Live Like a Girl with Dr. Mindy Pelz - Understanding the Changes in Your Female Brain After 40 with Dr. Lisa Mosconi

Episode Date: May 6, 2024

Neuroscientist Lisa Moscone discusses the evolutionary reasons behind menopausal brain transformations, emphasizing resilience and complexity. This episode covers brain function shifts, the grandmother hypothesis, and the impact of hormone therapy on brain pruning. Along with Dr. Mindy, Lisa stresses the importance of research on menopause's mental health implications and advocates for personalized menopausal toolkits. They also highlight the benefits of a plant-forward diet, fibre for hormonal balance, and the influence of estrogen on brain health. To view full show notes, more information on our guests, resources mentioned in the episode, discount codes, transcripts, and more, visit https://drmindypelz.com/ep234 Dr. Mosconi holds a PhD degree in Neuroscience and Nuclear Medicine from the University of Florence, Italy. A world-renowned neuroscientist, she ranks in the top 1% of scientists of the past 20 years by official metrics. Recognized by The Times as one of the 17 most influential living female scientists and honored in ELLE 100: Women That Are Changing The World, Dr. Mosconi has been acclaimed as "the Mona Lisa of Neuroscience" by ELLE International.  Check out our fasting membership at resetacademy.drmindypelz.com. Please note our medical disclaimer.

On this episode of the Resetter podcast, have I got a crazy treat for you? I have brought you Lisa Mascone. And this conversation for all of my perimenopause, menopause, and postmenopausal friends out there, this is the brain conversation I've been dying to bring you. So let me tell you who Lisa is and what you're. about to hear. So hopefully you've heard of Lisa, but if you haven't, she has written the XX brain and her most recent book is called The Menopause Brain. And she is a neuroscientist, and she is in deep with research specifically around all aspects of the female brain.

The most current research she's been doing is on the menopausal brain. So I have been dying to bring her to you all to really dive into some key, helpful pieces of information we can all use to navigate this crazy brain experience that many of us have as we go through the perimenopause and menopausal journey. So with that said, here's what you're going to hear. So for starters, we talked about three major times in a woman's life where there is a neuronal pruning that happens. What that means is that the brain actually starts to get rid of what no longer serves it and a new brain is formed. So many of these three times of life will be familiar to you. It's puberty, pregnancy, and perimenopause. But what is fascinating about what Lisa and I

discuss in this is that when you look at puberty, there's a very specific reason the brain needs to prune itself and grow bigger. We talk about that. When we look at pregnancy, same thing. Very specific reason. We need to do away with some of the neurons that are weighing us down so we can tap into being able to take care of children. We talk about that. But here's where it gets really fun, is what is the primal reason that the menopausal brain needs to prune the old and grow a new brain? And that is the part of this conversation where this gets really interesting. So if you want to make sense of what's happening to your brain as you go through menopause. This is the episode for you. In fact, I love it so much. I hope you share it with all your menopausal friends. If you're also asking, like, what do I do about

HRT? Should I do it? Should I not do it? We discussed this in a very balanced conversation. I loved that part of the conversation. And then we dove into diet, what diet is best for the menopausal brain. And of course, we landed on fasting. What does Lisa think of fasting and ketones and its experience to the menopausal brain. Phenomenal conversation. I bring you this with so much joy. I hope it gives you so many answers. And please share this out because this is what I have been trying to synthesize and bring

to women for the last several years. And we just nailed it, Lisa and I, in this conversation. I'm so excited for you to hear. So Lisa Mascone, the menopause brain, enjoy. Welcome to the Resetter podcast. This podcast is all about empowering you to believe in yourself again. If you have a passion for learning, if you're looking to be in control of your health and take your power back, this is the podcast for you. Gosh, I have so many things that I personally want to say to you. For starters, the XX Brain, I've read that several times. It was one of those books that as I was

going through my perimenopausal journey, I was just trying to understand why my brain was thinking different. And even though so much of that book was geared towards women of all ages, it was like the only resource we had at the time. And it actually took, the XX brain actually took, I went from my, my, what you taught me in that book to PubMed. And I started just looking into PubMed. And I was like, okay, well, what about what happens when estrogen goes away to the brain? And what happens when testosterone and progesterone? And I started doing all my own research, which I want to talk through with you today. But I also then when I saw the menopause brain came out, I was like, thank you. Lisa, thank you, because we needed a more, a deeper conversation specifically around the menopause brain.

So that's my intro to say that I'm a total fan and I'm so excited. excited you wrote this book. So let me just say welcome and thank you so much for putting the time and effort into this book. We really needed this. Thank you. Thank you so much. I so appreciate it. When I wrote my very first book, Brain Food, everybody wanted to talk to me about Alzheimer's prevention. So then I wrote the XX brain, which is really about Alzheimer's prevention in women. And what everyone wanted to talk to me about was menopause. Yep. And so now I have the men of my brain. Now everybody wants to talk to me about the mommy brain, pregnancy and motherhood.

Oh, yeah. And how dad and pets brain. This is so funny. And if you want, we can talk about this more later. But I was speaking with Gabby Reese. It was on her podcast. And I just said something to her just anecdotally. I thought we were just doing like a little warm up conversation.

And this snippet is like a 20 second thing about how women's breaking. change in pregnancy and with motherhood just went vital with almost two million views. Wow. And they was like, oh my God, this is something I just said kind of like conversationally. And I wish I did that. I wish I just had more time to elaborate more. So maybe we can spend a minute on that at some point. That mommy brain and the menopausal brain are both massive shifts in hormones.

So they, they, they, I would think they act very similar. Yes. Is that how you look at it? Yes, that's not the fun fact that I shared with her, but yes, we are now looking at similarities between menopause, pregnancy, and puberty. Yes. Or not, because these are all pivotal times in a woman's life that I refer to in the books of the three P's, right?

Puberty, pregnancy, and peri, menopause, during which brain aging or brain development is substantially impacted and progresses in ways that we don't usually associate with aging. When you think about brain aging, I think we're all familiar with those kind of graphs, where you see that when you're 30, 35, everything is great and flat. Basically, the curve is, the neuron and density curve is flat. And after 35, 40, there's a slow gradual decline in the number of brain cells that we have. and then for some people is faster, for some people is gentler. Forget it if you're a woman.

That kind of model is almost 100% based on studies done on men, where their brain aging is actually quite gentle and linear. But if you look at the way that the female brain, a woman's brain, changes throughout the lifespan, is way more complicated than that, because as soon as we hit puberty, our brain gets in sync with the ovaries, right? This connection, the neuroendocrine system gets activated.

And from that moment on, every time the ovaries cycle, the brain micro cycles, right? So there's nothing flat there. It's like little waves throughout your entire reproductive life. And then once you get pregnant, there's an overactivation of this system that then is followed by a little bit like a crash and burn, postpartum, when the brain goes through a massive remodeling, with some parts of the brain lose volume and shrink, and some other parts of the brain actually gain volume and gain an increasing cognitiveity. So it's not linear.

It's more like a tornado, right? Every time a woman gets pregnant. And then there's menopause. That's another major turning point with another little tornado. and then cellular ages actually. A big one. Can we call it a little bit bigger than a little? Like a hurricane, a major disaster.

Yeah. For some women. For some women, right? Yeah. Yes. But some women, it's more like a breeze. And for some women, it could be really massive. But then when you look at the whole trajectory, there's nothing linear about it.

It's very complex. And we never talk about this complexity. And you know what? We never give women credit for navigating this inherent complexity, making through it, and taking care of everybody else at the same time. So, you know what's interesting? Thank you for saying that. And one of the through lines that I read in your book that I just love is this compassion for ourselves. And one of the things I've noticed about women is that when our health goes off, we don't. tend to blame the people around us, we turn on ourselves. Yeah. And we blame ourselves. And this is why I think discussions like this, books like yours, are so important because all of a sudden a woman sees herself. And she's like, oh, I'm not alone. Oh, this way that my brain has been thinking is actually a hormonal

shift. It's not because I hate my job or I hate my kids or I don't want to be with my partner anymore. I mean, those can be like situations, but it's, I think giving language to these brain changes is really interesting. The thing that I find fascinating about these three P's is that each one of them, there is a primal reason that the brain is doing what it's doing. And when you look at puberty and you look at pregnancy or postpartum, you come out of those initial experiences and it's like the brain has to function. in a heightened way to be able to adapt to the new job. Postpartum is a great example. When you said, oh, it's switch. All of a sudden, there's new neuronal growth in other parts of the brain.

It's like, well, yeah, that makes sense because you need to be able to use your brain in new ways to be a mother. But in menopause. Also. I don't. Okay. So this is the root of one of the major questions I have for you is if we have this hormonal shift, which is also followed by a potentially by a neurotransmitter shift that I want to talk to you about. What is the upside? Where is the brain going as these things are shifting? And what are the

new things that are coming online for the menopausal woman? And I think if we understood that, we could weather the storm a little bit better. Yes. And I loved that you're interested in that part. So when I was writing the book, I had this super long part about puberty pregnancy and how they really help menopause make sense. And then I thought, oh, everybody always said that I overdo it with the science. And so I shortened it, they shortened it. But oh, my God, I love the part so much. Can I, can I elaborate?

Yeah, please. Yeah, tell us. Give it to us now. I love this. Yeah, this is like a 100% neuroscientist take on women's brains as we go through reproductive changes. So what happens at puberty for both boys and girls is that the connection with the reproductive system turns on. And it is important to realize that the major drivers of evolution are

having sex and having children and being able to feed yourself. Right. So a huge part of your brain is actually wired to respond to reproductive health. This is just evolutionarily sound information, just we know that. Just a huge part of the brain that is a network with the reproductive system. So at puberty, humans are supposed to start having children, or at least are able to start having children, right? So you can't still be a kid. Your brain needs to switch and prepare for the new job,

where the new job is allowing you relatively young human to not only become a parent, possibly, but also to become a member of society. Because humans are not particularly strong animals in some ways, right? You have to fight and hunt as a team. And that's really how the human race survived, is by bonding with each other and sticking out together. So the brain rewires itself in two ways. Number one, there's pruning.

There's a huge amount of pruning, the play, we're almost 50%, almost half, of all your neurons are gone. The brain just says, this is my biological clue to get leaner and meaner, if you will. Why is that important? Because neurons are extremely expensive to carry. So as the brain, yeah, so the brain is the most metabolically expensive organ of the entire body. It takes up a huge amount of energy and resources. not just to make it work, but also just to have all those brain cells.

So if you don't need them, it's best to get rid of them. Now, what kind of brain cells you don't need anymore? Plenty, because at this point, you can tie up your shoes, you can make your own food, you can find your way home, you can ride a bike, right? All these little neurons that were responsible for encoding every little step of the way, those are not needed because at that point you can do all these things in autopilot. Yes. So the brain can just get rid of all this stuff, you know, like spring cleaning.

I don't need it. Let's get rid of it. And now let's put all our energy and resources towards reassembling the noodles that we're keeping to make them stronger and better connected. So if you're a brain, you want to actually be a little bit smaller, but more dense. You want to have a higher density on nutrients inside the brain. What part of the brain is rewiring and getting stronger? The theory of mind network. This is a very special network that is involved in developing social cognition,

mentalizing, developing empathy, and the ability to put yourself into another person's shoes. Right? So for girls, this remodeling happens a little bit earlier on in life, around age 11, 12, as we hit puberty. For boys, it takes a little longer around age 14, 15, which many people say this is the neurophysiological correlate of the fact that girls tend to mature neurologically

a little bit earlier than boys. Then the brain keeps growing. But all these changes that take place of really the mechanism by which your brain allows you to become an adult. Now, this process is wonderful and is really the key to keeping society alive.

However, it's not painless. Right? Every time the brain rewires itself, there may be consequences. The big emotions, right, of reckless behavior. All this drama than the natures go through,

I would say. All the weepiness and the brain fog. And the sweatiness, there are a lot of neurological science and psychiatric symptoms that are correlated with becoming an adult with puberty and adolescence. Fast forward to pregnancy, which obviously only women go through, and something really similar happens another time. So the brain sheds neurons, which is give rid of a lot of gray matter, not a lot. I mean, relatively speaking, there's some gray matter loss, which, in my opinion, is another

clue to let go of a bunch of stuff you no longer need, because at that point, you're likely a little bit older, and you need to make room for becoming a mother. So the brain rewires itself another time, and once again, this theory on mind network gets an upgrade. Oh, so it's the same place. It's the same place. Yes. So the reproductive system is always connected to the same parts of the brain.

Right. Okay. The theory of mind network is a really important one. And then there's the cognitive estrogen network. So both these parts of the brain, which is huge in the brain, really changed together every time we go through these transformations. And so pregnant women, especially after the baby's born after postpartum, there's a reduction in gray matter. the strengthening of some other parts of the brain, like the theory of mind, because now you really have to rely on your intuition. You literally have to be able to read minds because that baby will not speak to you coherently. But a really long time, you need to make sure the baby survives.

You need to protect the baby from danger. You have to feed the baby. You need to function on no sleep. So there's a lot that your brain needs to be able for you to do, for you to succeed. Right. So once again, there's the upgrade. There's the super mom brain. Yeah. But there's also baby blues. There's postpartum depression.

There's lips with night. There's brain fog. There's confusion. There's reduced focus. Right? All the things that we associate with the mommy brain, usually in a negative way. without thinking, well, but look at all the things that you can do now. Yep.

Right? And fast forward to menopause. Again, it's the same brain network. But what happens now? You're done having children. You don't need all those neurons that were responsible for having a menstrual cycle. They were responsible for hosting a pregnancy. They were super, you know, they were making you the super intuitive mom.

So it's possible. that the brain just sheds those neurons again. There's another pruning going on. And then the brain rewires itself another time. And this is not published yet, but we find evidence that connectivity in the brain is increased after the menopause transition in some parts of the brain.

This time we're frontal. So it's more about planning. Aha, yeah, it's more about planning. It's more about being rational. Yes, it's more about being in conventional. control. So less impulsive, less reactive, more stable, more center, more grounded. And if you think more empathic, there's another boosting empathy and there's a boost in, well, we would say emotional transcendence. You would probably say given fewer. F. Fucked. Yes. You can say it. You can

swear on this podcast. You do. I can tell you as a postmenopausal woman, you do give. Give a lot less fucks. This comes up so many times. Yeah. With everyone I talk to, everybody is that, you know, I just don't sweat the small stuff anymore in the or give you know, but it comes up all the time and they think it's such a blessing in so many ways. I think that was so beautifully described because I now where my brain goes is so then what is this the purpose? Like with with puberty, the purpose is to become the way I interpret what you said, the purpose is to become a higher member of the community, like a more higher functioning member of the community. With postpartum, the purpose becomes to have this really good intuitive sense for your baby. Okay, so if all of a

sudden there's another pruning that's happening in menopause and now all this upside comes in, what is our purpose? And specifically, what is our purpose in relation to the cultural society? Yes. So there are theories where all these changes are really in place to support women to transition from being reproductive to being non-reproductive but remaining highly productive. And the best theory is the grandmother hypothesis. Ah, yes. Right. I need to explain that to everybody.

Yes. So I find it to be a beautiful, beautiful theory. Look, not everybody buys into it, but I think that the premises, the neurophysiological premises are sound and the genetics are sound up to. Yeah, I'll explain it. So the grandmother hypothesis was developed by Dr. Hope. Kristen Hawks, where she was studying the Hudson, a tribal community. And she was really interested in dispelling the myth of men the hunter. Because she was saying, well, look, when men go out hunting, more often than not, they actually come back with nothing.

They come back empty-handed, right? So, if daddy isn't bringing back the bacon, who is? Who is taking care of the babies and the elderly and everybody else? And it turns out is the women. And yes, they're foraging, but that's really what provides the vast majority of sustenance for the entire community most of the time, not always, but most of the time. But then she went a little bit further. She kept studying these women, and she realized that once,

The younger women started having children. The older women who were past menopause, they just stepped in and started taking care of everyone and everything. So they would do all the foraging. They would take care of all the grandchildren. They would effectively raise the little ones so that their own daughters or daughters-in-law could keep having children themselves. So effectively, they stepped into a leader.

position that was only made possible by there being postmenopausal because at that point there was no competition for reproductive fertility with their daughters and also they were not risk dying by keep getting pregnant at older ages. So in a way, there was a win-win situation. That is actually really interesting to me as a scientist because it goes clearly against Darwin's theory of evolution, which again was developed by men based on men. Right? Where you're saying the only purpose of being alive on this planet is to pass your genes on to the next generation.

This is only true if you're a man. Right. Because men are fertile into their 70s and 80s sometimes. But for women, that would be extremely disadvantaged. There would be an extreme disadvantage. And so I started thinking, well, what if nature is actually not as misogynistic as those were writing about it? Because if you look at this process, right, if you look at this process from a female perspective,

it makes so much more sense to stop being reproductively viable at some point and remain alive so that you can just enjoy the rest of your life, but also being effectively taking care of everyone. Right. Oh my God. Okay. You just answered a three-year quest that I've been on to figure out why the female brain changes the way it changes during menopause. And one of the things that fueled me even more is I brought Dr. Amen on to my podcast. And I trust his opinion. And I asked him, I was like, tell me why we have this massive change in hormones. And I want to get to neurotransmit. And I want to get to neurotransmit. is here in a second, why does the brain go through this in the perimenopausal years and what is the body up to? And his response was, oh, you weren't meant to live as long as we're living right now.

Right. And that made me so, that made me so mad because I was like, so wait, were we supposed to just be tossed aside once we stopped reproducing? But I couldn't answer the question of what happens to the brain for the good. Like, where does the brain go when you get all? on the other side of the perimenopausal process. And you just said it so brilliantly. And that needs to be, every woman listening needs to understand that's where your brain is going. How much suffering would be helped if we knew that was the brain? The brain is training for a leadership position in the culture.

I love that, actually. Right. That is so beautiful. It's training for a leadership position. God, I love that. Yes, it's beautiful. And look, what he mentioned is the opposite theory. It's called the mismatch hypothesis of menopause. That is 100% derived from Darwin's theory of evolution and was really what everybody saw menopause was until the grandmother hypothesis and some derivatives started being formulated and confirmed and replicated and whatnot. The theory was

And this, I think, is very important to recognize, then if you are born with ovaries, the idea of going through menopause is a no-brainer, right? We just know that at some point the ovaries will stop ovulating and then we're going to go through menopause. But in reality, menopause is a major biological riddle because... Redo. Yeah. Riddle. It's a puzzle. It's a big question mark.

It feels like a riddle when you're going through it. Yeah. Oh, yes. For sure. But if you just look at biology, most female animals do, in fact, die. Their lifespan coincides with the reproductive spin, but not for women. And women are one of very few species on the planet, animal species, who have evolved the ability to live past. menopause. So the only other species are some whales. That's what I wondered, yeah.

Killer whales. Okay. Norwolves. Another type of whales. One type of the Asian elephant, one type, perhaps one type of giraffe, and then a little bug. It's called the Japanese aphid. For whatever reason, obviously it doesn't menstruate, but is able to outlive fertility. Yeah, what are the reason? Why are there only a handful of species that have this function? Well, see, that speaks to evolution and to an adaptive quality because it's really hard to live without the superpowers of your hormones. So there has to be a big adjustment that takes place where your entire body and brain is able to find a new way to function that does not include. estrogen, progesterone, and to some extent, testosterone, but switches to alternative routes. And that is a big accomplishment.

And I think when people say you were supposed to die after menopause, and it's only that modern medicine and technology is keeping us alive for longer than nature intended, that I'm thinking, hmm, not real, I mean, perhaps, but the reality is that this kind of evolutionary changes take a really long time. Yeah. To occur. And it's every woman on the planet. So this cannot have happened in the past 50 years. There must be something genetically that is more ancient that is being perhaps pushed or boosted by improvement in health quality, of course, that that would play a role as well. But it can be the only reason. There has to be more. because otherwise it's just weird.

I mean, I think genetically it would be a little bit too quick over change. Yeah. Okay. So that leaves me to two questions. Okay. One is, no, this is like, you have no idea. This is the conversation I've been dying to have, and you're just, you know, you're, you're sparking so many answers for my curious brain. So how long is this pruning process supposed to take when you're in menopause?

And is there a way to speed it up? And what happens if all of a sudden I start putting patches and creams and trokeys and pellets and I start manipulating the system with an exogenous source of hormones. Does that change what is supposed to naturally happen, which is what I now am going to think about is a pruning so that you can be take on this cultural leader position that we were meant to be in? Right. It's a wonderful question. These are two wonderful questions.

So the first answer is that we're looking into it. Okay. In 2017, we published the first study, brain imaging study, looking at women going through menopause. 2017, the first. It's not offensive. As a woman, I think, is ridiculous. Oh, no, it's offensive because we've never looked at a woman's brain this way. We've never done it before. How is that even possible? Every woman goes to menopause and it just was not been studied using, at least using brain scans. But I think the brain, you know, it's one of the most important organs that we have. And more than 75% of menopause of women really have neurological symptoms from hot flashes and night sweats to brain fog and memory lapses. So I was like, well, so many people come to us, so many women will come.

to us for our studies and for the Alzheimer's Prevention Clinic, I need to be able to give them an answer. So I went and said, what's been done? You know, what do we know about the menopause brain? And the answer was basically nothing. All the studies they were done, there weren't that many studies to start with. And all the studies were done after menopause, but after by a long shot, like women were like 70s or 80s or late 60s. So we started looking into that. And so far, still today, this is what, 2024, our studies, thank goodness I remember, our studies are the only studies that look at women over time using brain scans.

And we, again, it's like, geez, can we just kind of make this a priority, please? Agreed. Because it's such a dramatic. brain change that until you actually go through it, you can't put words to it. I mean, it's very difficult to explain. I completely agree. I completely agree. And now we're looking at all different aspects of this transition. And what we find is that the brain starts changing before the final menstrual period during peri menopause. Actually, the menopause transition when women go from having a period to not having a period,

that is the most intense phase for brain rewiring and remodeling. Then there's still changes, as far as I can tell on this, there are still changes for about six years after the final menstrual period. And then it depends. What we see, and we obviously need to be replicated, but at least we know something, right? So what we see is that for some women, the brain eventually, these changes kind of slow down. And then they kind of plateau.

For some women, there's a little bit of a rebound. So you see more energy, you see more cellular energy production, you see a little bit of more, even more volume in the brain in some parts of the brain. But then for other women, it keeps declining, right? The changes keep occurring. That's what we're trying to understand. There seems to be a family history component. So we work, the first study was all done on women who are at risk for Alzheimer's disease, because that's what I specialize in. Then we extended our cohort to women who do not have a family history of Alzheimer's. And so by comparison, we could say, well, those who do have a predisposition to Alzheimer's disease seem to be more likely to not stabilize, but to keep declining.

And this is not universal, it's not 100%, but it was a higher chance of experiencing a continuous brain decline, memory decline. And that's when we start talking about Alzheimer's prevention, because it's really important to do that. But overall, to answer your first question, it looks like this brain rewiring can take up to 15 years. Yeah. Sometimes it's much faster. I don't know exactly what the average is, but I would say around seven or eight years, during which we see consistent changes for most women in the studies as well. And now we have hundreds.

I would love to have hundreds of thousands. Yes, I would love you to have that. too. Let me know how I, let me know how I can assist you. We have lots of women that follow, follow this podcast. You know, if you ever need more subjects, you let us know it. Yes. In fact, I would like to talk to you about this maybe later. There are two studies that we're actively recruiting for. Yes. But first I'm going to say your second question. Yeah, please. Before I forget. Before you metapausal break, forgets, go for it. And I'm not even in manifolds, not even close.

Oh, sorry. I didn't mean to aim. No, no, it's okay. That's totally fine. I'm preparing. I'm actually preparing. This is just a preview. I don't know if taking hormones would change that. My assumption is that it would just make the transition smoother. Because the transition will occur whether you take hormones or not. The point is that hormone therapy may actually alleviate the symptoms. It won't change the process. process needs to happen, I think. Right. But you'll make it smoother, you'll make it easier for you, for some women at least to go through. Okay, so a thought I have on that is if there is a pruning process that is necessary to

step into this new brain that you get post-menopausally that can serve you in so many ways, if I start, and I'm not pro or anti-HRT bioidenticals. I'm just, I feel like we've gone from a cultural hush about menopause to cultural chaos where nobody knows what to do. So I really trust your opinion and want to like get this clear for women. If you start adding in estradiol or you start adding in like an exogenous source, are you now slowing down the pruning process? Like, what if there's, I'm a little bit of,

what if you just need to rip the band-aid off, let the pruning happen, and then let the new brain grow, or is it just you're going to have a slower pruning process, but a little less suffering and you'll all end up in the same place? It's just a matter of, you know, it's not speed, it's pain of, of going through the experience. Right. So I cannot fully answer this question because the research has not been done.

But what we know from basic science is that the pruning will happen no matter what because it's something that just needs to happen. There's a good reason for that to happen. However, the effects of the prune, the perceived effects, the symptoms, the quality of life changes, the severity of the symptoms. may be alleviated by taking hormone therapy. Now, what we are studying, which I think is fascinating, and hopefully in a couple of months I can tell you more about what we're doing now.

But the reason is that hormones alone don't really matter as much as the unit. So the hormones only work together with receptors. Okay. And when we're born as women, our brains and their bodies, but really our brains are full of estrogen receptors. We have a ton of estrogen receptors, which means that their brains are wired to respond preferentially to estrogen. Progesterone is important. Testosterone is important. Estrogen is really important based on the quantity of the receptors that we have and how much they matter for a whole lot of. of things that need to happen inside your head. So when your estrogen concentration in plasma is low,

the brain increases the number of receptors to balance it out. It's like a hormetic stress. It makes itself, it's, it makes itself ready for the influx. It tries to grab it. Right? Where your estrogen levels are higher, like during ovulation, close to ovulation, the brain doesn't need there's many receptors. And so some receptors just recede. Interesting. So once estrogen is just right, it's going to be in balance with the number of receptors. And that is optimum. So what we should be trying to do with hormone therapy with bioidentical estradiol or estradiol, no matter the bioidentical, whatever quality, is that we might want to preserve the concentrations so that the brain doesn't have to change its activity too much.

Ah, so it doesn't, it doesn't, these receptors don't have, get out of balance. Yes, that's, that's where, we don't know, we don't know, you know why. We don't know balance of estrogen-dial should be. I mean, do we, I mean, until you research it, we actually know. I can't talk to you about it because it's not published. But we're doing it. We're working on it. Okay.

And what we are learning, you know how hormone therapy is typically prescribed after menopause? Yeah. Most providers, if you go to a provider, you say, I still have a menstrual cycle, even though it may be once every few months in the head of the symptoms, they may or may not put you on hormones or suggest that you take hormones. many doctors would prefer to wait until you are effectively menopause. So 12 months after the final menstruate. What science says, which I know there's a huge gap between science and clinical practice,

it takes 17 years for the research to turn into a clinical recommendation. I know that from science, the right time, the best time to start taking hormones is before the final menstrual period. It's when your estradiol starts fluctuating because that's going to send your brain into a flux, just trying to keep up. Right. So we're studying that. That's from basic science. We need to make sure that women's brains react the same way. So we're trying to measure that now. And we're also going to then do clinical trials to make sure that we can preserve the conversation. We're just going to take a minute. But we're coming to the rescue. Hopefully not 17 years. We don't have 17. years, so you got to get this.

Yeah, yeah. That's what I said to everyone. By the time I start going through pari, menopause, I want answers. Excellent. You know, I want to know what to do. Great. So I'm working as fast as I can. Okay, so it's self-serving.

Very much. But I also, I also really want to help other women because there are so many women who really have a hard time doing menopause. And there's no research. It's very little research. There's very little support. There's very little understanding. You know, we go through puberty and it's a huge celebration. Oh, my God, you're a grown-up. This is amazing. Yes. You go through, you get pregnant. There's baby showers. This picture has been taken. Everybody loves you. And it's such a one. You go through menopause and nobody cares. No. You know, a statistic that really has grabbed me and has me searching for answers is that, the most common time for a woman to commit suicide, the most common decade, is between 45 and 55. That has to be because of the brain changes.

And I've actually seen some research that shows there are the parts of the brain that actually initiate suicidal thoughts gets activated in, and now I'm looking at this a little different, but in the menopausal transition, that part gets activated. Oh, no, for sure. I think it's all in balance. you know, some parts of the brain becomes stronger or more protected. And that's done at the expense

of other parts of the brain. Right. Like what you're saying, it's very clear to me, at least neurologically, that menopause does not cause, disease does not make you do things, but it does increase vulnerability

to whatever predisposition you have. So if you have a predisposition to depression, it's very likely that you may experience depressive symptoms or receive a diagnosis of clinical depression as you go through menopause. If you suffer from anxiety, you may get panic attacks. For us, in neurology, multiple sclerosis, you know, the signs the lesions in the brain tend to become clear during this transition state. The Alzheimer's plaques, we see them very clearly when women's stress.

start missing their cycles, in paramedopause. That's when we find the red flags for Alzheimer's disease, and women with the predisposition to Alzheimer's. So menopause is a little bit of an activator, if you will, with whatever medical risks you have are likely to make an appearance as you go through menopause. So it's a little bit of a preview for the rest of your life. Of what's coming down.

Yeah. So I, in my research of trying to figure out what was going on with my own brain, because my brain in general, I'm 54. I've been post menopausal for about a year and a half now. And the way that I would, I should have thrown myself a party. I didn't think about that. I was too busy writing books. So, so, but what I, the way I can describe it is that all of a sudden my brain felt raw. I could not handle the stress that I used to be able to handle.

I couldn't put in the workday that I used to be able to put in. Sleep, of course, became difficult. Anxiety and depression showed up for no reason. There was nothing that I could point of my finger at. So after a few, like a year or so of that, I realized that something was shifting. And so, of course, I, you know, I'm the one who loves to read the research that people like you do. And I landed upon this really interesting study that talked about how estrogen progesterone, and mainly those two, that they actually also stimulate a whole set of neurotransmitters.

So with estrogen, estradiol specifically stimulating dopamine and serotonin, acetylcholing, glutamate, Gabba, BDNF. And so I started looking at this like, oh, it's like a shedding of a neurochemical armor. It's like there is this neurochemical armor that has protected us from our stressors and has given us this superpower to be able to multitask and connect with other humans, it's coming down. And as it comes down, we can either curse it or we can say there's an opportunity here to do exactly what you're saying. If we, how about we, it's time we handle our traumas.

How about we look at a deeper, look at our relationships through a deeper lens and what relationships need to stay and maybe what relationships need to go. Maybe we need to look at what our career path or what's coming down in the next, you know, as Jane Fonda calls it, our third act. Like, it's an opportunity because this neurochemical armor comes down and then there's a rebirth of something new. Would you say clinically, like, or from a research lens, do you agree with this neurochemical armor theory? I love it. And I think you're coming up with like the best analogies. Just like incredible with his pearls of wisdom. Yes. So with estradiol does primarily, it's a, it's actually it's a growth hormone in many ways. You know, it was so it was discovered in the 1930s by scientists

that were studying reproduction and fertility. And so immediately it was done, you know, with dog this is a sex hormone. And we've been stuck. with this definition forever, but in reality, in 1996, in the 1990s, brain scientists realized that the same hormones that are involved in having children or not having children are also just as equally important for the functioning of our minds and their brains. And estradiol in particular is the master regulator of women's brains. Because it's a little bit, So estradiol is to the brain, what fuel is to an engine or to a car. Yep.

If you look at neurons where the estrogen receptors are, Estradio just flows riding, it hits the receptors, and that activates a whole cascade, a cellular event, where energy production is improved. Okay. So estradial pushes your neurons to make energy. and work faster and harder. So that will mean that you have more serotonin, you have more dopamine,

you have more glutamine-cumine-gutamine conversion, and you have all these beautiful things happening inside your brain. And then as Estradaeus receives, we lose this activation effect. And the brain is to recalibrate and start burning other sources of energy instead of glucose or in combination with glucose to support cellular energy. So this is a big shift. shock to the system in many ways, and it puts women a risk for suffering more from the effects of stress. There's a lot less resilience to stress. We just established the study that I'm very proud of.

We would show that cortisol levels, right, where cortisol in serum is a marker for chronic stress, predict the amount of cellular Alzheimer's plaques in the brain, are correlated with lower gray matter density in the brain and lower brain energy levels, especially in women, and especially in women who are postmenopausal. So it's really important to keep that in mind, also in part because stress release, a really stress reduction should really become part of the menopausal toolkit. Yes. I would say.

Yes. Okay, so, and that I only discovered by powering through my perimenopausal years. And really, I mean, I ate well. I changed my exercise. I tried to sleep when I could. Like, I repaired my microbiome. I detoxed in my 40s. The one thing I could not get a hold of was the, I call it the patriarchal pace.

That pace of production where you're like, keep going, keep going. you know, you're having to do so much. And so stress stayed high. And it hasn't been until recently when I really just put my foot down and said, okay, now I'm going to handle stress, that I all of a sudden felt like my brain started to come back online. Yeah. And I think that is not emphasized enough is how cortisol and chronic cortisol is really, before we even think of lathering ourselves with all the creams are putting patches on, we have to think about how are we going to manage stress. Yeah, because stress, I mean, in the end, that really sinks your hormones as well, right? So sex hormones and stress hormones are produced at the same time from a common precursor.

It's called pregninolone. And so the body needs to make more cortisol. It will take the preknenolone away from the estrogen. Yeah. And so more cortisol, less estrogen. So I think it's really important to balance the two. And to your point before, there's research, especially from Europe and Asia, showing that generally, once you're past menopause by about six years or more,

the reason an increase in life contentment. And there's a renewed sense of energy and possibilities. And it's a good time for many women to really enjoy their lives. a lot more. Yes. Yeah. And that seems to be statistically significant. And you know the anthropologist, Dr. Margaret Menned, she used to talk about the menopause

of zest. Once you're done with menopause, there's this renewed interest in life. And you feel like you have a new, you know, you just, there's a different park in your eye. And you have a different way to approach life and there's so much to look forward to. And I know that this is not universal. I know that many women just suffer throughout menopause and beyond, but I think it's also important to realize that this is not universal. And then actually more women, the not, tend to report an increase in life contentment

once they're a little bit older. So I think this is something to look forward to and to really set your mind towards. And you want to set the tone for the rest of your life. Yeah. And I think there's power. Our minds are powerful and there's power in our choices. And I think mindset also plays an important role that we don't talk about that much. I love that because if you think about, let's think about the 35-year-old or the 40-year-old who's like starting to embark upon this perimenopausal journey and has heard about all the suffering. Yeah, all this is like you. But, you know, so many of my friends that are 10 years younger than me, they're like, thank God, Mindy, you've already been through it so you can turn around and like help us through it. Absolutely.

We've gone from, again, not talking about it to now everybody's talking about it and they're scared about it. And I think the next place I would love to see the conversation go to is this is preparation of cultural leadership. This is an opportunity where you can actually. step into the most authentic version of yourself and you may end up the back half of your life, this may be the most joyful time that you've ever experienced with. So now if I'm 42 and I'm depressed or I can't hold on to memories or that suicidal part of my brain is being activated, if I have a vision of what my brain is doing and where I'm going, that's a threat of hope that so many women can now hold on to as they go through this time. It's almost like pregnancy and birth.

Like you're birthing a new brain and then you're going to have to push it out and then you get the reward. Yes, I love this way of thinking about it. For me, you know, as a scientist, I've never been scared of menopause. I've never been scared of pregnancy. I just know what happens and why it happens. And I think it's so important to just spread the word and share the knowledge so that. that it doesn't feel alien when it happens. Because I think a lot of the reasons that women may have such a hard time during menopause, it's just you don't know what hit you. You're not prepared for it.

And it feels like somebody just pulled the rug out of you. And you feel blindsided by your body and let down by your doctors and you just don't know what to do or how to take care of yourself. So I think it's really important to, first of all, understand the science and be familiar with the science. And also the terminology, if I may. And then look at solutions, right? What are all the things that can make this transition better and gentler and easier and what kind of solutions would work for you as an individual?

And there's no right or wrong answer. So I'm also not pro-HRT. I am pro-solutions and I'm most certainly anti-suffering. Right? There's no need to suffer. Yes, it's a long transition. It can take a long time. So I would say, let's look at all the solutions. Maybe something will work now and then we'll change to something else later. But let's just be informed about all the things that can actually work and then come up with a plan that works for you. And for me, again, because I am a scientist, it's important to share the right words with women. Because what I noticed coming into this. feel a little bit from the back door in a way is that menopause is really portrayed as a medical catastrophe. Like you open a textbook and a medical textbook. A menopause in Western medicine is defined as a state of estrogen deficiency caused by ovarian failure. Oh, yeah. How is that going to make you feel great?

You know, that's me. It's terrible. And then there are experts or other people who are like, well, no, no, no, no, no. Let's take a step back. That's just a scientific definition is based on mice. Let's just consider menopause as part of the natural aging process. And that's also being a little bit out of touch with reality. There's nothing that feels natural about it.

And that feels like you should just kind of ride the wave and do nothing because it's just natural. And so the correct definition of menopause is a neuroendocrine state or a neuroendocrine transition where your body, where your brain and your ovaries and your hormonal system are changing at the same time. So this is a biologically programmed event, which needs to happen. However, it's not part of chronological aging. It's endocrine aging, which is different. It's its own sets of pros and cons where the. Cons are obvious. There are symptoms. There's the heart flashes. There's the brain fog. But there's also pros. And the pros is that this is needed for you to transition to a different phase of your life where you have just a completely different biology. Right? So let's use this terminology. Menopause is not a disease. We do not need to treat it as such because it's not a disease. You don't have to necessarily medicate it unless you find relief.

in prescription medications, which is great. If you do, wonderful. But let's, let's not start with a mindset. This is something that's making you sick. Yeah. Oh, thank you for that. Because it's very disempowering, I think. Agreed. Yeah. And it's not saying you shouldn't use medications. It's more just saying, let's stay calm. You know, this is not making you sick. We're not dying. Yeah. But let's look at solutions. I think it's a better way. And do you think, Do you think I love that because I think one of the things that I've been really trying to emphasize to my followers is there's not one solution. There's your solution. And so you've got to find your rhythm with these changes that are going on in your brain and your body as you go through the menopausal experience. And I think one of the places we start disserving women is when we're like, everybody needs to put a patch on. Everybody needs to do bioidenticals. And then a woman tries it and all of a sudden maybe she gains, you know, 20 pounds or another

woman tries it and she becomes suicidal. Like we have to, I think the weight, what you just said was so powerful. And then I feel like we need to take it even deeper and say, and your goal as you go through this experience is to find your menopausal toolbox. And you might sometimes need to pull out a patch. and other times you may need to get rid of the alcohol. It's like there has to be a set of tools that you're given, and then you need to learn how to use those tools as you go through the experience.

Yes, and in the end, you do, you. You know, you are the expert when it comes to your health and your well-being. And it's wonderful to know what things have helped other women. That's obviously a wonderful starting point. But in the end, unfortunately, For menopause, it's a little bit trial and error. And I think part of the reason that this is the case is that we do not have an integrated framework for menopause. If you think about it, you're going through menopause and you're experiencing the hamp flashes and you're experiencing the brain fog.

Maybe you can't sleep at night. Who do you go to? You go to an Obi-Gyne, an OBJWayen specialist. Wonderful, but they don't do brains. Right. They're not trained. I mean, it's not a critique in any way, shape or form. They're wonderful specialists, but they're not trained to manage brain health.

They're not trained. They don't specialize in the brain. And it's really, I think, a missed opportunity. The brain specialists are not involved in a woman's medical checkup when it comes to menopause care. Because we do have something to bring, I promise, we bring a lot to the table. we can really support women through this transition and it's wonderful to work with our colleagues in OBJYN. Yeah.

So that and also preventative cardiology and metabolic health and sleep health. Everybody. It would be wonderful to have a more integrative approach with all different specialists that are able to weigh in as needed. Oh, to address a different point. Yeah, it's a dream. We do this actually, Walcona medicine, where we collaborate with our colleagues in Obigine. Also, Obigine surgery, because surgical menopause is a little bit harder on the body or can be harder on the body and the brain. We work with our colleagues who specialize in breast cancer

and reproductive cancer. So they were all together. And what they do is that they send their patients to us for cognitive testing when necessary brain imaging and all these evaluations that we do for cognitive health and brain health. And the other way around, our patients, once we figure out, okay, these problems you're having are much more likely to be menopause than Alzheimer's disease, for example, let's go talk to our colleagues in OBJWIN and see what they recommend for the treatment plan. And then let's try everything together. So I think this is... So beautiful. I wish everybody operated like that. What do you think, where do you think lifestyle fits into this? Like, how important is your lifestyle as you're going through, I'm going to start calling it the pruning process.

I feel like instead of called perimenopause, it should be called the brain pruning process. Yes, and I think it's interesting that we define a brain process based on the ovaries, right? We completely disconnect. We don't acknowledge the fact that the brain is involved in menopause. Everything is always based on the function of the ovaries, which I think is confusing to a lot of the patients as well because they don't really match your experience. But anyway, I think lifestyle is very important. It's really your foundation and is your starting point for health. And the healthier you are as you go through menopause, the less likely you are to have severe symptoms or discomfort. And of course, it's not a 100% correlation, but there seems to be an impact.

things like regular physical activity, a healthy diet or balanced diet, stress reduction, sleep hygiene, avoiding toxins, regular medical checkups. Those are all things that just support health overall and do support hormonal health as well. So I think they're very important. You know, if I go back to the grandmother hypothesis, one of the things I was thinking about when you were talking about the purpose of the grandmother in back in the primal days, how if they didn't come back with a kill, then they had to take what they had forged close by to the cave. And that was probably plant-based. So if you look at what the

diet for the perimenopause menopausal woman, I would think it was probably a mixture of definitely some animal meat, but you didn't have access to that all the time. So it also is probably very much a plant-based diet. And what I've seen as much as there's incredible conversation around protein right now and the need for more protein, which I agree with, I also think equally for the menopausal woman is the need for plants because just off the grandmother hypothesis, sometimes grandma had to go get the plants and bring it back, right? And that's what we all, and maybe it's not just menopause. Maybe it's all ages of female reproductive cyclone. I would say then, most of the research shows that a plant-forward diet seems to be really beneficial for women's health

overall. I love that. Which is a flexible diet and really is focused on getting the nutrients in. Yeah. Right. And you can get a lot of good nutrients from eating plants. And then like you said, you know, meat and fish and higher protein sources can be helpful as well. But it's also good to know that you can get a lot of nutrients from eating plants.

Because really, the strongest correlations I have seen are with fiber in women's health. I'm talking hormonal health and women's health is really fiber. And you were talking about balancing your microbiome before. Antioxidants seem to be super important. Why? Because the brain and the ovaries are extremely metabolically active organs. and the more metabolically active you are, the more sensitive you are to free radicals in oxidated stress.

They're very damaging to cells. And the only way to reduce oxidative stress is by importing antioxidant nutrients from your diet. Yeah. So those have to happen. And also, you know, for the microbiome, something that was really interesting to me is how a part of the microbiome is called the estrobulum. Yes. I love this part. This is my favorite part. Tell me what you know about it. It's so cute. I mean, you might just

the term is so cute. There's a collection of bacteria and microorganisms in the microbiome that are part of this strobolon. And is this sector of the microbial population that is very specifically involved in regulating estrogen levels. by deciding whether the estrogen needs to be expelled from the body, paid out or not, or needs to be reintegrated in the circulation. And the way, so it's important to have a healthy estrobolum to make sure that your estrogen levels are in part balanced. They're not the only determinant. They're still being studied, but they do seem to play a role. Now, how do you keep them healthy by consuming a plant breach?

diet that includes a lot of fiber, oligosaccharides, antioxidant nutrients, prebiotics, probiotics. So that's another reason to consume more plants. You know, like we were saying before, I'm not pro-HR-T. I'm not pro any specific diet. I am pro the diet that works for you, that is sustainable for you. As long as it's healthy and really is well-rounded includes a diversity of plant-based foods, because those are good for health. It's good to have diversity when it comes to the phytochemicals and phytonutrients. And that is sustainable so that there's no, okay,

I'm vegan for three weeks and then I'm going to go keto because they can't weight or the other way around. That is much more disruptive to keep switching diets or keep, you know, the yo-yo dieting or sudden changes in anything is confusing to your body. Yes. So I think whatever diet is sustainable for you that is high, it's a nutrient-dense diet. Yeah. I'll support you. You know what? You're the first person I've talked to that has a very similar approach to diet that I do.

Because I feel like there's a lot of good in all the conversations we're having around diet right now. The only one I'm opposed to is the standard Western diet that's packed with chemicals and inflammatory oils. So that you have to figure out what diet works best for you. And when we become dogmatic and we're like, you eat this way, you don't eat this way, now I feel like we've lost our way. We need to look at all the different diets. Maybe keto's better for you.

Maybe it's not. Maybe vegan's better for you. Maybe you need to do the carnivore diet for a few weeks. I mean, let's look at all of them and like see where they may fit and you figure out what works best for you. So I just take a more holistic approach to food than we're doing right now. So, I mean, honestly, in the end, if you're able to just eliminate processed foods from your diet, at that point, whatever diet your own is a matter of optimization. But the base is solid. So if there's one recommendation that we could give to people that's really just try to stay away from processed foods, highly processed foods, highly processed foods, especially, fast food, packaged foods,

with a ton of preservatives. Once those are out of the diet, then, you know, you basically have way through, if not more than that. Yes. Yeah. Amazing. So before we close, I do have to ask you then, what do you think of fasting? Where do you think fasting?

Oh, my goodness. Do I fast like a girl? You know what I think? I better. I bet. So surprisingly enough, I have been a knowing. practicing intermittent fasting or a sort of intermittent fasting for my entire life. Because I was born and raised in Florence in Italy.

I studied in France for high school, so in Europe, where it's very common to have a light dinner earlier in the evening, especially my parents. They eat very, very early, like 6, 7 p.m. they're ready. And then that's it until 8 in the morning. So just naturally we are raised to go for at least 12 hours without any food daily. And I've been doing this for my entire life. I haven't tried to go like 14, 15, 16 hours, but I have no problem doing that. Like I've seen if I need to go for a blood test, right, and my appointment is at 11 or 12, I don't need to eat.

I'm fine noting. So I think that my body's kind of comfortable with yes. idea that you don't have to constantly eat. And it makes a lot of sense for me because you need to give your liver a break. You just have to. You can't keep munching and snacking and the midnight fridge around. It's just not a healthy practice. So that's what I'm, I also would love to see more research. Here's what I would love you to research. I'm going to put it on you. On the man. Since I have direct access to you in this moment, is the key. It's the key. ketone. So if you look at what the ketone does in the studies that I've seen, one of the things

that is that is the ketone, you switch over into this ketogenic energy system. What the ketone brings with it is GABA. So actually, the more your ketones start to kick in, not, I'm not talking about ketoacidosis. I'm talking about a short, small burst of ketones. You now have a little more GABA. Okay, that's really helpful to the menopausal woman who's losing progesterone. and is feeling anxious all the time. I see where I'm going with this? The other thing a ketone does is it upregulates BDNF. Well, that's really helpful for when I'm losing estradiol, who was also upregulating BDNF.

Now, she's gone. Could I use my own internal ketogenic energy system with cycling in small bursts of fast to get these ketones to come in and create a neurochemical change, that is going away because my hormones are starting to diminish as well. So I shall point you to the research of my colleague, Dr. Roberta Diaz-Brington, who's done a lot of research on this, and she has shown that indeed the postmenopausal brain is higher in ketones and fatty acids, beta oxidation, in response to the changes in estradiol. So estradial is a glucose-loving hormone.

Okay. So for as long as your estradial levels are high in your brain, which is not 100% dependent on the ovaries, because the brain also makes estradiol in-house. Right. But as long as there's enough estradial in the brain, then the brain runs some glucose. Okay. When estradiol withdraws, then there's a switch in the way that the brain metabolize. energy or produces energy. I'll send you, I'll send you the paper. It's really beautiful.

It's a beautiful graph. I'd love to see it. Where, first of all, there's an increase in beta oxidation, so the brain starts burning fat. Then there's an increase in ketone body reduction. And at the same time, there is a reduction in oxidative phosphorylation. Now, all this work is done in animals going through menopause. what these animals experience is a first stabilization in energy levels that eventually leads to a crash. So that's not good news. No, right. No, it's not good news.

However, mice are not women. Mice are not supposed to outlive menopause. Women are. So I will be really interested in seeing how this research translates. to women's brains. And we're trying to do that now. Together, we work together. So that's really wonderful. And maybe at some point we'll give you a better answer. But for now, we do know that there is an increase in ketone metabolism in the brain. It is not necessarily diet correlated, is internal in the brain. We don't quite know the consequences of that in women.

So the way I would translate what you just said is maybe for the post-metaposal woman, the brain could favor ketones. It could actually be, you know, take some pulses of ketones. I wouldn't say favor. The brain has to switch to ketones. Okay, it's necessary. Okay. So, yeah, and I don't, because then people will get people. People are going to think, oh, well, then we really want this ketone body.

We really need to go on a keto diet, which is not. It's more sensitive. Yes. It's more sensitive. It has to switch. It has to switch. So before it was running on glucose, and now the glucose is kind of reduced. So we need to switch to an alternative energy source.

Yeah. Yeah. We become a hybrid. The brain becomes more of a hybrid. Yeah. I mean, like a hybrid car. Yes. I always say that all the time.

Yeah. So which is kind of how I found fasting was in those perimenopausal years when the brain fog kicked in. I realized at certain points. of my cycle is that if I actually fasted, all of a sudden I had mental clarity, it came back online. So it was all in my own. And then I noticed it with my patients and my online community the same way. I love to do a clinical trial of that because I heard so many women come to me and say,

you know, now that I'm doing fasting, my brain is kind of coming back to life in a way. That's right. And I would like, yeah, that would be. I would love to study that more than that. because I find we have a lot of basic science. A lot. We have some basic science done. But the studies in humans, especially women who are not obese or who are not athletes,

we need more. We just need more. Thank you. Right? Yes. We need to understand what's happening because it could be a really wonderful tool. Yes. And we really.

Please study that. But come to the study. If I do it, I'll call him. Please. I will send all the men of pot. Post-menopausal, perimenopausal women, I'm sure those of them listening right now will say a hell yes to that. Because what I love is the power of the ketone is it's an internal resource you can tap into.

And we really need to be thinking about free ways to help women. It can't always be an expense. And what I love about fasting is if you learn how to cycle fasting, it is completely free. you just need women need to know how to do it for their hormones. And in all the research I've seen, we don't have enough research on women and we definitely don't have enough on post and postmenopausal women. So I'm going to task you with doing that. So anyways, Lisa, this is, thank you for giving me so much of your time. I have to tell you, this is one of my favorite conversations that I've had in such a long time because what I've asked you are questions I've been asking myself and I have been

trying to find answers to. I was one of the fans that ordered this book. The minute you put something out about it, I was like, I want this book. I got to get this book. And the minute it came to me, I scoured through looking for all my answers. And so what a delight for me to be able to have this conversation with you. It's just real treasure on a personal level. So thank you. I appreciate that. You You know, you really make it fun. Like you promise me as well. This is another fun. And thank you.

I really, really appreciate it and just the opportunity to talk to you and your followers and to women and just share the knowledge and bring the science out of the lab. It's extremely, it's just wonderful. And I thank you for that. Yeah, it's like we're all necessary in the conversation, right? Like we need all of us to be opening this up and having this beautiful conversation so that we women feel heard. I think that's the most important, even if we don't have answers.

Yes, yeah. Oh, no, for sure. And also that the reason it's not black and white. Like I don't spend a lot of time on social media. But when I do, sometimes it's a little bit like daunting because like, oh, my goodness, did you just say that? Agreed. And I find it very intimidating. Like, if I approached this.

as not as a scientist or a researcher, I would be very confused and perhaps a little scared because of the good things that you hear. So I think it's important to have a more balanced conversation where, yes, obviously, menopause is no picnic, right? And we need to speak to that. And the knowledge what women have been reporting for thousands of years that we need support, there has to be more pharmaceutical development, there should be more research looking at lifestyle and behavioral intervention,

as well. But it's also good that I think it's good to know that it's not doom and gloom. And then there's a much positive, much more positive way to think about this life change. Intervene accordingly, right? Nobody should suffer. But at the same time, keep an open mind and the positive attitude because in the end, most women spend the third of their life in a post-menopausal stage. We can't approach it as something we don't want. That's right. Oh, so well said. Okay, I have to finish up on this question. I could talk to you all day. Yeah, I'm sorry. I always ask every guest because I think that we often don't have language to what health is. So we all have our own personal language. So what does health mean to you? And you've already spoken of some of your health goals. Do you have any health goals for yourself that you're currently working on?

I have so many. I have so many. My husband thinks I'm nuts. I just, as I go through the research, I'm like, okay, I'm going to enter perimenopause soon enough, I suppose. I want to be prepared. I want to do everything I possibly can to make it easier on myself. And on him, you know, we have. Of course, yes. Yeah, we have a realization. You will thank you.

Yeah. Also, my daughter is probably going to go through puberty when I go through Perry. So it's important that we support him during that. that so yes I mean for me health is just being healthy being comfortable in my own skin like I feel like I have the energy to do things that I look forward to just waking up in the morning and living my life you don't have to worry about oh my god I can't do this because I'm not feeling good or I can't go there because I have a headache or I don't want to feel limited so being healthy is a way to be free and freedom is really important to me physical

and intellectual. So well said. I love that. It's an investment. I think, you know, health is wealth, but also brain health really is the ultimate treasure, at least for me. So I really optimize for brain health. And I come from my last two years have been really demanding.

Like I've been working 50, 60 hours a week. Wow. I don't really, I remember my last lunch break was in April of 2021. Oh my God. What I took an actual, yeah, yeah. I mean, I eat, obviously, but it's in a hurry. Like, I mean, an actual lunch break, what I'm not working at the same time.

I'm not talking about work at this time. So my goal is to really engage in more self-care and find some time for me more and for my family, of course, so having more balance. And I think it's possible, my that the book is out. And I'm kind of saying no, to a lot of things.

Yes. You have to do at some point. You do. I'm very fortunate that I'm in this position where I can actually choose what I'm going to work on and what I am doing and not doing. So I know I'm very blessed. I know that not everybody has this luxury. I also think I earned it, to be honest.

Yes. Yes, you did. Yes, you did. Two amazing books is a lot. Thank you so much. I think XSides. Well, you've done three. You've done, how many?

Three. Yes. This is my third. Yeah, third time's a charm. But I think getting back into having a regular exercise routine, I love working out. I love it. And sometimes I just can't find that kind of window time that they can actually relax and just work out. I'm usually just like, okay, I have 20 minutes.

What can I do in 20 minutes? And now I'm like, no, I'm going to have time. I don't want to work on weekends if I can avoid it. I want to spend time with my family. And I've been meditating for a really long time. So that really helps me. As we talked about, I don't eat at night. I'm kind of fasting.

I eat super healthily in general. That's a good foundation. And sleep. Yeah. I need to sleep more. Yeah. Get it well you can. Yes.

Yeah. Yeah. Well, Lisa, this was amazing. How do people find? Where do we send people for your book? Is it the typical spots? Yes, typical spots. I have a website, unbelievable.

It's at Lisa Moscone.com and then on Instagram is probably the best way. I'm more active on Instagram. You're on, yeah. I'm a little scary. It's a little scary for me, social media. Stay on, but in the wild, wild west. It's a lot.

It is scary. You are putting yourself out for constant interpretation. So, you know, it would never occur to me to be rude to another person. Me neither. online or otherwise. It just would not occur to me. No, agree. So that I find very strange. Yeah.

Well, this is amazing. We're going to keep this conversation going. Someday I hope to meet you. And just thank you for this. This was like so thirst quenching to my mind. And I just appreciate all the work you're doing. And we just have to keep helping women see the information that all of us are bringing. and so that there's hope. There really needs to be hope.

Absolutely. Thank you for all you do. Thank you. Thank you. Thank you. Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it.

So please leave us a review, share it with your friends, and let me know what your biggest takeaway is.