What Every Woman MUST KNOW to PREVENT Alzheimer’s | Neuroscientist Lisa Mosconi X Rich Roll Podcast

menopause is in fact changing your brain so we started looking at menopause and I was like well what's been done let's look at how many brain Imaging Studies have been published what did they find there wasn't a single one not one and so I said well let's do it and we started scanning this is what we learned my guest for this discussion is world-renowned neuroscientist Dr Lisa Moscone Dr mosconi's work may very well provide answers as to why 2/3 of all Alzheimer's patients are women once you have Alzheimer's disease there's only so much we can

do menopause is a ridle because it goes completely against Evolution when it comes to brain health quick fixes don't work this just cannot [Music] today's episode is brought to you by the awesome organizations that make this show [Music] possible so nice to meet you thank you for doing this I'm so excited to talk to you thank you for having me yeah I think it would be cool to just learn how you got into Neuroscience because there's a really interesting backstory to everything that you do now are you open to sharing that of course of course

so I was born and raised in Florence in Italy and I know you have an affection for my home town yeah I grew up into science I I like to say that half of my family has a PHD and the other half is in the Army so we sit up very straight As scientists but both my parents are scientists they're professors of nuclear physics at the University of Florence which made for an interesting childhood yes very intense I would imagine at times the dinner table conversations must have been interesting it was interesting I remember I

was maybe six and I had no idea who Cinderella was but I I knew everything about proton decay and you know energy states and gravity and relativity so it was very interesting but the most interesting part to me is that so that's in Florence Italy in the 80s and back then it was a very small University so a lot of my parents students would come to the house on the weekends just to ask questions and and get some workshops done with my parents and they were taking turns and that they would Babys seit me in

the mean time so they would talk to me about nuclear physics and some of them then transitioned to work in nuclear medicine which is this branch of radiology that uses radioactive isotopes to measure different things inside the brain and other organs of the body they would talk to me about that I remember one of the students Dr Sandra p who's a professor now at the University of Florence would you know kind of walk me around on his shoulders as a big guy strong guy and talk to me about all this different nuclei and Isotopes and

this and that so I developed a love for that kind of work from a very young age but I always wanted to study brains I was always interested in Psychology and people's behavior and why do we do the things that we do and why do we do things that we really should not be doing and so then I said to my parents I was going to study neuroscience at the University which I did right if you had said psychology how would that have been received like that's a soft science like I did say psychology and

my grandmother did not talk to me for M she was so terrified like no you're not doing psychology I was like what so it was neurocience for me that's a hard science way into human behavior yes but it was fantastic I loved every every class initially graduating can take any anywhere between five years and whenever mhm and I did it in four because I was so I just loved it and I I immediately started working on my thesis and I wanted to do a Hands-On project so I started going to the hospital the clinic of

research hospital in Florence and I was working with eegs and event related potentials so immediately I was 18 and already I was doing my own research that was on the brain wow I was so good and what brought you to the states my PhD so I graduated I did my fellowship my training in nuclear medicine and neurology and then I applied for a PhD program in neuroscience at the University of Florence and I got in it's quite competitive so it was very fortunate to be able to do that and then my mentor who is wonderful

I have been so lucky with my colleagues and my mentors he said there's an opportunity to go to New York NYU NYU medicine to work with Dr monia Deion who's a Pioneer in the field of the early detection of Alzheimer disease would you want to go now that was at the same time that my grandmother who lived right next door to us started showing signs of cognitive impairment and dementia mhm and she was informally back then diagnosed with Alzheimer's disease and in just a matter of a couple of years her two younger sisters also developed

cognitive impairment and then Alzheimer's so that was heartbreaking but also really scary and I remember talking to my parents and saying I want to research this I want to understand if it's just my family if it's just us and what's the actual risk for my mother for myself and if it's not just my family then I I think we should really try to understand better what happens in Alzheimer disease and doesn't matter if you're a woman or a man and so that became my PhD thesis cuz curiously your grandmother's brothers did not develop Alzheimer's yes

so my grandmother was one of four siblings three sisters and one brother who all live to the same age but all three sisters develop dementia and died of it whereas the brother was spared so when I asked my professors to my PhD studies I said doesn't matter if you're a woman or a man and they would say well so what we know so far is that Alzheimer's disease affects more women than men So currently out of every three Alzheimer's patients two are women mhm at least in Europe and in the United States that we had

data for but the thing is they said Alzheimer's disease is a disease of old age and women live longer than men so unfortunately it's just aging but it makes sense the more women the men end up with a diagnosis of Alzheimer's disease that never really made sense to me right it doesn't really hold up under investigation no because well number one I think that the longevity Gap is not that wide so the difference in lifespan is four years and they United States not 10 or 20 and in England the difference is 2 years so women

tend to live about 2 years longer than men but Alzheimer's disease is the number one cause of death for women and not men with a difference of two years so and a differential of 2third in terms of who gets Alzheimer's and who doesn't on a gender basis yes or on a a sex basis yeah like and it's Unique you know there are other disorders that are age related that do not show that prevalence like vascular dementia is 50/50 there are other forms of age related neurod degenerative disorders that do not show the two3 the 2:1

ratio so there's something about Alzheimer's and women that I felt was not being examined as in depth as it deserved and so I did it and that became my PhD thesis and I I've been researching that forever and at that time was about the State of the Union in terms of what people understood about Alzheimer's and the XX brain there was no further investigation or science to support the claim that it was merely a factor of women living longer than men there was very little research done shocking actually I tend to agree as a woman

and the scientist it's a bit dismaying but no back then it was kind of a Dogma that Alzheimer disease is a disease of old age and women live longer than men so who cares mhm kind of right so hence begins you know your investigation into this world and the many discoveries that you've made and at the kind of core of that is this premise that women's Brains and men's Brains are not exactly the same which is any woman can tell you yeah any anybody can tell you but is also simultaneously a controversial statement that requires

a little bit of you know Nuance to understand what you mean specifically about that yeah yes so I'm talking about sex differences at a very raw biological level we do not talk about Behavior or intelligence as being different or genetically cured um in different ways so I think this is an important distinction because we do have a problem in our field that is called neurosexism and is nothing short of the backbone of modern Neuroscience which is to say the for a very long time actually since the 19th century scientists systematically set out to proed that

women's Brains were inherently inferior to men's Brains and the way that they constructed this hypothesis what obviously flawed but it was really based on key teachings by Darwin you know among other other very important scientists and what they discovered somehow is that women's Brains are smaller than men's Brains on average and they weighted all the different brains they put them on a scale and found out that on average women's Brains were about 5 ounces lighter than men's Brains and that immediately based on the principle the bigger is better that immediately was taken to reflect the

women's Brains we're weaker smaller inferior less functional less well developed the men's Brains how long ago was this in the 19th century mhm 1850 more or less the problem there is that they did not measure head size right so if you consider that men on average are also taller and bigger than women and that their heads are proportionally bigger then it makes sense that their brains would be bigger as well because you don't want to have an enormous skull and the tiny tiny brain inside so your brain is proportional to your head size and overall

body size so once you take that into account then there's really no difference mhm but back then they would use that biased and flawed information to keep women out of universities you know it was like reinforcing the status quo that women did not deserve certain rights or certain opportunities like going to school or holding prestigious jobs so there was effectively a political weapon to keep women at Bay and the patriarchal society just love the kind of research it was the only research that was done no that doesn't happen anymore but there's still some problems where

very often if if I provide evidence that there is a biochemical difference right between men's Brains and women's Brains that could be used to say that women can't drive mhm you know or that men can't do their laundry so you have to do it for them so there's still a little bit of over interpreting biological effects and having whatever effect on Behavior or IQ or personality or just making these stupid stereotypes that we still carry with ourselves a lot and this starts with pink and blue when we're born but then the consequence is that there's

I don't know how many men sitting on the Supreme Court decide in what to do with Women's Health rights right so there's a range of problems that can come from the research that we do that we don't want for sure I would never want to do anything that could potentially harm women or men based on our research but what's important to understand is that there are biological differences between men's Brains and women's Brains and that these differences have nothing to do with intelligence or potential or opportunities or preferences or any such thing that is biology

what these differences matter for is health because they do have consequences in terms of your health of your risks of your vulnerabilities and very often on the the choice of treatment and course of action that needs to be targeting your own biology and this is missing in medicine right now it's an approach called Precision medicine and we have it more for other parts of the body but really behind when it comes to the brain and the differences that you highlight at least specifically with reference to your work in terms of cognition and Women's Health relates

primarily to the relationship between the brain and our hormonal regulation and the differences that you're highlighting really have to do with the differences sort of constitutionally that women have with respect to their hormonal landscape vers men and the impa of that on the brain because it's a communication between these two mechanisms that you know create the differences that are most Salient to the work that you're doing yes you say this so perfectly see I have nothing to what's interesting I lik you know the way that you explained kind of the history of of medicine and

science with respect to women's health and I think as much as we would like to believe that that's an archaic vestage of a bygone era it it continues to linger right it still sort of persists in this somewhat invisible but also very palpable way and continues to show up in the way that practitioners treat women in their offices to this day and you have a term for it you call it medic it is Bikini medicine I I would say that still today we teach and practice bikini medicine which is to say that from a medical

perspective what makes a woman a woman is those body parts that we cover with a bikini so a reproductive organs and historically medical professionals and scientists we've been diagnosing the Sexes as if we were all the same person and Men mhm and aside from those body parts that again are involved with reproduction most practictioners would just treat and diagnose the genders exactly the same way even though we know and we're known forever that there are differences in the ways that our bodies process information even process nutrients there are differences in the way that we metabolize

different substances including medications and most importantly our brains are just not the same and the problem with with Neuroscience is that for whatever reason sex differences have not been investigated really aside from whatever parts of your brain are involved in reproductive functions so there's this misunderstanding that a man's brain and a woman's brain is exactly the same and most of what we know about the brain comes from studies that were focused on men and excluded women and this is a problem because women have a higher risk of a number of brain conditions from depression depressive

symptoms and anxiety the risk is 2 to one the stress is high women as this men we have three times the risk of developing an autoimmune disorder including those that attack the brain like multiple sclerosis we're four times more likely to suffer from headaches and migraines as every man knows right and we're also more likely to die of a stroke and we're more likely to develop some kinds of brain tumors called meningiomas especially after menopause and like we were discussing before women have a higher lifetime risk of developing Alzheimer disas that men do so if

you don't acknowledge that there is such a disparity and if you don't understand the root causes of these disparities we will never be able to fix the problem so explain how you characterize that difference like what is it that is specifically different about the woman's brain versus the man's brain and I'm using those terms you know probably incorrectly like I I want to be sensitive to you know kind of gender identity here and distinguishing that from biological sex yes so when I use the term women I I'm talking to individuals who were born with two

X chromosomes XX brain right and the so-called female reproductive system meaning if you have two ex chromosomes and you have ovaries that's the biological definition of female sex for lack of a better word women but we fully appreciate that there are many individuals who were not born with those characteristics and identify as women and there are plenty of people who were born with those characteristics and do not identify as women so you know it's hard yeah no I understand yeah yeah so we've qualified that yes so we we going forward this is not Universal help

me understand what those differences are so there are many ways to look into this question one key finding that we have been developing and that we've been working on is that women's Brains age differently from men's Brains and that difference is very at least in part related to differences in our reproductive systems and the hormones that drive those systems so this is actually a nice thing to talk about as you know as a woman and a scientist is then we are born with a very important and Powerful system which which is the neuroendocrine system is

like a pathway that connects the brain the neurological system with the ovaries via the endocrine system that is powered by our hormones and this system we're born with but is effectively activated during puberty for both men and women and then for women is reactivated every time you go through a pregnancy and then is eventually deactivated the turned off listing part once women reach menopause now what's important about this system is that men have it women have it but the hormones that drive the system differ in their types and quantity so when women are born our

brains come equipped with estrogen receptors the far outnumber receptors for other hormones like testosterone for example for men is the other way around you have a lot of Androgen receptors in your brain and some estrogen receptors which means that women's Brains are regulated for the most part by estrogen or the women's Brains run effectively on estrogen men's Brains are more modulated more heavily modulated by testosterone levels and other androgens now that has consequences because hormonal fluctuations for women occur on a monthly basis for as long as you have a menstrual cycle then there's a long

period of time that I'm hoping we'll talk about it's called per menopause the menopause transition that can last a decade during which there are strong hormonal shifts that can kind of hijack your brain a little bit this is what we're going to talk about and then these hormones effectively recede at least some of the estrogens recede after menopause which could be a bit of a shock to your system right this does not happen to men because testosterone levels decline more gradually usually reaching andropause which is the male equivalent to menopause in the 70s or 80s

so it's a more gradual decline there's more time for that to happen for women is midlife the average age a menopause is 51 52 but in reality if you look across the globe is 49 you're not even 50 when that happens it's the average human being on this planet but the changes start years prior and that prompts increased cellular aging at that point also in your brain so your neurons become a little bit more vulnerable can become a little bit more vulnerable to certain things and there's a whole remodeling that takes place that can have

a strong impact on mood on cognition on sleep on stress on all the things that we usually take for granted what's interesting in reading your book is this Antiquated notion that menopause was seen as a disease yes which is crazy because it happens to every woman you know how could that be that's some people say that today and really not studied in any kind of effective way but also this idea that it's not an onoff switch that it is a transitionary phase that has you know sort of sub phases within it it's a process it's

a moving from you know one state to another that is endocrine driven but also has these very real implications in terms of of how the brain operates and understanding that as a pathway towards a little bit more self-compassion like there's this narrative also something that still persists that you know that that women go crazy or you know they lose their minds and on top of that that experience of menopause can vary wildly wildly um between women and also its onset uh can vary wildly in terms of when it occurs agewise yes how do you understand

why it's so that experience can be so different for different people and why it would show up at different stages you know age-wise for different people yeah so I think it's it's really important to clarify that menopause is not just something that happens to your ovaries right as a society I think that in so far as we have understood menopause at all it's traditionally or historically been just the half that speaks to the functionality of the ovaries and brain scientists were really not involved in that definition so now we understand that menopause is actually neuroendocrine

transition state which means it's a neurologically active phase during which your brain is impacted just as much as your ovaries are in some ways more because when your brain is impacted then you have all these symptoms that sometimes really prompt fear in many women who have no clue what is happening to them and when women talk about having half lashes and N sweats and depression and anxiety and insomnia and brain fog which is scary and memory lapses and forgetfulness or panic attacks or even skin crawling Sensations if you don't know why you're having those symptoms

it is legit to really worry that that there's something really bad happening to you in your brain so those symptoms are in fact symptoms of menopause that have nothing to do with the ovaries those are neurological symptoms that are prompted by your brain because menopause is in fact changing your brain when we started looking into this I I come from a different field I I I do Alzheimer's prevention and I landed on menopause which is an interesting story because some of our patients were having a hard time with cognitive testing and that's how we we

kind of made a connection and so we started looking at menopause and I was like well what's been done let's look at how many brain Imaging Studies have been published what did they find what can we learn from it how do we move forward there wasn't a single one not one not one they looked at women's Brains that's crazy as they are going through menopause all the studies that were published we looking at menopause as the outcome so they were all done after menopause like in women in their 60s and 70s and 80s but then

you're done at that point you're in the postmenopausal stage right there's not much to learn about how menopausing effectively impacts your brain and so I said well let's do it that was there a bit of a shift so I we call the oby department and we started working with our colleagues uh in general obig and obig surgery as well for a wonderful of wild Corel medicine and we started scanning women who were all middle-aged women and midlife is any year any age between 35 and 65 right it's a broad definition and we were we're trying

trying to characterize them based on their menopausal status so we had a group of women who were premenopausal group of women who were par menopausal in transition skipping periods and having symptoms and a group of women who were postmenopausal and we age match them to a group of men right because you want to take age out of the equation as much as you can and we were doing all these different brain scans that looked at things like brain energy levels and brain anatomy volume how much gray matter do you have in your brain and we

looked at connectivity and we also looked at Alzheimer's plaques we can do it with brain scans right now this is what we learned before menopause women men no difference during per menopause as you start skiing your cycles and some of the symptoms arise but you still have a cycle you're not in menopause the men are fine at their age matched one by one the women start showing changes that are flag for Alzheimer's disease and I'll show you the brain scans in one second and then when we look at the postmenopausal group and AG match men

the men are still fine the women are not so great they start showing red flags even more of things that we want to stop or prevent and again I'm not saying that they had Alzheimer's disease back then but there were signs of trouble in the brain which those red flags and those signs of trouble being what an increase in ameloid plaque deposit yes yeah and reductions in brain glucose metabolism which is a sign of neurons not working as hard or as fast interesting as prior and they are localized in some of the same brain regions

that are clinically affected in patients with Alzheimer disease I need to to clarify very clearly we work with individuals who have a family history of Alzheimer's disease and or genetic risk factors for Alzheimer's disease so they have a a high a priority risk for developing the condition which is why we're trying to do early detection MH we try to catch the earliest possible signs so that we can intervene right away once we look at individuals who do not have a f of a history of Alzheimer's disease which we're doing now we find a little bit

of the same things but not as significantly so so what conclusions can you draw about the genetic predisposition to Alzheimer's and the ability or the agency that one has to you know sidestep that genetic predisposition like in other words like how much is your genetic predisposition a driver of outcomes it's very hard to quantify that so when we talk about genetics it's important to clarify what genetic mutations are and what genetic risk factors are because they're very different so genetic mutations are errors in your genetic code that lead to Alzheimer currently we know that there

can be genetic mutations in three genes the AP and the precin one and two genes that are causative of Alzheimer's disease these mutations typically run in families MH you can track them down and they prompt the symptoms of dementia quite early on in life so they're called early onset autosomal dominant genetic mutations where the affected family members develop Dementia in their 30s and 40s sometimes 50s but early mhm usually before age 60 for everybody else it's called late onset Alzheimer disease even if it's 60 62 if you do not have a genetic mutations we refer

to that as spaic or lonset Alzheimer's you can still have a family history we just don't know which genes are involved but not genetic mutations so we can screen that by doing genetic testing which we do in that case genetic background is important but in terms of higher and lower risk it does not trigger Alzheimer does not cause Alzheimer's necessarily and these genetic mutations are found in about two maybe 3% of all Alzheimer's cases which means that for the vast majority of individuals with Alzheimer's other factors are yeah it's a non-issue comparatively so to try

and answer your question depending on the St studies that we look at there's evidence that between 20 and 50% of all Alzheimer's cases may be due to Lifestyle and medical conditions rather than genetic mutations for sure probably in combination with some kind of genetic blueprint they were trying to unravel but there is a strong lifestyle component that I think has been overlooked right in medicine for a long time I bet there's a lot of you out there who've been pondering that new website you'd like to have but just haven't pulled the trigger well with Squarespace

it's easy and affordable to build your own beautiful designer website so Squarespace has been a long time partner of the show and what I love about it is it just demystifies everything about what's required to make a website you don't need to be a designer you don't need to know how to code everything is right at your fingertips they make it super simple and they've got these unbelievably beautiful templates to choose from that are oriented around whatever your needs may be whether you need a simple landing page or a full-on online shop snap crackle pop

Squarespace has the tools you need to launch your business including e-commerce templates and inventory management so make that website you got it click the link in the description below for a free trial and when you're ready to launch use offer code Rich Roll to save 10% off your first purchase of a website or [Music] domain drilling down on that a little bit deeper I gather from that that if you lack that genetic predisposition towards the mutation or otherwise that does not obviate you from risk if your lifestyle is a certain way you can easily find

yourself in that 2/3 group but if you are a member of that group is is there Clarity around how adopting healthier lifestyle protocols can help you avoid that Alzheimer's manifesting like those are two different things right like if you're in the outgroup and you don't have the genetic predisposition you're still at risk because obviously the numbers prove that out but with lifestyle I assume you can opt out but if you have the predisposition if you have genetic mutations lifestyle help it can delay the onset of dementia mhm it's hard to avoid dementia once you have

that kind of mutations they're causitive MH yeah but if you do not have those genetic mutations Li style is more impactful right for sure Al something that has been on my mind for a little while is that there's um there's a genetic risk factor that's been publicized as been the Alzheimer's G and I think it's really important to clarify that it is not is this the Chris hemworth situation yeah yes so there's a genetic risk factor called the APO lipoprotein e or APO e APO e Gene right then we all have this Gene and it

comes in three forms there's an Epsilon 2 form there's a Epsilon 34 and there's an Epsilon 4 form and each one of us has two copies of the alals right one from the mom one from the dad so if you have a 2 two genotype that is considered protective against Dementia or a 2 three combination is protective if you have a 3 three combination is neutral but if you have even just one copy of the Epsilon 4 Al if you're in 34 carrier 44 carrier then your risk is higher relative to people who don't have

that specific a genotype but it is not a genetic mutation it does not cause Alzheimer disease it increases your risk especially for women now we know that Gene has been quite well characterized and well studied and if nothing else I think we we understand a little bit more what can reduce the odds or developing dementia for people who are carriers of the apoe4 genotype interesting yeah but I think it's important to said it it does not mean that you are going to develop dementia there are plenty of people who have dementia and do not have

the E4 there are plenty of people who have it and do not have dementia so I think it's really important to understand that it's not a black and white situation and that that you do have power over your genetics right I would assume that you would recommend that everybody get tested for that though we're going to get to testing later but I would not I would not recommend because it just rents space in your brain in a perhaps not so healthy way I think that what we have learned from clinical practice is that the response

to genetic information is very highly individual let's say if you find out you don't have it then you're fine but if you find out that you have a genetic risk for anything not just dementia but any kind of condition some people take it well they use it to motivate themselves to make healthier choices and take care of themselves even more other people have mixed reactions maybe Panic initially but then they kind of go ahead and live with that there are people who really become suicidal so I think what what I do recommend is that if

you if you decide to do genetic testing that genetic counseling is imperative and this is the guideline of every professional Society there are a lot of people who come to us was really really in a panic because they did 23m me or something similar and they find out that they have this apo4 genotype and then they hear on television that that is the bad Alzheimer's Gene and that they're doomed that they don't really understand the nuances that's something that needs to be addressed or conversely if you find out that you are not at risk then

perhaps you're less enthusiastic about upgrading your lifestyle habits you know what I mean but that's harmless isn't it yeah yeah yeah well let's get back on track in terms of of what you're beginning to discover about the XX brain um specifically with respect to menopause and then I want to tie that to alzheimer's as well so as somebody is progressing into that menopause phase and they're experiencing those endocrine shifts we've all heard about or exper you know people have experienced the hot flashes and you know all that like we're all kind of culturally aware of

those things but there's also some interesting benefits also that certain people experience with menopause yeah oh yes in terms of what's Happening cognitively yes um so something that I I find it's being quite overlooked in medicine and culture is that menopause is not all doom and gloom there are actually some positives that result from any neuroendocrine transition and I I like to think about especially for women's Brains I I like to call them the three PS which is puberty pregnancy and perod menopause which is um again a transitional phase before menopause and what we have

learned is that your brain changes during each one of these three PS and also if you have multiple pregnancies every time a woman is pregnant and what happens is that there's a remodeling that takes place inside the brain so when you you kids who are yes my daughter is eight and she already knows everything about puberty and how her brain is going to change and what to expect and what I would expect nothing less from your child yes but so what happens during puberty is that the connectivity of your brain really changes and I'm telling

you this because it matters for menopause as well it matters in ways that not all parents enjoy necessarily right there's The Reckless Behavior there's the tempered tensions in some ways and uh there can be depressive States and the blues and the brain fog and the sleep too too late and can quite manage them but that's the downside of a brain that is in transition and is in transition for a good reason so the teen brain serves a very important evolutionary function which is to connect some parts of the Primitive brain which are called hippocampus and

amydala to the frontal core cortex where the Primitive brain regions are more reactive they're more impulsive whereas the frontal cortex is in charge of impulse control and reasoning and thinking and planning besides multitasking and language and when these different universes Collide is when the brain becomes mature enough to develop a strong theory of mind or mentalizing which is the ability to put yourself in somebody else's shoes and empathy as well really grows around us those interactions of different regions which is key to become members of society to be able to put your needs to the

side and prioritize the need of your group in a way and just being able to work with us and other people and cooperate as well Theory mind is very important for women's Brains because once you are pregnant those same brain regions go through another remodeling where in this case the Primitive brain regions get a bit of an upgrade so they have more of a saying over your frontal cortex which is extremely important if you're growing a baby who's physically helpless for ears right so that they can grow their own big brains and you as mother

number one you have to protect them so your aggression the mama bear Behavior can come up but also your theory of mind is super strong because you need to be able to read the mental states of someone who has non-verbal communication only infants can speak so you really have to learn to read minds quite literally and the mommy brain can do that is neurologically wired to be able to pick up all these nonverbal signals and clues and just understand your baby state of mind and there's a problem before there is a problem anyone you know

anyone can do at the same time that comes with some issues we all know that there are depressive symptoms that can happen during pregnancy and during postpartum many women experience brain fog we don't talk about it but a lot of pregnant women have half flashes as well so those are very similar symptoms to menopause because it's the same pathway it's the same neuroendocrine system that is changing so you have changes in body temperature a puberty as a woman because you need to have a menstrual cycle so you need to increase your body temperature just a

little bit around ovulation so your brain is to be able to do that with pregnancy same thing you need to activate your thermo regulation because you have a burn in the oven right but then comes menopause and all the system is dismantled and so that comes with glitches that we know about the symptoms and the medical risks and the depression symptoms and the anxiety and the brain fog but at the same time your brain is rewi in in a way that is quite beautiful and we never talk about because the the theory of Mind Network

gets another update another upgrade as well and so what happens is then number one life contentment if you look at the graphs women who are postmenopausal report greater happiness than women who are premenopausal and younger than they are but also they report being happier that they themselves were before they went through menopause which is quite interesting and fits in with the notion that happiness follows a sort of U shape right with a it's a little bit of a midlife slump but then it goes back up which is interesting number two greater empathy again it's the

theory of Mind Network that is rewiring and ends up with greater empathy so postmenopausal women are the greatest empath and if you measure empathy levels across you know at any age range between genders is really the postmenopausal women that stand up which is a beautiful way to think about aging and nurturing and just being able to take care of others but then there's one thing that I find so sweet that a lot of women tell me that after menopause they kind of reach a state where they give fewer yeah they just don't give a [

__ ] anymore I mean I think I think what's what's interesting about that is it's all the more powerful given our kind of cultural relationship with women as they age like the fact that women postmenopause are actually happier in a culture that discards women at a certain age and has a unhealthy kind of relationship with how we think about older women to me demonstrates how palpable that kind of theory of mind is at that stage of Life uh and then on top of it from an evolutionary perspective there's this grandmother effect thing right so there

is like a rationale behind why this is the case yes there's a rationale and there's a neurological explanation so for the giving fewer FS there's something very interesting that happens to the amigdala to this reactive region that basically just part of that gets turned down so that you do not respond to negative things or upsetting things as reactively as you used toh so you're able to sustain happiness for longer and just don't care too much about things that would have been upsetting otherwise and this fits in with this theory that menopause is actually a good

thing for women and also for humans as a species so as a scientist so for anyone who who's born with ovaries or anyone who knows women I think that menopause is just a fact that at some point you go through menopause and then you just stay in it for another third of your life or so but in reality as a scientist man menopause is a riddle because it goes completely against Evolution right according to Darwin who we know didn't love women very much the only point to being alive is to reproduce a pass on your

genes so the fact the women stop reproducing at some point and don't die is effectively against his theories I like that it's some kind of uh you know glitch in the in the system or you know vestigal in a way that nobody could make sense of no can make sense what people have tried so men have said or scientists have said just go for it like speak your mind come on mismatch hypothesis that says that we should die after menopause but modern medicine is increasing lifespan beyond what nature intended artificially keeping all these women alive

for no reason what why we just kind of crowding yes but then there's the opposite Theory which is called the grandmother hypothesis that it takes a complete different spin on menopause which I find much more reasonable and says women are helpful even if you're not reproductive you can still be productive and productive we sure are and so Dr Kristen Hawks came up with this Theory where she realized that it is effectively better for women to stop attempting child birth birth once you reach a certain age because the the the risk of dying is is higher

the older you are and also the risk of birth defects in the children Offspring so it is better to stop reproducing and take on a caregiving role where you effectively have pure children have more children because you're still passing down your genes not directly but you're still promoting your genes to be passed on and at the same time what she was saying that I think is very smart is that those women back then were talking cavemen their ancestors those were the fittest women possible right they had jeans that number one kept them alive after multiple

pregnancies and they were likely more physically strong because they were able to make it to old age it was very challenging to do that and therefore the jeans that were being passed on were like a Wonder Woman's jeans and genetic code that perhaps made these women's children also live longer and go through menopause and then take on the caregiving role that allowed their species to really multiply Beyond any other animal species so that's what she says yeah grandmothers are actually evolutionary heroins it does make sense yes I think it makes sense I want to get

back to the scans which you were going to share and I want to better understand the relationship between menopause and these endocrine ships that are occurring in women and how that connects with the onset of Alzheimer's and other forms of cognitive decline MH so these are the r I'll show you it's Show and Tell show and tell so this is a kind of brain scan that I I specialize in so this is a posit emission tomography or pet scans that looks at the way that the brain takes up glucose and burns it to make energy

in the form of ATP and ATP is the energy currency of all cells so what we're seeing here is a metabolically active brain where the red Parts indicate very high brain glucose metabolism high energy levels and the blue in the middle indicate no metabolic activity because there's fluid inside the brain which we need to have right for cushioning for hydration for protection but what we need to look at is the brain so anything that is red yellow or green is brain tissue and this is a very healthy looking brain so this brain belongs to a

woman who was 43 years old when she worked with us the first time when she got her first brain scan and you want your brain to look pretty much like that you want this part of the brain which is the frontal cortex in charge of thinking and reasoning and planning and language and multitasking as well to be really in the red range and this part in the back of the brain which is back here to be pretty much as red so it's like an inverted triangle MH shape and this is the prunus and posterior singular

cortex which is important for social cognition for example for has a sort of Integrative role and also autobiographical memory it helps you remember things that you have done so it's the memory of you that's a little bit in this part of the brain and then you want the left side we're looking at the brain from the top so the nose would be here and the ears would be on the side and this is the back of the head you want the left side to be broadly as bright as the right you want to have symmetry

symmetry beautiful so this is a beautiful looking brain for 43 years old we kept doing brain scans as this woman got a little bit older she was premenopausal at this stage so regular menstrual cycle she went through menopause fairly quickly PTO within like 8 n years which is not fast by any definition but biologically it is and now I think you can see how the intensity changes in different parts of the brain where the red turns yellow and the yellow turns green and this is going to Loop and start again right so you see there's

a lot of red that just kind of Fades away not completely obviously but there is clearly a shift and I'm now going to put this side by side and they think it's quite clear that the before and after scans are effectively different you can see there's a lot more green here mhm now quantitatively that's approximately a 20 to 30% reduction in brain glucose metabolism which is the one of the best measures we have for brain energy levels now why is this important for a couple of reasons number one the people don't take women seriously when

we go through menopause and say I don't feel well I don't feel like myself I feel like I'm losing my mind right there is an actual biological correlate to that so basically what we're doing is that we're validating what women have been saying for centuries or longer by showing evidence that we're not making things up it's not your imagination it's not fiction There's an actual change that's happening in that can happen inside the brain now I think is that just the only woman who shows this right no sorry to interject but quickly just to clarify

it's also not a situation where there's a change and then it snaps back to some kind of homeostatic state that it was before which I think is a kind of persistent misunderstanding like you go through menopause and then you reset to some balance point there's a before and an after where you don't return to the way the brain was before yes there is such a scenario so this was one of the very first studies that we did and we only had the before and after but we keep scanning our participants those who allow us to

do so of course we're very grateful for longer MH and we did publish this that it depends so this seems to be quite the average change although some women do not show these changes but just very mild or no changes and some women show more severe changes so there's a rain already here but then what happens after that is quite interesting so this is the typical scenario right premenopausal per menopausal and then for some women that's it the brain finds a new normal and stabilizes and that is your new Baseline at least in terms of

metabolic activity for some women there's a little bit of a rebound in some parts of the brain I have not seen brains that go back to the premenopausal level but we're also older at that point but when there is a little bit of rebound that also seems to correlate with the fact that the symptoms go away that your memory is clearer that you're you're more like yourself and you feel overall better some women keep declining those are the people that we really recommend Alzheimer's prevention for so I think that's a good time to think about

prevention and what we can do to make sure that is not going to lead to more serious issues and I want to preempt I'm not aware of any other studies they have shown this yet so I would love for other scientists to do what we're doing and track women over time starting in midlife so that we can compare notes right now all the evidence we have is from kind of from us is there a sense of what accounts for the differential between and amongst women in terms of symptomology and their experience you know through this

process why it's severe for some and and Mild for others there are many indications and we have some information that the type of menopause for instance matters now we think a menopause is a single entity but that is really not the case so women go through menopause for different reasons usually when we talk about menopause we're thinking spontaneous menopause which is part of the aging process just your ovaries run out of follicles and eventually you stop making these hormones and then you just transition to menopause which is now the piece of cake necessarily but is

the gentlest way is the most gentle way to go through menopause many women unfortunately go through menopause for other reasons some women have something called POI primary ovarian insufficiency which is when you develop menopause before age 40 or 45 so quite early on in life that could be due to genetics to autoimmune conditions or to Medical interventions that impact uh the onset of menopause so sadly one in eight women in the United States under go a hysterctomy which is the surgical removal of the uterus with or without the ovaries and about half of those women

undergo hysterctomy before menopause that can prompt surgical menopause at any age can happen when you're a teenager if you have the ovaries removed at that time yes can happen in your 20s in your 30s in your 40s any age before menopause because it's a surgery the ovaries are are gone then the answer to menopause is obviously abrupt is rapid and the consequences might be more severe so the symptoms might be more severe and the health risks the menopause can bring about also more severe that's very important to consider because we don't do that enough is

there a study that tracks women who have had hysterectomies and developed Alzheimer's later in life yes and what does that ratio look like uh well what this started show is that women who undergo menopause because of surgeries have a higher risk of Alzheimer disease and dementias compared to women who go through menopause span ously the risk is just a little bit higher if only the uterus is taken out but is significantly higher if the ovaries are taken out before menopause and I'm hoping that we're going to talk about hormone replacement therapy because we're moving in

that direction I definitely have a lot of questions about that I'm always worried that I'm not going to more category of women that really don't get much attention sadly are women who go through menopause medically in used menopause because of chemotherapy and radiation those there women who have a history of breast cancer or ovarian cancer or IND demetrial cancer and very often the endocrine treatments that are used that we use stop menstruation sometimes it's only temporary it's called the Mena sometimes it's permanent so they may end up developing menopause because of that which it's really

unfortunate and they suffer that we don't have a better grasp on how to do things differently or that could lead to different outcomes and what do we do for treatment so this is this is something that really needs to it needs to become more of a topic of of research and medical yeah yeah I mean I I do want to you know ask you about studies you'd like to see done that you feel are most pressing or urgent in this field and that feels like that would be one yes for you yeah when we talk

about about Alzheimer's and Dementia cognitive decline um I want to better understand the differences okay amongst these things like what is Alzheimer's exactly how is it different from what we would call Dementia or other forms of perhaps just natural mental or cognitive decline that comes with age so dementia is an umbrella term that includes many different disorders that negatively affect cognition so there are many different forms of dementia that are defined based currently based on symptomatology and histopathology so Define whatever happens inside your brain in terms of lesions is used to characterize one form of

dementia from another Alzheimer's disease is the most common form of dementia and is defined at autopsy by the presence of very specific lesions Amo beta fibros or PL Alzheimer's plaqu neurofibrillary Tangles which are to pathology mediated damage inside the neurons so the plaqu are between neurons and impair communication whereas the tangles disrupt the neurons from the inside so it's like a double attack on neurons from the outside and the inside and then there is neuronal loss as a result in synaptic deterioration where neurons can no longer communicate effectively with each other and then the symptoms

of Alzheimer's are predominantly memory based so there's severe memory loss but there's also loss of attention there's loss of language there loss of sense of direction and in the end you have a problem with daily living activities where you just can no longer take care of yourself so alarm disease is a it's a neurod degenerative disorder that is silent has a silent onset it's in your brain for many years before the symptoms show up on clinical examination and that basically makes you become debilitated slowly over time hey everybody today's episode is brought to you by

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on it on some level there's there's shared DNA between uh cardiovascular disease and neuro degenerative disease in the sense that these are diseases that build up over decades we think of dementia as an old AG disease but honestly it just manifests at that stage of life and it is the result of things building up over a great period of time um to what extent is dementia a result of circulatory disease in the way that cardiovascular disease is because when you think about lifestyle and we're going to get into that and diet and you know chronic

inflammation and all these sort of things that contribute to heart disease America's number one killer it would seem that there's an extreme amount of overlap in terms of how that's affecting brain health For Better or Worse yes so there's a form of dementia that's called vascular dementia that is more specifically related to cardiovascular and heart issues and very often overlaps with Alzheimer's disease we talk about Alzheimer's as being one thing but in reality most people have a mixed type type of pathology there's there's a lot of different things that can happen and cardiovascular health is

extremely important for brain health and having heart disease and different risk factors for heart disease are in turn risk factors for Alzheimer disease dementia as well mhm so I think that there's a strong lifestyle component to dementia and a lot of people in the United States of America leave lies that are quite sedentary and include components that are quite pro-inflammatory like you said and those are all things that are within our power to change and mitigate and work on that could also significantly impact our chances of developing Dementia or not so I think it's really

prevention is key when it comes to alzheimer's because once you have Alzheimer's disease there's only so much we can do so the drive that are approved right now are mostly symptomatic drugs like atil Colinas Inhibitors or memantine they slow down progression for a little bit they can alleviate the symptoms for a little bit but they do not reverse the disease nor do they stop it nor are they all that efficacious right I mean there's a lot of room for improvement there I mean it it's a whiplash situation because on the one hand we're seeing the

numbers in terms of Alzheimer's and Dementia going through the roof it feels like everybody you know has somebody in their life who's being impacted by this disease there's a lot of fear amongst people in my age bracket about what might come you know for ourselves and it's scary yes also if you're a woman knowing that menopause is something that you're going to undergo no matter what and that there is this connection between what's occurring in the body and how that relates to what happening in your brain and what may happen later um is a frightening

Prospect but at the same time to your point I think there's been this narrative that this is a genetic predisposition and there's very little that you can do about it right and the truth is that we have great agency over the extent to which any of these disorders are going to manifest if at all and these decisions that were making now understanding that that these diseases are taking root for decades before they they truly show up and impact Us in negative ways is a call to action but also encouraging because we do have control over

the arc that our brain is going to take so let's talk about that we were talking before the podcast you've written three books in a very short period of time you've been incredibly prolific with sharing your wisdom experience and knowledge but curiously in interestingly your first book was called brain food like and I was like shouldn't that be the third book like first you do the neuroscience and then you do kind of like the protocol but you came out of the gate first to address lifestyle in terms of brain health clearly you know diet is

important as is exercise we'll get into all of these but maybe let's start with diet like if you're concerned about your brain as everybody should be uh we should be deeply mindful of what we're putting in our mouth a couple times a day I completely agree and also to look back to Al disease and contextualize lifestyle and diet in particular or other things as well um all women go through menopause but only in quote 20% develop dementia so I think this is important to clarify because it's not like menopause causes dementia right is it's something

that inre apologize if if I created that impression no you do not I did and it happens and that's why I want to to clarify this that means that there are other factors at Play right because if menopause gave you dementia then that would be it but in truth not all women obviously develop dementia so it's important to understand that there are things that you can do to mitigate your risk and make sure that you don't get dementia I just want to say because I don't want to be absolute like menopause out I just don't

want to scare anybody no that's a very important point I guess would it be fair to say that the endocrine system and neurological shifts that occur as a result of menopause create a greater susceptibility to thank you that's that's exactly the point no it does not cause dementia it just increases vulnerability I believe yeah okay and uh thank you you know I always want to make sure it's clear because I don't want people to to make choices based on an assumption that I wasn't clarifying enough so thank you I think we're clear so diet first

let me just say of all these lifestyle choices and interventions is there a hierarchy in what's most important or are they all working in concert with each other I think it's a combination of things that becomes really important because you can eat all the broccoli you want but if you're super stressed you don't sleep you don't exercise there's only so far the broccoli can take you even though they are very helpful and the other way around so I think it's multifactorial and most preventative efforts are in fact based on a comp combination of different things

in my hands when we tried to rank different lifestyle factors in terms of outcomes measurable outcomes in the brain diet usually comes up on top sometimes exercise yeah I thought it was exercise but I guess it depends on how you look at it in our studies at least statistically diet played a big role and that's what brought me to write brain food and really focus on diet more exercise is a big deal and what we tell patients to start with if when we talk about prevention if there's if you only have time for one thing

exercise because especially the kind of aerobic exercise like you do it really stimulates blood flow to the brain seems to be almost like an immediate health boost for brain health so you can get results quickly however diet is important because most people eat at least three times a day every day which means that we have at least three chances every single day to make a smart decision and nourish a brain in a way that is also protective against Alzheimer disease dementia aging and whatnot or the opposite and really create problems for your body and brain

health at the same time so diet is powerful I think it's very powerful and we're constantly bombarded by chemicals that are being released in the environment in including our foods that we probably don't quite appreciate the kind of damage they can do for you so I think it's important to there's toxins in our home care products our cleaning products and in our packaging and all the like but just to stay on food for a little bit understanding that there are a lot of battles being waged on the front lines of the diet Wars choose your

words carefully social media acad what do we know about food and brain health you call it neuronutrition neuronutrition how do we how do we eat to fuel our brains we eat in a way that is based on chemistry because food is not food food is information and food is biochemistry and your brain needs to want the food that you give it so the brain is a very interesting organ in that some nutrients and some substances can get inside the brain easily by passive diffusion like alcohol and caffeine but most nutrients cannot there are very specific

gates in the brain that only allow specific nutrients in when the brain needs them so it's an active Choice from your brain to utilize some nutrients or not and I think this is important in the field of brain nutrition because I think there's a little bit of misinformation sometimes that when I started writing brain food I didn't use social media at all back then so it's a little bit shocking at first but there was a theory going around that the brain is made of fat especially cholesterol therefore you need to eat foods that reach in

cholesterol to feed your brain and I was like what though it's important to understand neurochemistry the brain makes its own cholesterol it makes it when we're born and as soon as possible it Shields the cholesterol away from the rest of your body so no cholesterol from diet will ever get inside your brain unless your bloodb brain barrier is compromised and then there are different things to worry about at that point but for as long as your brain is healthy and self-sufficient no cholesterol from whatever meat you eat will get inside your brain so that's one

important thing fat same exact problem saturated fat can get inside the brain but the brain doesn't really want it after adolescence the saturated the fat Gates do not open as often and we see with the brain tracers because we try to make the traces lipophilic which means that they bind to Fat so that they can get inside the brain more easily and it's very hard to do it because some fats just don't get in it's really hard you can't push stuff instead your brain the brain needs to want it and the kind of fact that

the brain wants is polyunsaturated so the Omega-3s the Omega 6 plant-based foods have a lot of really good building blocks for the Omega-3s and the longer Omega 6 and Omega sixes so that's the kind of fat that your brain wants that they think we would want to prioritize in our diet right the brain runs on fat you should be eating a high fat diet high in cholesterol because the brain needs that cholesterol all nonsense nonsense okay thank you for that you've advocated for a Mediterranean diet approach to nutrition with an emphasis on greens like a

sort of you know pro turbo green version of the Mediterranean diet which is really kind of a plant slant focus on the Mediterranean perhaps a little bit away from the higher fat or the fish and more on the dark leafy greens and yes like lean protein as well that comes from vegetables that's what this kind of Greener Mediterranean diet prioritize but I I think it's not about a specific diet or another it's really about the kind of nutrients that your brain wants and needs and it's about making sure that you have this kind of nutrients

from whatever sources you like so you're plant-based right great so let's make sure that your diet includes all these different nutrients that your brain really thrives on so antioxidants EAS it on a plant-based diet for me personally the most important nutrient group for brain health is antioxidants why because the brain is the most metabolically active organ in the body and it runs on glucose so glucose is the main energy source for the brain and when you burn glucose to make energy inevitably oxidated stress is formed Med and free radicals can damage your brain and the

only way that you keep them at Bay is to import antioxidants from your diet so the most important antioxidants for brain health at least the best studied are betacarotene which is the precursor to vitamin A and then vitamin C and vitamin E and selenium which is a rare mineral that's find in Brazil Brazil so these antioxidant nutrients are found exclusively in PL based foods so if you're eating a carnivore diet exclusively meat you're depriving yourself of those nutrients then it is important to supplement meat in general does not include I I think the antioxidant levels

would be very low so in that case I think it would be really important to supplement when at least the multivitamin uh but I an oxidants are important for brain health no matter Brazil nuts but what are some of your favorite High antioxidant foods that you would recommend so my daughter I'm very very lucky she loves fruits and veggies she's a high carb girl spontaneously so we have all sort in the house and I like to go seasonal so right now prons M we found this kind of prons that are cross with apples they're a

little crunchy and the orange so any orange produce contains beta karot almost all contain beta carotene or some form of vitamin C so I would say you know lemons are a fantastic source of vitamin C and also citric acid which is really good for digestion oranges grapefruits is winter at least in New York so those are the fruits you find but even apples uh contain antioxidants and blackberries most people think about blueberries but black berries actually have a higher antioxidant content the blueberries GOI berries are great source of vitamin C amla the Indian Gooseberry is

probably the highest antioxidant capacity of all fruits oh I didn't know that what about Moringa and MinGa citrola yes that also is good mulberries and they taste like honey which is really sweet it's a good snack prunes prunes prunes they have a good amount of vitamin C antioxidants and soluble fiber on our grandparents and great grandparents at least in America America drinking their prune juice they they knew what was up yes the juice depends what's left in the juice right but the prunes are good you can soak them in water we do it it's a

very European thing to do by the way you soak them in water and then they're like little dessert they're yummy nuts and seeds and green leafy veggies leafy greens are also really good sours of vitamin SE so broccoli pale cruciferous veggies the more the better is I think really you can't go wrong with fruits and veggies what is the efficacy of of supplementation we could start with antioxidants I mean you can go and get Resveratrol or turmeric in in capsule form I'm always curious like is this doing anything obviously it's always better to digest your

nutrients within the Matrix of the food that they they come with but I'm curious if there's any understanding about the usefulness of supplementation of individual nutrients in that way there's some understanding and I think at least in in science and Academia we advocate for what what you just said which is that supplements cannot replace a healthy diet supplements are helpful once you are deficient in specific nutrients or your levels of some nutrients are low from a clinical perspective even if you're not deficient they could be below average and you think that they might be helpful

in that that respect over supplementing does not seem to be helpful so there's only so much of these vitamins that your your body needs some are fat soluble so they store in tissues and fat so you can build a reserve but high doses can be toxic I mean they have to be really really high so in general what what we try to do is to establish a baseline it's really helpful to do Labs right if there's any indication that somebody might be deficient in some nutrients because maybe the diet isn't as healthy or there are

medical conditions like arries abbs Crohn's disease like where you can't really absorb the nutrients as easily because of digestive issues then you won't to run tests and check the level of specific nutrients with vegan diets as well it may be helpful to measure some of the nutrients like the fatty acids or you know whatever you're concerned about and then if you're low then it makes sense to suppl otherwise it doesn't seem to be beneficial what what for brain health what are common deficiencies that somebody who is menopausal or postmenopausal might experience and with respect to

whatever those common deficiencies may be is there an understanding of how they might connected to alzheimer's I do not think the menopause has been linked with nutritional deficiencies but calcium could be low and we tend to to recommend calcium and Vitamin D supplements for bone health has that been related to Alzheimer disase not really but again we have so little research on manopause that I think this is a little bit maybe at some point there will be research so lack of evidence does not mean that there's no benefit just that the research hasn't been done

in that respect in our hands I can tell you we've done some studies and I would love to do more but we have shown a positive associations between a higher intake of antioxidants and these brain scans in women of menopausal age Prem menopausa per menopausa it seems to correlate so the more antioxidants you have the higher your brain energy levels which is something that we want to and you do nothing else to increase the amount of antioxidants in your diet every day I think that is very because as you do it I mean you should

do that anyway yes and as you do it it means you're prioritizing foods that are good for you to start with right so you also get the fiber I like to say the fiber is like the name of the game in women's health which is maybe an overstatement but it is very important for Women's Health for a number of reasons number one it helps your gut microbiome it's really important for Digestive Health as we all know but also it modulates the action of the sex hormone binding globuline which is that protein that regulates how much

free testosterone in men and women and free estrogen we have in the circulation so it helps shuttle estrogen and other sex hormones where they are needed and fiber has a positive effect on this specific substance so so it also has a positive effect in estrogen levels and also eating carbohydrates or plant-based Foods is important to support the estrobolome so you know there's a gut microbiome that is not just one big family of microbes and what not but is the city with many communities living in the city and one of the communities is the estrobolome which

is made a good friendly bacteria that are involved in estrogen metabolism they help regulate estrogen levels there's one enzyme in particular it's called beta Gus that's been investigated right now this seems to have a modulatory effect so estrogen like any substance stays in your bloodstream for a certain amount of time and then it's either reutilized or is expelled and this part of your microbiome tends to help decide whether you need more estrogen so it keeps it in your circulation for longer or not and so you want this bacteria to be happy and healthy because they

are helpful to you in return and the best way to do it is to eat plants because they feed on plants and especially oligosaccharides which are type of carbohydrates that comes from plant Foods there's lightly beer like onions and asparagus and beetroot and Ginger yeah yeah and they're really helpful in that respect as well so there are many ways that you can use diet to support hormonal health and of course phytoestrogens MH most people are fiber deficient in their diet uh and it's a pretty easy fix yes all you have to do is just incorporate

more plants into your diet and more diversity of those plants and it seems Curative in that regard but understanding that and the relationship with hormone regulation in microbiome is kind of fascinating and it speaks to the you know emerging complexity and understanding that we're only beginning to develop around the microbiome and its impact on you know every sort of biological system in our body not the least of which is the gut brain access like this communication between our microbiome in our gut and what's happening in our brain is nothing short of fascinating dictating everything from

cravings and impulses to modulating all of these you know unconscious systems that were running in the background M anxiety it's unbelievable right that the culture of your microbiome could dictate the Cravings that you have like sending these impulses to the brain about what you would like to eat thinking well my body's telling me I need this and it's like well your microbes are mhm I think it's fascinating and it really goes against a lot of the things that I was taught in school which is that the brain is in charge of the rest of the

body but is relatively unaffected by what happens from the neck down which turns out to be completely wrong yeah it's sort of it sort of makes inroads on our our degree of sentience right like are who's making the decisions up here and and why right yes which is humbling I guess it's humbling but also I think it gives you power because then you can effectively help your brain right if you know what kind of factors go from the bottom up then you can do all the things that your brain could benefit from and I think

this is very empowering it's much more interesting than just saying it is what it is and you have no power over your your brain health let's talk about exercise let's talk about you sort of referenced uh you know low int consistent movement as the most beneficial moderate intensity moderate intensity that's like hiking is when you can talk but you would have a hard time call zone two around oh my goodness why do you laugh thank you thank you so okay is there a sense that that's really what the focus should be like do we do

we know or is there something we still need to learn about what high intensity exercise does to our brain the differences between something like strength training or resistance training uh versus that low intensity or moderate intensity uh in terms of what's happening in our brain like do we have scans on that over time that tell us anything interesting no when I was talking about the moderate intensity exercise it comes from studies that specifically looked at Health outcomes in women in menopause and what they have shown is that there's an inverted U curve between intensity and

gains but not Fitness gains rather it reduced risk of cardiovascular conditions it reduced risk of diabetes it reduced risk of obesity and what they showed is then obviously if you if you don't exercise at all there's no improvement in health but as you start exercising and this is intensity a low intensity there are some benefits moderate in sens there are more benefits but then it want once you start going high intensity the benefits go down mhm now why is that I think this remember these are observational studies they're not clinical trials so what I think

they're capturing there is that moderate intensity activity is more sustainable for women who are of menopausal age well obviously if you don't move you can't expect benefits but there is some evidence that high-intensity exercise does not work for all women after menopause because of a sort of interaction between the fact that adrenaline would be increased and perhaps cortisol would be increased and that has a negative effect on your sex hormones at the same time or maybe just the fact that it's hard to sustain over time so what I was trying to say at that point

is that obviously if you can do more do more if it works for you great but many women are discouraged by what they hear on social media or television that you have to do all these difficult things they're very intense and they just don't do anything at that point or they try and hurt themselves or the recovery takes too long and then you're sore all over and you haven't slept your muscles don't have the time to rejuvenate is that a go mhm so if you stay in your zone two it seems to be more sustainable

and more doable and that might be linked to Better Health outcomes so the bottom line is just don't be too hard on yourself you know if walking is your thing do it if dancing is your thing do it if running is your thing great whatever works as long as it's something you can sustain over time because the truth is when it comes to brain health quick fixes don't work they just cannot because from the neck down our bodies or engineered for change right so if you think about cellular turnover blood cells renew every few weeks

even the skeleton is renewed at the rate of 10% a year so your body can respond to changes quickly and if you go on a diet if you start exercising you can see the changes relatively fast not so much in the brain because the brain is built for stability our neurons the vast majority of our neurons are born with us and stay with us for a lifetime and they are very very protected from changes in the environment from changes in the diet from changes in your exercise activity because if if every time we went on

a different diet that had an immediate impact on our brains we would all be crazy yeah we'd be lunatics it would be lunatics can you imagine it would damage your brains very easily that can be so lifestyle changes are important and are impactful but only they have a gentle effect on your brain which means that you have to build up the effects over time and that's why consistency is key right you can go to the gym two weeks the best exercise is the one you're actually going to do yeah yeah time and time again is

there an idea around I mean it's never too late but um I'm imagining the person who's listening to this or watching and thinking well you know I don't know I've just never done anything and now I'm 65 and like it's kind of said and done like is there a sense that if you could pick up these habits later in life even if it's a situation where these amalo plaques have been building up uh where you can through lifestyle slow it or hit the brakes on it or is there a point of no return obviously it's

going to depend individually and all of that but but honestly exercise helps also patients who have Alzheimer's disease it really has a positive effect on on their mental health for sure but also on cognition you can see that in patients with dementia who work with a trainer sometimes I I know quite a few and it really has an impact so if you don't have dementia the impact is much more obvious I would say and it is true that it's never too late it's never too late to start I I would love to see more clinical

trials they really are done by age but I also think that exercise and the type of exercise ex you decide to do can help your brain in different ways so we know for instance aerobic exercise is really good for cognitive Health it seems to be given the the strongest boost to neuronal health because it stimulates so many different parts of your brain in different ways but is also important for Thermo regulation so for instance when women are having hot flashes and night sweats then aerobic activity can really help me those symptoms which I think is

really important like there are studies showing that women who are physically active in midlife have almost up to 50% fewer half flashes the women who are sedentary oh wow and also there are studies that followed by hundreds of women for many many years up to 40 years and they showed that women who were physically active in midlife more with a cardiovascular fitness style of exercise had the 30% lower risk of dementia later in life as compared to those who were sedentary wow midlife is up to 65 right but there's no that's massively significant it is

really important and then if you add strength training to that that's been linked with better mood as well and fewer depressive symptoms and less anxiety as well as a more resilient metabolism which slows down sometimes after menopause and then there's yoga Mind Body techniques and flexibility and balance exercises that are also important for better sleep and to reduce stress so there are so many different ways that we can impact brain health by moving our bodies that just out of common sense you know if you can do different things that can help different aspects of brain

health so if we all had time to do it that would be wonderful yeah but the point being like get off your butt and start moving if you're not already right it is really important and perhaps the most important thing yeah can we talk about hormone replacement oh yes yeah oh we're getting into it now yeah it's going to get it's going to get controversial so as you know there was this Danish study that came out recently that that seemed to say on the surface that hormone replacement therapy was associated with a 24% increased risk

of dementia now this created a lot of you know discourse out there because it sort of upended what people thought about HRT so what say you like what's really going on here and how do you think about HRT as a advisable protocol yes so that study was was interesting because everybody started calling me I was like and that prompted a thorough examination of the effects of hormone replacement the on the risk of Alzheimer disease and dementia because I really wanted to Not Just Give opinions but actually come up with numbers because I'm a scientist and

I I opinions really don't matter to me but numbers do and so see here's the thing there's biology and then there's pharmacology and they don't always go hand inand so what we know about estrogen is that estrogen is the master regulator of women's brain health it's like the Orchestra conductor mhm in women's Brains it's involved in a number of functionalities that have nothing to do with having kids and everything to do with having a healthy brain that's endogenous estrogen is the estrogen your body makes for a reason the reason being that the system the neural

endocrine system is active and responds to estrogen so the way the estrogen works is done estrogen alone doesn't really matter what matters is the system and the system is the estrogen plus an estrogen receptor which is a compound that you find throughout the body in the brain in the ovaries in many many tissues everywhere in organs that is like a lock and the estrogen is like the key so the estrogen has to bind to the receptor activate the receptor and then the receptor triggers a number of transcriptional Pathways that lead to high energy levels glucose

consumption immunity and more neuroplasticity and more blood flow exogenous estrogens the estrogens that we introduce in the body are not the same as the estrogen we make they could be molecularly speaking the same but we also need to understand when to use them and when to stop using them and who benefits from them and and why right so just for history because this frustrating to me when estrogen was discovered in the 1930s and as soon as it was discovered two things happened one it was immediately linked to sexual behavior and reproduction and fertility and so

it was dubbed a sex hormone and we've been stuck with that definition since so number two pharmaceutical companies realized that there was also a link between estrogen and menopause and so boom estrogen replacement there y became the number one drug in the United States until 2002 pretty much now what happened in between 1992 scientists realized that the same hormones estrogen testosterone progesterone they were so important for fertility and reproduction actually had a huge impact on the brain they were just as important for the functioning of our minds 1996 is when the scientific Community really bought

into idea that sex hormones actually not sex hormones they're neuroendocrine hormones right they serve multiple roles what's the problem when do we get to the moon 30 years prior when did the biggest clinical trial of hormone replacement therapy begin 1993 that's the Women's Health Initiative it is to this day the largest clinical trial investigating hormone replacement therapy for prevention of cardiovascular disease and dementia also relief of menopausal symptoms that trial started before anyone had any clues of how estrogen actually worked in the brain so what they did they powered their study based on outcomes they

said we need to know if if giving estrogen to women can prevent heart disease and dementia when do you start getting heart disease and dementia when you're older after menopause right especially that's when it shows up you start getting it when your in your teens probably but the measurable outcomes like heart attacks and dementia those are things that happen later on in life usually so they said well I only have 10 years to do this trial so I'm going to start enrolling women men who are 65 and older what's the problem with that they're already

postmenopause they're post menopausa by a decade at least the system has shut down and you can't just push stuff inside your brain right so what happened in these trials is that they were interrupted earlier on ahead of time because the investigators were concerned that they noticed that a lot more women that they estimated were getting heart disease they were were getting heart attacks they were getting Strokes they were getting blood clots and so they interrupted the trials and they also noticed an increased risk of breast cancer for the women who were taking hormones as compared

to those who were not and they noticed a double risk of dementia so twice as high rates of dementia among some hormone therapy users as compared to Placebo and then the media jumped on it and they I think everybody says that so I think it's ha to say that they really inflated the risks to the point that ton women just decided to stop hormon both cancer and dementia that's enough to to scare right yes and pharmaceutical development also stopped and so did research so that was a problem because we know that hormones are meant to

be taken as you go through menopause not after right they're supposed to replace the hormones that your body is no longer making but it's a sort of supplement really although you do need a prescription but if you start too far or too long after this window of opportunity has closed then we now know that the effects could be either neutral or not so great mhm okay ever since there have been many studies published mostly observational studies is because clinical trials are hard to do they look at hormone replacement therapy use in some women as compared

to women who decide not to take hormones and then what happens later on in life do you get Alzheimer's do you not get Alzheimer's now it's becoming more of a thing so every couple of months there's a new study that comes out where in July hormone replacement therapy will completely Vanquish any chance of getting dementia and then in September the then I don't remember when it was but in the fall another study comes out showing that actually is going to give you demena what do we do we cannot look at one study and assume that

that is the reality for all women that's one piece of the puzzle what we need to do is to take all the available evidence and do something called The Meta analysis which is a statistical integration of all different findings from different studies all over the world that will give us greater confidence whether or not taking hormones is bad for you or good for you when it comes to alzheimer's prevention so I don't usually do med analysis to be honest I do brains but I said to my team we have to because this is just just

too confusing so I'll show you where we're found all right so so far as far as I know this is the largest meta analysis done including I believe close to 6 million women from all over the world and over 50 studies including the women's health initiative but also everything else that came after the Women's Health Initiative which I think is just as important and this is what we found two things when you take hormones matters if you take them for menopause as you go through menopause is different than if you take them later on in

life when you're done with your transition number two the type of hormones that you take also matters so if you have a uterus you need to take estrogen with a progesterone or progestogen so there are different types of hormones they can be bioidentical it's what people talk about a lot which are molecular replicas of what our hormones actually look like more or less exactly like the hormones that the ovaries make or you can take slightly different versions that we refer to as synthetic or progestins okay turns out that matters for women who do not have

a uterus because they've had a hysterctomy then you don't need to take the progesterone you only take the estrogen so we have estrogen only formulations and estrogen progestogen formulations we're going to look at them separately because the outcomes are different based on what you take at least as far as we know at this point estrogen only these are women who no longer have a uterus okay if you take estrogen only within 10 years of the final menstrual period that is associated with a significant reduction in the risk of dementia ler in life it's about 32%

which is good signicant yeah significant and the important thing is that the data was quite I mean it was variable but it reached statistical significant which means the vast majority of studies show the protective effect if you start taking estrogen only more than 10 years after the final menstral period that has neutral effects on the risk of Alzheimer disease and all cause dementia there's an increas it doesn't make it better estrogen and a synthetic progestin if you take it before menopause or within 10 years of menopause onset there is about a 23% reduced risk of

dementia however the data here is a lot more variable so this is a trend so there's a trend towards reduced risk of dementia which means the data is not conclusive because some data some studies show an increas in Risk like the denish I believe and some studies show a reduction in Risk so what what determines what different studies find is an interesting conversation but then if you start taking estrogen and progestogen more than 10 years after menopause that is linked with a possible risk increase now the the tip of the icebreak here is the Women's

Health Initiative that we now was was really a bit of a problem but there are studies to show protective effect even then only when you combine them all together it looks like there's a possible increase in Risk if you start taking hormones at that point not if you start in midlife and keep taking them that's a good thing right but if you more than just a risk I mean that's a pretty steep curve there yes the point is that there's a trend again it doesn't reach significance because some studies show protective effects and some studies

not and a subanalysis which is something you do after shows that the studies that really show an increas in Risk use a type of synthetic progesterone that is called MPA that is no longer in use today whereas other forms of synthetic progestins do not increase risk nearly as much in the most important thing I think is the bioidentical progesterone which is what most people use now has never been linked with a higher risk of Alzheimer's so so the takeaway really is timing is important we need more research yes uh timing and type and like really

being with a practitioner who understands this landscape well yes also these studies are observational which is a problem from a clinical perspective you want clinical trials right right because you can control a lot of variables you can standardize they're more conservative is better the problem is you cannot physically run a clinical trial for 20 years so to my mind we should stop trying to correlate because at that point is a correlation use a hormon in midlife with something that happens 20 years later what would be better is to take hormones at the right time and

use brain Imaging as the outcome makes so much more sense right right right right so this is what we're doing now so this is what you're doing at your lab yes we just started a clinical trial that uses brain scans as an endpoint and also uses a very interesting type of estrogen it's called phym is this what you're going to is pH want to ask you about this okay yeah do so it's like a plantbased plant derived version of estrogen that you're currently testing yes it's um it's called the designer estrogen so it's a serm

is a selective estrogen receptor modulator that's been specifically engineered to go straight into your brain and support cellular function in the brain but has either a neutral or inhibitory effect on reproductive tissue why because there are different types of receptors for estrogen there are three different types the most important ones are alpha and beta so the alpha receptor is more expressed in reproductive tissues breasts overies um uterus the better receptor is more expressed in the brain so what this specific serm phyto serm does is that it binds only to the better receptor so it leaves

your breast alone and is not been linked with a higher risk of breast cancer that sounds promising I think it's very interesting yes and it was developed by my mentor Dr Roberta Diaz Brinton at the University of Arizona and she's amazing she's a rock star in the field and she exciting yes so she so good so preventing dementia is one thing and it's complicated to do but there are things the hormone replacement therapy can do for you that are important immediately as you go through menopause and this is reducing half flashes and nice sweats improving

sleep in some women to some extent exent reducing the risk of osteoporosis and also helping with vaginal dryness and vaginal atrophy and painful sex or painful intercourse which is very prevalent after menopause so these are FDA approved indic sleep is not yet but the the heart flush reduction and the osteoporosis and these genital urinary symptoms are all FDA approved indications for HRT and according to professional Society is taking hormones is actually recommended for women who have a hysterctomy and ectomy before menopause so I just want to mention that because it is very controversial whether whether

or not hormones are helpful to you and these are things that the FDA says these are good indication these are on label indications and then there's more evidence that taking hormones may also help some women with depression due to he in menopause and sleep and possibly also brain fog and memory lapses so just to say they may be helpful no matter what happened 20 years ago they is still driving most women's decisions to not try the hormones in the first place there women who are not eligible to take hormones we understand that but most women

are only they choose not to do so not because they don't want to try but because they're worried the risk of bre canc so I think it's important so that women have the information they need to make a decision that is not based on fear but is based on facts and updated information are there other pharmacological interventions that you would recommend somebody who's on the precipice of of going through menopause explore well I think hormone hormon therapy is the best one that we have some anti-depressants can help and especially women who are not eligible to

take hormones could safely consider some anti-depressants that have been shown to reduce hot flashes uh there are some new formulations there's one drug for medicine for menopause that was just recently approved that does not increase the risk of breast cancer because it's not um estrogenic phys inant but we still need to see more studies yes we need to see more stud we need to see how it actually works in clinical populations testosterone for some women is something that's being considered especially for low libido that's that's the primary indication at this point and then there are

supplements and then there is lifestyle and I think it's important to talk about those Solutions because they can really improve the half flashes like diet just one second to go back to diet uh women who follow this Mediterranean style diet it's just a healthy diet that is plant Centric and there's all the good nutrients and the good foods have at a minimum 20 to 30% fewer half lashes than women on Western diets wow that's a lot yes that's more significant than I would have thought yes yeah yes and I think it's important to know that

that you can change your outcomes and you know even uh with women with breast cancer can safely go on a healthy diet and reduce the risk of heart flashes and menopausal symptoms that way along with exercise and other techniques in some studies uh women who didn't start out on a Mediterranean whether style diet but they were on less healthy let put it their way diets and then they change the diet pattern showed a significant reduction not just in the number but also in the severity of half lashes which really supports a role for dietary interventions

in that case and another study with thousands of women show that consuming more uh fiber rich foods and I study fish as well was part of the pattern also was associated with a later onset of menopause as compared to women who e a lot of processed foods and refined grains and refined sugar and sugary beverages who tend to experienced an earlier onset of menopause which really nobody needs that's wild so if you're dining out consistently on Ultra processed foods you're looking at an earlier menopause mhm which is really a Pity wow yes that's interesting sleep

sleep we talk about sleep all the time here like I don't want to reinvent the wheel like we all know we need more sleep than we think and it should be a priority and that our hygiene around sleep is of Paramount importance but I do think it would be worth spending you know a few minutes just talking about the importance of sleep and brain health from a neuroscience perspective and perhaps like what the scans show you or what you know about what happens when we sleep that is reparative and restorative to our brains and protective

against these cognitive you know declining diseases mhm so sleep really is the only chance that you brain has to take care of itself because when you're awake or even when you are at the early stages of sleep your brain still needs to supervise your entire body when you go through deep sleep that's when your body is fully still and the brain has a chance to have a little me time and what happens is that there's a system inside the brain that is very specifically activated during slow wave sleep for deep sleep that is like a

little bit like a dishwasher in a way where all the fluid comes out and the Brain takes a shower quite literally and that is very important because that's how it flashes out toxins and waste products and Alzheimer's plaques and all the enzymes and substances that have been degraded throughout the day so it's effectively cleaning service that the brain is able to activate that is very important for brain health because if if you think about it in the rest of the body we keep flushing out stuff every time we go to the bathroom is effectively a

waste removal mechanism and the only way that the brain can do that is by flashing out the substances in the cerebral spinal fluid and then release it outside of of the brain itself and that can only happen during a very specific time that we're sleeping so why is that important because so many people experience fragmented sleep right we don't sleep soundly through the night many people wake up multiple times and the way the Sleep works it's in Cycles so you always start from cycle one before you reach cycle four and five which is where you

really get this good uh brain healthy sleep and so if you keep waking up you just had to go back to Baseline and you don't give your brain a chance to really take care of itself and that's been linked with an increasing accumulation of Alzheimer's plaques it's been linked with inflammation it's been linked with a reduced ability to withstand infections as well a higher risk of infections and of brain fog and other negative things that can impact your brain and for women in particular I would say the menopause can disrupt sleep significantly more than half

of all women of P menopausal and post-menopausal age had troubles sleeping and at least one in three has trouble not only falling asleep but also staying asleep through the night so this is something that deserves a conversation because it doesn't just think your energy has a really negative effect on everything else also all hormones work in tandem right so when you go to sleep it means that your body needs to produce melatonin that helps you regulate sleep and wake Cycles but if that cycle is disrupted and your melatonin production is impaired then your cortisol production

your stress hormone production will be increased and that in turn reduces a suppresses your production of estrogens for example uh so it's all Rel Cascade of the whole thing and chronic sleep deprivation or lack of adequate healthy sleep on a consistent basis leads to a buildup of these things that need to get consistently flushed out to the point where even if you then are getting periodic good restful sleep it's not enough to really flush and drain that system out in a restorative way yeah but it is a very common thing you reach a certain age

and and you wake up in the night you got to go to the bathroom a little bit more my wife she'll wake up at like 2: she's like I'm up and then she'll start her day and I'm like I don't know how you function she seems fine wow yeah I mean amazing it's wild she'll have a super productive day and I was like I don't think this is good though but she's like I can't go back to sleep so what do you say to that person who is having their sleep disrupted consistently but is you

know the idea of like finding a way to get back into a restful state is elusive oh that is that is rough and that happens a lot and I'm not asleep expert but what people say is that there are a few things that you want to watch out for which you know number one is the amount of stimulants that you introduce in your body such as alcohol and caffeine for instance which is why I switch to Decap I'm preparing for not sleeping because my sleep is not great to start with but I don't have the

energy that your wife has for sure I mean you know she her body is her Oracle like she doesn't put you know that's not an issue with her I don't know what's going on I think she's you know I don't know it's just the way it is she's you know channeling energies from the Beyond or something but anyway that's so good for common women I think it's more really about watching uh stimulants they introduce in your body and stress levels and whether or not you have moved your body during the day because as some point

your body will wake you up if it's ready to go even if your brain doesn't want to yeah so these are things that are important and especially I find a lot of people drink so much coffee without realizing the half life of caffeine right so if you drink a cup of coffee at noon and half life caffeine is 5 to 6 hours it means that by 600 p.m. you still have half of that caffeine going around your blood and inside your brain but also means then you know three hours later you still have 25% of

that going around so by midnight you still caffeinated and that is not helpful if you're trying to sleep and the same thing with alcohol and things that have a dehydrating effect that can negatively impact sleep and your ability to fall asleep and stay asleep as well so it's something to watch out because sometimes you know it happens after menopause I I hear I'm told that sometimes a lot of women would be like well you know really I'm going to maybe have a glass of wine to just try and help myself go to sleep without realizing

that that can wake you up later in the middle of the night so that's something to consider other than that stress stress is a very pervasive issue and it does increase with the menopause transition where our ability to this stress are reduced in part because you're tired and you you have every reason to be tired but in part also for physiological reasons which is that stress hormones and sex hormones all come from the same precursor so your body needs a hormone that's called prolon the mother of all hormones to then either make cortisol the stress

hormone or make sex hormones so if you're under chronic stress and your production of cortisol is elevated your body can do that by reducing or suppressing production of other hormones so effectively too much stress also syncs your estrogens which is one more reason to think about stress reduction as a also as a brain protective strategy besides something that can help with menopause as well testing I want to talk about testing uh as we kind of begin to wind this down a little bit but if somebody is listening to this or watching this and thinking I

really need to take stock and inventory of of where I'm at right now from a health perspective from a brain health perspective from a hormonal perspective we touched on your thoughts on apoe but what would you recommend that person do to get a clearer picture of where they're at and what the near future might hold for them well in general it's good to have a really good Baseline so blood work is helpful we and which blood markers do you think are most critical to pay attention to is it total cholesterol and HDL LDL HDL low

density lipoproteins as well total cholesterol triglycerides for the lipids for metabolic markers usually it's insulin glucose levels hemoglobin A1c if you want to go fancy there are other things but this would be the key met bolet markers I would look at thyroid function as well so TSH T3 and T4 and then iron iron levels in B12 because so many people are anemic and many people are B12 deficient and don't realize that it's very common as we get older so this is something I would I would measure I would measure nutrients as well but I know

that this is is now Cinder do care so these are important to look at right what I would really love is to do a cognitive evaluation right and what does that look like that's what I wanted to ask it depends of course but I would say at the minimum there are tests that measure Global cognition that's a good first step and then we have more specialized tests that look at memory attention language executive function fluency and processing speed I would do them all it takes two hours at the most and you get a really good

sense of where you are because then you get Z scored into percentiles so you can get a sense of where you are relative to other people your age and with your same educational level but most importantly that's you when you're feeling good so then you have a baseline you have a baseline that you can refer back to so let's say you're 40 or 50 or 60 and you you come to us and we do this nice uh count testing battery and then you come back 5 years later because you may be a woman going through

menopause and you're scared that you might be experiencing early on S dementia because you can't remember things you have trouble coming up with words or you just feel weird or you are older and maybe you're 65 or 70 and you start forgetting things and you get concerned about dementia which is very very common then we do the test again we can compare you with you which is every doctor's dream right rather than saying well you know relative to other people you never met who have at your same age and also completed a high school degree

or something you're fine that's not nearly as reassuring it's good it's good it's a great thing to know but it's not nearly as reassuring as saying well look you scored 28 over 30 when you were doing so good and now you score 26 over 30 and it's fine because this is consistent with an age related change right if you were below 24 then that could be a problem because we have different thresholds with cognitive impairment and then demential but at least a standardized you know what's happening and you know what is common during aging and

what is not and then you can get a better sense of where you are and I strongly advocate for brain scans yeah well just to put a pin on the cognitive testing basically if you feel great go do it and then you have that Baseline you don't feel MH which is a great idea I think it's a great investment I think it's a great investment I have seen so many people come to us really I I'm not exaggerating terrified that I'm losing my mind and going crazy maybe I have dementia maybe I have this maybe

I have that if we do a cognitive testing we're like look you're fine H you're effectively fine let's talk about what may be happening that makes you feel that way but the relief the relief of seeing some objective measure of your own cognitive performance and and looking at the numbers and seeing I am not losing it this actually happens and I'm just one of the many people who go through this for this reason or that reason or that reason relief is just like palpable yeah I think I need to do this cuz I do that

like every once in a while I was like I can't remember the name of that actor in that movie and I freak out I'm like oh it's beginning It's Beginning you know and it haunts me of course I completely completely relate but talk about these brain scans I want to have my brain scan too will you will you scan my brain if I come to New York of course absolutely and bring your wife I need to know where she got the I love to see what her brain scan like yes we would be delighted to

so um I I run the Alzheimer's prevention program a wild kette medicine in New York City what on the Upper East Side so it's 72nd New York just for context it's easy to get there and we're NIH funded to do research where we do a lot of tests of course that include the blood work that we mentioned before we also do hormones so we measure hormones as well including cortisol the stress hormone which is interesting to look at we do cognitive testing and we do a number of brain scans they are done for research obviously

there's there's currently no easy way to get this kind of brain scans for prevention unless you're part of a research program MH and so what we do we start with an MRI scan and we do seven different sequences which means that we look at seven different things in about 45 minutes to an hour so we do volumes we do volum matrics we measure your gray matter white matter in every part of your brain we look at whether or not there is evidence for any sort of damage we screen for so many things because the brain

can get affected obviously so you may have cyst you may have tumors you may have a brain tumor there could be anisms that can be malformations that can be vascular damage that can be gliosis that can be inflammatory disease that can be demyelination so we screen for everything I have a really long list of stuff that we screen for and if there's anything that we find an incidental finding we manage that so there are different things that one can do to address what we find anything that we find is it common to have incidental findings

no it's not common but it does happen so we do that and then we look at the connectivity inside the brain which is actually kind of pretty you see all the different fibers and tracts that connect your different brain regions to each other and we do blood flow and we also measure ATP production directly in the brain and that we do using something called spectroscopy it's a different technique but it's still MRI M based and then if you let us we also do the brain scans we were looking at before where we look at the

way that your brain uses glucose to make energy but we also do Alzheimer's plaqu as a screening for for prevention it's kind of scary though too it feels very vulnerable um I guess yeah it's good to have a baseline let me tell you because AG it's very unlikely you are doing the work that you're meant to be doing cuz you just light up when you talk about this stuff so you know I I can tell that it's very authentic and genuine like your your love for this field and the last thing I wanted to ask

you before we close it down we talked about hygiene in many different ways sleep hygiene just you know brain hygiene in general but I think it would be instructive to share a little bit of media hygiene because to your point and our conversation around the Dutch study and hormone therapy Etc the health pages of you know know whatever magazine you're reading or newspaper or social media channel that you're on there's so much coming at us about what this study says and what that study says and how these studies get interpreted in the media and fed

to us through titling and synopsize that isn't necessarily accurate that creates a level of confusion and at times paralysis and can drive unhealthy real life choices that we're making in the world so how do you think about the media's relationship to this world that you're in because you're there and you understand it better than anybody and then I'm sure you pick up the newspaper or turn on the TV and see you know strange interpretations of your field I suffer that that's I think that's the short puz you could become a full-time social media Warrior on

this you know can you imagine no I I cannot newspapers I really appreciate the New York Times And The Wall Street Journal we were mentioned or featured they reviewed often uh these past years and their fact checking is superb at least with me maybe because I drive everybody crazy with fact checking because I'm terrified of being miscoded but they were extremely extremely thorough I never had a bad experience and I learned learn to always read for as for a read back whenever I'm learning social media is harder for me it's really I don't really know

how to address it because you know we're all entitled to our own opinions obviously what is shocking to me sometimes is and we were talking about that before but it's just the level of confidence that people have in sharing information that is not and that I don't know what to do with that they have no expertise in whatever field they're talking about expertise is tricky to qualify in some ways because there are people who are very qualified and they're just not up to speed with the research and there are people who maybe have don't have

the same degrees but really read and pay attention and inform themselves you know education is is a lifelong process so it is hard to know who do I trust and up to which point and also something that is very strange for me about social media is that we really have 2200 words or characters to explain something complex so there's an oversimplification that must happen and is really hard to be clear and be interesting and be accurate at the same time so I appreciate enormously people who can do it and who also take the time to

really talk and and use their platforms like you do to bring good information to a lot of people and but other than that I don't I don't do you do you know what to do no I mean there's no real easy answer but I think the solution isn't do your own research or just casually consume information passively through your social media feed I think because of the kind of climate that we're in in terms of we consume news and information it's incumbent upon us we have to shoulder the responsibility for taking that seriously and and

and really kind of vetting our opinions and what we're consuming against other sources that have some uh Legacy or credibility of trust yeah to stress test all of this stuff that's coming at us before we just digest it and make assumptions about its veracity and that's hard and I feel like we shouldn't have to do that you know and you know I'm old enough to know where this wasn't a thing where you know there was there's Legacy Media that's trustworthy that earned that trust and for some reason or for a lot of reasons I guess

like trust has been eroded in certain media outlets and that creates an environment where there's a receptivity to uh other ideas and sometimes that's good and sometimes that's toxic and not so good but all of it creates confusion and and I think in terms of health and the choices that we're making every single day like there are real world implications immediate implications in terms of behavior that's occurring and so I'm always curious around sourcing and you know where the experts in their given field go to get their information in a trustworthy way yeah it's a

really good it's a really good point I get my information from scientific Publications and call going to cell and Nature and Science and all these things that like none of us are going to read but we trust you to read them and interpret them for us Lisa and then to write great books about the stuff that you know best It's Tricky so there's there's something called peer review in Academia that I I never appreciated as fully as I do now which is that when when you write a paper when you write up uh your work

then you send it to a journal know and they send it out to peer review so there are other scientists in your field who are qualified to review your work and they can weigh in so you really should I think the process is is conservative enough that everything is being checked right and you cannot make strange claims everything has to be backed up either by your own data or by referencing other people's work and there's also this thing that I find on social media that it's very funny that people just hear something somewhere but they

never site their sources right you never say oh this person said this and now I'm going to say it again it always sounds like you came up with those things that make you also sound a lot smarter than perhaps you are in some cases whereas in in Academia you just cannot do it you know you always have to site your sources and give credit to whoever's done stuff before you [Laughter] it is I know that this is not possible to do outside of Academia but something that I I think could be helpful is if books

were checked a little bit maybe more thoroughly sometimes and for social media I don't know I think in part the problem is that scientists and doctors don't really have much of a voice and we are under a lot of stress to do research if you're a scientist and to see patients if you're a doctor and there are standards to meet like you're being evaluated in terms of billing really not just how happy your patients are how if they feel better or not but how many patients you bring in how fast and how much money you

bring into your hospital the same for scientists we basically like CEOs of a star that we not exit and we're being evaluated not just based on productivity but based on how much money we bring in which is beyond stressful let me tell you is not it's not a good system to my mind so we don't really even have the time to talk to people we're put in a position we're just constantly working around the clock and we stay within Academia you know it would be wonderful if more scientists and more doctors were out there explaining

things to people but they have no idea how to make that Happ I think it takes a very certain type of individual like you're a very effective science communicator but communication skills don't necessarily go hand inand with the skills that drive a great researcher absolutely and being a public face of an idea or a corner of the Science World is its own vocation you know with its own pressures and responsibilities and you know I think people go into science mostly because of their interest in the science itself yes and I think that's one of the

reasons why I think what you're doing is so laudable because you are an effective communicator and I know that you have your own stresses running your lab and you've got all these other things going on in your life and you write these books so that you can share with us what you've learned and you know relate what's important about these topics so that the public has an understanding and then you go out and you sit down with people like me to communicate around it and I know that's a Str yeah it's it's a lot it's

a lot right but I think that is you know an antidote to The Perils that we just addressed so that's probably as good a place as any thank but I appreciate it yeah I hope it's helpful no it's great and the books are wonderful so the latest is the menopause brain which just came out as of the date that we're releasing this or is coming out imminently and the XX brain and then you have brain food so all three of them it's great thank you very much come back and talk to me some more I

could talk about Neuroscience all day oh thank you thank you thanks and I do want to get my brain scanned oh good so I'm going to follow up with you on that yeah that's cool cheers peace cheers [Music] yay that's it for today thank you for listening I truly hope you enjoyed the conversation to learn more about today's guest including links and resources related to everything discussed today visit the episode page at Rich roll.com where you can find the entire podcast archive as well as podcast merch my books Finding Ultra voicing change in the plant

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to our newsletter which you can find on the footer of any page at roll.com Today's show was produced and engineered by Jason Cameo with additional audio engineering by Kale Curtis the video edition of the podcast was created by Blake Curtis with assistance by our creative director Dan Drake portraits by Davy Greenberg graphic and social media assets courtesy of Daniel CIS thank you Georgia Wy for copywriting and website management and of course our theme music was created by Tyler Patt Trapper Patt and Harry mathys appreciate the love love the support see you back here soon peace

plance namaste [Music]