In Part 1 of our conversation with neuroscientist Dr. Lisa Mosconi, we learned about the connection between estrogen, menopause, and Alzheimer’s.

In short, in perimenopause and menopause, as estrogen declines, women lose some of the neuroprotective advantages of the hormone, making them more vulnerable to Alzheimer’s disease.

Make sure to listen to Part 1 to get grounded in the science. In Part 2, Dr. Mosconi lets us in on how we can help protect our brains from the cognitive decline of Alzheimer’s. Food, exercise, intellectual stimulation all have a part to play, so you’re going to want to hear what Dr. Mosconi has to say. (Bonus: a lot of these tips can help men age better, too.)

Learn more about Dr. Mosconi, the Alzheimer’s Prevention Clinic, and how you might participate in their research. If you want to start nourishing your brain against age-related decline (“eating for retirement,” as Dr. Mosconi puts it), get your hands on a copy of her fascinating and very readable book, Brain Food: the Surprising Science of Eating for Cognitive Power.

What does nutrition have to do with our brains?

Jill:  So, we talked a lot about HRT and estrogen and the power of hormones. But for those women who can’t – you obviously have done a lot of work in this area as well, and you’ve recently released a book, titled Brain Food: The Surprising Science of Eating for Cognitive Power, and this starts to address the alternative, I think, if you will. I really want to hear more about the book.

Dr. Lisa:  I’m a neuroscientist and also a nutritionist, and I find that there is a lot of confusion around healthy diets, especially diets for the brain. So I decided to write the book as a scientist’s answer to all those questions. Like, is it true that some foods can really affect our brain performance and impact our mental capacities? Is it true that diet influences risk of Alzheimer’s as we get older? Is it true that high-fat diets are great for you and for your mental performance? Is it true, is it true, is it true… I get a lot of these questions, and I thought: well, I can write another several papers in scientific journals and nobody will read them; or I can write a book for the public that is based on solid, peer-reviewed research and hopefully provide some clarity. That’s really the purpose of the book.

And the reason I did it is, number one, it’s part of my research. I’ve been working in the field, I’ve been looking, I’ve been researching brain nutrition for at least 10 years, I think, at this point. We use brain imaging techniques to really look at the effects of diet on the brain in real-time, because most research was done before brain imaging techniques even became available. And so, what people would do was to measure diet now, and then wait 10 years to see if somebody would get Alzheimer’s or mild cognitive impairment or show any signs of cognitive decline and then try and correlate that with diet. But that’s kind of bypassing the brain. So our question was: well, what’s happening in the brain that’s really related to your diet?

So that was my research and I think it … it is still my research, I’m still doing it. It’s really important, because as a society we are comfortable with the idea that we eat for our bodies, but we’re not as aware that we feed our brains as well.

And I think it’s really important that we spend a little less time focusing on the immediate present, like, “ok, I need to slim down for the wedding,” “I need to go out on a date,” “I need to prepare for summer” – that’s usually why you change your diet, but I think we should also really start thinking about our future and focus on the fact that some foods and nutrients can help us age gracefully and keep our mental capacities intact. Whereas other foods will have the opposite effect and really increase the risk of dementia and cognitive deterioration down the line.

So, in a way, the same way that we would like to save for the retirement, we should also start eating for retirement. And that’s what I wanted to share.

So what should we eat to fuel our brains?

Jill:  Oh, I love that – eating for retirement! So, I obviously want you to sell more books and I don’t want you to give it away, but of course, I… I’m going to ask two questions. I’m going to say: what should we eat to prevent or to fuel our brains? And what do we want to stay away from? And I’m sure there’s so much more in the book that’s covering all of this. You’re not going to totally give away the punchline, but please share.

Dr. Lisa:  Sure, no, gladly! So, what should we eat? I think because we’re doing this podcast about women, I would like to focus on what women should eat as well. There are, of course, foods that are helpful to both men and women. And I think, in general, it sounds intuitive. The problem is that just so many people don’t do that.

We should all really, really focus on fresh vegetables and fruit, fish, healthy, unrefined oils, healthy sources of glucose, which is really important for the brain, because the brain runs on glucose. And also drink water. I find something that so many people underestimate is the impact that water has on brain function.

So, the brain is made of water. 80% of the brain’s content is actually water. And every single chemical reaction that happens in the brain needs water to occur, including energy production. So, if you don’t have water or you don’t have enough, your brain will just not be able to make energy.

And this is really important to understand, because even a minimal loss of water, like 2% reduction, which is not even clinical dehydration, it’s just a very mild dehydration – it can actually cause neurological symptoms, like brain fog, confusion, fatigue, dizziness and even worse. Brain imaging studies have shown that people who are just mildly dehydrated show brain shrinkage as compared to those who are well-hydrated. You don’t want your brain to shrink.

Jill:  Right, no, absolutely not! And water is easily attainable.

Dr. Lisa:  And what is even more important is to talk about the quality of the water. Because I had so many people come up to me and say, “hey, I’m drinking water right now.” And I say, “hey, that is purified water.” That’s not water – it does not have any minerals, it does not have any electrolytes. That is not water, it’s just fluids. It will not help you at all. And some of my friends will be like, “oh, but I’m drinking club soda or seltzer,” that’s not water. It’s not water. It does not contain the nutrients that keep you and your brain hydrated.

Tap water should be accessible to a lot of people. I understand, in many parts of the country, it’s just not good. So, it needs to be filtered. If you filter your water, you have to take supplements – mineral supplements and electrolytes. It’s really, really important!

Specifically, for women there’s evidence that women, more than men, really need plants in their diet. Especially if you are menopausal or you’re in your 40s. There are some foods that really support production of estrogen in the body. And that could help.

There are some foods that actually contain phytoestrogens. And phytoestrogens are estrogens from plants. The really interesting thing, if you’re a scientist, about hormones, is that they go cross-species. So, hormones that are made by plants pretty much mimic whatever effects human estrogens have in the body. So, that’s very helpful… you can eat plant-based foods and have more estrogens inside your body or other compounds that mimic the effect of estrogens.

The foods that are helpful specifically to women to support estrogen production would be sesame seeds, flax seeds, chickpeas, all sorts of legumes; many fruits like apricots, strawberries. Veggies like yams, carrots, kale, celery; of course, the soy products. The soybeans are very rich in estrogens in a compound called Genistein, I think, that has a similar function as estrogen inside the body. So, women probably would do well to really up their veggies and fruit in their diets starting from age 40. And even much more so than men.

What should we not eat to protect our brains?

Jill:  What do we want to stay away from?

Dr. Lisa:  We want to stay away from processed foods, fast food, deep-fried foods. And we also want to minimize the amount of animal products in the diet. All these foods, overall, are pro-inflammatory, and they cause inflammation everywhere in the body and the brain. There’s evidence that some ingredients in these foods are especially bad news for the brain, like trans-saturated fats; saturated fat when it’s too much. Copper, as well, for some reason, is really a problem inside the brain.

There’s evidence that people who consume more than 2 grams of trans-saturated fat a day have twice the risk of dementia than people who eat less than 2 grams a day. And 2 grams is not much.

Who has it figured out?

Jill:  That just explains the epidemic nature that you’re projecting in Alzheimer’s, because that is how the American public eats or a large portion of people eat on a regular basis. Have you studied then … obviously if this is so related to diet and diet is very cultural, have you studied the growth and rise of Alzheimer’s amongst the Japanese culture? Because the diet you laid out there, many of those aspects they embrace … lifelong.

Dr. Lisa:   They do and they don’t. Even in Italy … Italy is considered a Mediterranean country, I mean, we are a Mediterranean country. We are known for our diet and our food. But now, whenever I go back to Italy, it’s quite evident that more and more people are actually adopting a Western diet, because it’s more convenient. You know, nobody has time to go to the farm and pick up fresh fruits and veggies and spend 3 hours cooking. And so for convenience they start eating processed foods.

And I don’t remember whether this is in Japan or China, but for Christmas they actually go to KFC. It’s the Christmas special. So culture … unfortunately, diets everywhere are changing for the worse.

So, it’s really interesting I think to look at centenarians – people who are hundred years old or older than that, and they still have their mental capacity intact. In fact, they’re much healthier than all of us put together, basically. There are some longevity hotspots everywhere in the world, they’re called the “Blue Zones.” One is in Italy, in Sardinia; there’s one in Greece; one in Japan, Okinawa – it’s an island of Japan. There’s one in Costa Rica; there’s one in California, actually, Loma Linda. There’s one in China; and in a little town in India. Pretty much everybody there is a centenarian.

And, if you look at their lifestyle, overall, they’re very similar, regardless of whether they are in Italy ,in Japan, in South America – they share common principles. And for diets specifically, all of them follow plant-based diets. They’ll have veggies two or three times a day. They start with a big breakfast and a smaller lunch and just a little bit of something for dinner. They’re high-carbohydrate diets, they’re veggies and fruit, local, fresh, seasonal; and then they’ll have healthy grains and sweet potatoes, potatoes, fish – many of them eat fish. They of course drink water. Occasionally, they’ll have a little bit of alcohol, but it’s made in the house. And animal foods like meat or dairy or eggs, they’re more like treats. And also, sweets are very hard to come by. They’re making it with honey or maple syrup or whatever is local and sweet, but that could be like a Sunday special. I think their diet should be an inspiration to all of us, because they’re clearly doing something right.

Jill:  Do you make any estimations around to what degree could diet minimize the onset of Alzheimer’s?

Dr. Lisa:   I think it’s hard to tell. We need clinical trials to really look into that. But I think, based on the epidemiology, it should have a fairly large impact.

We now have clinical trials that actually show an effect of lifestyle modifications on risk of cognitive decline. There’s a very large study called the FINGER study, it’s done in Finland. And they show that if you take a group of people and really do a complete revamp of their lifestyle and change their diet, the way I’ve been talking about, and you have them exercise consistently, nothing crazy, just consistently, even just walking. You keep them intellectually stimulated and also address cardiovascular risk factors, then those people really improve cognitively over time. There’s a 150% improvement in executive function.

What should we do to stay sharp as we age?

Jill:  So that’s physical. How about mental? You see a lot of new apps and tests and things coming out that if you keep your brain stimulated, you can ward off… I see you rolling your eyes. Tell us more about that, what do you think?

Dr. Lisa:   I think there’s evidence that … it’s controversial, it’s controversial. I think that companies have to market their products in a way that makes them very appealing to people and so saying that “this is going to help you avoid Alzheimer’s” is a strong factor in driving sales. I think we need a lot more research to see if playing a little game makes you a little better at the game, or really improves your memory in every aspect of your life. I think that’s a little bit of concern among scientists, that you’re not necessarily improving memory – you’re improving people’s ability to play that particular game, right? And there are clinical trials that show how intellectual stimulation of that kind actually helps. And there are trials that show the exact opposite. So, I think we need more work. It’s wonderful that people are interested in doing that.

But outside of apps and games, there is actually evidence from very large-scale studies that intellectual stimulation definitely helps. You need to exercise your brain, it’s like a muscle. You either use it or lose it. Connections between neurons are only strong if you keep them linked together. We have this saying in the neuroscience that “neurons that wire together, fire together.” Keeping your brain intellectually stimulated is actually really good for you.

These studies are, again, in France and Italy, but they show that if you’re like… I think the average age there is between 50 and 75, so people who keep intellectually stimulated by playing board games show very low rates of decline to dementia, as compared to people who never play board games. Even playing cards or Scrabble, and that kind of board games – they really keep you engaged and intellectually stimulated and also have a social component. They keep you part of the community. It looks like being part of a community and the sense of belonging is also preventative against dementia. Just feeling supported and loved – I know it sounds a little strange or corny, but it’s true.

Jill:  And I think, it’s important to note the difference between board games or intellectually … keeping your brain active and its correlation to dementia versus its correlation to Alzheimer’s.

Dr. Lisa:  Dementia is basically a larger and broader term that includes many different kinds of pathologies. Alzheimer’s is the most common form of dementia, but there are other forms of dementia as well, like vascular dementia is very prevalent; Parkinson’s disease with dementia, frontotemporal dementia, Lewy body dementia – there are many different forms, but most people with dementia actually have Alzheimer’s or a combination of Alzheimer’s and something else.

What are the most important steps I need to take?

Jill:  I could keep this conversation going forever; I don’t want it to come to an end, but like every good thing, we’re going to wrap this up. And I hope to continue down a few different lines in the future with you, Lisa. But as a closing note, what would your advice be? I’m a 44-year-old woman. What is your advice to me in terms…? Obviously, I heard diet, but what do you recommend, in terms of me taking control of my health and “eating for retirement” and thinking about protecting my brain as I head into menopause myself?

Dr. Lisa:  I think everyone one of us would really benefit for a very complete evaluation. I think this is a good time to get a baseline that really looks at every aspect of your health and not just your diet – although, of course, diet is very important – but also your sleep quality or your exercise activity levels, that’s also very important in women to prevent osteoporosis and heart disease as we get older.

Stress – are you stressed out, are you not? Because stress really increases inflammation everywhere in the body; actually, seriously increases risk of cardiovascular events. How much coffee do you drink? Do you take medications? What’s your family history? Also, since we are talking about women and fertility, I think it would be really important to find a doctor, preferably a neurologist who also understands hormones, or an endocrinologist or OB/GYN who also understands brains. Otherwise, find more than one doctor so that you really get all the support that you can get.

Or, come to the clinic, since this is exactly what we are doing. So, we just started a study on women’s health and Alzheimer’s risk, and that’s exactly what we offer. And it’s a research study, so it’s free.

You know, get a baseline. Just really look at everything you can possibly look, so that you have it. And then you can check if there are any changes as you get older and you go through these different stages in your life. I, personally, I want to get a brain scan.

Jill:  I think you’ve made all of us want to get a brain scan, at this point. Well, Lisa, this has been, I think, riveting, in terms of the knowledge that you are bringing to the world, and I’m such a fan of your work. Thank you for what you’re doing. Thank you for joining us today.

Dr. Lisa:  Thank you so much for having me – real pleasure.

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Shannon Perry

Shannon is a celebrated author and global educator. Whether she’s interviewing a physician or producing a podcast, her appetite for research, facts, and truth culminates in credible health education and programming that women can rely on. An avid runner, cyclist, and climber, Shannon knows a thing or two about thriving in midlife and lives in Seattle with her cat, dog and boyfriend.

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