I've already posted it on another thread so it may not work... but
When Lisa Mosconi told her family of her career choice they were dismayed. Her parents were nuclear physicists at the University of Florence and psychology seemed an unpromising avenue for their daughter to go down. “Everybody panicked,” she says. “They were, like, ‘Oh my God, she’s never going to be able to have a salary.’” Her grandmother didn’t speak to her for a month. Mosconi switched to neuroscience, which was also regarded with suspicion.
Her determination to study the brain was only reinforced by what she saw in her family. “That was pretty much the same time that my grandmother started showing signs of cognitive deterioration,” she says. At first the changes in her grandmother were slow. “It was a gradual change, but very clear. She wasn’t able to remember things. She started repeating herself and she had always had an incredibly strong personality, so there was also a lot of anger and that was quite scary.”
Within a couple of years her grandmother’s younger sisters started showing the same changes, while their brother did not. “I remember one terrifying summer where my grandma and her sisters stayed with us and no one could remember anything,” Mosconi says. “It was incredible, like a horror movie. And so I started looking into that.”
Her PhD, on the early detection of Alzheimer’s using brain imaging, included discussion of gender differences. Some academics said she was wasting her time. “Sweetheart, it’s a question just not worth looking into,” she was told.
Yet inspired by her grandmother’s descent into dementia, she persevered and devoted her career to finding ways to detect Alzheimer’s. Today she is the director of the Women’s Brain Initiative at Weill Cornell Medicine medical college in New York and the author of The XX Brain, which became a New York Times bestseller this year.
Her hunch about a gender imbalance in Alzheimer’s patients has been shown to be correct. “It turns out it’s not just my family. Alzheimer’s disease has a disproportionate representation among females. Out of every three Alzheimer’s patients two are women.”
Women’s and men’s brains work differently, but brain research has traditionally been dominated by men studying men’s brains, and even today she says women and men are studied as if broadly indistinguishable. “Women’s brain health is one of the most underrepresented and unspoken concerns, one that is constantly glossed over as a result of the male-based medical paradigm,” she writes.
The right diet can ensure the brain remains stronger longer
The right diet can ensure the brain remains stronger longer
GETTY IMAGES; POSED BY MODEL
The XX in her book’s title refers, of course, to the mighty X chromosome, which contains many more genes than the Y chromosome. Women with their double X have more genes than men and many of them play important roles in hormone production and brain activity.
The hormone that stars in Mosconi’s XX book is oestrogen. Research points to oestrogen being a significant — perhaps the significant — hormonal driver of women’s brain health, she says. We mislabel oestrogen and testosterone — which is abundant in men’s brains — as the sex hormones. “They don’t just work in the reproductive apparatus. They’re also in the brain every minute from the time of conception to the end of life,” she says when we talk by video call. Although based in New York, she is staying in Massachusetts during the Covid-19 lockdown.
“We have these hormones in our brains that serve so many different functions. We refer to oestrogen as the master regulator of the female brain, like the orchestra conductor,” she says.
Oestrogen and testosterone give energy to neurons and power the immune system. While men’s brains produce more serotonin, the “feelgood” neurotransmitter involved in mood, sleep and appetite, women produce more dopamine, which is responsible for drive and reward-motivated behaviour.
The role of “raging hormones” in reorganising the brain in puberty is well documented. During pregnancy a woman will experience a surge in her level of oestrogen, progesterone and the “love hormone” oxytocin, and the forgetfulness and inattention that can occur is attributed to “pregnancy brain”, a condition closely related to “baby brain” with its symptoms of mental fogginess after a child is born. All that’s happening, Mosconi says, is that the brain is undergoing a refurbishment to cope with the demand of motherhood.
The menopause, a similarly enormous landmark in a woman’s life, receives less attention. “Men age and we think of that like wine,” Mosconi says. “The older you become, the more precious you are, right? But then when women age it’s more like milk; there’s this expiration date after which you’re, like, ‘Ooh, it’s still good or not?’”
Mosconi has a way of talking about the menopause that makes it easy to understand even for those of us who are shockingly ignorant of what happens. “When you lose your oestrogen as a woman during menopause, your brain loses its super power. You really lose this incredible ally,” she says. “It’s like if you have a team that’s been working together for so long and all of a sudden the programme manager quits. Your energy levels are down, your immune system is down, your neurons stop growing.
“When women tell you they’re having hot flushes, night sweats, anxiety, brain fog, you forget those symptoms don’t start in your ovaries. They start in your brain and they’re very clearly an indication that your brain is going through an adjustment. So that’s really the time of life when we should be taking better care of ourselves and our brains.”
Women are twice as likely as men to develop depression, and many women who have not had depression before have it during the menopause. “We have a three times’ higher chance of autoimmune disorders including those that attack the brain, like multiple sclerosis,” Mosconi says. “We have a four times greater chance of headaches and migraine; a higher likelihood of developing meningiomas, which are the most common form of brain tumour, especially after menopause. We have far greater risk of dying of a stroke.
“What all these conditions have in common is that they’re really made worse by menopause. So all these conditions that are more prevalent in women than in men seem to also be linked to menopause. And if you have a predisposition for Alzheimer’s disease, that’s when it comes out.”
We’re back where her academic life began, searching for truths about what happened to the women in her family and worrying what it might mean for her mother, herself and any daughters she might have (she now has a four-year-old girl).
Mosconi: “When you lose your oestrogen during menopause, your brain loses its super power”
Mosconi: “When you lose your oestrogen during menopause, your brain loses its super power”
Hormonal changes during the menopause “potentially diminish” the brain’s ability to resist diseases such as Alzheimer’s, Mosconi believes.
The gulf between the incidence of Alzheimer’s in men and women is not because women live longer, she explains. That longevity gap is closing and statistical models show that women with Alzheimer’s outnumber men with Alzheimer’s by two to one regardless of their age, age at death and differences in life span. Brain-imaging studies show that women seem to start getting Alzheimer’s earlier than men. Scans show some women transitioning to the menopause with an increased accumulation of plaques that are a sign of Alzheimer’s.
Genetic mutations in DNA are a cause of Alzheimer’s, but in fewer cases than originally thought. Environment, lifestyle, medical history and hormonal health are also very important.
There appears to be a strong correlation between when women develop Alzheimer’s and when they go through the menopause. Mosconi is cautious, and won’t go farther than saying that the menopause is a “possible trigger” for Alzheimer’s. “For some women that does seem to be the beginning of Alzheimer’s disease.” Of all the risk factors for Alzheimer’s, the menopause is the only one that is specific to women.
Mosconi believes we can all do things to look after our brains better. A previous book was on diet and the brain. Now she is specifically urging women to get their brains in shape to face the menopause.
As someone who studies brain images she is a big fan of using scans for disease prevention, but their availability at a few specialist clinics rules them out for most people.
Hormone therapy can help to alleviate the symptoms that some women have during the menopause, but more research is needed on whether it can help to prevent Alzheimer’s and maintain cognitive function.
In the meantime, she recommends lifestyle changes, starting with diet. The right diet can act as an “epigenetic lever” for switching genes on and off in a way that can minimise the genetic risk of diseases such as Alzheimer’s and also ensures that the brain remains stronger longer.
In a nutshell: cut out trans fats and slosh olive oil around. In brain-imaging studies Mosconi and colleagues found that those who followed a Mediterranean diet had healthier and younger looking brains than those the same age who followed a typical “western” diet.
Her “three golden rules” on managing carb intake: 1) Vegetables should make up half the food on your plate at any meal. 2) Whole grains in; refined grains, such as white flour, white pasta and white bread, out. 3) Eat legumes and starches such as sweet potatoes.
She says that studies show that people who eat two servings of leafy green vegetables a day have fewer memory problems and less cognitive decline than those who rarely do. A study of more than 1,600 women showed that those who regularly ate flavonoid-rich berries, such as blueberries and strawberries, had slower rates of cognitive decline.
Plenty of fibre should have a good balancing effect on oestrogen levels, while natural oestrogen replacement therapy can come in the form of phytoestrogens found in soy, seeds, whole grains and many fruits and vegetables.
Brain imaging research shows that a diet rich in antioxidants including vitamin E and vitamin C is associated with steady brain energy levels and fewer Alzheimer’s plaques, particularly in women.
However, Mosconi contends that the single most important thing to do to look after the brain is to cut out processed foods with their trans fats and unhealthy chemicals.
The anti-inflammatory properties of omega 3s, found in fatty fish, are great for the brain and low omega 3 levels are linked to increased risk of depression. Refined foods can hasten the onset of the menopause. Full-fat milk, rather than skimmed or semi-skimmed, helps to promote hormonal health and fertility.
Treats? Dark chocolate with a cacao content of more than 70 per cent is rich in theobromine, an antioxidant that supports cellular ageing. Mosconi allows for “a small glass of wine” once in a while, and no more than once a day. And lots of water because even mild dehydration can lead to cognitive issues.
Mosconi cites new research that points to caloric restriction boosting cognitive capacity and reducing cellular ageing. It is also linked to boosting the brain’s antioxidant defence system, which is important for women in particular.
Some of her recommendations are sensible but obvious. Good sleep, managing stress (she’s a fan of meditation) and exercise are good for the brain.
Aerobic exercise pumps oxygen and nutrients to the brain and the antidepressant effects of exercise are well documented. Brain scans show that sedentary people have accelerated cellular ageing and brain shrinkage and more Alzheimer’s plaques. During the menopause and beyond she recommends less intensity of exercise, but more frequency. Brisk walking, cycling, swimming, yoga or a fitness class three to five times a week for 30 to 45 minutes should be the goal.
Mosconi is an evangelist for bringing science out of the laboratory and showing women — and the men in their lives — the problems that exist and how they can try to overcome them. She hopes to “validate what women have been saying for ever, that something is happening not just to their ovaries but also to their brains. This is a great time to change the conversation around aging for women. We don’t need to feel ashamed of getting older.”
The XX Brain: The Groundbreaking Science Empowering Women to Prevent Dementia by Dr Lisa Mosconi is published by Allen & Unwin on June 4, £14.99