Aspen institute. I want to thank you for being here today for what will be a fascinating conversation. While the pandemic has prevented us from gathering in person on our aspen campus, were continuing to host informative and inspiring conversations between the leading health scientists, innovators. And today were hosting a fascinating and breakthrough conversation between lisa mosconi and Natalie Morales about dr. Mosconis new book the xx brain and research on womens brain health. Shes made it her lifes work to study the female brain and a road map for reducing their risk of dementia. If youre interested in a copy, well have a link in the chat, and for more information. I would recommend it, its fantastic. As we begin to dive into this, let me briefly and properly interrogatory dues our speakers. Lisa mosconi at real cornell medical college, the founder of the womens Brain Initiative and associate of the alzheimers clinic. Adjunct member of psychology at nyu school of medicine and ph. D. In neuroscience and Nuclear Medicine. Her research is focused from the Early Detection of alzheimers disease in at risk individuals, especially women and how memory loss and alzheimers disease can be prevented through the combination of medical care and life style modifications involving diet, and intellectual fitness. And she is is the author of the xx brain. Welcome, lisa. Thank you for having me here today. And were delighted to be joined by Natalie Morales and natalie as you knows the west coast anchor o nbc today show. The host of dateline and behind closed doors with natalie morals on reelz channel. And access, cohost of access live and new anchor today and she cohosted t third hour. She joi today as a National Correspondent and reports for all nbcews platforms including nbc nightly news, dateline and were grateful natalie, for your excellent reporting during these Tumultuous Times and were gla that you made time for this fascinatg talk today, but i want to point out that natalie has special connection to this. She has a book called simple recipes for healthy living, from my familys kitchen to yours where she shares her Favorite Recipes and tips for a healthy life style. Thank youor being with us here today. Its my pleasu, 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 tt you ote, the brain is fascinating and i thinkts so important for women to understand the significance of the research, but also the preventative tips that you put t in this book and im thrilled to share thi time with you. Ill a turn the mic over to you and he a wonderful conversation. Hank you so much. Dr. Mosconi, the first as we said is called the xx brain, were talking about women and the fact of the matters were twothirds more likely to end up deloping alzheimers in our lifetime. Arewomens brainshat different than mes . I know men are from mars and women are from venus. [laughter] but is ithat were wired so differently . We are, we are wired differently and i am a neuroscientist and a brain scientist my background isn Nuclear Medicine and the way i approach this objective, i look at brains in man different ways many different parameters and what stands out most clearly is that womens brains age differently than mens brains. And something that weve learned just recently, thats part of my research, is the way na our hormones change is really key to brain aging in women, which is the connection ats being largely unexplored pret much forever. So its a very new topic and a very interesting topic and i think its worth talking about it because all women go through menopause. Yeah, and tha really is quite a ing, im told and especially for a brain. It is a thing, im getting there. m there now, well, at whom point we all will. Yeah. And we need to understand what happens to a brain during the transition to menopause and why thats been associated with higher disease for someomen and anxiety, with depression with memory losses,ith increased risk of medical conditions im sure well tal about. Yeah, were going to dive ep into all of those topics. Thats what were all fascinated about is how can i better, peaps, decrease my chances of developing alzheimers. So, well get into that. But let me go back to what you said, that the Scientific Community really only now is beginning to understand tt women and our hormones may be somewhat linked, but why has gender been removed from the problem and from the equation in the medal community . Yes, thats such a good qution and something that i have personally struggled for a really long time. Ive been trying to study the womens brains for 20 years, in part, bause they have a Family History o alzheimers diseas affecting the womenn my family. And as soon as i was 19 i starte to do brain scans nuear medicine as a volunte of course because my parents are nuclea physicists. So it kind of runs in my family. W. Yeah, its very teresting. The point is nody had answers for me. My questions were for the woman, for the man, is it genetic, is itife style, somethg else . And see where the problem is that we have a huge gender gap in research, especially as related to brain health. And still today, womens brain heal is one of the most overlooked, underdiagnosed and underresearched fields. And thats really because 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 i dont know if you want to get into it, but the point is there wano research with women in. And the second thing is then, all of this medical research that excluded women broug substantiated the bias again womens brains that i describe as bikini medicine. Which is really like saying what makes a woman a woman from a medical perspective is reproductive organs, the par of the body that fit under the bikini. If you think about Womens Health its about her breasts, her ovaries,er hormones. We dont talk abouher bin. Espeally when were talking about womens brains, and Womens Health, we never talk about wons brain. And all of this contributes to wome just being excluded from research and bei misdiagnosed, a not even looked at. You talk about your connection with alzheirs, and my motherinlaw had been diagnosed in her mid 50s wh alzheimers swell. Its been interesting looking at how to cra it, and looking at hormones. Specifically estron with won. What does estrogen have to do with alzhmers . Its a really good questio and something were actively ploring right now. I think, from the conversation our our brains cannot work in isolation. The bin is connected with the rest of the body a eecially with women, they have the action between the brain and the reproductive system,ts really key to brain aging and that isecause our hormones need this communication between the brain and the reproductive system and we all know that hormones differetween the genders, and men he testosterone and women have estrogen. What people dont reaze is that the hormones that we ve in the body are the same hoones that we have in our brains. We just have a different function in the brain. We think of the hormones as repruction and children. But in the brain we think of a different function for ener. And women push this t burn sugar, glucose. If estgen is high. Your eney is high. Estrogen is a super power in the brain. It keeps your Brain Healthy and young. Its testostone for men. And its away over time and usual uslly whereas women lose the super powers of estrogen in mid life, during menopause, but then w live anoer 30 years, in the stage without that production that the estrogen provides. Excuse me, how does that affect the brain as you start going through menopause and start experncing that loss of estrogen . We, we can see on brain scans is that neurons slow dow and make less energy. And that is associatedith an accelerated aging process. I think a lot of women report that aftermenopause, your skin ge a little drie not all women, obviously. But many women do notice, the sk is drier, the hair is a little more fragile. Something very similar happens inside the brain. Its not a huge severe problem, that the brain is also starting to age and we can see that on brain scans and for some women, the changes are very, very mild. But for others, theyre quite exeme. We have published hundreds of men and we find qui a bit drop in Energy Levels in the brainhich i want to crify does not correlate with reduced cognive performance. Women perform just as well as the men of the same age. Thank u. [laughter] and women brains are concentrating were trying to find out how were concentratingnd the brain lose the energy, lose the estrogen, but performing really well and we want to understand what happened so that we can promote and support that compensary mechanism. So you write a whole a couple of chapters in the book, but a whole section particully that focuses on hormone replacement therapy and who should thi about it, who shouldnt. Ill recmend people reads read that because theres a lot of areas you say go through that and suld or shouldnt. Cancer o Breast Cancer survivors you have to approach it differently. But those approaching menopause, or aeady there already. At do we need to be asking ourselves when it comes to hrt. Do you need it or wan it . There are Different Things that can be aachieved with hrt. There are some women who are not eligie for hrt. For some women, it depends on what youre trying t achieve. What kind of symptoms you wt to minimize or alleviate and im interested in what i would really hike to test for alzheimers is prevention. Itseen done in some ways, but not in the best posble way. I think we need to start younger, before menopausend that hasnt been done yet. Andhat has to be explored. There are many questions that need to answered and im also interested in things that we can do instead of hormonal therapy. If there are many natural, behavioral strategieshat can be used, that pretty much have the same results for many women and do not involve a prescription. Were going to get into that, life style, prevention, exercise, sleep, h all of that pys a part. Let me ask you first though, what about genetics . What about the genetic link. My motherlaw about early onset of alzheimers and my husband and i are into health and wellness because we kw now there is perhaps a risk for him . Well, i would recommend testing. And i have whole chapter in the book about how to approach testing, which really starts with a very detailed Family History questionnaire becaus yes, early onset alzheimers, but did it happen to other family members . Like, are there multiple family members affected . Because if so, is it genetics . If its an isolated case, there are a number of things clinically that we would like to find t and with better guide. And basically alzheimers disease comes in two major forms, early onset genetically determined, tt is caused by genetic mutation, and that is an aggressive form of alzheimers disee. Im happy your husband does not carry any genetic mutations, but he is most likeable eligible for testing. Actually his mher is firs 1998, 99 o all alzheimers cases do not carry genetic mutation and for the majority of alzheimers cases, its really the interplay of genetic factors, thats a mutation with medical history,ife style and environment a theyre really altogether modulate. Hit me ask you about that, there are medical risk factors that could also aect your risks of developing alzheimers. Heart disease, thyroid disease, metabolic dirders, tdi, traumatic brain injuries as well. Can you talk about that . Yes, there are many dinner medicaconditions that do know the actually directly affect the brain that cause alzheimers and could trigger, they could prote alzheimers disease and these include the ones you jt mentioned and for women mixed body disorders, because they do have the hormonal component and, but i think its really, really important is then tre are many different risk factors for alzheimers disease that we know of and i believe in the book. It lists over 30 and were just learning howhese risk factors affect the genders differently. And it really looks like men and women almost have two sets of pathways towards aheimers disease, the men are more in nature and women are hormonal and methodic and and there are some for risk factors in women than in men d the other way around. And its funny in a way that many risk ftors affect women more than me only women not men in case of alzheimers disease, but the number one risk factor in men is not being married to a woman. What . [laughter] why is that . There are so ny possibilities, from mutations and the number one for men is not being married to a woman. In that se, i mean, i dont think its nessarily related to a woman as much as being in a supportive, healthy, nurturing relationship because these studies were done on Data Collected many, many years ago, and were not allowed in this country and men to were married to women, traditional marriages. Women are very good at taking carf people. Yes, we are. [laughter] in lifeere charged of the health of entire family, rit . We sedule the medical appointments, making sure the husband is taking pills, and making sure the health of the family. I think it was really cute. Which is aerfect segue to life style and prevention and tips. And we ve some viewer questions, somebody asking what is the singlemost important thing that a woman can do for her postmenopausal brain . The single most important thing is to really look at your life style and fd the one part of yourife style thats not where it should be and youre likely to be. Everybody has different risks and everybody has different for me, that it would be stress, stress reduction because im not good at that. Me neither. [laughter] its very hard. For a lot of women, its maybe diet and if youre physically active, intellectually stimulated and just not eating healthily. And accumulate late the stats to a very healthy female brain before and after menopause, and they include mental stimulation and activity. Especially when learning is involved. Learning is to your brain, what exercise is to your muscles. Does it stimulate growth, and stulates connections between the brain and thas what really keeps the brain plastic, which in biology meansyoung. Right. Arning, you need to challeng yourself. Like if you le to read a book, dont read a novel, read something that i really challenging. If you like to watch movies, watch a documentary as well, where you learning something. So you really need to feel engaged in what youre doing. My mom plays majong almost four times a week. Playing games. [laughter] but besides that, i know that diet has to be in that eight steps, right . Diet. How important is moderating what you eat, but also what kinds of foods should wee eating, as you also wrote the book the brain book. Diet is really important for two reasons, number one, the nutrients that we eat have an effect not just on our boes, but also literally inside our brains, our brains are made of nutrients, its a really big part. So we need to replenish on a dialy basis. For women, i recommend antioxidants. We found in brain scans, a correlation between your eating of antioxidants and the diet, vitamins a, c, e in your brain Energy Levels throughout the life span, but also after menopause. It really looks like the more nutrients you consume on a daily basis, the higher your brain energy over time. And the second reason is then, we eat three times a day, most people do, three times a day, sometimes even more tha that, so we literally have Three Chances every day to make a choice that supports oples brain health. Its not just about the way we look, its really about feeding our brains the nutents so that our brains can perform so ch better for us and a strong proponent of a heahy diet, and questioning with my own di, i really eat for my brain as much as i can and my research influenced the way w e eat, with my family. Andith my family im italian. And the mediterranean diet you write in the book the quite that most people shoul follow, right . I think its a good tplate for a very fresh diet. Very rich in nutrients that the brain wants and needs all the time. Its not a deprivation diet, which i think is really important for mood. I cant be depred. [laughter] i want to enjoy my food. So i think its a sensible diet and wha i like about it, it didnt come out with somebody thinking about it. And write this book about it. Its really theesult of thousands of years of women doing the diet and doing significantly better than women who are on a western diet. Doesnt have to be a mediterranean. It could be like t frame work, plantbased or plant centric with a good amount of vegetable oils, especially, and a lot of bers. Fiber is good for you and regulates hormones something that we dont talk about and we should. Fish, legumes. So theres a huge study done in england with hundreds and hundreds of women showing that the more fh and legumes you eat, later on in life you go through menopause. Intereing. I think its really interesting. Yeah. The fiber and the omega three fatty acids. There are the complex carbohydrates. And it shows the more processed food in the diet and the eaier in life forenopause even if you have no genetic reas to do it. So i think that really speaks to diet, and not that its something that we do for pleasure, but food is function. And its something that we can actively do and we have control over it. An exercise also is an important factor and i like, you write i the book that slow and steadyins the weight. Moderate exercise is t route to go rather tha a lot of people are now taking all of these, well, whe we were going togym, w could take high intensity classes and now were doing the video at home. Why is slow and steady a better pace for exercise is this how much exercise should wee getting . I think slow and steady really translates tooderate tensity, and theyre starting to look athat in women. Only women, and not men and womentogether. And theyhow this very clear inverted ushape between intensit and gain. If you have zero intensity or very low intensity,ou have no gain. In the exercise of tse super helpful. For many women, you huge group of people, what works for the average person. Women are older than 40 and especially postmenopausal, on exercise more sustainable. It gives you enough games but you also do it often enough that you can see a benefit. Whereas for many people you go very high intensity and then youre tired, you just dont do it consisteny enough. If you do it, great.