The Menopause Doctor: This Diet Delays Menopause! Menopause Is Shrinking Your Brain! Dr Lisa Mosconi

this is evidence of what women have been saying all along menopause changes the functionality of your brain it looked there like the brain was basically shrinking yes and there are two reasons why this is very important number one and this is something that impacts not all women but also all men Dr Lisa mcone is a neuroscientist whose groundbreaking research has discovered and revolutionized our understanding of the menopause and the adaptions that can be made in order to thrive during this time of life this is new research looking at brain changes during the different phases of menopause the process that can take years so this is before menopause this is after wow and this shows the 30% drop in brain energy levels so when women say that they're having hot flashes insomnia depression 2third of all women experience brain fog those are brain symptoms not recognized in medicine in fact we know that Black and Hispanic women may experience more severe symptoms and women have been portrayed is mentally unstable in medicine for a really long time we need to change that but on top of doing the research I am actively doing a number of Lifestyle adjustments that are known to have a positive effect on menopause so let's have a look at these things then okay the first thing I do is Dr Lisa one of the things I found fascinating is I read that there was a miracle food for delaying menopause a diet rich in has been linked with the later onset of menopause by how much 3 years we've just hit 6 million subscribers on the D Co um so me and my team would like to do something we've never done before as little thank you and we're calling it The di of a CO subscriber raffle and here is how it works every episode this month we're going to pick three current subscribers at random and we'll send one of you a 1,000 voucher one of you tickets to come and watch the dire SE behind the scenes live with our team and one of you will have a 10-minute phone call with me to discuss whatever you want to talk about if you're a subscriber you're in the raffle thank you from the bottom of my heart for allowing me to do something that me and my team love doing so much it is the greatest honor of my lifetime and I hope it I hope it continues uh off into the Future Let's get to the episode Dr Lisa there's a high chance many millions of people have clicked on this conversation for whatever reason men women of all ages what is the reason that all of those individuals need to listen to this conversation about the menopause brain I think the main reason is that women are important and Women's Health matters and Women's Health has not been taken seriously in society and in medicine for hundreds of years and this is time to really change the conversation and help and support women throughout an interesting and complicated transition that all women go through because this will make us all better this is important for society as a whole why should men listen men should listen because number one it's really important to understand what happens to your spouse to your friend to your mother to your aunt and all women go through menopause so this is something that impacts not all women but also all men really and I find this so interesting and so really so heartwarming when I receive emails from men and they do a lot like daily and they're saying to me like you know thank you you really helped me understand my wife better or you really helped me understand my mother or my my sister my daughter and now as a family we're making different decisions or we're having different conversations and everything just better it's also really important to understand how humans actually work you know physiologically medically and there's so much in society that has been done against women or to help women but that didn't quite work out and we're now understanding what's really important to do and not to do to support Women's Health I've had conversations about menopause before I've had a few conversations on this podcast with friends with one of my friends deina mcco about menopause and it's really open my eyes oh you know her yes yes yes she wonderful fantastic absolute Shining Light In My Life um and she's talked to me about the menopause but very few people if I would say and nobody's talked to me about this extra War word that appears on the front of your book which is the word brain I didn't realize that there was any impacts on a woman's brain when she goes through menopause but that seems to be what you focused much of your work especially in this book to identify and to illuminate what do we need to know from a very Topline perspective about the impacts of menopause on the brain what we need to know is that as a society we tend to really focus on only half of what menopause is all about which is fertility and as we were talking about before most people are aware that at some point or the other in a woman's life fertility ends usually around midlife and that's the end of your menstrual cycle and the end of your ability to have children but what the vast majority of people do not realize is that menopause also impacts the brain in a very significant way they were on starting to gather the real data about so the research is ongoing and what we and others have shown is that menopause is actually a renovation project on the brain and the vast majority of women will experience brain symptoms or neurological symptoms during menopause so when women say that they're having hot flashes nice sweats insomnia anxiety depression brain fog 2third of all women going through menopause experience brain fog and memory lapses and those symptoms yes they are related to menopause but they have nothing to do with the ovaries those are brain symptoms they are neurological symptoms that come from the ways the menopause changes the brain I want to get into how you know this and the work that you've done but but first I've got to ask who are you I am Dr muscone and I have a PhD in neuroscience and nuclear medicine which is a branch of radiology where we use brain Imaging techniques to study the functionality of the brain the biochemistry of the brain and we can really deeply explore how the brain changes at different times in a person's life and the reason I am here is that I am the director of the women's brain initiative live a wildon medicine New York Presbyterian in New York City where I also lead the Alzheimer's prevention program and I believe it's fair to say that our team is at the Forefront of reproductive Neuroscience or gender neurology which is the study of how brain health plays out differently in women than in men I heard you you've published over 150 Medical journals yes yeah yeah over 150 scientific papers in to summarize because I because I did a quite extensive piece of research here you're basically leading the way as it relates to understanding a woman's brain especially as it relates to menopause the changes I because I was reading that you did the first brain scans yes on a woman's brain to compare what a woman's brain looks like before and after menopause and also before and after surgical menopause which the remal of the ovaries and you actually have those scans which we'll talk about later but you have some of those scans to show me today but you the first to do that to my knowledge super interesting why hasn't anything been done here why just generally on the subject of menopause why hasn't there been research and investment into this area such a good question and it's the question I asked when I started looking at menopause for the first time there was in 2015 so my my specialty is used to be at least Alzheimer's prevention so I'm really I've always been really focused on supporting cognitive health and cognitive aging and preventing or at least reducing the risk of dementia Alzheimer disease and dementia and in 2015 we have kind of ran out of ideas especially when it when it comes to women's brain health because what most people don't realize is that um Alzheimer's disease affects more women than men so almost 2third of all Alzheimer's patients are women particularly postmenopausal women and this was my question even for my PhD at the very beginning of my career and back then people would say to me well yes we've known since 1994 that after aging and getting older itself being a woman is the most significant risk factor for devel veloping demential however the explanation back then was that women live longer than men and Alzheimer's is a disease of old age therefore at the end of the day more women than men have Alzheimer's disease and that never made sense to me in part because I have a family history of Alzheimer's disease that runs in my family obviously and affects the women in my family and I know that this is very common where your grandmother has Alzheimer's or dementia and for me it was my grandmother and her two sisters who all developed Alzheimer's disease and died of it but their brother who lived exactly to the same age did not and so my PhD thesis actually was to show that Alzheimer disease is not a disease of old age it's actually a disease of midlife with symptoms this start in old age so what happens is that Alzheimer starts in the brain with negative changes that take years to reach a certain threshold before the damage is so severe that people start losing their memories they can't come up with wordss they have attention deficits but in reality Alzheimer starts for many people in midlife so that changed my entire question right then the question becomes okay if Alzheimer starts in midlife and more women than men end up with Alzheimer disease what happens to women and not men in midlife they could potentially explain the higher lifetime risk of Alzheimer disease for women and look we tried everything we tried genetics we looked at Medical factors we looked at diabetes we looked at high cholesterol levels we looked at insulin resistance we looked at obesity we looked at every single thing we could look at diet lifestyle exercise and those things certainly matter but they couldn't quite explain the difference that we were seeing because what we were seeing is that already in midlife women show these red flags of Alzheimer disease in their brains whereas men do not and we can see that by doing brain scans and doing brain Imaging and the question was what what is it that really tips the scale and then one day my students were doing cognitive testing on one of our participants a woman in her 40s and she was having a really hard time just getting through the tests and she said I I'm really having a hard time can you open the window and that doesn't happen very often and my students are like the window sure actually no because it's Hospital in New York City you can't open the windows but we can we can play with the fan perhaps and she just could not get through the test and then she had to stop and said look I'm having hot flashes I just can't think straight I have to go and so she rescheduled and then she came back later but my students came to me in a panic she said she had half flashes what is it is she okay well we we had to stop the session is is are we in trouble basically and say half lashes that's interesting and so we went back and we I explained to them that means that she's going through menopause and this is a sign a classic neurological sign of menopause that we do know can impact concentration and focus but back then we didn't know that it could be a bigger a bigger change in your brain right impacting your your ability to focus and memorize information and so we went back and we asked all the women in our study about their menopausal status and their menstrual cycle and their symptoms and then what we found is this then if you compare a group of premenopausal women to men of the same age and look at their brain scans there are no differences or very little differences but if you look at women who are per menopausal and compare them to Men of the same age you see an increase in the amount of Alzheimer's plaques in the brain already in midlife in per menopause in Perry so not even in menopause but just starting to lose your skipping menstrual cycles and when you when your period becomes infrequent and usually the half flashes start making an appearance in the brain fog as well and then after menopause when we compared postmenopause of women to men of the same age then the difference was quite striking where men barely had any Alzheimer's plaques and the women had statistically significantly more red flags for Alzheimer's disease okay so this is a really naive question but please do explain this to me like I'm a 10-year-old what is manopause what is menopause so there's a standard medical textbook definition that is entirely based on the function of the ovaries okay and then there's an updated definition that I'm trying to promote more and more because I think it's important that really looks a menopause for what it is from a scientific persp practice I'm going to give you both the standard definition of menopause is when a woman hasn't had a menstrual cycle for 12 consecutive months there are three phases there's a Prem menopausa phase when a woman is in her 30s or older and has a regular menstrual cycle approximately every month and then at some point the frequency and severity can change so that's when your period becomes more infrequent or there's less menstrual blood yes usually a combination of the two and what we really focus on clinically is the frequency okay so when you start skipping your period for more than two three months at a time that is considered the per menopausal phase which is an in between between having a menstrual cycle and not having a menstrual cycle so that first stage we were talking about is there a name that's per menopause pre pre PR menopause preop menopause PR there's per yeah which is in between is that stage two that's yeah okay stage two so if you you want stage two yes stage usually we say stage one and two for cancer s malignant oh okay but yes first and second okay stage um and then at some point you will not have a menstrual cycle anymore for up to 12 consecutive months and then in retrospect you go back to the year prior and say okay as of 12 months ago that was your menopause and you are now postmenopausal in the postmenopausal stage which is the third phase if you will lasts for the entire remaining of a woman's life so most women today spend at least 30% if not more of their lives in the postmenopausal stage so you have this Perry menopause stage which happens in your mid to late 40s typically yes usually around age 47 that's the average but in reality it can start when you when you're in your 30s or sometimes in your 50s the average is 47 and it tends to last about 10 years and this is really when your estrogen levels start to dip that's a good point so it can usually lasts between two and 10 years if you're lucky let's say four between four and seven okay this is actually when estrogen levels fluctuate okay and that's what makes it tricky to diagnose based on blood tests so blood tests are not that helpful in this respect because one day your estrogen is high and the next day your estrogen is low and it does start gradually declining overall but it doesn't really bottom out until your your past the transition and you are effectively in a postmenopausal state stage so yes there is a continuous decline in concentration but day by day it's a little bit of a roller coaster which is also why women start having symptoms of menopause the brain symptoms of menopause before the final menstrual period not after and that's a big misconception in medicine and science that menopause is just one day on the calendar a little bit like puberty right as a woman once you have your first menstrual period That's aect effectively your first but in order for you to really have your last menstrual period That's a process that can take years and that is not captured in the definition of menopause is one day on the calendar when you stop having your cycle and another misconception is that menopause happens when you're old and it's really not the case in the United States but also in Europe the average age is 51 52 but if you look at the global female population is actually 49 and that is not old by any standards what's the youngest you've seen menopause which is stage two in that in that process so it depends if we're looking at spontaneous menopause or induced so women can go through menopause for a number of different reasons which also again this is another misconception that menopause is the same for everyone that's absolutely not true but the three main reasons um are aging just the neuroendocrine aging process that I like to refer to as spontaneous menopause some people say natural but that to me is misleading because it makes it sound like the other types are unnatural which is really the last thing anybody needs right it's hard enough to to go through menopause because of medical reasons rather than as part of the agent process and so the other two types are induced menopause which can be surgically induced or medically induced surgically induced is when you have your OV is removed usually as part of a hysterctomy which is the surgical removal of the ueros or just the ovaries alone and that's called an ectomy the surgical removal of the ovaries before obviously before going through menopause but menopause can also occur for medical as a result of Medical Treatments like therapy for cancer that can induce menopause sometimes just temporarily and sometimes more more often than not permanently so the youngest stage is actually puberty because there are transgender individuals who have their ovaries removed as part of their transition to a different gender so in that case if you have the the surgery the ectomy and hysterctomy when you are a teenager that's when you go through menop the spontaneous menopause what's the earliest you've seen or heard of um 40s early 40s but some women some women with P PCOS or primary ovarian insufficiency can develop menopause even earlier than that however in that case is not part of the aging process is because there's something that needs to to be further investigated whether it's genetics or an autoimmune disorder or other causes so just to summarize then there's three stages to menopause there's per menopause which happens mid to late 40s the average age is 47 years old and this can last typically so you said 2 to 10 years this is when estrogen levels begin to fluctuate as you said there's menopause which is um when she when a woman has reached one year since her last period the average age at menopause is 51 to 52 and the menopausal transition can last seven to 14 years and then you have postmenopause which is the rest of the woman's life when she is without a period just on that then so I I think I I used to think that menopause was the last stage and then once you're in menopause you're in menopause until yeah see the terminology is also confusing but menopause is actually just basically a mark on the calendar there and say as of today you are in menopause but it's not a stage so what's the difference diagnosis but it says it lasts three stages yeah pre menopause before okay so there okay three yes so from puberty until you start skipping periods okay okay then there's Perry yeah second stage when you start skipping periods and your hormones start fluctuating and then there's post menopause okay so before in the middle of the transition Peri and then after so that transition period yeah that's the per menopausal or menopause transition that typically last four to seven years but it can actually last up to 14 for some women and what's going on in that transition phase there's a lot going on and we're at least from a brain perspective we're starting to really understand it now and I think what's important to know to really understand what P menopause is and what's going on in your brain and your body during that transition is that women are born with a system called the neuroendocrine system that connects the brain the neurological system with your ovaries and the rest of the endocrine system this system you're born with meant to but for women that system is activated during puberty is overa activated during pregnancy every time a woman is pregnant is partially turned off during postpartum and I'm hoping we can talk about that too the mommy brain is really it's really quite a thing and then is quite dismantled after the transition to menopause so this is a system that is extremely important because reproduction and fertility are effectively some of the most important drivers of evolution and that means that a huge part of your brain is really wired to respond to your reproductive organs okay so the brain talks to the ovaries and the ovaries report back to the brain every day of a woman's life for as long as you have a menstrual cycle and probably also after which is something that most people don't realize there's a reason to keep your OV is after menopause because they do still have some functionalities now if you think about it when we look at those graphs that show how the the way that the brain ages it usually looks like there's a flat line and then after midlife like in your 60s 70s 80s neuronal density starts going down right there's a everything is good and all those graphs they usually talk about the way that the brain ages and how neurons age and how we lose neurons in the brain you know most people are aware that everything goes well until you get a little older and then you lose a few neurons here and there just so some kind of gentle neuronal loss over time not for women those graphs are based on men women's Brains change in a way that is quite complicated where starting a puberty throughout every every single month when your OV cycle your brain microcycles every single yes every two weeks there's a little micro cycle what's a micro cycle so um the way that the ovaries in the brain communicate is by sharing hormones and we'll talk about those hormones as sex hormones for women these are chiefly estrogen progesterone some testosterone I think is important but people usually kind of put it to the side and other hormones that are made by the brain they keep going back and forth from the ovaries to the brain from the brain to the ovaries now these hormones are called sex hormones mostly by mistake in a way they were discovered in the 1930s by scientists that were studied reproductive function and they did realize that you needed to to have certain levels of these hormones for menstruation to happen and for a pregnancy to be established and so they labeled estrogen progesterone testosterone sex hormones but it took another 60 years it wasn't until the 1990s the late 1990s the brain scientists came to the rescue and show that the same sex hormones really serve a multitude of functionalities they have nothing to do with having children and everything to do with having a healthy brain an energetically active brain so those hormones that are important for reproduction are just as important for brain function those are brain hormones too right so what happens in the brain especially for women's Brains estrogen is possibly the most important in some ways uh to the point that it's being referred to as the master regulator of women's Brains why because estrogen is to your brain as a woman one what fuel is to a car it Powers a lot of different things that need to happen in the brain so when your estrogen is high your neurons you can see them they they start sprouting out little branches they're called dandrites and become better interconnected with each other and blood flow to the brain is higher there's more blood going to your brain which is wonderful because you get all the oxygen and all the nutrients you have more immuno protection your brain is more protected against insults and things that can go wrong inside your brain and there's um estrogen is also growth hormone so it stimulates overall plasticity in the brain which is the brain's way of being resilient and able to make changes but most importantly estrogen pushes your neurons to burn glucose to make energy so in a way it's an activator and is able it's a little bit everywhere it's like this wonderful CEO that knows all the aspects of the business and can speak to any person who is needed to run the business it's like an Orchestra conductor they make sure that the symphon is exactly the one that we want but then what happens in per menopause and then after menopause the estrogen retires if you will a specific type of estrogen called estradiol which is the most potent form of estrogen is no longer being produced or just a tiny little bit and so another estrogen takes over it's called estrone which is wonderful but is not as powerful as estradi is and then the brain keeps playing the orchestra keeps playing but the tune is not quite the same got you does it make sense and that happens yeah I'm really trying to understand this the difference between the menopause phase physiologically and the postmenopause phase because it says it lasts for S to 14 years so I'm asking myself what's going on for those seven to 14 years in terms of the body some kind of transmission yeah do you want to see please show me the brain scans I think is the best way look like you mentioned before this is new research relatively new research it's also the only research still that looks at changes in women's Brains as a woman goes through the different phases of menopause okay so just for people that don't aren't watching on video for whatever reason um Lisa has some brain scans on her iPad in front of me which she going to explain to me yes so this is what's happening to this brain as the woman that the brain belongs to is going from having a menstrual cycle to not having a menstrual cycle and this is going to Loop so this is before menopause when everything is nice and red and bright and as you can see changing the red is turning yellow and the yellow is turning green and after menopause the entire brain scan is a lot greener than before menopause there's a lot less red and yellow and a lot more green what does that mean because it kind of looks like some of the lights are going off yes no exactly that's a really good interpretation what that means quantitatively that's a 30% drop in brain energy levels which means that your neurons are able they have access to the sugar to the glucose but they're not burning it as fast or perhaps as efficiently as they used to before going to menop no people don't know this no people don't know this and the reason that this is so important there are two reasons that I believe this is very important number one this validates what women have been saying for hundreds if not thousands of years that there's something happening in their heads that they feel like their brain is changing the feeling of I don't feel like myself anymore or there's something happening I have the brain fog I have mental fatigue in clinical terms we say cognitive fatigue mental fatigue and this is actually evidence of what women have been saying all along that menopause changes your brain as surely as it changes your ovaries and very specifically changes the functionality of your brain and now we've done plenty of studies I plenty obvious say I want to do many more but we've done enough studies to say that menopause also impacts the structure of the brain the volume of the brain the connectivity of the brain blood flow to the brain so menopause really is a renovation project on on the brain it's a neurologically active state that is associated with measurable and quantifiable changes in a woman's brain if I'm a woman and I'm I'm the before brain yeah um and then I go through menopause and I'm now the after brain that I just saw there which seems like a lot of the lights have gone down yeah what is the real world change in my behavior that people would see that I would feel that I would that would present so one thing that's important to clarify is that not all women show these changes right so this is one woman this is actually pretty average in terms of changes we find that the vast majority of women uh experience something like this whether they describe it as such or not some women do not show any brain changes they very little brain changes and some women show much more severe brain changes so some some women's brain changes are much worse than that yes yes much more uh marked in many ways and we also find changes in connectivity and changes in brain structure and changes in white matter volume and changes in gliosis which is like this teeny tiny little uh spots bright spots that we find on the MRI scans as part of aging but for women that really seems to happen more so dur manopause so how would I change if my brain if my brain changes if I'm that woman my my brain has had those changes how will I feel different and how will the World Experience me different so this is something we're trying to understand a little bit better these brain scans do not speak to behavior they speak to biology and there's never a onetoone correlation between biology and behavior than goodness right but what we are um starting to show right now and actually we have a paper under review that shows that this changes correlate quite strongly with brain fog which is this feeling of mental exhaustion where you feel CAU and brained you feel like your brain just won't turn on in some ways and many women experience um what we Define clinically a subjective cognitive decline where you as a woman are aware that your cognitive performance is not as good as it used to be but if you go for a standard neuros pyic evaluation you're still performing within normal values and this is good and bad for a number of reasons number one is that historically women would not be taken seriously right the overall idea is like okay she's going crazy she's hormonal she's losing her mind it's it's all in your head I hate that terminology I got that a lot from even in the scientific community that those symptoms are kind of made up or a sign of psychological distress some kind of psycho emotional issue because women have been portrayed as widely emotional and mentally unstable in medicine forever and ever did you know even the word hysteria which means Madness comes from Greek and literally means ueros really yes yes because ever since ancient Greek ancient Greece there was this mindset this this framework in medicine where anything that the woman would report in terms of cognitive disturbances or mental health issues or just just concerns were immediately ched away as there's something wrong with your udus and there's this weird connection between the uterus and the brain that makes women susceptible or vulnerable to Madness or hysteria where things like right now we're aware they kind of they were kind of right in one sense you know that's that's the bizarre part that yes there is a connection and yes that connection can impact your mental health yeah but there's no reason to be put down or be patronized or be dismissed is actually something that's really worth investigating they didn't have the science we have now but but you're saying me that they even back then they believe there was a connection between the utherus in the brain yeah the wom in the brain they I think it's so obvious any woman any woman can tell you I find a lot of the research that we do is really all about just proving women right just saying okay so you you we've all been saying this forever nobody took us seriously and now there's actual scientific proof that what women are saying is scientifically viable and valid is not all in your head I mean it is all in your head in a way but not the way the people think how many what percentage of women that go through per menopause and postmenopause struggle with brain fog 62% up to 62% is almost 2third the majority of them and and when I I have heard the phrase brain frog B brain fog but I've never understood what it means is it just like a l uh an inability to think as clearly as you once did I think it's more than that it's a feeling that something is hijack in your brain and that no matter what you do your brain won't turn on and it's a very specific symptom that is different from other things that can impact cognitive performance like when you can't sleep at night you're tired and it's harder to think clearly right but you know that that's going to come back with fog there's a there's a little bit of desperation in a way because you feel like you have no control over your outcomes is it about attention as well as memory It's a combination of things usually brain fog impacts memory concentration Focus attention and language as well something that's very common is this tip of the tongue phenomenon where you just can't come up with words and it's hard to just complete a sentence it feels almost like fasia in a way which is an actual clinical uh syndrome or a form of dementia even but when when you just can't come out with words and you know that you know the word and you just can't find it in your head and I I know so many women who really use communication is their superpower yeah and they need to rely on communication for work and what not and they really are miserable are there any symptoms that you believe are a consequence of the changes in the brain that we see in those the symptoms on the symptoms oh yes yes we just need to you know when you ask me as a scientist what do the brain scans translate to I need to have a study that shows you I go from this to this but the idea is that menopause all the different things that happen during menopause lead the brain to rewiring itself and there are so many different changes inside the brain that imp impact very specific brain regions that are important for instance for thermal regulation for regulating body temperature right so there's the structure of the brain which is actually exactly the structure that receives all the information from the ovaries is the first um Center of communication it's called the hypothalamus and is in charge of regulating body temperature so when estrogen levels and progesterone levels are fluctuating why ly that means that the hypothalamus which is dependent on these hormones for regulating its own functionality will have a hard time regulating body temperature and then as a woman you get half lashes why does the brain CU it looked there like the brain was basically shrinking yes so some parts of the brain lose volume yeah some parts of the brain become less connected some other parts become more connected and overall energy metabolic energy is reduced and the ability um so there's this little stru there are many little structures in the brain and in the rest of the body mitochondria yeah and they're responsible for uh converting cellular energy into ATP which is a usable form of energy or the energy currency of all cells and what we have found using um a very interesting brain Imaging technique is called 31 fos for as mrss or magnetic resonance spectroscopy we have found that there's basically an ATP crisis in a woman's brain as most women go through menopause where ATP is just not produced as much as it used to or perhaps is used too fast like the brain just can't quite meet energy demands and so all these different parts of the brain that need estrogen for support for energy support and for fuel but they also need ATP just to do things find themselves a little bit at a loss right it's like you you're losing the superpowers of estrogen and all the things that come with it and is that why the brain is looks like the lights are going down because of the the loss of estrogen most likely is a combination of loss of estrogen and also uh all this rewiring that takes place and the fact that some neurons are lost as well in other hormones that okay so let me get this straight okay so I should be viewing menopause as the physiological reconstruction of the brain yes really based on the loss of estrogen I and I'm going to try and go a little bit further here with my science so there's receptors in the brain that estrogen interacts with and as estrogen doesn't show up those those receptors start to shut down and that's why we're seeing the brain appear to sort of shrink in volume a little bit but also just the the activity of it seems to drop and it's really the loss of estrogen as the causal factor of that so if in my mle science here this is you know science for 10y olds over here over this side of the table anyway um I go okay well what we'll do is we'll Tak some estrogen and ping we'll inject it everything will be fine the brain will stay nice and illuminated we'll avoid the brain fog The Hot Flashes the depression um the Sleep disruption and everything we'll just inject some estrogen yeah I would inject it but yes I don't know how do you how do you administer it by mouth or we'll eat it we we'll rub it we'll do everything we'll rub it we'll inject it we yes we'll put it on top of cereal we'll do whatever we have to do to keep it up yeah we'll do facial do estrogen facials and we'll keep it up we'll put in the coffee everything right we'll smell it sniff it and and then everything will be fine yeah that's the end of the podcast then that's it bye if only it were that simple mhm so we do have hormones that are available for treatment I think most people are familiar with the term hormone replacement therapy or HRT and that option has a strangely tortured history where in the 1940s um estrogen therapy was actually the number one best selling drug in America and many other parts of the world and most women going through menopause in the 50s and 60s and 70s and what not were put on hormones and left on hormones high doses of hormones for life and the idea back then is that these hormones would not only reduce the heart flashes and make menopause better and more tolerable or just gentler but would also protect against things like heart disease and dementia and then in the '90s the government intervened and said well you can't just do hormones to women without doing clinical trials first even though that was the practice for 30 years right and so they launched the largest clinical trial in history looking at HRT for relief of heart flashes but also for prevention of heart disease and dementia and that was in 1993 and the study was running and it was suddenly stopped in 2002 because what they found is that hormone therapy was actually doing a lot of damage to some of the women in the study and what the media reported is that the hormone therapy in particular was increasing the risk of breast cancer while also increasing the risk of heart disease and dementia and everyone panicked and so many women just stopped taking hormones overnight it that also obviously kicked off a lot of lawsuits and effectively stopped research on hormones for menopause and prevention of chronic diseases and it took 1520 years for the research to resume say 10 but really it's taking a lot longer than than anyone would have thought and now we know better so one thing that everybody says is that that study is called the Women's Health Initiative um they did the best they could with the knowledge they had and the population they had but the problem is that they were looking at women who were in their 70s and 80s right so if your brain has changed at that point and The receptors are not there you can't simply put the hormones back in because the system is not there to use them and what those investigators have found is that actually that can do more harm than good with the hormones that they were using back then okay right so today we have different hormones um we use lower doses the hormones are taken either by mouth or transdermally like the patch through the skin which is gentler on the liver and reduces the risk of blood clots and other vascular issues we have different types of progesterone which is another important hormone we today we tend to use bioidentical hormones rather than synthetic hormones which were used back then and that overall seems a lot safer and at the same time hormones should be used for menopause when women are going through menopause not after not after and a lot of research including my work has shown that hormones work best for the brain if you take them within a 10-year window of the final menstrual period in Tech Al you want to start taking them prior to your final menstrual period because what these hormones do is that they stabilize your hormonal concentration so they're not just supplements but the real power the real magic if you will of hormone therapy at least the way it was intended is that you take it before menopause to really stabilize things so your hormones don't start fluctuating back and forth and hopefully you don't even get the symptoms The Hot Flashes the nice wor the insomnia give me an analogy for that then so those studies that were done in the 1990s there was what 160,000 women took part in that study yeah the Women's Health Initiative that's was a disaster for an analogy because they were because they were giving the hormones to women that were in their 70s 80s yeah it's effectively like trying to put Petrol in a car when the petrol valve is sealed or the car is Prett much pretty much yes just pumping it into there when the systems are no longer on doesn't work and the systems are no longer on because they shut down because there was no estrogen yes they didn't those systems didn't shut down because the person was just old those systems would have carried on working if they were given estrogen is that accurate that's the idea yes okay so the whole idea you want to just start you really want to be thinking about taking estrogen when you're when those systems are still on and working so that it can work and sustain the systems that's right and the the idea is to hormones when you have the symptoms it's kind of like a car cuz if you don't use a car for a long time it just doesn't you know the engine stops working yeah pretty much if you left a car for 10 years just on the side and then tried to put Petrol in I'm pretty sure it still wouldn't work um there would be glitches at a minimum right yeah at a minimum so what what age then because you know I've got a partner that's what she's 30 31 years old that's young that's young to start I think once you have once you start having the symptoms of menopause the heart flashes so right now hormone therapy is only approved for vom Mo symptoms which are H flashes and ey sweats okay it's also used off label for support of sleep especially when sleep is disrupted by having hot flashes at night and it's it's also used for relief of mild depressive symptoms that are caused by menopause and not other reasons we're doing research now to test whether hormone therapy may be helpful for brain fog because believe it or not it's not an indication and hormone therapy is not currently recommended for support of cognitive function and there are a lot of scientists myself included who find that a little bit puzzling but we also agree that more research is needed so we are trying to do the research and show that well we want to understand if taking hormones can can actually support cognitive function because look when I go through menopause I want to have all the solutions and options that I can possibly have so I'm doing the research as fast as I can to also help myself in the lot of other women but right now if you have brain fog as a menopausa woman the overall recommendation is kind of suck it up what would you do you said when you go through menopause what would you do so the the pillars of uh life style adjustments for menopause are diet exercise sleep hygiene stress reduction avoiding toxins which is where I go a little bit overboard sometimes regular medical checkups to make sure that um you are in good health overall and there's nothing in your medical history that might make your menopause worse and then I am also looking into phac pharmaceutical options which I do not take at this time but I am I'm deciding whether or not that's an option for me when the time comes do you know a prepper is it's a term for someone who's preparing for the end of the world oh goodness and they have like a bunker they have a food supply they're like buying guns that I wouldn't do but they do other things like um there's no plastic in my kitchen plastic okay so let's have a look at some of these things then preparations and why you're choosing to do them before we do that I just wanted to to for people that don't know the full range of symptoms and when those symptoms the phase in of menopause in which those symptoms typically show up okay are there different symptoms for different phases no they're not they're just a variety of symp so since you seem to be interested in the stages let's go a little bit deeper okay all right let's say so your girlfriend is in her 30s yeah right so most women in in in their 30s have a regular menstrual cycle as soon as you hit 40 ish ballpark you still have a regular menstrual cycle but you may start seeing changes some months it could be a little bit shorter some months it could be a little bit longer some months it could be a little bit lighter some other months it could be a little bit heavier I strongly recommend keeping track because that's very helpful to realize when you are past the premenopausal stage and when you're about to enter the per menopausa stage which is more complex than just one two three stages so once you have a regular menstrual cycle is the Prem menopausa stage and there's actually two separate phases there's the early phase where your menstrual cycle is the way it's always been for women with a very regular menstrual cycle then it starts changing a little bit maybe just a couple of days maybe a little bit little bit earlier little bit later lighter heavier but still very regular that's the late premenopausal stage at that point you may start skipping periods but maybe you just skip it one month and then it's back and then at some point you skip it for two months and then it's back and is regular that's the early per menopausal stage at that point the most common complaint is difficulty sleeping it's poor sleep okay when women start having a hard time not just falling asleep but staying asleep and that's usually because progesterone is going down it's unusual to have hot flashes at that point but brain fog may happen especially around your menstrual cycle when you wake up in the morning you have no energy and just the idea of checking your email feels like an ordeal it can really happen usually it may last just a couple of hours perhaps it lasts a day but it's something to pay attention to because because that could be a preview to the menopausal transition so then you start skipping periods and then you start skipping more periods and at some point your periods would be more than three months apart so you have one today nothing for three months you're not pregnant it will come back but you know what I mean so the the frequency is going to diminish it's get you're going to get fewer and fewer and periods spaced apart more and more that's the late Pam menopausa stage where the symptoms really creep in so that's when most women have the half flashes the nice sweats actual insomnia sometimes mood changes sometimes there's irritability sometimes there can be tearfulness sometimes you cry for no reason sometimes you just feel really down in the dumps and you don't know why there could be the brain fog there could be forgetfulness it's important to know that that as disruptive as that might be it's actually not common I can't say normal because it does not feel normal for sure but it's expected included in many women I saw in your book you said things like vaginal dryness yes that's not the brain symptom is a bodily symptom that can happen earlier weight gain yeah that can happen slow metabolism and digestive issues overactive bladder yeah that's a little bit later usually more like after menopause muscle tension and aches yeah look there's a whole range of symptoms yeah well you can have tinitus tenius which is that bringing in the air yes or electric shock Sensations panic attack please do keep going with your that was very helpful you're going through the phases and overlapping them with the symptoms yes so the late per menopausa stage which is defined as not having your perod for three months or more at a time is when the symptoms really kick hard then at some point you just stop having your period for good sorry what age does the symptoms start kicking hard typically on average 47 47 you 45 47 okay it's harder on black women and Hispanic women why we don't know but there are some differences related to race and ethnicity and usually um yeah Black and Hispanic women may experience more severe symptoms of menopause which is something that we should really talk about because there's hardly any research done on this and it's it's completely unfair you know I was reading a stat that really shocked me about suicidality yes yes it tends to increase for women in in midlife and it tends to be at least a corate of going through menopause also the rate of divorce is significantly higher as women transition to manop see that's why it's important for men to know these things too I read that the time in a woman's life where she's most likely to die by Suicide is when she's in that sort of 55 years old region yeah it's right after so let me get through the the so there's the late per per menopausal stage then you hit menopause which is a DI agnosis right and then you start the early postmenopausal phase that's as hard as the late per menopausal stage so the the four years around the final menstral period in either direction both directions are the hardest right so the few years the the last three to four years before the final menal period and the 3 four years right after the final menstral period those are the worst by all accounts this is when most women really have a hard time uh the women who do have the symptoms as I mentioned there's a whole range of symptoms not just the type of symptoms the number of symptoms but also the severity of symptoms that is not recognized or formalized in medicine which I think is is unacceptable and is is really not okay if you think think about pregnancy right so this is what I wanted to tell you before and I'm going to say now because I think it's important the modern definition of menopause is that menopause is a neuroendocrine transition specific to women that ends with reproductive inessence the end of fertility but also impacts a number of different systems in the body including the brain and the reason that this is important to realize is that it's a very specific and unique medical category that cannot be equal to getting older and cannot be compared to having a disease it's it's a very unique thing that happens in medicine that only has three entries in this category of neuroendocrine transition brain hormone transition there's puberty there's pregnancy and there's per menopause right now what happens with puberty and pregnancy let's talk about just pregnancy what happens with pregnancy is that we all know that many pregnant women experience changes in mood for example changes in attention changes in focus and concentration brain fog also 30% of pregnant women have half flashes it's just something we never talk about so the symptoms are not that different from menopause we've seen them before only when you're pregnant everything is gorgeous Everything Is Beautiful there's baby showers there's parties people take pictures and if you're having a hard time everybody's very compassionate and supportive and tries to make you feel better so you're saying we need to have a manopause party yes little but also I want vocabulary because we know that for example with pregnancy post parm it is understood that this transformation is not just that you're having a baby your body is changing and so is your brain some women have no depressive symptoms some women have baby blues some women have post depression and some women have postpartum psychosis right yeah it can happen it's rare but it can happen and it's a range and now that we understand that number one it's important and it's common and there's a range we have a framework to address it so once you have a baby and you go to the pediatrician for the baby you mother get a screening for depression and the pediatrician you don't have to go to a psychiatrist they do it right there and then you are effectively screened and monitor it to make sure that you're fine if you have postpartum depression we now have therapies the very specifically work for that type of depression that is different from other types of depression you know what I mean there's no such thing for menopause there's no system in place where you can even describe your symptoms to a provider because the language is in there you're going to have to say I have brain fog and nobody knows what brain fog is because it's not a clinically meaningful category how much education do doctors get on medical very little so it's one in five OBYN residents what's an OBGYN for anybody that's in Europe athetics and Gynecology okay person is the person that you go to for menstrual cycles and pregnancy and then menopause okay and anything related to fertility or the function of your reproductive organs they don't know about menopause one in five does but in reality when you look at the curri ulum is more like six maybe eight hours in total of training throughout the entire Residency program so it's it's not much it's really not much so I would say that the vast majority of Specialists are not OBGYN Specialists are not actually manopause Specialists and even those who are don't receive a lot of training so in school at least so it's really important to go see a specialist who number one is a certified menopause specialist you can find it on the internet and number two somebody who has personal experience because at this point you really have to to gain your own experience and the thing that is very upsetting to many professionals is then even the best OBGYN specialist is not a brain specialist right so menopause has been pigeon hold as an issue with the ovaries go see an Oban specialist where the symptoms that most women actually suffer from are neurological in nature and the specialist you go to is not trained to manage or diagnose anything brain related they're not supposed to right it's a complete different organ instead of skills so we're trying to change this framework so the brain Specialists can be involved in the medical evaluations and treatment of menopausal women have we finished off with the stages there so we were yes we finished off no just one more just one more stage so there's the early post menopausa stage that is still a little bit like a tornado it can be a tornado with a lot of symptoms but then six years after the final menstrual period That's the late post menopausa stage which is the stage that a woman would live into for the rest of her life that stage varies and that I find is really interesting for many women the symptoms like hot flashes the night sweats the mood changes the brain fog tend to go away over time I've got a graph that I'll put on the screen that shows how brain flog changes over time and as you can see it's kind of like a u-shape so it's there's no brain fog and then it goes you have severe brain fog and then the brain fog seems to recover not to the same height as it was um before menopause but postmenopause which is I'm getting when it guessing where it recovers there this is yeah this is post menopause so this cognitive function right it's nice and high before it menopause then it takes a dip yeah during the transition then it goes typically back up for a few women it would be up here so it goes back to premenopausal level levels cognitive function for most women is a little bit lower than it used to be but still pretty good this is good news yes that is good news absolutely and but for other women is not it keeps going down it keeps declining and that's why a lot of women come to us at the Alzheimer's prevention Clinic because they're really scared that that may be a sign of early dementia is there any reason why some women's brain fog doesn't return back to normal levels postmenopause we are looking at that right now is this also why you're prepping Yes actually it's the study that we have under review that I believe is the first to look at brain Cates of menopausa brain fog so as far as I know this is the first study that shows that that there are very specific changes in the brain that strongly associate with having or not having brain fog that is the first step to then clarifying why certain women have it and certain women don't have it and how how can I make it better right is it hormones is some other kind of therapy how how can I reverse it how can I prevent it so this brings us back to this conversation around prepping you you're you're in this phase of life where you're prepping um why does exercise matter for menopause so exercise matters for everything from hormonal Health to brain health to heart health because everything is interconnected right we are effectively a system where every part of you needs to be healthy for you to feel healthy as a person um for both menopause and brain health we know that physical activity stimulates the production of certain proteins that can travel all the way inside your brain and they're also made inside the brain that support neuronal Health from growth hormones to very specific peptides they have um a boosting functionality and for menopause in particular all exercise is good but cardiovascular activity seems to be a especially helpful for the Hat flashes in the brain fog where strength training seems to be more helpful to preserve metabolic activity and bone mass but also mood it supports mood and um flexibility exercises and Mind Body techniques like yoga Pilates taichi those are helpful not just for flexibility but also for stress reduction and sleep so it's good if possible to do a little bit of everything and if if time is a constraint then it's helpful to know the different types of exercise may be especially helpful for one thing or another there's a study in your book I think in Chapter 13 where you where you case study uh I don't think it was a study you did around the Latin women 3,500 Latin women me but wonderful study wasn't it and and it showed that those who engage in regular to moderate intensity exercise were almost 30% less likely to have severe hot flashes than those who exercised less yeah which is a really compelling argument for exercise in that phase of life and there's some other sort of um related information that I read that said that women in their 40s are the highest demographic group to exercise inconsistently or not at all yeah yeah so we know exercise is great for that phase of life and we to know that women have no time is that what it is is it a timing issues typically for most women is a combination of factors I think midlife is a bit of a is a turbulent time when you're sandwiched in between a lot of different responsibilities if you have maybe young children and older parents and you're trying to to maybe get a career advancement and you also want to take care of your health and then boom you get hormonal changes and menopause so it is a bit of a it's it's a different age to navigate in some way is and what a lot of women report is that one they have no time to take care of themselves and number two sometimes that the reasons are outside of your control like this fatigue that so many women report the lack of sleep or uh that that is a bit of an issue when it comes to feeling energized enough to also go to the gym so there are some barriers and um I think it's good to to be creative if you can right and also realized then you don't have to wear fancy clothing you don't have to go to the gym it's good enough to go for a walk in the park just keep your body moving is there a certain type of exercise that is um too much can you can you do too much exercise CU I don't want people that are listening to this now that are in that phase of life to just suddenly start running marathons every single day or something thinking that they'll be able to save off menopause I think that's that's actually what most people hear when you say exercise is really good for you and they see themselves like oh my God I have to join the gymm and just work out three hours a day that's not what the research shows because your cortisol levels would go up as well yes it may happen and also your recovery time may increase okay especially after menopause but what Studies have shown is that in this case there's an inverted u-shape relationship between intensity of exercise and health gains and I'm not talking about Fitness or muscle mass I'm thinking about overall health how health you how healthy you actually are as a whole and with the research in women especially women who are recently postmenopausal of 50s 60s what the research shows that if you don't exercise at all obviously there's no gains but as soon as you start even just in mild intensity the gains start increasing and the peak of the curve is for a moderate intensity regimen at high frequency which is which is you work out in a way way that brings some pink to your cheeks and you may have a hard time singing but you won't have a hard time talking okay so your heart rate goes up but not so high up that you can't breathe physically actually and there's different intensity intervals of course uh Rich Roll called the he said to me this is what professional athletes called zone two okay so Zone to everyone okay but if you increase the intensity a lot more more the gains actually start diminishing after menopause which is not Universal there's plenty of women who can do beautiful things physically but on average what that suggests is that just do the best that you can try to shoot for this zone two or moderate intensity exercise just do it often enough that the gains are consistent and as it relates to alzheimer's you talked about those Alzheimer's plaques in the brain yeah if I exercise more do women in that exercise more have less of those Alzheimer's plaques yes yes you do have few Alzheimer's plaques and also what the research shows is that women who are physically fit in midlife have 30% lower risk of Dementia in old age as compared to women who are sedentary in midlife so that's also really important to have because if I had a pill that can reduce your risk of dementia Alzheimer's Disease by 30% I would be rich and everyone would buy it you should become a personal trainer yes pretty much but the prescription is try to exercise at least the moderate intensity um level but do it consistently enough which means three to five times a week so let's talk about your um diet then your diet regime as you prepare for that phase of life let's start with caffeine oh yes I switch to decaf You Don't See to everybody's anguish in my house yes are you already switched to De CF why because caffeine is a little bit of a trigger for Sleep disturbances for a lot of women and what people don't realize is the caffeine is not just like the cup of coffee that you drink at the moment although you do feel a little bit of the energy rush but what happens is that caffeine um stays in your system and in your brain for a really long time so the half life is six hours which means that six hours after drinking that cup of coffee half of the caffeine will still be in your system and the fall life is 12 hours so it effectively takes 12 hours to get rid of all the caffeine from your body and your brain which also means if you drink a cup of coffee at noon some of that caffeine is still going to be in your system at 10 p.m. right and if you drink a cup of coffee at 2 p.m. half of the caffeine will be in your system by 800 p.m. and the quarter of the caffeine will still be circulating everywhere in your body and brain at 10 p.m. so you can't just have a cup of coffee at 2 p.m. and then hope for a good night sleep unless you go to sleep late which I can't afford because I'm up at six so could could one also argue then that coffee is going to increase because if coffee is still in our brain you know if I have a coffee at 9:00 p.m. you know people used to have coffees after dinner isn't that mad yeah they still do that in restaurants they they you eat your food and then they come around and ask if you want an espresso absolute Psychopaths I have no idea it's so crazy they don't ask as much anymore but to digest this is again is the idea of optimizing for one thing without realizing that you're de optimizing for another so you improve digestion in some ways but you're disrupting your sleep cuz it's waking your body back up and going go on yeah just before you need to sleep right so if I have a coffee say 600 p.m. 7:00 p.m. 8:00 p.m. at night M and midnight you still have to half at the caffeine which means I'm not going to sleep as well which means my brain isn't going to um do its job of clearing things out and restoration that's exactly why which is going to increase my chance of demension Alzheimer yes yes because what happens is then um the brain needs to go through certain stages of sleep and there's one stage of sleep that is called a slow wave or deep sleep which is really the only chance that the brain has to clean itself up it's like your brain's me time where the rest of the body is completely still which is really important because even when we're sleeping during the other stages of sleep the body can still move and that means that the brain needs to be partially active to control that movement and initiate that movement so deep sleep is really the only chance that your brain has to take care of itself from the inside out and there's a system inside the brain that's called the glymphatic system that gets activated only during slow wave sleep and it's like a car wash in know way it's like a dishwasher there's like Jets of fluid that goes everywhere inside the brain and clean it up and remove all the waste material so all the toxins the byproducts the waste products the Alzheimer's fragments they get cleared during that stage of sleep so if you miss out on that window which is most people tend to do because a lot of eyes unfortunately tend to wake up at like 2: 3 in the morning when we should be in deep sleep but we're not because we wake up and then you miss out on that cycle because the brain starts again from cycle one from stage one so sleep is super critical here it is really important there must be a pretty strong link between people who don't sleep much and Alzheimer's as well then there is a link yes it's been explored and it seems to be consistently significant across studies and is there a relationship with alcohol and menopause yes alcohol unfortunately is a trigger for some of the symptoms a menopause it can make it can really make them worse my biggest concern is that alcohol is a dehydrating substance it's def functional is one of the main functionality of alcohol as a molecule is dehydrating and dehydration is a problem for brain health so the brain is 80% water which is more than everywhere else in the brain and water is crucial for every single chemical and cellular reaction to take place inside the brain so the brain is the one organ that is especially sensitive to the effects of dehydration where even a two to 4% water reduction of water volume loss can prompt neurological symptoms the headaches and migraines and dizziness and brain fog so actually alcohol by dehydrating your brain and those sticks around in your brain for a long time can make some of the symptoms of menopause worse but also at any age it can really have a bad impact on cognitive function there's some studies that I find very interesting where people studied the effect of hydration on cognitive performance and they showed that if you have two groups of people who need to do certain mental tasks like neury testing and reaction times Compu I tests that measure your pressy speed and if you give one group a glass of water or a couple of glasses of water before taking the test they actually perform 15% better than the group of people who didn't drink any water prior D I need to start drinking water on this podcast yes and look yes you should and I will also say that water isn't just water right A lot of people drink purified water that's not water that's just fluid so your brain doesn't just want some wet it wants water with electrolytes and minerals and salts because it's the combination of these factors that really supports hydration so tap water is fine as long as it's clean right and one thing that we did at home is that we install this ginormous filter for the entire house where the water is now filtered in a way that removes removes all the impurities but preserves all the electrolytes what else have you done sort of scientist slab of a house that you're building this you mentioned toxins I'm a little bit strict sounds like and yes so there's no plastic in my kitchen not at all everything is just glass why because plastic is really an issue it's a very very common contaminant and pollutant and what happens is that when you heat it the particles can penetrate into your food and drinks and beverages but also in the M also when you put plastic in the dishwasher right the hot water will make it leak and then it leaks into your plates and glasses and what not and then you drink it right back or you eat it right back when you put plate food on a plate so pollutants in general accumulates in an organism concentrate in an organism by bioaccumulation which means that you start a lower doses by they stick around for a really long time so they keep piling up over time and that's especially an issue for women and for children but for women in particular because we have more body fat than men for instance and pollutants tend to accumulate in body fat especially breast tissue so they've been linked to an increased risk of reproductive issues like reproductive infertility endometriosis thyroid disease and more recently to dementia as well not plastic in particular but pollutants in general breast cancer breast cancer yeah reproductive cancers as well and you could never say it's 100% this or that but the fact that there is a strong Association is reason enough for me to stay away from plastic and what else what do you put in your mouth in terms of food uh so there's plenty of research showing that the brain really wants and needs very specific nutrients to function at its best because the reality is that when I was studying my favorite class has always been neurochemistry and I was learning about this all these different molecules and all these different chemical reactions that are so important for brain function and neuronal health and whatnot and then I realized well we're really looking at potassium and sodium and magnesium and omega-3 fatty acids and protein and glucose and those are nutrients so the nutrients that we obtain from the foods that we eat literally become part of the fabric of our brains so every day we have a number of opportunities breakfast lunch and dinner to either make a smart choice that supports her brain health or the opposite and feed her brain garbage that is going to be unfortunately Incorporated in the fabric of your brain and I don't want that brain I don't want that for my brain exactly so it's really important to focus on clean Foods the nutrient dense and they prioritize the nutrients that your brain wants the brain is not a sponge I keep saying that because I think there's some confusion in the world where people think that whatever you eat can have a direct impact on brain health for instance I learned that individuals who really are interested in brain health would say things like the brain is mostly fat has a lot of cholesterol which is true therefore you need to eat a lot of cholesterol to support the fatness of your brain which is absolutely not correct the cholesterol from the diet can never get inside your brain there's no way for that substance to actually get inside your head I mean your head yes but not inside your brain so eating cholesterol rich foods will not help your brain at all eating antioxidant rich foods will so the nutrients that your brain really relies on are anti an oxidants like vitamin C vitamin E selenium betacarotene um things that you find in fruits and veggies basically and some nuts and seeds preferentially uh lean protein so amino acids the essential amino acids and polysaturated fatty acids which can be from plant-based sources or animal sources but they really have to be the poly ins saturated fatty acids that the brain really wants and needs and need to be replenished consistently so you're saying if I'm on if I'm struggling with menopause then I should be aiming at the Mediterranean diet pretty much yes thank you that's the bottom line so a Mediterranean style pattern seems to be correlated or at least associated with better outcomes overall for Women's Health what about supplements supplements are typically used to supplement a healthy diet not to replace it and I think that's important because the Le here there's a tendency to recommend really high doses as supplements to everyone across the board but we do know that supplements only work if you have a deficiency or at least a subclinical deficiencies whereas giving high dose is something that your body or let's let's say the brain at least I just stay in my Lane but high dose is something that your brain doesn't want or need they're not going to be very helpful you're just going to either pee them out or do they're just going to accumulate in other parts of the body so they're not as helpful because everyone that talks to me about the brain talks to me about omega-3 as a supplement that I should take for every time I take omega3 I think I'm doing my little brain a favor you may or may not so the research shows that the brain seems to need a certain amount of omega-3 fatty acids that are between three and six grams per day now if you're able to obtain that from a diet then maybe supplements are not necessary but if you're not then supplements may be helpful Omega-3s yes those are the poliner fatty acids that the brain really needs antioxidants as well I I take vitamin C oh okay so you are on the supplements you were just trying to keep them all to yourself no I'm joking wasn't well I you know what I really like is more extracts okay and Botanicals okay I'm not a take my pill kind of person I I actually get quite annoyed when I need to take pills I just don't like it mhm I think because I work in a hospital right so I associate that as being sick so I don't like that feeling but what I really enjoy is to get my nutrients from either extracts or concentrates from plants and veggies and fruit so in the morning the first thing I do is that I drink water immediately but also then I have non juice which is a sometimes you give me the eyebrow you're just yeah yeah yeah no no juice no n o n i a wonderful juice from the Pacific Islands that has a little bit of a bitter taste which is always good because beers are really good for digestion and gut health and that's important for brain health and and elimination as well and clearance and is very rich in vitamins and minerals and a lot of phytonutrients so that's a good concentrated source and this mixed with blueberry juice so that's that's also really good to have one of the things I found quite um fascinating is I read that there was a study done on legumes that proved yeah yeah it was in your book it was in chapter 14 where it says there's a legumes apparently to be seem to be a bit of a miracle food for delaying menopause yeah so a diet that is rich in legumes and also fish fatty fish yeah has been linked with the later onset a menopause by how much 3 years whereas women who follow the standard American diet like the said diet with more lots of sugary Beverages and processed foods and package meats and whatnot that's been linked with an earlier onset of menopause by about three four years and the last thing you want is to go through menopause earlier in life if you don't have to right I was reading as well in your book that um women who do con consume enough omega-3 may experience different types of menstrual pains and fertility issues and stuff is that true yeah well the research shows an association between consumption of omega-3 fatty acids and um well also lower risk of depression in recurrent depressive symptoms in menopause as well as better fertility overall and the same for antioxidants antioxidants have also been linked with the gentler menopause overall and fewer menstrual crams and less pain uh and the lower risk of premenstrual syndrome as well I all of this begs the question because it seems that the human body is designed if you believe the theory of evolution which I do to be very smart and to do things for clear and obvious survival benefit and reason but when I think about menopause it you know it's hard hard to see on the surface what the evolutionary reason for such a process is why does it happen why don't women just you know why don't women's estrogen levels just stay the same throughout their life until they die and you know because it seems to be the case that it's not the same for men so is there an evolutionary basis for everything we've talked about today the theory of evolution was developed by Charles Darwin who did not love women oh really yes let's move on then and the theory makes sense if you're a man but not if you're a woman because the theory of evolution says that pretty much the only reason to be alive is to pass your gen On to the Next Generation so the fact that women will stop being reproductive in midlife and be able to live after that is clearly against the classic theories of evolution but I I was thinking about this and I was thinking well is it is it not just because in the what 1700s 1800s the average life expectancy was like 35 40 yes but there was a notion already back then that women who were able to live past that age at some point in their lives would stop being reproductive and hopefully remain alive so for this is what I will tell you that if you're born with ovaries that menopause seems to be just a fact of life there is an understanding that at some point your ovaries will stop ovulating and you'll go through menopause but in reality menopause is a biological puzzle is a big question mark because most animal species in most animal species females actually die right after menopause so your life pin as a female animal tends to match your reproductive pin which is what Darwin was talking about now this Theory only makes sense if you are not able to outli menopause and there are two different theories when it comes to menopause there are people who like Darwin say well women should just die or women areos were supposed to die after menopause like all other animals on the planet except just a few like killer whales for example killer whales are able to leave live long past menopause or do some elephants and some giraffes and some insects interestingly enough but then there's another theory that says no no no it's not just medical improvements are supportive women and enabling women to live past menopause the reality is that menopause makes sense for a number of reasons and this is called the grandmother hypothesis and what this hypothesis says in a nutshell is that evolution is much more complicated than what Darwin was thinking perhaps and what makes more sense if you are a woman and you have to bear this children you have to grow a child and there's a strong risk of dying from child birth the older you are and there's also a risk to The Offspring to the children the older the mother is then it makes a lot more sense to stop being reproductive as simple point in your life and remain alive to help your daughters and your sons and your grandchildren by providing all the resources that they need for them to outlive you know to keep on going and keep having children so the theory is that there at some point in the course of evolution where our ancestors were still cavemen that the strongest women who were able to live past multiple pregnanc is the most fit of women at that point somehow underwent these mutations that enabled or perhaps that were able to activate it to activate their longevity genes where their bodies evolved to be able to outlive menopause by many many years if put in the right environment of course and that means that yes you're not passing on your own personal genes to the Next Generation but you are effectively stepping into the role of grandmother and caregiver and that helps your own children have more children and then you're going to make sure that your grandchildren don't die because you're going to be there to provide for them this is very important when your babies can't really take care of themselves for a really long time like human babies can't they're basically helpless for many many years the parents had to keep providing for them the grandparents had to keep providing so that makes sense for humans that women will stop being reproductive but will keep being productive and stay alive and anyone who's ever had a grandmother would know that that's very very important to have so this idea that menopause is actually an issue because we're living longer yes I really don't that that well some people think it's true some people think it's not from what I can see clinically our bodies have this unique capability to really remodel themselves and change themselves to adapt to menopause our brains rewire our bodies rewire and the idea that there is such a mechanism in place suggests adaptation I'm going to let you in on a little secret what is in the DI of a COO Cup this cup that sits in front of me when I interview these people sometimes for 3 hours and sometimes three people day and the answer is this perfect de I invested in the company on Dragon's Den and since then they've gone from an idea to the fastest growing energy drink in the UK it is a mat energy drink and it is absolutely delicious but that's not why I choose to drink it on this podcast the reason I choose to drink it is because it gives me what I call all day energy I don't get the same crashes that I used to get with other energy drinks if you're in the middle of a conversation or you're in the middle of a talk on stage or in the boardroom the last thing you want to do is a crash you don't want Jitters and you need focus and that is why they now sponsor this podcast not only is it delicious but it gives me a significant competitive Advantage if you haven't tried it go down to a Tesco go to a waitrose or go online and use the code diary 10 a checkout and you'll get 10% off and when you do try it let me know how you get on I think I read in your work that a woman is never happier than in that postmenopausal phase than in any period in her life an average Maybe because she's dumped him or she's had the divorce maybe that's why that's true though isn't it that a lot of women do do go through divorce in that phase of Life they it seems like the number of divorces increase exponentially that point in life know what they want a little bit more yes I think that you know that comes up a lot also in our research but mostly in psychological research there's something that seems to happen in part it might be Aging in part you're older you know better but there's also something that happens neurologically where this not my work but other people have shown that there's one part to the brain called the amydala that's in charge of emotional control it's like the center the emotional Center in the brain and after menopause it gets quite selectively turned off in a very special way where emotions like sadness or anger don't hold quite the same charge so your amigdala doesn't quite fire as strongly when something negative happens to you but it keeps firing just as strongly when something good happens to you so the ability to sustain joy and potentially contentment and just wonder is if not Amplified is certainly stable and that's been linked with better emotional control after menopause and those emotional Transcendence that in the words of many of my friends is really more like giving fewer FW I've actually got a graph graph that I found in your work that shows that by the time women are in their 60s they're sta statistically they've never been happier yes well so it depends on the studies right and that's always an average so these Studies have measured life contentment as a function of menopause look we have the graph here if you want Oh at the graph yeah yeah yeah perfect so this is what these Studies have shown and of course it's not Universal it's never Universal there are women who are miserable before and after menopause and women are happy all the time but there seems to be again a little bit of this U curve and then suddenly where life contentment is whatever it is is Baseline over here and then it takes a dip during the transition to menopause when a lot of women just have a hard time you know I think it's it's import important to acknowledge that but then life contentment goes back up see that's the window before like the three to six years after menopause when things are still not quite perfect you're still adjusting but then it looks like it's going back up and this is the late postmenopausal phase where usually the symptoms go away and you feel more like yourself again or you feel better overall and life contentment tends to increase you have some other graphs on there you have another one uh that shows the impact of you call surgical menopause yeah do you want to see that yes please yeah what many people let's just be honest nobody talks about surgical menopause right um what happens sometimes very often actually is that women need to have their uterus removed with or without the ovaries often enough before menopause these are very common surgical procedures in fact a hysterctomy the surgical removal of the uterus is the second most common surgery for women in the United States after the C-section that's one in women either one in eight or one in nine depending on the statistics and what happened historically is that until 2008 so very recently professional guidelines of medical societies recommended removing the ovaries all the time as part of a hysterctomy so let's say that you go to your surgeon because you need to have the uterus taken out sometimes it's because of cancer more often than not is not because of a malignancy but it's more for things like endometriosis or benign reasons up until 2008 the surgeon will say no matter the woman's age as long as you're done having children the ovaries are redundant don't really matter let's just take them out so in 2004 of the over 3 million women who had their uteruses removed in America over a half also had their ovaries removed without a medical reason to do so it was just common practice to say well I'm in there let's get rid of the ovaries as well why because it's a smoother it's a more straightforward surgery and also that reduces the risk of developing ovarian cancer in the future while that is true the r risk of ovarian cancer is relatively low for women who do not have genetic risks or a strong family history but what people were not realizing is that surgical menopause this procedure of removing the ovaries in women who had a menstrual cycle would effectively plunge a woman into menopause almost overnight and the consequences are far more severe than going through menopause as part of the aging process and the tall on the brain is actually significant because surgical menopause has been linked with an increased risk of cognitive decline and dementia parkinsonism stroke and major anxiety and depression so this is something that we need to talk about in 2008 the American College of um Oban surgery changed their recommendations saying that they now recommend and preserving the ovaries whenever possible now this is not a strict medical guideline it's a recommendation which means that you've reached different people at different places at different times and still today a lot of Surgeons advise their patients to have the ovaries taken out even when the ovaries are healthy because of surgical considerations without necessarily thoroughly explaining the possible side effects of that procedure and look this is not to say that women should decline medical advice but it really calls for an informed conversation where you go to your doctor and say well why should I be taking out my ovaries now and what are the consequences of doing so and if I do it what do I do to feel better because the symptoms of menopause may be more severe and we know that that's no picnic and then we need to consider the increased risk of these other medical complications like an increased risk of osteoporosis and heart disease and brain and neurological disorders so this is something that we need to talk about and this is what I wanted to to show you which we've just done this study I I'll say to everybody that's watching um the podcast it's on the screen but for those that aren't watching the podcast because you're listening and you walk in the dog or whatever all of the graphs and images that we're talking about will be listed in the description below so you can click on them and take a look for yourself so this is something else that we're doing for the first time as far as I know at least to my knowledge which is to do brain scans in women before and after an ectomy the evidence that we have so far is more clinical so we know that ectomies are associated with all these risks or neurological disorders but to my knowledge there are no studies did are really looking at women's Brains before and after the surgery if there are any I haven't seen them send them to me I would love it this is what we are seeing in our own cohort and population so this is one woman uh who's been working with us for over a year and we had done three sets of brain scans the first brain scan before the surgery like a couple of weeks prior the second brain scan six months later and the third brain scan one year after the surgery this woman is not taking hormones and we are looking at the brain's gray matter right now and when you see I we're also showing parts of the brain that is losing gray matter and those are shown as blue blobs I would say there are blue spots okay over the brain scans which show the parts of the brain that are losing volume so this is the Brain before for the surgery this is the brain 6 months later and this is the brain one year later where all these parts in light blue are parts of the brain that have lost gray matter her ovaries were removed and the gray matter of her brain shrunk has diminished has it seems to have disappeared in some parts of the brain is thinning quite a bit and these are statistical maps that I'm showing so these are regions where the change is statistically significant okay but that you know there's an overall thinning and it just goes to show that that relationship between the ovies in the brain and this is very direct because one of the things that been happening to us for a few years now that we studying menopause is that there's push back that what we're seeing is not menopause it's just aging and look I show you one more thing that we've done to say no it's not actually just aging it's much more like to be menopaused and aging so now we have women who are exactly the same age these are all women who are 50 years old one has a regular menstrual cycle one has irregular menstrual cycle she's in per menopause and this woman is also 50 years old and does not have a menstrual cycle do you see the differences I mean yeah their brains look completely different thank you and they're all exactly the same age drastically different so the the lady there in premenopause her brain is really really illuminated um and then the same a different lady but the same age in post menopause I mean yeah if it looks like it kind of looks like the lights have gone down you can see this just by eyeballing a brain scan it's crazy and again these are three cases and we now have more and more women so we're going to do a statistical examination a group differences but still it you can't tell me how you feel this how do you cuz you you know you've got the scans you've done the work and then you must look out into the world and see a narrative which you know is wrong how does it make you feel I mean you know as a scientist that's the whole process you do things and then you wait for other people to replicate what you have done but you know there's women right now that are suffering I know that is because they're misunderstood but it's also really important for the research to be substantial enough to really be sure that this is menopause that you know we have hundreds of women in the study I would love to have thousands right and the more people look at this question from different angles in different countries with different populations and they higher our confidence that what we're seeing is actually menopause and if she had taken in the last graph you showed me in the last image you showed me with the three women same age different phases of menopause if she on the right who was in postmenopause had been on hormon on hormones I don't know she's not on hormones that's why I'm showing their skins but we're also looking at that we're also doing clinical trials to test whether hormone therapy uh can change this brain scans so this is another thing that's quite upsetting as a woman and the scientist um the only clinical trials have have looked at the effect of hormone therapy on cognition or using brain scans have been focused on women who are past menopause there isn't a single clinical trial that uses brain scans to test the efficacy of hormone therapy in women who are per menopausa for example which is bizarre to say the least so we started we're doing one right now so we have an active clinical trial where so the other concern is that hormone therapy has this terrible reputation for being linked with the higher risk of breast cancer right and that's been addressed and professional societies are saying actually whatever risk increases very small and it's actually a rare occurrence but there's there's history there's history and a lot of women are just scared of taking hormones and so what we're doing we're working with an alternative which is an estrogen designer estrogen is a designer estrogen I'm very excited about that so this is the new generation of hormone options hormonal options and they're called selective estrogen receptor modulators or serms or designer estrogens and the one we're testing is called the neuro serm is a serm is an estrogen for the brain that's been very specifically developed by my colleague Dr Roberta D Brinton at the University of Arizona she's a genius she's an absolute Rockstar in this field and she's been studying estrogen in the brain since the 199 is and she's amazing and she was like okay I am tired of hearing that people won't take hormones because of this this problem with the breast cancer link and the association we're going to start fresh and she went back to the bench and she worked for 15 years and she came up with this formulation of this new type of estrogen supplement actually it's more like a supplement than a medication that goes straight up to your brain it's like a little GPS for your brain and leaves your breast Ries alone so this selectively improves brain function while having no impact on your breast and reproductive tissues which means that can either have no effect on cancer risk or actually reduce the risk of cancer while selectively supporting brain health and now we're testing it with brain scans we do cognitive testing we do all sort of evaluations and we're actively enrolling participants so if anyone is interested we're looking for p menopausal and postmenopausal women with hot flashes specifically women who have at least seven or more hatot flashes a day who might really benefit from this treatment in a short amount of time who are willing to work with us in New York City and everything is sponsored by the ni the National Institute on health is a phase to randomize Placebo control clinical trial which means it's one of the most thorough clinical trials you'll ever get a headache for us how do they get in touch with you if they want to take part they can email my team can we share their email yeah yeah we'll put it on the screen afterwards so everyone can see it while you're finding that I wanted to share something from your book that I found to be quite fascinating there's a section where you talk about um how to predict when a woman will go through menopause and I pulled out a few things I found fascinating here which I'll probably be speaking to my my partner about said the best predictor of when a woman will go through menopause is when her mother went through menopause that's right and the experience of the symptoms of menopause is similar to for mother and for daughter another indicat is a woman's experience during puberty or pregnancy for instance if they have mood disturbances during puberty or pregnancy they are likely to have it for menopause that's right so maybe we should be having conversations with our mothers if we're women um to understand their experience with menopause because it might be the clearest indicator um of our own potential future experience that's right it gives you a sense of when you might be going through menopause what kind of symptoms you may be having and then you consider your own medical history so if you ever smoked cigarettes for instance you may go through menopause a little bit earlier in life than your mom has or if your diet is not very healthy same considerations or if you don't exercise at all those are all factors that um reduce the age of onset of menopause so you may go through menopause earlier on but it's always good to talk to your mom so that's really my my best advice here is ask your mom because mothers just you know it's really bizarre how very few at least for my mom's generation nobody would talk about menopause my mom talked to me about puberty and periods of course because you have to be prepared need to know what to do she never once mentioned menopause until I asked so how how was it for you what age you know should I should what am I expecting what's going to be in store what what's in store for me and I think it's a good conversation to have ahead of time so then you have time for you know to prepare you should talk to your girlfriend I'm going to I mean I had no idea about all of this stuff so it's um thank you so much for for sharing it in the way that you do and doing the work that you do because you're really shining a light on an uh a very unilluminated part of life that I think by 2025 they say that a billion women are going to be experiencing or have gone through manipa which is crazy a billion people that walk amongst us that's what one one in8 one in N people are currently going through or have been through menopause at that stage and that that means that someone in your life is going to go through this your mother your partner your your daughter whoever it is so being um armed with this information helps us to be I think better supporting um acts to those people but it helps us to understand ourselves better and helps us to be more empathetic and to know how to to show up for those people even if we're not one of the the people that will be going through menopause ourselves and that's allowed me in my own life to understand people in my life that I maybe didn't understand before I thought well they're acting strange or their Behavior's weird or they're being a bit weird and you can sometimes isolate those people and the stats show that you know the suicidality amongst that age group of people that are at sort of 55 plus is probably so high in part because they're confused they don't have the answers and those around them don't have the answers so they can be shunn they can be rejected they can be misunderstood and that's exactly what your work confronts and it shines a really important unique light on the brain which I had absolutely never thought about before never considered never seen the scans and now I have a better understanding of the full um physiological process that's going on when people go through the different stages of menopause Dr Lisa thank you so much we have a closing tradition on this podcast where the last guest leaves a question for the next guest not knowing who they're going to be leaving it for and the question that has been left for you if you could have one last conversation with your parents what would you say goodness my parents are here right now oh one last I would just say thank you thank you for everything thank you for being there for me my entire life and thank you for being my my 100% backup plan you know I I feel so fortunate that my parents are such good people and they've always been there for me I never had I never worried about not knowing where to go and when I was little I didn't fully appreciate that but now I really do I appreciate it so much that I I never felt on my own I always felt like I had a safety net both financially legally physically and mentally and it's just it's such a blessing and I would just say thank you I love you so much and I I'm sorry that that was difficult when I was a teenager but I think I redeemed myself you certainly have thank you so much for all the work you're doing and behalf of all the people that I have to say this I amum last had a conversation about menopause I for people that don't realize how sort of impactful this is the top comment on the video was had I not found these videos I would have been convinced that I was dying heart palpitations migraines itchy skin insomnia pure rage crying spells the list goes on I'm 43 and I literally do not recognize myself and the other top comment was sweating I can deal with hot flashes I can deal with what I can't deal with is the paralyzing fear anxiety depression and fatigue there the two top comments on the video about menopause and I think that's why it's so important for us to keep having these conversations to stigmatize it to inform ourselves and then to by doing so push the research forward push attention push investment forward in this subject it's so wonderful that you're working on the designer estrogen um because again that if that if that is successful it will help to change even more people's lives so thank you so much Dr Lisa thank you thank you so much for having me and for doing this really appreciate it a [Music] [Music]

Channel: The Diary Of A CEO

Views: 321,165

Keywords: The Diary Of A CEO, steven bartlett steve bartlett, podcast, the diary of a CEO podcast, life lessons, CEO

Id: Cgo2mD4Pc54

Length: 119min 14sec (7154 seconds)

Published: Thu Jun 13 2024