What You Need to Know about Women's Brains

Welcome back, Kwik Brains. Here's your question of the day: what you should know about women's brains. This is going to be a very big topic. I'm looking forward to having this conversation. And by the way, if you're a man watching this or listening to this, this is important because we all have women in our life, females in our life that we care about. And I'm excited. Welcome back, Dr. Lisa Mosconi. Thank you so much for coming back. She is the author of Brain Food. I think we haven't had a lot of repeat guests, but you've been back a number of times.

Thank you.

I'm so glad. By demand. People have so many questions because you have an interesting perspective and an expertise with your background, you know, for decades. So people who are new, To her work. She's an associate professor of neuroscience, neurology, radiology. She's the founder and director of the Women's Brain Initiative at— it's—

Weill Cornell Medical College in New York.

Astonishing. And so she's done a lot of research in everything from Alzheimer's, especially, you know, the conversations you and I have been talking about is on women's brain health.

Yes. Now, why we're doing this specific episode on women, which is amazing because so few people actually really talk about women's brains. For so many years, there was this conception that men's brains were superior to women's brains, at least in medicine. Then there was, or in psychology, or, you know, there's even this saying that brilliance mathematics is a man's quality.

Interesting.

Yes.

Interesting.

Which completely disregards the fact that men have had access to higher education for so much longer than women, and that there are fantastic, brilliant female mathematicians in spite of that, right? And then pretty much the opposite happened, right? At some point everybody was like, well, I don't want to sound like sexist, so I'm going to say that men and Women have exactly the same brains, or that male brains and women brains are exactly the same, which is not true.

They're not?

No, no. I mean, it depends what you mean, right? So if I look at a brain scan, which I do for work, it's my background, I have a dual PhD in neuroscience and nuclear medicine, so I do brain scans for a living, basically. And there is no way to tell the brains apart just by looking at them. So it's not like your brain has some parts that my brain doesn't have. You know, anatomically, structurally, we're pretty much the same other than men tend to have bigger brains just because you guys are bigger than women overall.

Correct.

But the differences are more subtle, but they are real. There are differences in the way that our brains are wired. For example, women's brains tend to be more connected. So different parts of the brain are more connected than men's brains. And there are some chemicals and neurotransmitters that are more prevalent in men's brains and some other chemicals that are more prevalent in women's brains. Like you guys make more serotonin, which is a feel-good neurotransmitter, whereas women's brains tend to make more dopamine, which is a reward-oriented neurotransmitter, right?

Mm-hmm.

It makes you a little bit of an overachiever. If you will, in some ways. But the real differences are found in the ways that our brains age.

Okay.

Men's brains and women's brains age differently, and that is science. It's not a stereotype. It's not something to be ashamed of at all. It just is not like women's brains age worse. We just age differently. We develop differently. We mature differently. And that means that also our medical risks are different.

So what are some of those? What are some examples of those?

So what many people don't realize is that women have an increased risk of many conditions that affect brain health as compared to men. So women have twice the risk of depression and anxiety as compared to men. We have 3 times the risk of an autoimmune disorder that can attack the brain, like multiple sclerosis.

Mm-hmm.

We have 4 times the risk of headaches and migraines, and we have far greater risk of brain tumors like meningiomas, which are the most common brain tumors in the population. And we're also far more likely to die of a stroke. But probably the one thing that women are not aware of is that Alzheimer's disease, which is the most common form of dementia in the population, attacks women's brains More than men. It really hits women harder. So of every 3 Alzheimer's patients, 2 are women. This fact has been pretty much disregarded for decades because everybody would say, well, it's just that women live longer than men. And now we know that that's not the case.

This is so unfair.

Yes.

So what would you say to women and men who are listening that care about the women in their life? What can we do?

There are many things that we can do. And I think what's really important is number one, to recognize that there are medical risks that women really need to address and to be aware of. Number 2, we need to understand when the risk becomes something that you actually have to address.

Okay.

Right? And then number 3 is obviously how do we do that?

Okay.

Yes. So unfortunately we're starting to have answers to all these questions. So that's the good news.

That is good news.

Yes, it is good news. I'm actually very excited about the Women's Brain Initiative that I started at Weill Cornell just recently. We have done a lot of work to really address question number 2 first. So of all the risk factors that can potentially trigger Alzheimer's disease in women's brains, which risk factors are really important to address and when? And a couple of years ago, we started to really look into that using brain scans. And one thing I should mention is that Alzheimer's disease is not a disease of old age. We tend to associate it with the elderly because that's when the symptoms really become manifest, usually around age 70 in the United States.

Sure.

But in reality, It starts with negative changes in the brain decades prior. So we know that for most people, the Alzheimer's process starts in midlife. And midlife is anything between 40 and 60, for some people 65. But we have shown that the problem is not that women live longer, it's that women tend to develop Alzheimer's earlier. And specifically during menopause, which is age 51 in the United States.

So can we look at one of these brain scans? Yes, we can. So some people are listening to this and some people are watching this on video. So you could explain.

Yes.

Here you have the same brain.

This is the same person, the same woman who's been working with us for many years. And we gave her brain scans before menopause, when she was a premenopausal woman, so no signs of hormonal issues at all. And then we scanned her again during perimenopause and then again after menopause. So the scan to the left is called the fluorodeoxyglucose scan, Mm-hmm. or a scan that measures brain activity. So you want the— you want your brain to look really bright. So red means the most active your brain can be. Yellow is also really good, nice and bright. Green is okay, and blue is fine because there is fluid in the brain, and blue means it's just fluid, which is normal. But the point is that you want your brain to be as red as possible, as red and yellow as possible. So this is a good-looking brain, right? If you are in your 40s. Now what happens when she when when she transitioned through menopause and the other side of menopause six years later? later is that the red turned into yellow and the yellow turned into green. And this scan is a lot darker, it's a lot greener overall. And that corresponds to a 50% drop in energy levels in this woman's brain.

How many years approximately?

6, in 6 years. And it's not normal. It's definitely not normal. And the point is, when we started, we had like 60 people in total in the study because it was so hard to get funding to even look into this. And now we have hundreds and hundreds of people with brain scans, and this is the average.

This is normal.

This is not extreme. Wow. I thought maybe I just picked the most unfortunate, the women, whereas this is actually quite the norm. Typical? Yes, it's quite typical. We don't just do these scans, we do a number. We do like 9 different scans in every person in the study. And we showed that for women who do experience this drop in energy levels, that's actually when Alzheimer's plaques start to accumulate.

With the lower of the energy?

Yes. So as you lose, as your brain changes and loses brain activity and brain energy, this is also when Alzheimer's plaques start to become measurable.

Now, is it because of— I'm sure there's a number of contributing factors, but is it because of the hormones, the change in hormones?

We believe it's mostly the hormones. So this correlates with hormonal levels, but mostly really correlates with the symptoms of menopause.

Which are?

Which are like when women complain that they're having hot flashes and night sweats, insomnia, mood swings, depression, brain fog. A lot of women come to us because of brain fog and cognitive slippage and memory lapses. Those don't start in your ovaries, they start inside your brain. The reason being, we think of estrogen, progesterone, you know, FSH, LH, as hormones that are important for fertility and reproductive functions. But that's only because that's the first function that we discovered as scientists.

Mm-hmm.

It was only in the '70s that scientists found that the same hormones actually had a lot of functions in the brain. So they're not just sex hormones. They're actual hormones. They have— they're brain hormones. And especially estrogen is called, what we call it, the master regulator in the female brain because it's in charge of a number of functions from immunity. It really boosts your immune system inside the brain. It's important for growth, for plasticity of your neural cells, of your neurons. And mostly it activates your brain. It's a trigger for glucose metabolism. So it really makes your brain burn glucose to make energy. And so if the estrogen goes down, let's say all hormones, if the estrogens, plural, decline or are all over the place, these specific brain regions that are very estrogen-dependent shut down. And this is what we see on the scans and we need to fix it.

And so—

We need to fix it.

So where would you begin with that?

I would begin as soon as I can. So for me, my goal has always been to really make preventive medicine available to everybody. And I think that brain scans should be a part of what we do in terms of preventative care. And these studies really tell us that women need medical care and medical attention in their 40s and 50s. In some cases earlier, you know, like a friend of mine, she's fully menopausal and she's 42, and she's not an isolated case. And there's a lot of evidence that if your reproductive lifespan is short, your risk of Alzheimer's is high. For example, there are women who go through menopause naturally, and that usually happens when you're in your early 50s. But there are women who are literally plunged into menopause overnight because they get surgery. Like if you have your uterus removed or your ovaries removed, chances are you're going to be menopausal very, very shortly. And that correlates with as high as 70% higher risk of Alzheimer's. So women who undergo a hysterectomy or oophorectomy, which is the—

Oophorectomy.

OVIACs, or the surgical removal of the ovaries, have a much higher risk of Alzheimer's than women who do not. And we've known this for decades and nobody talks about it.

Right.

Nobody addresses that. Like, if you go to your doctor, to your surgeon, because you need a hysterectomy or for, you know, some people just do it because they don't want to have a period or they don't want to have hot flashes. But nobody tells you your brain might, Also experience a change. I think it's really important that women become aware of these changes, that there is nothing to be ashamed of or afraid of.

Yeah.

And so when so many women are confused, you know, I find that it's very common for women who are going through perimenopause to just feel like they're going crazy, like they don't know who to talk to, they don't know if it's a natural problem, they don't know if Maybe it's just them, you know, people don't talk about it. Doctors don't talk about it. Your mom doesn't talk about it, right?

Right.

Because there's this culture of just suppressing symptoms. And I think it's really important to raise awareness and make sure everybody's comfortable talking about it and asking for solutions because we don't have enough options. And I'm going to say this because I know you're not gonna be offended, but if men were having hot flashes, These would have been solved centuries ago. Whereas women have it, they go to their doctors and they very often get a prescription for antidepressants that don't do any good to the actual root cause of the problem, which is not addressing the actual problem. So I think we need to address it.

And so this takes a lot of the— I imagine, because with my women friends, They feel depressed, they feel alone, they feel confused, and they don't know why. So it also takes away some of the self-judgment. And I think it's so important to have compassion for yourself.

Yes. And the stress that comes with that, right? If you're cloudy, if you can't think straight, and nobody can help you, you don't know where to go for help, your stress levels are going to go up to the roof. And if your stress goes up, your sex hormones go down because they're imbalanced. And so you're making it even worse. So there's so much— And it becomes a cycle. And then becomes a cycle and it's really hard to break it. So many women can't sleep. So many women have stress, especially in our 30s and 40s and 50s when we're most likely juggling a career, kids, a partner, and your parents also who probably are going to need help at some point. And that's the time in a woman's life when she really needs to take care of herself. And the most common answer is, I just don't have any time. I just don't have time.

Right.

So we really need to address that because taking care of our brains today is really going to make a huge difference in the future.

So for everyone that— women that are watching, what's the best way for people to stay in touch with you?

I would say Instagram, dr_masconi.

Okay, and so what we recommend everyone do, and we'll put this all in the show notes at jimkwik.com/notes. We'll put a link to your website.

Yes.

I recommend everyone in the meantime, if you haven't listened to our previous episodes with Dr. Mosconi, please do so and get her book, Brain Food. It's absolutely extraordinary. And also take a screenshot of this episode and tag Lisa, tag myself in it, post it, and as always, share your big aha. What is your big aha that you got out of this conversation? Because we know when you share something, you get to learn it again and again. And also, that's the other way we learn something. We want to learn it for ourselves and then learn it for other people that we care about. And thank you so much, Lisa, for being back on the show.

Thank you for having me.