107: What You Need To Do To Help Prevent Alzheimer’s Disease w/ Dr. Lisa Mosconi

107: What You Need To Do To Help Prevent Alzheimer’s Disease w/ Dr. Lisa Mosconi

by Dr. Anna Cabeca October 20, 2019

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Women have a greater risk of having Alzheimer’s Disease when we get older than men. Alzheimer’s starts in the brain, so it’s important to protect our brain health from an early age. Dr. Lisa Mosconi joins us to talk about Alzheimer’s, brain health, and women’s changing bodies through menopause.

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Lisa is Italian, living in America, and holds two PhDs in Neuroscience and Nuclear Medicine. She’s the author of two books,The XX Brain(coming soon) andBrain Food. As a certified Integrative Nutritionist, Lisa promotes eating a Mediterranean diet to have, not just a healthier body, but a healthy brain.

You should start looking after your brain health right away. If you haven’t been eating for health, it’s time to start. The brain is so important to our bodies and they begin deteriorating almost as soon as we start forgetting things.

Women are more likely to develop Alzheimer’s disease than men because of our estrogen levels, which is necessary for optimal brain health, begin to decrease when we go through menopause. 

Lisa talks about why physicians should use an integrative medical approach to women’s health to have maximum impact, prevent overlap, and get a clearer sense of what’s going on in your body. Lisa explains what you can start doing right now to help prevent Alzheimer’s disease from developing when you get older. 

Women who have their ovaries removed are at higher risk of developing Alzheimer’s disease earlier in life. Plus, the symptoms typically associated with menopause, such as hot flashes, night sweats, memory fog, and even stress, all start in the brain. Lisa discusses why this happens to our brains and bodies.

Lisa talks about the role of progesterone in our bodies and how important it is for our brain health. Then, lastly, she returns to the concept of what we eat and says the single greatest thing we can do for our health is to eat at least one large salad every day.

Do you eat a salad a day? How do you keep your brain healthy and active? Are you in menopause or perimenopause? 

In This Episode:

  • How a Mediterranean diet can help your brain be healthier
  • When you should start looking after your brain
  • What happens to our bodies when our brains start forgetting
  • Why more women have Alzheimer’s Disease than men
  • How an integrative medical approach can make a more positive impact on your overall body health
  • What you need to do to help prevent Alzheimer’s disease
  • What happens to your brain’s physiology when you go through menopause
  • What the role of progesterone is in our bodies
  • Why you should eat at least one salad every day

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Quotes:

“Estrogen makes your brain produce energy.” (12:24)

“Women develop Alzheimer’s earlier and that eventually leads to higher prevalence and death.” (16:28)

“20% of women physically don’t suffer from menopause, they have no hot flashes, night sweats, nothing. Whereas 80% of women have some brain signs of menopause. Some women only have hot flashes, but most women have a combination of things.” (38:49)

Links

Buy The XX Brain

Find Dr. Lisa Mosconi Online 

Find Dr. Lisa Mosconi on  Facebook |Instagram |Twitter

 

Transcript

Lisa Mosconi:
The latest news is that these risk factors actually vary by gender. So the reason... Then women get Alzheimer's for different reasons than men. Or there are different pathways towards Alzheimer's for men and women depending on what of these factors are. And for women, they're more related to metabolism and hormonal health. Whereas for men they seem to be more related to heart health, the cardiovascular stressors.

Dr. Anna:
Welcome to Couch Talk, I am your host, Doctor Anna Cabeca and this is a place for shameless, open, discussion every week. And today I'm going to talk to you about brain health. Women's health and brain health and something that we fear, and that's Alzheimer's disease. So today's guest is Doctor Lisa Mosconi and she is originally from Italy now in New York, working on the women's brain initiative, looking actually at imaging as a woman's brain ages and what to do about it.

Dr. Anna:
So I'm super excited to introduce Doctor Mosconi to all of you. She is a Ph.D., an Associate Professor of Neuroscience in Neurology and Radiology at Weill Cornell Medical College. She serves as the Director of the Women's Brain Initiative and Associate Director of the Alzheimer's Prevention Clinic. She's also the author of Brain Food: The Surprising Science of Eating for Cognitive Power and in March 2020 she is coming out with The XX Brain. So really looking at and studying women's brains.

Dr. Anna:
Now she is a pioneer in this field. No one has done this before. No one has been looking at this and looking at the effects of food, hormones or lifestyle factors, and in our interview, we go deep into this. She's going to share with you some key aspects that are preventative, like what we can do to actually prevent disease in the brain as we continue to age and what a difference it makes. We've discussed how even the Mediterranean diet is. Modification of the Keto-Green diet, how it can create three times longer telomeres, that's associated with anti-aging, a 25% decrease in heart disease and stroke, a 50% reduction in breast cancer risk. And just in general, we want a healthier-looking younger brain, right? But, so one of the things is that 80% of women have brain symptoms as they go through menopause.

Dr. Anna:
That's a huge amount and this cannot be written off because it associates us with a higher risk of Alzheimer's disease. So enjoy our interview. Doctor Lisa Mosconi I've been looking at her work for years and she again is bringing us some really great... You have not heard this yet. So enjoy, and I look forward to your feedback. Let me introduce you to Doctor Lisa Mosconi. Well, hello Lisa, let me tell you, I have been looking forward to this interview for a very, very long time. So I'm so grateful for you being here with me and my community of listeners. Thank you.

Lisa Mosconi:
Thank you so much for having me. So it's a real pleasure to be talking to you and really I was looking forward to it.

Dr. Anna:
I am glad. Well, we're mutual admirers for changing the face of medicine for women.

Lisa Mosconi:
Yes.

Dr. Anna:
Again, you're bringing it out in such a way... Our standard of medicine daily practices probably will take at least another decade, if not more to catch up with your work. And the fact that you're bringing it out in your first book Brain Food?

Lisa Mosconi:
Yes. And then...

Dr. Anna:
The XX Factor of the XX-

Lisa Mosconi:
The XX Brain is my next book. I actually just finished writing it and it's coming out in March of 2020. So I'm really excited about that. It's really about my research on women's brains and in all the risk factors that are really important to address in terms of women's brain health, right? And all the things that we should do and other things that we should not do, but specifically for women. So I'm really excited that gender medicine is finally embracing the brain as well as our ovaries and breasts. I think that there's been this constant denial that there's more to women than just the reproductive organs. So I think it's important that were talking about brains.

Dr. Anna:
I always love to say as a gynecologist, I'm like "It's all connected. It's all connected." You can't just look at Alzheimer's honestly, let's be honest.

Lisa Mosconi:
And why would it not be? That's really what's being puzzling to me for so long. I have a dual Ph.D. in neuroscience and nuclear medicine, which is really the brain being seen in many different ways and using all these different tools. And when I was in school and... We were talking about my accent, so I just want to clarify-

Dr. Anna:
Tell us [crosstalk 00:05:08].

Lisa Mosconi:
Yeah, we said that I just clarify for everyone. So I was born and raised in Florence, Italy, but I went to a French high school. So I think Italian is my first language and French is my second language. So English is my third and it suffers because of the other two. But yeah that's my accent. And I've been really looking into women's brains ever since I went to university because I have a family history of Alzheimer's disease in my family. Obviously, my grandmother, she suffered and passed away due to a pretty aggressive form of Alzheimer's, although late-stage old age Alzheimer's.

Lisa Mosconi:
And then her two younger sisters developed exactly the same form of Dementia when they were the same age as my grandma. As they got older and reached the same age where my grandmother started showing the symptoms of dementia so did they, whereas their brother did not. So for me, it was a little bit of whoa, what's going on kind of moment if... For my mother of course as well. So we really... My mom is a nuclear physicist and so is my father, which is really interesting, both of my parents are nuclear physicists, and that's how I got into nuclear medicine, right? Thanks to them in a way.

Lisa Mosconi:
But then we really started thinking about our brains. And when do we need to start taking care of our brains? Should you wait until you have symptoms? Should you start when you're in your 20s. Back then, because it was almost 20 years ago at this point, and there was so much confusion about Alzheimer's and dementia, there was so much stigma around it especially as far as women are concerned right? Every time a woman says, "I can't remember things," boom, your PMS. Or well, it's got to be a woman, so maybe it's menopause or maybe you should sleep more, right? Or maybe you should just take a deep breath and take an antidepressant. And that's been forever. So it's been really a long journey for me. I went to school right away, I went to neuroscience and I've been studying the brain ever since. So it's been a long-

Dr. Anna:
So long of it.

Lisa Mosconi:
Yeah, it's been a long journey.

Dr. Anna:
And just focusing, so I'm really excited especially about your next book, The XX Brain because it works differently and at different times of our life too-

Lisa Mosconi:
Yes.

Dr. Anna:
... and I think that's really critical. And it was interesting there's a magazine, a New York magazine called... in New York magazine, the section cutter that looked at schizophrenia in the perimenopausal woman.

Lisa Mosconi:
Yes.

Dr. Anna:
And something that I always... I jokingly say, but you'll always hear someone say, "Well, she has bipolar." I'm like, "Is it bipolar or is it hormonal?" And the actual reality is, what are we using for fuel? So I'm going to share a couple of slides and I'm going to share a couple of your slides actually. I know I'm-

Lisa Mosconi:
Oh really?

Dr. Anna:
I am. Well, I'm going to spring it on you because we didn't talk about that I was going to do this.

Lisa Mosconi:
No. Good. Worth the mention I'd do the same to you. Pop up some slides. I have one that I think you might like, so you show me my slides and I'll show you more.

Dr. Anna:
Deal. All right, so we're going to talk through it for those of you that are listening and during the podcast too. For those of you that are watching, this is a great video to watch till we play this on YouTube. And if you're listing you can always come back and see it on YouTube, on my channel or @drannacabeca as Couch Talk page, then my Couch Talk page. And then you can see that Lisa is growing a village in her background. There's a toy village. Lisa's daughter, she negotiated. There's a unicorn, you just got to come watch them.

Lisa Mosconi:
I forgot about the unicorn.

Dr. Anna:
Well then, not a problem.

Lisa Mosconi:
And [crosstalk 00:09:00] in our home unicorn [inaudible 00:09:01].

Dr. Anna:
Yes. So we'll share that. But I want to show you this sign. This is one of my slides now. Lisa, this is not proportionate to serum levels, but to give you an idea of for me the importance of hormones in our physiology as we're aging. So one thing that I've always recognized was this work... this here, the progesterone decline as well as estrogen decline. Really for progesterone declining mid-30s to 55 right? We see this huge dip and during this time we see a tremendous amount of symptoms. We associate it often with estrogen dominance. The PMS, the weight gain, the brain fog, suddenly irregular cycles. We see other physiologic occurrences such as bone loss, vaginal dryness, loss of libido, weight gain, the weight loss resistance. We also see insomnia, anxiety.

Dr. Anna:
And during this time frame is a period, which we would agree, is neurologically vulnerable. So it's a period of neuroendocrine vulnerability, neurologic vulnerability. And what happens to women during this time period, they're getting antianxiety medications, right? They're getting antianxiety medications, they're getting antidepressants, they're getting sleep medications, benzodiazepines-

Lisa Mosconi:
Benzos yeah.

Dr. Anna:
... and then later on because of bladder issues, they're getting anticholinergic medications. These three, each one of them is associated with an increased risk of Alzheimer's, right?

Lisa Mosconi:
Yes, correct.

Dr. Anna:
Put them together, and what are we doing to the female brain? But now this is where I found... This is your slide. This slide is brilliant. For me, this was such an eye-opening moment because when I got into my Keto-Green way, right? When I got into my Keto-Green way, understanding that I needed to get alkaline and then get into ketosis, not only did I lose weight and balance my hormones but the brain clarity, this... I call it spiritual enlightenment, this energized enlightenment came through to me to enable me to make better decisions, reclaim my memory that was feeling lost. And so do you want to go through what your findings are here on this slide or...?

Lisa Mosconi:
Right. So basically what we have shown in... There's been a lot of work done to really understand how hormonal changes affect the brain in women. But most of the work was done in animals. And mice, for example, don't actually go through menopause. You have to give them an ovariectomy. You have to cut out their ovaries to trigger menopause in mice. So it's nothing like with women those who pretty much right? I mean there's a huge difference between a mice model organism and the actual disease or conditioning in humans.

Lisa Mosconi:
But there was already an understanding that menopause affects brain energy levels and specifically glucose metabolism, which is... So glucose is the primary fuel for the brain in terms of energy. And estrogen is a massive regulator in the female brain. And one of the many functions that estrogen has is to really improve or stimulates glucose uptake in the brain, and therefore glucose transport into the mitochondria and therefore ATP production.

Lisa Mosconi:
So in other words, estrogen makes your brain produce energy. So if you don't have estrogen or progesterone for what matters... We look at estrogen's plural like all female hormones working as a whole. So when your hormones are in tune, your brain is very energized. But when your hormones are off-balance, then women show a drop in metabolic activity inside the brain. And so much work is done in animals, we have done it with actual women, the human brain. I do a lot of brain imaging. My background is in nuclear medicine and I mean my [inaudible 00:13:01]. But yeah.

Lisa Mosconi:
So we have shown them if you take a population of men and women, who are 40 to 60 years old, and you give them a number of brain scans to look at their neurons, do they have neurons in their brains? And how well are these neurons working and do they have Alzheimer's plaques or not? Then the men are pretty much okay. But if you look at the women... If you're premenopausal, you're broadly as good as a man's brain, right? Your brain is almost as highly energized as a man's brain of the same age. But then as women go through menopause, there is a drop in energy activity inside the brain and there's really the onset Alzheimer's plaques inside the brain, and it looks like when they're starting to accumulate, and that gets worse as women go through post-menopause, through menopause and post-menopause.

Lisa Mosconi:
So there's the little, initially the drop of the red line. So that was really shocking to me personally. So my background is in neuroscience. I've been working in psychiatry and neurology for pretty much my entire career and we don't tend to associate our hormones, or menopause at least with changes in the brain. It's a little bit of a stretch in thinking that we need to make... And like you were saying everything is connected and that should be obvious to everybody, but it's not. Somehow it's surprising and I suffered from the bias as the scientist. And then I started looking into that and the research really led me to launch the Women's Brain Initiative at Weill Cornell Medical College where I am... I'm a professor there. I'm also the associate director of the Alzheimer's Prevention Clinic at Weill Cornell. So the two things combined were incredibly helpful doing more and more research on women's brains and why these changes that we're not actually aware of as doctors and clinicians and even scientists or appropriate mentors can potentially trigger Alzheimer's disease in a woman's brain when we are in our 40s and 50s not the 70s.

Lisa Mosconi:
So it's really a little bit of... These findings really led a lot of people to rethink Alzheimer's disease and especially women's risk of Alzheimer's. And also I should just say the reason this is important is that many people are not aware that there is a strong gender disparity in Alzheimer's. But out of every three Alzheimer's patients, two are women. And that's pretty much all over the world, that we have data for. And whenever I mention that usually, the answer I get is that well that's because women live longer, right? So it's not even a question worth looking into it because you live long... you guys live longer, and so, of course, you get Alzheimer's more.

Lisa Mosconi:
But this work really shows that the point is not that we live longer, which actually we don't. If you think about it, there's maybe a four years gap. Like in the United States, women tend to live maybe four and a half years more than men. In England, women live two years longer than men. But still, Alzheimer's is the number one cause of death for women and not for men in England. And there's still the same two to one ratio. So the problem we believe is that women develop Alzheimer's earlier and that eventually leads to higher prevalence.

Dr. Anna:
Well, I think it's so fascinating. When I saw this, first of all, that there are gender strong not just gender disparities but strong gender disparities, right? A two to one.

Lisa Mosconi:
Yes. [inaudible 00:16:47] to [inaudible 00:16:47] ratio.

Dr. Anna:
That's huge. And so we have to look like, okay, but why? And again, looking at this, the drop in progesterone, I really think that's a big deal, Lisa. I really think we're going to have to look into that more too, as long with the estrogen because compare the flow, right? And that difference, we know that it requires estrogen to use glucose for the brain fuel, right?

Lisa Mosconi:
[inaudible 00:17:12].

Dr. Anna:
And so my whole thing and with your Brain Food is glucose is to gasoline, right? Or-

Lisa Mosconi:
Yes.

Dr. Anna:
As ketones are to jet fuel. And so [inaudible 00:17:26] from glucose to ketones at least intermittently is going to hugely... And it does. It hugely helps these symptoms that are associated here. And some of these symptoms that you listed were the anxiety, insomnia, the depression, the mood swings, the brain fog, the memory loss, all of that shifted by changing from glucose to ketones right?

Lisa Mosconi:
Yes, yeah. There's a shift absolutely, yeah. But I think it's a huge issue that just completely unaddressed by anyone. Doctors don't know about it, nutritionist doesn't necessarily know what's happening in the brain and not you, but when you go to an OB-GYN when you go to reproductive medicine doctor, they don't really think about the brain as much. So it's all about diet. So it's a little bit of a combination of factors. I think an integrative medicine approach would help tremendously right? Just the combination of different disciplines and of course research to better understand what to do and when, what is the window of opportunity to make changes, and I don't think that window of opportunity ever closes. Right? There's always time, it's never too late you just really need to take action and be consistent over time.

Dr. Anna:
Yeah. And I think that's really valuable. I think what age do you see these symptoms... Like the decrease in glucose utilization or glucose metabolism in the brain, what age are you seeing that initiate?

Lisa Mosconi:
So that's an important question and I think it depends on... So for women who are going through menopause naturally, then that's actually we see before menopause, during the perimenopausal stage. In our population, it varies between as early as 42. So you can find it when women are in their early 40s. But if you actually go through menopause because of surgery, then it's any age. Now you could be 30. As long as you get a hysterectomy or an OVX, then there are clear changes in the brain then I think they need addressing.

Lisa Mosconi:
We've known since... I think it was 2004, the first time that somebody showed that unilateral more so bilateral oophorectomy... So this is surgical removal of one or two ovaries can increase the risk of Alzheimer's in women by up to 70% as you prepare for this [inaudible 00:20:10].

Dr. Anna:
That's a huge amount. So having even one ovary removed is up to 70% increased risk?

Lisa Mosconi:
That's for two.

Dr. Anna:
70% for the two ovaries.

Lisa Mosconi:
And this can go up to 70% but even [inaudible 00:20:25] yes. And less is lower with just a unilateral OVX, but it's still a prompter increase in risk. And women are just not counseled in these terms, right? Nobody tells you that having your ovaries removed or if you take medicines that can block your ovaries like cancer medication as tamoxifen, estrogen blockers, aromatase inhibitors, what kind of effect do they have on your brain? On top of your ovaries, what kind of effect do they have on your heart? Right?

Lisa Mosconi:
There's so little that's been done to really research that consistently. And that's why I wrote my next book. So The XX Brain. I really go into these... in the research of what we know what we don't yet know but where the evidence so far is pointing to and why this needs to be addressed. I'm really trying to... With doing this brain initiative and with my work and with partnering with Maria Shriver's Women's Alzheimer's Movements. They're huge advocates of women's health and Alzheimer's. And we're really trying to raise awareness that we need more information, we need actual, evidence-based, sound, clinically-tested recommendations that we can give to women because women's brains do not age the same way the men's brains age. And by age, I don't mean 70, 80, 90, just changes over time from puberty until age 120, hopefully.

Dr. Anna:
Yes.

Lisa Mosconi:
So we really need to come together. And I think... Maria Shriver actually always says that women are at the epicenter of the problem and women really need to come up with a solution. And I think it's such a... just such a strong, powerful thing to say and I also think that this is so true because it's our problem, right? And we can't wait for Prince Charming to come and fix it for us. It just doesn't work like that. We really need to... we need to figure it out.

Dr. Anna:
I think that's so important. You think hysterectomy, so BSO increasing our risk of Alzheimer's, I would never have thought of that number one, and nor did I know to counsel my patients on that. And secondly, I wonder birth control pills affecting the ovaries, is that something that could be affecting... increasing our risk of Alzheimer's as well?

Lisa Mosconi:
I looked into that... it's a very good question when I was doing all the research for The XX brain. And so far there is no strong evidence that birth control increases Alzheimer's risk. I'd like to say there's also not much research really. There's not a lot of work that's been done to really find an association between the two things. What seems more consistent, what was being found instead is that birth control can affect your mood, especially IUDs. So if you do have a predisposition towards depression, it seems like it brings it up more in some women, not all women. But it may increase your risk of actually developing depression.

Dr. Anna:
Okay. That's fascinating. So let's go back into the brain.

Lisa Mosconi:
Did you just write it down?

Dr. Anna:
Yes, I'm writing-

Lisa Mosconi:
[crosstalk 00:23:44] write it down.

Dr. Anna:
... I'm writing it down. Looking at those associations, this is fascinating. I love this stuff, Lisa. Thank you so much.

Lisa Mosconi:
And also in the oophorectomy, right? We know that it will increase the risk of Alzheimer's, but also will increase this risk of depression.

Dr. Anna:
Oophorectomy increases risk of depression-

Lisa Mosconi:
And so-

Dr. Anna:
... increases the risk of heart disease, cardiovascular mortality is increased by as much as of 25 to 50%.

Lisa Mosconi:
Yeah.

Dr. Anna:
Back into the brain what's happening? So some of your research has shown the difference. Again, what's adding to this diversity between the female and male brain? So estrogen, progesterone, estrogen in a woman's brain versus estrogen in a man's brain.

Lisa Mosconi:
There isn't much estrogen in a man's brain, right? Men are more testosterone-driven and as they get older testosterone can still be converted into estrogen whereas [inaudible 00:24:43] women just lose their estrogen, just go to menopause. Women lose estradiol more right? And usually, at least for us, when we talk about estrogen, we actually mean estradiol, which is the most powerful of hormones. We still have the backup form of the hormone, but that doesn't seem to be as helpful.

Lisa Mosconi:
So what we have shown is that... And what we see all the time, we started with maybe 60 women in the study and now we have hundreds and hundreds, which is fantastic. There are changes in the brain. About 80% of women report neurological symptoms during menopause. We don't call them neurological, but they do start in the brain, not in the ovaries. So neurologists should be aware that hot flashes and night sweats, insomnia, memory fog, cognitive slippage, increased stress even like you've reduced tolerance to stress, reduced inflammation, they all... reduced inflammation that's about everything that starts in the brain, right?

Lisa Mosconi:
So this is really something that led at least me to really think women's health in some ways. Because if you look at the woman through the lens of women's health, you might look at her breasts, you might look for cancer in the ovaries and the cervix, you might check the heart, put it within EKG when we're going through menopause, but there's nothing done to really provide women with a solid brain check. But we know that menopause increases the risk of Alzheimer's and dementia in women. It's always been known then after aging itself, female sex is the major risk factor for Alzheimer's disease. But we know that we don't know what to do about them.... or we're starting to actually know what to do about it, which is really the good news.

Lisa Mosconi:
A lot of work has been done to really clarifying that Alzheimer's disease is not necessarily genetically driven. My research is there are genetic mutations that cause Alzheimer's, but those are found in less than 1% of the population. And even if you look at all the families that are affected by Alzheimer's disease, about 7% of families have genetic mutations and everybody else does not. So there's something, of course, to be said about genetic vulnerability or genetic risk factors that are the same that make your eyes beautiful brown-green and my eyes of blue, right? So there's genetic variability and the same genetic variability may make somebody more likely to get Alzheimer's as compared to somebody else, but they do not cause Alzheimer's.

Lisa Mosconi:
So there's a number of other facts, like medical, hormonal of course and lifestyle factors that increase the risk of Alzheimer's in an enormous amount of the population. And the latest news is that these risk factors actually vary by gender. So the reason... Then women get Alzheimer's for different reasons than men. Or there are different pathways towards Alzheimer's for men and women, depending on what of these factors are. And for women, they're more related to metabolism and hormonal health whereas for men, they seem to be more related to heart health, the cardiovascular stressors.

Dr. Anna:
That's fascinating to look at that. And so what can be done about it? What are some of the top brain foods? What are the strategies that every individual need to be implementing right now?

Lisa Mosconi:
Yes. So I would say the pillars of Alzheimer's prevention are really, you need to pay attention to your heart. So cardiovascular health, making sure that you manage diabetes, possibly that you don't get diabetes or insulin resistance, obesity, depression in midlife it is a risk factor for Alzheimer's disease in both men and women but is the strongest risk factor in women specifically. And it's not the kind of depression that you necessarily need to treat with antidepressants right? It's mostly hormonal depression or hormonal mood swings probably related to changes between peri and post-menopause.

Lisa Mosconi:
Then hormonal health of course with women. And then we have diet, exercise, intellectual activities, social engagement, sleep, and stress reduction. I think most people agree they're the major risk factors for Alzheimer's disease and pretty much all of them increase Alzheimer's risk in women more than men. So we really need to address these. Then some of the risk factors you have to work with a doctor [crosstalk 00:29:17].

Dr. Anna:
Can you say those again, Lisa? You said these... So we've said cardiovascular disease, insulin resistance or diabetes, depression midlife especially women greater than men. And then diet, exercise, sociability?

Lisa Mosconi:
So diet, exercise, intellectual stimulation or intellectual activities, social engagement, smoking is something that women especially need to avoid. And then I believe I said sleep and stress reduction.

Dr. Anna:
Sleep and stress reduct... Okay, perfect.

Lisa Mosconi:
Yes.

Dr. Anna:
Good. So those are all areas that are free to manage for most of us, right?

Lisa Mosconi:
Yeah.

Dr. Anna:
[inaudible 00:29:56].

Lisa Mosconi:
It's easier said than done. And in some cases, it really easier said than done. Like I'm on two hours of sleep because my husband snored, all night, last night. And so, of course, I suffer so much.

Dr. Anna:
No more no-

Lisa Mosconi:
There's so much-

Dr. Anna:
... that is not sustainable. We're going to have to fix his sleep... so his snoring, so you can sleep. Oh my gosh.

Lisa Mosconi:
He's trying. He's doing his best, absolutely. No, he's fantastic. He's really super helpful. Yeah. So there are modifiable risk factors, right? There are things we can't change it like your age, your family, your DNA, for now we can't change any of that, your ethnicity. But then everything else is really under... can be controlled and can be managed, and in many cases can really be eliminated, completely eliminated. Like smoking has got to go. It's got to go. It's the number one cause of ovarian failure and infertility and [inaudible 00:30:52] impacts ovaries so badly, it also puts your menopause early.

Dr. Anna:
Earlier. Average age, in your early 40s.

Lisa Mosconi:
And if menopause it's [inaudible 00:31:02].

Dr. Anna:
Yeah. It can be as much as 10 years earlier from menopause in some of-

Lisa Mosconi:
It's shocking. And there's no reason to do that. There's really no benefit to smoking. But so many women's smoke. I started noticing more and more recently in... I'm walking in New York city and many people are kind of health-conscious in New York, but yet people smoke right by the street. They're just walking around with a cigarette, I said, "Wow." Same in Italy. A lot of people smoke in Italy. Yeah, Italians love their cigarette.

Lisa Mosconi:
But then so diet then comes in so handy, right? So important because the only way to counteract the effects of smoking and free radical productions and oxidative stress is by really consuming antioxidants. So the brain is the one organ of the body that has the lowest antioxidant capacity. So it gets oxidized incredibly fast. And really we need to bring all the antioxidants in for the brain to be able to counteract the effects of aging and oxidative stress. So I know you talk about that in your book.

Dr. Anna:
Yeah, absolutely. But I can't talk about it enough. So speaking of that too, I'm going to share with you... You see this slide of you, this is your web page.

Lisa Mosconi:
Oh, this is my web page.

Dr. Anna:
The fact that you have dark chocolate on here with navy rose hips. Oh my gosh. I just loved you even more when I saw that. This is a Keto-Green salad, was that tuna? Lots of greens, avocado, healthy fats, good blend, lots of colors. I mean just a beautiful presentation. So-

Lisa Mosconi:
Thank you.

Dr. Anna:
... I was so happy to see this and share this. So for everyone who's listening, check out lisamosconi.com. L-I-S... sorry. Lisa, you spell it for me.

Lisa Mosconi:
Yes it's L-I-S-A-M-O-S-C as in Charlie, O-N as in Nancy, I-.com.

Dr. Anna:
Lisa Mosconi and then-

Lisa Mosconi:
Yeah and there is chocolate. Yes. Well, dark chocolate is such a good source of antioxidants. Like theobromine is a fantastic substance that is also vasodilator. So it gives you a little bit of the stimulant effect of caffeine without giving you the jitters, and at the same time it improves blood flow to the brain and this really helps balance out insulin levels. So it's helpful for people with insulin resistance. That is, it has to be really dark. 85% or higher and with very little sugars. So it's not necessarily a... And I'm not talking about candy just to be-

Dr. Anna:
No right.

Lisa Mosconi:
... to be clear.

Dr. Anna:
Although yes, it is so good. So really 85% and can't do that 80%? Are [inaudible 00:33:56].

Lisa Mosconi:
Yeah it's really... Yeah okay, 80%.

Dr. Anna:
Okay. We're good. We're still friends. All right.

Lisa Mosconi:
I made that one. I made that chocolate that you were showing.

Dr. Anna:
Did you really? Okay, so you're going to have to share that recipe. So we will post that recipe too. Now I want to share this research that you did. You did a research, imaging the brain. And this is fascinating and this, the MRI of the brain, because we talk about this in psychiatry. Psychology is the only area of medicine where we don't image the organ we're studying. And that [inaudible 00:34:27] change. That has to change. And this is so important with the brain. So I would love for you to talk about this. Share with us what this is showing, I mean...

Lisa Mosconi:
Right, so this is the PET scan-

Dr. Anna:
PET scan.

Lisa Mosconi:
... this are PET scans. So this are positron emission tomography scans that look at brain activity. So this is really... We use the tracer that is basically glucose, is a sugar is labeled with a compound called fluorine-18, which is slightly mildly radioactive. So it goes in your brain and then the brain thinks that that's sugar. And so it starts burning the sugar, but the F18 gets trapped in tissue and these parts literally shooting out x-ray, gamma rays of light out the machine.

Lisa Mosconi:
And so then we can take a picture of the light that is coming out of a person's brain and then do some fancy mathematical transformations that create an image of how metabolically active the brain is. And here's the story. So this is the first woman we imaged when she was a premenopausal patient, so to speak. So she had no signs of menopause. She was in her 40s, she was doing fantastic, and so what's her brain. Right. So this is a good looking brain. The one to the left. Brain activity is nice and bright, you want your brain to be all in the red-yellow range, especially at the top of the brain. Yeah, right there.

Lisa Mosconi:
So that's the frontal cortex, which is in charge of thinking and reasoning and language and planning. And you want the brain to be isometabolic. So you want the left side to be as bright as the right side. You also want the bottom of the brain and the middle... Yes, thank you right there, to be nice and bright. That is the posterior cingulate and precuneus, which are really in charge of autobiographical memory. Basically it tells you, my name is so and so today I'm working from home and yesterday I went to the office and three years ago I was doing this and that. So this is important that these parts of your brain really work well and they're very energized.

Lisa Mosconi:
And then we kept working with this woman over time and we always repeat the brain scans every two years and then four years and six years for as long as the patient will stay with us. And as she went through menopause, her brain really changed in a big way, which is the scan to the right. I think you can see how the red turned into yellow and the yellow turned into green and everything is much more green than red. Right. And this is just in maybe seven years. Then this is a 50% drop in metabolic activity in the brain.

Dr. Anna:
This is so interesting because I want everyone listening who's suffered with brain fog, memory issues to recognize, like if you can't just think yourself better, right? There's physiology behind this that is creating a decrease, a compromise, there's period of neurologic vulnerability in the brain, there's compromise. So I mean these critical memory recall centers of the brain like-

Lisa Mosconi:
[inaudible 00:37:36] yes.

Dr. Anna:
You lost the-

Lisa Mosconi:
I really-

Dr. Anna:
Yeah. Patients would say all the time, I lost my edge, I used to be able to organize everything and now I can't stay organized or I'm just... I'm losing it. So this is just a beautiful illustration of that. And as much as I-

Lisa Mosconi:
It's a scary one. It's a really scary one. I was really quite shocked when I saw that. This is not actually an extreme example. This is quite average. And of course, if it's just one person, it means nothing for the population. And so what we did was to go ahead and look at hundreds. Oh at this point we really have more than 300 people in the study with this kind of brain. We keep seeing this over and over and over again. Is that there's a drop in energy level. Then that kind of stabilizes. For many women, maybe it's reversible, we don't know. Maybe it just plateaus at some point and then your brain readjusts and reassess, which is perfectly plausible.

Lisa Mosconi:
I would say these changes are found in about 80% of women, which is also consistent with the... I know it sucks but... Is also consistent with the clinical observations that 20% of women show... basically don't suffer from menopause. They have no hot flashes, no night sweats, no nothing, they're totally fine, whereas 80% of women have some brain signs of menopause. [inaudible 00:39:03] women only have had flushes, but most women have a combination of things.

Lisa Mosconi:
And so we're now looking into whether we can capture these different patterns using the brain scans. There's probably... The 20% of women whose brains remain pretty much stable over time and they also have no signs of the brain being a little bit discombobulated if you will. And then perhaps there's a specific pattern for women who only have hot flashes or night sweats and nothing else. And there may be another pattern for women who have hot flashes and also memory loss or some cognitive slippage and an increased risk of Alzheimer's.

Lisa Mosconi:
So we're really trying to phenotype the brain menopause if you will, which is difficult to do and there's something I want to celebrate because I know you're going to be excited about this. One of the problems I have with women's health as a field is that we're treating women without having the information we need to actually make that judgment call.

Lisa Mosconi:
So we can measure hormones in blood. Like [inaudible 00:40:10]. We can measure them in plasma we can... There is no correlation between your hormones in blood and the hormones in your head. They're two separate systems. They speak to each other, but if your hormones are changing in your blood because your ovaries are changing, it doesn't mean that your brain is changing at the same time. And the problem is that while we can measure hormones in blood, we can't measure it in the brain.

Lisa Mosconi:
All these women who are taking HRT by hormonal replacement therapy, estrogen replacement therapy, SARMs all the newer therapies. These clinical trials are not able to test what they should be testing, which is the effect of these drugs on the brain. Because we have no tools, we have no machines that allow us to measure estrogen or progesterone in the brain. So what I think you're going to be excited about is that we are developing the tool right now.

Dr. Anna:
Well tell me-

Lisa Mosconi:
And I still think...

Dr. Anna:
... what is this tool? Yes.

Lisa Mosconi:
It's a tracer. It's a trace for positron emission tomography that goes inside the brain and basically works... It's estradiol. It's estradiol that will go inside the brain and then bind to the estrogen receptors in the brain and then we're going to get with the pictures like this image that we just showed for metabolic activity, but instead of looking at the effects of estrogen binding in the brain in terms of glucose changes, we're going to be able to actually quantify how much estradiol is going inside your brain and how much of that binds to your receptors.

Lisa Mosconi:
Because the problem in a brain is whether or not the receptors are working. Right. And we have no information because nobody's ever done it, which to me it's offensive-

Dr. Anna:
Right.

Lisa Mosconi:
... I think for women, right? I mean, so many women are taking hormones and we know the hormones have an effect on the brain and nobody has ever looked at that.

Dr. Anna:
Heck-

Lisa Mosconi:
[inaudible 00:42:13].

Dr. Anna:
... it's hard enough to get us physicians to test hormones. So this is huge, this is amazing.

Lisa Mosconi:
Yes.

Dr. Anna:
And I keep thinking, so if you're going to be able to put that estradiol with a tracer, look at where it's targeting in the brain, right? You'll be able to see where it's targeting, and then you'll be able to see the shift because you're doing PET in glucose utilization to see if it's instantaneous or is it longterm?

Lisa Mosconi:
Yes.

Dr. Anna:
Then does it burn out after time. I'm fascinated. Do progesterone too.

Lisa Mosconi:
Yeah it's going to be following.

Dr. Anna:
I know, my heart's out in progesterone, I think it's such a big factor. But tell me this one thing because I'm just curious and I can't move on until I get you to answer this question. What is this area of the brain, because that doesn't seem to change much in the premenopause to the post-menopause.

Lisa Mosconi:
It's the thalamus. Thalamus and [inaudible 00:43:08] and [inaudible 00:43:08]. So this is called the striatum, and it's a part to the brain that is very important for relaying information between different parts of the brain. So the brain is divided into systems. There's a limbic system that is more primitive, and then there's the neocortex that is more recent. And the thalamus is really kind of the dispatcher. It gets information from all different parts of the brain then send them back to the parts that need to receive the information. So that part is not changing as far as we can tell.

Dr. Anna:
That's fascinating. So that means the recovery of the brain should be [inaudible 00:43:47]. So have you then imaged these postmenopausal women at a ketogenic diet or in a state of ketosis or fasting?

Lisa Mosconi:
No. We have not. So we have... We've got a few of our patients who are on keto diets. I think then the best way to test it would be to do a clinical trial then look specifically into that. Because observational studies are always complicated. You want to standardize, you want to make sure that they are really following the diet you want them to follow and so we're not currently doing that, but it would be interesting.

Dr. Anna:
It would be. It would be fascinating because in just sharing the dietary changes... Like again, this is another one of your slides, your pictures. So the Mediterranean diet versus the Western diet, more atrophy in a brain on the Western diet.

Lisa Mosconi:
Yes. We see that also all the time. So the Mediterranean diet, and I'm slightly biased just a little bit but then... but in truth, it's really the one diet that's been shown to work very well for women, at least from a scientific point of view. It's been tested over and over again and it seems to work well. And it's mostly plant-based. You have your green focus in your diet plan, and it contains [inaudible 00:45:15], veggies, some fruits. So legumes and whole grains. I mean everybody knows what the distribution in diet is like. But also fish, that's a big component. Healthy fats based on quality rather than quantity. And it's been shown to work quite well on women.

Lisa Mosconi:
So women following these diets have three times longer telomeres. Telomeres are biological indicators of aging. So the longer they are the younger your cells are so which is good news. They also have a 25% lower risk of heart disease and stroke, they have a 50% lower risk of breast cancer, they have about 20% of reduced risk of hot slashes even, and most importantly, their brains look younger. So if you compare women on a Mediterranean style diet with women on a Western diet, which I think everybody agrees is not a healthy diet, then the Western dieters show much faster brain aging. There's almost an acceleration of brain aging that equals to an extra five years worth of aging as compared to people who eat healthier. So this is quite a thing to look into.

Dr. Anna:
The Mediterranean diet is associated with three times longer telomeres.

Lisa Mosconi:
Yes.

Dr. Anna:
So that's anti-aging. 25% decreased risk of heart disease and stroke.

Lisa Mosconi:
And stroke.

Dr. Anna:
50% reduction in breast cancer, five zero percent?

Lisa Mosconi:
Five zero percent. Yeah. 50% lower risk of breast cancer as compared to Western dieters.

Dr. Anna:
That's fascinating. And then [crosstalk 00:46:59].

Lisa Mosconi:
Those are big numbers. Yes. I had to read them of course, because they'll never even remember them. But yes, these are quite consistent. They're quite consistent. And these are studies that include thousands and thousands of women. Like the one showing 25% reduced risk of heart disease and stroke is done in 78,000 women. So it's quite a strong finding and yes. So it's not 10 women and four didn't get... It's really 78,000. So I tend to trust that.

Dr. Anna:
Yeah, that's huge. That is huge. That is concrete. We call that concrete data right? Concrete...

Lisa Mosconi:
Big data yeah it is.

Dr. Anna:
And so one thing that I've heard, in our brain, we have circulating estrogen. I think it was Doctor Mindy Pelz quoted "The man's brain produces six times as much estrogen as the female brain."

Lisa Mosconi:
Yeah [crosstalk 00:48:01].

Dr. Anna:
Because we're getting it from the ovaries. We're getting our estrogen from our ovaries so our brain doesn't need to produce is that correct? To this era-

Lisa Mosconi:
[crosstalk 00:48:09].

Dr. Anna:
A circulating level of estrogen in the male brain, probably testosterone to estrogen conversion, which would be interesting compared to a female brain as far as production. So that's fascinating. So what about progesterone in the brain? Because let me tell you, Lisa, why this is such an important area for me. Because when I started working in bioidentical hormones more and more as a young gynecologist, one thing that I recognized was that, again, when women have hysterectomies we were told as gynecologists, well, they don't need progesterone because they don't have a uterus, right?

Lisa Mosconi:
You're right.

Dr. Anna:
Progesterone is brain-protective, it's in our fascia, it's in our vagina, I mean it's in our bones. We need progesterone. There are progesterone receptors all over our bodies.

Lisa Mosconi:
Yes.

Dr. Anna:
So I started using progesterone in women who'd had oophorectomies or hysterectomies with their ovaries removed. And they would always tell me, "Doctor Anna," they'd come back in like two weeks, six weeks, "Doctor Anna, I feel like a cloud has lifted, I feel like a cloud has lifted." They would say that over and over and over again. And that's without using estrogen. Certainly there's some peripheral conversion, but I found that so incredibly fascinating.

Lisa Mosconi:
I agree. There's a lot of research done on the effects of progesterone with pregnancy. Like how the need for progesterone and the activation of the receptors for progesterone really change before and after and during of course pregnancy and in case of psychiatric disorders, in cases of depression and for traumatic brain injury. But progesterone is really needed... Both estrogen and progesterone are really needed for recovery after a TBI or concussion in women specifically.

Lisa Mosconi:
So yes, I think there's so much that we don't know that is incredible. It's just incredible. Actually, when you mentioned that, yes, the reason that women with a hysterectomy, only get estrogen is really because of considerations around the cancer, not considerations about around women's wellbeing. Right. So we're just trying to avoid cancer occurrence, but we're not optimizing for brain health and it's just so not right. It's incredible.

Dr. Anna:
You are absolutely right. So let's close with some of your favorite foods from your book Brain Food that we should be eating on a regular basis or we should think about incorporating [inaudible 00:50:43] trip or not to mention a trip to Italy to really [inaudible 00:50:48] a good wholly a Mediterranean diet.

Lisa Mosconi:
Yes. So I think everybody knows that vegetables are really good for you. So darkly leafy greens and other greens like broccoli, cabbage, anything green is basically good for you because these veggies really contain vitamins and minerals and phytonutrients that are so important, especially for the immune system. They really boost your ability to ward off disease to the point that there are big studies showing that even just eating one salad every day can keep your brain younger by as much as 11 years. So I think that's a strong reason to do that.

Lisa Mosconi:
Plus of course they're fantastic source of fiber. And fiber is a specially important for women's health, because fiber has a modulatory effect on the sex hormone-binding globulin the SHBG, which is the molecule that really regulates estrogen levels in the body and blood and in the brain probably as well. So that's another good reason to do that. I'm going to say fruit. I don't know how you feel about fruit in the context of your diet. Do you allow it do you say maybe avoid it?

Dr. Anna:
I say there's organic fruit is something essential to have during your feast days. I don't villainize any food, but there's time and a place because fruit will for the most part, especially in perimenopause, kick us out of ketosis, but low-glycemic, like I can have a handful of blueberries or some sliced strawberries, but I can't eat a slice of watermelon and stay in ketosis. And I rather-

Lisa Mosconi:
Yes.

Dr. Anna:
... [crosstalk 00:52:29] for my glass of wine. So, to be honest-

Lisa Mosconi:
Trade-offs I see trade-offs [crosstalk 00:52:37].

Dr. Anna:
But definitely, especially in the summer we're coming... where there's watermelon and there's beautiful fruits and-

Lisa Mosconi:
Yeah.

Dr. Anna:
... I mean season of fruits. It's a season, it's not all year in most cultures, right?

Lisa Mosconi:
That's right.

Dr. Anna:
So, but yeah... But again, definitely pushing especially the perimenopausal or menopausal woman into ketosis, but you flex in and flex out. So yeah, love it.

Lisa Mosconi:
For fruit [crosstalk 00:53:01]-

Dr. Anna:
So-

Lisa Mosconi:
... I was going to say that in the Alzheimer's field or in the brain aging field, fruit is actually very recommended, especially the low-GI fruit, like berries, like you mentioned. So blueberries, raspberries, strawberries. And that's mostly because they contain a good amount of antioxidants. So in that light, everybody is aware that blueberries are very good for you, but in reality, blackberries are better. They have a higher antioxidant power. They have a higher ORAC density. So they're more antioxidants, they're more anti-aging and this is the season, they're cheaper now, so it's a good time to... this summer. Goji berries are also good sources of antioxidants and they're perhaps the most concentrated source of vitamin C, so just a little handful goes a long way.

Lisa Mosconi:
My daughter loves them. It's incredible. Ever since she was two years old. One time I think she had an indigestion, she was really like... [inaudible 00:54:10] was hysterical. So, we've talked about antioxidants and fiber. Omega-3 fatty acids are really important for brain health, including women's brains. So studies that looked at women specifically and I go into much more detail in The XX Brain. Really, looks at diets specifically for women. But basically trans-saturated fats, increase risk of heart disease in women by 33%, which is a lot, and also the real increase.

Lisa Mosconi:
So people who eat more than two grams of trans-saturated fats everyday have twice the risk of dementia as compared to people who minimize these bad fats in your diet. And the best way to avoid them is to stay away from processed food. I think everybody agrees that processed food is not good for you. So that, smoking's got to go and processed food as well. And then pretty much whatever else that you're eating is better.

Lisa Mosconi:
Whereas polyunsaturated fatty acids, especially the Omega-3, the antiinflammatory Omega-3 ones are very helpful to the health of your heart, and the health of your brain, especially as a woman, they've been shown to reduce the risk of heart disease by 25% or higher. And they reduce risk of Alzheimer's by up to 70% as long as you're eating enough, so more than three grams per day from different sources, right? They've also been associated with a lower risk of depression in women, lower risk of postpartum depression as well and also better reproductive life in general.

Lisa Mosconi:
So basically they really help your hormones. So they're very important to have them in your diet I think as a woman. So fish, seeds, nuts, veggies. Extra Virgin Olive Oil is a really good source of those polyunsaturated and monounsaturated fatty acids and also antioxidants all blend in, which is great. So a nice punch of vitamin E and all the good nutrients. And it tastes really good.

Lisa Mosconi:
And then well we talk about chocolate, but I would say water... I realized that when I was talking with Doctor Perlmutter, he's the first one who made me notice how for me it was a no-brainer that you have to drink a lot of water. But he was like, "A lot of people don't really stress the importance of water. And why is it so important for your health?" And the answer is that 80% of the brain is water, which is a lot. This is a lot more than in the rest of the body. So is the one organ that really contains the most water. And water is needed for every single chemical reaction to take place inside the brain. Everything needs water. Not just for volume, but also really to trigger chemical reactions. Like energy production cannot happen unless you have water molecules in your mitochondria. So you need to have both...

Lisa Mosconi:
And so what happens is that the brain is the one organ in the body that is really sensitive to dehydration. So even mild dehydration, like a 2% water loss can actually trigger neurological symptoms. Like dizziness, confusion, brain fog, even memory disturbances like you... I can't remember anything when I'm not hydrated. And of course different people have different sensitivities right? But in general dehydration has been associated with brain shrinkage, as we can see on MRI scans. Your brain is kind of a sponge. So if you don't give it fluids it's kind of like... kind of compressed and then it dilate back as you rehydrate.

Dr. Anna:
That's amazing.

Lisa Mosconi:
So [crosstalk 00:57:54]. Yeah. Yeah it is. Actually it is incredible.

Dr. Anna:
You think of that, just thinking of back into neuroanatomy classes, you know the brain is that spongy.

Lisa Mosconi:
Yes.

Dr. Anna:
And if spongy very watery and that actually we can dehydrate it.

Lisa Mosconi:
That's-

Dr. Anna:
That's phenomenal.

Lisa Mosconi:
[inaudible 00:58:12] yeah. It's like a jellyfish, right? When you think about the jellyfish, they kind of let go of... It's kind of like that. But the reason that I bring it up is that everyone, so many people in the United States drink purified water, and that is not hydrating. That's fluid. So the brain doesn't just need something wet. It needs electrolytes. So the water hydrates you because it contains minerals in salts that are the function in electrolyte capacity and really provide the sodium and potassium and manganese and all these different nutrients that allow rehydration in the body. So purified water is clean, no arguments, but it doesn't contain any of the nutrients. So it doesn't rehydrate you. So tap water is actually better unless you live in Flint, Michigan.

Dr. Anna:
Yeah, I know. Yeah and I write about that in my book too.

Lisa Mosconi:
Mm-hmm (affirmative).

Dr. Anna:
So what water is... So because you could think of the chlorinated and fluoridated water. So you can't [inaudible 00:59:21] that right?

Lisa Mosconi:
No. You need to make sure you don't get the toxins first. So you don't want the toxins but you want the nutrients. So I think it really depends on where you live. Like in New York we have very good tap water. It's clean because the city filters the water for impurities, but it also retains most of the nutrients. Springwater is totally fine. For spring water everybody says to me it's expensive and I'm like, but I'm not saying that you should drink Evian.

Dr. Anna:
That's right.

Lisa Mosconi:
Or some fancy $6 a bottle water. There's spring water or mineral water that is not... is cheaper than soda.

Dr. Anna:
Yeah.

Lisa Mosconi:
So if you can afford to buy soda then you may as well swap for water and just do your brain a favor.

Dr. Anna:
So what about adding mineral drops? I have my mineral-

Lisa Mosconi:
Yes.

Dr. Anna:
... salts. I have my salts. So sometimes I just put a little bit of the mineral salt in my water.

Lisa Mosconi:
Exactly. That's the other thing. So if you're drinking purified water because you're concerned about impurities and toxins, that makes perfect sense. But then you do need to supplement. So actually I don't... Do you make them, is it one of... Is it part of your line? The mineral drops?

Dr. Anna:
No, not yet.

Lisa Mosconi:
Make some.

Dr. Anna:
Can be a good idea.

Lisa Mosconi:
Make some.

Dr. Anna:
Yeah. But you know-

Lisa Mosconi:
Everybody ask me for a good brand. So if you end up making them let me know [crosstalk 01:00:45].

Dr. Anna:
I've been thinking about it. Because I do all the time, like I make this concoction in my water, that is so good and that definitely makes the difference, and that is good advice. So you've given us so many great, great pearls this... I'm just so grateful for you sharing your information. I'm excited for this book, that Brain Food and then your XX Factor, The XX Brain.

Lisa Mosconi:
XX Brain.

Dr. Anna:
XX Brain. Oh my gosh.

Lisa Mosconi:
Yes. Me too. I am [crosstalk 01:01:13].

Dr. Anna:
So good.

Lisa Mosconi:
I'm so happy that I got to do that. I'm really trying to help women as much as I can. It's always been my passion. Just women's brains health. And when I started really nobody cared. Nobody cared. There was so much pushback like, Oh, women just live longer, women just have hormones and women complaints. And now finally the field has come around and we were able to get a number of grants from the government, from the NIH, to look into women's brains. We have foundation grants to look into women's brains for so much more. So many scientists have come together to really denounce this gender bias, not just in medicine, but specifically in neurology and psychiatry, which I think really is needed, is really needed. So [crosstalk 01:02:06]-

Dr. Anna:
And from a different discipline.

Lisa Mosconi:
Yes.

Dr. Anna:
And we-

Lisa Mosconi:
The media as well has been really incredibly supportive. The Wall Street Journal wrote about the work just recently, The New York Times wrote about it, The Los Angeles Times wrote about it, so it's really... I think there's so much more awareness for now and there's so much more desire for information. And so many more women are really demanding the information. And I think that's the biggest driver of really good work.

Dr. Anna:
Yeah.

Lisa Mosconi:
And [inaudible 01:02:36].

Dr. Anna:
And the endocrine field, we need to get more involved in this. It is so crucial.

Lisa Mosconi:
Please come help.

Dr. Anna:
The endocrinology of the brain... I'm coming, I'm coming, I'm [inaudible 01:02:46] I will be there. I want to meet your beautiful daughter building a city, a blooming architect. Beautiful.

Lisa Mosconi:
She wants to be a brain scientist. She'll sit in my lap every morning and we look at brains together and then I just changed the color so that she... There's a rainbow thing that she can do and... But she knows like "Oh, that's the frontal cortex mommy," and "Show me the hippocampus," so it's there [inaudible 01:03:11].

Dr. Anna:
How old is she?

Lisa Mosconi:
She just turned four.

Dr. Anna:
Oh my gosh. All right. A budding genius. Okay. We need more XX Brain researchers.

Lisa Mosconi:
[inaudible 01:03:22].

Dr. Anna:
So awesome. Well, I thank you so much for your time today and-

Lisa Mosconi:
Thank you for yours.

Dr. Anna:
... I am so grateful for all the work you're doing in this field, and I would love to have you back, and especially when your next book comes out. I am-

Lisa Mosconi:
I would love to.

Dr. Anna:
[inaudible 01:03:38] I know my audience is soaking this up and I'll tell everyone where to get you. So Lisa Mosconi, L-I-S-A-M-O-S-C-O-N-I. Get it right?

Lisa Mosconi:
Yes, correct.

Dr. Anna:
And you're on Facebook and you're on Instagram and so we can follow your work, because your blogs and your recipes that are there are all... Everyone they're Keto-Green approved. So many of them are, and so you can look at those. Like I'm going to get the dark chocolate recipe from you to add.

Lisa Mosconi:
So good with the rose petals.

Dr. Anna:
The rose petals, beautiful.

Lisa Mosconi:
And then [inaudible 01:04:13].

Dr. Anna:
Yeah. So it's perfect. And we'll bring you back for The XX Factor. So for our listeners today, I just want to thank you for tuning in. And you know that this is information that you've got to share. So please share this information and share with me what you've learned, what your aha moment is, and whether you're listening on Podcast Addict or iTunes. Check out the video too, because we've put up some great slides that I think just... For me I love looking at those images to kind of hone in how important this is and how much is our own control.

Dr. Anna:
So share Couch Talk with your friends, give us a rating on iTunes and Podcast Addict and definitely share this message from Doctor Lisa Mosconi and keep an eye out for her books coming up in the future and her current book, Brain Food that's out right now that is a must get. So I want to thank you all for being here today. See you next time on Couch Talk.

Dr. Anna Cabeca
Dr. Anna Cabeca

Dr. Anna is a Triple Board Certified OB/GYN, Anti-Aging Medicine expert, and author of the best selling book, The Hormone Fix.

Dr. Anna helps women heal the 9 most dreadful symptoms of menopause with natural, safe solutions. Follow her for content on hormonal imbalances, vaginal dryness, menopause (and more) that are medically backed, and created to empower women — not just treat them.