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Dr. Lisa Mosconi: Menopause Strips 30% Of Brain Energy

Mosconi shows menopause is a brain event, not just an ovarian one; imaging finds up to 30% energy loss, and hormone timing alters dementia risk.

Dr Lisa MosconiguestSteven Bartletthost
Jun 13, 20241h 59mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 2:14

    Intro

    1. LM

      This is evidence of what women have been saying all along, menopause changes the functionality of your brain.

    2. SB

      It looked there like the brain was basically shrinking.

    3. LM

      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 Mosconi is a neuroscientist...

    4. SB

      ... whose groundbreaking research has discovered and revolutionized our understanding of the menopause.

    5. LM

      ... 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, a process that can take years. So this is before menopause, this is after.

    6. SB

      Wow.

    7. LM

      And this shows a 30% drop in brain energy levels. So when women say that you're having hot flashes, insomnia, depression, two-thirds 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 as 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.

    8. SB

      So let's have a look at these things then.

    9. LM

      Okay. The first thing I do is...

    10. SB

      Dr. Lisa, one of the things I found fascinating is I read that there was a miracle food for delaying menopause.

    11. LM

      A diet rich in ... has been linked with a later onset of menopause.

    12. SB

      By how much?

    13. LM

      Three years.

    14. SB

      We've just hit six million subscribers on The Diary of a CEO. Um, so me and my team would like to do something we've never done before as a little thank you, and we're calling it the Diary of a CEO 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 pound voucher, one of you tickets to come and watch The Diary of a CEO 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.

  2. 2:14 – 4:10

    Why People Should Listen To This Conversation

    1. SB

      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?

    2. LM

      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 the 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.

    3. SB

      Why should men listen?

    4. LM

      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 I do a lot, like daily, and they're saying to me, like, "You know, thank you, you've really helped me understand my wife better," or, "You've 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's just better." It's also really important to understand how humans actually work-

    5. SB

      Mm-hmm.

    6. LM

      ... 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.

    7. SB

      I've had conversations about menopause before.

  3. 4:10 – 6:21

    What People Need To Know About Menopause And The Impact On The Brain

    1. SB

      I've had a few conversations on this podcast with friends, with one of my friends-

    2. LM

      Mm-hmm.

    3. SB

      ... Davina McCall about menopause-

    4. LM

      Yeah.

    5. SB

      ... and it's really opened my eyes.

    6. LM

      I love Davina.

    7. SB

      Oh, you know her?

    8. LM

      Yes, yes, yes.

    9. SB

      Yeah, she's-

    10. LM

      She's wonderful.

    11. SB

      ... fantastic.

    12. LM

      Yes.

    13. SB

      Absolutely 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 wo- 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-

    14. LM

      Mm-hmm.

    15. SB

      ... from a very top line perspective about the impacts of menopause on the brain?

    16. LM

      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 only starting to gather 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, night sweats, insomnia, anxiety, depression, brain fog, two-thirds 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 your ovaries. Those are brain symptoms, they are neurological symptoms that come from the ways that menopause changes the brain.

  4. 6:21 – 8:08

    Who Is Lisa Misconi?

    1. LM

    2. SB

      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?

    3. LM

      (laughs)

    4. SB

      (laughs)

    5. LM

      I'm Dr. Lisa Mosconi, 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 at Weill Cornell Medicine-NewYork-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.

    6. SB

      Uh, I heard you- you've published over 150 medical journals.

    7. LM

      Yes. Yeah, yeah, over 150 scientific papers, and-

    8. SB

      To summarize-

    9. LM

      Yeah.

    10. SB

      'Cause I, 'cause I did a, quite an extensive piece of research here.

    11. LM

      Mm-hmm.

    12. SB

      You're basically leading the way as it relates to understanding a woman's brain, especially as it relates to menopause, the changes. I, I, 'cause I was reading that you did the first brain scans-

    13. LM

      Yes.

    14. SB

      ... on a woman's brain to compare what a woman's brain looks like before and after menopause-

    15. LM

      It does.

    16. SB

      And also before and after surgical menopause, which is-

    17. LM

      Yes.

    18. SB

      ... the removal of the ovaries.

    19. LM

      Yes.

    20. SB

      And you actually have those scans, which we'll talk about later.

    21. LM

      Yeah.

    22. SB

      But you have some of those scans to show me today.

    23. LM

      Mm-hmm.

    24. SB

      But you were the first person to do that.

    25. LM

      To my

  5. 8:08 – 14:28

    Why Hasn't There Been Research And Investment Into Menopause?

    1. LM

      knowledge.

    2. SB

      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?

    3. LM

      Such a good question and it's the question I asked when I started looking at menopause for the first time. That 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 had 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 two thirds 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 developing dementia." 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's disease is not a disease of old age. It's actually a disease of midlife with symptoms that start in old age. So what happens is that Alzheimer's 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 words, they have attention deficits. But in reality, Alzheimer's starts, for many people, in midlife. So that changed my entire question, right? Then the question becomes, okay, if Alzheimer's starts in midlife and more women than men end up with Alzheimer's disease, what happens to women and not men in midlife that could potentially explain the higher lifetime risk of Alzheimer's 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, 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, what we were seeing is that already in midlife women...We're 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 were like, "The window? Sure." Actually, no, because it's a 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 hot flashes? What is it? Is she okay?" We, we had to stop the session is, is... Are we in trouble basically, and I said, "Hot flashes? 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 by 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, that 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 perimenopausal 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.

    4. SB

      In perimenopause only.

    5. LM

      In peri, so not even in menopause but just starting to lose your... Skipping menstrual cycles and when your f- when your period becomes infrequent and usually the hot flashes start making an appearance and the brain fog as well. And then after menopause when we compared postmenopausal 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.

  6. 14:28 – 15:54

    What Is Menopause And Signs

    1. LM

    2. SB

      Okay, so this is a really naive question, but please do explain this to me like I'm a 10-year-old. What is menopause?

    3. LM

      What is menopause? So there's a standard medical textbook definition that is entirely based on the function of the ovaries.

    4. SB

      Okay.

    5. LM

      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 at menopause for what it is from a scientific perspective, so 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 premenopausal 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.

    6. SB

      So that's when your period becomes more infrequent-

    7. LM

      Irregular.

    8. SB

      ... or there's less menstrual blood?

    9. LM

      Yes, usually a combination of the two, and what we really focus on clinically is the frequency.

    10. SB

      Okay.

    11. LM

      So when you start skipping your period for more than two or three months at a time, that is considered the perimenopausal phase which is an in-between between having a menstrual cycle and not having a menstrual

  7. 15:54 – 19:07

    Menopause Stages Start Before You Think!

    1. LM

      cycle.

    2. SB

      So that first stage we were talking about, is there a name? That's perimenopause?

    3. LM

      Pre.

    4. SB

      Premenopause.

    5. LM

      Yes.

    6. SB

      Okay, so premenopause.

    7. LM

      Before menopause.

    8. SB

      Premenopause.

    9. LM

      Then there's peri-

    10. SB

      Yeah.

    11. LM

      ... which is in between.

    12. SB

      Is that stage two?

    13. LM

      That's... Yeah.

    14. SB

      Okay, stage two. So-

    15. LM

      If you-

    16. SB

      Peri-

    17. LM

      ... you want, stage two, yes.

    18. SB

      Yeah.

    19. LM

      Stage... Usually we say stage one and two for cancer or something malignant.

    20. SB

      Oh, okay.

    21. LM

      But yes, first and second-

    22. SB

      Okay.

    23. LM

      ... 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.

    24. SB

      So you have this perimenopause stage which happens in your mid to late 40s typically?

    25. LM

      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.

    26. SB

      And it tends to last about 10 years, and this is really when your estrogen levels start to dip.

    27. LM

      Mm. That's a good point. So it can usually last between two and 10 years if you're lucky. Let's say four, between four and seven.

    28. SB

      Okay.

    29. LM

      This is actually when estrogen levels fluctuate.

    30. SB

      Okay.

  8. 19:07 – 22:35

    What's The Youngest Person With Menopause

    1. SB

      What's the youngest you've seen menopause, which is stage two in that, in that process?

    2. LM

      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-

    3. SB

      Mm-hmm.

    4. LM

      ... 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 aging 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 ovaries removed, usually as part of a hysterectomy, which is the surgical removal of the uterus, or just the ovaries alone, and that's called an oophorectomy, 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 chemotherapy for cancer. That can induce menopause, sometimes just temporarily and sometimes, more, more often than not, permanently. So the youngest age 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 oophorectomy and hysterectomy when you are a teenager, that's when you go through menopause.

    5. SB

      The spontaneous menopause, what's the earliest you've seen or heard of?

    6. LM

      Um, 40s, early-

    7. SB

      40s.

    8. LM

      ... 40s.

    9. SB

      Right.

    10. LM

      But some women, some women with PCOS or primary ovarian insufficiency can develop menopause even earlier than that. However, in that case, it's not part of the aging process. It's because there's something that needs to be further investigated, whether it's genetics or an autoimmune disorder or other causes.

    11. SB

      So just to summarize then, there's three stages to menopause. There's perimenopause, 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 7 to 14 years. And then you have post-menopause-

    12. LM

      Mm-hmm.

    13. SB

      ... which is the rest of the woman's life when she is without her 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 ...

    14. LM

      Yeah. See, the terminology is also confusing. But menopause is actually just basically a mark on the calendar and say, "As of today, you are in menopause." But it's not a stage.

  9. 22:35 – 29:54

    Perimenopause Transition

    1. LM

    2. SB

      So what's the difference?

    3. LM

      It's a diagnosis.

    4. SB

      But it says it lasts 7 to 14 years.

    5. LM

      So there's three stages.

    6. SB

      Yeah.

    7. LM

      Pre-menopause, before. Pre.

    8. SB

      Okay, so there's ... Okay, three.

    9. LM

      Yes.

    10. SB

      So there's four then.

    11. LM

      Which is from puberty until you start skipping periods.

    12. SB

      Okay.

    13. LM

      Okay. Then there's peri.

    14. SB

      Yeah.

    15. LM

      Second stage. When you start skipping periods and your hormones start fluctuating. And then there's post-menopause.

    16. SB

      Okay. So-

    17. LM

      So before, in the middle, the transition, peri, and then after. Those are the stages.

    18. SB

      So that transition period.

    19. LM

      Yeah. That's the peri-menopausal or-

    20. SB

      Okay.

    21. LM

      ... menopause transition that typically lasts four to seven years, but it can actually last up to 14 for some women.

    22. SB

      And what's going on in that transition phase?

    23. LM

      Oh (laughs) , 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 perimenopause 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, men too, but for women, that system is activated during puberty, is over-activated during pregnancy every time a woman is pregnant, it's partially turned off during postpartum, and I'm hoping we can talk about that too, the mommy brain, it's really, it's really quite a thing, and then it's quite dismantled after the transition to menopause.So this as a system 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.

    24. SB

      Okay.

    25. LM

      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 ovaries after menopause because they do still have some functionalities. Now, if you think about it, when we look at these 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-

    26. SB

      What's that?

    27. LM

      ... everything is good until... All those graphs they usually talk about the way that the brain ages-

    28. SB

      Mm-hmm.

    29. LM

      ... and how neurons age-

    30. SB

      Okay.

  10. 29:54 – 33:09

    Menopause Brain Scans

    1. SB

      Got you.

    2. LM

      Does it make sense?

    3. SB

      And that happens... Yeah, I'm really trying to understand this, the difference between the menopause phase physiologically-

    4. LM

      Okay. Yeah.

    5. SB

      ... and the post-menopause phase 'cause it says it lasts for seven 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.

    6. LM

      Yeah. Do you want to see?

    7. SB

      Please, yeah, show me.

    8. LM

      The brain scans, I think, is the best way. Look, like you mentioned before, this is new research.

    9. SB

      Yeah.

    10. LM

      Relatively new research.So, so the only research still that looks at changes in women's brains as a woman goes through the different phases of menopause.

    11. SB

      Okay. So just for people that don't, aren't watching on video for whatever reason-

    12. LM

      Right.

    13. SB

      Um, Lisa has some brain scans on her iPad in front of me, which she's gonna explain to me.

    14. LM

      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.

    15. SB

      What does that mean? 'Cause it kind of looks like some of the lights are going off.

    16. LM

      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-

    17. SB

      People know this?

    18. LM

      ... before going through menopause. No.

    19. SB

      People don't know this?

    20. LM

      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. Where there's something happening, I have the brain fog, I have mental fatigue." In clinical terms, we say cognitive fatigue or 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, and, "plenty," obviously 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 the brain. It's a neurologically active state that is associated with measurable and quantifiable changes in a woman's brain.

  11. 33:09 – 34:28

    Some Women Have More Shocking Brain Scans Than Others

    1. LM

    2. SB

      If I'm a woman and I'm, I'm the before brain-

    3. LM

      Yeah.

    4. SB

      ... 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-

    5. LM

      Yeah.

    6. SB

      ... what is the real-world change in my behavior that people-

    7. LM

      Uh-huh.

    8. SB

      ... would see, that I would feel, that-

    9. LM

      Right.

    10. SB

      ... I would experience, that-

    11. LM

      Right.

    12. SB

      ... would present?

    13. LM

      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-

    14. SB

      Mm-hmm.

    15. LM

      ... whether they describe it as such or not. Some women do not show any brain changes or very little brain changes, and some women show much more severe brain changes.

    16. SB

      So some, some women's brain changes are much worse than that?

    17. LM

      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 those teeny-tiny little, uh, spots, bright spots that we find on DMRI scans as part of aging, but for women that really seems to happen more so during menopause.

  12. 34:28 – 38:05

    Behavioural Changes From Menopause

    1. LM

    2. SB

      So how would I change if my brain-

    3. LM

      How would you change? (laughs)

    4. SB

      If my brain changes, if I'm that woman and my brain has had those changes, how will I feel different and how will the world experience me different?

    5. LM

      So this is something we are trying to understand a little bit better. These brain scans do not speak to behavior, they speak to biology. And there's never a one-to-one correlation between biology and behavior, thank goodness, right? But what we are, um, starting to show right now, and actually we have a paper under review that shows that these changes correlate quite strongly with brain fog, which is this feeling of mental exhaustion where you feel cotton-brained, you feel like your brain just won't turn on in some ways. And many women experience, um, what we define clinically as 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 neuropsych evaluation, you're still performing within normal values. And this is good and bad (laughs) 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 all in your head." I hate that terminology. I get 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 wildly 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 uterus.

    6. SB

      Really?

    7. LM

      Yes. Yes.

    8. SB

      Ah.

    9. LM

      Because ever since Ancient Greek- Ancient Greece, there was this mindset, this, this framework in medicine where anything that a woman would report in terms of cognitive disturbances or mental health issues or just, just concerns were immediately chucked away as, "There's something wrong with your uterus" 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-

    10. SB

      But they're-

    11. LM

      ... we're aware that-

    12. SB

      ... they're kind of r- r- they were kind of right in one sense.

    13. LM

      You know, that's, that's the bizarre part, that yes, there is a connection and yes, that connection can impact your mental health.

    14. SB

      Yeah.

    15. LM

      But there's no reason to be put down or be patronized or be dismissed. It's actually-

    16. SB

      There's a-

    17. LM

      ... something that's really worth investigating.

    18. SB

      They didn't have the science we have now.

    19. LM

      No, clearly.

    20. SB

      But, but you're saying to me that they, even back then, they believed there was a connection between...

    21. LM

      Mm-hmm. The uterus and the brain.

    22. SB

      Right.

    23. LM

      Yeah, the woman and the brain. They... I, 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.

    24. SB

      Yeah.

    25. LM

      Just saying, "Okay, so you, you, we, 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. It's not all in your head." I mean, it is all in your head in a way, but not the way that people think.

  13. 38:05 – 39:53

    How Many Women Experience Brain Fog?

    1. LM

    2. SB

      How many... What percentage of women that go through perimenopause and postmenopause struggle with brain fog?

    3. LM

      Hmm. 62%.

    4. SB

      So-

    5. LM

      Up to 62%, it's almost two thirds.

    6. SB

      The majority of them. And, and when... I, I have heard the phrase brain frog, brai- brain fog.

    7. LM

      Fog.

    8. SB

      But I've never understood what it means. Is it just like a la-, uh, an inability to think as clearly as you once did?

    9. LM

      I think it's more than that. It's a feeling that something is hijacking 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 d- 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.

    10. SB

      Okay.

    11. LM

      With brain 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.

    12. SB

      Is it about attention as well as memory?

    13. LM

      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 aphasia in a way, which is an actual clinical, uh, syndrome or a form of dementia even, but when, when you just can't come up 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 as their superpower.

    14. SB

      Yeah.

    15. LM

      And they need to rely on communication for work and whatnot and they really are miserable.

  14. 39:53 – 41:11

    Menopause Rewires The Brain

    1. LM

    2. SB

      Are there any symptoms that you believe are a consequence of the changes in the brain-

    3. LM

      Mm-hmm.

    4. SB

      ... that we see in those PET scans?

    5. LM

      All the symptoms.

    6. SB

      What, all of them?

    7. LM

      All the symptoms. Oh, yes, yes. We just need to... S- 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-

    8. SB

      Yeah, yeah, yeah.

    9. LM

      ... 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 impact very specific brain regions that are important, for instance, for thermoregulation, for regulating body temperature, right? So there's this structure of the brain which is actually exactly the structure that receives all the information from the ovaries. It's the first, um, center of communication, it's called the hypothalamus-

    10. SB

      Mm-hmm.

    11. LM

      ... and is in charge of regulating body temperature. So when estrogen levels and progesterone levels are fluctuating wildly, 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 the hot flashes.

  15. 41:11 – 43:57

    Symptoms As A Result Of Brain Change

    1. LM

    2. SB

      Why-

    3. LM

      Why-

    4. SB

      ... does the brain... 'Cause it looked there like the brain was basically shrinking.

    5. LM

      Yes. So some parts of the brain lose volume.

    6. SB

      Yeah.

    7. LM

      Some parts of the brain become less connected, some other parts become more connected-

    8. SB

      Okay.

    9. LM

      ... and overall, energy, metabolic energy is reduced and the ability... Um, so there's these little struc- there are many little structures in the brain and in the rest of the body are ca- mitochondria-

    10. SB

      Yeah.

    11. LM

      ... and they are 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, it's called 3D-1 Phosphorus MRS 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, that the brain just can't quite meet energy demands. And so all these different parts of the brain, they need estrogen for support, for energy support and for fuel, but they also need ATP just to do things-

    12. SB

      Mm-hmm.

    13. LM

      ... 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.

    14. SB

      And is that why the brain is- looks like the lights are going down, because of the, the loss of estrogen?

    15. LM

      Most likely. It's 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, and other hormones that-

    16. SB

      Okay. So-

    17. LM

      ... I think-

    18. SB

      ... let me get this straight.

    19. LM

      Okay.

    20. SB

      So, I should be viewing menopause as the physiological reconstruction of the brain-

    21. LM

      Yes.

    22. SB

      ... really, based on the loss of estrogen, i.e., and I'm gonna try and go a little bit further here with my science.

    23. LM

      (laughs)

    24. SB

      So, there's receptors in the brain-

    25. LM

      Yes.

    26. SB

      ... that estrogen interacts with, and as estrogen doesn't show up, those est- 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, the loss of estrogen is the causal factor of that. So if... In my model of science here, this is, you know, science for 10-year-olds over here, over this side of the table anyway, um, I go, okay, well what we'll do is we'll take some estrogen-

    27. LM

      Right.

    28. SB

      ... and ping, we'll inject it. Everything will be fine. The brain will stay nice and illuminated. We'll avoid the brain f- fog, the hot flashes-

    29. LM

      Right.

    30. SB

      ... the depression, um, the sleep disruption and everything. We'll just inject some estrogen.

  16. 43:57 – 51:50

    Isn't The Cure Simple?

    1. LM

    2. SB

      And everything will be fine.

    3. LM

      I wouldn't inject it, but yes.

    4. SB

      I don't know. How do you, how do you administer it?

    5. LM

      By mouth or by-

    6. SB

      We'll eat it.

    7. LM

      ... skin.

    8. SB

      We'll, we'll rub it.

    9. LM

      (laughs)

    10. SB

      We'll, we'll do everything. We'll rub it, we'll inject it, we'll-

    11. LM

      (laughs) Yes.

    12. SB

      ... we'll put it on top of cereal. We'll do whatever we have to do to keep it up.

    13. LM

      Put it on your face in the morning.

    14. SB

      Yeah. We'll do a facial.

    15. LM

      (laughs)

    16. SB

      Do estrogen facials and we'll keep it up. We'll put it in the coffee, everything.

    17. LM

      Right.

    18. SB

      We'll smell it, sniff it, and it will... And then everything will be fine.

    19. LM

      Yeah.

    20. SB

      That's the end of the podcast then.

    21. LM

      (laughs) That's it. Bye. Bye.

    22. SB

      (laughs)

    23. LM

      (laughs) If only it were that simple. Mm-hmm. 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 whatnot 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 hot 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 hot 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 this 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. 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 15, 20 years for the research to resume. Let's say 10, but really it's taken 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.

    24. SB

      Okay.

    25. LM

      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.

    26. SB

      Not after.

    27. LM

      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. And technically, 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 night sweats, the insomnia.

    28. SB

      Give me an analogy for that then. So those studies that were done in the 1990s.

    29. LM

      Mm-hmm.

    30. SB

      There was, what, a 160,000 women took part in that study, I think.

  17. 51:50 – 52:50

    What Age Should We Think About Treating/Preventing Symptoms

    1. LM

    2. SB

      What would you do? You said when you go through menopause, what would you do?

    3. LM

      So the, the pillars of, uh, lifestyle adjustments for menopause are diet-

    4. SB

      Okay.

    5. LM

      ... 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 pharmaceu- 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.

    6. SB

      Do you know what a prepper is?

    7. LM

      No.

    8. SB

      It's a term for someone who's preparing for the end of the world.

    9. LM

      Oh, goodness.

    10. SB

      And they have like a bunker, they have a food supply.

    11. LM

      Oh, wow.

    12. SB

      They're like buying guns. It's, um, it's like-

    13. LM

      That I wouldn't do, but I do other things like, um, there's no plastic in my kitchen, for example.

    14. SB

      No plastic, okay. So let's have a look at some of these

  18. 52:50 – 58:34

    Going Deeper Into The Stages Of Menopause

    1. SB

      things then about-

    2. LM

      Okay.

    3. SB

      ... our 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-

    4. LM

      Yes.

    5. SB

      ... the phase in... of menopause in which those symptoms typically show up-

    6. LM

      Okay.

    7. SB

      ... are there different symptoms for different phases?

    8. LM

      No.

    9. SB

      They're not. They're just a, a, a variety of symptoms.

    10. LM

      So since you seem to be interested in the stages, let's go a little bit deeper.

    11. SB

      Okay.

    12. LM

      All right. Let's say, so your girlfriend is in her 30s.

    13. SB

      Yeah.

    14. LM

      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 then you, 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 are about to enter the perimenopausal stage, which is more complex than just one, two, three stages. So once you have a regular menstrual cycle is the premenopausal 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, a little bit earlier, a 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 it's regular. That's the early perimenopausal stage. At that point, the most common complaint is difficulty sleeping. It's poor sleep.

    15. SB

      Okay.

    16. LM

      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 and 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 lasts a day. But it's something to pay attention to because that could be a preview to the menopausal transition. So then you s- 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 gets... you're gonna get fewer and fewer periods spaced apart more and more. That's the late perimenopausal stage where the symptoms really creep in. So that's when most women have the hot flashes, the night 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 uncommon. I can't say normal because it does not feel normal for sure, but it's expected-

    17. SB

      Included in that.

    18. LM

      ... for many women.

    19. SB

      I saw in your book you said things like vaginal dryness.

    20. LM

      Yes. That's not a brain symptom. It's a bodily symptom. That can happen earlier.

    21. SB

      Weight gain?

    22. LM

      Yeah. That can happen.

    23. SB

      Slower metabolism and digestive issues. Overactive bladder?

    24. LM

      Yeah. That's a little bit later usually, more like after menopause.

    25. SB

      Muscle tensions and aches?

    26. LM

      Yeah. Look, there's a whole range of symptoms.

    27. SB

      Weak bones.

    28. LM

      Yeah. Well, you can have tinnitus.

    29. SB

      Tinnitus, which is that ringing in the ear.

    30. LM

      Yes.

  19. 58:34 – 1:02:55

    Link Between Suicides And Menopause In Women

    1. LM

    2. SB

      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.

    3. LM

      Mm-hmm. Yeah. It's right after. So let me get through the, the-

    4. SB

      Yeah.

    5. LM

      So there's the late perimenopausal stage.

    6. SB

      Yeah.

    7. LM

      Then you hit menopause, which is a diagnosis, right? And then you start the early post-menopausal phase. That's as hard as the late perimenopausal stage. So the, the four years around the final menstrual period, in either direction, both directions, are the hardest, right? So the few years, the last three to four years before the final menstrual period, and the three, four years right after the final menstrual 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 it 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 senescence, the end of fertility, but also impacts a number of different systems in the body, including the brain. And the reason that this is impo- important to realize is that it's a very specific and unique medical category that cannot be equaled to just 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 perimenopause. 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 hot 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.

    8. SB

      So you're saying-

    9. LM

      Right?

    10. SB

      ... we need to have a menopause party.

    11. LM

      Yes. (laughs) Absolutely let's have a men- But also want vocabulary because we know that, for example, with pregnancy and postpartum, it is understood that this transformation is not just that you're having a baby. It's that your body's changing and so is your brain. Some women have no depressive symptoms. Some women have baby blues. Some women have postpartum 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 at the pediatrician. You don't have to go to a psychiatrist.

    12. SB

      Mm-hmm.

    13. LM

      They do it right there and then. You are effectively screened and monitored to make sure that you're fine. If you have postpartum depression, what we now have therapies that very specifically work for that type of depression that is different from other types of depression.

    14. SB

      Mm-hmm.

    15. LM

      You know what I mean?

    16. SB

      Yeah.

    17. LM

      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 isn't there. You're gonna have to say, "I have brain fog," and nobody knows what brain fog is because it's not a clinically meaningful category.

  20. 1:02:55 – 1:07:28

    Brain Fog Over Time With Menopause

    1. LM

    2. SB

      How much education do doctors get on menopause?

    3. LM

      None. Very little. So it's one in five OB-GYN residents who get-

    4. SB

      What's an OB-GYN, for anybody that's in Europe?

    5. LM

      Obstetrics and gynecology...

    6. SB

      Okay.

    7. LM

      ... person, is the person that you go to for menstrual cycles and pregnancy and then menopause.

    8. SB

      Okay.

    9. LM

      And anything related to fertility or the function of your reproductive organs.

    10. SB

      They don't know about menopause?

    11. LM

      One in five does. But in reality, when you look at the curriculum, it's 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 we say that the vast majority of specialists are not... OB-GYN specialists are not actually menopause 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, is 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 that even the best OB-GYN specialist is not a brain specialist. Right? So menopause has been pigeonholed as an issue with the ovaries, go see an OB-GYN 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, they're not supposed to. Right? It's a complete different organ and set of skills. So we are trying to change this framework so the brain specialist can be involved in the medical evaluations and treatment of menopausal women.

    12. SB

      Have we finished off with the stages there? So we were in the-

    13. LM

      Yes, we finished off. (laughs)

    14. SB

      We finished it.

    15. LM

      No, just one more.

    16. SB

      Yeah.

    17. LM

      Just one more stage. So there's the early post-menopausal 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-menopausal stage, which is the stage that a woman will live into for the rest of her life. That stage varies, and that I find is really interesting. For many women the symptoms, the hot flashes, the night sweats, the mood changes, the brain fog tend to go away over time.

    18. SB

      I've got a graph that I'll put on the screen that shows how brain fo- fog changes over time. And as you can see, it's kind of like a U-shape. So it's...

    19. LM

      Mm-hmm.

    20. SB

      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 post-menopause, which is, which is, I'm getting when it, guessing where it recovers there.

    21. LM

      Mm-mm. This is, yeah, this is post-menopause.

    22. SB

      Okay.

    23. LM

      So this cognitive function, right? It's nice and high before menopause, then it takes a dip-

    24. SB

      Yeah.

    25. LM

      ... during the transition. Then it goes typically back up. For a few women it would be up here.

    26. SB

      Oh, really?

    27. LM

      So it goes back to premenopausal level- levels, cognitive function. For most women it's a little bit lower than it used to be, but still pretty good.

    28. SB

      This is good news.

    29. LM

      Yes. That is good news. Absolutely. And, but for other women it's not. It keeps going down.

    30. SB

      Oh, really?

  21. 1:07:28 – 1:11:04

    The Benefits Of Exercise

    1. LM

    2. SB

      So this brings us back to this conversation around prepping. You're, you're, you're-

    3. LM

      (laughs) I'm prepping.

    4. SB

      ... in this phase of life where you're prepping. Um, why does exercise matter for menopause?

    5. LM

      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. They 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 that have, um, a boosting functionality. And for menopause in particular, all exercise is good, but cardiovascular activity seems to be especially helpful for the hot flashes and 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, tai chi, 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.

    6. SB

      There's a study in your book, I think in chapter 13, where you, where you case study a, a ... I don't think it was a study you did, around the Latin women, 3,500 Latin women.

    7. LM

      I mean, a wonderful study, wasn't it?

    8. SB

      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.

    9. LM

      Yeah.

    10. SB

      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-

    11. LM

      Yes.

    12. SB

      ... at all.

    13. LM

      Yeah. Yeah.

    14. SB

      So we know exercise is great for that phase of life, but that-

    15. LM

      And we also know that women have no time.

    16. SB

      Is that what it is? Is it a timing issues typically?

    17. LM

      It ... For most women, it's a combination of factors. I think midlife is a bit of a, it's 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 in menopause. So it is a bit of a ... It's, it's a different age to navigate in some ways. And what a lot of women report is that, one, they have no time to take care of themselves. And number two, sometimes there are reasons are outside of your control, like this fatigue that so ma- many women report, the lack of sleep or ... And that, that is a bit of an issue when it comes to feeling en- energized enough to also go to the gym. So thi- there are some barriers and, um, I think it's good to, to be creative, if you can, right? And also realize 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

  22. 1:11:04 – 1:14:11

    Link Between Exercise And Alzheimer's

    1. LM

      moving.

    2. SB

      Is there a certain type of exercise that is, um, too much?

    3. LM

      Oh.

    4. SB

      Could you, could you do too much exercise? 'Cause 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-

    5. LM

      Yeah. (laughs)

    6. SB

      ... to stave off m- menopause.

    7. LM

      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 gym and just-"

    8. SB

      Yeah.

    9. LM

      "... work out three hours a day." That's not what the research shows.

    10. SB

      'Cause your cortisol levels would go up as well.

    11. LM

      Yes, it may happen. And also your recovery time may increase.

    12. SB

      Okay.

    13. LM

      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, h- how healthy, how healthy you actually are as a whole. And what the research, in women especially, women who are recently post-menopausal, so 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.

    14. SB

      Which is?

    15. LM

      Which is you work out in a 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.

    16. SB

      Okay.

    17. LM

      So your heart rate goes up, but not so high up that you can't breathe basically.

    18. SB

      Okay.

    19. LM

      Actually, and there's different intensity intervals, of course. Uh, Rich Roll called it, he said to me, "This is what professional athletes call zone two."

    20. SB

      Okay.

    21. LM

      So zone two, everyone. (laughs)

    22. SB

      Okay.

    23. LM

      But if you increase the intensity a lot more, the gains actually start diminishing after menopause. Which is not universal.

    24. SB

      Yeah.

    25. LM

      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 2 or moderate intensity exercise. Just do it often enough that the gains are consistent.

    26. SB

      And as it relates to Alzheimer's, you talked about those Alzheimer's plaques in the brain.

    27. LM

      Yeah.

    28. SB

      If I exercise more, do women that exercise more have less of those Alzheimer's plaques?

    29. LM

      Yes. Yes, you do have fewer 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-

    30. SB

      Wow.

  23. 1:14:11 – 1:18:08

    Caffeine, Sleep And Menopause

    1. LM

      week.

    2. SB

      So let's talk about your, um, diet then.

    3. LM

      My... Yes.

    4. SB

      Your diet re-

    5. LM

      Yes.

    6. SB

      ... regime as you prepare for that phase of life. Let's start with caffeine.

    7. LM

      Oh, yes. So I switched to decaf. (laughs)

    8. SB

      You don't seem happy about that.

    9. LM

      To everybody's anguish in my house. Yes. I already switched to decaf.

    10. SB

      Why?

    11. LM

      Because caffeine is a little bit of a trigger for sleep disturbances for a lot of women. And what people don't realize is that 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 full 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 10:00 PM, right? And if you drink a cup of coffee at 2:00 PM, half of the caffeine will be in your system by 8:00 PM, and the quarter of the caffeine will still be circulating everywhere in your body and brain at 10:00 PM. So you can't just have a cup of coffee at 2:00 PM and then hope for a good night's sleep unless you go to sleep late, which I can't afford because I'm up at 6:00.

    12. SB

      So could, could one also argue then that coffee is going to increase... C- because if coffee is still in our brain, you know, if I have a coffee at 9:00 PM... You know, people used to have coffees after dinner. Isn't that mad?

    13. LM

      Yeah.

    14. SB

      They still do that in restaurants. They, they, you eat your food, and then they come around and ask if you want an espresso.

    15. LM

      I know.

    16. SB

      Absolute psychopaths.

    17. LM

      (laughs)

    18. SB

      I've no idea. It's so crazy. Uh, they don't ask as much anymore, but, uh ...

    19. LM

      Helps with digest.

    20. SB

      B- but it had ...

    21. LM

      See, 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-

    22. SB

      Yeah.

    23. LM

      ... you're disrupting your sleep.

    24. SB

      'Cause it's waking your body back up and going, "Go on."

    25. LM

      Yeah.

    26. SB

      Just before you need to sleep.

    27. LM

      Right.

    28. SB

      So if I have a coffee, say, 6:00 PM, 7:00 PM, 8:00 PM at night.

    29. LM

      Mm-hmm. At midnight, you still have half of the caffeine.

    30. SB

      Which means I'm not gonna sleep as well, which means my brain isn't going to, um, do its job of clearing things out and restoration.

  24. 1:18:08 – 1:20:52

    Is Alcohol Bad For Menopause?

    1. LM

    2. SB

      So sleep is super critical here.

    3. LM

      It is really important.

    4. SB

      There must be a pretty strong link between people who don't sleep much and Alzheimer's as well, then.

    5. LM

      There is a link, yes. It's been explored and it seems to be consistently significant across studies.

    6. SB

      And is there a relationship with alcohol and menopause?

    7. LM

      Yes. Alcohol, unfortunately, is a trigger for some of the symptoms of menopause. It can make, it can really make them worse. My biggest concern is that alcohol is a dehydrating substance. It's, their functionality 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 four percent water reduction of water volume loss can prompt neurological symptoms like headaches and migraines and dizziness and brain fog. So actually, alcohol, by dehydrating your brain and also 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 found very interesting where people study 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 neuropsych testing and reaction times-

    8. SB

      Mm-hmm.

    9. LM

      ... computerized tests that measure your processing 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.

    10. SB

      Damn. I need to start drinking water on this podcast.

    11. LM

      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 something 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 installed this ginormous filter for the entire house where the water is now filtered in a way that remuse- removes all the impurities but preserves all the electrolytes.

  25. 1:20:52 – 1:22:40

    What Toxins Should We Be Aware Of?

    1. LM

    2. SB

      What else have you done in that house-

    3. LM

      Even in the shower.

    4. SB

      ... sort of scientist lab of a house that you're building? This, well, you mentioned toxins.

    5. LM

      I'm a little bit strict.

    6. SB

      Sounds like it.

    7. LM

      And... Yes. So there's no plastic in my kitchen, not at all. Everything's just glass.

    8. SB

      Why?

    9. LM

      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 mi- also when you put plastic in the dishwasher or the hot water will make it leak and then it leaks into your plates and glasses and whatnot 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 at lower doses but 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.

    10. SB

      Breast cancer?

    11. LM

      Breast cancer. Yeah. Reproductive cancers as well. 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.

    12. SB

      And what else, what do you put in your mouth in terms of food?

    13. LM

      Uh,

  26. 1:22:40 – 1:25:42

    Specific Foods That Help Stave Off The Menopause

    1. LM

      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... So when I was studying, uh, my favorite class has always been neurochemistry, and I was learning about these, 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 our brain health or the opposite and feed our brain garbage that is going to be unfortunately incorporated in the fabric of your brain and I don't want that-

    2. SB

      I don't want that. I don't want that for my brain.

    3. LM

      ... for my brain, for sure. Exactly. (laughs)

    4. SB

      (laughs)

    5. LM

      So it's really important to focus on clean foods that are nutrient dense and they're prioritized 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 fat inside your brain," which is absolutely not correct. The cholesterol from the diet can never get inside your brain. There's no way for the 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 antioxidants like vitamin C, vitamin E, selenium, beta-carotene, um, things that you find in fruits and veggies basically and some nuts and seeds preferentially, uh, lean proteins, so amino acids, the essential amino acids, and polyunsaturated fatty acids which can be from plant-based sources or-... animal sources, but they really have to be the polyunsaturated fatty acids that the brain really wants and needs, and need to be replenished consistently.

    6. SB

      So you're saying if I'm on, if I'm struggling with menopause, then I should be aiming at the Mediterranean diet.

    7. LM

      Pretty much, yes. Thank you. (laughs) That's the bottom line.

    8. SB

      Okay.

    9. LM

      So a Mediterranean-style pattern seems to be correlated or at least associated with better outcomes overall for women's health.

  27. 1:25:42 – 1:30:06

    Are Supplements Needed In Our Diet?

    1. LM

    2. SB

      What about supplements?

    3. LM

      Supplements are typically used to supplement a healthy diet, not to replace it, and I think that's important, because at least here, there's a tendency to recommend really high doses of 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 doses of something that your body... Or let's, let's say the brain, at least, I just stay in my lane, but high doses of something that your brain doesn't want or need are not going to be very helpful. You're just going to either pee them out or they don't... They're just going to accumulate in other parts of the body, so they're not as helpful.

    4. SB

      'Cause 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 omega-3, I think, "I'm doing my little brain a favor."

    5. LM

      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 polyunsaturated fatty acids that the brain really needs. Antioxidants as well. I, I take vitamin C. Um-

    6. SB

      Oh, okay, so you are on the supplements. You were just trying to keep them all to yourself.

    7. LM

      No.

    8. SB

      I'm joking.

    9. LM

      (laughs) I wasn't. Well, I... You know what I really like is more extracts-

    10. SB

      Okay.

    11. LM

      ... and botanicals.

    12. SB

      Okay.

    13. LM

      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-

    14. SB

      Mm-hmm.

    15. LM

      ... I think because I work in a hospital.

    16. SB

      Right.

    17. LM

      So I associate that as being sick-

    18. SB

      Yeah, yeah.

    19. LM

      ... 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 noni juice, which is a... (laughs) I s- sometimes you give me the eyebrow. You just go like... (laughs)

    20. SB

      Yeah, yeah, yeah.

    21. NA

      What?

    22. SB

      Noni. Noonie juice?

    23. LM

      Noni, N-O-N-I.

    24. NA

      Noonie.

    25. LM

      Is a wonderful juice from the Pacific Islands that has a little bit of a bitter taste, which is always good because bitters are really good for digestion and gut health, and that's important for brain health and, and elimination as well, and clearance. And it's very rich in vitamins and minerals and a lot of phytonutrients. So that's a good concentrated source, and it's mixed with blueberry juice, so that's, that's also really good to have.

    26. SB

      One of the things I found quite, um, fascinating is I read that there was a study done on legumes that proved-

    27. LM

      Yeah, yeah.

    28. SB

      It was in your book, it was in chapter 14, where it says there's, uh, legumes apparently to be, uh, seem to be a bit of a miracle food for delaying menopause?

    29. LM

      Yeah. So a diet that is rich in legumes and also fish, fatty fish-

    30. SB

      Yeah.

  28. 1:30:06 – 1:37:14

    What Is The Evolutionary Reason For Menopause?

    1. LM

    2. SB

      I- okay, all of this begs the question-

    3. LM

      Yeah.

    4. SB

      ... 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 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, 'cause it seems to be the case that i- it's not the same for men. So is there an ev- evolutionary basis for everything we've talked about today?

    5. LM

      The theory of evolution was developed by Charles Darwin, who did not love women.

    6. SB

      Oh, really?

    7. LM

      (laughs) Yes.

    8. SB

      Let's move on then.

    9. LM

      And the theory makes sense if you're a man-

    10. SB

      Okay.

    11. LM

      ... 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 genes on to the next generation. So the fact that women would stop being reproductive in midlife and be able to live after that is clearly against the classic theories of evolution.

    12. SB

      But I, I was thinking about this, and I was thinking-

    13. LM

      Mm-hmm.

    14. SB

      ... well, is it... Is it not just because...In the, what, 1700s, 1800s, the average life expectancy was like 35, 40.

    15. LM

      Yes, but there was a notion already back then that w- 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. It's a big question mark because most animal species, in most animal species, females actually die right after menopause. So your lifespan as a female animal tends to match your reproductive span, which is what Darwin was talking about. Now, this theory only makes sense if you are not able to outlive 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 are suppo- 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 live long past menopause. They 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 supporting 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 is, 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 these children, you have to grow a child, and there's a strong risk of dying from childbirth 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 at some 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's, 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 pregnancies, the most fit of women at that point somehow underwent these mutations that enabled or perhaps just 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 would stop being reproductive but would keep being productive and stay alive. And anyone who's ever had a grandmother would know that that's very, very important to have.

Episode duration: 1:59:13

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