0:00

Welcome to the Dr. Gundry podcast,

0:02

where Dr. Stephen Gundry shares his

0:04

groundbreaking research from over 25 years

0:07

of treating patients with diet and

0:09

lifestyle changes alone. Dr. Gundry

0:11

and other wellness experts offer inspiring

0:14

stories, the latest scientific advancements and

0:16

practical tips to empower you to

0:18

take control of your health and

0:20

live a long, happy life. Sometime

0:27

in the early 80s, Ario Speedwagon's

0:30

airplane made an unannounced, middle-of-the-night landing.

0:32

This is my friend Kyle McLaughlin,

0:34

the star of Twin Peaks. And

0:37

he's telling me about how he discovered a

0:39

real-life Twin Peaks in rural North Carolina, not

0:41

far from where he filmed Blue Velvet. What

0:44

was on the plane was copious amounts of

0:46

drugs coming in from South America. Supposedly

0:48

Pablo Escobar went looking for other

0:51

spots, quiet, out-of-the-way places to bring

0:53

in his cocaine. My

0:58

name is Joshua Davis, and I'm an investigative

1:00

reporter. Kyle and I

1:02

talk all the time about the strange things we

1:04

come across, but nothing was quite as strange as

1:06

what we found in Varnam Town, North Carolina. There's

1:10

crooked cops, brother against brother. Everyone's got

1:12

a story to tell, but does the

1:14

truth even exist? Welcome

1:17

to Varnam Town. Varnam

1:19

Town is available wherever you listen to

1:21

podcasts. Lisa,

1:28

welcome to the program. Thank

1:30

you so much for having me. So what

1:32

inspired you to write the XX

1:35

Brain? What kind of research went

1:37

into writing this? Oh,

1:39

a lot of research. Yes.

1:42

So I got inspired, for

1:44

lack of a better word,

1:47

by my family, because I have

1:49

a family history of Alzheimer's disease

1:51

that really affects the women in

1:53

my family. So my

1:55

grandmother was one of four siblings,

1:57

three women, and one man. three

2:00

sisters and one brother. And all three

2:02

sisters developed Alzheimer's disease and died of

2:04

dementia, whereas the brother did not, even

2:07

though they were the same age. So

2:10

that was quite a

2:13

shocking experience for us

2:15

as a family, and I really

2:17

wanted to better understand what causes

2:19

dementia in general and what causes

2:21

dementia specifically in women. And

2:24

of course, my family is a very

2:26

small dataset, but then I

2:28

started looking into the bigger picture

2:31

and it turns out that statistically,

2:34

this seems to be the case all over

2:36

the world. So today,

2:39

two thirds of all Alzheimer's patients

2:42

are women, which means that for

2:44

every man suffering from Alzheimer's, there

2:47

are two women. And

2:49

that is something we just don't talk about

2:52

enough. And all my research has

2:54

been really focused on women's brains

2:56

and better understanding how brain health

2:58

plays out differently in women and

3:00

in men. But the

3:03

focus of my research is really on

3:05

women because we have

3:07

just been excluded from research for

3:09

so long and we have been

3:11

under investigated and there's so much

3:13

stigma around anything that could potentially

3:15

happen to a woman's brain that

3:17

that was really a big part

3:20

of my research, if not the biggest

3:22

part of my research. Yeah,

3:24

I think that's really important. I know

3:26

Maria Shriver and I have talked about

3:28

this, that most

3:31

people, I think the general

3:33

public assumes that

3:35

men get dementia more than

3:37

women. But in fact, the

3:40

opposite, like you say, is completely, you

3:42

know, it's exactly the opposite. It's

3:44

exactly the opposite, yeah. The vast

3:46

majority of people who get dementia Alzheimer's

3:48

are women and you guys are so

3:51

much healthier than us men. I mean,

3:53

You would assume, right? And

3:56

also what I think is really interesting is

3:58

that Alzheimer's only

4:01

age-related neurodegenerative condition

4:03

that affects more women than men,

4:05

like Parkinson's more men, vascular dementia

4:08

50-50. So there

4:10

seems to be something specific to

4:12

women that increases risk of Alzheimer's.

4:14

Now in your book, you make

4:17

it clear that your DNA is

4:19

not the sole deciding factor in whether

4:21

you get dementia or not. So can

4:24

you elaborate on that? Can you tell us about

4:26

the APOE4 gene? What's

4:30

your thoughts on all this? For sure. Because

4:33

of my family history, I approached

4:36

Alzheimer's at first in

4:38

terms of genetics. And

4:40

my PhD was about genetics. Also

4:42

for context, I have a PhD

4:45

in neuroscience but also nuclear medicine.

4:47

I have a dual PhD. So

4:49

I've been doing brain imaging since I was like

4:51

19. And

4:54

that really convinced me

4:56

that genetics are incredibly

4:58

important, that they're not

5:00

as deterministic as most

5:02

people think. Like for me,

5:04

I was really worried that a genetic

5:06

mutation was running in my family and

5:08

about my mom's risk and my own

5:11

risk. But

5:13

all this work and everybody else's

5:15

work has shown that no

5:17

more than 2% of all Alzheimer's

5:22

diseases are caused by a genetic

5:24

mutation. So

5:26

for the vast majority of Alzheimer's

5:28

patients, risk is

5:31

genetically mediated, if you will. Of

5:33

course, your DNA is a huge

5:36

component of your health and being.

5:39

But it's not as causative of

5:41

Alzheimer's as most people fear. And

5:44

that for me was incredibly empowering because at

5:46

first, I was really like, if

5:48

I have these

5:51

mutations that were not, what do

5:53

I do? But then it turns out that

5:55

your chances of actually carrying a genetic mutation

5:57

are very, very small. Whereas, I was very,

5:59

very surprised. Everything

6:01

else, all the choices you make in

6:03

your life, everything else that happens to

6:05

you in your life in terms of

6:07

lifestyle and medical history and your environment,

6:10

these factors are also incredibly

6:12

important for brain health and

6:14

Alzheimer's risk with the

6:16

difference that we can't change a DNA

6:18

or a family, but we

6:21

can change the lifestyle and their

6:23

environment and their medical report

6:25

card. Thank you, Fred. So

6:28

what is it about

6:30

women's brains that

6:32

are so unique that

6:34

this seems to be a

6:36

problem more for women than for men? Yes,

6:39

there are many things that make women's

6:41

brains really unique and I think a

6:44

big determining factor is really

6:47

hormonal health because

6:49

I think it's very helpful to

6:51

think of brain health as impacted

6:54

by a number of factors like you have

6:56

your genes, you have your DNA, you have

6:58

your lifestyle, you have your medical health, you

7:00

have your environment, you have your hormones and

7:03

all these factors really act

7:06

synergistically to determine a person's risk

7:08

of Alzheimer's, but at the same

7:10

time, a person comes with allies.

7:12

You know, there are things that

7:15

reduce your risk and other factors

7:17

that can increase your risk by

7:19

the apolipoprotein E, the APoE4G, and

7:21

you mentioned before, and

7:23

hormones are actually

7:25

incredibly powerful allies that protect

7:27

you against Alzheimer's and

7:30

brain aging at large.

7:33

The difference is that men

7:35

have a lot more androgens like

7:37

testosterone. Women have

7:39

a lot more estrogens like estradiol. All

7:42

these hormones are very powerful. They're

7:44

very energizing and they really keep

7:46

Alzheimer's plaques at bay. They're anti-inflammatory.

7:49

They support neuronal growth and

7:51

plasticity, but they

7:53

have different lifetimes, right?

7:57

Testosterone levels don't really decline.

8:00

much until later on in life whereas

8:03

female estrogens really drop

8:06

pretty dramatically during menopause and

8:08

menopause is midlife. So

8:11

when we started looking into that we

8:13

found that women's brains change quite a

8:15

bit in midlife during

8:17

menopause and therefore some women

8:20

and we looked at their brains and using

8:22

their brain scans you know once, twice, over

8:24

time, over the years. What

8:27

we found is that for some

8:29

women the drops in estrogen levels

8:31

correlate with the formation of Alzheimer's

8:34

plaques which is

8:36

counterintuitive because we associate

8:38

Alzheimer's with old age and menopause

8:40

with middle age, right? So that

8:42

is a little bit like a

8:44

paradox. So

8:47

you have a paradox. It

8:51

is true and what my

8:53

work and other people's work has

8:56

shown is that Alzheimer's disease starts

8:58

with changes in the brain years

9:00

if not decades prior to clinical

9:03

symptoms. And for women that

9:06

crucial time seems to overlap

9:08

with menopause. So

9:11

you don't start worrying about your risk of Alzheimer's when you're

9:13

70 as a woman. You

9:16

better start thinking about it when you're 40 and 15. Okay

9:19

so that's the bad news. So

9:25

are you saying that let's

9:27

just generalize that

9:30

every woman should think about

9:33

hormonal replacement to prevent Alzheimer's

9:35

or what are you saying?

9:38

What I'm saying is that there are many

9:40

things that one can do to reduce risk

9:42

of Alzheimer's and hopefully prevent it

9:45

and what our data is giving

9:47

us is a timeline. So

9:50

we now know that women tend

9:52

to develop Alzheimer's earlier than men

9:55

in their brains and that we can catch

9:58

the signs of increased risk. risk

10:00

very early on in life. We're

10:03

looking at women who are in their

10:05

forties and we can really find signs

10:07

of an increased risk of Alzheimer's. And

10:10

then I think it's really –

10:12

that's really the key to prevention. I think

10:15

it gives us a timeline and it also

10:17

suggests that perhaps hormonal

10:19

replacement therapy, which you mentioned,

10:22

could be helpful. We

10:24

don't know for sure. We don't know for sure. And

10:26

I think a lot more research is needed to test

10:29

the preventative potential of

10:32

hormonal therapy. Okay. So nobody

10:35

should go away from this saying, Dr.

10:39

Moscone says I have to get

10:41

on hormonal replacement therapy when I'm

10:43

40 or it's the end. No,

10:46

no, no. I would not say that.

10:48

Actually, I'm very cautious in recommending medications

10:51

for Alzheimer's prevention. I think – I

10:54

believe in clinical trials. I

10:56

believe that drugs should be

10:58

tested very thoroughly for efficacy

11:01

but also side effects. And we really need

11:03

to understand who's eligible for it and who

11:06

would benefit from these

11:08

drugs. So something I want to

11:10

clarify is that not all women

11:13

who go through menopause develop

11:15

Alzheimer's plaques. And not all women

11:17

with the plaques develop dementia later

11:19

in life. So I think phenotyping

11:22

is very important. It's very important

11:24

to have a solid baseline. And

11:27

it's important to understand their

11:29

own risks. And like what

11:31

we were saying before, there

11:33

are many risk factors for

11:35

Alzheimer's that we can control.

11:37

They can also really help improve

11:40

hormonal health, right?

11:42

So instead of jumping to a pharmacy

11:44

with a prescription in hand, there are

11:46

other things that I would recommend doing

11:49

first, which really speak to

11:51

lifestyle like diet, exercise,

11:53

other things that we know impact

11:55

our hormones. Stress reduction is a

11:58

big one. The

12:00

earnest a good segue into those

12:02

ah cause a are everyone who

12:05

comes in my office does not

12:07

get a prescription for as to

12:09

die on progesterone and testosterone. Quite

12:12

frankly in fact most dogs out

12:14

and I agree with you and

12:17

I say just did a podcast

12:19

on this are there are certainly

12:21

oh well recognized of facts of

12:24

estrogen on women particularly vascular reactivity

12:26

and I have no a subset

12:28

of women who. Even.

12:31

Small amounts of estrogen replacements

12:33

as as a pads makes

12:35

a huge difference in the

12:37

way their brain functions and

12:39

I was sort of taught

12:41

this by or gynecologists he

12:43

says. you know, Blame.

12:46

If you know there are women who

12:48

absolutely have to have a small amount

12:50

of estrogen or their brain will not

12:52

work and their vascular reactivity will not

12:54

work in their brains, Is that what

12:56

you guys are finding? I. Think

12:58

there's a sponsor at a replacement.

13:01

Yet is variable. If is someone

13:03

for someone is a godsend, someone

13:05

of really swear by it. Or

13:08

the when is set at it.

13:10

So the responses very highly individualize.

13:12

indistinctly. We need better tools and

13:15

better tests to really predict whether

13:17

or not. Each. Individual woman

13:19

with benefit from this cat the and

13:21

we worry can develop him that any

13:23

isn't in is very dear to my

13:26

heart as and is a scientist because.

13:28

Thing. Season. Because

13:30

we can measure for miss him

13:33

blinds by did is no correlation

13:35

between. Those

13:37

two research on hormones and elements

13:39

inside a person's brain so we

13:42

need to be able to quantify

13:44

estrogen levels in the brain to

13:46

really tell his disunity to directly

13:48

into it. A tiny so do

13:50

we we can better understand. Went

13:53

to start. And when to

13:55

stop they do. We want to wait and

13:57

see a woman is men are closer. To.

13:59

Give it. The hatch which is kind of

14:01

us common practice or would it be

14:03

better to perhaps start earlier in see

14:06

we can delay men opposed with that

14:08

the better. So it seemed as a

14:10

lot of research the really nice to

14:12

happen. In and hasn't happened yet

14:14

which. Is. Honestly, offenses you

14:16

know we would have been going

14:19

through menopause for ever and everybody's

14:21

complaining. A Hot flashes, night, sweats,

14:23

depression, mood swings, brain fog, memory

14:26

lapses, And. We haven't

14:28

really done. The. Research

14:30

that we need yet and as

14:32

half with a population. So

14:35

usually say in your book of. The

14:38

idea that women have no

14:40

control over menopause is a

14:42

myth to elaborate on a

14:44

standard. A man in it's surrounded

14:46

men are posted a many things

14:48

that we don't fully understand. that

14:51

perhaps and not being explained sword

14:53

early or accurately to women so

14:55

many women don't actually know how

14:57

men oppose works An ice I

14:59

need endearing in some ways. When

15:01

I when I do explained it,

15:03

Monopolize starts in the brain. And

15:06

so many women are not aware of

15:08

Dad and his heels. So relieved when

15:10

I mention that because any woman can

15:12

tell you that that you ascend to

15:14

for is something is happening inside their

15:16

heads and a warrior that and my

15:18

be going crazy or dan on maybe

15:20

it's have any only to them and

15:22

not to the other. eighty eight hundred

15:24

and sixty mean he'll hundred plan and

15:26

were not going through menopause and that

15:28

it. In are experiencing exactly

15:31

the same level of confusion or

15:33

changes so that that's something that

15:35

really made a point to try

15:37

to sign in the book and

15:39

is a lot of stigma about

15:41

men oppose in Twenty Twenty still

15:43

quite a taboo that it is

15:45

so much that we understand now

15:47

and it was really need to

15:49

talk about in Disguise with women

15:52

and in between Women and with

15:54

men. Honestly because it's a family

15:56

thing in the and England by

15:58

to your point man upon. is

16:00

partially genetically mediated in that if

16:03

your mom went through menopause when

16:05

she was 43, chances are you're

16:07

also going to menopause at the

16:09

same age. If your

16:12

mom went through menopause at 55, then

16:14

you're very fortunate because there's a good

16:16

chance you may also go through menopause

16:18

later than average. However,

16:21

there are things that

16:23

are known to precipitate

16:25

menopause and other things

16:27

that are known to delay the

16:29

onset of menopause. The

16:32

bad things are definitely smoking, which

16:34

is the number one cause of

16:36

early menopause, an unhealthy

16:38

diet, and a very high

16:40

level of chronic stress. So if

16:43

your mom went through menopause at 58, right,

16:46

but you've been smoking for 20 years, chances

16:49

are that you'll go through menopause much earlier

16:52

than she did. And then

16:54

there are all the good things that actually delay

16:56

menopause, which are the good

16:58

things we always talk about. Oh, let's hear it.

17:00

Like a healthy diet. Let's talk about that. So,

17:04

well, a healthy diet is a big deal. There

17:07

are many studies, including an examination of

17:09

hundreds of thousands of people showing

17:12

that the more fish you have

17:14

in your diet, the

17:16

later the onset of menopause

17:18

as a woman, of course. And

17:21

on the other side, you see

17:23

a lot of refined sugar and

17:26

refined grains that seems to accelerate

17:28

the hormonal decline that leads to menopause.

17:31

So it's good to think about diet in terms

17:33

of something that can actually impact the

17:36

health of your hormones as well

17:38

as the health of your brain. And

17:41

there's evidence that dietary patterns like

17:43

the Mediterranean diet, for example, to

17:47

really promote hormonal health in women,

17:49

also support fertility, and that

17:51

associate it with fewer flashes

17:54

in the later onset age

17:56

of menopause, as well as a

17:58

number of other things. better cognitive

18:01

health, reduce cardiovascular issues, reduce

18:03

depression in women. So a

18:06

healthy diet is

18:09

very crucial I think for overall

18:12

health. You know, everybody's on a different diet

18:16

but I think then on average

18:18

just staying away from processed food

18:20

would be a really good

18:23

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19:37

let me let me back up for

19:39

a second. Is there

19:41

any evidence then you're the expert

19:44

on this that if you

19:46

go into menopause early let's say in

19:48

your 40s early 40s versus going

19:53

into menopause in your 50s

19:56

that you're better off the later

19:59

you go. go into menopause

20:01

number one and number

20:03

two if you go into menopause early

20:05

do you throw up your hands and

20:07

say I'm screwed oh my

20:09

gosh now what do I do? The

20:13

first answer is yes the second answer is

20:15

no. Ah okay. Good

20:18

so there is increasing

20:20

evidence that a longer

20:23

reproductive lifespan is

20:25

protective against dementia in women

20:27

especially in women and

20:30

by longer reproductive lifespan is

20:32

kind of a

20:34

metaphor for the longer your body

20:37

is exposed to your estrogens. So

20:40

women who develop

20:42

and go through puberty at

20:45

the average age or a little bit earlier like

20:47

when you're 12 and go through

20:49

menopause later on like maybe around age 55, 56

20:51

they really

20:54

seem to have the lower risk

20:56

of dementia as compared to women

20:58

who have a shorter reproductive lifespan

21:01

so they start menstruating later in

21:03

life and to go through menopause

21:05

earlier whether genetically or

21:07

because of medical interventions and I

21:09

would like to mention hysterectomies

21:12

and ophorectomies are the number

21:14

one cause of early menopause

21:17

for American women and

21:20

those are surgical procedures in

21:22

which the uterus and or

21:24

the ovaries are removed and

21:27

unfortunately there is evidence that

21:30

having the uterus and more

21:32

so the ovaries removed prior

21:34

to menopause correlate with a

21:36

much higher risk of dementia

21:39

later in life for women. So

21:41

I think it's really important to talk about

21:43

this and it is depressing news and it

21:45

is a upsetting news but it's

21:48

really important that we talk about it because

21:50

so many women are not aware and so

21:52

many doctors are not aware so many OBGYNs

21:54

just don't know and

21:56

so if you go to your doctor because you

21:58

have fibroids. And they're

22:00

like, well, you know, you're suffering so much,

22:03

maybe we should take out the uterus. Let's

22:05

talk about keeping the ovaries. Because

22:08

one of the major reasons for removing

22:10

the ovaries is that they

22:13

just happen to be there with their uterus. Well, we're

22:15

in there, yeah. Yeah. So I

22:17

think it's important to raise awareness of the

22:19

fact that reproductive organs are there for a

22:21

reason, and they can't just

22:23

be taken out that

22:25

easily because there's a connection with your

22:27

brain that is not being

22:31

a conversation material, but it's true.

22:33

Your brain is in constant interaction

22:35

with your ovaries as a woman,

22:37

and the ovaries talk back to

22:39

the brain, influencing brain health in

22:41

return. So it's a network that we really

22:43

need to nourish. And that's a big part

22:45

of my book is really

22:47

about understanding the system and these

22:49

interactions and how to really nurture

22:52

them. Now another part of

22:54

that is, okay, so what about pregnancy?

22:56

Where does that come in, in the

22:59

picture? It's a very

23:01

good question. It looks like the number of

23:03

pregnancies is just not associated with Alzheimer's

23:05

risk. There are some studies showing

23:08

that the more pregnancies, the more

23:10

children you have, the higher your

23:12

risk of Alzheimer's. But as other

23:14

studies have shown, absolutely opposite. So

23:18

at this point, we don't know.

23:20

What we do know is that

23:22

the number of pregnancy does not

23:24

correlate with your age and menopause.

23:26

It doesn't seem to, because

23:28

some people think, well, I haven't had

23:30

my cycle for nine months, so I'm going to

23:32

catch up. You know, it's going to be menopause.

23:35

It's going to be delayed by at

23:37

least nine months. But that doesn't seem to

23:40

happen. Ah, interesting. So

23:43

is there any correlation between

23:46

pregnancy or no pregnancy

23:48

and developing Alzheimer's

23:51

or dementia? I

23:53

think the research is not clear on that.

23:55

And this is something that we're looking into

23:57

right now, clearly, the women's brain initiative. because

24:01

it's such a big deal for women's brains.

24:03

And my friend,

24:05

one of my friends, she's a psychiatrist,

24:07

and she got pregnant years ago when

24:10

having kids was not even a thing

24:13

for me, not even on the radar. And

24:15

she was telling me that she felt

24:17

like she had postpartum dementia, that

24:19

she could not remember things, she

24:21

was having such a hard time just getting through

24:24

the day mentally. She's one of

24:26

the smartest, most capable women on this planet.

24:28

And that was like, yeah, yeah, yeah, you

24:30

just need to sleep. Then

24:33

I had my baby, and it

24:35

was like, oh my God, what is

24:37

happening to me, to my head? And

24:40

so I think this is something I really want to

24:42

look into. There's this

24:44

beautiful study in Nature and Nodoscience

24:46

that came out just a few

24:49

years ago, showing that

24:51

women's brains after

24:53

pregnancy, throughout pregnancy and after

24:55

pregnancy, really go through

24:58

a remodeling, where the

25:01

brain kind of loses gray matter that

25:04

you can see on MRI scans, which sounds

25:06

like a negative thing, right? I'm losing

25:08

something inside my head. But

25:11

a lot of people believe that

25:13

this change is like a maturation

25:15

process, like something that, like, what

25:17

happens in puberty, that the brain just

25:19

starts going through this pruning

25:22

phase, where a lot of connections are

25:24

discarded because you don't need them anymore,

25:26

and it's much more efficient to have

25:28

a very efficient, very compact brain.

25:31

And it looks like something similar might happen to

25:34

women's brains, as we become moms, because

25:36

all the attention needs to be on

25:38

the baby. That is better from

25:41

an evolutionary perspective. And

25:44

that leads to discarding other connections

25:46

that are no longer needed. And

25:48

I find that to be very

25:50

insightful, and I wonder if something like

25:53

that can also explain menopause. You know,

25:56

we men, we as humans, we're

25:59

just one of the voices. very few species

26:01

that go through menopause at all. There

26:03

are just two species on the

26:06

entire planet that go through menopause

26:08

and these are women and killer

26:10

whales. And I find that so

26:12

cool. But if you think that all

26:14

other species, in all other species,

26:17

the female dies when she's

26:19

no longer her dad. Whereas

26:21

for us, it's an advantage to

26:23

become grandmothers at some point.

26:26

Or at least that's what nature intended for

26:29

us. And no longer

26:31

be fertile, but still be around and help

26:34

the family really thrive

26:36

and grow. So I find it very,

26:38

I find it beautiful in some ways.

26:41

So you have a

26:43

PhD in imaging. And

26:46

help me with this. We've had

26:49

Dr. Aiman on our program and

26:51

also Dr. Dale Braddison and I

26:53

consider both of them my friends.

26:58

Give me your thoughts. Do we need PET

27:00

scans of the brain? Do we need MRIs

27:03

of the brain? Do we need spec scans

27:05

of the brain? Come on, you're the world

27:07

expert. What do you like? I

27:09

do them all. So at the Women's

27:12

Brain Initiative, we do, I believe, 11 brain

27:14

scans. And we have a

27:22

very interesting MRI sequence.

27:25

So we have all our patients

27:27

receive an MRI scan. That is

27:29

mandatory. And during the MRI

27:31

scan, I do seven different sequences. So

27:33

we're looking at blood flow. We're looking

27:35

at inflammation. We're looking at gliosis. We're

27:38

looking at obviously brain

27:40

shrinkage and neuronal density. We

27:44

look at mitochondrial activity. We

27:47

do spectroscopy as well. And

27:49

then I do two PET scans to start

27:51

to the participants who are willing to receive

27:54

the procedure, of course. And

27:56

one is to measure brain metabolic activity.

27:58

It's called SDG. positive animation

28:00

tomography or PET. And

28:02

the other one is called PIB, or

28:05

Pits Per Compound B, which is a

28:07

tracer that looks at amyloid plaques, or

28:09

Alzheimer's plaques. So we

28:11

try to do all the scans to all

28:13

of our participants. And we also repeat them

28:16

over time. Every two years

28:18

is the recommended time to follow up.

28:21

And do they need to get

28:24

all those scans? Well, we're

28:26

doing that mostly for research, but

28:30

the point of doing this is

28:32

to really validate brain

28:34

imaging as a diagnostic

28:38

tool, but also as a preventative

28:40

tool. So my thought

28:42

is women get

28:44

mammograms. As soon as you get to age

28:46

40, perhaps 42, if

28:49

you don't want to do it so early, but

28:51

you do get a mammogram so that you have

28:53

a good baseline. And then with

28:55

age, your risk of breast cancer

28:58

increases, but then you can do another mammogram and

29:00

go back to your baseline and compare. PAP

29:03

tests, they keep doing more about the other

29:05

ear, or it depends on your doctor. My

29:07

doctor says every five years, even. Colonoscopy

29:10

is the same exact theory.

29:13

So you want to have a

29:15

strong, solid baseline and see the

29:17

predictive value of these procedures.

29:19

And we're trying to determine that

29:21

for brain imaging. I don't think

29:24

that everybody needs to

29:26

do brain scans. And we're

29:28

really working to find out which brain scans

29:30

are most helpful and most

29:32

predictive of future health risks.

29:35

So you've got

29:38

all these scans. Which

29:40

food should women be eating

29:42

the most frequently for

29:45

their brain? And which, you

29:47

kind of touched on this, which should

29:49

we just avoid at all costs? I

29:53

don't know that there is one specific

29:55

type of food. In

29:57

terms of nutrients, I find... that

30:00

women's brains really benefit from

30:03

three nutrients. Can

30:05

I do three? Three. Okay.

30:08

Or maybe two. Polyunsaturated

30:10

fatty acids are really, really

30:12

important for women's health. There

30:15

are plenty of studies showing that

30:17

a diet rich in polyunsaturated fatty

30:19

acids, especially the omega-3

30:21

type, is associated with a 25% reduced

30:25

risk of heart disease in women,

30:27

a much lower risk of depression

30:29

as well as menstrual pain and

30:31

infertility, and even a 70% lower

30:35

risk of dementia for those who consume

30:37

more than four grams of polyunsaturated fatty

30:40

acids every day. So I think this

30:42

is really good news. Well

30:44

now, wait a minute. Corn

30:46

oil and soybean oil are polyunsaturated fatty

30:49

acids for the most part. I

30:51

don't think- Soybean, but they're more omega-6, no? Yeah,

30:53

they're omega-6s. Yeah, they're my- Yeah.

30:56

I think you- I would hope

30:59

you'd mean like things like

31:01

fish oil or plant-based

31:03

fish oil replacements.

31:05

Yeah. Okay. Most

31:08

certainly, fish. Yes. Fish,

31:11

shellfish, and also- No, no, no. No

31:14

soybeans. But

31:17

also, omega-3s from plant-based foods

31:19

like olive oil, which

31:22

are just like almonds, chia seeds.

31:25

Chia seeds, there are many

31:27

plant-based foods that contain omega-3

31:29

fatty acids. You made a phase. I think chia

31:32

seeds are not on your list. Yeah, the problem with chia seeds,

31:34

I- actually, Professor Lauren Cordain,

31:36

who was the original author

31:38

of the Paleo Diet, and

31:41

I were talking years ago. And

31:43

chia seeds are a source of short-chain

31:46

omega-3 fats. And

31:48

I was a big proponent of them, and we

31:50

were talking on the phone one day. He says,

31:52

don't you read the literature? And I said, what

31:54

are you talking about? Yes, I do. And he

31:56

says, well, there's two studies in humans where chia

31:59

seeds promote inflammation. I said, you're

32:01

kidding. He said, no, the studies

32:03

were done to prove that chia

32:05

seeds increased your level of omega-3

32:08

fats in your blood. And so

32:10

just as part of it, they wanted

32:12

to show that chia seed consumption decreased,

32:15

in this case, C-reactive protein.

32:18

And so they did a blinded study.

32:21

And it turns out that the

32:23

chia seed group, they did increase

32:25

their omega-3 fats, but their C-reactive

32:27

protein went up. And so ever

32:29

since that day, I've stopped recommending

32:31

chia seeds. So even

32:34

though they are a source of

32:36

short chain omega-3 fat. Also,

32:38

did I find them to be kind of trendy?

32:42

Yeah. What I recommend is basil

32:44

seeds. They will

32:46

actually make the same

32:48

sort of jellily-like stuff,

32:51

but they actually promote health

32:54

rather than perhaps- Good. I

32:56

love basil. I mean,

32:58

I like basil everywhere. Yeah,

33:01

that's right. Basil on everything. I agree.

33:04

So, you know, that brings up

33:06

a good point. What are your

33:08

thoughts on lectins? Because there is

33:10

some interesting research on lectins and

33:12

their effect on the brain, particularly

33:14

in Parkinson's disease. In

33:16

Parkinson's. And what kind of negative

33:19

effects, I'm assuming? Yeah, negative effects.

33:22

It turns out that lectins have

33:24

been shown to climb

33:26

the vagus nerve and

33:29

actually cause neuroinflammation. And there's

33:31

really interesting studies in people

33:34

who've had vagotomies where

33:36

their vagus nerve has been cut for

33:38

ulcer disease back in the good old

33:40

days, that people who've

33:42

had vagotomies actually have a 50%

33:46

less incidence of Parkinson's than

33:48

people whose vagus nerve is intact.

33:52

This has actually been reproduced in

33:54

animal studies that lectins can

33:56

climb the vagus nerve and

33:58

actually lodge it. in the

34:00

substantia nigra, which

34:02

is fascinating to me. So needless

34:04

to say, as a kind

34:07

of an anti-lectin guy, I'm

34:10

not big on lectins in the brain, so. Yeah,

34:13

for sure, and I think diet is

34:15

so personal, right? It's good to know

34:17

what possible risks and possible stressors might

34:19

be, and it's in

34:22

part genetically driven.

34:25

So I think it's really important to know your

34:27

stressors. You know, for some people, gluten is a

34:29

big issue. For other people, I guess, the lectins

34:31

are a big issue. For people like meat, meat

34:33

is hard to digest. So I

34:36

think it's really important to understand what kind of

34:38

foods and nutrients work for

34:40

each individual patient or person, and

34:43

how to maximize brain health. And I'm a

34:45

big proponent of flexibility, like

34:47

a flexible diet, as long as

34:49

it's overall healthy. We have

34:51

some patients who are keto, some

34:54

patients who are paleo, many patients

34:56

who are vegan, and I respect

34:59

all diets. We just try to really

35:02

incentivize and motivate people to make the

35:04

healthiest possible choices that they can make.

35:07

And I really think that eliminating

35:09

processed foods from the diet is

35:11

something that everybody agrees is good

35:13

for you. And

35:16

it's the one thing that nobody does.

35:18

Yeah. Like everybody's eating frozen

35:20

pizza, they go to McDonald's, they do

35:22

takeout all the time. So

35:25

I think that that's really the number one

35:27

thing that I would recommend. Just really try

35:29

to minimize the

35:31

amount of processed foods and packaged foods

35:33

and preservatives in your diet, and your

35:36

brain can only rejoice, and so

35:38

will your heart. So why not? Yeah,

35:41

exactly. The Dr. Gundry podcast

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law speaking

36:52

of keeping your brain in

36:54

tip-top shape and we talked

36:56

off-camera a little bit about this so

36:59

are there any supplements give

37:01

me three supplements that

37:03

women and men for that matter

37:05

should be taking for optimum brain

37:07

health there is no real

37:10

agreement or consensus on which supplements are

37:12

really supportive of brain health and could

37:14

potentially reduce risk of Alzheimer's so my

37:16

take on this is that we need

37:18

to get tested because if

37:21

you have a subclinical deficiency or

37:23

obviously a deficiency then taking supplements

37:25

makes a lot of sense so

37:28

assuming that a person benefits

37:30

from the supplements I would say

37:32

my number one with the

37:34

polyunsaturated fatty acids the omega 3 is

37:37

in case one is deficient or subclinical

37:40

a decision especially for people with high

37:43

homocysteine level in

37:45

which case B vitamins

37:48

seem to be also very important for

37:50

brain health and to reduce risk of

37:52

Alzheimer's especially B6 B12

37:54

and folate and

37:57

then antioxidants especially for women

38:00

Antioxidants are so important because the

38:02

brain is the number one organ

38:05

that is really affected by oxidative

38:07

stress and the only

38:09

way to reduce the oxidative stress

38:11

is through the diet by really

38:13

importing all this antioxidant nutrients from

38:15

our diet. And so I'll just

38:17

mention here that everybody thinks about

38:19

blueberries, but blackberries

38:22

have a much higher antioxidant power

38:24

than the blueberries. So whenever possible,

38:27

I personally go for blackberries because

38:29

they're also really yummy. Yeah,

38:31

I'm glad you brought that up. So

38:34

many people don't know, and

38:36

I'm glad you said that,

38:38

that blackberries carry a much

38:40

more potent punch than

38:42

blueberries. Plus, as I tell anyone

38:44

who will listen, our blueberries, particularly

38:47

here in the United States and

38:49

now around the world, have been

38:51

bred for sugar content. And

38:54

when I was growing up, blueberries were these

38:56

little bitty, bitter things. And

38:58

now they're the size of grapes. They're

39:01

enormous in the space. In Italy, we

39:03

still have the little ones. They're

39:06

called wild blueberries here, right? You

39:09

find them frozen. Yeah, you can get them at Trader Joe's.

39:13

That's not an endorsement, but that's where you can find them.

39:17

But yeah, and Whole Foods usually has some frozen

39:19

ones. But yeah, blackberry

39:21

and even a raspberry, the

39:24

egalic acid in raspberries is

39:26

fantastic as polyphenol. Right. And

39:29

shall we mention espresso? Yeah,

39:32

so I'm, of course,

39:34

an Italian PhD has got

39:36

to mention espresso. Well,

39:39

it is the beverage with the

39:42

highest antioxidant capacity of all beverages.

39:44

So a freshly brewed espresso

39:47

goes a long way. But I think

39:49

it's good to mention that one espresso

39:51

a day has also been associated with

39:53

a much lower risk of dementia later

39:56

on in life, whereas no coffee at

39:58

all. And more than that. Has

40:00

been shown to not be really as effective.

40:02

It looks like there's an inverted U shape

40:05

So I think that's good news, you

40:07

know, we're talking blueberries blackberries Coffee

40:10

and dark chocolate, of course, of

40:12

course is a joke and antioxidant and

40:14

have a bite of dark chocolate with

40:17

your espresso Right, but

40:19

don't put a bunch of milk in

40:21

it and make it a latte and

40:23

maybe or sugar Yeah, or sugar, you

40:25

know I

40:27

put a little milk actually we do Cafe

40:30

macchiato. That's what I do. That's

40:32

exactly what I do Yeah, and I tried

40:34

and I try to convince my patients to

40:37

change over to just a little macchiato Preferably

40:40

with a to milk. I'll get a plug-in for

40:42

a to milk Okay, so

40:44

let's talk about exercise. Now since we've

40:46

been talking about food How

40:49

how important for women is

40:52

working out for brain health?

40:55

It is very very important and

40:57

I think there's quite enough convincing

40:59

research showing how women

41:02

don't exercise nearly as much as they could

41:04

or should and they must

41:06

certainly exercise Less than men do

41:08

for a number of reasons, which is not to

41:10

blame women for it but it's really a number

41:12

of reasons that go from you know,

41:14

just being a mom and Holding full-time

41:16

jobs and taking care of this family and

41:19

taking care of your parents and your husband's

41:21

parents There's just so much

41:23

that's going on in a woman's life and the

41:25

men's life as well, but for some reason Women

41:28

and I think any woman would put

41:30

a knowledge that we're just so good

41:32

at putting Everybody else and

41:35

everything else before us and

41:37

then the downside is that we don't

41:39

get move our bodies as much as

41:42

we could But there's a

41:44

lot of evidence that exercise is

41:46

not just good for overall health

41:49

It's also specifically helpful for

41:51

your brain and is really

41:54

a well-established preventative against

41:56

Alzheimer's and dementia. So

41:59

the fact that women don't exercise as much

42:01

as they should raises

42:03

concerns because that could also be one

42:06

of the reasons that more women than

42:08

men end up with dementia later in

42:10

life, right? And there is very encouraging

42:12

research showing that exercising reduces

42:15

the risk of dementia for

42:17

both men and women, but

42:19

more so for women than

42:21

for men. There was just

42:23

this wonderful study published

42:25

with, it was over 200 women

42:28

that were followed for over 40

42:30

years, which I found was

42:33

incredible. And they showed

42:35

that your cardiovascular level, your fitness

42:37

level in midlife is really predictive

42:39

of future risk of Alzheimer's disease.

42:42

So the women with the highest

42:44

level of fitness basically

42:46

did not decline to Alzheimer's disease.

42:48

They declined rate close to 0%,

42:52

but as women in the lowest

42:54

percentile of fitness, decline to Alzheimer's

42:56

at a rate of 30%, which

42:59

means of every three women who don't

43:01

exercise, at least one is going

43:04

to get Alzheimer's disease. So it

43:06

does not convincing enough. I don't

43:08

know what could be. And they also want

43:10

to mention, because I don't want anyone to

43:12

feel bad about not exercising. We have so

43:14

much guilt around not doing

43:16

every single thing we could, which is

43:19

clearly unsustainable. You only have that much

43:21

time in a day or a week.

43:24

But there's very encouraging evidence that you

43:26

don't have to run a

43:28

marathon. We think about

43:31

exercise mostly in terms of

43:34

running, jumping, aerobic exercise. And a

43:37

lot of women just can't do

43:39

them. Maybe they're too tired, or they're going through

43:42

menopause, they're so much

43:44

else going on. But there's a lot of

43:46

evidence that lower intensity exercise

43:48

is done consistently. It's just as

43:51

good as high intensity exercise done

43:53

once in a while. And there's

43:55

also less likely to cause inflammation

43:58

in the body for women. men

44:00

who are going to menopause, they pet a

44:02

menopause and have a lot of cortisol and

44:04

have trouble sleeping. So

44:07

slow and steady wins

44:09

the race as long as it's consistent. Yeah,

44:12

I agree. In fact, I write

44:14

prescriptions for many of my patients to

44:17

get a dog because

44:20

dogs actually make you exercise twice a

44:22

day, whether you want to or not.

44:25

Yeah, that's a lovely idea. I actually

44:27

write a prescription. And don't say they

44:29

keep you company. Lower your stress level.

44:32

Yeah. It's a good old. It's really interesting.

44:34

I have a number of people who come

44:36

back with that prescription frame that it was

44:38

the best prescription a doctor had ever written

44:41

for them. So I'm going to keep doing

44:43

it. I love that. If it's okay, I'm going

44:45

to mention that you do that because it's such a

44:47

good idea. No, please. So

44:50

can you reverse dementia?

44:56

Reverse is an interesting word for a

44:58

scientist. You know, I know it

45:01

has been used with books,

45:03

podcasts, the magazines. For

45:05

me, reversing Alzheimer's means that

45:07

you're getting rid of the symptoms and

45:09

you're getting rid of the pathology. So

45:12

the Alzheimer's plaques are gone. The tangles are

45:14

gone. The inflammation are gone. Your neurons are

45:16

growing back and your symptoms are gone. So

45:19

far, I haven't seen that happen. The

45:22

hope is that it will. Rhino,

45:26

I think, we're

45:28

as the field, the Alzheimer's field is

45:30

coming together in finally

45:33

accepting that prevention is feasible.

45:36

We got so much pushback for so long

45:39

that we couldn't even publish a

45:41

paper with the word prevention in it. Just

45:43

recently, we had to cross it out at the title.

45:45

Really? Yeah, absolutely. There were,

45:48

I think we had six reviewers,

45:50

which is a lot of reviewers, and

45:52

at least three raised concerns

45:54

about the word prevention. And so we

45:56

had to cross it off

45:58

and just replace it. with risk reduction.

46:03

You know, you do what you're gonna do, but

46:05

the point is a lot of people still don't

46:07

believe that prevention is feasible.

46:10

The risk reduction is more, you know,

46:12

is more like, oh, okay, it's not

46:14

a strong word, but obviously

46:16

I'm the associate director of the

46:18

Alzheimer's Prevention Clinic at Wacornel, which

46:21

I thought was kind of brave. So

46:25

obviously I believe that prevention is feasible

46:27

and there's a lot of data showing

46:29

that at the very least

46:31

one third of all Alzheimer's cases

46:33

are potentially preventable. So

46:36

I do believe in prevention and I most

46:38

certainly hope that Alzheimer's disease will be reversible.

46:41

All right. Well, that's a good place to

46:44

end all this. So

46:47

Dr. Moscone, how can people

46:49

find you and

46:53

follow your work and get the book,

46:55

obviously? So the book is

46:58

available in all stores and of

47:01

course it's on Amazon and Barnes

47:03

and Nobles and online everywhere. And

47:06

I really hope that you like it. I really

47:08

put my heart and soul into the book and

47:10

it's such an important part of me,

47:12

really that went into the book. As

47:15

for getting in touch with me,

47:17

I'm on Instagram. I'm not big

47:19

on social media, but I am

47:22

on Instagram at dr.moscone, dr. underscore.moscone.

47:25

And I have a website,

47:28

which is lisamoscone.com and

47:30

I actually answer direct messages.

47:33

Wow. Yeah, for

47:35

now. I really do have

47:37

to really respond and make

47:39

friends and it's really be

47:42

in touch with everybody because it's so informative.

47:44

I find that all the questions really inform

47:46

my research because as a scientist, there are

47:48

a lot of questions that I have on

47:50

my mind and a lot of things I

47:52

wouldn't think about. So

47:55

this feedback is incredibly Enriching for us. No,

47:58

it's very true. And In fact, One

48:00

of my books I dedicated to my patients

48:02

for. Asking me questions

48:04

I did not have the answer

48:06

to ah or telling me about

48:09

something that I didn't know and

48:11

so I'm I'm always thankful for

48:13

any question. Mad at all My

48:16

patience A Keep me informed South

48:18

Seas are we got an audience

48:20

question? I'm going to ask you

48:22

to participate in this if you

48:25

know mine John Galt one on

48:27

you to bass is olive leaf

48:29

extract better than olive oil since

48:32

it's more potent. Ah, Well I'm

48:34

an Ama Xml make you start and

48:36

I'll I'll finish up waiving. His

48:38

ama think it's an interesting question. It again

48:40

I'm Italian so olive oil is a date.

48:43

The. Also me I love that and

48:45

I see li. At One

48:47

is assassinate. Made. It the

48:49

accent when the other one is a

48:52

condiment so I seem to have been

48:54

really helpful to be. Better. That

48:56

is also olive oil has been signed

48:58

studies that is of is the at

49:00

the core at the Mediterranean diet wishes

49:02

Etti brain healthy and heart healthy diet

49:05

and why not taking the to supplement

49:07

as well. Just as interestingly

49:09

enough or we know that the

49:11

the poly seen all content of.

49:14

Leaves is actually much higher than

49:16

the poly seen all content of

49:18

the fruit of that treats of.

49:21

For instance, there's far more polyphenol

49:23

when apple leaves than there are

49:25

and apples. And there's actually far

49:27

more polyphenols in raspberry leaves or

49:30

blackberry. Leave them there are in

49:32

raspberries or black bears. So I

49:34

agree with your eyes. As you

49:36

know or maybe know, I think

49:38

the only purpose of food is

49:41

to get olive oil into your

49:43

mouth and. Assess assess

49:45

the I have arrived. I use

49:47

both olive leaf extract and I

49:49

use our part of olive oil

49:52

and more Poly seen all when

49:54

the all the world a better

49:56

run. Upstairs in in. Our.

49:58

I won't. Thanks for joining us. Good luck

50:00

with the bought guy know it's gonna

50:03

be a great and thanks for bringing

50:05

this attention to women! Up.

50:08

For some obscure reason, we've gotta

50:10

get the word out that you

50:12

know is that women are the

50:15

main sufferers of Alzheimer's Disease. Test.

50:18

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being. I've grown to appreciate his

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research, experimentation and reporting. Great to

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hear you both together! While thanks

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Roger I, he's an inspiring individual

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and of way will have I'm

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on multiple times because we always

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do a deep dive into some

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crazy. so thanks a lot. I.

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Hope you enjoyed this episode of the

51:19

Dusty Gundy podcast. Is he did please

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