The Food Medic - S7 E11: Female brain health and Alzheimer's Prevention with Dr Lisa Mosconi

Episode Date: March 16, 2022

In this episode, Dr Hazel is joined by Dr Lisa Mosconi who is the Director of the Women's Brain Initiative, where she serves as an associate professor of neuroscience in neurology and radiology. In addition, she is an adjunct faculty member at the NYU Department of Psychiatry. She is the author of Brain Food and The XX Brain. This episode covers:- How is the female brain different from the male?- The role of oestrogen in brain function?- Common myths when it comes to women's brain health?- Unique risk factors that put women at risk of Alzheimer's disease - Brain fog vs dementia - How we can best support our brain health I hope you found that podcast as insightful as I found it and if you did enjoy the episode please rate, review and share the podcast with someone you think will enjoy it too. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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the Instacart app and enjoy $0 delivery fees on your first three orders. Service fees, exclusions, and terms apply. Instacart, groceries that over-deliver. Hello and welcome back to the Food Medic podcast. I'm your host as always, Dr. Hazel Wallace. I'm a medical doctor, nutritionist, author and founder of The Food Medic. It's the final episode of the season. We usually do 10 episodes per season, but I just had to squeeze in this last episode and it is not to be missed. I am absolutely delighted and honoured to be joined by Dr Lisa Moscone, who is the director of the Women's Brain Initiative, where she serves as an associate professor of neuroscience in neurology and radiology. In addition, she is an adjunct faculty member at the NYU Department of Psychiatry. She's also author of Brain Food and the XX Brain.

As someone who is very passionate about female health, I am in awe of the work that Lisa does in paving the way for women's brain health. I felt so inspired as a woman and a health practitioner after this conversation and I hope you will be too. I think I would just love by starting to ask you you know who you are, what you do and what you're passionate about. You do so many things. Okay. I am a neuroscientist. So I'm a brain scientist by training. I was born and raised in Florence and my parents are nuclear physicists, both of them. So I grew up in, I really grew into science and I have a dual PhD in neuroscience and nuclear medicine. I moved to New York during my PhD and I transferred to NYU, NYU Medical. And then I was hired as a faculty member at NYU right away. And I just, I moved to Weill Cornell Medicine in New York four years ago now, where I launched the Women's Brain Initiative, which is really my passion project. and unapologetically dedicated to women's brains and women's brain health

and to understanding how brain health plays out differently in women than in men, which has been incredibly rewarding. And as I was mentioning just a minute ago, I just took on the role of director of the Alzheimer's Prevention Clinic. So we're now really, we have the research and we're able to apply the research to clinical practice by really having these two different entities work very closely together and with women's health. So I am as busy as a human being can be I think and also I'm working on a new book so I'm also writing at the same time and I'm a mom so yeah

I'm busy you are doing that all well I really appreciate you giving us your time today and I mean it's so fascinating reading the research that you're doing um you know I've read your book the XX brain which is fantastic and so excited to hear about the clinic as well and I definitely I mean I really want to step into the conversation around kind of the sex differences and in the brain and also the specific risks that women have. But I'd love to know, how did you fall into this area of research? Where did your passion for Alzheimer's disease start? Yeah, I wouldn't call it a passion. I would call it fear, really openly dread in some ways. I have a family history of Alzheimer's disease that affects the women in my family.

So my grandmother was one of four siblings. So there were three sisters and one brother. And all three sisters developed Alzheimer's disease and died of it, whereas their brother did not. And my grandmother started showing signs of cognitive impairment when I was in college. And that was incredibly scary for me because brain health is really incredibly important for me. Being able to perform intellectually is something that I've always counted on. I was raised by two nuclear physicists, so I knew who Einstein was when I was five, but I had no idea who Cinderella was.

And so for me, just being able to perform intellectually was everything. And seeing my grandmother who was so incredibly intellectually sharp and just so highly educated. She was a professor. She was one of the very first women to go to university in Italy at all. And she just declined in a way that was heartbreaking, but also incredibly frightening. And so I wanted to find out if that was just me and my family, or if there was a bigger lesson to be learned. And sure enough, it turns out that Alzheimer's disease affects more women than men. Almost two thirds of all Alzheimer's patients are women, which really means that for every man suffering from Alzheimer's disease, there are two women. And for a very long time, people would just say to me, don't worry too much. It's just that women live longer than men. And Alzheimer's disease is a

disease of old age. So unfortunately, more men get heart disease and more women get dementia. And that sounded a bit flaky to me as an answer because it was like well how much longer do we live right it's not like women live 20 years longer than men the United States the difference is four and a half years in England the difference is two years could that really be the only factor the women live a couple of years longer than men, but rates of dementia are twice as high. I don't know. I thought it was bizarre. And the most important thing that we discovered and other people discovered is that Alzheimer's disease is actually not a disease of old age. Alzheimer's starts in midlife when negative changes in the brain that then accumulate over time,

leading to the clinical symptoms of dementia in the 70s. But in reality, the process of Alzheimer's disease starts in the brain years, you know, decades prior. And that really changed the whole conversation for me because I could say, okay, so now that we know that Alzheimer's starts in midlife, then the question changes to what happens to women and not to men in midlife that could potentially explain why women get Alzheimer's more than men. And so we did a gazillion studies, which are now becoming popular in a way. Many people have heard about these studies, which is fantastic. And it turns out that menopause is a big problem in a way for women's brains in terms of the risk of Alzheimer's disease. It's fascinating.

I mean, your story is also super interesting, and I resonate a lot with it. And the work that I do stems from having a father who passed away from a stroke, and so my interest has gone down that route. And it's interesting how that shapes the work that we do but going back to Alzheimer's and the specific risk that women have are we pinning this all down on the lack of oestrogen going through the menopause or are there more things

happening? There's more there's definitely more I think that menopause is a big issue that's really been overlooked in medical sciences for centuries. And this is why everybody's now getting really excited about our work, because it's the first time that we really have shown that menopause changes the brain. And we have shown that using brain scans. They're quite convincing because you can see it, right? You can see it happen. And that I think is really, really important. And the reason that menopause is important is because it really speaks to different biologies, which then also explain the other risk factors for Alzheimer's disease. So something else that we have done, going back to your question, is that we've shown that there are many different risks for Alzheimer's disease. It's not just genetic. Most people think of Alzheimer's disease as something that has to do either with bad genes

in your DNA or aging or both. But it's now understood that there's over 30 different risk factors for Alzheimer's disease. So they're not genetic. They're not necessarily about aging, but really about lifestyle and medical history and the environment. And the good thing is that these are modifiable risk factors. And people have calculated that risk reduction of Alzheimer's disease, some people will use the term prevention, like we do at the clinic, might be feasible in 30 or up to 50% of all Alzheimer's disease patients, future Alzheimer's disease patients, which I think is fantastic. If we can prevent Alzheimer's disease, even in just 30% of cases, that would be huge. I think we can go for 50 even better. And by the way, all these risk factors are also risk factors for stroke. I mean, not all of them, but many. So it's really about protecting the brain as an organ. And these different techniques are very similar and also really speak to what you do because diet, exercise, these are cornerstones of Alzheimer's prevention.

And so sleep and stress reduction and medical checkups and avoiding toxins, environmental toxins, all sorts of toxins and pollutants. And those intellectual activity is a big factor to protect the brain against aging and different insults. And what's really important, I think, is that menopause seems to be a trigger, but reproductive health is more than just menopause for women. And so we're looking into all different factors like hormones. So many women are in birth control, some form of birth control,

and that has an impact on the brain. If you take hormones for menopause, that has an impact on the brain. If you have your ovaries removed at a young age, that has an impact on the brain. So we're looking at all these different risks that are more female specific, because we want to find very specific risk factors to prioritize, right? I can't have a person come to the clinic and give them a list of 50 things they have to change. They'll just walk out of the door. They'll just give up after two it's too much so I think it's really important to prioritize and we want to find the best priorities and you need the research to do

that yeah but I think it's almost reassuring to know that it's not just the hormonal change and that there are things that we can do because I guess if it was purely down to hormones, then we would see a huge risk reduction by simply giving HRT. And although HRT can have benefits and risks to taking HRT, we're not really seeing a huge benefit from an Alzheimer's prevention point of view, are we? No, we're not. Also, I wouldn't think of giving HRT to all women. I don't think we have the data to support that. We're trying.

We're really trying. The history of HRT has been complicated. I think right now there's no clear evidence that giving hormones the way we've been doing it could prevent Alzheimer's disease. I would also personally argue that perhaps we we've been doing it, could prevent Alzheimer's disease. I would also personally argue that perhaps we haven't been doing it right. Clinical trials start after a woman is in menopause. And we are now starting a clinical trial of women who are not yet in menopause, because I think that's when the system is changing.

That's when you really want to support it. This is five years away. But to your point, I think there are so many other things that one can do that does not involve taking hormones. There are risks associated with that. There's benefits as well, and it needs to be really a personal, individualized decision. But I think other things are just as important. There's plenty of evidence that a healthy diet and a consistent exercise routine can definitely support hormonal health. Sleep as well and stress reduction are huge factors

and they're all really related to each other. They speak the same language in a way and I think a healthy lifestyle is a very powerful preventative not just for the body but for the brain as well absolutely and when you mention you know healthy diet's really important from a risk reduction point of view I think healthy diet means so many things to different people. And people think that you mean like something extreme or restrictive or has supplements. What is the best diet for a healthy brain? And I know you've done research on this, so you're the best person to ask.

I've done a lot of research on that. And I also read a lot of clinical trials and I review grants in this space, which I think is really important. And we have a clinic, right? So I would say the restricted diets are not considered the best diets. A lot of nutritionists and RDs have concerns over restricted diets. I think in

general, just generally speaking, balanced, well-rounded diets that include a variety of fresh fruits and vegetables are arguably the best diets according to most experts. In our research, a Mediterranean style diet turned out to be really healthy for the brain. I can't say the best because I haven't compared it to any other diets personally, but other people have done it. And I think if you look at the scientific

literature as a whole, there are thousands and thousands of studies showing a positive effect of a Mediterranean style diet on multiple aspects of health. So your brain, but also your heart, your hormones, your liver, liver your lungs your mental health and a little bit everything is positively impacted by that kind of diet and by mediterranean style diet i think we're we're all thinking i mean i hope nobody's thinking pasta and pizza that is your part of that i being italian you know, I don't mind a little pasta here and there. But I think it's really, it's a plant-centric diet where the focus is on fresh produce.

So seasonal fruits and vegetables and clearly whole grains and legumes. Smaller amounts of unrefined oils, like extra virgin olive oil is a main staple. We all know that. There's different oils, but I think that's what everybody thinks about for that specific diet is extra virgin olive oil.

And fish is often on the menu, whereas dairy products and red meat or meat in general, they're considered more of a treat in that kind of diet. So they're used sparingly and in moderation. And that kind of diet seems to be really working well for women. Like anyone who's ever looked at women, women's health, almost anyone has shown a positive association with the Mediterranean diet.

So women on this diet have a 25% lower risk of heart disease and stroke. There's a 50% lower risk of breast cancer, a much lower risk of depression and dementia, and also fewer hot flashes. And it tastes good it's doable if the diet is timeless in many ways it's not restrictive you you can totally follow that diet for a long period of time and be satisfied i think and it really supports variety and diversity which i think is important for a healthy microbiome and it's not scared of cards i saw your post exactly it's you know it's very nutritionally balanced and as you mentioned it doesn't just support the brain but it supports all of the organ systems in the body, which is

really important. And after the menopause, you have this huge risk of heart disease and stroke, which just kind of increases once you go through that transition. And so anything you can do to bring down that risk is important. So I guess in the clinic, nutrition is a cornerstone to what you're doing. And you mentioned physical activity and sleep. What are some of the other key things that are important for supporting a healthy brain and trying to reduce that risk of Alzheimer's? I think it depends on how granular you like to do. But we try to work with the patients and try to make sure that we don't recommend things that are not doable for that specific person so you really have to

to let the patient tell you what they want to do and then you try to to make it healthier or more doable for them in some ways but in general um no processed foods i would say that is my that's my number one that's our number one recommendation is to really try to completely avoid processed foods especially those that still include trans saturated fats that are just really really bad for you across the board and that is very hard to do surprisingly for so many people that's the hardest part stay away from processed food junk food fast food especially in the states they're just really really everywhere but we encourage that another thing is again eat more fruits and vegetables and try to focus on antioxidants. That is something that

we spend time really explaining what antioxidants are and why they're so specific, important for brain health, especially for women. We have shown in a number of studies that brain energy levels are quite strongly correlated with your overall intake of antioxidant, especially vitamin C, vitamin E, and selenium. So we really try to prioritize foods that contain those nutrients because supplements, antioxidant supplements, don't work that much. Clinical trials have shown this time and time again, that the observational studies are all saying, if you consume enough vitamin C and vitamin E, there's a 70% lower risk of Alzheimer's disease down the line. But then when you go to clinical trials with the supplements, they actually don't quite show the same effect. So we really try to explain

the importance of adopting a very healthy whole foods diet and trying to avoid supplements unless there's a vitamin deficiency, which we try to measure by doing plasma blood tests or serum tests. Omega-3 fatty acids are also really important for brain health. And a lot of people here don't eat fish or don't like fish, or many are vegan, vegetarian. So in that case, we do suggest supplements. But again, we measure omega-3 levels in blood. And then we try to adjust the diet to support this level like for me personally I'm plant-based so I've been using flax oil have you tried it I don't I still eat fish so um I would I try to prioritize having my one portion

of oily fish a week but I do use flaxseed in my diet but I would echo the recommendations that you have when working with people who are plant-based and typically I I would kind of say consider an omega-3 supplement because you know you can get omega-3 in plant-based foods but it's slightly different to the omega-3 that you'd find in in oily fish and so sometimes if someone's not having enough flaxseed or flaxseed oil, it can be helpful to supplement. But, yeah, it's great that you guys are giving that recommendation and you're able to check the levels as well

before just recommending that everyone takes it. Yeah, and the same for b vitamins um you know vitamin b6 b12 and b9 or folate are really key for brain health and brain aging so we want to make sure that everybody has access to the vitamins and it is it is tough to get the b12 on vegan diets so we we pay attention to that the nutritional yeast has become like a big deal in my house yeah we have to so that's broadly the diet model we try to minimize animal fat although i know it's not trendy a lot of people here are on high fatfat keto diets that we don't use at the clinic. Yeah, it's less trendy, I think, in the UK, keto diets.

Or maybe they're just going out of fashion. I think these things come and go. Vegan diets are really big at the moment. But I think, again, coming back to the Mediterranean-style model, it's like finding that kind of plant-centric as the words that you used where that's the focus of your diet and um I think most a lot of people here still eat consume a lot of red meat and processed meat and you know from a total health perspective if we can get more people moving away from that even a little bit more

oh for sure here uh meatless mondays are really big and i think it's a really good practice to have to just try and go one day at least without eating meat it's a really good start it makes you feel good about yourself that you can do it and you know that you're not depriving yourself because you have options anyway whatever is sustainable healthy but sustainable i think is a win-win situation for most people and then really try to optimize for your own specific risks like if you used to smoke in the past or if you have smoked more than 100 cigarettes in your lifetime then i would say take an antioxidant as well or try to get the antioxidants from like i really love extracts do you take any i have my i love them

my daughter loves them we have um dark tart cherry with blueberries and ginger in turmeric at all times in the fridge and i drink noni juice as well i've been drinking it for a really long time and it's a fantastic source of antioxidants and coffee i love it i do a lot of that look there's actual research on that so there are studies very large um epidemiological studies showing that one espresso a day maximum two but really one espresso a day is associated with positive outcomes for brain health and dementia later in life. This is about 300 milligrams of caffeine a day. But the thing about coffee, like good coffee and good coffee beans, that they're very high in polyphenols and also in hydrosinamic acid,

which is a great source of antioxidants. So I think, you know, antioxidants foods are really... I guess the next question that people often ask you when you talk about antioxidants is red wine oh sure yeah oh this is terrible for me actually because I don't drink alcohol that's not terrible that's great nobody believes it and then anyway yes so red wine is a very good source of resveratrol, which is another antioxidant-rich compound. However, if you don't like red wine,

then pomegranate juice has almost the same amount of antioxidants, and not the juice, the extract. Yeah, and surely the alcohol in the red wine has to cancel out the benefits of the antioxidants, surely. Alcohol is dehydrating. And that's my concern. Although I don't like alcohol, it just doesn't work for me for a senior resident in the family. But the main function of alcohol is dehydrating. And what we have learned about brain health, what we've known for a long time is that the brain is the one organ that is really affected by dehydration, right? So the brain is over 80% water content.

And for every cellular reaction to take place in the brain, there has to be enough water. There are H2O, but also the electrolytes are just as important. So even mild dehydration, like a 2%, 2% to 4% water loss can cause neurological symptoms, which is something we don't appreciate as a society. So all the fatigue that people report, the brain fog, the lack of, they're having a hard time concentrating. Very often that could just be very mild dehydration. So drinking water is something that we strongly recommend. And I don't know if eight glasses a day is enough. It depends. It's case by case. But you can measure fluid retention, right? There are those machines that we use to measure total body composition that you can break down into fluid

content as well. And that's a good indication for the rest of the body. So if the rest of the body is dehydrated, then your brain is definitely not doing great. You should drink more water and more electrolytes. And they always say the purified water is not water, right? Your brain needs the fluids and the electrolytes. The brain doesn't just need something wet. It also needs the nutrients and the electrolytes the brain doesn't just need something wet it also needs the nutrients that are part of the water so it's best to invest in

my opinion in regular water spring water even tap water if it's clean right you buy a filter instead and just filter out the impurities but retain the nutrients so this is something that we always underline which may sound really silly but at least here in the states people don't drink water you know yeah i don't i think a lot of people do tend to run on the more dehydrated side um and i think you know like simple rule of thumb also checking your urine like if it's running clear a straw then you're good to go but yeah I mean you make a really you said it's a simple point but it's a really important point because dehydration we see like dips in mental performance physical performance so it's just it's really important and I think as we get older as well

we lose those thirst receptors and so we don't actually know that we're thirsty so it's kind of helpful to just keep reminding yourself to keep topped up yeah and so one thing we didn't talk about was um physical activity and whether there's a best form of exercise you recommend or do you just think that all movement counts when it comes to supporting your brain? For brain health, there's evidence that all intensities work, right? So I think, and you know this much better than me in practice, I think that exercise has to work with the person. You can't force a person to run if they hate running and you can't force the person to do yoga if they hate yoga. It has to be something that you enjoy doing because

I think what the research shows is that low intensity exercise is better than no exercise and it counts especially for older people. Even just a regular walk in the park every day like 30-45 minutes walk in the park is really it really improves the brain you can see the hippocampus the memory center of the brain kind of growing volume instead of over time which is huge by just walking but I think for people who can do more, it's definitely better than do more. And you don't have to kill yourself, but you do need to be consistent. What studies have shown for women in particular is that there's an inverted U shape between the intensity of the exercise and the gains. So if you have no intensity, very low intensity, you have very little gains.

But as you increase your intensity to a moderate level, you have the highest gains. But if you keep increasing the intensity, then the gains start decreasing, especially with perimenopause and aftermenopause. So I think it's really important to know what works for you and find something that you really enjoy but then stick to it I like running and for me it's the best thing I can do for myself

but then there are some days that I just don't have the time I don't have the energy and then I switch to yoga so you can still do something also for people like me who just sit all day you have to move you do i think the message to move more and sit less but move in whatever way you enjoy is a good message yeah and there's really just strong evidence that especially again i keep going back to women. It's important. Also, we never talk about women. I know. It is different for women. And there's studies with hundreds of people who were followed for 40 years, which is amazing.

And they showed that women with higher cardiovascular fitness in midlife have a 30% lower risk of dementia in old age as compared to women who are sedentary in midlife. And midlife is any age between 35 and 65. So there's really no excuse, right? So you can't just sit. I know, you know, especially in lockdown with COVID, it's been really hard to leave the house and make time for physical activity. But I think it's really important to think that it matters. Yeah. Your health in midlife is the best predictor of your health

in old age and for the rest of your life. So this is really the time to focus on it and make sure that we are as healthy as we can possibly be because that is really a huge investment for the long term. Yeah, and these are low-hanging fruit that we can all focus on. It doesn't require spending lots of money or time or energy. It's just about prioritizing these things and I think one of the other things that we tend to not prioritize and also that women seem to struggle with a lot more than men is sleep and sleep quality and again

similar to kind of brain health we see these like during those hormonal transitions, women, you know, whether there's pregnancy or the menopause or across the menstrual cycle, women really struggle with sleep. And so how important is sleep and the risk of Alzheimer's disease? Well, sleep is huge. Yes. I think we live in a society that really hails productivity and deprecates sleep, right? You want to be in the city that never sleeps, as if that's a good thing. And sleep is incredibly important for brain health as well. We we know that and the thing neurologically and physiologically is that the brain is constantly active the brain is in is in constant movement because it's got to supervise the rest of the body as well at all times except during sleep and except especially except during a specific phase of sleep that's called a slow wave sleep or deep sleep, which is when the body is completely still, you're rigid.

And that's the only chance that the brain has to take care of its own. So it's like the brain's me time. Everybody else is taken care of. Everybody's sleeping. I can take care of everybody's sleeping i can take care of myself and what happens specifically during that part of beauty sleep for the brain is then the brain activates a different system that's called the glymphatic system that really cleans the brain up so the brain is taking a nice long shower at last and it removes all the impurities all the toxins toxins, all the waste products, even Alzheimer's plaques

actually degraded and eliminated during that specific phase of sleep. So if you keep waking up at night, your brain is not going to have the time to go into that specific component of sleep. And that's why you feel terrible the day before and for months to come. And once you have a kid for years, once you're a new mom, it takes, my daughter didn't sleep for two years. So that was rough. But we also know now that that really has long-term effects. And there's a strong correlation between poor quality of sleep, especially in midlife, but also later on in life,

and more Alzheimer's plaques in the brain, and therefore a higher risk of dementia. So I think it's important to prioritize sleep and also prioritize mental health, because I think they really go hand in hand, right? And hormonal health is obviously involved because sleep is in part regulated by melatonin level melatonin is this hormone that regulates the sleep-wake cycles and is made by the brain and is made as part of all the hormones right all the hormones are made and released as a system. So there's an association between your levels of estrogen, for example, and activity in some parts of the brain and your brain's ability to regulate sleep efficiently. So something that a lot of people ask is,

why can you not sleep as a woman in midlife and going through menopause. And one reason is that estrogen is a very potent brain hormone as well. It's not just involved in reproduction. It's also involved in a whole number of brain functions, including sleep. So there are a lot of estrogen receptors in one part of the brain that's called the brainstem. It is in charge of regulating sleep and wake. So if estrogen starts fluctuating in the years leading up to menopause, then estrogen won't be able to regulate

this part of the brain consistently, right? Because it's all over the place. And so the brainstem has a hard time regulating the sleep and wake cycle and that we can't sleep, which is one of the many things that happen in many perimenopause and on the years on either side of menopause yeah and it's so interesting that we are starting to understand this more with the research that we have and yet we don't have any

tangible ways or practical advice to give to women like unique sex specific recommendations when it comes to sleep I find that I find that mind-blowing and yeah yeah and it's a public health issue because sleep is related to so many other things but I want to circle back to something you mentioned about you said you know menopause is like this trigger for you know for Alzheimer's disease and I think when women go through the perimenopause and the menopause there is this whole uh kind of thing that women often say that they experience called menobrain or brain fog and when that happens, it can be, I mean, I've not gone through it myself, but from reports of women, it can be very scary, because they don't know whether this is Alzheimer's, or if it's the menopause, or if it's lack of sleep. What advice do you give to women? You know,

is this something that's transient? And how can you tell? Yeah, So that's, that's a really good question. And it is one of the biggest reasons that people come to us is the brain fog. And it's really interesting. I think that so many women experience brain fog during menopause, and we don't even have a term to describe it. Like brain fog is not a medical term it's something that we as women use to describe what we're feeling but the medical world is just so behind they're just not interested in women's health that we don't even have a proper definition of what brain fog is so i find it so bizarre but so what one thing that we set set out to better understand is why do we have it? What's the cause?

Is it Alzheimer's disease? Is it menopause? How does it work? And one thing we've shown by working with women who started out as premenopausal and then transitioned to perimenopause, and then they made it through menopause is that the brain really changes. There is a gradual decline in brain energy levels.

They can really see it when you do the brain scans and I have some on my website where I show them, my TED talk, that if you look at the brain of a woman when she's premenopausal, the brain is really nice and bright. It has a lot of brain energy. But then there's an average 30% drop in brain energy levels

during the transition to menopause. And something that I'm really excited about and answers your question is that after menopause, brain energy levels go back up, either plateau in most part to the brain or there's even a little bit of a rebound which I'm very interested in and we're exploring that more now so my explanation for that to be confirmed is that women's brains have the ability to find a new normal with menopause. Energetically speaking, it's a different normal, but it's still normal.

It's a new baseline. And the brain has the ability to adapt and adjust to menopause. So the ovaries, yes, the ovaries stop making certain hormones like estradiol and progesterone but the brain is to carry on because most women spend over 40 percent of their lives in a post-menopausal stage and they're fully functional which is something that most people don't realize we always look at the downsides of menopause i feel like crap i have the hot flashes i have the insomnia the memory lapses the brain fog the night sweats the anxiety the depression but at the same time cognition is preserved for most women which i find fascinating because it really speaks to

the brain's ability to compensate and adjust so we do cognitive testing and what we find what everybody else honestly finds in this film is that yes it is true that you're not feeling great as a woman you have every reason to feel like your memory is a bit fuzzy your thoughts are clouded but effectively when you're being tested formally you perform just fine there is a little bit of a dip in cognitive performance, especially verbal memory, during perimenopause, but then performance rebounds soon after menopause. And that's for the average person. It is also true that for some women, cognitive performance is not changed at all throughout

the whole transitional 10 years of perimenopause. And the women outperform men on cognitive testing at any age, before, after menopause, and even after a diagnosis of Alzheimer's disease. Now, all that said, there are women who do show cognitive changes during menopause, then progress. Their cognitive performance keeps declining over time. And at some point, it might turn into mild cognitive impairments and then later on dementia, which is why it's so important to do early testing. So our patients come to us and we do all these cognitive tests and we do all the brain scans.

We look for a gazillion possible risk factors for Alzheimer's disease. And then we work with people over time, not just to address these risk factors, but also to repeat testing. Because I want to have a baseline for you when you're not okay in your 70s, in your 80s, 90s, whenever, we can go back to the baseline and see what's happened to you, person, throughout your life, throughout your adult life, or from your 40s onwards that could really speak to an impending cognitive impairment situation or not. This is so interesting and there's some kind of

let's just call it brain fog um during the menopause this transient change in energy as you've described is that what women who are pregnant often report or is is that a similar situation so to my knowledge there are no pet studies of pregnant women because the studies that we do involve radiations right so the tracers that we use are radioactive to measure the glucose metabolism in the brain but there are other studies that have been done using MRI scans which are completely non-invasive. And these studies are really fascinating because they do show that the brain is changing during pregnancy as well, in a way that you wouldn't expect, I think, which is that the brain loses great matter during pregnancy. Like our brains shrink as we get pregnant and especially after delivery. But then there's a bit of a rebound in many parts of the brain

about two years after the baby is born. And that really speaks to how plastic our brains are. And it is very possible that the changes that take place in the brain could provoke the brain fog and you know, just the fact that you're not as great in multitasking perhaps although I have to say that new moms are amazing in multitasking and being able to function absolutely right so I don't know we always think about the downsides of the pregnant brain or the mummy brain and we don't look at the positives, which is like, you had just grown a human being. And now making sure this baby who is completely helpless is able to survive and thrive. And I think that is fantastic. And from a neurological perspective, I like to think of these brain changes that take place during pregnancy as the brain getting rid

of neurons that it no longer needs. There are so many things that you just don't need to keep in your mind. Like what somebody said to you three years ago, that could go. Wearing high heels, forget it. That could no longer be nutrients anymore. Or the brain has a chance to reset

and just kind of clean up. Like it's like a spring clean. Pruning. Yeah, spring cleaning. Exactly. We don't need all this stuff anymore. That can go. Because now we need to regrow parts of the brain

and we need to strengthen those neurons that are going to really support the bonding with the baby and your ability to survive sleepless nights and respond to the myriad needs of this new creature that really depends on you so i think it's it's beautiful in some ways that yes there are some symptoms and you you don't feel fantastic for a little while but then not only goes away but your brain has changed in such a way that is no more efficient than it was before and i like to think of menopause as being a similar process yes your brain is changing it's downsizing in a way but it's also true that you don't need those neurons

anymore because you're not going to have a baby again yeah all these neurons that are growing during pregnancy that you have since birth some of those can actually go and you can make room for for other skills and other other neuronal connections yeah it's like downloading an update for your brain upgrade exactly you're restarting your operating system so that yes you'll take care of the grandkids if you have them but you you don't have to grow one anymore no need for lactation there's no need for pregnancy anymore. So all those connections between your brain and your ovaries can just be discarded.

So your brain is lighter and leaner, right? But more efficient. Yeah, I like that. I like that way of looking at it. So we're coming close to an hour and I really have loved this conversation. So to wrap up, I ask every guest three questions. The first is really straightforward.

It's just what would be your number one takeaway from this episode that you want women and men or anyone listening to go away with? I would say that you really want to take care of your brain. It is in your power to do so. And it's really, really important to treat your brain like your best friend. And think of your brain more like a muscle. There are things that you can really do to strengthen it and make it stronger and more efficient. You can feed it properly.

You can exercise it properly. You can let it rest properly. And if you take care of your brain your brain will perform so much better for you at any age and it takes discipline it does but the benefits are for life oh i love that such a good message and the second one's a little bit different if you could go back and tell your 18 year old self one piece of advice, what would it be? Oh, to me, I would say slow down, honey. Work less, enjoy, play more, enjoy your life a little bit more.

I would say, yeah, I would say, you know, just take care of yourself. I've always been kind of running my way up to something and working a little bit too much I think and I know it's not going to change it doesn't sound like it's going to change any time but yeah slow down I think that's that's and also maybe think about your spiritual life more because it's something I don't do yeah that's nice and the last is, what one book do you recommend that everyone reads? Well, the book that's been incredibly beneficial for me has been Meditation for Beginners by Jack Kornfield.

Oh. Yes. It really changed my life for the best in many, many ways. And another one would be Peace is Every Step by Thich Nhat Hanh, who just passed. Those are meditation books. They're very easy meditations for beginners. And I think they can really, really change everybody's lives. Amazing.

And then my book. Of course. Everybody's interested in women's brains but i think those two books are really um especially meditation for beginners is a must you it's a must have i'll add it to my reading list but i do know that after this podcast there will be many people listening who will want to get their hands on your book so it's called the XX brain and where can we find it I have it here yeah see that's the UK version uh it's on Amazon for sure I think that's the easiest way and through my website if you want to have links yeah so great well thank you for giving me

your time today I know how busy you are and I am so grateful for all the work that you're doing for women's health. It's amazing. Oh, thank you so much for having me. I hope you found that podcast as insightful as I found it. And if you did enjoy the episode, you know the drill, please rate, review and share the podcast with someone you think will enjoy it too. Well, I guess that brings this season to a close. Please continue to send your feedback on social media so I can continue to improve and I would also love to hear who you want me to interview next. That's all from me, until next time, stay well.