What's the deal with pregnancy brain? (feat. Allison Williams)

15:59Emily Oster:and like a million other things and then gets a zillion lab tests and tries to draw conclusions, which is actually really hard because he's doing 150 things at once to optimize his health.

16:08Perry Wilson:He monitors his erections every night. He like has a system to see how good his erections are every night.

16:14Emily Oster:Everyone doesn't do that? That's an uncommon. That's fine. That's fine. So yeah, he's really into the data. And when he came out with this autoimmune gastritis, it's also a little bit, like I should say this condition can just pop up like any autoimmune condition, you don't always know what the precipitant is. But in someone who's taking a million different supplements and probiotics and methylene blue and rapamycin and all these things, it's like, do you think maybe any of these things could have had this particular adverse effect? And we'll never know because he's doing 150 things at once.

16:46Perry Wilson:I will tell you the thing about this story I found most interesting and would love to understand better, which is I think part of how he found this was related to his decision to have a colonoscopy, he's actually 48. And this was his first colonoscopy. So this is a person who's doing literally everything, taking every random supplement, but he actually was three years late on one of the very basic things that we recommend people do to prevent cancer, which is a colonoscopy. So there's something so odd in my head about that. Like in the order of things I would say health-wise, I would put colonoscopy so far above methylene blue.

17:30Perry Wilson:You couldn't even see methylene blue from the colonoscopy in my list. Yeah.

17:35Emily Oster:Do the evidence-based things first and then play around.

17:38Perry Wilson:And then later play around with your - Whatever the stuff is. We wish him well, I guess.

17:43Emily Oster:We do wish him well.

17:44Perry Wilson:What is he doing about this?

17:45Emily Oster:Okay. So his team reportedly is talking about doing CAR-T therapy for him. This is crazy. So there's no actual treatment for autoimmune gastritis. Like you do iron supplementation, you monitor. They have an increased risk of cancers. And so you just do gastric cancer screening with endoscopy and stuff. It's just sort of supportive care. CAR T-cell therapy is like primarily a therapy for cancer where you take people's T-cells out of their body and you rev them up so they're hyperactive and you infuse them back in and you have this massive immune reaction that's supposed to kill tumor cells. In the hospital, the reaction that patients get when you re-infuse CAR T cells into them, that inflammatory immune reaction is so robust.

18:30Emily Oster:We call it a CAR-tastrophe. They often get into the intensive care unit. It looks like septic shock, like their pressure is bottoming out and their fever is spiking. But there's no infectious organism. It's just they have all these revved up T cells in them. This is a classic example of VIP syndrome, like very important person syndrome. where doctors will do weird stuff for people that you wouldn't do for an ordinary person, and actually it probably harms the VIP. This definitely happens.

19:05Perry Wilson:All right. With that, let's turn back to Pregnancy Brain.

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21:27Emily Oster:All right, we're back with what's the deal with pregnancy brain. And we're so excited to welcome Allison Williams back to discuss with us. Hi, I'm happy to be back. I'm sure all of that health news was fascinating.

21:44Perry Wilson:Okay, so we are going to talk today about pregnancy brain. We're going to talk about our personal experience with this, but also scientifically about what happens to the brain during pregnancy. And I think the way I would like to structure answering your questions, Allison, are to start by talking about literally what do we know happens to the brain, and then talk about how that connects to some of these things like ADHD or postpartum depression and how we can separate diagnosis from actual changes, from life circumstance changes, and hopefully get to the bottom of it. So I want to start with the fact that your brain shrinks during pregnancy.

22:28Perry Wilson:That is my first most interesting fact. And Perry, since you're the doctor here, but have never been pregnant, please tell us. Yeah, why did you do that to us? Our brain sizes. What's wrong with you? Why did you decide to do that to us?

22:41Emily Oster:I'm going to spin this in the most positive way I can. I mean, if you're listening at the top of the episode, pregnancy is a complete physiologic disaster. But let me put a number on it. The estrogen level of a premenopausal woman varies over the course of the month, but let's say it's 400 picograms per milliliter. So, okay, 400. In the third trimester of pregnancy, it's 30 ,000. It is absolutely insane. And for the men, because it's about time someone speaks for the men when it comes to pregnancy. Thank you for doing this every time too. I'm so brave. You got to center the right people. Men. Do you remember the testosterone replacement therapy episode where we pointed out that anabolic steroids, like the kind you're juicing with, are just synthetic forms of testosterone that are about 10 times more potent.

23:38Emily Oster:And that 10 times increase in testosterone level causes muscles to grow, but also liver disease and heart disease and roid rage and hair loss and acne and all these horrible things. That's 10 times the baseline level of your sort of standard hormone. Pregnancy is 100 times higher. It's insane. You asked about brain shrinkage. The positive spin on this is, yeah, so this is true. This is based on actually several studies that have used MRIs and other techniques, and it finds about a 4.5 % to 5 % decrease in gray matter, which is literally the neurons in your brain over the course of pregnancy. The thought is that pregnancy is actually a neuroplasticity event.

24:26Emily Oster:The brain is cutting a bunch of connections that had existed to essentially make room for a slew of new connections, including the ones that will lead to the social interaction with the child, which is going to become such an important thing to the brain once delivery happens. So it might not just be that you're sitting in a toxic stew of hormones for the last three months of pregnancy. It might actually be evolutionary indicated so that your brain is ready to bond better with your child. What do you think, Em?

25:00Perry Wilson:I feel like this is like it's cutting all the parts of the brain that knew how to go out to the club and then replacing the parts that are about staying up really late. I took a medical explanation for losing those parts of the brain much earlier. For me, it cut the parts of the brain that were like, you don't need to cry right now. This is – you're good. But is this – a question that I have wondered about and I think is sort of in here is like we are not using all of our brain all the time. So we are not using all of the – you know, this like fact that you're told as a kid is like you only ever use 10 % of your brain and most of it just sits around or whatever.

25:43not really sure if that's 100 % true.

25:46Perry Wilson:I don't think it's true.

25:47Emily Oster:But you're right that we're not using all of our brain at every second. Yeah.

25:51Perry Wilson:But when we shrink our brain by 5%, is that a meaningful number? This gets to some of the broader questions of like, is it just like it's shrinking and kind of in ways that are not that important? Or is it shrinking in ways that are meaningful? Allison, I'm curious whether you felt during pregnancy. I know we're talking about after, but did you feel during pregnancy that your brain was shrinking? I started to – I didn't feel it for the first two trimesters, but by the end, I was like, I'm not in my body. I'm not in my brain. Whose amygdala is this? Like everything felt foreign. And also, I'm not a hyper-emotional person.

26:30And Emily, I know you're deeply emotional, so this might be hard to relate to. That was a joke. Because I'm sort of like wishing we had a deeply emotional person here to represent what that's like because I can't imagine what that would be like. But I just have this one snapshot of me about two weeks shy of delivering when I made myself pasta. And when I took it off the stove, I just dumped it into the sink without a colander. I don't cook a lot, obviously. And I burst into tears. I was like, this is an unfixable problem. Like that time is gone. That pasta is gone. I just was like weeping in the kitchen sort of like paralyzed with the inability to decide what to do next, like lacking all the skills to handle this situation.

27:18I felt like a little kid again. And that is a moment where I felt just like, I want all of my old machinery back. And I never got it back. Like I got new stuff. I feel like I, when I lost the 5%, it didn't, that same 5 % didn't just come back. it was, you know, it was different. Yeah.

27:41Emily Oster:Something fundamentally changed.

27:43Perry Wilson:Yeah.

27:44Emily Oster:Yeah. So I think this connects to the second piece here, which is what happens to measured

27:52Perry Wilson:cognitive function in the data, because it's one thing to sort of say, okay, the brain shrinks, and then it comes back to normal, and it maybe comes back to normal in a different, with a sort of different set of connections. But there was also a fair amount of research about sort of during pregnancy, specific declines in cognitive function, in memory and executive function. A lot of this is about kind of processing speed and these sort of measures of like just how quick, how much stuff can you hold in your brain at the same time and how good is your verbal memory? That's like a common way to measure this.

28:26Perry Wilson:And I think this will, this illustrates to me a general problem with all of these discussions, which is that there's something we can measure, which is how is your brain actually changing? And then if we measure some change, we then want to say like, why? We want a just so story about like, either it's because of the hormones all in the brain, or it could be because you're tired, or because you're paying attention to it, or it could be because like, you're thinking about a lot of different things, and there's a lot of new stimuli. And when you poured the pasta in the sink, it wasn't because you got stupider.

29:00Perry Wilson:It was because you were also thinking about how you had to buy a crib. And you were on three hours of sleep. And you hadn't gotten enough sleep. So I think in all of this stuff, it's going to be incredibly difficult to separate the life circumstance change from some kind of true biological parameter.

29:17Emily Oster:And we've also talked before about how hard it is to measure something that we all understand conceptually, like brain fog, whatever you want to call it, right? Like pregnancy brain, brain fog, baby brain, these subjective states of like, I don't feel as smart as I normally do. There's no test for that, right? There's not an IQ test that pulls that out. You have to do all this really specific neurocognitive testing to see if there are problems with like, oh, your verbal memory, which is, can you think of the word for colander or your semantic memory, which is like, do you know who fought in the war of 1812?

29:54Emily Oster:Like these are actually different things and they get teased out differently. Can I tell my wife's pregnancy brain story? Because I think it illustrates this really nicely. So my wife is a breast cancer surgeon and she was in the operating room, very pregnant with our second. And you've probably seen this on TV, but it's literally true. If you're the surgeon, you don't want to look away from the field. like you're looking down into the operating field. And so you just stick your hand out without looking and you say the name of the instrument you want, right? Like you want an AdSense retractor or you want, you know, a DeBakey or whatever it is.

30:30Emily Oster:They have these names.

30:31Perry Wilson:I was going to say the same thing. Yeah, yeah, yeah. Those are the ones I'm actually holding those right now.

30:36Emily Oster:How many, my, I have a desk that's full of DeBakeys right here. And the scrub tech's job is they're standing with all the clean instruments is to hand you the thing that you ask for or to anticipate the thing that you asked for. And she was having this situation where she's like in there, she's operating and she holds her hand out and she's like the thing, the one with the teeth, the thing. And the scrub tech, because scrub techs are amazing, handed her the proper instrument. And they all kind of laughed about it because they'd been pregnant too. And it's one of those situations, but it illustrated to me.

31:13Emily Oster:So like operationally, the muscle memory is there and all the testing in pregnant women and postpartum women suggest that like physical memory, muscle memory doesn't really change. If you can swing a golf club, you can still swing a golf club. But so she could do the operation just fine. She just couldn't name the instrument that she needed at that time. And verbal memory is certainly affected during pregnancy and after pregnancy. That is fascinating. Yeah. You're literally a surgeon doing a surgery and yet you're still not spared. You still have a human brain. Yeah. Yeah. Okay. So there are a million physiologic changes that happen when you're pregnant, and it might be worth just talking about how those things affect your brain.

31:53Emily Oster:So for example, you might know that there's a 40 % to 50 % increase in blood volume during pregnancy. So, okay, that's crazy in and of itself. But what that means, that volume expansion outpaces the production of red blood cells, which gives some anemia. Pregnant women tend to have more anemia, less red blood cell counts, which means not as much oxygen carrying capacity, which can certainly affect if your brain is firing on all cylinders. Let's talk about the cardiovascular changes. So your heart rate is up by about 30 to 50 % during pregnancy. This is a big energy expenditure. This takes calories and that can contribute to fatigue, reduces cognitive stamina.

32:43Emily Oster:The respiratory side, tidal volume, how much air you breathe in when you take a breath increases until you're restricted by belly volume. But for the first couple trimesters, about a 30 % to 50 % increase in tidal volume leads to slight hyperventilation, which means your blood carries less carbon dioxide, which can contribute to feeling lightheaded or dizzy. And one last thing I've mentioned several times, just the enormous, enormous surge in hormones. We talked a lot about estrogen, but progesterone also goes up by about 500-fold compared to baseline. And progesterone has some mild sedative effects.

33:28So it's almost as if the

33:30Emily Oster:whole physiologic state of pregnancy is conspiring to put you in a place where your brain is not working well, where you're tired. And your body is just... People sometimes say that the purpose of your body is to get your brain from one place to another, right? Your body is to support your brain. You are your brain. Well, true, except during pregnancy when the body just decides, screw you brain, I'm focusing on the baby. Okay.

34:01Perry Wilson:Let's talk about the two good things about brains before we talk about postpartum changes. So one is that while your brain is remapping, you get better at recognizing, recognition tasks. So if we sort of think about the pieces that you don't, that you need to be, don't need to be as good at, like going to the club or whatever, then there's a set of things you need to be better at in an evolutionary standpoint, which is like recognizing threats. And so we do see some evidence that people get better at sort of differentiating between like known and unknown faces in pregnancy, which may have some beneficial ability to like recognize who is, you know, an out group and in a group member and who do you want to trust more with your baby?

34:45Emily Oster:That's super fascinating. I always feel like so much of the things we think of as our own thoughts and emotions are just like the monkey inside of us doing monkey things.

34:56Perry Wilson:Yeah. I think that's true. But then I also think it's so easy to write just so stories about evolution. We're just like, well, I guess evolution is why that happened. It often is the culprit. Generally true. But I also feel like when you were saying this is like a medical disaster pregnancy. I've been saying this for a long time. Like I have so many notes for like whoever's in charge for Charles Darwin, I guess, because I'm like, why do men have nipples? Why do I have pinky toes? Why, like why, you know, all of these things, appendices, like we don't need. And why are children brought into the earth the way they are?

35:38Why is there no new way? A Velcro opening perhaps, or a zipper, or a magic wand? As I approached childbirth, I was like, is there honestly no VIP secret third way to do this? Who do I have to talk to to not go through either of these situations.

35:58Emily Oster:This is so geeky of me, but I remember watching Star Trek when I was younger and they would have every once in a while, like someone would be pregnant. And I was like, why don't they just transport the baby out? Like we're beaming people down to the planet. Why? Like what? How is this not, how's this not the main way? That's what I want my tax dollars going towards. It's the hovercraft from Back to the Future that we were promised and has not appeared. You were told.

36:23Perry Wilson:Where is that? We were told. And I want to be able to like disapparate my child to use Harry Potter verbiage from my belly into the world. But I also think about the fact that evolutionarily, also because I have a four and a half year old, we talk about dinosaurs all the time. We've been around for a tiny blip of history, but like a triceratops by the time they were extinct was like peak triceratops, had had millions of years to become the best version you're saying we're not done yet we've got work to do and we're gonna like still the triceratops was not disapparating the baby out but well right wasn't it egg laying according to jurassic park i know nothing about triceratops but i assume science is jurassic park yes triceratops which also seems like a better way we're egg laying yeah that's right i mean if it's small my worst pregnancy dream was one where the the baby did just come out um and then but it was like too early and then I had to like get it back in.

37:23Perry Wilson:But it came out just like a Velcro, not like painful, just like Velcroed itself out. And then I had to be like, no, no, no, it's not time yet. Like put it back in.

37:33Emily Oster:Do you know that humans have babies way earlier than they should according to our body size and level of fetal development? Like we should be pregnant for several more months and we're not because our brains are so big that they have to get out. What is it called? The cranial – there's a name for it, a conundrum because, yes, evolutionarily, like our hip size versus our brain size have forced us into a – what is it called? Do you remember? I don't want to be born into Homo sapiens now. I want to do it in 100 million years when we are like peak Homo sapiens.

38:13Perry Wilson:Okay. Anyway. Sorry. I got us right in our field. Let us come back to our pregnancy brain because I want to come back to the post-pregnancy period because many of these physiological issues that happen during pregnancy actually do sort of resolve post-pregnancy. So your brain grows back differently, but it gets its 5 % back. And there's actually some super interesting research about the age of your brain as measured by brain age researchers. postpartum. So in the period from like two weeks postpartum to like three months postpartum, your brain actually ages backwards quite quickly. And so whatever sort of terrible aging was occurring during pregnancy, you like get some of it back postpartum.

39:02Perry Wilson:And so there's this sort of feeling of like things are kind of returning brain-wise in some way. And yet this is also a period in which we see a lot of, we see postpartum depression, we see postpartum anxiety, we see potentially changes in other kinds of diagnoses. And I think that's this sort of secondary period. And it's really hard to separate how much of those changes are about actual brain changes and how much of those changes are about almost a diagnosis window where you're seeing people more.

39:38Emily Oster:And there's no neuroanatomical correlate of depression. Even putting aside postpartum depression. You can't take people with major depressive disorder and put them in an MRI scanner and see significant differences in brain structure. I mean, there are some experiments that are trying to tease this out, but it really is about the connectivity and the interactions between brain regions that drive these things, which means like a simple test, like how big is your brain, how small, you know, whatever is, is not going to be enough.

40:07Perry Wilson:Yeah. All right. So let's talk about postpartum depression and postpartum anxiety first, because these are probably the main primary diagnoses that people get. So Allison, you said you had postpartum depression. Can you talk about that? Are you open to talking about that? Yeah. I'm an anxiety girly, so that's the side of the street I was familiar with. So I don't think been in a depression in my life. So I didn't actually identify it until I was out of it, which is apparently a very common thing because you're just getting through it. And also those early months and weeks of motherhood are such a subjective experience that it's one of the few moments in life where you can exchange techniques, data, concrete information, but trading experience stories is not an impulse I had until I was through it.

41:02Whereas now I get a ton of, I don't know, satisfaction from talking about something I'm dealing with in this exact moment as a parent with my friends who are also going through it. There's a reporting live factor that I was not able to channel in the moment. And I think part of it is a, it felt like a valve was switched in my brain that was like, no need to overthink any of this, just get through it. And what was happening was just overwhelming emotionally. It was a lot of instances of just real feeling very disconnected from my son initially, feeling very alone, very isolated. And despite having family nearby, a super supportive, loving husband, therapist, I had kind of all the resources you can have.

41:53We did not have a nanny or a night nurse or anything. So I also was dealing with sleep deprivation. But it just felt like everything was devastating. And I would very often sit on the couch where I was constantly breastfeeding our son. And I have this very clear example of what it felt like to be in my body. My husband would come flying through the hallway doing his 12th load of laundry. And he'd be like, do you need me to refill your water? And like time would stop. And then like 10 minutes later, I would have done the complicated trigonometry to answer the question. Because what my brain was doing was, okay, yes, my water bottle is empty, but I want to be self-sufficient.

42:42I want to be the kind of person that can fill my own water bottle, but I'm breastfeeding. So I can't, and it'll be a little while and I need water to breastfeed. He's standing right there, oh my God, he's so impatient. I'm still thinking this through. Shouldn't I be? And it was just happening. And I'm a ruminator in general, but it was going on twice as long, twice the self-judgment. It was just like everything was magnified. And slowly after I came out of it, I realized just how dark some of those moments were and how difficult it is to express them while they're happening. And I think that's part of what makes it so gnarly is that I don't know a ton of women who were able to speak from their postpartum depression while it was happening rather than about it in retrospect.

43:36But it also sucks because you're like, when people ask you how it's going or how's the baby, there's one right vibe to channel after that question. It's going great. Yeah, exactly. I love it so much. It's the best. Because that's also true. You're completely obsessed with this little person who you also are so frustrated with sometimes and so exhausted by. So both things are true and intuitively you just know that just give the surface level answer and keep it moving. I wish I had been treated for depression while it was happening. I probably should have begun treatment before I delivered because I think it kind of started a little bit before then.

44:20And yeah, I mean, that's sort of what it looked like. It's very hard to describe as you just experienced because I talked for like five minutes and said nothing because it's hard to channel that place again. It's hard to go back there, but I can just see moments of just being completely stuck and feeling like I was underneath a wave that I couldn't get up and out of.

44:42Perry Wilson:So about half of, because we're saying about half of postpartum depression starts during pregnancy. And so that, and that is often not screened for. And then when you have the baby, this, the hormonal changes, like the, this estrogen that was like bathing yourself for all of this last trimester, like totally could just tanks off a cliff. And those changes are very, very difficult. And so almost everybody, I think this is part of the sort of diagnosis issue here. Almost everybody has a period of kind of quite significant mood changes like immediately afterwards. Yes. My friends were like, beware day three.

45:25You're going to just like burst into tears on day three. And then I was like, I feel fine. And then 20 minutes later, I was just bawling and I sent them a picture of myself like just weeping for no reason. I was like, it's day three.

45:36Perry Wilson:I have many memories of that period. And then for many people that sort of for some people that normalizes and sort of what we would really think about as diagnosable postpartum depression is sort of can then creep up as late as, you know, almost a year after. I mean, it can creep up anytime, but sort of can be considered postpartum depression even up till a relatively long period of time afterwards. And I will say some of it is, as Perry said, like the, there is no way to put you in an fMRI machine or do some kind of like blood test and be like, okay, this is what you have. And so we are left with trying to screen people and give them appropriate treatments.

46:16Perry Wilson:But it really, in some ways, doesn't matter whether you diagnose or not. Like if you have this constellation of symptoms, then you should be getting some treatment. Yeah.

46:24Emily Oster:And I do think, you know, what Allison brought up that's really important for people to hear is that, of course, you have an alternative explanation than postpartum depression. There's a million other ways that you can justify it to yourself that like, oh, I'm probably okay. and I'll just get through this. But don't do that. These symptoms are significantly different than baby brain and brain fog. The things that make postpartum depression, postpartum depression, if you look at the diagnostic criteria, it's intense dysphoria, right? This is real deep sadness, not confusion and stuff like that, like you might see.

47:02Emily Oster:It's anhedonia, which is that inability to feel pleasure in things that you normally take pleasure in, right? A numbness can be depression. Many, but not all women with postpartum depression actually have insomnia, which is sort of different than what you see with more typical exhaustion. I'm up all night. If you can't sleep when the baby is sleeping, those are signs of postpartum depression. And of course, many women make it through this and that's great, but not all of them do. This is a potentially life-threatening disease. So it's not something to sleep on. And we're talking a lot about the funny baby brain stories and whatever, like my wife asking for the wrong instrument in the operating room and it's like, ha ha.

47:46Emily Oster:But postpartum depression is what, 10, 15 % of women, at least as far as we know, probably even higher because it goes undiagnosed and is even potentially life-threatening, right? So be careful.

47:58Perry Wilson:Yeah. So we talked about postpartum depression and postpartum anxiety is a different experience, but diagnosed in almost exactly the same way. it's actually the same screening tool for anxiety and depression. There's like sort of slightly different ways of scoring it. And I think this gets again at the question of like, it's a little hard to separate experience from like that there's some truth. Generally, postpartum anxiety is more anxiety and less depression, but there's a sort of fine line there. And so when we think about diagnosing, it's really about just trying to figure out things are going and then what is the right next treatment as opposed to like we need to label it a particular way.

48:40And they're treated very often with the same medication too. Exactly. And they, yeah.

48:45Perry Wilson:Okay. I want to talk about then some of these later things like the ADHD diagnoses, because there is, there's like the immediate postpartum period when I think people expect, maybe there's some, you have some postpartum depression or postpartum anxiety. You also expect to feel like slower and so on. But then there's a much longer postpartum period in which I think many people with small children kind of feel like I'm still not quite like, like I'm not back. You know, I was hoping to be back and I'm not, I'm not back. And this is where, so I pulled up in thinking about your question, thinking about this episode, what I think is kind of our best data about ADHD in particular.

49:32Perry Wilson:So there is a, it's actually a very recent paper. It's like two months old. It's the most recent paper we have discussed on this podcast.

49:40Emily Oster:Is this the one from the Danish study?

49:43Perry Wilson:So it's a Danish study, which looks at ADHD diagnoses around pregnancy. It's very big because in these European studies, you have like everything about everybody. So this study has -

49:56Emily Oster:That's amazing. That's amazing. They have over there. It's amazing.

49:58Perry Wilson:So they have like 360 ,000 mothers, 520, sorry. Yeah, 363 ,000. Yes. Yep. Oh, my God. I'm like, my children are 15 years old and 11, so I'm still recovering. Oh, my God. They have a very large sample size. Let's just say that. And they're looking at these ADHD rates. And it's quite interesting because they actually decrease during pregnancy and remain low for a couple of years. And then they increase significantly, about 25 % higher diagnoses, two to five years postpartum. So we sort of are seeing this, like, uptick in this particular diagnosis in this kind of, like, when your kid's a toddler.

50:43Perry Wilson:And I think that's... I'm right there. I'm in this population. You're right there. And there's actually, like, many different ways to interpret that. So one, I don't think that in this paper we can really tell what's going on. So I think one possibility is that this is like actually brain changes that are driving differences in sort of the way that your brain works postpartum. I think a second option is that the symptoms here are close enough to the symptoms you might have of sort of being overwhelmed and being tired and having a lot of things going on that it would kind of, you'd get a diagnosis, even though it's maybe almost situational isn't quite the right word, but it's sort of being driven by life experience.

51:24Perry Wilson:And another possibility is people had ADHD this entire time. And it is only because it's a little exacerbated by having kids. And also this is a period of time in which maybe people are paying more attention, perhaps maybe because they're noticing some of the symptoms in their own kids that then they're saying, oh, that was me. And this is a thing I hear a lot from parents, which is very interesting. is sort of like my kid was diagnosed with ADHD and I realized, oh, like I have that too. Like all of these things that I thought were just like the way that I am are actually like, I maybe could have been getting some treatment for this.

51:58Perry Wilson:And so I think there's like a bunch of stuff there. I'm not sure we really have any ability to separate those things out. I'm not sure it matters, but. Yeah. Well, I guess what's, what intrigues me about like, why do I want to know the answer to that is sort of, I always find diagnoses of any kind empowering. I think part of that is having anxiety means that before the diagnosis, a huge amount of my operating system is expending energy coming up with theories. Even in the back of my mind, it's just ruminating on what this is, why it is blank. And so someone saying you are experiencing X, Y, or Z, I find deeply relaxing, even if what they're telling me I'm experiencing is objectively stressful because then I'm no longer wondering.

52:44I just know. And now I can do something about it. And so for me to think of myself as having a new brain rather than waiting to come back has been a very useful distinction for me because I found it depressing to think of my brain, which I really liked, which was very high functioning. I was a big fan. I can say that now because I feel like I don't have it anymore and I'm not like bragging.

53:09Emily Oster:It feels like someone else is right now. It's not bragging anymore. No, it's not. It's like I'm talking about like, I don't know what my calves looked like when I was 12. Like, you know, it's something past part of me that doesn't exist anymore. I loved it. And waiting for it to come back was depressing. It was upsetting. It was frustrating. And it wasn't going to happen. And so for me, switching to thinking this experience that I had fundamentally altered me in literally every way, but it altered my like synapses, my, you know, everything about my cognition such that I now have a new operating system.

53:44I have to learn how it works and learn how to best support it and find out how to use it. Like I learned how to use my old brain and use this one for whatever I need it for now. Um, and I found that to be really useful and that could just be me or it could be other people as well.

54:03Perry Wilson:No, I think that's actually a very interesting and valuable frame for people in part because so many of these things are really like diagnoses of experience and how are things working for you. And so to say like, well, you didn't have ADHD before, so let's not look for that as a solution, it may be unhelpful as opposed to being like, right now we should try to figure out like what's going on and how can we best support your functioning as a person, whether that's something that was true before or not. And it may be for some people to say the like, well, no, you know, the operating system is different and we need like a different set of, you know, software tools.

54:47I also think we live in a time where we're really lucky. We don't technically have to white knuckle a lot of the things that we tolerate. So the idea that I can talk to my psychiatrist and say, okay, we're going to address my anxiety because that's too much. I'm fed up. I can't live like this. It's exhausting. And then once that's been addressed, there are all these other behaviors and these other executive functioning issues that are revealed not to be part of the anxiety, but something else. The fact that I don't have to live with those and tolerate those and spend the energy operating around those is such a privilege of, you know, I talk, I was talking a lot of shit about being a human in this stage of evolution, but we're very smart because of those big brains and we've developed medication that means I don't have to just figure out how to live with these things if I don't want to.

55:36There is help available to me, which is so incredible. And I wish I had availed myself of it sooner. And I can't like, I don't know, biohack my way through it or just, you know, I don't know. Or drink your tea. Have you tried any peptides? And get rid of it. Have you tried any peptides, Allison? I have a few. I injected them into my brain and it didn't work. Was I doing it wrong?

56:02Emily Oster:As you're talking about, you know, what changes are long-term. And yes, of course, it's really hard to measure. But I will just say, like, number one, our brains are changing all the time, right? Like, we can learn. We can go to therapy. You know, it's always been sort of an amazing thing to me that talk therapy works. And it's just somehow like if you really make it abstract, like someone is speaking words into your ear and it's reprogramming slowly your brain until it's connected in a slightly different way that makes you feel better. I always think that's amazing. So these changes are always happening.

56:40Emily Oster:I can't imagine a more significant physiologic event than pregnancy. I think I've said this multiple times right now. You know, I don't think anyone would take a person who like, like went through chemotherapy and came out the other side cancer free and would be like, like, okay. And so you're back to normal now, right? Like everything, you're the same person you were before you did chemo, right? Like that would be almost considered inappropriate. Like, how are you not respecting the struggle I just went through? And pregnancy is much like this. Like, I definitely think your brain is different.

57:13Emily Oster:It's different forever. That's not all bad. In fact, Emily pointed out some of the brain aging data that looks at when you're 60, do you have a brain of a 61-year-old or a 59-year-old or a 55-year-old? And one of the predictors of how young your brain is in older age is how many children you've had with more children. I was going to ask, is it cumulative, these effects, over several children? Yeah. So the study that I was looking at, there's two here. One is from the UK Biobank, which is a big study, hundreds of thousands of people over time, which does show that multi-paras women, women who had more than one child, had younger brains than women who had one child, which had a younger brain than women who never had children.

58:04Emily Oster:There's also a smaller study out of Rotterdam that basically showed a dose response where the more kids you had, the more gray matter volume you had in older age. So yeah, so it's the same gray matter that like shrinks during pregnancy. You end up with more in older age. I did dig a little bit deeply and found there was one study that like, what's the term, Emily, for women who've had like a lot, a lot of babies, like super multi-paris, what's it called? Yeah. Yes, it's super multi-paris.

58:32Perry Wilson:Is that what it is? Something like that, yes.

58:34Emily Oster:I'm honestly, I forget. In any case, there does seem to, maybe it falls off like after, you know, seven, eight kids. But the question is, I don't think it's the pregnancy that makes your brain better. I think it's the children to some extent. Like children represent this whole new source of novelty in your life. Like the thing that I -

58:56Perry Wilson:Counter point, Perry.

58:58Emily Oster:I'm about to say something very sweet about my children who may listen to this someday. one of the wonderful things about having children is that it's the only way you get to experience something you love for the first time again. So like I got to watch the fellowship of the ring with my oldest daughter and I got to go through the whole thing again, even though I'd seen it, you know, 30, 30 times, um, by the time. And I think that's good for your brain. I think it, I think it keeps you, I think they keep you young. All right, Emily, I'm wrong. Why?

59:32Perry Wilson:uh you know just in in rats uh having babies uh improves their maze performance and long-term spatial learning and memory and you should see me going through a maze because they're parenting at a high level i mean there's no fellowship they didn't show them the fellowship of the ring or whatever they just probably have their babies and just like take them away because it's fucking rats this is pure anecdata but i actually do resonate with that idea of spatial um like i I think I recognize faces and places better now than I did. Oh, that's cool. My memory of like, have I been to this restaurant before?

1:00:08Have I met this person? Have I stayed at this hotel? It was really bad before and now it's decent. So that's interesting.

1:00:15Emily Oster:If it helps recognizing faces, I would love to be pregnant. That is my main spot.

1:00:20Perry Wilson:I cannot recognize faces and I have been pregnant twice and it did not improve. You have like the true face blindness? Not the true face blindness, but I just can't. I like name face. I barely know who you are. Who am I? I don't know. If you can help me know, that'd be great. It's good that your name is on the, you know, podcast thing. Yeah, exactly. Okay. I want to, before we, before we end and get to question, I want to talk about, I want to sort of step back one thing because I think we talked a lot about like brain changes that are real and you know, the fact that maybe some of this is inevitable and so on, but there actually are some like biological changes during pregnancy that if you are feeling very tired or just very off, it actually is a worthwhile to get some blood work because for example, a large share of women who have been pregnant, women of childbearing age are anemic and which means your iron is too low and anemia can cause a lot of the kinds of symptoms we're talking about in particular, like brain fog and fatigue and just like a feeling of being quite exhausted.

1:01:28Perry Wilson:And so I would sort of balance a little bit as like your brain is new and you got to learn to live with it. And also like go get your thyroid and your anemia checked because if it turns out that the answer to some of this is like you need to be taking an iron pill, like that would be good to know and too bad to miss.

1:01:48Emily Oster:Right. Yeah. Go for the easy fix. Yeah. Totally. You know, other sort treatments for, we're going to put postpartum depression aside, obviously, postpartum depression, you want to get your treatments from a doctor and things like that. But for just the regular baby brain fog and stuff like that, obviously, sleep is going to come up number one, two, and three on the list.

1:02:11Perry Wilson:Most frustrating piece of advice. Oh, just sleep more. You should just sleep more.

1:02:14Emily Oster:I don't know why you guys - No, I didn't think of that. Why didn't I think of that? Oh. So actually, this is a good question. You both had a partner after the baby was born. How can partners support the new mom during this period so that she can get the much needed rest? Is it bringing cups of water without being asked? Standing in that doorway as long as I need you to before I can summon the words that I need. I think men, just bring a glass of water. You don't need permission. Yeah, don't even ask. Don't ask. just bring the water. I feel like honestly, it's having respect for what's happening.

1:02:54It feels like there's just a knowledge gap. I don't think it's just among men. I think most women who go through this process don't understand what's happening to their bodies either. But I think that amount of hormonal shift is worthy of respect and awareness and acknowledgement and understanding that for, I don't know what the biggest hormonal shift in a man is. I'm guessing it's around arousal probably somehow.

1:03:25Emily Oster:And we just don't have anything comparable in any way. But even doing steroids, anabolic steroids for weightlifting is not the same. Yeah, maybe. I mean, but even that, I just feel like understanding that both things can be true at the same time. The person you're talking to is your spouse, and you should take what they are saying and experiencing seriously. And if they wrote a document and had it notarized about their opinions and their feelings in a given moment, it may not feel correct anymore a week later. And that is okay. And it doesn't mean you should ignore what they say. You're in a liminal space where it is and it isn't your partner and what they say is and isn't true.

1:04:09And just deal with it because you're going to deal with it for such a brief period compared to the amount of time they spent in that liminal space themselves. That's kind of what I'd say. Emily, what do you think?

1:04:18Perry Wilson:That's such amazing advice. The main thing my husband did is when he's made a spreadsheet that we could keep track of how many minutes my daughter was eating at different times and how many frequency of pooping, which I actually wouldn't recommend. I remember you saying that on the podcast. There's an app for that now called Baby Tracker, which I will shock you by telling you I also use just to feel some control over completely uncontrollable.

1:04:42Emily Oster:I feel like spreadsheets are Emily's love language.

1:04:45Perry Wilson:Totally. No, but I just don't think that's for everybody. I'm not sure that's for everybody. But I will say my husband was constantly making sure that I was eating. His love language was like there is always water and fruit next to the breastfeeding chair. So nice. It's great. It's so nice. We haven't really discussed endurance sports yet, And so I just wanted to pop in here and say that your elevated blood volume retains for about a year postpartum. And so there is some people think that that's why some people perform quite well at their sporting events in the first year postpartum because of the potentially higher blood volume.

1:05:29And I represent the group that thinks LOL sporting events in the first year postpartum.

1:05:34Perry Wilson:Yeah, it's not like a yes. There are some other things that make you slower. Moving not in a walking pace from one room to another. Yeah. All right. Perry, smash or pass on the pregnancy brain? I don't even know what this means.

1:05:49Emily Oster:I think it's important for me to weigh in here though. Yeah, totally. As always. I'm a pass. You know, let's get over it. I agree with Allison. I don't know. Techno bros, fix pregnancy. Emily, how about you? Smash or pass?

1:06:04Perry Wilson:I'm a smash because I, my kids, tiny pieces of my kids are around in my brain and that's, and that's so great. Allison. I guess I'm a, I'm a reluctant smash for the same reason. Cause now I'd be like passing on my child existing and that feels insane because he's made the world so much better. But I have a lot of notes for the way it all goes down and I don't know who to talk to about this, but we have a lot of room for improvement, I would say. That is it for Pregnancy Brain. Allison's mailbag question of the week after the break.

1:06:46Emily Oster:Zach, nice vacation spot, but without T-Mobile 5G home internet, I feel so cut off. It's scary. Relax. Just breathe in the woodsy woodsy-ness. Don't open it. It's a monster. I just know it. Buddy, it's just our DoorDash driver delivering our T-Mobile 5G home internet. Here you go, guys. Thanks. Look, Donald, now you can get the fastest 5G home internet with same-day delivery powered by DoorDash. And it's easy to set up. See? Nothing to be afraid of. We're saved.

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1:08:59Emily, I've come to realize that you are not just a casual runner. You are runner like Ken is beach. You are runner. And thus, I have a question for you. I have to start doing cardio because I'm doing a movie that's going to require me to be cardiovascularly alive in a way that I'm not on a day-to-day basis. I have to pretend to be a type of person I'm not, which is my whole job. And I don't have extra time, though, to do this cardio. So I am wondering what is the best bang for my buck if I don't have a lot of time, but I just – it's not necessarily about weight loss or anything. It's just about getting my ability to deliver lines while hyperventilating to be like, what's the, what did Taylor Swift do before the AeroStore so she could sing and run a hundred miles in a day?

1:09:51You know, what do I do?

1:09:52Perry Wilson:Okay. So first of all, what Taylor Swift did was she ran every day on the treadmill doing the entire set for three hours. So she would run like three hours a day on the treadmill doing the entire set. It sounds to me like you don't have time for that. You definitely don't. Although I could because I'm such a Swifty, I could do the whole set. But you don't want to run. Is that – I can't. My knees are just – it's like someone read the instructions wrong when they put my knees together. They don't work properly. So you're pretty – I think this is not a very hard question to answer because what you really want to be doing is spending some time in like a high heart rate zone, like zone four, five.

1:10:36Perry Wilson:and out of what? What is that? What did you just say? There's five zones. It doesn't matter. You want to be raising your heart rate. That's maxed out like five out of five. I don't know much, but that's a hundred percent. It's a hundred. Yeah. Okay. Yeah. Okay. You want to be working hard. Like you want to think about getting some time in a cardio activity where you couldn't talk or like if somebody came to sort of your husband's game and started chatting, you would just like not be able to chat back to him but it can be like intervals of that you don't have to do that for like a long period of time your best bet is going to be a bike you should get some kind of very fun exercise bike situation you can get these bikes people the the endurance guys really like these Zwift bikes where you can like race other crazy people in like inside a Zwift race and it like adjust the things you can be like in the Tour de France with the other guys.

1:11:32Perry Wilson:And if you win, then you like win extra accessories for your bike, your fake Zwift bike in the game. It's a video game. It's a video game biking app. But at any rate, you want some kind of interval-based biking on like a stationary bike where you are working quite hard to the point where you couldn't talk. Can I ask a very ignorant question? It feels like there's a lot of types of indoor bikes. There's the SoulCycle one that I did when everyone was doing SoulCycle and I obediently also did it. So there's that one where you're like leaning forward. There's one that's also in gyms where it seems to be more of a sort of seated upright situation.

1:12:17And then there's the third one, which is there's a big fan in the front and your arms are part of it. Which is the bike you picture when you say biking?

1:12:27Perry Wilson:Just any of these is fine. Just a regular bike is fine. You just need to go set the resistance hard enough that your heart rate goes up. That's all.

1:12:35Emily Oster:Okay. Okay. What do you think about swimming, Em?

1:12:39Perry Wilson:I generally do not think swimming is going to raise her heart rate enough. And it takes a lot more time because you have to like go to the gym and you have to put your swimsuit on and you have to get in the water and the gym pool is not available. The bike is like, stationary bike is like the easiest. You tell me you have 30 minutes, you do like five minutes of warmup, three minute intervals with a one minute rest until you feel like you're going to die and then you get off the bike. That sounds, yeah. Love it. That sounds like. It sounds terrible and that's what you want. That's what you want.

1:13:10I know, I know. Again though, if any tech bro can come up with a version of this where I don't actually have to work very hard and can be physically comfortable while something is doing my cardio, So I'm interested.

1:13:23Perry Wilson:That's what the peptides are for. Thank you for being here, Allison. We really appreciate it. Thank you for allowing me to be here and acquiescing when I refused to take no for an answer. I'm so grateful.

1:13:36Emily Oster:You have carte blanche for any future topics. Do not say that. I've talked so much in this episode because I'm so excited. It's embarrassing. But okay, fine. I'll come back every week.

1:13:46Perry Wilson:Great. Stick with us next week. when we'll ask, what's the deal with alcohol?

1:13:57Perry Wilson:Wellness Actually is produced in association with iHeart Media. Our senior producer is Tamar Abishai. Our executive producer at iHeart is Jennifer Bassett. Our theme music is by Eric Deutsch. And our content is for educational purposes only.

1:14:12Emily Oster:If you like the show, help other people find us. Leave a rating and review on Apple Podcasts or your podcatcher of choice. And help us spread the word about the show. You can follow us on Instagram at wellnessactuallypod. And don't forget, we want to hear from you. Head over to wellnessactually.fm and leave us a question for our mailbag. Or suggest a topic for a future show.

1:14:34Perry Wilson:We'll let the influencers have the last word. You cannot trust your pregnant brain. Last week, I went to lunch. I got there early. I was so proud of myself because I usually run five to ten minutes late. but I got there 10 minutes early. I wait for 30 more minutes. Am I getting stood up for the very first time in my life? Couple hours later, I get a text from this person and they're like, oh my gosh, we're meeting next week.

1:14:58Emily Oster:But yeah, I was sad. I hurt my own feelings.

1:15:14If you're someone who's tracking your sleep, your steps, and your macros, then you already know that what you eat is kind of everything. You should also know that Sprouts Farmer's Market can help make eating for longevity easier. Sprouts has all the high-quality, nutrient-dense organic foods and cutting-edge supplements you need. So whether you're focused on protein, gut health, or optimizing how you feel day-to-day, it's all there. And here's what no other grocery store can offer. An in-store wellness expert to help you find exactly what you need. So whether you're after longevity or on any other health journey, it's easier at Sprouts Farmer's Market.

1:15:49Emily Oster:Say big on your landscaping project now at Menards. We make it easy for you to enhance your outdoor living space with the largest in-stock selection of concrete landscape block. Ready to take home today. Build a fire pit or retaining wall with our tumbled Belgian wall blocks. On sale now. Say big on your landscaping project at Menards. Plus check out our weekly flyer on Menards.com for all the great deals happening now. Save big money at Menards. Hey, Portlandia fans. Carrie Brownstein and Fred Armisen here. The dream of the 90s is alive in podcast form. We're launching Podlandia AO Rewatch, our brand new podcast where we revisit every episode of Portlandia together.

1:16:32Breaking down sketches, going deep on our iconic characters, and pulling back the curtain on how it all got made.

1:16:37Emily Oster:And we'll also be joined by the people who helped bring it all to life. Guest stars, collaborators, and friends, including director Jonathan Kreisel, the mayor himself, Kyle McLaughlin, legendary musician Amy Mann, and many more. Kyle is going for it here. You fully improvised, not just words, but a song. Well, I thought you were all going to write a song.

1:16:56Perry Wilson:I remember you thinking that. Listen to Podlandia, AAO Rewatch on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is an iHeart Podcast. Guaranteed human.