Dr. Lisa Mosconi
Appearances
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
The brain is the most energetically expensive organ. And it does run on glucose, no matter what other people think. It runs on glucose. There are other energy sources as well, but at least through menopause, every time you burn glucose for energy, there is oxidative stress that's been produced.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And if the amount of oxidative stress in free radicals exceeds your brain's ability to detoxify, which is not a trendy term necessarily, really the brain needs to get rid of these free radicals.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Medical detoxification, yes. The only way is to supplement from the diet. So you need to import antioxidants from your bloodstream. It's basically the only way to supply antioxidants to the brain. And it's a very important thing to do. Because antioxidants just damage everything. They have a rusting effect. They make your cells age faster. They impair metabolic reactions.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
They impair cellular reactions at all different levels.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
They'll age you, yes. Right? Yes, you can't see it. Hit them with the vanity.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Yeah, yeah. I meant you can't see it in your brain that it's aging, but you can trust the science that it is. So I think it's really important to focus on foods that have rich in antioxidants, and those are fruits and vegetables and some nuts and seeds, some whole grains as well.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
So it's one more reason to, you know, there's this way that people, this terminology people use now to go plant forward, right? And I think it's a good way to think about it. You want to up. your consumption of produce, basically. Fruit and vegetables. If you don't eat fruit, at least eat the vegetables, because they really are the best source we have of readily available antioxidants.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Most people think blueberries, and blueberries are a wonderful thing to eat. There are other foods that provide even more antioxidants, like blackberries. If you like berries or goji berries, or... The Indian beer is called amla. Yes, it's one of the most powerful foods in terms of antioxidant capacity. And artichokes. highest antioxidant capacity of all veggies, as far as I know, at least.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Goji berries, great source of vitamin C. Some little plums are also really good sources. And then lemon, orange, grapefruit, and leafy vegetables, cruciferous vegetables, all sorts of vegetables. Those are really important for brain health as well. Also, they contain fiber. And fiber is important not only for digestive health, for a healthy microbiome, but also to regulate estrogen levels.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
So fiber has a positive effect on this protein that's called the sex hormone binding globulin that regulates the amount of free estrogen relative to bound estrogen. So it regulates endocytosis and other hormones, but it regulates bioavailability of these hormones in the bloodstream. So it's important to eat fiber for that reason as well.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And then there are very specific nutrients that provide nutrition for the good bacteria in the gut. They're called oligosaccharides. They're a type of carbs that we don't really fully digest in the stomach. So they... land in the intestine almost untouched. And it's what this good bacteria that we have in our guts, the microbiome, feeds on.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And there's one interesting part of the microbiome that is called the astrobalone that has been discovered recently that is a part of the microbiome that specifically helps to regulate estrogen levels in the bloodstream.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And you can damage these microbes by eating processed foods or not eating enough fiber in your diet and by taking antibiotics or by ingesting other chemicals that can disrupt your flora, your intestinal flora. Or you can keep them healthy by making healthy choices and eating enough fiber and drinking enough water and having enough of the antioxidants and anti-inflammatory foods as well.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
So there's one more reason to go plant forward, if you will, which it really can just come down to eating enough fruit and vegetables throughout the day.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Yes. So my research, as you know, I'm a brain scientist by training and I do brain imaging or brain scans for the living. And they usually focus on Alzheimer's disease, the risk of Alzheimer's and how to prevent Alzheimer's disease, especially in women. And there was my research on cognitive aging and dementia.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
that led me eventually to study menopause as a risk factor for Alzheimer's disease and cognitive aging in women. So this is an interesting connection that was not really fully explored until we came along. In some ways, there was a lot of preclinical research, but what was missing, I think, from the picture was a very clear
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
illustration of how menopause can impact the brain as women go through it. So there was research showing what would happen, what can happen to women's brain health after the fact, right? So insofar as research had any interest in menopause until 2017, it was always in terms of the outcomes. So menopause was seen more as an endpoint rather than a process.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And for me, the question was what happens during, right? Can I catch any changes by looking at women's brains before, during, and after menopause? And to me, as a woman, besides a scientist, I was shocked to realize that it really had not been done. That was 2017. I come from a completely different line of research.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And I was like, okay, I understand that menopause is so important for women's brain health. What's been done already? How do we build up on it? and nothing had been done in terms of before and after. So I went to my team and they said, I realized that this is different, what we've been doing for the past 15 years, but we need to, we need to do it.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And so we gathered, we enrolled a lot of women in the study and we started doing brain scans and we were able to map the neurological effects of menopause in women going through the menopause transition. So these are the brain scans. These are some of the brain scans that we've done.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
So when we started, we had 60 women in the study, 20 premenopausal, 20 perimenopausal, which is the in-between, 20 postmenopausal, and we compared them cross-sectionally, right? One woman against another woman. But the real question was, what happens to you as a woman, as you yourself? transition from a reproductive to a non-reproductive state? Is it just your ovaries that change?
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Does that really impact your brain? So let me show you. Yes, yes. Well, we started gathering evidence and now more and more investigators are trying to do the same. So we have more data, we have more information, which is really great. This is one of the very first patients who has been working with us for many years because going through menopause takes a while, by the way.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Most people think it's like overnight. Absolutely not. It can take a decade to fully go through menopause. Now, we worked with a woman, many women, but this is a patient who was 43 years old.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Yes. And she went through menopause a bit early. And we can talk about that.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Exactly what the range is. But the important thing is that we were able to map her transition in a reasonable amount of time, right? In like less than 10 years, which means she's been with us for 10 years at this point. And I've been doing this forever. This is 10 years of my life. But yes. So this is the type of brain scans that I specialize in.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
This is called the positron emission tomography or PET scan. that looks at broadly brain energy levels in the brain. We use a tracer that's called fluorodeoxyglucose, which maps the intracellular concentration of glucose, a simple sugar, in the brain. Why? Because the brain runs on glucose. So glucose is the primary energy source for the brain. So this is like the fuel that the brain utilizes
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
produce energy or ATP at the cellular level. So these kind of brain scans shows the speed at which the brain takes up glucose from the bloodstream and converts it to energy. So it's awesome, isn't it?
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
It's amazing. Yes. And you want your brain to look really red when we're using this color scale.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
It shows that your neurons are hungry for energy and they're burning energy. They're burning glucose efficiently, which is wonderful. It's a sign of a healthy brain. And you want your brain distribution to be mostly like this. So isometabolic, which means that the left side of the brain is as bright as the right. It's kind of symmetrical. In the top... which is called the frontal cortex.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
It's brighter, but almost as bright as the very bottom part there, which is the precuneus or the parietal cortex and posterior cingulate cortex. And then you want these little structures in the middle that looks like I don't really know what it looks like, but the little butterfly shape in the middle, which is the thalamus, the basal ganglia, to also being really nice and bright.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
So this is a wonderfully looking brain.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Yes, this brain has all those things. This is the before menopause. Yes, this is what you want your brain to look like when you're like in your forties. So really nice and bright with a lot of red and a lot of yellow and a lot less green and blue, okay? But then we're superimposing the after menopause scan on the before menopause scan so that we can really see the change in the brain.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And I think you can see how the red turns yellow and the yellow turns green and the whole scan, the whole brain turns greener.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Than ever before, there's a lot less red. It's like fading. in a way, and we're going to loop the image so we can see it again. Right, so this is a boom, bright. Now you see it's really, really red, very activated. And then pretty much the whole cortical mantle declines in terms of energy utilization and production. So we can put them side by side.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Yes. So the after was before age 50. So that may have been like less than seven years.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
That's a lot. Yes, it's significant, I would say, especially in seven years, right? Not all women show these changes. Not all women go through menopause in seven years. Usually it takes longer. But I think this is a really good... example of what can happen, metabolically at least, as women go through menopause.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
So there's no... I think it's obvious that the after scan is different from the before scan, which was taken by many as conclu... more conclusive evidence that menopause impacts the brain, right? Menopause changes the brain. Because really, many clinicians still don't believe that. Many scientists do not believe that or are not aware of that.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
So I think that this was very helpful to many to see, oh, now I have evidence that I can actually discuss and talk about. There's something... that I can see, that I can quantify and measure is not just women's imagination. I don't know why we have to clarify that, but evidently we do.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
So I always say our work is largely about validating what women have been saying for thousands of years and providing a good level of evidence that this is true. It's not just all in your head, like many people believe. So we're legitimizing women's experiences for centuries, basically.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And we're trying to raise awareness that this is not just something that happens in the brain and stays in the brain. There's behavioral correlates, there's symptoms, there's medical risks that come from these changes.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Oh, it's perfect. Yes, it's completely accurate. And thank you for saying that. I think as a society, we have missed pretty much 50% or half of what menopause really is. So menopause is a neuroendocrine transition, which means that your brain and Your hormones are all in transition. Your reproductive organs are changing and your brain is changing accordingly.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
But if you think about the way the menopause is perceived in society, it's all about fertility. So most people realize that yes, something is happening to the ovaries and then you're going to stop having a menstrual cycle. You won't no longer be able to have children. So menopause is usually seen as the end of fertility.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And because in Western societies, most of the Western world, really a woman's worth is usually associated with her ability to carry out a pregnancy and have children, that menopause is seen in the extreme negative as something that is a problem for women that we need to either completely ignore and not talk about or heavily medicalize.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And I think it's really important that we get a clearer picture of menopause and isn't. And that really starts with understanding the connection between the brain and the reproductive system. And this is important not only for menopause, but for life, right? So I try to clarify in the book and in my talks and in my work also that we think of aging as a linear process.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
You're born and then you grow and then you age in this kind of linear overtime stable. That is not the case for men or for women. There are very specific transition states that accelerate growth and then accelerate in others that accelerate aging. So it's more like a step ladder of sort. And for women, there are three very important pivotal times, which I call the three Ps.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Puberty, pregnancy, perimenopause, which is the transition to menopause. Can I talk more about it?
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
So I think it's so important to realize that we are born with a very important system in our bodies that connects the brain to the reproductive organs. We never talk about this system, but it's right there, and it's a strong driver of brain health and longevity for both men and women, right? So we are born with a sort of gigantic system that neurological.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
system that connects the brain in women with the ovaries and in men, the brain with the testis. This is called the neuroendocrine system that connects the brain, your neurons, to your hormonal system, the endocrine system. And in women and men, this system is actually activated as we go through puberty.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And that leads to a complete remodeling, as we all know, of the body from the neck down, but also of your brain. Your brain changes massively when all human beings go through puberty. We can talk about it if you like a little bit more, because it's important to understand pregnancy and that menopause in women. But then this same system is reactivated during pregnancy.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Every time a woman goes through pregnancy, it's not just the body that changes. You're not just having a baby. You are effectively remodeling your brain to prepare for motherhood. And we just really never acknowledge that as something that is worth being happy and proud of. And I would love to change the narrative around this as well.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And then the system, however, this neuroendocrine system is shut down after menopause because you no longer need to have kids. So this very elaborate and metabolically expensive system has no reason to be there anymore, so we're going to turn it down, which is a way more efficient way to live and move forward than just keep carrying all this infrastructure you no longer need.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
But that leads to another remodeling that in this case comes with some glitches. like the symptoms of menopause that everybody is concerned about and that so many women experience. Over 80% of all women experience neurological symptoms during menopause, brain symptoms. They just don't realize that those symptoms come from the brain.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
So when women say that they're having hot flashes, night sweats, insomnia, depression, anxiety, panic attacks, memory loss, forgetfulness, brain fog, Those are all symptoms of menopause that do not start in the ovaries at all. They start from the brain. They are neurological symptoms. We're just not used to thinking about them as such.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And therefore, we don't quite know how to address them properly because menopause means OB-GYN territory, right? But half of this transition is actually neurological and there are no brain doctors involved.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Do you want to see it? Yes, please.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Yes. So these are quite a few studies that nobody seems to know about. They're mostly from Europe and some from the United States where scientists have very creatively started thinking of menopause not as a loss or as a medical issue, but as something that has a reason to be. And it's the grandmother, the grandmother of artists that we were talking about before.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
But this is what the data shows, right? So before menopause, let's say your life satisfaction starts at whatever level on the Y-axis, right? So it's pink, the pink line. For many women, life contentment and happiness takes a dip.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
during perimenopause, which is the transitional phase during which we start skipping periods, and all these symptoms can make the first appearance and usually hit you hardest, like the half flashes and the forgetfulness, the depressive symptoms, lack of sleep is a huge one, right? And life satisfaction goes down accordingly, which honestly is no wonder.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
I would say many women report not being as happy or having a hard time. But what was striking to me is that once the transition is complete and we Basically, we merge into the postmenopausal stage. At some point, like two or three years, sometimes up to six years after the final menstrual period, life contentment resumes and it starts increasing.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And at some point for many women, it will be even higher than it used to be before. And what's important is the variability, right? So we have the pink line that shows the average change, but then we have a lot of variability, which is the pink to blue shadow behind, which really says if menopause was the same for all women, we would have very little variability. But the variability is huge.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Also during perimenopause, it can range from the very top of the curve to not having any issues, your life satisfaction pretty much remains the same, to being extremely sad and depressed. And the outcomes are generally positive, but they're more positive for some women and not as positive for other women. So the question for me was why? What are the factors that can make menopause better for you?
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
What are the factors that can help you or not? How do we prepare? And how do we keep our brains healthy after the fact? So a lot of my research now is really focused on menopause. and specifically hormonal transitions for women. And men, we're starting a program for men as well because You know, not everybody realizes that men go through a sort of menopause too.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
It's called andropause, which is different, is more gradual, and usually hits in the 70s and 80s, but it does happen. And there are hot flashes, and there are sleep disturbances, and there's forgetfulness and other concerns that I think are very important to investigate for men. as well, and then address.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
I believe that lifestyle plays a crucial role in brain health overall, and you and I have talked about this before. And I think this is especially true when it comes to menopause as well as puberty and pregnancy. It really, the way you live your life and the choices you make have a huge impact on your health. not just your physical health, but your cognitive health and mental health as well.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
And one reason for it that I like to discuss is that the brain is not like the other organs in the body. So most of our organs, the cells in most of our organs regenerate continuously. there's a very rapid turnover. So if you look at your blood cells, they're constantly discarded and regenerated every three months, right? If you look at your hair, you lose hair very often, but then it regrows.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Even the skeleton is renewed at a rate of 10% a year. So whatever change you make in your lifestyle, whether it's diet, exercise, stress reduction, you can see the effects very quickly because your body is optimized for change. Not your brain. Your brain is optimized for stability. So our neurons do not regenerate.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Some can grow over time, but most of the neurons we have are born with us and stay with us for life. So the best way to have a positive impact on your brain health is to be consistent. This is why quick fixes do not work. From brain health, these three weeks magic plans that people try to sell, not happening when it comes to brain health.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Because if you could change your brain in a matter of day, we would all be mad. We need to protect.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
It's good that your brain is stable.
Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
But the changes then are long lasting. So lifestyle practices that are done consistently frequently enough for a long enough period of time have the best chances of making a positive or negative impact on brain health.