Leading Neuroscientist Reveals The Truth About The Female Brain | Dr Lisa Mosconi

Dr. Lisa Mosconi 0:00 Women's brain health remains one of the most under-researched, under-diagnosed, under-treated fields of medicine, and it's really a direct consequence of the reductive understanding of what a woman is in the first place. And that I take personally, and I find it incredibly offensive. For every man suffering from Alzheimer's, there are two women, which is something we never talk about, right? So we know that women have a higher risk of breast cancer, for sure, and breast cancer gets the pink ribbon, and everybody clearly understands breast cancer is a women's health issue. But a woman who's 60 years old is almost twice as likely to develop Alzheimer's disease in the rest of her life than she is to develop breast cancer, and nobody talks about Alzheimer's disease as something that women should be concerned about. [upbeat music] I started looking at brains when I was 19, and one of the reasons that I was so passionate and so interested in women's brain health is that I have a family history of Alzheimer's disease. It runs in my family and really hits the women in my family pretty hard. And so already back then, I was asking everyone, "Does it matter if you're a woman or a man? What, what are the genetics of Alzheimer's? Um, is it worse if you're a woman? Does it hit... You know, does it affect women more than men, and why?" And back then, there were no answers whatsoever. And so I, I literally, I dedicated my entire career to studying women's brain health. It's literally what I do for a living, and everything else is more, you know, like a side dish. [laughs]

Dr. Rangan Chatterjee 1:53 Yeah, so, so, so there's, there's two strands for me that I'd like to pick up on. One is about the ordering of your books then in terms of if this is the more natural one.

Dr. Lisa Mosconi 2:02 Yes.

Dr. Rangan Chatterjee 2:03 It's surprising to me that you then, or it's interesting to me that you started writing a book on food and the brain, and I wonder if that's to do with, you know, the fact that food dominates everything, right? When we talk about lifestyle, generally the conversation goes around food. We, we often neglect the stress, sleep, other factors.

Dr. Lisa Mosconi 2:23 That's right.

Dr. Rangan Chatterjee 2:23 We like talking about food. So was it easier to get that entry point into writing a book i- in a way to sort of communicate your work to people?

Dr. Lisa Mosconi 2:32 [laughs]

Dr. Rangan Chatterjee 2:33 Was it easier through food than, you know, the brain?

Dr. Lisa Mosconi 2:37 No, it w- it was not. It was, it was quite a thing. Also, I am, I'm a scientist. I'm, like, 100% scientist, so it was... It, it's already hard enough for me to just talk to non-academics. And my work, again, is really about brain health and especially women's brain health. So it was quite interesting to me. I had the opportunity to write this book about, uh, diet and nutrition for the brain, and that was really a great time for me to do so because, you know, research comes and goes.

Dr. Rangan Chatterjee 3:12 Yeah.

Dr. Lisa Mosconi 3:12 The topics change. So when I started, I was looking at genetics. I was looking at DNA and the genetic factors that cause Alzheimer's, that predispose to Alzheimer's disease, and that was a few years of my life. And then I started looking into lifestyle and nutrition and exercise and intellectual activity and sleep, and that was a few years of my life, again, of my research, because research goes in cycles, right? You have three years worth of funding, five years worth of funding. And so that was a great time for me to really focus on brain nutrition because number one, I was teaching neuro nutrition at NYU-

Dr. Rangan Chatterjee 3:50 Yeah

Dr. Lisa Mosconi 3:50 ... for a little while I was at NYU. And then I moved to Weill Cornell, where I am still associate director of the Alzheimer's Prevention Clinic, which was funded by Dr. Richard Isaacson-

Dr. Rangan Chatterjee 4:03 Yeah

Dr. Lisa Mosconi 4:03 ... whom I know you, you know well. And that's really all about behavioral interventions that can mi- minimize risk of dementia in people and also really just support cognitive health. But then I was able to go back to women's brains, and I've been doing that since.

Dr. Rangan Chatterjee 4:22 Yeah.

Dr. Lisa Mosconi 4:22 So it really is my passion, is women's brains.

Dr. Rangan Chatterjee 4:25 I, I think you can tell that when you read this book, whi- which is-

Dr. Lisa Mosconi 4:28 Yes, it's very passionate. [laughs]

Dr. Rangan Chatterjee 4:30 Yeah.

Dr. Lisa Mosconi 4:31 Yes.

Dr. Rangan Chatterjee 4:31 Your, your Italian passion's definitely coming through.

Dr. Lisa Mosconi 4:33 Yes. [laughs]

Dr. Rangan Chatterjee 4:35 Um, but, but it's, it's, it's such an important book. It's such an important topic.

Dr. Lisa Mosconi 4:40 Yes.

Dr. Rangan Chatterjee 4:40 And you mentioned already in this conversation a few times the female brain, the female brain, right?

Dr. Lisa Mosconi 4:46 Yeah, female brain.

Dr. Rangan Chatterjee 4:46 And normally-

Dr. Lisa Mosconi 4:47 Not the same as the male brain.

Dr. Rangan Chatterjee 4:49 Well, I think that's... I think we should start there, really. What, what-

Dr. Lisa Mosconi 4:52 Yeah

Dr. Rangan Chatterjee 4:53 ... what is going on there? Because I think in my profession as a, you know, in medicine, we very much have not been taught throughout-

Dr. Lisa Mosconi 5:04 Right

Dr. Rangan Chatterjee 5:04 ... our careers, and even now when you talk to colleagues, I'm not convinced that there is a widespread understanding that the female brain is different from the male brain.

Dr. Lisa Mosconi 5:16 Yes, I agree with you. There's, there's marketing, right, where we are being presented as different beings, starting from very, uh, early on in life with pink and blue, Barbie and Lego. Like, we are aware that there are behavioral tendencies, not differences, but more like tendencies that have been totally exploited by the industry and marketing. But then I think it's really important to recognize that there are some differences between the female brain and the male brain, that they're not... they have nothing to do with, like, Mars and Venus, [laughs] so to speak, because I get that a lot, but there, there are real biological differences that are really important for our health. So I've been looking at brain scans forever, as I mentioned, and I can guarantee that there is no such thing as a gendered brain. When people tell you, "I can look at two brains and tell you this is male, this is female," absolutely impossible. Just, there's no way to do that. The differences are subtle, and they're functional rather than structural. It's not the anatomy that is different, it's really the functionality of the brain. And what's really important and what my research has shown consistently, which I'm very happy about, is that our brains age differently. That we think about aging as something that is quite linear, and that is pretty much the case in men, which is great. It's a great thing. For women, it's more like a stepladder. There are some very important turning points that accelerate aging and slow down aging. Accelerate aging, slow it down. And as scientists and as clinicians, we're just never told that this is the case. We're not told that we age differently, and we're not told why that is the case. And one of the big answers that we have come up with is that our hormones are really key for brain aging, especially in women.

Dr. Rangan Chatterjee 7:23 Yeah.

Dr. Lisa Mosconi 7:23 Yeah.

Dr. Rangan Chatterjee 7:25 That is-

Dr. Lisa Mosconi 7:26 It's a lot of information all at once. [laughs]

Dr. Rangan Chatterjee 7:28 It, it, it is, but I, I think what you have just said there, Lisa, is so profound and so important. Because actually, if society is not aware of that-

Dr. Lisa Mosconi 7:44 Mm-hmm

Dr. Rangan Chatterjee 7:44 ... if scientists, if doctors are not aware of that, then we can start to put that bias into how we talk to people. How-

Dr. Lisa Mosconi 7:54 Right

Dr. Rangan Chatterjee 7:54 ... as a doctor I treat my patients. You know, that, that, that bias can infiltrate... And actually, I guess as a broader philosophical point for me, as I'm reading your book, and you sort of do cover this in your introduction, you know, actually what we're talking about on some level is a form of discrimination really, isn't it?

Dr. Lisa Mosconi 8:14 Yeah. [laughs] Clearly so. It starts with Darwin, you know, the father of evolution and all modern theories of biology. He, he was incredibly misogynist, and he would say that, uh, women's brains are inherently inferior to men's brains. And this is pretty much the framework that scientists were operating under for centuries, just trying to prove that women's brains were not as good as men's brains. And that was really based on observations of size. So if you do compare a number of brains, male and female brains, female brains, women's brains are smaller. But that's because women are smaller than men on average, right? Our head size is smaller, so it makes sense that our brains are also smaller. Once you account for head size, there's really not much difference in volume. What we do find is that there are very specific subtle differences in some parts of the brain that are also correlating with behavior, which I think is really nice when we say, for example, that, um, we know that women have better verbal memory than men. This is related to some differences in the structural and functional connectivity of the brain that is slightly different in women than in men.

Dr. Rangan Chatterjee 9:37 Can you explain verbal memory?

Dr. Lisa Mosconi 9:39 Yes. Verbal memory is our ability to remember verbal information. So if somebody tells you something, [laughs] you as a woman remember it. [laughs] I'm laughing because we have this... You know, with, with my husband, I literally had to repeat the same thing five times before he actually even pays attention to me. Um, but-

Dr. Rangan Chatterjee 10:00 Well, he's a man, right? So his verbal-

Dr. Lisa Mosconi 10:01 He's... Yeah, exactly. [laughs]

Dr. Rangan Chatterjee 10:02 His verbal memory is inferior to yours as a woman.

Dr. Lisa Mosconi 10:05 Yeah. It's not his fault, right? Um, but then it is true that men have better visu- visuospatial abilities on average. Again, this is not an absolute, but better sense of direction, for example. And there's a lot of, um, debate over whether that is the case or not, but it does seem to be, to be true. And it is also reasonable if you think about evolution, right? A long time ago, our ancestors, um, used to go out hunting, the male, right? The men used to go out hunting and needed to be able to go back home. Whereas the women would stay back and nurture the children and take care of the elderly. So it makes sense then those parts of the brain that are involved in direction-finding would be more developed in men to some extent. And those parts of the brain that are more about nurturing and raising a family might be a little bit more, um, I'm not gonna say developed, because that's unkind to, to fathers who are incredibly wonderful. But th- they're just built a little bit differently in women. They- they're wired a little bit differently. I would say wired is a good word. Our brains are somewhat wired differently, and that really starts from the moment of conception, because our genes are different, right? Women are born with the XX genotype, which is also the title of my book, The XX Brain. Men are born with an X and a Y chromosome. And it's really interesting that these chromosomes are quite different. Like, the X chromosome is so much bigger than the Y chromosome. It's got 1,098 genes as compared to the 78 genes in the Y chromosome. So women are literally born with 1,000 genes more than men, which are important for reproduction, but also for brain function. So from the moment we're born- Our DNA is telling our brains, as women, that our brains really respond to a reproductive organ in a very strong way, and that is really such an important underlying mechanism for our entire research on brain aging, because it's really the interactions between the brain and the reproductive organs that, in many ways, drive brain aging in women.

Dr. Rangan Chatterjee 12:32 Yeah. You said before that for women as they age, there's often a stepwise change. You know, with men it's-

Dr. Lisa Mosconi 12:40 Yeah

Dr. Rangan Chatterjee 12:40 ... more gradual. What... You know, are there key moments in life where these step changes start to happen, and if so, what are they?

Dr. Lisa Mosconi 12:51 They are the, the three Ps, puberty, pregnancy, perimenopause. So puberty is obviously common to both men and women and is really the beginning of our life as adults, right? So the brain from the moment of conception, the brain has been growing, growing, growing, growing, growing at light speed. But once we hit puberty, there's a moment that... These are called neuroendocrine transition states, and what the word means is that is our neurological system, our brain, and our endocrine systems that are in transition together. So something is changing. You're maturing from a sexual perspective, but so is your brain in ways that go above and beyond reproduction. So during puberty, there's this explosion of hormonal power that v- in a very interesting way leads to the brain losing volume. You would think the brain would explode as well. Instead, it's exactly the opposite. The brain says, "Okay, that's it. Enough growing. I need to specialize." And so a number of synapses, which are the connection between neurons, are just being discarded because the brain doesn't need them anymore. At that point, you know how to lace up your shoes, right? You know how to ride a bike. You don't need to remember all the, the, the different little steps. Those neurons can go. Those connections can go, and the brain gets smaller but more efficient. And those, those neurons that you have in your brain once you're an adolescent are pretty much all the neurons you'll have for the rest of your life. Your synapses will change, will grow, will get discarded, but your neurons pretty much are final. And then for men, things remain pretty stable over time, and I want to just clarify that these changes are mediated by our hormones, and we all know that hormones differ between men and women, right? Men have more androgens like testosterone. Women have more estrogens like estradiol, which is the most potent of estrogens. And what's important is that these hormones are not just key for reproduction and fertility. They're also really incredibly important for brain function. They literally supercharge your brain. So when the levels of these hormones are high, your brain energy is also high.

Dr. Rangan Chatterjee 15:25 Yeah. I mean, it's, it, it's really profound because-

Dr. Lisa Mosconi 15:29 Mm-hmm

Dr. Rangan Chatterjee 15:29 ... we... You know me. In common parlance, we, we often talk about, oh, puberty and how people start, you know, obviously what it means for boys and girls when they go through puberty. Um, we, we know about these different stages in life, but we often think about them through the lens of hormones, and even, you know, the general public will talk about it as hormonal changes.

Dr. Lisa Mosconi 15:51 Yeah.

Dr. Rangan Chatterjee 15:52 But we often don't make the link-

Dr. Lisa Mosconi 15:55 Never

Dr. Rangan Chatterjee 15:55 ... that, that hormones-

Dr. Lisa Mosconi 15:57 [laughs]

Dr. Rangan Chatterjee 15:57 ... that are changing in our body also have an impact on our brain. And, and so I think what you're doing with your work is really, you know, almost getting that conversation up on a par saying, "Yes, it's hormones. You, you know it's hormones, but those hormones actually change the way your brain functions as well."

Dr. Lisa Mosconi 16:16 Yes. Those are the same hormones, and it's just not common knowledge, I find, even with scientists. I, I studied neuroscience. I have a PhD in neuroscience and nuclear medicine, and not once did anyone mention hormones to me. Menopause, yeah, you know, we know that that happens to women, but how and why nobody seems to care about, to really talk about. So it's interesting for me that I, I literally work at the intersection between neurology, neuroscience, and women's health, and it's a really strange space to work in. [laughs] And there are many people who work in neuroscience, and there are so many people who work in women's health, but they don't talk to each other. So if you go to a brain person like me, we understand the brain. We don't really understand the ovaries or reproductive systems. And then you go to an OBGYN or a, a women's health doctor, and they don't fully understand how the brain works.

Dr. Rangan Chatterjee 17:21 Yeah.

Dr. Lisa Mosconi 17:21 So I think it's so important to, to have this conversation and make sure that people are aware that the brain is not an isolated organ but rather that there, there, there's a constant communication going on between our brains and the reproductive organs every day over life. So the health of the ovaries for women and the health of the reproductive organs for men and women is so crucial for brain health-

Dr. Rangan Chatterjee 17:50 Yeah

Dr. Lisa Mosconi 17:50 ... and the other way around.

Dr. Rangan Chatterjee 17:52 Yeah, I mean, I think one of the, the reasons I've always been drawn to your work and really, really connected with it is because you very much do see the body as a system.

Dr. Lisa Mosconi 18:02 Mm-hmm.

Dr. Rangan Chatterjee 18:03 You know, th- that's one thing that I really like. It's very, very aligned with how I look at the human body as well. But you also, as you write about in, in your latest book, you know, you don't believe in this sort of one-size-fits-all approach, um, whi- which again is completely aligns with, with how I think.

Dr. Lisa Mosconi 18:22 Mm-hmm.

Dr. Rangan Chatterjee 18:22 And I think a lot of the tips towards the end of the book, whi- which are so practical, I think it really helps people try and identify what are the right approaches for them, what they can experiment with to see if it works for them.

Dr. Lisa Mosconi 18:36 Yeah.

Dr. Rangan Chatterjee 18:36 So yeah, I, I, I think it's a super, super interesting point. And I, I, I've got to be honest, I think it's one of my frustrations with, with medicine is, uh, you know, there's, there's a lot within the profession I'm proud of.

Dr. Lisa Mosconi 18:47 Mm-hmm.

Dr. Rangan Chatterjee 18:48 But actually I do think on some things we've got slightly off track and we've got very, very microscopic through one lens looking at a particular organ-

Dr. Lisa Mosconi 18:57 Yeah

Dr. Rangan Chatterjee 18:57 ... without seeing the big picture, and your work highlights that so beautifully.

Dr. Lisa Mosconi 19:02 Thank you. I used to be very vertical in my work, you know, just one topic and go really, really deep. And I, I find as you start going horizontal, it's so much more interesting and so much more satisfying to really think about you as a person, not as a bunch of bits and pieces that magically work together. You know, we are systems, like you said, and I think we, as a society, we have a tendency to think of our brains as not being part-

Dr. Rangan Chatterjee 19:35 Yeah

Dr. Lisa Mosconi 19:35 ... of the system, whereas I think it's so important to understand that everything that happens in your body has an effect on your brain as well.

Dr. Rangan Chatterjee 19:43 Yeah.

Dr. Lisa Mosconi 19:43 So by taking care of your body, you take care of your, of your brain and your cognition and your mood and your affect and your sleep and everything you need for life.

Dr. Rangan Chatterjee 19:54 Do you remember when exactly that changed for you? And, and the reason I ask that, Lisa, is because, you know, I always talk about the fact that I'm a clinician, okay?

Dr. Lisa Mosconi 20:03 Mm.

Dr. Rangan Chatterjee 20:03 So I'm not a researcher. So I've spent, you know, nearly 20 years seeing patients.

Dr. Lisa Mosconi 20:09 Mm-hmm.

Dr. Rangan Chatterjee 20:10 And so I always listen carefully. I observe what's happening, who's getting better, who's not getting better, what's going on, why do people come in with three or four different symptoms, and if I can, let's say, help them change various aspects of their lifestyle, all three or four of them start to get better as well. And you think, "Okay, h- hold on a minute. What's going on here?" So my perspective that everything's connected comes very much from what I've seen with patients.

Dr. Lisa Mosconi 20:36 Mm-hmm.

Dr. Rangan Chatterjee 20:37 What... You know, a lot of scientists, by nature, the scientific method, I guess, has to be slightly reductionist at certain times. So what happened to you? W- do you remember that exact moment when you started-

Dr. Lisa Mosconi 20:48 Yeah

Dr. Rangan Chatterjee 20:48 ... to think less vertically and started to move out horizontally?

Dr. Lisa Mosconi 20:51 I do. I do. And it was, it was [laughs] in some ways it was frustrating. So I was, I was studying Alzheimer's disease, again, trying to understand what causes Alzheimer's disease. And this is, this is particularly important because Alzheimer's is the most common form of dementia on the planet, affecting almost 6 million patients in the United States alone, and similar, um, a similar two to one ratio is found pretty much in all countries that we have data for. Which means for every man suffering from Alzheimer's, there are two women, which is something we never talk about, right? So we know that women have a higher risk of breast cancer, for sure, and breast cancer gets the pink ribbon, and everybody clearly understands breast cancer is a women's health issue. But a woman who's 60 years old is almost twice as likely to develop Alzheimer's disease in the rest of her life than she is to develop breast cancer, and nobody talks about Alzheimer's disease as something that women should be concerned about or should know about. And when I started working in this space, and we get so much pushback, like the whole time, the whole time. It was always, "Well, sweetheart, you know, the thing is..." [laughs] I always get the sweetheart, you know, the condescending, "Yes, girl, but..." Um, women live longer than men, and Alzheimer disease is a disease of old age, so it's inevitable that more women than men develop Alzheimer's disease. And it took a really long time for me and for other scientists to really prove that that is just a bias. We're just not thinking about it correctly. Number one, women don't live that much longer than men. But most importantly, Alzheimer's disease is not a disease of old age. We tend to associate it with the elderly because the symptoms develop usually when people are, like, in their 70s. The average age of onset here in the United States is 71 years old. But in truth, Alzheimer's disease starts with negative changes in the brain years, if not decades, prior to the cognitive symptoms. It's a very insidious disease. It's a, it's a silent disease that starts in midlife and accumulates over time, and then eventually the damage is so severe that you get clinical symptoms. And so the question changed to, given that Alzheimer's disease is a disease of midlife or middle age, what happens in midlife only to women and not to men that could potentially explain why more women than men have Alzheimer's disease? And we just showed recently that what happens to women is that we tend to develop Alzheimer's plaques before men do, at an earlier age than men do, and specifically during the transition to menopause. And that created a chaos [laughs] when we showed that. That was like a, like, "Whoa." Because we never, ever talk about menopause as something that could be associated with Alzheimer's disease. We never talk about menopause as something that could potentially impact our brains. Right? Let alone increased risk of Alzheimer's in women. So that was a big deal, and for me, I was not expecting that, to be honest. So that was my aha [laughs] moment. We had to shift gears here and just start completely from scratch.

Dr. Rangan Chatterjee 24:37 Yeah, I mean, Lisa, as you, as you sort of talk through that-

Dr. Lisa Mosconi 24:41 It makes sense

Dr. Rangan Chatterjee 24:42 ... it, it, it makes complete sense.

Dr. Lisa Mosconi 24:44 Yeah.

Dr. Rangan Chatterjee 24:46 And I, I have, I have a sort of whole different range of emotions-

Dr. Lisa Mosconi 24:50 Mm

Dr. Rangan Chatterjee 24:50 ... um, from anger to frustration to, you know, feeling this is very, very unfair. I, I guess I'm slightly clouded at the moment that my, my elderly mum's not going through a great time at the moment.

Dr. Lisa Mosconi 25:04 Mm.

Dr. Rangan Chatterjee 25:04 Uh, with, she lives by herself. She's falling a little bit. My brother and I are-

Dr. Lisa Mosconi 25:08 Right

Dr. Rangan Chatterjee 25:08 ... helping out loads. We're trying to get things, uh, back on track, but, but, you know, occasionally I, I, I, I talk to my brother and go, "Hey, is Mum, is Mum still kind of-

Dr. Lisa Mosconi 25:20 Okay

Dr. Rangan Chatterjee 25:20 ... you know, s- have you noticed something?" And then a few days later she's better again. So, like, you know, it's... And I'm too close to it to be objective, but I guess the point I'm trying to get to is you think this research-

Dr. Lisa Mosconi 25:36 Mm-hmm

Dr. Rangan Chatterjee 25:36 ... if you wound it back and let's say it was done 50 years ago-

Dr. Lisa Mosconi 25:41 Yeah

Dr. Rangan Chatterjee 25:41 ... or 100 years ago, right?

Dr. Lisa Mosconi 25:42 Yeah.

Dr. Rangan Chatterjee 25:43 How many women's lives might have been changed?

Dr. Lisa Mosconi 25:47 Many.

Dr. Rangan Chatterjee 25:48 Preemptive action could have been taken, and again, look, that's the nature of progress. That's the way the world goes. I get that, but I do get the sense, and I think these things are particularly acute at the moment, you know, as you mention in the book, the Me Too movement.

Dr. Lisa Mosconi 26:02 Mm.

Dr. Rangan Chatterjee 26:02 We've seen this year with the sort of racial tensions in America and around the world, but there's that theme of discrimination and unfairness-

Dr. Lisa Mosconi 26:13 Mm

Dr. Rangan Chatterjee 26:13 ... and trying to create a more equal society, and-

Dr. Lisa Mosconi 26:15 Mm

Dr. Rangan Chatterjee 26:16 ... although you've written a health book to help women, actually, there's a political aspect to this as well. There's a-

Dr. Lisa Mosconi 26:24 Yes

Dr. Rangan Chatterjee 26:24 ... you know, there really is. It's about equality in science, about not looking through the world, and I appreciate I'm a man saying this, but, you know-

Dr. Lisa Mosconi 26:33 No, no, no

Dr. Rangan Chatterjee 26:33 ... a very male-focused world. It's about-

Dr. Lisa Mosconi 26:36 Well, yeah, but I, I think so, everybody reacts this way, men and women. And, and nobody wants to treat women poorly. Nobody's aware that women are being discriminated in research, and I, uh, I think, uh, it doesn't take a scientist to denounce the fact that women's social, financial, and physical security remains inequitable. Not doing that. But it does take a scientist or a doctor to denounce the fact that women are also overlooked medically, where our needs go way too often unacknowledged and unaddressed, especially as far as our brains are concerned. Women's brain health remains one of the most under-researched, under-diagnosed, under-treated fields of medicine, and it's really a direct consequence of the reductive understanding of what a woman is in the first place, and that I take personally, and I find it incredibly offensive. I talk about bikini medicine-

Dr. Rangan Chatterjee 27:41 Yeah

Dr. Lisa Mosconi 27:41 ... in the book, and I think it's, it's an interesting term that really speaks to the fact that historically medical professionals and scientists truly believed that women were essentially smaller men with, with different reproductive organs. So from a medical standpoint, it was really like saying that the only thing that makes a woman a woman from a medical perspective is the reproductive organs, those parts of the body that you can cover under a bikini, and that means that women's health is inherently flawed and biased because all the attention is really about the reproductive organs. You go to a women's health doctor. They, they draw blood to check your hormones, to do a Pap test, to check your cervix for cancer. If you're over 40, 42, you get a mammogram to make sure your breasts are okay, and that's great. We should, we should. We should take care of all... We should take advantage of all those tests. It's incredible progress, but nowhere in the conversation are our brains mentioned, and I just want to, to clarify for context that Alzheimer's is only, Alzheimer's disease is just one part of a much bigger picture where 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 attack the brain, like multiple sclerosis. We're four times more likely to suff- suffer, I'm going to underline suffer, from headaches and migraines. We're more likely, far more likely, to develop a meningioma, which is the most common form of brain tumor, especially after menopause, and we're far more likely to die of a stroke. And still, when we talk about women's health, we very specifically do not talk about our brains.

Dr. Rangan Chatterjee 29:36 Yeah, absolutely, Lisa, and, you know, as you were going through those statistics, which I, I am sure will be brand-new information for a lot of my listeners and viewers-

Dr. Lisa Mosconi 29:46 Yeah

Dr. Rangan Chatterjee 29:47 ... you, you can't help but thinking if men were much more at risk of these things, I suspect we would know about them.

Dr. Lisa Mosconi 29:55 Yeah.

Dr. Rangan Chatterjee 29:55 And, you know, it's... I, I, I wanna make clear that whoever's listening to this or watching this on YouTube right now, this is a conversation that's relevant for all of us, men and women.

Dr. Lisa Mosconi 30:08 Yes.

Dr. Rangan Chatterjee 30:08 Your book actually, Lisa, is relevant for men and women. You know-

Dr. Lisa Mosconi 30:12 And for women.

Dr. Rangan Chatterjee 30:14 No, but it is. It's kind of-

Dr. Lisa Mosconi 30:14 [laughs]

Dr. Rangan Chatterjee 30:15 ... men need to know this because-

Dr. Lisa Mosconi 30:16 Men need to know that, yeah

Dr. Rangan Chatterjee 30:17 ... but no, I do. I mean, it's-

Dr. Lisa Mosconi 30:18 The book is unapologetically for women, but I think it's so important for- all men to be aware of these facts, right? Because it's never, it's never about women without men. It's never women against men or, or women instead of men. It just, that's not the point. It's really about-

Dr. Rangan Chatterjee 30:36 I, uh, Lisa, I think men will enjoy this book-

Dr. Lisa Mosconi 30:38 Yeah, I hope so. [laughs]

Dr. Rangan Chatterjee 30:38 ... honestly, right? I, no, because actually we've all got mothers, right?

Dr. Lisa Mosconi 30:42 Yes. It's, uh, wives-

Dr. Rangan Chatterjee 30:43 We, we may have daughters, we may have girlfriends, wives, we may have friends-

Dr. Lisa Mosconi 30:48 Yeah, yeah

Dr. Rangan Chatterjee 30:48 ... aunties. You know, it's not as if we live, you know, m- m- we live in our silos as just men. No. We kind of, I think a lot of us would be super interested in learning, wow, the female brain is different.

Dr. Lisa Mosconi 31:00 Yeah.

Dr. Rangan Chatterjee 31:00 Maybe this is gonna help, if men read it, help them understand and have more, maybe more compassion for what a partner or a female friend-

Dr. Lisa Mosconi 31:09 Yes

Dr. Rangan Chatterjee 31:09 ... might be going through at a particular time of life. Do you know what I mean?

Dr. Lisa Mosconi 31:13 That's right.

Dr. Rangan Chatterjee 31:13 I think that's why it's so important for all of us.

Dr. Lisa Mosconi 31:16 Yeah, for sure. I think especially, like, the chapter about pregnancy, I think nobody knows that the brain changes during pregnancy. I, I think nobody knows that the brain changes during perimenopause, and that's act- I, I don't think, I don't really think that most people know what perimenopause is. [laughs]

Dr. Rangan Chatterjee 31:34 Well, let's go through it, because, you know, this, we, we'll never be able to cover the whole contents in this conversation.

Dr. Lisa Mosconi 31:39 Yeah.

Dr. Rangan Chatterjee 31:39 But I, p- there is such practical information, so let's sort of go through, you know, what happens in pregnancy, what happens in-

Dr. Lisa Mosconi 31:46 Yeah

Dr. Rangan Chatterjee 31:46 ... perimenopause.

Dr. Lisa Mosconi 31:47 Yeah.

Dr. Rangan Chatterjee 31:47 And as a way we can use that and then, then maybe go into a lot of practical-

Dr. Lisa Mosconi 31:52 Yes. Well, do we do that?

Dr. Rangan Chatterjee 31:53 ... tips and ideas.

Dr. Lisa Mosconi 31:53 Yeah. [laughs] Yes. So we talked about puberty and how the brain stabilizes after puberty, and then with aging things change a little bit, but slowly. We, we can kind of hypothesize a linear, um, decrease in synaptic density and whatnot. That's especially in men, because testosterone and androgens in general decline very slowly with age, which is not to say that they don't change. It's not to, you know, undervalue concerns as related to men's health. The point I want to make is that the change for women is much more dramatic. But let's say that a woman goes through pregnancy. Pregnancy is huge. It's huge. I have my little daughter, and I look forward to a play date whenever we happen to, to be in the same country [laughs] at the same time-

Dr. Rangan Chatterjee 32:45 Definitely

Dr. Lisa Mosconi 32:45 ... hopefully.

Dr. Rangan Chatterjee 32:46 And, and you did, Lisa, you may not remember this, on either our first Facebook Live or our first podcast, you offered to scan my brain next time I'm in New York, and it's on my to-do list, and I promise you next time I'm in New York I will be calling you to say, "Please scan my brain. I wanna know what's going on."

Dr. Lisa Mosconi 33:02 Oh, good. Great. Yes, let's do it. That's wonderful, because I, I do want to clarify that we care very much about men's brains as well, and actually in my research program, which has grown exponentially in the past couple of years, I'm very happy about it, we have a program for women and a program for men, which is starting. So I'm very excited about that, because men's brains have risks of other things. So we should be really addressing both and, and, you know, equality, like we were saying before. It should be healthcare, like, really good healthcare for both men and women, which is not the same as one healthcare for both. I really believe in gender medicine and specializing the fields, also as far as our brains are concerned. That said, I'm gonna go back to pregnancy, and as everybody know, pregnancy is another explosion of hormones, right? For the entire time that a woman is pregnant, there are things that are happening in the brain and in the body that are really driven by these hormonal surges, like, our, our hormones le- hormone levels literally balloon to three times what they're usually, um, during a regular non-pregnant stage of life. But what is really interesting is what happens after giving birth, and studies using brain scans have shown that the brain shrinks once the baby is born, and in some ways then it grows back, which I find incredibly beautiful. And people are looking into that more and more right now, and there's a physiological explanation, which I'll give you in a second, and then there's a psychological behavioral explanation, which I find really adorable. The physiological explanation is that you have to give birth to a human being, so at some point neurogenesis, which is the birth and the growth in your synapses, stops. And when the baby is born, we actually find a reduction in brain volumes that is really correlated with the slowing down of the brain growing new, new cells. Because at that point, what you need to do as a mom, according to Mother Nature, is kind of forget about yourself and take care of your baby. Once the baby's self-sufficient and you stop breastfeeding, and it's usually around nine to 12 months after birth, neurogenesis kicks back in and your neurons start growing again, and you go back to baseline, which is insane. If you think about all the things that we learn about the brain, at least I was told that the brain doesn't change. Once you're a grown-up, you have one brain. You can, you can lose parts of it, but pretty much the brain is stable, it's static, and it turns out it's not. It's very dynamic. It still retains plastic properties that are very evident in women as we go through these huge changes that impact the body and the brain.

Dr. Rangan Chatterjee 36:00 Yeah.

Dr. Lisa Mosconi 36:00 So that's in pregnancy, and I personally interpret that, and that could be incorrect, as new moms really don't have time to worry about a lot of stuff, right? And your brain reflects that. Like, wearing high heels, forget about it. I don't need the, those neurons anymore, right? Or where did I put my keys? [laughs] Who knows? For a couple of months you just kind of- Resign yourself to the fact that you're busy, you're underslept, you have a lot of stuff to do, and a lot of things just don't matter that much. At that point, a long time ago when women were pregnant and, you know, we still lived in caves, all the focus had to be on the baby, making sure that the baby survives. Once the baby's fine, your brain goes back to being like, "Oh, you also... Yeah, there's you too, Mom. Let's see if we can have another baby," and we start again. That was a long time ago. So this is pregnancy, and I think what's really fascinating is that the brain changes have been correlated with maternal attachment and with mothers' ability to theory of mind, to really understand the mental state of the baby and really making sure that you can support growth of your infant, which... I know, it's so beautiful. Isn't it beautiful? It's published in Nature, um, I think it was a couple of years ago. It's just incredible, and brain scans are so crucial to really understanding how our brains work. I'm so fortunate that I get to do them pretty much daily.

Dr. Rangan Chatterjee 37:35 I, I mean, Lisa, I'm, I, I'm blown away by, by what you've just told me, and there's, there's a couple of things that I wanna comment on. One of them is, you know, the term mummy brain or pregnancy brain-

Dr. Lisa Mosconi 37:50 [laughs]

Dr. Rangan Chatterjee 37:51 ... right? The, these things are out there in the vernacular in society. But what I think you beautifully add to the conversation is you're actually saying there is, this is real, right? There are biological-

Dr. Lisa Mosconi 38:05 Yeah

Dr. Rangan Chatterjee 38:05 ... changes happening, and what it does is it makes it real for people. I, I, I can think now to so many friends or female patients who, who will tell you things that are going on or say how they feel, and we'll come to the menopause shortly. And, and, and I have so many-

Dr. Lisa Mosconi 38:24 That's going to be interesting

Dr. Rangan Chatterjee 38:25 ... reports of, of stories that patients are saying, like, "My, you know, my, my mind feels as though it's separate from my body now."

Dr. Lisa Mosconi 38:32 Mm-hmm.

Dr. Rangan Chatterjee 38:32 The sort of thing that unless you've been taught... Now, I'd like to think I've been, uh, shown empathy to patients who said that. I certainly hope I have. But if you've not been taught that, that, you know, you could easily be dismissed. And so-

Dr. Lisa Mosconi 38:45 Oh, my God, yes

Dr. Rangan Chatterjee 38:46 ... you know, and I'm sure-

Dr. Lisa Mosconi 38:47 That's exactly why we're doing this work

Dr. Rangan Chatterjee 38:49 ... yeah, and I'm sure there's women listening-

Dr. Lisa Mosconi 38:50 Yeah

Dr. Rangan Chatterjee 38:50 ... to us right now who are going, "Yeah, you know, you, you don't say, Dr. Chatterjee. Of course, that's, that's my life with my daughter for the last five, 10 years," or whatever, right? I get that, and I appreciate I'm a man trying to have this conversation, but I can only talk from my perspective. I think it's incredibly valuable to, to raise awareness.

Dr. Lisa Mosconi 39:07 Yeah.

Dr. Rangan Chatterjee 39:07 I also think when you, when you talk about that and the kind of evolutionary rationale for it, I think back, you know, you are... I think you were born in Italy. Is that right, Lisa?

Dr. Lisa Mosconi 39:16 Yes, in Florence, near.

Dr. Rangan Chatterjee 39:18 Right. So you're born in Italy. You live in America.

Dr. Lisa Mosconi 39:20 Yeah.

Dr. Rangan Chatterjee 39:21 Um, and I've got friends who've moved out to America, and, you know, I think one of my friends, I think she went back to work maybe four weeks after having a baby in America.

Dr. Lisa Mosconi 39:34 Mm-hmm. Yeah, I think.

Dr. Rangan Chatterjee 39:34 I think so.

Dr. Lisa Mosconi 39:35 Yeah.

Dr. Rangan Chatterjee 39:35 Yeah, and you did. Okay, and so when we start to think about what's going on with the brain-

Dr. Lisa Mosconi 39:40 Yes

Dr. Rangan Chatterjee 39:40 ... and then the pressures from society now on women, and you sort of feel that actually brains evolved in a different time for a different pace and a different style of living, yet by not recognizing that the female brain is different, we're trying in many ways to force women in some level to live a kind of life potentially that's not in harmony with their biology, which I find incredibly interesting. And I, I wonder if you've had any experiences since the brain, since the book came out with people in Scandinavia, where women and men-

Dr. Lisa Mosconi 40:15 Mm-hmm

Dr. Rangan Chatterjee 40:15 ... get a lot more paid maternity and paternity, so in some ways are better able to allow nature to do what it wants to do. Do you see what I'm getting at?

Dr. Lisa Mosconi 40:27 Yes, I, I think it's a, it's a great point, and yes, to your point, the experience of the postpartum period is very different depending, well, on sex. That's a big difference. It really is different objectively between new mothers and new fathers, which is again not to say that it's easy for new fathers, absolutely not. It's just that their brains are not changing.

Dr. Rangan Chatterjee 40:55 Yeah.

Dr. Lisa Mosconi 40:55 That was shown very clearly with the brain scans. Yes, you're tired. You're sleep deprived. You love this kid. Your life has changed, but your brain has not, and your body has not. And maternity leave, those four weeks that we get, six if you're lucky, is a joke. If not, then we're on vacation for four to six weeks, and then we're immediately ready to go back to work. But regardless of that, depending on where you are, the symptoms are different. There are so many women with the mummy brain or the baby brain, right, after giving birth, but it seems to be worse in countries like the United States, where the stress is a little bit higher, or probably a lot higher, um, in that societal, from a societal perspective, where you have so many pr- so much pressure to just go right back to work. You don't really have a lot of support either. Like, I don't have family here. I have to rely on babysitters I've never seen in my life. So

Dr. Lisa Mosconi 41:56 it, it is different. It is different. I think the severity or the impactfulness of the experience may be very different in different societies. The same with menopause. You know, when we know that as women approach the next phase, the next transition stage, which is the perimenopause to menopause transition, we're all familiar with the fact that women experience things like hot flashes or night sweats or insomnia, depression, anxiety, the brain fog you mentioned before. As a society, we associate all these symptoms with the ovaries. But in reality, all of the symptoms start in the brain. Those are neurological symptoms, once again, that happen only to women, not to men, and that are really a symptom of the fact that your brain and/or the entire neuroendocrine system is in transition. In pregnancy, so many women will tell you, "I can't remember what I had for breakfast," or, "I'm feeling tired and confused," but then it goes away, right? And something similar happens with perimenopause and menopause, with the difference that you're older at that point, so the recovery time is longer. And we have shown that the brain, once again, changes during this phase of a woman's life. For when- for many women, there are no symptoms, but for most women, there are symptoms that need addressing, and need, like you said before, compassion.

Dr. Rangan Chatterjee 43:30 Yeah. Compassion goes a long way, you know?

Dr. Lisa Mosconi 43:33 It does.

Dr. Rangan Chatterjee 43:33 It, it may not change the structure of the brain, although I think [laughs] there are some signs pointing it does start to change things physiologically.

Dr. Lisa Mosconi 43:42 Oh, it does. Yeah.

Dr. Rangan Chatterjee 43:42 But it is the most important step, I think, in trying to help anyone, is a feeling of being heard, that actually, okay, so you're feeling like that. Okay, let me try and figure out why that might be, which is what I think a lot of people, particularly women, don't often find they get. You know, you see this-

Dr. Lisa Mosconi 43:59 Yes, yeah

Dr. Rangan Chatterjee 44:00 ... a lot around the menopause. It's very common that women will say, "My doctor didn't understand, didn't take it seriously."

Dr. Lisa Mosconi 44:07 Yeah.

Dr. Rangan Chatterjee 44:07 And, and I think there's a wider point there that I've been thinking about over the last couple of days, which is, you know, in the UK, we qualify pretty early as doctors. You know, you can, you know, I, I went to medical school within two or three weeks of my 18th birthday. And, you know-

Dr. Lisa Mosconi 44:24 Hey, same

Dr. Rangan Chatterjee 44:25 ... yeah, so you're, you, you're coming out, you know, 22, 23-

Dr. Lisa Mosconi 44:30 Mm

Dr. Rangan Chatterjee 44:31 ... trying to help people, and you're like, "Well, what kind of life experience [laughs] do I really have to really understand-

Dr. Lisa Mosconi 44:36 [laughs]

Dr. Rangan Chatterjee 44:37 ... some of this complexity of, of someone's life?" And, and I guess also, you know, uh, the term you used before, gender medicine, that's super interesting. I don't think I've heard that term before.

Dr. Lisa Mosconi 44:47 Mm.

Dr. Rangan Chatterjee 44:47 And you think, well, as a guy, you know, uh, you know, as a guy in my early, mid-20s, did I really have an understanding of women's issues? Could I relate, you know? Uh, can I now? I think you'd have to ask my wife if she'd agree that [laughs] I can relate now.

Dr. Lisa Mosconi 45:07 [laughs]

Dr. Rangan Chatterjee 45:07 But I think it's, uh, uh, so, I mean, it's really interesting to me that, you know, are, are, is there certain structural things within the medical system as well-

Dr. Lisa Mosconi 45:16 Yeah

Dr. Rangan Chatterjee 45:16 ... meaning that women don't get the best care that they could do?

Dr. Lisa Mosconi 45:19 For sure. Also, gender medicine is a really recent thing. It's ju- it's just happening because so many more scientists and, like myself, and other doctors would just say, "Hello, we're not the same." You know, even just metabolically speaking, we're not the same. We metabolize drugs differently.

Dr. Rangan Chatterjee 45:36 Yeah.

Dr. Lisa Mosconi 45:37 And yet, when you look at clinical trials, it's always men and women lumped together. Uh, drug efficacy is rarely tested separately in men and women, which is again an effect of this bikini medicine situation, where we're assuming that if you have a drug that works for the heart, the heart doesn't fit under a bikini, so the drug is probably working the same for men and women, not taking into account that women's hearts are also working differently. They're also functionally different from men's hearts. Like, we don't experience a heart attack the same way. Usually, the, the common symptom, the pain in your chest in the left side, and the shooting pain down the arm, the Hollywood heart attack thing, that's predominantly male. Women feel like they have the flu, which led to so many women being undiagnosed in the middle of a heart attack. Women are seven times more likely than, than a man to be discharged from the ER while having a heart attack, because doctors just can't recognize the sym- doctors are not trained to recognize the symptoms of a heart attack in women.

Dr. Rangan Chatterjee 46:49 Wow.

Dr. Lisa Mosconi 46:50 Yeah. Ambien, the most common sleeping pill, was given to men and women at the same dose, and what happened was that women were definitely kind of overdosing, because the metabolic activity is different. You know, the way we absorb the drugs is different. And the reason that the dose was changed by gender was that insurance companies realized that all these women were having car accidents. And so they made it known that there was something about women. Women can't drive. These women just can't drive in the morning. And then it turns out, well, this is why they're... That's because they're overmedicated.

Dr. Rangan Chatterjee 47:27 Wow.

Dr. Lisa Mosconi 47:27 And so that led to the FDA changing the dosage and cutting it in half for women. And this is again a consequence of the fact that women were excluded from research until 1993, that for decades the FDA said, "No women in research," because of some issues that... Do you know about thalidomide?

Dr. Rangan Chatterjee 47:47 Yeah.

Dr. Lisa Mosconi 47:48 Right. So there was, in the 1960s, this drug called thalidomide was being given to pregnant women, because people didn't know that the drug would cause severe birth defects. It was really catastrophic for the pregnancies and for the babies, who were born with severe malformations and disabilities and whatnot. And so the FDA took a cautionary stance and said, "Okay, from now on, women of childbearing age," which is, however, any woman from puberty through the end of menopause, "need to be excluded from experimental clinical trials to avoid this happening again." However, everybody panicked, and then women were just excluded from, from research, period. So then we had decades of medical research with no women in it. So all the knowledge we have are from studies in men, and the assumption is just that that's gonna be good enough for women as well. And even now that we have men and women in research, we- where it's mandatory now to enroll men and women for research, the vast majority of studies just lump them together, right? And then use statistical procedures to remove the effects of sex and gender. So it's still, we're still saying that women are indistinguishable from men, except there are some ovaries in there.

Dr. Rangan Chatterjee 49:12 Yeah.

Dr. Lisa Mosconi 49:13 You know? And it's much more difficult to do what we're doing, which is looking at men and women separately, because then you need twice the amount of patients, twice the amount of time, twice the amount of money.

Dr. Rangan Chatterjee 49:24 Yeah.

Dr. Lisa Mosconi 49:25 And you need to really want to do this [laughs] because it's, it's quite a thing.

Dr. Rangan Chatterjee 49:29 Yeah, and, and, and, you know, when you really follow that line of argument to its kind of obvious conclusion-

Dr. Lisa Mosconi 49:38 Yeah

Dr. Rangan Chatterjee 49:38 ... it's like, well, how many other fields in medicine have we made this mistake in? You're highlighting it in the brain beautifully, but what are we doing, as you say, with the heart? What are we doing with mental health problems?

Dr. Lisa Mosconi 49:49 Yeah.

Dr. Rangan Chatterjee 49:49 What are we doing-

Dr. Lisa Mosconi 49:50 Yeah

Dr. Rangan Chatterjee 49:50 ... with all kinds of other problems-

Dr. Lisa Mosconi 49:51 Yeah

Dr. Rangan Chatterjee 49:51 ... where we might find some pretty clear explanations, oh, this is why women have got so much more anxiety and depression.

Dr. Lisa Mosconi 50:00 Yeah.

Dr. Rangan Chatterjee 50:00 Or this is why. You know, and so I guess all change has to start somewhere.

Dr. Lisa Mosconi 50:05 Yes.

Dr. Rangan Chatterjee 50:05 Um, you know, so that's, that, you know, as, as a note of optimism, that's a good thing that things are-

Dr. Lisa Mosconi 50:10 Yes

Dr. Rangan Chatterjee 50:10 ... starting to change. If we go about some menopause a second, because I really want to talk about-

Dr. Lisa Mosconi 50:13 Yes

Dr. Rangan Chatterjee 50:14 ... estrogen, because when people think-

Dr. Lisa Mosconi 50:15 Let's do it

Dr. Rangan Chatterjee 50:15 ... about hormones and they think about male and female hormones, I think people often think about testosterone as the male hormone and estrogen as the female hormone. So what is-

Dr. Lisa Mosconi 50:28 Yeah

Dr. Rangan Chatterjee 50:28 ... estrogen-

Dr. Lisa Mosconi 50:29 Right

Dr. Rangan Chatterjee 50:29 ... and what goes on with it around the menopause, and how does that affect our brains?

Dr. Lisa Mosconi 50:35 Right. So hormones, sex hormones are broadly divided into androgens, and testosterone is the most popular one, and estrogens. And we use the word estrogen to refer to three different hormones, estradiol, estrone, and the other one I can't remember [laughs] right now, that is made only during pregnancy.

Dr. Rangan Chatterjee 50:59 Yeah.

Dr. Lisa Mosconi 51:00 And estradiol, 17 beta estradiol, is the most common, is the most potent form of estrogen, and is the most common sex hormone in the brain. And what is really important to know is that, um, the brain evolves, in good part develops and matures, in good part because of the action of estradiol, or let's just say estrogen, on very specific receptors. So I want to mention that because it's important to just understand the physiology in that, uh, hormones work like a key that needs to get inside a lock. So the hormones are the key, and receptors are the lock. When the hormones go in the brain and find the lock and open the lock, everything happens. Everything great happens. So brain activity goes up, brain energy levels go, go up. Basically, estrogen literally pushes neurons to burn glucose to make energy. So when your estrogens are high, your brain, your brain energy is high as well. When your estrogens decline, which is the case during menopause, your neurons start slowing down, and they start aging faster, which for some women has been associated with the early deposition of Alzheimer's plaques in the brain. For some women, not all, and this is a lot of my research. But also, we talk about estradiol and estrogens in general, also progesterone, FSH, LH, all these so-called sex hormones, have very important effects on the neuroplasticity of the brain. They can literally stimulate the growth on your dendrites from neurons, the new little branches that come out of the neurons, and synaptic connections are really supported by this plastic effect of the hormones. They're also involved with the immune system, for example. They're boosters for immune, uh, resilience, not just in the body, but also in the brain. So overall, what these, what these hormones do, attest testosterone in men, or androgens in men, and estrogens in women, and also there's a little bit of crossover, right? So men's brains and bodies contain a little bit of estrogens, and women's brains and body contain a little bit of androgens. But what all these hormones have in common is that they have, like, superpowers, right? So estrogen is the master regulator of the female brain. It's like the orchestra conductor that just says, "Okay, immune system, y- we need you over there. We need more energy in the hippocampal formation because we need to make some memories there. We need some more estrogen in the frontal cortex because you need to do something with the memories I'm forming. We need to grow more neurons in this part of your brain." So everything is orchestrated by your hormones, and unfortunately, women starting in midlife experience very strong and very sharp declines in the levels of estradiol, and we start going through perimenopause, which is a transitional phase between having a regular cycle and no longer having a cycle. So as you go from the premenopausal age to a post-menopausal stage, there's this in between, there's this confusing gray area called the perimenopause or the menopause transition that can last up to 10 years in some women. Where the frequency of your cycle or the severity of your cycle changes, the duration, frequency, and length. Um, and you start having symptoms. For some women, they're bodily symptoms like osteoporosis, vaginal dryness. For other women, they're really neurological symptoms that seem to be quite disruptive, like the brain fog and depression, anxiety, um, even forgetfulness. A lot of women come to us because they're worried. They don't know if they're just having a, a rough year or is that something worse? Is it like Alzheimer's disease? Is it something, um, do I have a neurological illness that I need to address?

Dr. Rangan Chatterjee 55:10 Yeah.

Dr. Lisa Mosconi 55:10 Fun times.

Dr. Rangan Chatterjee 55:11 [laughs] It's-

Dr. Lisa Mosconi 55:14 But the thing also that I want to mention is that all women go through menopause, all of us, right? A- and the degree of, of, of disruption varies widely, but the fact remains that all women go through menopause. Right now on the planet, 850 million women have just entered menopause or are about to enter menopause, 850 million women.

Dr. Rangan Chatterjee 55:40 Wow.

Dr. Lisa Mosconi 55:40 And the vast majority has no clue what's happening to them because we don't talk about it, and they're scared, they're concerned, they're worried, and they don't know what to do.

Dr. Rangan Chatterjee 55:54 So what should they do?

Dr. Lisa Mosconi 55:55 What should they do? It's a great question. So that's the second part of the book that I really wanted to develop because there are some solutions that are really based on science, and I didn't even know that there's a whole field and there's a whole number of investigators that are looking specifically at things that can really improve and support cognitive health in women, and also reduce the risk of dementia, which is the focus of the book. But it's not just about dementia, it's about the anxiety, the depression, and everything else that we need to address. And-

Dr. Rangan Chatterjee 56:28 But also, can I just, can I just highlight-

Dr. Lisa Mosconi 56:30 Yes

Dr. Rangan Chatterjee 56:30 ... what you said earlier, Lisa? 'Cause I think it's a point that people often don't think about enough. You, you said that dementia's not a disease of old age.

Dr. Lisa Mosconi 56:39 That's right.

Dr. Rangan Chatterjee 56:40 It's so important for people to get that because, you know, I've spent a lot of time with Professor Dale Bredesen, um, in, in California. I think y- I'm sure you've seen some of Dale's work and some of his research. And, you know, he's said on many occasions that, you know, Alzheimer's or other forms of dementia may be starting even 30 years before it shows up. Now I'm not, you may or may not agree with that, but he is, he has sort of said that, that the idea being that when you get symptoms is not when this starts. This starts-

Dr. Lisa Mosconi 57:13 That's right

Dr. Rangan Chatterjee 57:13 ... a long way before, and therefore-

Dr. Lisa Mosconi 57:16 Yeah

Dr. Rangan Chatterjee 57:16 ... there's an opportunity if we're aware of that to start taking preemptive and preventive action, you know, in our 30s, in our 40s, in our 50s-

Dr. Lisa Mosconi 57:26 That's right

Dr. Rangan Chatterjee 57:27 ... not when we're suddenly getting the diagnosis at the age of 72, let's say. So-

Dr. Lisa Mosconi 57:31 Right

Dr. Rangan Chatterjee 57:31 ... I wanna just hammer home that the, the, the things in your book that, uh, are based absolutely in science in terms of what people can do, they're kind of relevant to everyone, particularly women, I would say no matter what your age, right? [laughs]

Dr. Lisa Mosconi 57:45 I agree with you. I, I completely agree on everything you said. Alzheimer's disease is not like you, you, you just all of a sudden catch a cold, right? It's not like tomorrow you go to the doctor and boom, you have Alzheimer's disease. There's something that's been happening in your brain for a really, really long time that eventually leads to the symptoms, which again speaks to how resilient the brain is, how strong these brains we have are, because they can literally fend off a whole amount of pathology and insults and, and problems for years and years and years. And your ability and your brain's cognitive reserve, of reserve, right, against these insults is really largely based on the way you live your life. There is a genetic component. Our DNA is part of whoever we are, everything we are. It's involved in every bodily and, and neurological function. However, your medical report card, report card and your lifestyle matter just as much for the vast majority of people. Like even in patients with genetically determined Alzheimer's, even for those very rare patients who carry genetic mutations that cause Alzheimer's at a young age, there's evidence that things like exercise can really delay the onset of dementia. And for the vast majority of the population, over 98% of people do not carry this genetic mutation. So risk is really more about the interplay of factors like, sure, there, there are genetic risk factors. Your genes are important, but your lifestyle is just as important. Your environment is just as important. Your medical health is just as important, and those are the things that we need to take care of pretty much as soon as we're aware that they're important. It's not like you're 50 and today you have to take care of your brain. No, this, this, brain health should really be part of overall health. We should really start thinking about our brains as our best friends-

Dr. Rangan Chatterjee 59:56 Yeah

Dr. Lisa Mosconi 59:56 ... and the part of us that needs nurturing and supporting, that is doing so much for us, right? So I think it's really important that we make choices that really support the brain, and I, I usually like to say that I encourage everyone to think of their brains more like a muscle. Right? There are things that you can do to make your brain stronger. You can exercise it properly. You can feed it properly. You can take care of it properly, and your brain will perform so much better for you. At any age. Really at any age

Dr. Rangan Chatterjee 1:00:29 Yeah. I mean, I, I wanna sort of get into this lifestyle piece 'cause there's-

Dr. Lisa Mosconi 1:00:32 Yeah

Dr. Rangan Chatterjee 1:00:32 ... so much that people can do. Uh, particularly the bit on movement as well, where less might be more for, for women-

Dr. Lisa Mosconi 1:00:39 Yeah

Dr. Rangan Chatterjee 1:00:39 ... which I found really interesting. It's something I, I've been thinking about for, for some time as well. Um, before we do that, I wonder if we could deal with hormones, and in particular-

Dr. Lisa Mosconi 1:00:51 Mm-hmm

Dr. Rangan Chatterjee 1:00:51 ... HRT.

Dr. Lisa Mosconi 1:00:51 Yeah

Dr. Rangan Chatterjee 1:00:51 Which is obviously a very hot topic. It's a very divisive-

Dr. Lisa Mosconi 1:00:56 Yeah

Dr. Rangan Chatterjee 1:00:56 ... topic.

Dr. Lisa Mosconi 1:00:58 Very.

Dr. Rangan Chatterjee 1:00:58 From you as a neuroscientist looking through the lens of the brain-

Dr. Lisa Mosconi 1:01:02 Yeah

Dr. Rangan Chatterjee 1:01:02 ... and with all the work you've done, what are your views on hormones and how they can be used to help brain health?

Dr. Lisa Mosconi 1:01:09 M- my views are that hormones are important and that the field has not developed the way that one would hope, especially as far as our brains are concerned, and I, I could talk about this for days to just give you the full detailed picture. But I, I think the bottom line is that preventing Alzheimer's or minimizing de- depression and anxiety is not the same as treating hot flashes, right? So we know that hormonal replacement therapy is very effective at reducing, minimizing, and in some cases completely eliminating hot flashes for women who can tolerate the medications. Some women are not eligible for hormonal therapy for menopause, but most women are, and that is something that has been shown to be successful for. Like, HRT can really help with hot flashes, with osteoporosis, with vaginal dryness, especially for women who, um, undergo a hysterectomy or oophorectomy, which is the surgical removal of the uterus and/or the ovaries. Now, when it comes to brain health, things become really complicated because the research is just not there. There have been clinical trials that looked at whether or not hormonal therapy could prevent dementia, right? And they showed that it cannot in women older than 65. So they were looking at women who were like 15 years post-menopause, and they were given hormones at that point, which is too late. It's just too late to start. Now, more recently, two very large clinical trials, um, tested the efficacy of hormonal therapy in women who were a little bit younger, so within five years of menopause, and they showed no adverse effects but also no benefit for cognition. And I would argue that that is, again, too late. We were talking about the lock and the key, the key and the lock, ah, the analogy, and the timeline is very important. Because what happens in physiology is that the system where the hormone locks to the receptor is really age-dependent. What happens to the receptors is that if you don't have hormones locking for a really long time, the receptor shuts down. It just closes. The lock is no longer a lock. It just turns into a piece of door. So if you try to give the hormones then, nothing is ever going to happen, right?

Dr. Rangan Chatterjee 1:03:57 Yeah.

Dr. Lisa Mosconi 1:03:58 You need to have plasticity, and you need to have the hormones and the receptors. If the receptor said, "Okay, sorry, guys, too late," there's no point giving hormones. So what, what we're trying to do right now is to better clarify this window of opportunity for brain health, and the way that we need to do it is not just by theoretically putting women in a clinical trial, but we need to look at their brains. We need to probe the system. Are these receptors working or not? Are they active or not? Does it make sense to give you hormones at this stage in your life as a woman?

Dr. Rangan Chatterjee 1:04:34 Yeah.

Dr. Lisa Mosconi 1:04:34 So I think this is missing, and it's hard for me to answer the question without-

Dr. Rangan Chatterjee 1:04:38 No

Dr. Lisa Mosconi 1:04:38 ... the right information. Right now, the question is we don't know. Maybe es- but for some women, especially women, again, who, who do receive hysterectomies and oophorectomies prior to menopause, the current recommendation is to take hormones.

Dr. Rangan Chatterjee 1:04:53 Yeah.

Dr. Lisa Mosconi 1:04:54 Because that's been associated with a lower risk of Alzheimer disease, a lower risk of osteoporosis or hot flashes, a lot of symptoms. For other women, the answer is that we don't quite know yet.

Dr. Rangan Chatterjee 1:05:06 So, so a couple of things there. So again, I don't wanna quote Professor Bredesen 'cause he's not here, and so I wanna make sure I'm-

Dr. Lisa Mosconi 1:05:13 [laughs]

Dr. Rangan Chatterjee 1:05:13 ... uh, accurately describing, uh, some of his work. But Dale very much takes a multi-pronged approach when he's-

Dr. Lisa Mosconi 1:05:22 Oh

Dr. Rangan Chatterjee 1:05:22 ... trying to help a patient. So he's saying, you know, he, he, you know, he, he would try and change seven, eight, nine different factors together rather than typically it's, "Well, try this one thing. Does it work? No, that's shown doesn't work. We'll try something else." And, and again, there's pros and cons of things, but I quite like that method in terms of it's not about trying to put everything onto one thing. It's doing multiple things, and I think-

Dr. Lisa Mosconi 1:05:48 Mm-hmm

Dr. Rangan Chatterjee 1:05:48 ... he was the first person who really tuned me into thinking, may- this maybe six, six years ago or so, that, oh, maybe women should be... Well, not women should be. Maybe some women would benefit from taking-

Dr. Lisa Mosconi 1:06:03 Okay

Dr. Rangan Chatterjee 1:06:03 ... oestrogen-

Dr. Lisa Mosconi 1:06:04 Mm-hmm

Dr. Rangan Chatterjee 1:06:05 ... in some form through and after the menopause to, not to withdraw that sort of trophic support to the brain. And I found that really interesting because, you know, as, as a husband, I was thinking, "Oh, well, when my wife gets to that stage-"

Dr. Lisa Mosconi 1:06:20 [laughs] That's gonna be rough. [laughs]

Dr. Rangan Chatterjee 1:06:22 No, no. No, no.

Dr. Lisa Mosconi 1:06:22 I know you were worried about...

Dr. Rangan Chatterjee 1:06:24 No. No. Oh, genuinely, it w- it was more, oh, once you know that, you can't un-know it, right? So it's, it's-

Dr. Lisa Mosconi 1:06:31 No

Dr. Rangan Chatterjee 1:06:31 ... then it's like, well, should women be routinely- ... taking that, t- or, or should we be considering that with respect to brain health?

Dr. Lisa Mosconi 1:06:41 Right

Dr. Rangan Chatterjee 1:06:41 And then, you know, where I get conflicted in my head is that, l- you know, we, we've looked through the evolutionary lens before about what men and women used to do when our brains were evolving. So I don't know if you're familiar with any work on this. I, I'm not. And if you go to something like the Hadza tribe in Tanzania, for example, a hunter-gatherer tribe who are still living their traditional lifestyles, right? And in terms of they're hunting, they're gathering, they're very much living these low-stress, uh, lives that are out in harmony with nature. I, I wonder, you know, do they have a word for the menopause? Do they suffer menopausal symptoms in the same way?

Dr. Lisa Mosconi 1:07:21 Right

Dr. Rangan Chatterjee 1:07:21 Is it... You know, I d- I don't know. I wonder if you've come across that at all, 'cause I think that would be really interesting.

Dr. Lisa Mosconi 1:07:27 It is really interesting and, and we do know that the experience of menopause really changes a lot depending on different cultures. Like in Asia, women do not report nearly as much discomfort as women in the United States of America. So I think, yes, there is a genetic component, but I think the lifestyle-

Dr. Rangan Chatterjee 1:07:48 Stress must be-

Dr. Lisa Mosconi 1:07:48 [laughs]

Dr. Rangan Chatterjee 1:07:49 ... right? You, you know, I, I-

Dr. Lisa Mosconi 1:07:50 Stress is huge. Yeah

Dr. Rangan Chatterjee 1:07:51 ... you know, a- and I-

Dr. Lisa Mosconi 1:07:52 Yeah

Dr. Rangan Chatterjee 1:07:52 ... wanna dive into this and, but this is probably a good time to get into stress.

Dr. Lisa Mosconi 1:07:55 Yeah

Dr. Rangan Chatterjee 1:07:56 I, I can say this is, you know, this is not a scientific trial, but in my clinical experience, a lot of my female patients who come in with significant menopausal symptoms also have high degrees of stress in their-

Dr. Lisa Mosconi 1:08:13 Mm-hmm

Dr. Rangan Chatterjee 1:08:13 ... life. Now-

Dr. Lisa Mosconi 1:08:14 Yeah

Dr. Rangan Chatterjee 1:08:14 ... of course it could be that-

Dr. Lisa Mosconi 1:08:15 Makes sense to me

Dr. Rangan Chatterjee 1:08:16 ... it could be that symptoms are getting bad and are not getting treated, which causes the stress. I-

Dr. Lisa Mosconi 1:08:21 Yeah

Dr. Rangan Chatterjee 1:08:21 ... I absolutely recognize that.

Dr. Lisa Mosconi 1:08:22 Yeah

Dr. Rangan Chatterjee 1:08:23 But when I've really tried to unpick lifestyles for a number of years before it, stress seems to play a really big role. And I think, as you've explained in the book with the pregnenolone steal, you know, there is-

Dr. Lisa Mosconi 1:08:34 Right

Dr. Rangan Chatterjee 1:08:34 ... a way that stress literally impacts and changes this kind of symphony of hormones in your body. So I wonder if you could expand a bit on stress and what that does to the brain.

Dr. Lisa Mosconi 1:08:44 Sure. So stress can literally steal your hormones, and that's because cortisol, which is the main stress hormone, is in balance with your estrogens. Because the, the body uses the same molecule, pregnenolone, which you mentioned before, to make cortisol and the sex hormones. So if you're super stressed out, like chronically stressed, your body will necessarily have to shift production of cortisol by taking the pregnenolone away from your sex hormones. And then you're going through menopause, so, or perimenopause, you're stressed out because you're a middle-aged woman with most likely a job, a family, elderly parents, you have no time for yourself. You're having hot flashes [laughs] or you're not feeling well because of hormonal changes, and then you also have the stress in your life and your hormones are going down further. So it really kind of turns into a vicious circle, right? Where the more stressed you are, the more symptoms you get. And who knows how we can stop it, but I think sometimes hormonal therapy might be a gateway to break the cycle. Sometimes it's more about lifestyle. You know, there are things that we all can and should do to keep stress at bay, and that is so important, not just for hormones, but also really for brain health, because something we don't talk about enough, I think, as a society, is that too much stress is not only bad for your heart, it's also literally bad news for your brain. And there is this incredible study came out last year with hundreds, h- probably thousands of people who got brain scans, and they were middle-aged, like 40 to 65. And what they showed is that if you have high cortisol levels, that really correlates with brain shrinkage already in midlife and with a worsening in memory performance. So high stress can really, um, negatively impact your ability to recall information already when you're 50 years old. And what I thought was particularly scary [laughs] is that the brain shrinkage, when they actually looked at gender, they found out that the brain shrinkage was only found in women who were post-menopause. Which is, again, you know, the gender bias. They didn't look at gender as a predictor. They were trying to remove the effects of gender, but then they realized that there was something really hard to get rid of.

Dr. Rangan Chatterjee 1:11:24 Yeah

Dr. Lisa Mosconi 1:11:24 And it turns out that it was the fact that only women and not men, only highly stressed women showed brain shrinkage.

Dr. Rangan Chatterjee 1:11:31 I mean, th- this is massive-

Dr. Lisa Mosconi 1:11:32 But men don't

Dr. Rangan Chatterjee 1:11:32 ... you're s- you're basically saying that stress affects the brains of women differently-

Dr. Lisa Mosconi 1:11:40 Differently, yeah

Dr. Rangan Chatterjee 1:11:41 ... than the brains of men.

Dr. Lisa Mosconi 1:11:42 That's right. It looks like men's brains are more resilient to stress, at least in midlife. And again, these studies are all the average, right? We're comparing the average man to the average woman. It tells you nothing about outliers and women who can tolerate stress beautifully and men who really suffer. But on average, women's brains tend to shrink in midlife when your levels, when your stress levels are really high.

Dr. Rangan Chatterjee 1:12:08 And when you say midlife, are you specifically talking about-

Dr. Lisa Mosconi 1:12:11 40 to 65

Dr. Rangan Chatterjee 1:12:12 ... what was that? Sorry.

Dr. Lisa Mosconi 1:12:14 40 to 65.

Dr. Rangan Chatterjee 1:12:15 40 to 65. So yeah, coming into that age of the perimenopause, I guess-

Dr. Lisa Mosconi 1:12:21 Yeah

Dr. Rangan Chatterjee 1:12:21 ... and be- and beyond. Um-

Dr. Lisa Mosconi 1:12:23 Yeah

Dr. Rangan Chatterjee 1:12:24 ... I guess that really, that really begs the question for me, and I, and I have, you know, men and women of all ages listening and watching this show, but if that really is the case, then- In some ways that turning point to 40-

Dr. Lisa Mosconi 1:12:44 [laughs]

Dr. Rangan Chatterjee 1:12:46 ... is quite a significant one in the sense of, look, you know, of course it's gonna be different in different people, and of course these are just generalities and it's... you know, we can't say it's the same for everyone.

Dr. Lisa Mosconi 1:12:57 Right.

Dr. Rangan Chatterjee 1:12:57 But it's almost like saying, "Hey, look, between your 20s and 40s, m- you know, while you're building up life, you know, figuring out who you are, what you wanna be, you know, tolerating all these kind of stresses," maybe there needs to be, again, like a step change in the way we view stress.

Dr. Lisa Mosconi 1:13:16 Yeah.

Dr. Rangan Chatterjee 1:13:16 And particularly, let's say for women, at the age of 40 go, "Hey, look, maybe I could get away with it 20 to 40, but over the next 10, 20 years I've got to be careful that I take some time for myself. I take some time to switch off."

Dr. Lisa Mosconi 1:13:29 Yeah.

Dr. Rangan Chatterjee 1:13:29 "That I don't take on too much." So that... Y- a- and I know it's hard 'cause culture is pushing us away from this, and I think that's another big piece of the puzzle here which we sort of touched on at the start, which is, you know, I think, I think, I think a lot of people have it tough in society, but I, I think women have got it super tough. You know, even in this pandemic, Lisa, I, I'm, I'm seeing it everywhere. I think-

Dr. Lisa Mosconi 1:13:51 [laughs] Yes. We do.

Dr. Rangan Chatterjee 1:13:53 By, by and large-

Dr. Lisa Mosconi 1:13:53 We really do, Rangan

Dr. Rangan Chatterjee 1:13:54 ... in my network, right? And the patients-

Dr. Lisa Mosconi 1:13:56 Yeah

Dr. Rangan Chatterjee 1:13:57 ... I've spoken to and in my network, and if I'm honest, in my house, women have taken on the bulk of the caregiving duties, the sort of childcare duties. Of course it's not in every case.

Dr. Lisa Mosconi 1:14:11 No, for sure.

Dr. Rangan Chatterjee 1:14:12 But I think that would be in... That, that I know has been incredibly stressful for m-

Dr. Lisa Mosconi 1:14:17 It is stress, yes

Dr. Rangan Chatterjee 1:14:18 ... for, for many women.

Dr. Lisa Mosconi 1:14:19 For sure. For sure. You know, we, we've [laughs] we've got six months of lockdown. I thought I was going to [laughs] lose my mind. Um, but it, it's hard regardless of pandemics, I think. I- and it's really, it's really about you being able to deal with stress, because there's always going to be something that is stressful in your life. Right now, everything is pretty much more difficult-

Dr. Rangan Chatterjee 1:14:44 Yeah

Dr. Lisa Mosconi 1:14:44 ... but there's always going to be stresses for everyone. And I think it's really important to start looking at strategies to reduce stress and really make it part of a culture, which is... it's not part of our culture. Right?

Dr. Rangan Chatterjee 1:15:00 Yeah.

Dr. Lisa Mosconi 1:15:00 Now in some schools, kids are being taught yoga and meditation, which I think is phenomenal. I wish I had it.

Dr. Rangan Chatterjee 1:15:08 Yeah.

Dr. Lisa Mosconi 1:15:08 I learned to meditate by myself. Actually, Dr. Rudy Tanzi-

Dr. Rangan Chatterjee 1:15:12 Yeah

Dr. Lisa Mosconi 1:15:12 ... talked me into that as soon as I moved to New York, and that really changed my life. I thought he was like kind of... Excuse me. [laughs] I had to. A scientist. And he was-

Dr. Rangan Chatterjee 1:15:24 So were you skeptical? This is interesting, so as a scientist you were skeptical of meditation?

Dr. Lisa Mosconi 1:15:27 Oh, my God. Of course. Yeah. For sure. Yoga, eh. I love both, and they have an incredible, incredible beneficial impact on the health of my brain, for sure, but also now we have actual clinical studies showing that they really change the functionality of your brain if you do it consistently enough and according to specific traditions or specific practices. And one practice that I describe in the book is the Kirtan Kriya, which is a form of Kundalini yoga, but is actually a meditation that's been scientifically proven in clinical trials to improve blood flow to the brain, reduce cortisol levels, and improve memory function, specifically in women during midlife and after. And it's an 11 minutes meditation that is very... You probably have done it with me.

Dr. Rangan Chatterjee 1:16:21 I've done it. Yeah. Yeah. I, I had some-

Dr. Lisa Mosconi 1:16:23 You have.

Dr. Rangan Chatterjee 1:16:24 I had some Kundalini yoga classes last year, uh, with my wife, actually. We had this-

Dr. Lisa Mosconi 1:16:28 Nice

Dr. Rangan Chatterjee 1:16:28 ... uh, instructor would come, uh, every Friday evening. We'd do that for a while. And-

Dr. Lisa Mosconi 1:16:33 Oh, good

Dr. Rangan Chatterjee 1:16:33 ... you know, I was... I'd do that meditation as well. It, it's-

Dr. Lisa Mosconi 1:16:37 Good

Dr. Rangan Chatterjee 1:16:37 ... so fascinating for me to hear the skeptical scientist, uh-

Dr. Lisa Mosconi 1:16:40 I was so skeptical. On my, on my-

Dr. Rangan Chatterjee 1:16:41 ... is now rocking out Kundalini yoga. You know, it's brilliant. [laughs]

Dr. Lisa Mosconi 1:16:46 [laughs] Yeah, I'm more into running. I, I'm more of a runner. But, um, yes, um, I think it's fantastic and I think th- there are tools that may not work for everyone, but I, I think if... There are so many different options and so many different forms. It's like exercise.

Dr. Rangan Chatterjee 1:17:04 Yeah.

Dr. Lisa Mosconi 1:17:04 There's something that will work for you. It's just a matter of finding out what you enjoy, what you can do consistently over time. Because if you do it for three days, it's not the same as really having a regular practice, and I think a lot of people have a hard time putting in the effort with regularity.

Dr. Rangan Chatterjee 1:17:24 Yeah.

Dr. Lisa Mosconi 1:17:24 But the beauty about this meditation is that it's literally only 11 minutes. 12. 12 minutes is the practice-

Dr. Rangan Chatterjee 1:17:32 And there's loads on YouTube if people wanna follow it. You can just-

Dr. Lisa Mosconi 1:17:34 Yes

Dr. Rangan Chatterjee 1:17:34 ... look it up on YouTube and follow-

Dr. Lisa Mosconi 1:17:36 Yeah

Dr. Rangan Chatterjee 1:17:36 ... along if people wanna try it.

Dr. Lisa Mosconi 1:17:37 Hard to find.

Dr. Rangan Chatterjee 1:17:38 I mean, Lisa, look, we've not even gotten to your eight pillars yet, and I have about 10 minutes left. So I, I know my on- audience are gonna love this, Lisa. We'll see what we can get through, and I might be able to persuade you for a part two at some point, uh-

Dr. Lisa Mosconi 1:17:49 Good

Dr. Rangan Chatterjee 1:17:49 ... because I really think people will enjoy this. But-

Dr. Lisa Mosconi 1:17:52 Good

Dr. Rangan Chatterjee 1:17:52 ... the things I thought... We'll get through more if we can, but I found the, the stuff on phytoestrogens and soy-

Dr. Lisa Mosconi 1:17:59 Yes

Dr. Rangan Chatterjee 1:17:59 ... really interesting, and I don't think people on my show have heard much about that before. So-

Dr. Lisa Mosconi 1:18:04 Yeah

Dr. Rangan Chatterjee 1:18:04 ... I wonder if you could expand a little bit on those.

Dr. Lisa Mosconi 1:18:06 Yes. So, um, we were talking about hormone replacement therapy, and which makes total sense, right? So as a woman, you're losing some of your estrogens, and the idea is to replace them with estrogens that come from the outside. Now, the source of the estrogen is something that a lot of scientists are looking into, because where are these hormones coming from, right? In the very early formulations of estrogen replacement therapy, and still in some formulations today, the hormones were coming from the urine of pregnant horses Which is not attractive perhaps in some ways, but it's a very reasonable source. You know, they have to come from something, right? So they can come from animals or they can come from plants. And something that I find very beautiful is that oestrogen or estradiol is arguably the most ancient of hormones, which means that it's shared across all living beings, plants, animals, humans, as we also are animals but we tend to forget about. So what that means is that plants make estrogens. They're called phytoestrogens, from Greek, estrogens from plants, and they are so bioactive and so easy to share across species that the estrogens made by a flower or a plant really works the same way as the estrogens made in our own body. They're just milder. The effects are milder. They're more gentle. So sometimes people wonder, and some people are looking into this right now, myself included, if a diet that includes a lot of phytoestrogens from safe sources could be a gentle replacement to hormonal therapy, and the answers from culture [laughs] broadly seems to be probably yes. So where are these phytoestrogens coming from? The most abundant source is soy, and soy is very controversial.

Dr. Rangan Chatterjee 1:20:15 Yeah.

Dr. Lisa Mosconi 1:20:15 But like we were talking about before, women in Asia do not suffer the kind of hot flashes and night sweats and neurological symptoms of menopause the same way that women do here in industrialized countries. It is possible that there's a genetic component. It is possible that the high quantity of isoflavones from the soy in their diet could also make a difference. Isoflavones are a very strong source of phytoestrogen.

Dr. Rangan Chatterjee 1:20:43 Yeah.

Dr. Lisa Mosconi 1:20:44 Now, soy here is different. It's polluted. It's GMO, you know, genetically modified, is more, uh, is more of an allergenic for us than for Asian populations. So that may not be the best way to think about phytoestrogens. But there are a ton of other foods that contain a different kind of phytoestrogens. They're called lignans, and those foods are perfectly safe, and they're found very often in the Mediterranean regions. And we know that women on a Mediterranean diet have a much lower risk of heart disease, heart attacks, strokes, depression, anxiety, breast cancer, and dementia than women on, like, a Western-type diet. So there's something about this diet that seems to be quite protective and quite supportive of women's health, and the key nutrients are sesame seeds, great source of phytoestrogens, uh, flaxseeds, also great source, dried apricots, believe it or not for some reason, all sorts of legumes, especially chickpeas and beans, some fruits, especially strawberries, melon, cantaloupe. All these fruits and vegetables are really rich in phytoestrogens, and I have a whole list. Of course, I'm a scientist, so I have a whole table in the book with all different sources by group and their bioactivity. So I think for me personally, that's the way I eat, and I've done so much research using brain scans where we show quite clearly that if you're, like, a 50-year-old woman, your brain looks at least five years younger if you're on a Mediterranean diet. I'm gonna say this again. If you're a 50-year-year-old woman on a Mediterranean diet, your brain looks at least five years younger as compared to a woman who's also 50 years old but who's been on a Western diet for most of her life. I mean, you can see them. You can see the brain scans. You can see the way the brain doesn't change when you follow a Mediterranean-style diet and the way your brain literally shrinks at age 50 when, when you are on a Western-style diet.

Dr. Rangan Chatterjee 1:23:03 A- and do we know... Obviously you've mentioned one component. Some of those foods there are obviously very prevalent in Mediterranean-style diets. The term Mediterranean-style diet gets misinterpreted quite a lot, and lots of people-

Dr. Lisa Mosconi 1:23:16 Yes

Dr. Rangan Chatterjee 1:23:16 ... use it to-

Dr. Lisa Mosconi 1:23:18 People

Dr. Rangan Chatterjee 1:23:18 ... to make the... Yeah, to make the case-

Dr. Lisa Mosconi 1:23:20 [laughs]

Dr. Rangan Chatterjee 1:23:20 ... for all different kinds of foods. And so I wonder, and I appreciate you've written a whole book, Brain Food, on different foods for your brain, which, which is well worth reading and so lots of practical advice in that and lots of specific foods. But, you know, is there some general broad principles of w- what you're talking about when you say the Mediterranean diet?

Dr. Lisa Mosconi 1:23:43 Yes. And I think, again, it's important to say Mediterranean-style diet, because otherwise it becomes really impractical. Even for me, I can't find the same foods here-

Dr. Rangan Chatterjee 1:23:53 Yeah

Dr. Lisa Mosconi 1:23:54 ... that I used to eat in Italy growing up. But the point is plant-centric, so vegetables and fruit and grains and legumes are really the focus of the diet. When we use condiments, they're more like unrefined vegetable oils, like s- extra virgin olive oil, flax oil. Flax oil is incredible for vegans. I know there are so many vegans in England, and a lot of your followers are vegan as well. I- I'm on-and-off vegan forever. Uh, flax oil is the oil with the highest concentration of polyunsaturated fatty acids, even more than extra virgin olive oil, and one concern about veganism is that unless you take supplements, your omega-3s could be quite low because especially the kind of omega-3s that are so important for brain health. So the DHA, because plants contain AHA that the brain needs to convert into DHA, and up to 70% is lost-

Dr. Rangan Chatterjee 1:24:57 Yeah

Dr. Lisa Mosconi 1:24:58 ... in the conversion. So just one tablespoon of flax oil is pretty much more than half of all the omega-3s that you need for the day.

Dr. Rangan Chatterjee 1:25:08 Wow.

Dr. Lisa Mosconi 1:25:09 So just a tip, because I was very excited when I found out. I did a lot of research on that. [laughs] But very, uh-

Dr. Rangan Chatterjee 1:25:13 But that's a great practical tip for people.

Dr. Lisa Mosconi 1:25:15 Yes. [laughs]

Dr. Rangan Chatterjee 1:25:16 Super great prac- 'cause that's something people can do right now if they, you know, they c- after this podcast, they can actually order something and actually start bringing it into their diet every day, right?

Dr. Lisa Mosconi 1:25:26 Yes. It's very yellow. It tastes really nice. It's great with salads. So why not?

Dr. Rangan Chatterjee 1:25:33 Fantastic.

Dr. Lisa Mosconi 1:25:33 It's a good tip. Yeah. Also, fish is a big part of the Mediterranean diet, whereas meat and dairy products are considered more like a treat, like an oc- an occasional treat. It's a very flexible diet. It's a very reasonable-

Dr. Rangan Chatterjee 1:25:49 Yeah

Dr. Lisa Mosconi 1:25:49 ... diet. It's not, you know, it, it's not in any way suggesting deprivation or food restriction, which I find very sensible as a scientist. We always talk about diversity in the diet as being real key to health.

Dr. Rangan Chatterjee 1:26:03 Yeah. And I think the, the, the, the, the diets which, over and over again, around the world, no matter how you sort of chop them up, that are associated with good health and longevity tend to be these diverse diets, minimally processed, a focus-

Dr. Lisa Mosconi 1:26:18 Minimally processed, yeah

Dr. Rangan Chatterjee 1:26:19 ... focus on whole foods, a focus on lots of different colors, right? It's these are the principles which I know you support as well.

Dr. Lisa Mosconi 1:26:26 Yeah, for sure.

Dr. Rangan Chatterjee 1:26:26 And, and this is what the evidence certainly supports. Um, before we wrap it up with some take-homes, just exercise, I know we sort of hinted at that-

Dr. Lisa Mosconi 1:26:36 Yeah

Dr. Rangan Chatterjee 1:26:36 ... before, why less might be more for women. I wonder if you could just-

Dr. Lisa Mosconi 1:26:39 Right

Dr. Rangan Chatterjee 1:26:40 ... uh, give a bit of an overview on that.

Dr. Lisa Mosconi 1:26:43 Yes. So exercise, for a really long time, nobody believed that exercise had an actual impact on brain health, and things have changed so much that now every single recommendation as related to brain health is really about exercising regularly. And especially for Alzheimer's disease, we know that exercise is a strong preventative. I guess Alzheimer's perhaps a strong word if any scientist is, is listening, but, um, exercise is really important for risk reduction, not just of Alzheimer's disease, but of de- depression, anxiety, of a number of conditions that can impact and affect the brain. And what's interesting, I think, is that exercise is just equally important for men and women. It's really men need to exercise, women need to exercise. But recent studies have shown that the benefits of exercise on brain health might be even stronger for women, and that was really interesting for us as women, of course. And it turns out one possible explanation is that women don't exercise nearly as much as men do starting at age 22. Pretty much when you're done with college, your exercise goes downhill for most women, at least in the United States. I think the, the research was done here in the United States. And so as some form of motivation that I would love to, to provide for, uh, women and men, of course, there's research, there are these beautiful studies with hundreds of women followed for, like, 40 years that really show very conclusively that your level of fitness in midlife is so strongly correlated with your brain health later on in life. So if you're actively... If you're physically active, if you're physically fit in midlife, you have a 30% lower risk of dementia later in life as compared to a middle-aged woman who's not working out at all, who's sedentary. 30%. Now, if I had a drug that could lower your risk of Alzheimer's by 30%, I would be rich and everybody would buy it. Instead, the prescription is simply move your body, exercise. And to your point, what research in women has shown is that a low to moderate intensity seems to work best for women bodies and brain, especially from perimenopause onward. There's literally an inverted U shape between inten- intensity and gains. So no intensity, no gains. Moderate intensity, maximum gains. Very high intensity, the gains go down.

Dr. Rangan Chatterjee 1:29:32 Yeah.

Dr. Lisa Mosconi 1:29:33 So you want to catch that specific, I think the specific balance of intensity and gains that works for you, right? Because that can change. What is moderate for me might be too high for you, or the other way around-

Dr. Rangan Chatterjee 1:29:48 Yeah

Dr. Lisa Mosconi 1:29:48 ... may not for you.

Dr. Rangan Chatterjee 1:29:49 Uh, at least in some ways that's, that's actually a really nice place to start closing off the conversation, because you said at the start there are these step changes-

Dr. Lisa Mosconi 1:29:58 Yeah

Dr. Rangan Chatterjee 1:29:58 ... in brain function throughout life for women, where it's more gradual for men.

Dr. Lisa Mosconi 1:30:05 Yeah.

Dr. Rangan Chatterjee 1:30:05 And then even what you just said there about exercise, it all kind of fits that there are different stages in our life. Bio- biologically, physiologically, the body, the female body is doing different things. It's g- it has, I guess, a different evolutionary role-

Dr. Lisa Mosconi 1:30:20 Right

Dr. Rangan Chatterjee 1:30:20 ... at different points in our life. And therefore, of course, if we can start to, you know, live in the modern world, do the things that we wanna do in the modern world, but try and just have part of our brain thinking about, well, what, what was my brain meant to be doing here? What... Why has evolution set things up this way?

Dr. Lisa Mosconi 1:30:37 Right.

Dr. Rangan Chatterjee 1:30:37 It kind of helps us, doesn't it? You know, modify stress at a particular point, modify-

Dr. Lisa Mosconi 1:30:42 Mm

Dr. Rangan Chatterjee 1:30:42 ... movement habits at a particular point. It's... It, it really is... It's, it's really beautiful when you think about it [laughs] actually, isn't it? Uh, um-

Dr. Lisa Mosconi 1:30:49 I think so. And also I, I feel like there's so much guilt- Around not being able to perform as well as the latest celebrity on TV. I, I find that we have re- unrealistic expectations, and that it's not about what other people are doing. It's really about what's the best that you can do, or there's something that you actually enjoy doing.

Dr. Rangan Chatterjee 1:31:11 Yeah.

Dr. Lisa Mosconi 1:31:11 Let's talk about having fun and not just doing things out of duty or because you have to. But I personally, I love running, and that makes me happy, [laughs] and so I do it.

Dr. Rangan Chatterjee 1:31:23 Yeah.

Dr. Lisa Mosconi 1:31:23 But it doesn't mean that somebody else has to go running. You know, you can find something else that really works for you, that is not too stressful. I think, I think the message here is d- d- don't follow trends in anything you do. I'm very anti-trend. Science is obviously very anti-trends, right? With diet, we want a diet that is perhaps traditional, but at least it is timeless, that's been tested over generations and generations of women, and it's been proven to work for a lot of those, right? That's a good place to start. Same for exercise. There's plenty of research showing that doing the stairs is good enough for your brain, that going for a walk, walking a little bit faster than just strolling, would be really ... It's just, just really good for your brain. So if you can push yourself harder, by all means do it. But if you can't, don't feel bad. Just really be proud of doing enough or taking care of yourself and your body. Because really, your health in midlife is the best predictor of your health for the rest of your life. So this is the time to really start being consistent, and if you're past midlife, then you have to be more consistent.

Dr. Rangan Chatterjee 1:32:39 Yeah.

Dr. Lisa Mosconi 1:32:40 You know? But it's the same strategies, the same process. It takes discipline to take care of our brains, but the benefits are for life.

Dr. Rangan Chatterjee 1:32:51 Lisa, I love the passion. Uh, I love the closing thoughts there. Final question. If you ... B- well, based upon what you've learnt as a scientist while writing this book, I was gonna ask what have you changed in your own life, but actually let me just, um-

Dr. Lisa Mosconi 1:33:07 [laughs]

Dr. Rangan Chatterjee 1:33:07 ... deepen that question. Yes, what have you changed in your own life-

Dr. Lisa Mosconi 1:33:11 Mm

Dr. Rangan Chatterjee 1:33:11 ... whilst writing that book and coming a lo- across certain research, and then what have you changed or tried to implement in your daughter's life to get these things rock solid from a young age to hopefully take her into puberty and beyond?

Dr. Lisa Mosconi 1:33:26 What I have changed in my life is that I really try to optimize. I think I have a very solid baseline. Like, I eat healthily. I'm aware that moving your body's important. I love to sleep, so I try to prioritize it. But I ... Stress, I think that, [laughs] I do have ... I work a lot. I'm an overachiever, as, as, you know, in some ways. I'm very hard on myself, and I am ... We have a lot of stress. We've had a lot of stress for a while in my family, and I, I never thought about finding ways to reduce stress for me. So I'm now very actively making time for things that reduce stress levels. So I literally ... I mean, if you look in my calendar, and I'm sure yours is worse, but I'm booked until the end of the year. I'm down to 30-minute slots for meeting. And so I, I really had to make room for me. So block out one hour to exercise, like daily. I make sure that I have 20 minutes to meditate or call my mom. You know? I just, just book it in, because otherwise it doesn't get done, and I know a lot of people could benefit from this same structure, where making time for you and for your health is actually mandatory as part of your week. So that's changed. The phytoestrogens have changed a lot. I am eating a lot more plant-based now. I mean, I'm, I'm ... I don't like meat that much, so I don't quite eat it, but I'm even more plant-based than, than I was before, and I am prioritizing fish, wild-caught fish, because I feel terrible for the animals. I, I would love-

Dr. Rangan Chatterjee 1:35:06 Yeah

Dr. Lisa Mosconi 1:35:06 ... to be vegan. I, I haven't found a, a good way to do it for me personally. Uh, sleep, I really prioritize sleep. I, I get up at 5:30, 6:00 to be able to work. So 10:00 PM I'm out. I don't want to hear complaints. I need to sleep. [laughs] And for my daughter it's kind of the same. She has to go to bed. She wakes up at a good time. She has a big breakfast. She eats a lot. She's so tiny, but she eats so much, and she's very, very aware that her snack is goji berries because of the vitamin C. She already understands all the nutrients and why certain foods are really good for you and for your brain, and will make you happy, it will make you sleep well, and other foods are not good for you. You can have them once in a while. But she understands. Uh, I think the education, I never, I never had that education, and she has [laughs] maybe too much.

Dr. Rangan Chatterjee 1:35:58 Oh, hey. Well, look, you're, you're talking to someone who thinks, "Hey, look, I can't wait for this play date," because I think my kids, uh, and your daughter can be chatting about phytoestrogens and phytonutrients-

Dr. Lisa Mosconi 1:36:08 Yes

Dr. Rangan Chatterjee 1:36:08 ... and the gut microbiome, because actually they, [laughs] those are the kind of conversations that roll over our dinner time, and I hope-

Dr. Lisa Mosconi 1:36:15 That's true

Dr. Rangan Chatterjee 1:36:15 ... time will prove us right, that we did the right things. Of course, like all parents, we're trying to do the best that we can.

Dr. Lisa Mosconi 1:36:21 Of course.

Dr. Rangan Chatterjee 1:36:22 And I'm sure from hearing what you say, the changes you're making, I think even just having, modeling that for your daughter, modeling you taking time for yourself, modeling-

Dr. Lisa Mosconi 1:36:34 Yeah

Dr. Rangan Chatterjee 1:36:34 ... the fact that you're gonna go out for that run and do these things, I think those things are really important. You talk about physical activity. We know that's a big problem, particularly with women. Certainly in the UK there's been quite a lot of national campaigns to try and get more women active. You obviously-

Dr. Lisa Mosconi 1:36:49 Mm

Dr. Rangan Chatterjee 1:36:49 ... mentioned before at the age of 21, 22, after college, it all starts to go down. So- You know, raising awareness of it, trying to model that behavior I think is super-

Dr. Lisa Mosconi 1:36:59 Yes

Dr. Rangan Chatterjee 1:36:59 ... super important.

Dr. Lisa Mosconi 1:37:00 Yes. You know another thing is, um, meditation. This is... I don't know if you do it with your kids. My, my daughter has to do two meditations before she goes to bed with me. I mean, she doesn't have to, she loves it. But for me, it's kind of we're not skipping that part. I don't care if it's late, I don't care. We're doing two meditations. And I found this lovely app. It- I'll send it to you if you like. Um-

Dr. Rangan Chatterjee 1:37:23 Please do.

Dr. Lisa Mosconi 1:37:24 Okay. So it's like meditations for kids. They're adorable. They're little stories where she is not only falling asleep very easily, she's out 8:30, and she's sleeping through the night. But she's learning the language of the meditation, which is something I wish-

Dr. Rangan Chatterjee 1:37:42 Yeah

Dr. Lisa Mosconi 1:37:42 ... I had for myself. Like, the kind of loving kindness words, the language is part of her identity. And I find that to be so incredibly beautiful and so... It's such a blessing. You know, she talks about her toes as her little toes who are, who are doing so much for her because she can walk.

Dr. Rangan Chatterjee 1:38:06 Yeah.

Dr. Lisa Mosconi 1:38:06 She appreciates herself and her body and the surroundings, and that's really part of the meditation experience. Also, of course, of nurturing on our part.

Dr. Rangan Chatterjee 1:38:16 Yeah. I, I think, Lisa, you, you know, you brought up such a great point there. It's giving them a language to kind of talk about these, explain them, not waiting till they're 30, 40, trying to go, "Oh, actually, maybe I should try and learn this stuff." You know, I... You mentioned what do we do. We, we, we have gone through phases, uh, where we do that with the kids before bed. In fact, we do it with them, so it's kind of very much like-

Dr. Lisa Mosconi 1:38:38 Mm

Dr. Rangan Chatterjee 1:38:38 ... this is a family thing together. We've either used the Calm app, um-

Dr. Lisa Mosconi 1:38:44 Right

Dr. Rangan Chatterjee 1:38:44 ... sometimes. And there's also one called Ananda Kids by Deepak Chopra. He's done a few-

Dr. Lisa Mosconi 1:38:50 Oh.

Dr. Rangan Chatterjee 1:38:50 And we've used that for a few years, and my kids actually really like it. They find it very comforting.

Dr. Lisa Mosconi 1:38:56 Good.

Dr. Rangan Chatterjee 1:38:56 But again, we've fallen out of the habit for the last few weeks. And so this is a really nice reminder for me to get back on track with my family-

Dr. Lisa Mosconi 1:39:05 [laughs]

Dr. Rangan Chatterjee 1:39:05 ... with the kids. So thank you for that reminder.

Dr. Lisa Mosconi 1:39:07 Of course.

Dr. Rangan Chatterjee 1:39:08 Um, and please do send me the, the app that you use. I'd love to-

Dr. Lisa Mosconi 1:39:11 Yes

Dr. Rangan Chatterjee 1:39:11 ... do that. Um, Lisa, look, I, I'm a big fan of your work. I, I honestly think-

Dr. Lisa Mosconi 1:39:15 Yeah. Thank you

Dr. Rangan Chatterjee 1:39:15 ... it's such an important book that you've written. You know, we didn't get through even two-thirds of it really. But, but-

Dr. Lisa Mosconi 1:39:22 Sleep

Dr. Rangan Chatterjee 1:39:23 ... but-

Dr. Lisa Mosconi 1:39:23 I was hoping sleep and toxins and why-

Dr. Rangan Chatterjee 1:39:26 But we... But, but look-

Dr. Lisa Mosconi 1:39:27 ... toxins affect-

Dr. Rangan Chatterjee 1:39:27 I'm sure the audience will like it. If I can, if I can get a slot in your tight schedule, uh, later in the year-

Dr. Lisa Mosconi 1:39:33 [laughs]

Dr. Rangan Chatterjee 1:39:33 ... we'll, we'll try and revisit some of this.

Dr. Lisa Mosconi 1:39:35 Mm.

Dr. Rangan Chatterjee 1:39:35 But, uh, thank you so much. I really appreciate it.

Dr. Lisa Mosconi 1:39:38 Thank you.

Dr. Rangan Chatterjee 1:39:39 And I can't wait until we can actually do it in person next time.

Dr. Lisa Mosconi 1:39:43 A little play date. Yeah. Thank you so much for having me, and thank you so much for really helping us raise awareness that women's brains are important and that brain health is women's health. And if I can say just one last thing, I-

Dr. Rangan Chatterjee 1:39:56 Of course you can.

Dr. Lisa Mosconi 1:39:57 This is a difficult time for us in the United States, right, politically, as I'm sure everybody's aware. And I do want to point out that women's health really came out of all the progress that was made in women's rights. And women's rights are now again at the forefront of many conversations, not just in America, all over the world. Not just for women, for everyone. And so this is a really important time to make sure that women's health really becomes part of a larger conversation around women's rights, and that the more women demand accurate information about the health of their bodies and brains, the sooner we will be able to come up with solutions that actually work.

Dr. Rangan Chatterjee 1:40:42 Yeah.

Dr. Lisa Mosconi 1:40:42 So it's just kind of a plea to all women and men to really start talking about these issues because they're real, they're important, and they can really make us better people and better partners and better parents.

Dr. Rangan Chatterjee 1:40:57 Yeah. I, I love that, Lisa, and it makes me excited for the kind of world my daughter's gonna grow up in and hopefully have the opportunity to thrive in a much more compassionate and kind world. So Lisa, thank you so much.

Dr. Lisa Mosconi 1:41:11 Good to see you. Thank you.

Dr. Rangan Chatterjee 1:41:11 I'll talk to you again soon.

Dr. Lisa Mosconi 1:41:12 Thank you so much.

Dr. Rangan Chatterjee 1:41:14 Thank you.

Dr. Lisa Mosconi 1:41:14 Ta. [upbeat music]

Dr. Rangan Chatterjee 1:41:16 Press Subscribe to get more inspiration and ideas on how to feel better so you can get more out of life. And if you have a moment, why not check out this conversation that I've picked out as a perfect follow-up? Remember, lifestyle change is always worth it, because when you feel better, you live more.