity for brain health and the way that we need to do it is not just by theoretically putting women in a clinical trial but we need to look at their brains we need to probe the system are these receptors working or not are they active or not does it make sense to give you hormones at this stage in your life as a woman so i think this is missing and it's hard for me to answer the question

without the right information. Right now, the question is, we don't know. Maybe for some women, especially women, again, who do receive hysterectomies and oophorectomies prior to menopause, the current recommendation is to take hormones because that's been associated with a lower risk of Alzheimer's disease, a lower risk of alzheimer's disease a lower risk

of osteoporosis or half such a lot of symptoms for other women the answer is that we don't quite know yet so so a couple of things there so again i don't want to quote professor bradison because he's not here and so i want to make sure i've accurately describing some of his work. But Dale very much takes a multi-pronged approach when he's trying to help a patient. So he's saying, you know, he would try and change seven, eight, nine different factors together rather than typically it's, we'll try this one thing. Does it work? No, that's shown it doesn't work. We'll try something else. And again, there's pros and cons of things, but I quite like that method in terms of,

it's not about trying to put everything onto one thing. It's doing multiple things. And I think he was the first person who really tuned me into thinking, this may be six years ago or so, that, oh, maybe some women would benefit from taking oestrogen in some form through and after the menopause to not to withdraw that sort of trophic support to the brain. And I find that really interesting because, you know,

as a husband, I was thinking, oh, oh well when my wife gets to that stage oh genuinely what it was more oh once you know that you can't unknow it right so it's it's then it's like well should women be routinely taking that or should we be considering that with respect to brain health? And then, you know, where I get conflicted in my head is that, you know, we've looked through the evolutionary lens before about what men and women used to do when our brains were evolving. So, I don't know if you're familiar with any work on this. I'm not. If you go to something like the Hadza tribe in Tanzania, for example, hunter-gatherer tribe who are still living their traditional lifestyles, right? In terms of their hunting, their gathering, they're very much living these low stress

lives that are out in harmony with nature. I wonder, do they have a word for the menopause? Do they suffer menopausal symptoms in the same way is it you know i don't i don't know i wonder if you've come across that at all because i think that would be really interesting it is really interesting and and we do know that the experience of menopause really changes a lot depending on different cultures like in asia women do not report nearly as much discomfort as women in the United States of America so I think yes there's a genetic component but I think the lifestyle stress must be big right you you know I want to dive into this and this is probably a good time to get into stress

but I can say this is you know this is not a scientific trial but in my clinical experience a lot of my female patients who come in with significant menopausal symptoms also have high degrees of stress in their life now yeah of course it could be to me it could be the symptoms are getting bad and are not getting treated, which causes a stress. I absolutely recognize that. But when I've really tried to unpick lifestyles for a number of years before it, stress seems to play a really big role. And I think, as you've explained in the book with the pregnenolone steel, there is a way that stress literally impacts and changes this kind of symphony of hormones in your body so

i wonder if you could expand a bit on stress and what that does to the brain sure the stress can literally steal your hormones and that's because cortisol which is the main stress hormone is in balance with your estrogens because the body uses the same molecule pregnenolone which you mentioned before to make cortisol and the sex hormones so if you're super stressed out like chronically stressed your body will necessarily have to shift production of cortisol by taking the pregnenolone away from your sex hormones. And then you're going through menopause or perimenopause, you're stressed out because you're a middle-aged woman with most likely a job, a family, elderly parents, you have no time for yourself, you're having hot flashes or you're not feeling well because of hormonal

changes. And then you also have this stress in your life and your hormones are going down further so it really kind of turns into a vicious circle right where the more stressed you are the more symptoms you get and who knows how we can stop it but I think sometimes hormonal therapy might be a good way to break the cycle sometimes more about lifestyle you know there are things that we all can and should do to keep stress at bay and that is so important not just for hormones but also really for brain health because something we don't talk about enough I think as a society is that too much stress is not only bad for your heart,

it's also literally bad news for your brain. And there's this incredible study came out last year with hundreds, probably thousands of people who got brain scans, and they were middle-aged, like 40 to 65. And what they show is that if you have high cortisol levels, that really correlates with brain shrinkage already in midlife and with a worsening in memory performance. So high stress can really negatively impact your ability to recall information already when you're 50 years old. And what I thought was particularly scary is that the brain shrinkage, when they actually looked at gender, they found out that the brain shrinkage

was only found in women who were post-menopause. Which is, again, you know, the gender bias. They didn't look at gender as a predictor. They were trying to remove the effects of gender, but then they realized that there was something really hard to get rid of. And it turns out that it was the fact that only women and not men, only highly stressed women show brain shrinkage. I mean, this is massively, you're basically saying that stress affects the brains of women differently than the brains of men.

That's right. It looks like men's brains are more resilient to stress, at least in midlife. And again, these studies are all the average, right? We're comparing the average man to the average woman. It tells you nothing about outliers and women who can tolerate stress beautifully and men who really suffer. nothing about outliers and women who can tolerate stress beautifully and men who really suffer. But on average, women's brains tend to shrink in midlife when your levels,

when your stress levels are really high. And when you say midlife, are you specifically talking about, what was that, sorry? 40 to 65. 40 to 65. So yeah, coming into that age of the perimenopause, I guess, and beyond. And I guess that really begs the question for me. And I have men and women of all ages listening and watching this show. But if that really is the case, then in some ways that turning point to 40 is quite a significant one in the sense of, look, you know, of course it's going to be different in different people. And of course these are just generalities and it's, you know, we can't say

it's the same for everyone, but it's almost like saying, hey, look, between your 20s and 40s, you know, while you're building up life, you know, figuring out who you are, what you want to be, you know, tolerating all these kind of stressors, maybe there needs to be, again, like a step change in the way we view stress, particularly, let's say for women at the age of 40, go, hey, look, maybe I could get away with it 20 to 40. But over the next 10, 20 years, I've got to be careful that I take some time for myself. I take some time to switch off that I don't take on too much. And I know it's hard because culture is pushing us away from this. And I think that's another big piece of the puzzle here, which we sort of touched

on at the start, which is, you know, I think, I think, I think a lot of people have it tough in society, but I think women have got it super tough. You know, even in this pandemic, Lisa, I'm assuming it's the same in America. By and large, in my network, right? And the patients I've spoken to and in my network, and if I'm honest, in my house, women have taken on the bulk of the caregiving duties, the sort of childcare duties. Of course, it's not in every case. No, for sure.

But I think that would be, that I know has been incredibly stressful for many women. For sure, for sure. You know, we got six months of lockdown. I thought it was going to lose my mind. But it's hard regardless of pandemics, I think. And it's really about you being able to deal with stress because there's always going to be something that is

stressful in your life right now everything is really much more difficult but there's always going to be stresses for everyone and i think it's really important to start looking at strategies to reduce stress and really make it part of our culture which is it's not part of our culture right now in some schools kids are being taught yoga and meditation which i think is phenomenal i wish i had it yeah i learned to meditate by myself actually dr rudy tanzi yeah taught me into that as soon as i moved to new york and that really changed my life I thought he was like kind of excuse me I didn't do a scientist so were you scared so this is interesting as a scientist you were skeptical of meditation yeah for sure yoga I love both and they have an incredible incredible

beneficial impact on the health of my brain for sure but also now we have actual clinical studies showing that they really change the functionality of your brain if you do it consistently enough and according to specific traditions or specific practices and one practice that I describe in the book is the kirtankriya, which is a form of kundalini yoga, but it's actually a meditation that's been scientifically proven in clinical trials to improve blood flow to the brain, reduce cortisol levels,

and improve memory function specifically in women during midlife and after. And it's an 11 minutes meditation that is very you probably i've done it yeah yeah i had i had some kundalini yoga classes last year uh with my wife actually we had this instructor would come uh every friday evening we do that for a while and you know i was i do that meditation as well it's so fascinating for me to hear the skeptical scientist it's not rocking out kundalini yoga you know it's brilliant yeah I'm more into running I'm more of a runner but um yes and I think it's fantastic and I think

there are tools that may not work for everyone but i think if there are so many different options in so many different forms it's like exercise yeah there's something that would work for you it's just a matter of finding out what you enjoy what you can do consistently over time because if you do it for three days it's not the same as really having a regular practice and i think a lot of people have a hard time putting in the effort with regularity but the beauty about this meditation is that it's literally only 11 minutes 12 yeah 12 minutes and there's loads on youtube if people want to follow it you can just you can look it up on youtube and follow one along if people want to try it i mean lisa look we've not even gotten to your eight pillars yet,

and I have about 10 minutes left. So I know my audience is going to love this, Lisa. We'll see what we can get through, and I might be able to persuade you for a part two at some point, because I really think people will enjoy this. But the things I thought we'll get through more if we can, but I found the stuff on phytoestrogens and soy yes really interesting and i don't think people on my show have heard much about that before so i wonder if

you could expand a little bit on those yes so um we were talking about hormonal replacement therapy and which makes total sense right so as a woman you're losing some of your estrogens and the idea is to replace them with estrogens that come from the outside now the source of the estrogen is something that a lot of scientists are looking into because where are these hormones coming from right in the very early formulations of estrogen replacement therapy and still in some formulations today, the hormones were coming from the urine of pregnant horses, which is not attractive perhaps in some ways, but it's a very reasonable source. They have to come from something, right? So they can come from animals or they can come from plants. And something that I find very beautiful is that estrogen or estradiol is arguably the

most ancient of hormones which means that it's shared across all living beings plants animals humans as we also animals but we tend to forget about so what that means is that plants make estrogens they're called phytoestrogens from greek estrogens from plants and they are so bioactive and so easy to share across species that the estrogens made by a flower or a plant really works the same way as the estrogens made in our own body they're just milder the effects are milder they're more gentle so sometimes people wonder and some people are looking into this right now myself included if a diet that includes a lot of phytoestrogens from safe sources could be a gentle replacement to hormonal therapy and the answers from culture probably seems to be probably yes so where are these phytoestrogens coming from the most abundant

source is soy and soy is very controversial but like we were talking about before women in asia do not suffer the kind of hot flashes and nice sweats and neurological symptoms of menopause the same way that women do here in industrialized countries it is possible that there's a genetic component it is possible that the high quantity of isoflavones from the soy in their diet could also make a difference. Isoflavones are a very strong source of phytoestrogens. Yeah. Now, soy here is different, is polluted, is GMO, is genetically modified, is more of an allergenic for us than for Asian populations.

So that may not be the best way to think about phytoestrogens. But there are a ton of other foods that contain a different kind of phytoestrogens. They're called lignans. And those foods are perfectly safe. And they're found very often in the Mediterranean regions. And we know that women on a Mediterranean diet have a much lower risk of heart disease, heart attacks, strokes, depression, anxiety, breast cancer, and dementia than women on like a Western type diet. So there's something about this diet that seems to be quite protective and quite supportive of women's health.

And the key nutrients are sesame seeds, great source of phytoestrogens. Flax seeds, also a great source. Dried apricots, believe it or not, for some reason. All sorts of legumes, especially chickpeas and beans. Some fruits, especially strawberries, melon, cantaloupe. All these fruits and vegetables are really rich in phytoestrogens. And I have a whole list because I'm a scientist. So I have a whole table in the book with all different sources by group and their bioactivity.

So I think for me personally, that's the way I eat. And I've done so much research using brain scans where we show quite clearly that if you're like a 50-year-old woman, your brain looks at least five years younger if you're on a Mediterranean diet. I'm going to say this again. If you're a 50-year-old woman on a Mediterranean diet, your brain looks at least five years younger as compared to a woman who's also 50 years old but has been on a Western diet for most of her life. I mean, you can see that.

You can see the brain scans. You can see the way the brain doesn't change when you follow a Mediterranean-style diet and the way your brain literally shrinks at age 50 when you are on a Western style diet. And do we know, obviously you mentioned one component, some of those foods that are obviously very prevalent in Mediterranean style diets. The term Mediterranean style diet gets misinterpreted quite a lot and lots of people use it to to make the yeah to make the case for different kinds of foods and so i wonder and i appreciate you've written a whole book brain food on different foods for your brain which which is well worth reading and said lots of practical advice in that and lots of specific foods but you know is there some general broad principles of what you're

talking about when you say the mediterranean diet and i think again it's important to say mediterranean style diet because otherwise it becomes really impractical even for me i can't find the same foods here that i used to eat in italy up. But the point is plant-centric. The vegetables and fruit and grains and legumes are really the focus of the diet. When we use condiments, they're more like unrefined vegetable oils, like extra virgin olive oil, flax oil. Flax oil is incredible for vegans.

I know there are so many vegans in England and a lot of your followers are vegan as well. I'm on and off vegan forever. Flax oil is the oil with the highest concentration of polyunsaturated fatty acids, even more than extra virgin olive oil. And one concern about veganism is that unless you take supplements, your omega-3s could be quite low. Because especially the kind of omega-3s that are so important for brain health, the DHA. Because plants contain AHA that the brain needs to convert into DHA. And up to 70% is lost in the conversion. So just one tablespoon of flax oil is pretty much more than half of all the omega-3s that you need for the day.

Wow. So just a tip because I was very excited when I found out. I did a lot of research on that. But that's a great practical tip for people, isn't it? Super great practical. That's something people can do right now. If they, you know, after this podcast, they can actually order something and actually start bringing it into their diet every day, right? Yes, it's very yellow. It tastes really nice. It's great with salad.

Fantastic. It's a good tip. Yeah. It's a good tip. Yeah. Also fish is a big part of the Mediterranean diet, whereas meat and dairy products are considered more like a treat, like an occasional treat.

It's a very flexible diet. It's a very reasonable diet. It's not in any way suggesting deprivation or food restriction, which I find very sensible as a scientist we always talk about diversity in the diet has been real key to health yeah and i think that the the diets which over and over again around the world no matter how you sort of chop them up that are associated with good health and longevity tend to be these diverse diets minim minimally processed, a focus on whole foods, a focus on lots of different colors, right? It's these are the principles which I know you support as well.

And this is what the evidence certainly supports. Before we wrap it up with some take-homes, just exercise. I know we sort of hinted at that before, why less might be more for women. I wonder if you could just sort of give a bit of an overview on that. Yes. So exercise, for a really long time, nobody believed that exercise had an actual impact on brain health. And things have changed so much that now every single recommendation as related to brain health is really about exercising regularly. And especially for Alzheimer's disease, we know that exercise is a strong preventative. I guess Alzheimer's is perhaps a strong word if any scientist is listening,

but exercise is really important for risk reduction, not just of Alzheimer's disease, but of the depression, anxiety of a number of conditions that can impact and affect the brain. And what's interesting, I think, is that exercise is just equally important for men and women. It's really men need to exercise, women need to exercise. But recent studies have shown that the benefits of exercise on brain health might be even stronger for women. And that was really interesting for us as women, of course. And it turns out one possible explanation is that women don't exercise nearly as much as men do starting at age 22. starting at age 22.

Pretty much when you're done with college, your exercise goes downhill for most women, at least in the United States. I think the research was done here in the United States. And so as some form of motivation that I would love to provide for all women and men, of course, there's research. There are these beautiful studies with hundreds of women followed for like 40 years.

They really show very conclusively that your level of fitness in midlife is so strongly correlated with your brain health later on in life. So if you're actively, if you're physically active, if you're physically fit in midlife, you have a 30% lower risk of dementia later in life as compared to a middle-aged woman who's not working out at all, who's sedentary. 30%. Now, if I had a drug that could lower your risk of Alzheimer's by 30%, I would be rich and everybody would buy it. is by 30% I would be rich and everybody would buy it. Instead, the prescription is simply move your body, exercise. And to your point, what research in women has shown is that a low to moderate intensity seems to work best for women, bodies, and brain, especially from perimenopause onward. There's literally an inverted U shape between intensity and gains.

But no intensity, no gains. Moderate intensity, maximum gains. Very high intensity, the gains go down. Yeah. So you want to catch that specific, I think, this specific balance of intensity and gains that works for you, right? Because that can change. But this moderate for me might be too high for you or the other way around.

Yeah. At least in some ways that's actually a really nice place to start closing off the conversation because you said at the start there are these step changes in brain function throughout life for women where it's more gradual for men and then even what you just said there about exercise it all kind of fits that there are different stages in our life bio biologically physiologically the body the female body is doing different things it's got it has i guess a different evolutionary role at different points in our life and therefore of course if we can start to you know live in the modern world do the things that we want to do in the modern world but try and just

have part of our brain thinking about well what what was my brain meant to be doing here what why is evolution set things up this way it kind of helps us doesn't it you know modify stress at a particular point modify movement habits at a particular point it's it really is it's it's really beautiful when you think about it actually isn't it i think so and also i i feel like there's so much guilt around not being able to perform as well as the latest celebrity on TV. I find that we have unrealistic expectations and that it's not about what other people are doing. It's really about what's the best that you can do.

What is something that you actually enjoy doing? Let's talk about having fun and not just doing things out of duty or because you have to. I personally, I love running and that makes me happy. And so I do it. But it doesn't mean that somebody else has to go running. You can find something else that really works for you, that is not too stressful.

I think the message here is don't follow trends in anything you do. I'm very anti-trend. Science is obviously very anti-trend, right? With diet, we want a diet that is perhaps traditional, but at least that is timeless, has been tested over generations and generations of women, and has been proven to work for a lot of those, right? That's a good place to start.

Same for exercise. There's plenty of research showing that doing the stairs is good enough for your brain. That going for a walk, walking a little bit faster than just thrombing would be really, it's just really good for your brain. So if you can push yourself harder, by all means do it. But if you can't, don't feel bad. means do it but if you can't don't feel bad just really be proud of doing enough or taking care of yourself and your body because really your healthy midlife is the best predictor of your health for the rest of your life this is the time to really start being consistent and if you're past midlife then you have to be more consistent yeah no but it's the same strategy it's the same process it takes discipline

to take care of our brains but the benefits are for life Lisa I love the passion uh I love the closing thoughts there final question if you well based upon what you've learned as a scientist while writing this book i was going to ask what have you changed in your own life but actually let me just um deepen that question yes what have you changed in your own life whilst writing that book and coming a lot across certain research and then what have you changed or tried to implement in your daughter's life to get these things rock solid from a young age to hopefully take her into puberty and beyond

what i have changed in my life is that i really try to optimize i think i have a very solid baseline like i eat healthily i'm aware that moving your body is important I love to sleep so I try to prioritize it but I stress I think I do have I work a lot I'm an overachiever as you know in some ways I'm very hard on myself and I we have a lot of stress we've had a lot of stress. We've had a lot of stress for a while in my family. And I never thought about finding ways to reduce stress for me. So I'm now very actively making time for things that reduce stress. I literally, I mean, if you look in my calendar, and I'm sure yours is worse, but I'm booked until the end of the year. I'm down to 30-minute slots for meetings.

And so I really have to make room for me. So I block out one hour to exercise daily. I make sure that I have 20 minutes to meditate or call my mom. You know, I just book it in because otherwise it doesn't get done. And I know a lot of people could benefit from this same structure where making time for you and for your health is actually mandatory as part of your week so that's changed the phytoestrogens have changed a lot i am eating a lot more plant-based now i mean i don't like meat that much so i don't quite eat it but i'm even more plant-based than than i was before and i am prioritizing fish wild caught fish because i feel terrible for the

animals i would love to be vegan i i haven't found a good way to do it for me personally uh sleep i really prioritize sleep i get up at 5 36 to be able to work so 10 p.m I'm out I don't want to hear complaints I need to sleep and for my daughter it's kind of the same she has to go to bed she wakes up at a good time she has a big breakfast she eats a lot she's so tiny but she eats so much and she's very very aware that her snack is goji berries because of the vitamin C. She already understands all the nutrients and why certain foods are really good for you and for your brain and will make you happy. It will make you sleep well and other foods are not good for you. You can have them once in a while.

But she understands. I think the education, I never had that education and she has maybe too much. education I never I never had that education and she has maybe too much oh hey well look you're talking to someone who thinks hey look I can't wait for this play date because I think my kids and your daughter can be chatting about phytoestrogens and phytonutrients and they've got microbiome because actually those are the kind of conversations that roll over our dinner time and I hope time will prove us right that we did the right things. Of course, like all parents, we're trying to do the best that we can. And I'm sure from hearing what you say, the changes you're making, I think even just having modeling that for your daughter, modeling you taking time for yourself, modeling the fact that you're going to go out for that run

and do these things. I think those things are really important you talk about physical activity we know that's a big problem particularly with women certainly in the uk there's been quite a lot of national campaigns to try and get more women active you obviously mentioned before at the age of 21 22 after college it all starts to go down so you know raising awareness of it trying to model that behavior I think is super super important yes you know another thing is um meditation this is I don't know if you do it with your kids my daughter has to do two meditations before she goes to bed with me I mean she doesn't have to she loves it but for me it's kind of we're not skipping that part I don't care if it's late and we're doing

two meditations and i found this lovely app i'll send it to you if you like please do okay so it's like meditations for kids they're adorable they're little stories where she is not only falling asleep very easily she's out 8 30 and she's sleeping through the night. But she's learning the language of the meditation, which is something I wish I had for myself. That kind of loving kindness words, that the language is part of her identity. And I find that to be so incredibly beautiful and such a blessing. incredibly beautiful and so it's such a blessing you know she talks about her toes as her little toes who are doing so much for her because she can walk yeah she appreciates herself and her body and the surroundings and that's really part of the meditation experience also of course of nurturing on our part yeah and i think i think lisa you know you

brought such a great point there it's giving them a language to kind of talk about these explain them not waiting till they're 30 40 trying to go oh actually maybe i should try and learn this stuff you know i you mentioned what do we do we we we have gone through phases uh where we do that with the kids before bed in fact we do it with them. So it's kind of very much like it. This is a family thing together. We've either used the Calm app sometimes, and there's also one called Ananda Kids by Deepak Chopra. He's done a few, and we've used that for a few years and my kids actually really like it. They find it very comforting. But but again we've

fallen out of the habit for the last few weeks and so this is a really nice reminder for me to get back on track with my family with the kids so thank you for that reminder um and please do send me the the app that you use i'd love to see that um lisa look i'm a big fan of your work i i honestly think it's such an important book that you've written you know we didn't get through even two-thirds of it really but people can get it i was hoping sleep and toxins but we but but look i'm sure the audience will like it if i can if i can get a slot in your tight schedule uh later on in the year we'll we'll try and revisit some of this but uh thank you so much I really appreciate it and I can't wait until we can actually do it in person next time a little play date yeah

thank you so much for having me and thank you so much for really helping us raise awareness that women's brains are important and that brain health is women's health and if I can say just one last thing this is a difficult time for us in the united states right politically as i'm sure everybody's aware and i do want to point out that women's health really came out of all the progress that was made in women's rights and women's rights are now again at the forefront of many conversations, not just in America, all over the world, not just for women, for everyone. And so this is a really important time to make sure that women's health really becomes part of a larger conversation around women's rights. And that the more women demand accurate information about the health of their bodies and brains the sooner we will be able to

come up with solutions that actually work yeah so it's just kind of a plea to all women and men to really start talking about these issues because they're real they're important and they can really make us better people and better partners and better parents. Yeah, I love that, Lisa. And it makes me excited for the kind of world my daughter's going to grow up in and hopefully have the opportunities to thrive in a much more compassionate and kind world.

So Lisa, thank you. And I'll talk to you again soon. Thank you. That concludes today's conversation. I really hope you so much. That concludes today's conversation. I really hope you enjoyed it. I think the work that Lisa is doing is incredible and so, so needed. But what do you think? Did it help you reflect better on your own life, your partner's life, your mother's life?

Is this a conversation you think that someone in your life needs to hear? Well, if so, why not take a moment right now to choose a few people who you think would benefit from hearing this episode and send them a link with a personal note. It's such an impactful thing to do. It serves as an act of kindness that has benefits not just for the other person, but for you as well. And of course, don't forget this episode, like all of my podcast conversations, is also available in high definition on YouTube, if they prefer videos as opposed to audio podcasts. Please do let Lisa and I know what you thought of today's show on social media. And you can also check out the show notes at

drchatterjee.com forward slash 129, where you can see links to Lisa's brilliant new book, The Female Brain, other articles about her work and her wonderful TED talk. As always, do try and have a think about one thing that you can take from today's episode and implement into your own life. For me, it was so clear and it's always good to be reminded of how damaging chronic unmanaged stress can be for our brains. If you feel you would benefit from some help here, my second book, The Stress Solution, really was written for this purpose to help you identify where stress lives in your life. And then most importantly, gives you some really practical tools that you can implement

to help you feel calmer, more in control and happier. The Stress Solution is available all over the world in paperback, ebook, but also as an audio book, which I am narrating. A big thank you to my wife, Vedanta Chatterjee, for producing this week's podcast and to Richard Hughes for audio engineering. I hope you have a wonderful week. Make sure you have pressed subscribe

and I'll be back very shortly with my latest conversation. Remember, you are the architect of your own health. Making lifestyle change is always worth it because when you feel better,