Dr Lisa Mosconi: So for women's brains, as you go through menopause, your brain literally loses the superpowers of estrogen. And then the opposite happens. Your neurons slow down and start ageing faster. And studies have shown that the loss of estrogen in the brain even perhaps triggers, perhaps coincides with the formation of Alzheimer's plaques in a woman's brain.
Dr Rupy: Welcome to the Doctor's Kitchen podcast, the show about food, lifestyle, medicine and how to improve your health today. My name is Dr Rupy. I'm a medical doctor, I also study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me on this podcast where we explore multiple determinants of what allows you to live your best life. And remember, you can sign up to the doctorskitchen.com for the newsletter where we give weekly recipes plus tips and hacks on how to improve your lifestyle today. For the third instalment of our four-part series on how to reverse ageing, my guest is Dr Lisa Mosconi. Someone I've been a massive fan of ever since her first book, Brain Food, that she sent to me a number of years ago, and has now written a second book that I think is arguably better than her first, and that takes a lot, honestly. It's called The XX Brain and it's about the groundbreaking science that A, recognizes and encourages people to recognize the gender differences when it comes to the risk of Alzheimer's disease, but also the knowledge that can empower women in particular to maximize cognitive health and prevent Alzheimer's disease. She is the director of the Women's Brain Initiative and associate director of the Alzheimer's Prevention Clinic at Weill Medical College, where she serves as associate professor of neuroscience in neurology and radiology. She's also a faculty member in the department of psychiatry at NYU School of Medicine. She's the perfect person to be talking about the subject, someone who has studied neuroscience, neuroimaging, and something that really does permeate through everything that she talks about is her holistic nature, the fact that she talks quite openly about meditation, food, as well as all the plethora of tools and adjuncts to conventional medicine that we have. Now, there's some pretty hard-hitting stats about how women are far more likely to suffer from anxiety, depression, migraines, even recovery from brain injuries, traumatic brain injuries, strokes, as well as Alzheimer's disease. So this podcast episode isn't just about Alzheimer's, Alzheimer's per se, it's about how women are at greater risk because of underlying mechanisms that are related, quite frankly, to the menopause and menstruation. Now, there are some facts that I really did not know about before. This is a real eye-opening podcast episode for someone like myself who works in primary care and in emergency medicine as well. So it's a brilliant podcast episode that I think has as much benefit to the male listeners as well as the female, but particularly for female listeners of the pod. We talk about a number of things, bikini medicine, her personal story of Alzheimer's in her family, why women's brains age distinctly from men's, as well as the symptoms like brain fog, depression, stress, insomnia, all of which can have some root in hormonal imbalances and how we can rebalance and actually create equilibrium within our bodies using lifestyle adjuncts. We talk about the key brain protective hormone, estrogen, something that I think a lot of people don't recognize as having key brain benefits. And we also talk a bit about abandoning the one-size-fits-all model of medicine that we currently practice in the NHS and across healthcare systems globally, actually. We talk mostly about evidence-based methods for protecting the female brain, which I think has relevance to our male listeners as well. We talk about the evidence-based methods for protecting the female brain, as well as what I believe has relevance for male listeners too. Diet, stress reduction, sleep, the microbiota, we touch on HRT therapy, but something that we're going to be talking about on a whole podcast episode more, giving it a lot more attention. And we do talk about Kundalini yoga in particular and the different types of practices that can reduce stress and actually how the stress response of females is vastly different to that of males. And again, is a product of male-dominated scientific research, something again that I didn't realize was this prevalent until listening to Lisa, and I'm definitely going to be paying a lot more attention to this in future episodes. Remember, you can catch all the things that we talked about on this podcast episode on thedoctorskitchen.com/podcast. Check out the episode show. Please check out my guest's book, The XX Brain. It's a wonderful read. It certainly will have benefits to many of your loved ones. And as I know a lot of listeners are female, I think this is definitely one of those books that will be timeless, as I said right at the start. So without further ado, please enjoy my conversation with Lisa Mosconi. I think the way the book is written, it's a timeless piece of writing that I think will help people over the next 5, 10 years. As I'm sure, yes, there will be more research, particularly to do with the personalized medicine section, but I think the classic stuff, like you describe the classic diet, for example, the Mediterranean diet, you describe like a lot of lifestyle principles that I think will hold true for years to come, if not decades. So I think it's going to be one of those books that will stand the test of time.
Dr Lisa Mosconi: I sure hope so. The research is very new, but it's very solid and it's ongoing. And I think it just really, it's not about trends. There are a lot of books that are trending, but what my work, because I'm a scientist, what I'm interested in is just reality as it stands. So something that doesn't change tomorrow, that does not change with marketing, that does not change with politics. So we really, we really want to understand how women's brains and bodies work and how to optimize them for the long term. And I think what's really interesting, at least for me, obviously it's my research, is to see the differences between women's brains and men's brains in a way that is completely unjudgmental. It's not that we're better or worse, we're just physiologically different. And women's brains have not been studied for so long. So we're really trying to change that.
Dr Rupy: And you'll stop me because I tend to really.
Dr Lisa Mosconi: We can get excited and talk.
Dr Rupy: I won't be stopping you at all. I'll be listening to every word and I'll try to minimize interruptions. But I love the way you described it as, as a scientist, you approach things with an unjudgmental perspective, particularly, I guess, as one of your interests is, well, your PhD was in neuroimaging. And so that's a way to really take a deep dive and have nothing on the out surface. You're just looking at scans and you're matching that with clinical pictures.
Dr Lisa Mosconi: Yes. So I'm a neuroscientist, I'm a brain scientist by training. And I've been looking at brains for 20 years, which is a long time. I started really, really young, if you will, because my parents are nuclear physicists, both of them. And my mom was teaching nuclear physics to students who, number one, were babysitting me on weekends. And number two, they transferred to medicine, to nuclear medicine, to really man up all the machines. So they were running the cyclotron, which is fascinating. And they had access to all these incredible technologies. So as soon as I went to college, really, it was my first year in university, and I said, can I volunteer? And they said, sure. They knew me, they trusted me, of course. They knew that they could just let me in the head if I didn't do anything wrong. And it was great. And I've been looking at brain scans since. And it was really at the same time that my grandmother started showing signs of sharp cognitive decline. And back then in Italy, there weren't a lot of resources to really help and support patients with a dementia diagnosis. There was very little you could do. And then just within a couple of years, her two younger sisters also started to show exactly the same symptoms, whereas their brother did not. And so basically, my grandma was one of four siblings, three sisters and one brother, and all three sisters developed Alzheimer's disease and died of it, whereas the brother did not. So obviously, it was very shocking for me, and I went to my, I was doing a PhD at that point, and I went to my supervisor and I was like, well, is it just me? Is it my family? Am I doomed? Is it genetic, or is there like a bigger lesson that we can learn from my own family? And back then, the answer is, I don't know. I don't know. People thought that Alzheimer's was essentially genetic. And they didn't really appreciate how the disease actually affects more women than men, regardless of your DNA mutations that cause Alzheimer's. And so now we know that Alzheimer's disease affects more women than men. So out of every three Alzheimer's patients, two are women. And that's really what I've been looking into using the brain scans that you mentioned, because we really, I really wanted to understand why, you know, what causes that? What can I do to avoid it? Not just for myself, but for my mom, for my daughter, for my friends, for all women in the world. How do we approach this? And I just slammed into so many different forms of bias and misconceptions and sexism, honestly, which is a form of discrimination that I've been dealing with for so long.
Dr Rupy: Yeah, you describe something that I've never, I actually haven't heard before, something called bikini medicine. And I remember reading it, I was like, I don't think I've ever come across this before. And I don't know whether it's from my own ignorance or whether it's something novel. I don't know, but I wondered if you could tell us a bit more about the term bikini medicine because it is one of those terms that's quite striking and it makes you, you know, you're not going to forget it once you come across it for the first time.
Dr Lisa Mosconi: Yes, it's a catchy term, for sure. But it's really to describe how historically medical professionals really believed that men and women were essentially the same person and that women were like smaller men with different reproductive organs, those parts of the body that you can fit under a bikini. Right? So setting those parts, those body parts aside, as if one could, really meant that medical professionals would diagnose and treat men and women basically the same way. The assumption was, if we're not treating your breasts or your ovaries, we're just assuming that your brain works the same way as a man's brain, that your heart works the same way as a man's heart, your lungs work, you know. So that is bikini medicine, which is really based on a fundamental misunderstanding of what a woman is to start with. We're not just different body parts that magically become a person. We're a different system. The physiology is different, the endocrinology is different. And now we're showing more and more that the neurology is different as well.
Dr Rupy: Yeah, and this is why I'm loving sort of the journey that you're taking us on over your the last two books that you've done, Brain Food and now the XX Brain, because I think it's a natural transition into something that is as important, the differences between male and female. And something that, you know, is really stark. I mean, I remember coming across some of the stats that you've put in the book about how the differences are there for anxiety, depression, migraines, but also brain injuries, strokes, MS, autoimmune conditions, as well as Alzheimer's. And I'll be honest, like, I knew about the increased risk of Alzheimer's, but across the spectrum, I didn't know that it was that stark with those statistics.
Dr Lisa Mosconi: Yes, there are so many conditions that brain conditions, neurological and or psychiatric conditions that affect women more than men. There are some conditions that affect men more than women as well, right? We don't want to underestimate men's brains, of course. The problem is that women's brains have not been studied, whereas men's brains have been, exactly for the reason we were talking about before, where starting in the 1960s, in the United States, but in many ways also in Europe, women were actually excluded from medical research, especially from clinical trials. And all the research was done in men. So now we have entire bodies of research that are really based on men, where women are not in the research, and so they're not informing the research either. Right? And then you add to this the point, the fact that people really believe that women's brains are the same as men's brains. And the result is that women's brain health is still today one of the most under-researched, under-diagnosed, and under-treated fields of medicine. And that's a problem if you think about the statistics that you just mentioned, that women are twice as likely as men to be diagnosed with an anxiety disorder or depression. We're three times more likely to develop an autoimmune disorder, including those that affect the brain, like multiple sclerosis. We're four times more likely to get headaches and migraines, as every man knows. But we're also more likely to develop meningiomas, which is the most common form of brain tumors, especially after menopause. And we're far more likely to die of a stroke. Like a ruptured aneurysm is a major cause of stroke, and it's much more prevalent in women than in men, again, after menopause, as we get older. And on top of that, we have Alzheimer's dementia that we mentioned before, with a two-to-one ratio against women. Yeah, then we have a harder time recovering from a traumatic brain injury, and we have a harder time dealing with inflammation. It's just a whole number of things that we should be able to address and that should at least be acknowledged that really haven't been. That's also because there is no framework for women's brain health. Right? We have a framework for women's health that explicitly excludes our brains. Women's health is all about our breasts, is all about our reproduction. But our brains are just never mentioned. So there's a lot of education that needs to happen as well.
Dr Rupy: Absolutely. Yeah, no, no, I mean, I agree. I mean, you know, I think, I find this absolutely fascinating because even during my medical training, these differences in gender weren't demonstrated in this much detail. Like you said, it was, it was a lot about gynaecology, reproductive organs, etc, but not really in neurology and the other specialties either. You know, I went to medical school like 15 years ago, so fairly recently. And I doubt that it's changed much to appreciate those gender differences. And perhaps, perhaps you could talk a bit about your initiative, the Women's Brain Initiative. Is that, is that something that is trying to rebalance those gender differences in terms of research?
Dr Lisa Mosconi: I sure hope so. So, I've been doing research in this space for a really long time, and I had such a hard time getting funding to really look at gender differences in Alzheimer's disease and brain ageing. And then something happened just a few years ago. I think Me Too, the Me Too movement really helped, because of course, women's health was really born of all the progress in women's rights. And now women's rights are once again at the forefront. So it's really a great time for scientists like myself to say, you know, it doesn't take a scientist to denounce the fact that women's physical, legal, and professional security remain inequitable, but it does take a clinician or a scientist to denounce the fact that women are also overlooked medically. So let's try to make this known so that more and more women can demand this information. And then the NIH, which is our equivalent of your NHS, gets to hear about it and is like, oh, wait a minute, the press is talking about it, women are demanding information, this needs to turn into a priority. And so finally, I started getting grants and grants and grants, which is wonderful. And I was able to launch the Women's Brain Initiative at Weill Cornell Medicine in New York City, where on the Upper East Side, which is a research program entirely dedicated to women's brains, but also men's brains, to be honest. We're really, the goal is really to understand how brain health plays out differently in women than in men. And in order to do that, we need to understand women as being separate from men, and men as being different from women. You know, because now that we have women in the studies, most people just lump men and women together. So before, we had all this research with only men. And now we're still saying that men and women are indistinguishable, except, you know, there's some ovaries in there. So we can't do that. We really need to understand men and women as being somewhat physiologically different and neurologically different. And this is really what we're trying to do and we're we're making good progress and we have a number of publications on the topic. We have one paper coming out in just a month that really shows how women's brains age differently from men's brains. Yes, so our brains start ageing a little bit faster than men's brains during menopause. Menopause is a very important time for a woman's brain. There's again, so much stigma and so much bias around menopause that here's one more bump on the road for me, but it's something that we really need to address because menopause kind of triggers accelerated brain ageing in some women. And that means that for women with a predisposition to Alzheimer's, that's really when the predisposition becomes measurable in a woman's brain. We can see these changes happening, which is huge because number one is saying that women develop Alzheimer's disease earlier than men. And number two, because it really gives us a timeline where we're starting to talk about Alzheimer's prevention when women and men, of course, but especially women are in their 40s and 50s, not in their 60s and 70s, that we have to start talking about prevention in midlife. So there's a whole conversation that needs to happen and I'm very grateful to you for helping us spread the word.
Dr Rupy: Of course, absolutely. And I just want to double click on that for a moment actually, about the whole idea that Alzheimer's and other sorts of dementias are a product of old age, whereas in reality, these are, we lay the foundations for a healthy brain much earlier in our lives. And I wonder when and how we change the thinking around that in the, in the scientific world, in the academic world.
Dr Lisa Mosconi: Right. So that was like the first issue that I really had to overcome. Because when I started looking into that and I was asking, does it matter if you're a woman or a man in terms of your Alzheimer's risk? The answer was always inevitably, you know, sweetheart, women live longer than men, and Alzheimer's is a disease of old age. So of course, more women than men have Alzheimer's disease. And it took, I would say 10 years since I started to really dismantle that bias because on two different levels. Number one, women don't live that much longer than men. You know, in the United States, to qualify for that degree of difference. I mean, if you say women live so much longer than men, you you picture like 10 years, maybe four. In the United States is four and a half years, not 10 or 20. In England, it's actually only three years. And there's this wonderful paper in Lancet that I think scientists, well, from England for sure. I was going to say Oxford, but I'm not sure. They published this wonderful paper showing that the longevity gap is actually closing. In the next 10, 15 years, there's going to be no differences in lifespan between men and women in England, again, in the United States, maybe it's going to take a little longer, but again, the differences are very small. Not definitely, it's not such a big age gap to justify that two-thirds of all Alzheimer's patients are women. But then, I think even more importantly than that, a lot of studies, including a lot of my work, really show that Alzheimer's disease is not a disease of old age. We associate it with the elderly because people develop the symptoms usually when they're in their 70s. In the states, the average age of onset is 71. The average age at diagnosis is 71. But what we have learned is that Alzheimer's starts with negative changes in the brain years to decades before the clinical symptoms emerge. So it's not like one day, it's not like you wake up and you have a cold, right? It's not like all of a sudden, oh, I woke up in the morning and I have Alzheimer's. It takes a really long time for these brain changes, for the Alzheimer's plaques and the tangles and the inflammation and the neuronal loss to produce a damage so severe that then people develop the symptoms. So again, this brings us to midlife, which really completely changed the conversation, at least for me, to, all right, so if Alzheimer's starts in midlife, then what happens to women and not to men in midlife that could potentially trigger Alzheimer's disease? And that's how we landed on menopause, which I was completely surprised about. I was not anticipating that at all because we live in this society, in Western medicine where if you're an endocrinologist, you don't really look at the brain. Or let's say if you're an OBGYN, you don't think about brains. And if you're a brain person, you really don't think about menopause, to be honest. And so that was a big whoa moment.
Dr Rupy: Absolutely. And I can imagine like, you know, you as a neurology or neuroscientist, I should say, and suddenly having to explore the world of female hormones or hormones in general, I think it would have been quite a, you know, a revelation for you, right?
Dr Lisa Mosconi: Yes, it was like, oh no. So it begins. Another problem. Because there's so much confusion around hormones and brain health. Right? There is so much that we still don't know and there's so much that we need to better characterize and really understand. Like I think a lot of people don't even know that menopause starts in the brain. Whenever I talk about it, everybody's like, what are you talking about? Menopause starts in the ovaries. I was like, no, this is exactly the problem that we think about our bodies as separate parts that somehow don't even talk to each other. And so if you think about it that way, sure, it makes sense that menopause has something to do with the ovaries, right? Your ovaries stop making eggs, so you're no longer fertile. But if you think about, just think about the symptoms of menopause, the hot flashes, what kind of power do the ovaries have that all of a sudden you feel hot or cold? Right? There's no way. It's the brain that regulates your body temperature. So if you think about it that way, it's really is like the conversation between your ovaries that are telling your brain we're running out of follicles here, right? And then the brain responding with like, oh my god, there's no estrogen here anymore. The brain region that is in charge of body temperature being activated by estrogen, and then you get the symptoms. So it's a whole network that's getting dismantled or that is just not working as efficiently as before, that honestly, in my field is not like in textbooks. Just to be clear. You kind of have to go back to the basics. It's like, oh.
Dr Rupy: I find this, it's super interesting and I find this across different specialties that I study, right? Whether it's gastroenterology or even respiratory medicine, everyone finds themselves going back to basics, the deeper they dive. And I think, you know, your unique perspective as, so you're a holistic practitioner as well, is that correct?
Dr Lisa Mosconi: Yes, I don't practice. I run the Women's Brain Initiative. So what I do is that I do the brain scans on all our patients because as you mentioned, I have a degree in neuroscience, but also in nuclear medicine. So my background is really, which you synthesized beautifully as neuroimaging. It's like, yes, perfect. That's exactly what I do. So I supervise everyone, but I also now have a team of 25 people. At this point, actually more because we just started a collaboration with women's health and OBGYN. So we're 32, I believe, which is fantastic. It's wonderful. So we have four neurologists, a nurse practitioner. I have six assistants, which is super helpful. And then we have all different specialists, like we have radiologists, we have physicists, we have image analysts, we have preventative cardiologists, we have OBGYNs. So we have, we're big, we're getting. And it's so wonderful how everybody is so excited to be part of this effort. It's really a consolidated effort and it's really, it's very rewarding. It's very humbling in many ways. And it's very rewarding. And I think it's also so beautiful that so many people want to work with us. You know, in research, one of the major issues we have is to recruit people for studies and for clinical trials. And you're lucky if you have 100 people in a study, you're very fortunate. We have a 3,000 people waiting list. It's brilliant. It's fantastic. So we're really, we're waiting for lockdown to not be lockdown anymore so that we can go back to work.
Dr Rupy: Start exactly. Yeah, yeah. So let's talk a little bit in depth about how women's brains age differently from men's a little bit more and why sort of this, we've alluded to it already, but this key protective neurohormone is actually estrogen, because I think most people, to your point, think of estrogen as something to do with the reproductive system and the menopause, etc. But it's actually something that has vital role across the body, but particularly for the brain.
Dr Lisa Mosconi: Yes, it's such an important role that is so easily neglected and overlooked. So I think the point is many people think of the brain as an organ that is broadly isolated from the rest of the body. But in reality, the brain is in constant interaction with the rest of us and especially with the reproductive system, which makes perfect sense if you think about it from an evolutionary perspective. The way that evolution, human evolution really moved forward was by reproduction. So it makes perfect sense that the brain would be so strongly linked and connected to your reproductive system. Now, we all know that our organs, our reproductive organs are really communicating with the brain via our hormones. Right? And we also know that our sex hormones, they're called sex hormones, differ between men and women. Men have more testosterone and women have more estrogens, right? What I think what most people don't realize is that these hormones were labeled sex hormones pretty much by accident or by mistake. Right? Because they were first discovered in relation to reproduction. But then in 1992, Dr. Bruce McEwen, who was a mentor of mine, was unfortunately passed away just recently, but he and his team at Rockefeller University discovered that these same exact hormones both play a huge role in brain health. So testosterone in men, estrogen in women, progesterone in women, they serve a number of roles in the brain that have nothing to do with reproduction, but everything to do with function. In particular, both estrogen and, or estrogen as you say, which is so cute. Estrogen and testosterone both are activating, energizing hormones. We refer to estrogen as the master regulator of the female brain because it just wears so many different hats. You know, it really promotes energy metabolism by telling neurons to burn glucose faster. Right? So it really stimulates the production of ATP. At the same time, it really promotes neuronal plasticity and growth. And also is involved in the immune system. So it really keeps you stronger, younger, more resilient. That's what estrogen does in women's brains and testosterone does in men's brains. Now, the problem is women lose their estrogens in midlife during menopause. And for some women, the process lasts a few years, right? You start out in perimenopause, and then within eight years at the most, you're postmenopausal. You no longer have your period, and your ovaries no longer make estradiol, which is the one form of estrogen that is really so powerful in your body and inside your brain. That doesn't happen to men. Testosterone declines more gradually over time, not as abruptly as the estrogen loss in women. So for women's brains, as you go through menopause, your brain literally loses the superpowers of estrogen. And then the opposite happens. Your neurons slow down and start ageing faster. And studies have shown that the loss of estrogen in the brain even perhaps triggers, perhaps coincides with the formation of Alzheimer's plaques in a woman's brain. So this is how women's brains age different from, differently from men's brains. But you also need to think about these changes on a system level, right? So yes, there are the plaques forming, but I think the most distinctive change in a woman's brain is the reduction of brain energy metabolism. And I have these PET scans that I wanted to show you. They're positron emission tomography scans where you can see how a woman's brain, the same woman, before menopause, her brain is very bright, is very active. You see the brain is all red and yellow, is very, very activated. But then if you look at the same brain within five years or six years as the same person goes through menopause, you find that all the red goes to yellow, all the yellow fades into green. The whole activity of the brain just goes down by an average of 30%. Wow. Just to double, just to explain for the listeners what a PET scan is, it's essentially a scan that looks at the glucose metabolism of the neurosis, so i.e. energy utilization. Yes, and I think I think most people must have seen some pictures of the brain where some parts look red and yellow and blue and green, right? And the point is that you really want it to be red and yellow because that's a brain that is very highly active. You don't want all of your brain to go in the green zone because that's a sign that your brain doesn't have the energy it needs to really perform efficiently. And this is what we find in women during this transition to menopause. Right? And the point is that the estrogen is not there, so the neurons just slow down. And they slow down in very specific brain regions, starting from the hypothalamus, which is in charge of regulating body temperature. So if estrogen doesn't activate the hypothalamus correctly, your brain doesn't regulate your body temperature correctly, and you, woman, get hot flashes. The same thing happens in the brain stem, which is in charge of sleep, but also stress. So a lot of women going through menopause have a really hard time sleeping, and they're also very stressed and very anxious. There's a, you know, there's a higher risk of developing anxiety during menopause. The amygdala, right, the hypothalamus, the memory center of the brain, all these brain regions are less activated than normally. And so we feel forgetful, or perhaps we feel brain fog because our frontal cortex is not as active as it was before. So basically, in other words, all my research is really to just validate what women have been saying for centuries, that something is happening in their brains as they go through menopause. And so many women are aware of these changes. They can feel these changes to the point that so many of our patients come to us because they're so worried that they're going crazy. They're literally like, I feel like I'm losing my mind. I don't know what is happening. I'm worried. And we say to them, your brain is going through a transition. And it really needs the time and support to adjust and go back to where it was or just plateau. You know, we need to make sure that your brain has a chance to stabilize and readjust and just power through. And this is something we can do in some ways by means of medications, like hormonal replacement therapy, but also really by changing people's lifestyles, by working on medical history and lifestyle. And by the way, your website is fantastic. It's beautiful. I just saw a couple of new recipes and I was like, oh my god.
Dr Rupy: That's very nice of you to say. I just wanted to pause there actually and just say like, I think for a lot of people listening to this and those who read your book as well, it'll be a huge revelation. And like you said, it's going to be very validating for a lot of the complaints and symptoms that women have been talking about for years. I'm like, there is something going on. I feel like I'm going crazy. And you know, and you can't just blame it on one particular organ. It's a definitely a collective system of things that are malfunctioning or changing. And that's what's leading to a lot of the symptoms that I get told about as a, as a general practitioner, even in, you know, in across primary and secondary care.
Dr Lisa Mosconi: Yes. So I think what's really important is to make it very clear. When women say that they're having hot flashes, night sweats, insomnia, depression, anxiety, brain fog, memory lapses, those symptoms don't start in the ovaries. They start in the brain. Those are neurological symptoms. We're just not used to thinking about them as such. So it's really important that, number one, we're able to communicate that to all women so that there is no panic. Right? Something is changing, but it doesn't have to be a negative change. Yes, the symptoms are not fun, but you'll get through it. The point is we need to support women's brains during this transition so that we can, number one, minimize the symptoms, and number two, really protect our brains for the years to come. And the other thing is that so many women with symptoms, they go to their doctor and they just get out of the doctor's office with a prescription for antidepressants. That is the number one reaction. I don't know in England, in the United States, women are just being put on antidepressants, which does not in any way, shape or form address the root cause of their symptoms. And many women, actually, you know, HRT, like hormonal therapy for menopause is controversial here, at least. So, I mean, there's a lot more to be said about that. But one more thing I would like to add, if it's okay, is the average age of menopause is 51 in the United States, but I think it's the same in England, maybe 52. Around, yeah, it's the same 51 to my knowledge, yeah. Right. There are a lot of women who go through menopause prior to that at much younger ages. And very often, well, sometimes it's for genetic reasons, right? It's just in your DNA, but that's a minority, a minority of women. More women go through early menopause because of medical interventions, especially a hysterectomy with or without an oophorectomy, which is the surgical removal of the uterus and or the ovaries, or therapy for cancer, so chemotherapy for estrogen receptor positive cancer. What I want to say is that we do have evidence that having your ovaries and to some extent the uterus removed prior to menopause is actually associated with a higher risk of dementia in women later in life, which no one knows about. You go to OBGYNs, you go to oncology surgeons, they don't know about these associations. So I think it's really important for, for number one, for women to be aware so that if they're, you know, if their doctor says, well, I think we should do a hysterectomy, which is the second most common surgery for women in the United States after mastectomy, of course. You can ask your questions, like, do I really need it? Right? Because if the problem is that I have fibroids, perhaps I can do something else. Perhaps I should maybe I can think about losing weight or changing my diet or doing some other form of therapy, you know, before I consider getting rid of an organ. You know, it's not there just to have it. It's a whole system that gets disrupted as you have the surgery. So it's really important to know what to do to protect your brain as well as a result of the surgery and during the recovery time. And also perhaps prior, right? We should really think about women's brain health as something that we need to work on consistently throughout our lives, not just when there's a problem.
Dr Rupy: Absolutely. Yeah, I'm really glad you brought that point up actually, because I think too often we think of parts of our body as singular and not interconnected. And I think also, if people are more aware of the potential ramifications, they'd be a lot more perhaps motivated to do things in a different way. That isn't to add like blame to people or obviously, you know, there are definitely reasons. In fact, I've had a previous guest who is a medical colleague who had to have her uterus removed for cancer reasons. And we had a whole discussion about the pros and cons of HRT, which to your point, yes, are controversial. But in your book, I love the way you've set it out. You've kind of taken people down the flow diagram as to whether, you know, this is something you should consider, what the windows are, whether there is, you know, some disadvantages at certain time periods, because it's a very tricky subject to navigate. And I commend you for taking this on. It's quite a feat.
Dr Lisa Mosconi: Trying. Well, it's really, it's very complicated as a field. I approach it from a brain perspective, of course, can HRT really help your brain? But I think we also need to understand how it works for the rest of your body and how the research was done, which was not done very well, and how a lot of information we have is really based on data that is not the most, is not the best data. So I think my whole point is, I mean, we could talk for hours about hormonal replacement therapy, and I have a lot of friends who are women's health specialists or menopause specialists who really love it and recommend it, and others who absolutely don't. You know, and I think it's important to say that every woman is different, and that maybe we should really try to understand the person before proposing medications.
Dr Rupy: To your point in the book, you know, I think now is a time where precision medicine is really coming to the forefront. This is something that the National Health Service in the UK is kind of slow to move on. And I think we're going to be relying on people really campaigning for better, more individualized care. We're a bit slow off the mark when it comes to new emerging technologies in healthcare because it's, you know, universal healthcare, which has its pros and cons. But you've dedicated a section of the book towards what people can do to personalize their own sort of treatments, their own lifestyles to their individual risks. I wonder if we could talk a bit about that.
Dr Lisa Mosconi: Yes, gladly. Of course, of course. That's actually the bigger part of the book is really about what you can do today to really support your brain and optimize cognitive health and hopefully prevent Alzheimer's as well as a woman. Honestly, many of the recommendations would work pretty well for men as well. But I was really interested in exploring the research that looked at women as women. So not that the average person, whether you're a man or a woman, I just want to know what happens and what works for women. And there's so much that's been done that we don't really talk about and that we should talk about more, I believe. And so there are basically eight pillars to Alzheimer's prevention in women, which I thought were very helpful. And I don't know if we have time to talk about all of them, but certainly about some of them. Do you know this saying is from Latin and it's mens sana in corpore sano, a healthy mind and a healthy body?
Dr Rupy: Oh, yeah, I've definitely heard of that, but not the original Latin form.
Dr Lisa Mosconi: Right. So there's this saying, I just, I was, I did this interview with a friend of mine, Jim Kwik, which I'm sure you guys are friends as well. Yeah. And I was like, well, you know, the Latin mens sana in corpore sano, and he looks at me like, I have no idea what you're talking about. The Italian just left the boat. I thought it was universal and it was just not at all.
Dr Rupy: I think we have an equivalent term in Indian sort of, like, old wives' tales would be a bad word. I'm trying to think of the right word. But yeah, we have like the equivalent of a healthy mind, healthy body, like, you know, your thoughts become your positive energy, so make sure you have positive thoughts. That kind of thing. But, but yeah.
Dr Lisa Mosconi: But nobody knows the Latin. And so I realized that doesn't help at all because what I usually, what I like to do when I have slides is that I write it down, like mens, M E N S, sana, S A N A. And then I use each letter to start like M for mental stimulation, E for exercise. But then I realized nobody knows what this means.
Dr Rupy: Maybe, maybe this podcast can help spread the message. I don't know.
Dr Lisa Mosconi: Maybe, yeah, maybe we'll write it down somewhere. But anyway, there are eight major things that women can do to really protect the health of their brains and also really stimulate hormonal production over time. So this is not just for women who are not yet in menopause. This is also for women who are many years post-menopause and they really just need to adjust the recommendations based on their hormonal status and their hormonal health. And I talk about that more in the book. Right now, I want to mention that diet and exercise are obviously super important and I'm sure we will talk about diet. So I'm just going to mention a few other things like mental stimulation, intellectual stimulation is really important because especially learning is to your brain what exercise is to your muscles. Learning is really what stimulates your neurons to strengthen their connections to other neurons, which makes your brain stronger and more resilient. So for example, if you like to read books, instead of reading a novel, you can try reading something more engaging or like something where you learn something, you learn to do something from the book or like if you, if you like to watch movies or television, you can watch a documentary instead of a science fiction movie, which is wonderful, but you know, you can watch a TED talk where you're actually mentally stimulated by the content of what you're reading. If you enjoy playing chess, don't play more chess, try to learn to play bridge. So keep challenging yourself intellectually. That seems to be really key. Then of course, we have sleep and stress. And if we have a minute, I would like to talk about stress, especially these days, I think we're all incredibly stressed out.
Dr Rupy: Absolutely. I think the more sort of tools that we can garner and sort of experiment with when it comes to stress reduction, the better because so many people are afflicted with stress, particularly right now.
Dr Lisa Mosconi: Right. And we have so many reasons to be really systemically and chronically stressed at this point. It's been half a year that everybody is, it's a long time, right? So a couple of words about stress. We all know that stress is bad for your health. What we don't talk about enough, I believe, is that stress is really bad news for your brain and especially for women, also for your hormones. The reason being that cortisol, the main stress hormone, works in balance with your estrogens. So if cortisol production goes up, your estrogen production goes down. And the other way around. So you want to reduce stress so that your cortisol levels go down and your body can resume producing estrogens. Right, which is very important for women in midlife because you already have fewer, you know, your hormonal levels are already lower to start with. So you don't want stress to make it worse. You want to really address your causes of stress. And this is also important because there are studies with thousands of people, like middle-aged people who received MRI scans to look at the structure of the brain and brain shrinkage. And the studies showed that people with higher cortisol levels also showed memory decline already in midlife, like in their 50s. And also brain shrinkage. However, when the studies eventually broke down the participants by sex, they found that yes, both men and women under chronic stress have memory difficulties, which makes a lot of sense, but only women show brain shrinkage. Yes. So this is one more reason, one more incentive, I would say for all women to really address high stress levels. And honestly, every woman I know is under stress and also a lot of men, honestly, to be fair. Yes. But I think the consequences are a little bit worse for women, especially women of age between 35 and 65. Right? So we really need to pay attention to that. And what's interesting is that when you look at stress research, boom, there's another big bias. All the research was done in men. The stress reaction was really characterized in men. And we're all familiar with the fight or flight reaction, right? When you're under a lot of stress, you either land a punch or run for the hills. That's in men. And it makes sense because our stress reaction developed a long time ago where our ancestors, male ancestors had to go out hunting. And they were facing predators and all sorts of sudden, very dangerous situations. But the women were not hunting. The women were staying behind. And fighting or flying when you're pregnant, or you have a bunch of kids, or you're taking care of the elderly, not so easy. So it turns out, it turns out that women's brains developed an alternative reaction. So we do have the fight or flight reaction, but after the initial explosion of adrenaline, norepinephrine, cortisol, women's brains release oxytocin. And oxytocin is the love hormone. It's the hormone that helps you, you know, having contractions and deliver your baby and also really nurtures the feelings of maternal attachment. Why do we have that in times of stress? Why do we need a hormone that calms us down and makes us feel like loving and nurturing? Probably because back then, the most important thing for a mother to do was to reach out to the kids. Right? So instead of fighting or running away, you need to take care of your children. And at the same time, by reaching out to other women who were there with you and ganging up together, they had a much higher chance of fighting off the predator or taking care of whatever danger they faced and surviving. Now, this reaction has been called the tend and befriend reaction to stress, which is almost prevalently female. Which translated to modern days, we don't have tigers anymore, right? We don't have perhaps flood or whatever it is that they faced. But we do have a number of other situations, like you're being locked in your house for half a year, right? Or I'm working full time and I have a small kid who hasn't seen any other children in forever. There are many stressful situations. People are rioting in the streets, understandably so. It looks like many women really benefit from this tend and befriend reaction when under stress. Instead of isolating yourself or closing yourself in a room, so much better to reach out and have a nice conversation, especially with your girlfriends if you can, and really talk things over and ask for help. And it looks like your brain will love it, your genes, your DNA will love it. And it may or may not work for you, but I think it's something worth trying.
Dr Rupy: I love that. I think again, like another, I'm just, I'm sat here like listening to all this information. I know it's in your book and I know I've read it, but hearing it from you, it just like, it just makes it seem so much more understandable. It's just, you know, it seems so sensible. And I love to take things from an evolutionary perspective. So yeah, I definitely, I do appreciate that. I think that's going to resonate with a lot of people listening to this. And, you know, 80, 80% of the listeners are female as well. So this is, this is very important.
Dr Lisa Mosconi: Good. I'm so glad. And I think it's, I find that so many women under stress or whenever we have a problem, there's this tendency to just soldier on. Right? In our society, we're so conditioned to the fact that you just have to keep going. You can't take a sick day because your kids need you, your husband needs you, your job needs you, your parents need you. So few women have even just a chance to have some me time or some downtime. Most, most women can't even sleep. So we're sleep deprived, we're stressed out, we don't have time for self-care. And I think this is a really important thing to acknowledge that even just the fact that women suffer from stress more than men. You know, I don't know how psychologists quantify that, but it's actually a fact. I have the statistics here that women suffer higher levels of stress than men. And the discrepancy occurs primarily in women ages 25 to 54 and really peaks between 35 and 44. This is the American Psychological Association. So there's an objective measure of stress where we can show that women have a ton, basically. So it's really important to find ways to reduce stress and really address the fact and acknowledge the fact that we're stressed out. You know, and not feel bad about it, but just say, okay, I'll try to hang out with my friends more.
Dr Rupy: The construct of our society is that women still take that caregiver role, but you know, but I think it's fantastic to see that, you know, being reversed as well and I know some colleagues of mine have taken the role of caregivers or shared caregivers as well. So it's, yeah. Yeah, and I love how these sort of stress reducing activities can apply to both sexes as well. I mean, I've certainly had my own stresses over the last six, six to 12 months, probably before then as well. And one of the things that you pointed out there of, of taking time to speak to other people can be one of the best stress relieving activities that you undertake.
Dr Lisa Mosconi: Yes. And if you're a little bit of an introvert, like I am, there are other things that you can do as well without feeling bad about it, without feeling guilty. Like if you need a little time for yourself, ask for it. I think it's something that we all need to learn to do. And then there are other things that are very helpful to reduce stress, like sleep, obviously, is a big one, but also exercise can really help. And really favouring green time over screen time as well. Sometimes a little social media distancing can help and just not looking at the news for three hours won't kill you, probably will help you out at this point. So there are many things that people can do. And I would just throw meditation in there for a second. Like as a scientist, I was very ambivalent about any new age. But then when I was a PhD student, I met Dr. Rudy Tanzi.
Dr Rupy: Yes, yeah, I've heard him speak.
Dr Lisa Mosconi: Fantastic. I think he's incredible. He's this incredible, really kick-ass scientist and he's such a wonderful person and he's so kind that he really took time to talk to me about veganism and meditation, which I knew nothing about. And I've been meditating since and I've been really looking at the research in that space and there is so much solid research really showing that if you have a serious, like a consistent meditation practice where even it could just be 12 minutes of Kirtan Kriya, like a Kundalini yoga based meditation. Do you do, do you practice meditation? I bet you do.
Dr Rupy: I do. So I've actually been practicing meditation intermittently since I was a teenager. So my parents taught me how to meditate just before my exams when I was doing my like exams when I was 15. And then I came back to meditation when I was a junior doctor age 24 when I had my own heart condition. So I had atrial fibrillation, long story short, diet and lifestyle essentially reverted a condition that I was going to have an ablation for. And one of the things that definitely helped, I believe, was stress reduction and meditation. And Kundalini yoga, if I'm right in thinking, kind of stems from Sikhism and a whole bunch of other disciplines. And Kirtan is the music that we play in our temples. And I find it super meditative. Whenever I go to the temple, which obviously I can't do right now, just listening to the music just puts me in a bit of a trance. And I found that there is some research around musical therapy and how this might actually have some solid science behind it too.
Dr Lisa Mosconi: Yes. And so there is the Alzheimer's Research Prevention Foundation with Dr. Dharma. I'm on their board. I'm their scientific advisory board. Obviously, I don't take a penny. And they do a lot of research on meditation. He's promoting this Kirtan Kriya meditation where you chant Sat Nam for 12 minutes doing finger tapping. First, you chant it loudly, Sat Nam. Then quietly, then just in your mind, then quietly, and then loudly for a total of 12 minutes. And they showed with clinical trials that if you practice this 12 minutes a day every day for three months, that is really associated with improved blood flow to your brain, lower cortisol levels, reduced inflammation and oxidation, oxidative stress, and better memory performance, especially in women with subjective cognitive complaints, which is like you feel forgetful, and also women who were under a lot of stress, especially caregivers. So I would encourage, and I'm sure you would too, you do it all the time, to just encourage all women, but everyone, really, regardless of whether you're a man or a woman, male or female or other, to really consider meditation as something that could be such an important tool for not just your physical health, but also your mental health.
Dr Rupy: Absolutely.
Dr Lisa Mosconi: Right? For me, it makes a huge, huge difference. Do you like Jack Kornfield, his work?
Dr Rupy: Jack, who's that?
Dr Lisa Mosconi: Jack Kornfield. I'm a huge fan. I've read all his books. Oh my goodness. Yeah. So he has this incredibly soothing voice and you just trust him instinctively. And there's an audiobook that I really love is called Guided Meditations for Beginners. It literally changed my life. And I have no reason to say this other than it really, I love it. And I have my daughter who's now almost, she just turned five, and we do meditations at night so that she can fall asleep gently and she's already learned the vocabulary around meditation and you know, just learning to be grateful and because it's really a mindset, it really changes the way you think. And that is better than an antidepressant sometimes.
Dr Rupy: Brilliant, brilliant. I did, I did notice the inclusion of Kundalini yoga in the, in the section of your book. Yeah, yeah. And I was glad that you put that in because I think most people would, you know, snuff at the idea of meditation could have such a distinct effect.
Dr Lisa Mosconi: I did too. Guilty as charged. You have to try it. You just have to. And it may not work for everybody.
Dr Rupy: Yeah, but it definitely won't harm. And I think, you know, we have to be open-minded to these different sort of free lifestyle interventions that could truly help as demonstrated by some clinical research. That's awesome.
Dr Lisa Mosconi: Absolutely. Absolutely.
Dr Rupy: Let's talk about food. I know you're edging to talk about food.
Dr Lisa Mosconi: Let's do it. Let's do it. So I was so looking forward to coming to England for the book tour. And I was so looking forward to you cooking for me.
Dr Rupy: I know. I'm so gutted I can't cook for you. I'm so sorry. What would you have wanted me to cook if I was going to cook for you?
Dr Lisa Mosconi: I don't know. I looked at the website. I was like, oh, I like everything.
Dr Rupy: Do you have any requests?
Dr Lisa Mosconi: I really love Indian food, but unfortunately, I'm allergic to pepper. I have very strong reactions, but I'm sure there's a lot of other things. Actually, are you vegetarian or vegan?
Dr Rupy: I'm actually plant focused. So I eat everything, but 90% of my meals, I would say, are completely plant-based. So I really keep it because I've gone vegan for like a couple of months, and I've done, you know, a whole bunch of different diets just personally in the past, but this is the one that I think fits for me. It's broadly Mediterranean, I guess. It's very, very minimal animal products, good quality fats, loads of plants, loads of legumes, all that kind of stuff. But it's kind of inclusive for people who don't want to go full vegan or actually benefit from having, you know, some animal products in their diet as well.
Dr Lisa Mosconi: Yeah, basically me too. It's exactly the same philosophy, I think. Right now, I'm even more plant-based. For a little while, it was very hard to find food in New York. And so, yes, it was very hard for a few months. It was very dangerous to go to stores and deliveries were very limited. And that's when I just realized, you know, I'm totally happy without meat in my diet. And I like fish. I mean, as you know, obviously as an Italian, I love my fish and it's really, you know, DHA is so important for brain health and for mood and for hormones. And I have a little girl in the house, so I want to make sure she has her protein and fat and a complete diet. But I find that a predominantly plant-focused diet is arguably very healthy and it works very well for me. Right? So as a scientist, I'm not necessarily trying to push one diet or the other on people. I'm our goal is to really work with whatever diet works for you and really optimize it by focusing on quality rather than quantity, right? If you want to eat a steak, let's talk about grass-fed meat, right? If you really love your chicken, one of my best friends, she loves chicken. I don't get it. For me, it's like when you're on a diet, you eat chicken. But she loves it. And so we talk about cage-free eggs, you know, and free-range chicken. And she just did not want to hear about it. And then one day, she had no option but to buy cage-free eggs because they're the most expensive ones and they were the only ones left in stores. And she got them and she called me and she's like, oh my god, they look better, they look like orange instead of yellow. They taste so much fresher. I like that. I was like, yeah. There's a reason that people do that, you know, it's not just to be posh or. So going back to women's health, I think there is enough research to suggest that a similar diet pattern works very well for women. Most of the research looked at the Mediterranean diet because we know from a number of different disciplines that is really supportive of health overall. And also in women, when you compare women on a Mediterranean style diet to women on a Western diet or an American diet, those on the Mediterranean diet are just much better off. They have three times longer telomeres, which is an index of biological longevity, right, of youthfulness at a cellular level. They have a 25% reduced risk of heart disease and stroke and a 50% lower risk of breast cancer. They also have a lower risk of depression, they have fewer hot flashes. And we have done a lot of research with brain scans looking at the Mediterranean style diet, which is, you know, a lot of veggies and fruits and grains and whole grains and legumes and some fish and healthy vegetable oils and a lower consumption of meat and dairy. That's broadly speaking the pattern. When you compare women on this diet to those on a Western diet, you can tell their brains apart by looking at the scans, especially over time. Like their metabolic activity is this high and remains high over time. They don't have Alzheimer's plaques in their brains and they just don't develop them over time. We have like up to five, six years of follow-up data. Women on the American diet or the Western diet, their brain activity is lower to start with and goes down by 3% a year over time, which you don't want, right? And they have a little bit more plaques, Alzheimer's plaques to start with. This is in their 50s. And then we literally can map an increase in the amount of Alzheimer's plaques that they have in their brains so that basically, if you use a statistical algorithm, it really tells you that the brain of a 50-year-old woman on the Mediterranean diet is five years younger than that of a woman of the same exact age who's on a Western diet. That's an average, obviously. But there really seems to be a biological advantage. And in part, that's really about the foods that are part of the diet that have just health functions. Like you say, it's about flavour and function, right? And I always say that food is information. Food is functionality. You eat for a reason. Those nutrients have specific effects in your body and inside your brain. So for women, foods that are high in antioxidants are really important because you don't want your brain to slow down, which is something that seems to happen quite naturally to women as we get older and we go through menopause and we lose our hormones. So we really need to have the antioxidants from the diet to really even things out, basically, you want to boost your metabolic activity by reducing oxidation and inflammation, which means veggies and fruits and nuts and seeds. They are so important. They're the best source. Especially for women, vitamin C and vitamin E and beta carotene, we showed using brain scans that women with the highest concentration of these nutrients in their diets, not just by asking, because a lot of people kind of cheat, but by measuring these nutrients in plasma, in blood, they literally have the highest brain energy levels at any age, starting from age 30 all the way to 70. So it's something that really seems to be associated with higher brain energy levels, reduced brain shrinkage or preserved brain volumes, which sounds nicer. And an avoidance of Alzheimer's plaques. So that's really important. Fibre is really important for hormonal health. Fibre really helps regulate the sex hormone binding globulin, which shuffles all your hormones around your body and brain. So you want to have enough of that too. And has a number of other benefits, obviously, for digestive health and reducing inflammation and bacterial growth, reducing bacterial growth as well. And then I would say one word, if it's okay, about phytoestrogens, because I find that something people don't know about, right? So a lot of women are interested in hormonal replacement therapy because they're thinking, well, I'm losing my estrogens, I want to put them back inside my body, and I need a medication to do that. And I would like to make everybody aware that medications were really generated based on nature. Nature is the source of the estrogens that you want to put back inside your body. And many foods contain phytoestrogens or estrogens from plants, which is beautiful if you think about it that, so estrogen is the most ancient of hormones, which means that plants make it, animals make it, we make it, and it can really go across species. So if you eat the estrogens that a plant makes, that a fruit makes, that a leaf makes, that estrogen is going to go inside your own body and really boost your hormonal reserve. It's going to act like a milder estrogen for you. So if you eat enough foods that contain phytoestrogens, that's effectively like a very mild estrogen replacement therapy without the side effects, unless, obviously, you overdo it.
Dr Rupy: It's very, it'll be very hard to do that, I think. Yeah, absolutely. And practically speaking, you know, all these collection of foods that you've just described, you know, I'm just imagining in my head like this colourful Mediterranean diet with beta carotene coming from your red and orange coloured vegetables. You have vitamin E and C, with vitamin E in and, uh, coming from nuts and seeds and C coming from obviously your citrus fruits. And the phytoestrogens, yes, you can get it from soy and tempeh, but you can also get it from things like flax seeds.
Dr Lisa Mosconi: Yes, from sesame seeds, dried apricots, sesame, sesame seeds, tahini, right? Um, apricots, whole grains, legumes, especially chickpeas. So we're back in the Mediterranean, right? Um, but also a number of fruits, like strawberries, melon, pineapple. I guess tropical fruits. They also have better fertility at all ages. Yes. And then other studies showed, actually this wonderful study, which I think was also from England, uh, showed that women who consume more fish and legumes in their diets, they have a much later onset of menopause. So it really promotes, yeah, well, legumes, I think in part is the fibre, in part is the phytoestrogens, in part is the complex carbohydrates. And fish, because it really is the best source we have of DHA. And DHA is a polyunsaturated fatty acid that is the most prevalent brain fat. And it's also really important in regulating mood and fertility as well. So I think it's really important for women to know that if you have enough, you know, if you don't eat fish, eat something else that contains omega-3 fatty acids, basically, that's the point. But if you have enough in your diet, then you have a much lower risk of heart disease, of depression, of dementia, for more than two grams of polyunsaturated fatty acids per day, especially DHA, and also reduced menstrual pain, fewer infertility, you know, fewer issues with infertility, miscarriages, and also much lower risk of postpartum depression, which is a big deal for so many women.
Dr Rupy: It's incredible like all these different dietary adjuncts and how many uses they have across the spectrum of conditions, particularly those that afflict women as well. And this is why, you know, I continue to do this work and continue to try and like help people understand just how much power they have with their plate. And, you know, the delicious collection of foods and just, you know, one of the things I think of is just the number of fruits and vegetables that people eat on a daily basis. The average is around three across countries. Um, even in the states, I think it's around 2.5 to three portions. Um, and we need to be getting, huh?
Dr Lisa Mosconi: Maybe one, if you consider quality. You know, it's like a piece of tomato and some iceberg lettuce.
Dr Rupy: Yeah, exactly. It's wholly, wholly insufficient. And it's like, we just need to be eating more and I'm dedicating a whole chapter to that in my next book about just eating more of the good stuff. And actually, you know, the opportunity cost of eating more is, it's not a cost, it's an opportunity gain is that you're going to be having less of the, you know, animal fats, animal products that you we need to have less of in our diets overall and more of the good stuff. So it's kind of just rebalancing our plate really.
Dr Lisa Mosconi: And it's not about necessarily restricting diets. It's really about being smart about food. You know, food is powerful. It has effects in your body and you literally have three chances every day to do something healthy and healthful for your body or not. And it's quite a thing. It's quite a, it's quite a thing. And I find it's so easy to be confused when it comes to diets, especially in the United States, I think where every day, now there's the carnivore diet that is a big deal and you know, and they're more marketing strategies than actual diets and they say they're backed by science, but they're really not. So I think it's important to really, if you care about your brain, look at science for guidance. And if you don't find the information, although, again, there's a lot of information in the book, but in general, if you don't find the information, you really demand it. I think that that is so important that women really demand accurate information. We don't need any more blogs telling us to buy supplements. We just don't need it. We need actual reliable information, especially from clinical trials if possible, but just from large scale studies. And if you don't have the information, you demand it because the more women demand this information, the faster we scientists and doctors will be able to come up with really answers and solutions that actually work, not just for Alzheimer's disease, but for women's brain health as a whole, because really, that's my usual take-home message. Brain health is women's health. And we really need to start thinking about them as such.
Dr Rupy: I really love that. And I think, you know, this podcast, your book, all the work that you're doing with the, the initiative, it's really going to be stepping people's understanding and actually empowering them to be more vocal about this as well, because it is discrimination and it has been, you know, an issue and it will continue to be unless people like yourself stand up and actually do all the work. So I thank you so much for your work on this and your fantastic book, honestly. And that's why I was so privileged to even be asked to to give an endorsement for it and have it slapped on the front of the book as well. That's great.
Dr Lisa Mosconi: And it's big polka dot. I love it.
Dr Rupy: That's great. Thank you so much, Lisa. Honestly, this has been brilliant. It's been a pleasure to connect finally, even if it is via the power of telecommunication and I promise you, I will have you in the in the studio kitchen and I will definitely cook for you one day for sure.
Dr Lisa Mosconi: Let's do it. Thank you. I would love it. All those beautiful things. I was like, how does he do that? Just the presentation is like, oh my god. It could just be like mushrooms, but it looks like a million bucks. It's like, whoa, mushrooms.
Dr Rupy: That's great.
