This in person on our aspen campus, we will have conversations between health advocates, artists, scientists, invo innovators. And today we have a conversation between lisa mosconi and on Womens Brain Health. Shes made it her lifes work to study the womans brain and a road map to diminish the risk of dementia. If you want to buy a copy well have a link in the chat. I would certainly recommend it, its fantastic. So as we begin to dive into this conversation, let me briefly and properly introduce our wonderful speakers. Lisa mosconi is professor of neuroscience in neurology and radiology at real Cornell Medical College where shes the founder and director of the womens Brain Initiative and associate director of the alzheimers prevention clinic. An adjunct faculty member o department of psychiatry at nyu school of medicine, a ph. D. In neuroscience and Nuclear Medicine. Her research i focused from the Early Detection of alzheimers disease in atrisk individuals espially women and how alzheimers disease can be prevented through the combination of medical care and life style modificatns involving diet, physical and intellectual fitness. Shes also the ahor of brain food, which is another great book and the xx brain. Lcome, lisa. Thank you so much for hing me. Its such a pleasure to be here today wonderful, thank you, lisa. Were excited to be joined by Natalie Morales and natalie as many of you know is the west coast anchor of nbcs today show, the host of dateline and behind closed doors with Natalie Morales on reels channel. Previously was host of access and cohost of access live and news anchor today where she cohosted the third hour. She joined today in 2006 as a National Correspondent and reports for all nbc news platforms including nbc nightly news, dateline and msnbc. Were grateful, natalie for your excellent reporting during these Tumultuous Times and were glad you made a point to be with us today and she has a special connection, a book, called simple recipes from my familys kitchen and yours, and she shares recipes and tips for a healthy life style. Were delighted to have you with us, thank you for being with us here today. Its my pleasure, peggy. Thank you so much for the warm introduction and its a wonderful topic and an opportunity for us to really focus on our health, especially right now. Dr. Mosconi, this book that you wrote, the xx brain is fascinating and i think its so important for women to really understand the significance of the research, but also the preventative tips that you put out in this book so im thrilled to be able to share this time with you and hopefully get the message out there. And so natalie, let me turn the mic over to you and have a wonderful conversation. Thank you so much. Dr. Mosconi, lets talk first, the book as we said is called the xx brain so were talking about women and the fact of the matter is that were two third more likely to end up developing alzheimers in our lifetime. Are womens brains that different than mens . I know men are from mars and women are from venus. [laughter] but is it that were wired so differently . We are, we are wired differently and im a neuroscientist and a brain scientist. Nigh background is in neurology, Nuclear Medicine. So the way i approach this province objective, i look at brains in many different ways, many different parameters and what stand out most clearly is that womens brains age differently than mens brains. And something that we have learned just recently and thats truly is a big part of my research, the way that the hormones change is really key to brain aging in women, which is a connection that is being largely unexplored, pretty much forever. So, its a very new topic, very new in topic and i think its worth talking about it because all women go through menopause. Yeah. And that really is quite a thing, im told, and especially for a brain. It is a thing. Im getting there. [laughter] well, at some point we all will. Yes, yes. And we need to understand what happens to our brain during the transition to menopause and why that has been associated with of alzheimers disease with womenen depression, and medical conditions im sure well talk about. Yeah, were going to dive deep into all of those topics because i think thats what were all so fascinated about and how can i, you know, better perhaps, decrease my chances of developing alzheimers. So well get into that. Let me go back to what you said, that the Scientific Community only now is starting to understand that women and our hormones may be somewhat linked. Yet, why has gender been removed from the problem and the evasion equation in the medical community . Yes, thats something ive personally struggled for a long time. Ive been trying to study womens brains for 20 years in part because they have a history about alzheimers disease that affect the women in my family and started asking as soon as i was 19 i was able to start doing brain scans at work with the Nuclear Medicine department as a volunteer of course, because my parents are Nuclear Physicists so it kind of runs in my family. Wow. Yes, very interesting. But the point is nobody had answers for me. My questions were difference for a woman and a man and alzheimers disease, is it life style . Is it Something Else . The answer wasnt there. And i think where the problem is that we have a huge gender gap in research, especially as related to brain health. And still today, Womens Brain Health is one of the most overlooked, underdiagnosed and underresearched fields. And thats really because theres i would say three things that happen. The first one is that women were actively excluded from research until 1993, especially from Clinical Trials for a number of reasons, but the point is that there is no research with women in it, and the second thing is then all of this medical research that excluded women, substantiated the bias, the bias against womens brains that i refer to as the medicine, which is really like saying that what makes a woman a woman from a medical perspective is the reproductive organs. Those parts of the body that fit under a bikini. When you think about Womens Health its about breasts, her ovaries, her hormones, we dont talk about her brain. Especially when we talk about womens brain i mean, about Womens Health, we he ever in talk about womens brains and so, it all is contributing to women just being excluded from research and being misdiagnosed, underdiagnosed, not even looked at. Its fascinating. You talked about your connection to alzheimers and my motherinlaw was diagnosed in her mid 50s with early onset alzheimers so it has been a passion of mine as well to try to crack the code and try to figure out how what we can be doing better in our lives, our life style. Lets go back to the question of hormones and specifically estrogen with women. What does estrogen have to do with alzheimers . Its a really good question and something that were actively exploring right now. I think for the conversation is that our brains do not work in isolation. Our brains are connected with the rest of the body. And especially with women, between the brain and the reproductive system are really key to brain aging. And that is because our hormones mediate communication between the brain and the reproductive system and we all know that hormones differ between the genders. Men testosterone, women have more estrogen. What people dont realize, the hormones we have in the body are the same hormones we have in our brains. We just have a different function in the brain. We think of these hormones as being involved in reproduction and having children, but in the brain, they really serve a completely different function that is related to having ener energy. For women, literally pushes neurons to burn sugar, glucose to make energy. If estrogen is high, your brain energy is high. Estrogen has a super power in the brain. It really keeps your Brain Healthy and young. So does testosterone for men, but the thing is that testosterone goes gradually away over time usually into old age whereas women lose the super power of estrogen in mid life during menopause, but then we live another 30 years, without that protection, that the estrogen provides. How does that excuse me, how does that affect the brain then as you start going through menopause and start experiencing that loss of estrogen . Well, we can see on brain scans is that neurons slow down and make less energy and that is associated with accelerated aging process. I think a lot of women report that after menopause, your skin gets a little drier, not all women, obviously, but many women do notice that their skin is drier, their hair is fragile. Something similar happens inside the brain. Its not a huge, severe problem with, but the brain is goes starting to age and we can see that on brain scans and for some women, the changes are very, very mild. But others, theyre quite extreme. Like we have published hundreds of women and we find a drop in Energy Levels in the brains which i want to clarify does not correlate with reduced cognitive performance. Women perform just as well as a man of the same age. Thank you. [laughter] and womens brains are concentrating and were trying to find out how were compensating. Because we do our brain kind of loses energy, loses estrogen, but theyre performing really well so we want to understand what happened so that we can promote and support that compensatory mechanism. And you write a whole theres a couple of chapters in the book, but theres a whole section particularly that focuses on hormone replacement therapy and who should think about it, who shouldnt. Ill recommend people read that because theres a lot of different areas where you go through and you say you should or shouldnt if youve been, obviously, if youve had cancer or Breast Cancer survivors, you have to approach it differently, but for those who are approaching menopause or already there already, what do we need to be asking ourselves when it comes to do you really need it and why do you want it. I think there are Different Things that can be achieved safely with therapy. And your risk and your strength, in a way and something to discuss with your doctor. There are some women who are not eligible. For other women, the best dosage depend what youre trying to achieve and what symptoms you want to minimize or alleviate and it is one would like to test for therapy is prevention, its been done in some ways, but not in the west possible way and we need to start younger before menopause and that hasnt been done yet so i think its that important unexplored area of research, you know, there are many questions that need to be answered, but im also interested in things that we can do instead of hormonal replacement therapy. And some have the same results in many women and does not involve a prescription. Were going to get into that, life style, prevention, exercise, sleep, how all of that plays a part. Let me ask you first though, what about genetics . What is the genetic connection and link . I mean, as i mentioned my motherinlaw with early onset alzheimers. My husband and i are very much about health and wellness now because we know perhaps there is a risk for him. Well, i would recommend testing. For him. And i have a whole chapter in the book about how to approach testing, which really starts at a very detailed questionnaire because, yes, early onset alzheimers, did it happen to other family members . Are there multiple family members affected . If so, it looks at genetics. If its an isolated case, it doesnt. There are a number of things clinically we would like to find out and would better guide the assessment. And basically it comes in two major forms. Theres an early onset genetically determined form by genetic mutation and thats an aggressive form of alzheimers disease. Im hoping your husband does not carry any genetic mutations, but most likely eligible actually his mother is first. 98, 99 of all alzheimers cases do not carry a genetic mutation and for the majority of alzheimers cases, its really the interplay of genetic factors, that is mutations, with also medical history, life style and environment, is really altogether modulate. Let me ask you about that because there are some medical risk factors that could also affect your risks of developing alzheimers, heart disease, thyroid disease, metabolic disorders, brain injuries as well. Can you talk a little about that . Yes, there are many different medical conditions that do not necessarily directly affect the brain and alzheimers, but they could trigger an initial predisposition. They could promote alzheimers disease and do include the ones that you just mentioned, especially for women, metabolic disorders i think is really, really important because they do have a hormonal component and its interactive. But i think its really important is that there are many different risk factors for alzheimers disease that we know of. I believe in the book that at least over 30 and were just learning how the risk factors affect the genders differently. And it really looks like men and women almost have two sets of path ways towards alzheimers disease, that men are not cardiovascular in nature whereas for women theyre more hormonal and inflammatory. So there are some things, some risk factors that increase alzheimers more in women than in men and the other way around and i think, funny in a way that many risk factors affect women more than men for only women and not men, but the number one risk factors for alzheimers disease in men is not being married to a woman. The studies were done on basically elected many, many years ago when samesex marriage which was not allowed in this country, men who are married to women, a traditional marriage. Women are really good at taking care of people. Yes, they are. In life we are in charge of the health of the entire family. We scheduled the medical buttons, make sure her was taking the pills and making sure the family was healthy. I thought that was really cute. Which is a perfect segue to lie still and prevention. We have some viewer questions. Summary asking what is the single most important thing a woman can do for her most postmenopausal brain . The single most important thing is, is to really look at your lifestyle and find one part of your lifestyle that is network should be or where you would like it to be. Everybody has a different Response Company but has different baselines. For me it was stress reduction because im not good at that. Neither am i. [laughing] a lot of women and maybe diet. It could be intellectual stimulation. There are eight key stats to very healthy female brain. They include mental stimulation, activity, especially when learning is involved. Learning is to get brain what exercise is to your muscles. It really stimulates connection between different neurons, and thats a really keeps the brain plastic which in biology means young comes to learning. If you like to read a book, dont read a novel, read something that is really challenging. If you like to watch movies, watch documentaries as well when you learn something. So you really feel engaged in what youre doing. My mom plays games almost four times a week so thats always keep in her brain young. Playing games. But besides that, i mean, i know that diet has to be in those eight steps. How important is moderating what you eat but also what kinds of food should we be eating . You also wrote the book the brain book. Thats right. Diet is really important for two reasons. Number one, the nutrients that we eat have an effect not just on our bodies but also our brains. Brains are made nutrients. We really need to replenish the nutrients. Pretty much on a daily basis to make sure our brain especially for women i recommend antioxidants. We have found using brain scans theres a very strong correlation between your intake of antioxidants and the diet and your brain energy level throughout the lifespan but also after menopause. The more the nutrients you consume on a daily basis, the higher your brain energy will respond. The second reason is that we eat three times a day, most people do come three times a day. Sometimes even more than that. We literally have Three Chances every day to make a choice to support the brain health. Its not just about the way we look, its really about eating our Brain Nutrients so brains can perform so much better for us. Im a a strong proponent of a healthy diet and quite specific of my own type. I really eat for my brain as much as i can in my research is really influence the way we eat as the family. Thats perfect. The mediterranean diet which is what you write about in the book being sort of the diet most people should follow, right . I think its a really good, i very trash diet that is rich in nutrients that the brain wants and needs all the time. Its not a deprivation diet. I enjoy my food. I think its a very sensible diet and what i like about is it didnt come out with somebody thinking about it or writing a book about it. Its really the result of information for women, doing significantly better than women who were doing a western diet. But it doesnt have to be admitted training. I think its more the framework. Some plantbased plant centric, good amount of vegetable oil, especially in unrefined once. A lot of fiber. Fiber is really good for you, especially for women. We dont talk that much about it, fish, lagoons. Theres this huge study in england with hundreds of led zeppelin showing the later on a life you go to menopause. Interesting. I think its interesting. The omega3 fatty acids, complex carbohydrates. It also showed the more processed foods in having a diet, the more refined sugar you have in your diet the early life you go through menopause even if you have no genetic reason to do it. Food is function. Its something we can actively do. We have control over it. Exercise also is an important factor, and you write in the book that slow and steady wins the race. The moderate exercise is the route to go, rather than a lot of people are not taking all these, where we were going to gyms, we could take highintensity classes. Now we were doing the videos t home. Why is slow instead of better pace for exercise and how much exercise she would be getting . I think slow and steady translates to moderate intensity. There are studies looking to that in women. Very they specifically only wom, not men and women together. They show a ushaped between intensity and game. If you have if no gain but if intensity starts going up, so are the gains until you reach the tip and thats a a moderate exercise. If you go to work highintensity your a game start increasing. Thats for women aged 40 and older to get looks like as long as their hormones really support in general you can do whatever you like, in exercise is really super helpful. For many women these are all average, they have huge group of people, what works for the average person. The women who were older than 40 and especially post menopause looks like moderate intensity exercise i believe is just most sustainable. It gives you enough gains but you also do it often enough and you can see a benefit, where as for many people you go very high intensity and then you are tired. You just dont do it consistently enough. If you do it, great. I think its important that if you can but if you dont like it thats okay. Theres no reason to feel bad about just because it is trendy. What about the ice when asked you about sleep. How does poor sleep quality impact women and their brains as they age . Thats my issue is the lack of sleep. National Science Foundation showed that women sleep worse than men, prematch at any age. Women have trouble falling asleep and staying asleep, and quality of the sleep come the structure of the sleep is much more easily disrupted as well. That seems to really overlap in midlife, middle age. I dont want to sound like im ripping [inaudible] the formal impact of sleep as well because with women it changes and theres a specific part of the brain called the brainstem, down here, and it is in charge of if your estrogen activates that region correctly, when estrogen started to go up and down, starting at age 35, then your brain region is not acting correctly and thats why we have a tendency to wake up in the middle of the night. Melatonin is really high throughout the first half of the night until two in the morning, and then it decreases and adrenaline goes up. You have a lot of stress, because of too much and you wake up at three in the morning which is what happens to a lot of women. Its important to prioritize your sleep. I know we have a hard time doing that. Do you sleep well. Would know, i dont. I have been struggling with sleeping look at obviously during the pandemic it is been worse. We are think stress and anxiety more but i am very menopause of when if you like it hot during the other night i have to get up and had to go back to sleep its very hard so ive been taking, which i i read your book as we, malaria and and some i i wad to ask you for supplements that women, what are some of the ones you recommend . Obviously these are things to talk to doctor about and make sure you get something that reacts well with your body. Yes. I am a strong believer in testing before deciding which medicine to take. Theres some Common People just go for the multivitamin which makes a lot of sense in principle but it doesnt really help and isnt as efficient. What we do, we do a lot of testing of information all the antioxidants, all the fatty acids and the b vitamins and if there any deficiencies we supplement. But first of all we go through a very thorough Diet Examination because the best way to supplement is really by changing your diet. Right. That said, in some cases a healthy diet is not enough. But in that case again supplementing is helpful. The supplements we can to recommend the most especially for women are negative three fatty especially for those who did not eat fish. If you eat fish enough men you shouldnt need them. Something im very fond of his flaxseed oil for women who dont eat fish. Often are basically you dont eat fish. Flaxseed oil has the highest concentration of mega three fatty acids of the oil. In just one tablespoon about half of all the omega3 you need for the day. Oh, wow. I switched so now im using that for lunch. Fascinating. What about vitamin e, vitamin c . Antioxidants is important. I would encourage postmodernism and especially to consider taking them. I feel it helps with sleep with women, especially the combination of vitamin c really alleviates the night sweats Clinical Trials. It has been shown to work for many women and it is worth trying because there are no side effects. In the worst case it doesnt work. So over the counter . Yes. But always ask your doctor for the best but that might help. Vitamin d is very strong antioxidant as well that also stimulates blood flow and oxygen levels to the brain. That is important because you keep your energy high so another fighting to keep in mind. Honestly, antioxidants is really best obtain from the food that we eat. If possible to consume more orange, yellow vegetables and fruits and very dark green, leafy vegetables, thats probably the best way to supplement. Then of course theres only so much sounded one can take. Theres so much information in this book i encourage everybody to read it. Again it is the xx brain. One more question, because you talk about testing. A viewer asks can you talk about what tests are scans used to study alzheimers and to track the progress of the disease . Is a testing accurate . Before we would like you said yourself going to have a brain scan which you havent done before so we can talk about that. Yes. I am a big fan, i strongly believe it is the best tool we have right now to really assess brain health. On the individual basis. Its a very strong diagnostic tool for alzheimers disease and also a good predictor tool. What we do with a lot of brain scan. Of the patients to make sure we address their concerns and would make them comfortable. But you dont have to do if you dont want to. But most participants do want to. We look at mri scans and then we do pet scan. My background is Nuclear Medicine. I did that for 20 years. We look at everything we can. We look at the structure of the brain. We look at the antioxidants of the brain. We tried to see if there is any shrinkage of the brain because that is a big red flag for alzheimers risk. We look for information in the brain. We look for white integrity which is how will different parts of your Brain Community with each other. We look at Energy Levels in the brain, really important during menopause. We look of course it alzheimers another marker. We look at vascular damage which is also very important, especially for women, in the brain. Its worse for women after menopause. We look at a lot of things and we always televisions [inaudible] the youngest at this point is 40 but we just lowered the age range to 35. Its really helpful to have a good, strong baseline. Because right now you have no promise, and this is your brain when you have no problems. God forbid him in ten years you would have some issue or concerns especially during menopause that happened a lot. We do another brain scan and we can compare. Because if you come to me when you are having trouble, theres only so much, unless theres a very clear problem that use immediately, i dont know which of brain was before. The baseline to compare it to. Yes. Its always better to check or change or no change. Because if there is no change your just having a hard time and we need to address this in different ways. If there is a change their we need to really address your brain. So it really helps a lot to have as many time points as possible. There is again so much information in this book. It is called the xx brain. Dr. Lisa mosconi is brilliant and i read it cover to cover within a couple of hours because i wanted to do just every bit of information in it. Thank you so much, and thanks to all who participated here today, be sure to check out this book if you like more information and you will be seen, if you missed the beginning of this podcast you will be able, or this webcast, you can see it at a future time as well. Will put up on the Aspen Institute streaming service as well. Thank you very much, and have a good afternoon. A note you are watching booktv on cspan2 every weekend with the latest nonfiction books and authors. 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