402 - Surprising (GOOD) News About Menopause | Lisa Mosconi

32:17Another one, so this was always interesting to me how in this country, a lot of people have said to me that they don't like to drink water because it doesn't have any flavor. I taste it. And a lot of people in Italy, where I'm from, are like, oh, this is this kind of water and this water is not as good as this other water. So I think your palate has something to do with that perhaps. But something that I find interesting, especially now that my daughter is little and sometimes she would like to drink something else, not just water, I do liquid clodophyll. Oh. Minty. Yes. Minty clodophyll. And I think that that's also nice in terms of rehydration.

32:57Like little drops and you could probably get them in the health store, on Amazon. Yeah, yeah, on Amazon. Yeah. Easily like a teaspoon makes everything taste minty and fresh. It looks green. So it's kind of cool. Yeah. But it also, that specific brand I'm thinking about at least that I thought was a good one, very clean, also contains salts and minerals. You want to say it because people are going to almost see in the comments. What's Lisa like? I don't recall. You don't recall? Okay. I'll find out and tell you. And we'll put it in the comments. Yes, yes, yes. I remember exactly what the bottle looks like, but now I'm kind of blacking out on the actual brand.

33:29We'll find it. No, I know. There's so many things out there. So let's keep going and talk about some of like the best and worst foods for our brain. So we know that water, A, yes, hydrate, hydrate, hydrate. B, let's get it with those electrolytes and minerals in it. And in terms of food for the brain, and again, you go into so much incredible detail in your book. So for all y 'all, you want the big full on, you know, uninhibited list, you have to pick up Lisa's books. We're going to talk about some top line things. And then I want to mention one thing that surprised the pants off me that I want to dig into more.

34:03So now I'm curious. Yes. But tell me, what are some of the top line things like when it comes to, let's say, amino acid profiles, what are the foods that give us the best support for mental clarity and sharpness for life? There are several nutrients and therefore foods that contain the nutrients that have been shown time and time again to be associated with better outcomes when it comes to the health of your brain where the outcomes can span from better mood to better sleep to better cognitive performance and there's a whole range and they really are whole foods and that is really important to say that nature provides for us and diversity is key so there are so different types of apples there are so many different types of nuts and seeds and whole grains and lagoons and And animal food is a different story, but that is helpful too.

34:59It can be helpful if you enjoy animal foods as well. I would say my top five are actually on the cover of the book. Yeah. And I'll tell you, the number one is caviar. Yes. That was the one that surprised the pants off me. Can I tell you, I have literally never had caviar in my life. Never had it. so i was like okay i need to go shopping and i don't i don't want i know it's expensive i was not trying to sell cover to people of course you're not but we gotta you're a scientist and like we gotta be mature you know what i mean like we have to have conversations where it's like not everybody needs to buy everything and not everybody needs to like everything and everybody's got you know i love there's a term it's like the bio-individuality you know my best friend in the whole world she's like my soul sister she's a vegan so right i have been for a long time yes So it's like, I, my friends, all of us, it's like, we're eating to the best of our ability in a way that we believe.

35:58Yes. And that works for you. Yes. That is the healthfulliest or most helpful for ourselves, the planet, like everything. Like we're, we're doing our best. So, you know, Dr. Lisa ain't telling us like, go out and do it like this. But so I miss, I misspoke. I was vegan. You were vegan. For a while. Yeah. I've been a vegetarian for a really, really long time, but an Italian vegetarian. So I do eat fish. on occasion. But again, I'm not trying to say you have to buy caviar. I'm aware that it's expensive. I'm aware of the way that it's produced. I'm aware of a lot of things. I was talking about the neurochemistry.

36:34Yeah. Let's talk about that. Again, this is important to talk about. We can be mature and know that there are considerations. It's good. So eggs in general, regardless of source, provenance, are a fantastic brain food because they're high in lean protein, complete protein they're very high in good fat especially fish eggs because they're high in a very specific type of fat that's called omega-3 fatty acids so polyunsaturated fatty acid which is basically the best brain food or the best brain fat right so this is what i was talking about before about these little gates that open and close so the brain very specifically needs polyunsaturated fatty acids for function because all the membranes of your neurons are made of saturated fat and polyunsaturated fat.

37:28But whenever a cellular reaction takes place, like synaptic activity, is the polyunsaturated fat that is being consumed. The saturated fat lasts for a very, very long time. Is that the myelin? Yes, the myelin sheet. But also, when you look at the tip of the neuron, there's a part that's called the synaptic cleft, in the synaptic button, where the neurotransmitters come out from. Wow. So yeah, so it's literally the membrane folds in to make like a little pouch that is filled up with neurotransmitters, and then the pouch is relieved. It's like a bubble that bursts in the synaptic cleft. And all of that is fat and protein, fat and protein, fat and protein.

38:10So there is quite a bit of cellular turnover. And the kinds of fat that are being used to make the membrane and rebuild the membrane are based on polyunsaturated fatty acids, predominantly omega-3s, omega-6s, omega-9s. There's a lot of different types. Yes. So that's the kind of brain fat that the brain really wants and needs. Whereas a lot of people are surprised to hear that cholesterol can't get inside your brain. There are no gates for cholesterol. And I think it's important to clarify that because many people are aware that the brain has a lot of fat, contains a lot of fat. And then the assumption is that you need to eat a lot of fat to replenish whatever fat is in your brain.

38:58And I'm always like, no cholesterol and no saturated fat so much either. So the gates for saturated fats are quite open when we're little and we're children. but they're kind of they're not very responsive as we get older interesting yeah and there are no gates for cholesterol why not because the brain makes its own yeah so self-sufficient complete yeah in terms of cholesterol yes and then it really shields the cholesterol away from the rest of the body and the circulation so there's some cholesterol um can come out either from the blood or cerebrospinal fluid but no cholesterol can get in unless there's a damage in your blood-brain barrier.

39:40It's huge cholesterol. It's a very big, chunky molecule. So it's more efficient for the brain to just make its own. Interesting. And so, okay. So fish is great. So fish is great. Any food that contains omega-3s, really. So almonds, hazelnuts. I love hazelnuts. Me too. You too? I love chopping hazelnuts and like putting them on salads. Oh, forget about it. Like hazelnuts, I can't even. Like I got to watch myself. But also, right, chia seeds? Chia seeds are good. Yeah. You know what's really surprisingly good? Green peas. Mm. For omega-3s? Not this sweet? Yes. So they're good sources, phospholipids, that are bound to the omega-3s.

40:22Amazing. Surprising. And those are quite high in protein. Yes. So for vegetarians, vegans, that's actually a good source of brain fat as well. I love it. Walnuts too. Walnuts. Also soy, soybeans. Yes. Edamame. Edamame. Really good. What do we think about, is there really a distinction there with black walnuts versus regular walnuts or not really? Maybe a little bit. You know, it's like when people say brown rice is so much better than white rice, but the amount of fiber is not, you know, yes, it's better, but it's a subtle difference in some ways. There isn't a ton of fiber. Right. Whereas if you get a red rice or a black rice.

41:01Now we're talking. Then there's more. Right? Now it's like party on when it comes to. And there's more fiber. Yes. Even better, wheat berries or spelt. Okay. There's more fiber there. Great. Yeah. What's the spelt? Has more protein than quinoa. Oh, wow. Yeah. And it tastes so much better. Ah, okay. So that has to be off my list because my tummy is not happy with the gluten. But all the other things. Than quinoa. All the other things. Than quinoa it is. Than quinoa it is. Okay. So let's talk about what's the number one nutrition tip you have for brain health, like the thing that we should stay away from.

41:35Oh, away from. Can I tell you what my number one tip is? For the pro? Yeah, for the pro. Brain. Antioxidants. Okay. Tell me. Tell us the top ones. A ton of research has shown that antioxidants are extremely important for brain health. Why? Because the brain is the most metabolically active organ in the body and neurons do not regrow. So what happens when you're metabolically active and you burn glucose for energy is that inevitably you're going to suffer from free radical production and increased oxidative stress. It's just a byproduct of running on glucose, right? The same when you, with regular fuel cars, there's, anyway, you get my point.

42:20And so what's really important to realize is that the oxidative stress will damage your neurons in the long run. And it's really important to counterbalance that kind of rusting effect. And the only way to do it is to bring in antioxidants from your diet. And there's a ton of research, in my opinion, there's plenty of research, to suggest that a diet rich in antioxidants is really supportive of brain health. And we see that with the brain scans, with the brain imaging, especially for women in our studies to be replicated, to be confirmed, but at least in my hands, the intake of antioxidant in the diet is strongly and directly correlated with brain energy in midlife.

43:07We work with women who are like 30 to 65, 70. Yep. And yes, and I think that's really important because brain energy, I mean, you can't do anything if you can't think, right? Absolutely not. Yeah. It's like a domino effect, which we'll start talking about. So vitamin C. vitamin C. I love vitamin E. I think it's really a little bit underrated when it comes to brain health, but the research shows that it's really... Supplement or food form? Like let's talk, yeah, let's talk about real food sources for both. So the overall recommendation is to get your nutrients from your diet. Yes. In part because the nutritional synergies and in part because we haven't fully mapped out all the phytochemicals in foods.

43:51So antioxidants for the vast majority come from plant-based foods. Fruits, veggies, nuts and seeds. Blackberries, wild blueberries. Yes, yes, yes, yes. Goji berries. Goji berries. Fantastic source of vitamin C. Amla, the Indian type of mulberry. Mm. Yes. I'm going to have to search that out. Okay, gooseberry. But amla. And it's probably one of the best sources of, concentrated sources of vitamin C. that you can find in foods like antioxidants. And then I would say coffee. Yeah. It's a great source of antioxidants. I was the nectar of the gods. I mean, I was off the food. And cacao. Oh, yeah. Come on.

44:36Also a really good source of antioxidants. Yeah. So you can have a good time. You can get all your antioxidants and have a really good time eating them. Oh, for sure. Yeah. Sure. Like eat the rainbow. It's like an antioxidant party. Yeah. Leafy greens, dark leafy greens usually are a good source of antioxidants as well as spinach, kale. Yes. All sorts of - All the rainbow. Leafy. Yeah. The Skittle of whole foods, just not Skittles. Speaking of, tell us the worst of the worst of the worst. And I was guilty of this for so long. So y 'all, when you hear this, and I just want to tell you about my recent journey, go for it.

45:10Well, processed foods, heavily, highly processed foods have been really strongly correlated with increased rates of cardiovascular disease, stroke, diabetes, obesity, and to some extent also with dementia. Yeah. And they also have been linked with an earlier onset of menopause for women and reduced reproductive fertility. And yeah, so. Anything processed. So obviously if it comes in a bag, if it comes in a box, right? Yeah. If you look on the back, you don't know what the hell these ingredients are. You can barely pronounce it. But I think this is important too, because I think for years I kind of let myself slide on this one.

45:51As an Italian American, there's a lot of really yummy deli meats. Oh my God, cookies. Well, there's cookies. Chocolate chip cookies. There's all of like, you know, again, in this country, like we're here in Soho and in the West Village, there's an Italian, for lack of a better word, a place that does the most amazing sandwiches. So it's got the salami, the mortadelle, the this, the that, and the other. And you're just like, yeah no mass right can't do it it's like terrible so can you break down it's not just the stuff that's in chips and crackers and all that stuff it's also food that's highly processed like the bacons the sausages the deli meats yes yes but also you know wonder bread yeah they kind of bakery goods so they're everywhere yeah it's incredible there's i mean i can't say specific brands i think it would be unkind but like you just look around there are all sorts of candy and treats and little i don't even know what they are but they're like muffins on the go or things that are just packaged and last forever yeah if something lasts forever it can't be good for you can't be natural yeah that's a cool rule of thumb also if it has really weird colors i think that's a good way if something's bright green or bright blue it's very hard to make a natural dye that looks that color right unless it's like blueberries or blackberries it's only they don't look bright no that's true right they look deeper and saturated yeah yeah yeah so that's it like for my daughter i always said to suhar did you see what color that is and she's like okay okay what a great way to teach her that's awesome she gets it and also you know it's good to provide healthy alternatives so it's not a deprivation you can't eat that it's more like why don't you have that instead yeah so yeah now she's happy and she eats everything i mean the other day she was like, mommy, where are my greens?

47:40Oh, yes. Smart. Smart soul. Not surprising coming from you. Okay. Well, I want to shift gears and talk about menopause brain. Yay. So congratulations. Thank you. New York Times bestseller. So many different bestseller lists that you've hit. Yes. How frigging awesome. It's fantastic. I know you look surprised. You should not be surprised at all. I was surprised. Instant. It was an instant New York Times bestseller, USA bestseller in Canada and then in England. And I was like, whoa. Yes. You know what? The reason I was surprised, it's a good book. I promise. I love it. But it's specifically about women, about menopause and about brains in menopause.

48:21So it's kind of like a very specific target audience. Yes. Right? So I'm so happy that it's been well received. It has been. And it will hopefully continue. I hope we get a lot more folks getting their hands on this. From a business and marketing perspective, it's actually the best way to sell anything is the more specific you are. Oh, good. Yeah. So home run. You open up with this nice little subhead, which I loved. Am I losing my mind? And then a portion of your sentence. Between the ages of 30 and 60, many women will wake up one morning and wonder what hit them. Brain fog, not being able to remember words or names, emotional darkness, depression.

48:58So a lot of women feel like this. I've certainly felt this and was like, what the hell is going on? Like, are we losing it? And one of my underlines in your book, you say, the truth is women brains are not the same as men's brains. They are hormonally, energetically, and chemically different. Can you break that down and talk about why it is so frigging important for every woman between the ages of 30 and 60 to educate themselves on that fact, on the fact that their brain is different and it's important to pay attention to it. Mm-hmm. Yes. And this is actually the main focus of my research. It's really about women's brains.

49:33And the reason being is that I have a family history of Alzheimer's disease that impacts the women in my family. And my grandmother, who was one of the very first women in Italy to go to university and graduate from university, and her two sisters, who also went to university, I mean, it was so adorable. They would set out every morning. They lived in Parma, but they had to go to school like hours away. So they would just wake up at dawn to catch the train. You know, it was in the 1950s, I suppose, in Italy. And she was so brilliant and so bright. But then she started showing signs of cognitive decline, which ended up in a diagnosis of dementia at that point in Italy.

50:19But it was obviously, I mean, it was so textbook Alzheimer's. Alzheimer's now that I know more about Alzheimer's and then her two younger sisters also developed dementia Alzheimer's disease and died of it whereas their brother was spared even though they all lived to the same age wow and that brought me to ask a lot of questions about Alzheimer's but also about women's brain health more generally and what would I think the most interesting takeaway from our research and from everything I've learned in more than 20 years of thinking about this is that like you said women's brains are not the same as men's brains but there's this misconception in medicine and in neuroscience that sex does not matter and that women are considered like smaller more emotional men with different reproductive organs but just those reproductive organs notwithstanding everything else is supposed to function the same way and grow the same way and age the same way and that is just absolutely not true so what we've learned you've seen those graphs where they show age over here in brain cells or neurons up here and then they say oh you know it's pretty much stable in midlife and then you just go down a little bit linearly there's a little bit you lose a little bit of neurons every year yes we say we talk about this all the time absolutely not that's a man that's what happens if you're a man that's a man's brain yes you're stable quit down a tiny little bit and unless something happens of course unless a neurological disease sets in for women it's a whole different thing and i wish i could draw it for you but basically we're born with a ton of neurons like a lot of neurons and then we hit puberty.

52:13And from then onwards, aging does not look linear. Let me tell you, at puberty, for both girls and boys, the brain shrinks, but the timeline is different. For girls, that happens earlier. And it tends to coincide with puberty. They will reach a peak on neurons, and then we just shed. It's interesting. It's called pruning. Yes. And a lot of neurons are being discarded. it and i have a whole explanation for this if you're interested but for now we lose the neurons and the connectivity in the brain changes and brain energy levels change it's a lot of changes but then what happens the boys the brains kind of settle down and you keep going for girls we get a menstrual cycle and what people don't realize is that their brains as women are profoundly connected with the ovaries so much so that every time your ovaries cycle throughout the month your brain micro cycles it's really in sync and the sex hormones that come out of the ovaries go straight inside the brain and convey messages to the brain and the brain sends hormones back right down in a feedback loop that is really important not just for menstruation and fertility but also for brain health.

53:30And that's for your entire life, your entire reproductive span. And then let's say you get pregnant, right? There's this neuroendocrine system that connects the brain with the ovaries that gets super overactivated every time a woman is pregnant, where your brain is having a party there, right? In many ways, I mean, you get all these wonderful hormones and there's this boost in a lot of different things, but then everything crashes down. Once the baby is born and there's a phase that is quite hard on the body as it is on the brain, the postpartum phase, every time a woman gets pregnant, and guess what?

54:10The brain loses neurons when we're pregnant, even more after the delivery. And then there's a little bit of a recovery, but most of these are rewiring. There's all these changes that take place and they keep happening. And then you get back your menstrual cycle, your brain keeps cycling until you hit menopause. And people think of menopause, which by the way, every woman goes through menopause, whether it's part of aging or because medical interventions, but all women who live long enough go through menopause. And we think of menopause as something that is more like one day on the calendar, right?

54:49We think about it like puberty. One day you get your period and you're an adult lesson, you're a teenager. But menopause is a process that can take at least 10 years from start to finish because it starts a few years before the final menstrual period. And for many women, it takes a few more years for everything to kind of adjust and settle down. And then your brain needs to basically regroup because now all these beautiful hormones, right they were keeping us healthy and young and energized are severely reduced and you need to find another baseline and keep carrying on so it's much more like a step ladder i would say if you're a woman and we don't fully appreciate the impact that having ovaries has on the brain one of the things i love about your framing of this and i want to thank you for it because when I read the menopause brain, it was really the first messaging that hit home that there was possibility of like optimism and upsides.

55:59Because I feel like, especially in maybe the past few years, you know, there's a lot of menopause talk and this is awesome. Like this is thumbs up all the way around. Discussions, understanding, talking about all the different ways that all different women can navigate this particular transition. But I haven't heard much about how coming out on the other side that we can actually be stronger and better. And so I feel like you have such a great sense of humor. And I want to get into the upside of menopause. What can you tell us about menopausal perks? Yes, I think it's important to put everything in context.

56:34So the first thing is that the menopause brain is a brain in transition, right? So menopause is a neuroendocrine transition state, which means that your brain is changing just as much as your ovaries are in your endocrine system, your hormonal system. And every endocrine state, neuroendocrine transition state comes with pros and cons. and we're used to really focusing on the cons and not really talk about the pros whereas i think it's important to have a balance right so what are the downsides they're obvious especially when it comes to the brain is the brain symptoms of menopause which a lot of women don't know that they come from the brain so i'll just add so when women say that they're having half flashes night sweats, insomnia, depression, anxiety, brain fog, memory lapses.

57:29Those are all neurological symptoms of menopause. They have nothing to do with your ovaries. Those are signs that your brain is being changed, it's being rewiring or transforming because of menopause, right? So those are neurological symptoms and they do impact over 75 % of all women so more than three out of every four women experiences at least one neurological symptoms and there's more than 30 I have a whole list in the book just because it's important to know that certain things like tinnitus could happen as you go through menopause and it's not your ears right it's your brain that's creating those symptoms or skin crawling sensation.

58:15It could be really scary.

58:21Your thermoregulation is all over the place, but you can have electric shock sensations as well. Wow. Which is a neurologic, because it's more rare, of course. But there's a whole range and menu of symptoms that comes from menopause that are neurological in origin. And we don't know how to talk about. Most women don't know why they're having them. And most physicians don't know how to address them because menopause is usually OB-GYN, right? OB-GYNs are not trained, to be fair, to manage your brain health. Right. That's what neurologists, psychiatrists, psychologists do. But then brain specialists are not trained to manage menopause.

59:01Right. So we are a little bit in the soup in that respect, but things are changing. So those are the downsides. there are upsides because these transformations have an evolutionary significance. There's a reason that they happen. And I think the best way for me to explain it is to compare menopause with puberty and pregnancy. So with puberty, the brain is shrinking, the connectivity is changing, energy is changing as well and there are symptoms we all know that adolescents are foggy brain they have trouble concentrating sometimes there's sleep is all over the map and there's this feisty emotions or hell yes reckless behavior there's a lot of crying and big emotions big feelings but the same transformations they trigger those symptoms in the brain are really important for the brain to strengthen some connections in the theory of mind networks now theory of mind is our ability to mentalize or to put yourself in somebody else's shoes which is the fundamental basis for becoming a grown-up and living in society so the symptoms are a side effect of this very important transformation that your brain is undergoing not just your body but your brain is undergoing so that you're able to take care of other human beings yeah so that's the perk of the teen brain or the teenage brain something similar happens in pregnancy the brain shrinks another time and the connectivity is changed so that the same exact network the theory of mind network is strengthened even more why because as a new mother with a child who can't speak for a very long time, you need to be able to literally read minds for a long time.

1:01:02And you need to be able to protect this child no matter what. So your intuition is up to the roof, right? Your ability to foresee what's going to happen is off the charts. Your ability to multitask and plan and function on no sleep. Your endurance is improved. At the same time you may have mommy brain you may feel sad you may feel weepy you may have postpartum depression you can have the brain fog 30 of pregnant women have half flashes it's the same brain it's the same system the neuroendocrine system that is impacted by hormonal changes and now we get to menopause menopause is the same process from a brain's perspective in reverse so now all those neurons that were so important to give you a menstrual cycle right to support the pregnancy should the pregnancy occur who gave you these instincts when your mother whenever they made you capable of taking care of your child these neurons don't need you just don't need them anymore and as a brain it's very expensive to have a ton of neurons so in my opinion menopause and other people's opinions of course menopause is a biological clue for your brain to go through pruning again shed all these neurons that are not needed anymore and and rewire all these different neurons in a different direction so yes you have the side effects unfortunately which can last a while because the transformation takes away the remodeling takes a while all renovations take longer than we want them to take.

1:02:45Yes. Especially because you can't, you know, your neurons need to stay with you for another 30 years. Yes, yes, yes. So you better go calm. Yes. You don't want to make mistakes. Right. Take your time. But the idea is that these changes will prepare women for the next phase of their life, which is not reproductive, but it's supposed to be productive. Yes. Right? So your ovaries can close down shop, but your brain needs to keep going. Yes. So this rewiring in a way, it's helpful because there are neurological changes that take place. They seem to give women more empathy, more calm, more peace of mind, and more emotional mastery.

1:03:29Yes. And I love it. in your book, and you said the polite version, I will say the full version, also known as giving fewer f***s, which is fantastic. And I loved kind of how you threaded all of this together because my friends and I, we often talk about this, and I have friends of all age groups. But I've noticed and I've watched and witnessed, especially friends that or older than I am, I'm like, oh, oh, oh, you know, like feistier and fiercer and more transparent and more just, nope, this versus this versus this. And I love it. It's like beautiful and amazing. And so when I was reading this, I was like, yes, emotional mastery, also known as giving fewer f**ks.

1:04:11The brain is growing leaner and meaner, discarding information and skills that we no longer need and growing new capabilities that we do. I love you also wrote interest, priorities, and attitude shift in a positive way, this notion of like a second adulthood. For many, a rush of physical and psychological energy. And Oprah's quote, it's a moment to reinvent yourself after years of focusing on the needs of everyone else. Those are all amazing. And I feel like I'm so happy that you have highlighted this and also are shining a light on it because we do need a more balanced viewpoint of it. Yeah. Because otherwise, the entire focus, besides this narrative of menopause is the beginning of the end.

1:04:56Yeah, which is bullshit. Yeah. But also then the focus is all about treatments. Yeah. Right. If you don't also have a balance in your understanding of menopause is and isn't, then you're just scared about the symptoms and you're just going to obsess about getting this treatment or that prescription medication, which is not to say that they're not helpful. Of course. Right, but I think the spirit or the attitude matters. Yes. That's why your mindset matters. Yes. And knowing that there's an evolutionary reason, according to many scientists and many clinicians, for women to go through menopause is important.

1:05:34Because, see, what most women don't know, to be fair, is that menopause is quite unique. If you have ovaries, menopause is a fact of life. But in reality, it's a little bit of a biological riddle. Because all over the planet, most females die right after menopause, right? So the end of fertility coincides with the end of your lifespan. for almost every female animal species on this planet except a handful. Women, killer whales, which I love that analogy, it's so cool. Norwals, I believe, another type of whale, some whales, a type of giraffe, a type of elephant, the Asian elephant, I love elephants.

1:06:26They're so adorable. And an insect, the Japanese aphid, which I don't know if you've ever seen one. No, I don't know if I have. I hadn't until I was looking up, you know, because of menopause. And what happens to this little thing is then as they become non-fraudile, they sprout spikes. They turn like into a kind of chestnut. Like, do not touch me. And I think that is really, really funny. They go from looking like a bug to a kind of hedgehog, you know? Yes. Okay, two things. I do want to talk about some practical steps. Yes. And then I want to get back to mindset because that's the place where I feel like it's so, so important.

1:07:08And again, we haven't had enough light shining or emphasis on that piece. So in your book, you talk about a lot of very practical steps for women to take to take care of themselves and their brains during this transition. Things, exercise, stress reduction, supplements, botanicals, and even self-talk. I love the botanicals. Oh, I love the botanicals too. I feel like I can so see that in your design and everything. And even that word I love. Like anything with botanicals, it's like a little magnet for me. Like I'm a sucker. One of my favorite pieces of skincare, it's like all botanical based. I'm like, yes, I'm in.

1:07:40Okay, exercise. Let's talk about how much exercise we really need. Weightlifting, which I'm a huge fan of. Gentle. How does exercise impact us and what does the research tell us? Yes. So first of all, there isn't a ton of research as you can imagine, right? But the research that we do have shows that different types of exercise may be more helpful for specific symptoms or specific needs or challenges during menopause. And there's three major exercise groups that have been identified as being beneficial for the menopause brain and just the body overall. So cardiovascular activity, like cardio, seems to be quite effective for hot flashes and for brain fog.

1:08:26weight training and resistance training is obviously helpful for bone density muscle mass but also for mood seems to be really uplifting and energizing in terms of mood and and then just flexibility and balance exercises and mind body techniques like yoga pilates tai chi more gentle if you will exercises they require coordination and posture, where form is really more important than intensity in some ways. And those are helpful for stress relief and sleep, as well as flexibility. So ideally, one would do everything. Yeah. Right? But if time is a constraint, as it is for so many women, then I think it's important to know that some types of exercise may help more or less with specific concerns.

1:09:21Yes. And you can always find ways, I think, to mix them up. Yeah. You can do weightlifting that also stimulates cardiovascular activity. Completely. Right. Or the other way around. You can walk, but with a heavy, you know, with a vest, with a weighted vest on. Or those little wrists or ankles. Oh, we can prancercise. Like that was one of my favorite things. So I'm going to go to Florida in a few weeks and I feel like I'm going to put on my ankle weights and just prancercise my ass all around Palm Springs or Palm Beach. I love Pilates. Me too. You do? I do. I love that. I love yoga. Well, I actually change it up because I have a little bit of an ADHD brain and I just like variety.

1:09:58So weight training, dance, yoga, and Pilates are like, I just kind of cycle through. Yeah. And you don't even, you know, they're the best. Because it has to be sustainable. Yes. I think what's most important is something that you can do consistently. There's that word again. Yes. It's a magic word. I think it's important. You know, there's nothing you can do for a couple of weeks that will have a long lasting impact. And again, menopause lasts for years. So if exercise is one way that we want to support our brains and have a gentler menopause, then I think it's important to find things that give you joy.

1:10:34That is not a chore. Yes. Right? It's something that you want to look forward to. And for me, that's Pilates. I even got a reformer. Oh, in your house? Yes. Good for you. I love it. And we just got a treadmill, like a bigger treadmill, because I love Pilates and running. Yeah. yoga i i'm not into weight lifting at all but i'm trying i was speaking with jj yeah and she was giving me little tips i want to try this i want to try that you know what you're here in new york right yeah yeah i'm gonna take you to a class oh you're gonna come with me and and i think i can i'm really good at this so one of the things am i gonna die no i would not take you to anything that would potentially make you i wouldn't even take you to anything that would like be scary i'm only gonna take i only take friends to like super joyful things but my my really dear friends always know I'm really good at helping people kind of move through little challenges.

1:11:22So we'll talk about it when we're done. Okay. Now I want to go to mindset because it's so fascinating to me. And I love how you put a lens through other cultures outside of here in the US. And I love our country. I love being in the US. I love being American. And there's every place that has its pros and cons. We have some awesome, amazing things, and we've got some things that are challenges. So you write, what I find particularly striking is the complete absence of any sense of achievement or gain in status associated with becoming menopausal. How many societies in the East and West see this milestone as a kickoff that moves you to a place of honor.

1:12:02So my favorite thing was this koneki. And if I'm not pronouncing that right, someone will correct me and that's cool. But the Japanese word for menopause, what does it mean? Renewed energy. Oh, come on. This is a season of renewal and energy. And I thought it was interesting you noted that only about 25 % of Japanese women report experiencing hot flashes. Now, of course, we don't know if that's about the reporting or whatever. Just interesting to note. I think it's interesting to note that in Japan, the most common complaint in menopause is frozen shoulder. Interesting. Yeah. It's more like aches and pains, joint stiffness.

1:12:40Yeah. But there are other societies where women also don't really report hot flashes, but they have like in some parts of India, the major concern is vision that they can't see as well, although that could be aging. But it seems to really be part of their menopausal experience. Then there are some societies and groups in South America where women have no symptoms, even though they tend to go to menopause, to menopause earlier. Fascinating. Yeah. And their hormonal levels are all the same. So it's not like for us, there's a drop in estrogen that is more severe than in other countries. It's all the same level of hormonal concentration in a way.

1:13:26And of course, you know, lifestyle plays a role. Culture plays a role. diet, genetics obviously play a role, but I think it's really important to know that the experience of menopause is not universal. Yes. And there are women who do not suffer. In Europe, all the studies showing that life contentment actually improves after menopause and remains higher and higher and higher over time. This is what I'm talking about. We're done in Europe. And I think, you know, it's not like they're so different from us. Yeah. many it's just not that different i think it's so cool like no i'm getting on board with that that one of my fascinations is in life and like my book everything is figureoutable is like this how this one simple belief can help you change your life in the world and i'm like look beliefs are just these thoughts that we think again and again and again and that we believe are the truth so you know regardless of whether or not we can quote unquote prove it i'm like i'm gonna pick some good shit to believe because it absolutely has positive impact.

1:14:27I've seen it in my life. So regardless, so I love that about the life satisfaction. And then I love the rural Mayan women who actually gain in social status after menopause and another group. And they don't have symptoms. They don't report symptoms. That's right. I thought that was, I was like, let's go for mindset. Let's go for this. Let's go for mindset. And I think it's a well-known phenomenon in science that there's a placebo effect, but there's also nocebo effect, right? So if you think that something will be good for you, you may experience a positive effect, even though you're just taking a sugar pill.

1:14:59But if you think that the same sugar pill will give you side effects, it will be harmful to you, you're more likely to experience a negative change. So if we think menopause is something that can harm us, is something that we have to fear, is something that needs to be fought, something that needs to be avoided, it's possible that the experience will be worse than it would have been otherwise. So I think mindset, just in general, I think the way that you experience and go through life, it's a powerful determinant of how you yourself react to think that the same thing can be very upsetting or not.

1:15:38And something I've learned from meditation, I love meditation and I strongly recommend it, is to practice non-judgment when you're having a hard time or mentally especially just look at the same situation without any judgment right do not evaluate it as good or bad just look at the thing for what it is and that sometimes just takes some of the anxiety away and that leads to relief in some ways and I'm not being I swear I'm not being patronizing or downplaying the severity of the symptoms No, of course not. Absolutely not. It's just one more tool that we may consider to feel better and support ourselves as we go through menopause.

1:16:21Because look, we're all going to go through it. A hundred percent. Yes. So it's important, I think, to spend those years, because we're looking at years. Years. Yes. As happy as we can. A hundred percent. Yes. No. Brilliant. end. So we've covered a lot of ground and I want to wrap up and I'm going to ask you if there's anything else that you want to leave us with. I obviously highly recommend all your books and people can just kind of pick or choose whichever one they want to start with. But I loved at the end you wrote, are you losing your mind during menopause? No, you're getting a brand new one.

1:16:58And I was like, hell yes, Lisa. So is there anything else that you want to wrap with today or share with our audience? What everybody wants to hear from me is about hormone therapy. I don't know if you do. I mean, listen, I'm always open when people ask the questions and if that's what the people want to know, I'm super, super interested. And I'm one of those open-minded people. I'm not like, no, never to this or yes, always to this. Talk to us. Me neither. I am not like necessarily pro HRT. I'm really pro solutions. Yes. Yeah. Yeah. And I'm also anti-suffering. We're going to have a lot of fun together.

1:17:37I really like this. Pro solutions, anti-suffering. Yeah. Because so many women suffer. And I'm saying this really with my patients in mind, our participants in mind, because so many women are terrified of brain fog. It's a common symptom very, very widely overlooked symptom of menopause impacting over 60 % of all women, at least in the United States. And sometimes the brain fog with the cognitive fatigue is so severe to really stop concerns around dementia. There are so many women who come to us because they're, I'm going to say terrified, perhaps concerned that they may be experiencing early dementia.

1:18:22And so I think I would like to clarify that brain fog is very common in menopause. And that there are things that one can do to find out if it's menopause or something else, right? There needs medical attention and intervention or prevention. This is something we do with the Alzheimer's Prevention Program at Wild Cornell. And we're open to see participants or patients. Oh, great. Yeah, yeah. Where can people find that? How can they? We're on the Upper East Side on 72nd and York. Great. We have brain imaging available for pretty much all our participants get brain scans. We do cognitive testing, which is so helpful with brain fog because, yes, you may be experiencing a change in performance, but it's still helpful to know if your performance is actually within normal limits relative to other women your age and education.

1:19:14And I also strongly recommend for women who are scared, maybe those with a family history of Alzheimer's, come to us if you can before you have an actual problem so that we can do a baseline. And it's every doctor's dream to have your baseline before there's an issue so we can compare you to you. And I think that's also really helpful to have for life. So that's one thing I wanted to say. The other thing is hormone therapy. I would say that it's been evaluated for brain fog and Alzheimer's prevention. It's not approved at this point, but many more scientists like myself are investigating this in detail at this point, whereas the research was simply just not there for a long time.

1:20:01And for now, hormone therapy is quite effective. It's actually, honestly, it's very effective for symptoms like hot flashes and night sweats and also prevention of osteoporosis and relief of genitourinary symptoms and low libido, recurrent UTIs, vaginal dryness, which are really a common complaint for so many women going through menopause, also perimenopausal women, right? Not just after the last menstrual period, the critical time, the difficult time is prior. So it's good to seek help. And also for two other brain indications, which is sleep. Sleep disturbances, especially when related to hot flashes and night sweats.

1:20:47And relief of mild depressive symptoms. Not clinical depression, mild depressive symptoms that are due to the perimenopause or menopause. I think it's important to know that these are FDA-approved indications for hormone therapy and that this therapy can help. That's awesome. Yeah, I would just like all women to make a decision based on information rather than fear. Yes. Or outdated findings and things that are just been told for like 20 years that are no longer valid. You know, they've been disproved. Now we know better. Professional societies have changed their recommendations. So what I always say when women say to me, you know, my OB-GYN won't give me hormones, even though I think I'm eligible.

1:21:36I say, you know what? Download the guidelines, the 2022 guidelines of the North American Menopause Society. They're free on the internet. Download it. It's a PDF. Just read it through. Find the part that's important to you. Print it out and go to your doctor and say, look, can we read this together? If I'm not eligible, I'm not eligible, but there's a chance I might be. Can we talk about this? and I think that that's quite helpful, could be. Oh, it's hugely helpful. Thank you. I'm so glad that you walked us through that because myself included, I know earlier parts of my life, I've gone to doctors and asked for a particular test and just been kind of shut down.

1:22:16And, you know, I'm from New Jersey, so I get really angry and really feisty and you know what I mean? It's like I'm flipping birds. I'm like, whatever, I'm out of here. But it's to feel empowered and to be able to take care of our own health and to be educated and to be able to walk in and have a collaborative, intelligent, fact-based conversation to quote unquote hashtag end our suffering when there are potential treatments available that can help us cognitively take care of our brains and our bodies and our mental and emotional and physical health. It's like we need to know this information.

1:22:49So thank you so much for taking the time to be on. I can't wait to – I'm going to take you around some twirls for classes. We're going to have so much fun. And for everybody, get your hands on Lisa's book. They are life-changing. And we'll see you soon. Thank you. Thank you. Thank you for having me. Hey, one more thing. If you're looking to start or grow your business, whether you're a total beginner or a seasoned pro, I've got some free business training workshops coming up that I promise will help you gain more customers and fans with less stress and overwhelm. Now, I only release these trainings once a year and now is the time.

1:23:26So don't miss out go to join b school comm that's join b school comm pop in your name and email and you'll get the free trainings the moment they're released