Women's Brain Health: Environment, Hormones, Menopause & Neuronal Pruning with Dr. Sarah McKay

On this episode of the Resetter Podcast, I bring you Dr. Sarah McCuy. Woo, you ready for some neuroscience? This is so good. And let me just kind of queue up what you're going to hear because I think your mind is going to be blown. First, I'm not met another human that loves neuroscience more than I do. But I would say that Dr. Sarah McCuy may have 10 times to me. Now, she committed her whole career to this. But if you look at her Instagram, which I highly recommend you go and look at, she has combined neuroscience. She is an official neuroscientist with women's health. And her focus is really helping us all understand the female brain. I love that she has on her Instagram. She calls herself a science communicator. And she absolutely is that. And she is the author, a three time author, but the most interesting one that she has brought forward is called the Women's Brain Book. And she just redid the, she did a second addition with new information in it. So what I wanted to bring Sarah to you all for is to, again, help us understand these brain changes that are going on after 40 as our hormones shift. And you've heard me talk a lot about Lisa Moscone. I did an interview with her about a year and a half ago. You've heard me talk about my new book, Age Like A Girl, which is all about the rewiring of your brain for the positive. And now you're going to hear the nerdy scientist. And I promise you it's going to be entertaining. So in this episode, we talk about this idea that Lisa brought forward, which is the pruning, the pruning of the neurons. What does exactly does that mean? How does that happen? We then dove into lifestyle tools for things like dementia. This one was really interesting about where does memory loss come from? And is dementia preventable? And you're going to be shocked at what she has to say. She says, based off science, HRT is not proving to prevent dementia. But she does list out about four or five different things that I had never even thought about. That can help to keep our neuroplasticity up and prevent things like Alzheimer's and dementia. Of course, we had to talk about metabolic health and how it related to neurons. We dove into neurotransmitters and the whole system of neurotransmitters and how that works in the female brain. It's super interesting and don't be scared by the science. I think we both did a really good job of keeping it applicable. And I made sure that anywhere that she got a little too sciencey that we dove into, how do we apply this to our everyday life? So I'm, this was probably one of my favorite conversations I've had on my podcast. I love some of the new science she's bringing. I will tell you that one of the conversations I've been wanting to have is around the menopause messaging that is happening out there. I fear that we are putting everybody into this chaotic crisis, fear state around menopause. And Sarah really shed some light on that and where she sees the menopause conversation going. She also brought forth some new science that she just received today on the messaging of menopause out in the world. So when I say this is a deep conversation, I am not joking. This is a very likable neuroscientist who is on a mission to help us all understand the female brain. So Dr. Sarah Makai and we will leave a link for her five day course. You will hear about it at the end if you're interested in learning more. But as always, I hope this helps and most importantly, I hope it helps you understand yourself better. Dr. Sarah Makai, enjoy. Welcome to the Resetter Podcast. This podcast is all about empowering you to believe in yourself again. If you have a passion for learning, if you're looking to be in control of your health and take your power back, this is the podcast for you. Well, first I just have to start off by welcoming you to my podcast, Sarah. You don't know this, but I've been stalking you for several years now. And I only mean that with loving. I only mean that with the lovey stalk. I just love neuroscience and I love what you've been up to with the female brain and educating all of us on it. So this is a real treat for me. So welcome to my podcast. Oh, thank you for the invitation. Thank you for stalking me. Yeah, I know. It's funny because it's a term we use a lot in my household because people stalk me. And then when they run into me in public, they're like, oh my god, oh my god. And I'm like, and I just laugh and I walk away. And I always tell my friends, I'm like, they just, you know, it's a kind kind of stalking. It's like they're diving to your information, but it feels a little stalkery. So anyhow, here's where I want to go with this conversation today. I've been on a 10 year quest to understand what is happening to the female brain and body after 40. And it started with observing patterns of women in my clinical practice that would come into my office and say, like, I have an amazing house. I have a beautiful husband. My family is incredible. And I think I want to kill myself or women that would come in and just say, I'm completely become stress intolerant. And I watched this pattern of really healthy, happy women dramatically shift through this process. Whereas on the other end of the spectrum, I had a lot of 70 and 80 year olds that seemed happier than ever before. And so fun to be around and calm and nothing ever bothered them. And so I started to really look at like, well, what's happening to the female brain between 40 and 60? There is something we are not talking about. So I want to start with that question to you is what is going on with the female brain as our hormones shift? My goodness, that's an enormous question. I'll caveat it by saying we don't know quite enough to be able to tell a nice coherent story right now. But there are some amazing scientists who are working very, very hard to fill the gaps. I know it's a bit of a narrative. We don't know much about women's health. Particularly within the neuroscience space. But there are amazing neuroscientists around the world who are working away doing the hard work. I just am here to help translate that work for them. When we think about the brain, it's a very big question because when we're thinking about how our brain changes, there are so many ways in. And then when we add hormones in as well, it gets a whole lot more complicated. So we could start by sort of zooming all of the way in and look at what we know about how hormones, as they even flow, dial up during pregnancy, dial down, even flow across immense recycle and then kind of roll a coaster through perimenopause and then fade away. How they change individual neurons and neurons structure and synapses and spines and dendrites on neurons. We could zoom out a little bit more and look at how those changes impact brain structure itself. We could look at how brain networks, so little kind of cohorts of neurons, how they network together, what we might call functional connectivity in the brain, how that shifts in shapes and changes across the lifespan and in response to hormones and in response to everything else that's changing around us. And then I suppose we could zoom out even more and look at what to do we know about how these changes underpin what women think and feel and how we might behave and react and respond. So when it comes to the brain, there's lots of different levels in which we can study the brain and talk about that. So I don't know where you want to start. Yeah, it's like zoom out or zoom out or something. Yeah, well, I think what I want to start with what Lisa taught me on a podcast interview and it was this idea that when estrogen starts to decline, there's a pruning process. So that would be going at the level of the neurons that there's a pruning process that is making way for a new brain to form that. That's a, that's a, yeah, talk to me about that. Yeah, that's a cool, that's a cool kind of concept and way of thinking about it. And I think we see this concept of pruning, I would always say pruning and tuning, because that's kind of what neurons are doing. We see this at different points through the lifespan of all humans, but particularly in females, we see this a similar process taking place during puberty and adolescence during pregnancy and early postpartum. And then we think what we're seeing, although we don't yet know as much as what we're doing these other life phases, this is what we might be seeing during perimenopause and then perhaps during post, those postmenopause years. And this word pruning is interesting because we're not yet, we're not talking here about pruning away of whole parts of the brain or pruning or removal of neurons. We've not got what we would call neural apoptosis, which is the death of, of new neurons and neurons. If we were seeing neural death would be in puberty, pregnancy and perimenopause, we'd be in a lot of trouble. When we talk about neural pruning, we're talking about the connections between neurons and how they are being, you know, sometimes flourishing, sometimes being pruned away. And sometimes what I would call being tuned, existing connections, being tweaked, maybe being weaker or stronger. And the way I would describe it is, if you imagine you've got one neuron and it looks a little bit like a tree. So we've got a cell body and then it has all of these branches coming out of the cell body, which we call dendrites. And they look like branches on a tree. And then we've got the long axon, which will be connecting to other other neurons or other parts of the brain. The dendrites are like input receivers. And at various stages through the lifespan and even in response to hormones across the menstrual cycle, we would see dendrites flourishing, particularly when we've got high levels of estrogen. We typically see dendrites flourishing and little spines on those dendrites, which look very much like buds on a tree branch in spring. We would see them flourish and then when we've got lower estrogen, they would kind of prune away. And so what may be happening, I'm not entirely sure about menopause, but certainly during pregnancy and certainly during puberty, when we've got these massive hormonal shifts, we see the pruning away of these little buds and twigs, which means that we're altering the connections between neurons. A little bit like we see a tree flourishing spring and then perhaps you might prune away the branches and the connections in the autumn if you were a gardener. You're not re-thing the whole, you're not pulling that whole tree out from the way planting a new tree in. And that alteration, we would call this synapse plasticity. These connections between neurons and how they are regulated and shift in change is kind of adds up to what we might see in terms of structural changes in the whole process. Or end or turn in terms of how networks react and respond and connect. So in pregnancy, which, and I'm just talking about this because we're pretty sure we know what is happening here. When you're going through the course of your first pregnancy and you've got all these sky-high levels of hormones that are made by the placenta, because the placenta is a gland, we're seeing there's a massive kind of flourishing and pruning and churning of all of these connections. But what we end up seeing is that gray matter gets slightly thinner. This might happen during perimenopause as well. Gray matter is getting slightly thinner. Now this isn't the brain degenerating. It always sounds terrible when you think about the part of the brain getting smaller. It sounds like degeneration or disaster or catastrophe. It's not, it's the brain's streamlining and refining and putting itself in a state of heightened plasticity so that the experiences that we then have can help continue to prune and tune that brain. So what I think might be happening during perimenopause. And we're not sure because we don't have very many studies yet. If we see reductions in gray matter volume, that's not because we've got less neurons. What we're probably seeing is reduction in the numbers of connections between neurons. That doesn't mean they're giving up. That means they're probably doubling down. Let's just for all of that energy. Energy and focus and to strengthening the connections that we absolutely need. Getting rid of this a perfluous ones. I think I believe what Lisa Mascione is. You know, she's trapped. Unfortunately, we haven't got a good longitudinal study. We've got a big group of women. We've tracked them all the way through. From pre peri, peri, peri, menopause, postmenopause. Because that might take like 15 years. It's hard to do good science with longitudinal studies. Because it takes a long time because it's longitudinal. But she's compared different cohorts of women. I believe her there's a figure on one of her papers that shows during perimenopause in gray matter. That's like the cortex of the brain. That's like this wrinkly outer covering of the brain. There's a bit of a dip and then it bounces back up. But right, menopause, which is kind of crazy. Maybe that's the downlining of wisdom. What's underlying that at this specific individual neural level is probably not apoptosis and neurogenesis. So the death of neurons and the birth of new neurons. We don't see that in cortex. What it is probably is the reorganization of the existing neurons in the networks so that they become kind of more streamlined. But why would the body do that? What the body reacts in response to all of the experiences that it has. So I always think about let's imagine kind of the brain. It's receiving a ton of information of what is happening in our body. Not least ebbs and flows of sex hormones, but all the kinds of hormones in our body. Everything that is happening in our body is, you know, that information is making its way up to the brain in various kind of ways. Whether it's neuro signaling or hormonal signaling or immune signaling. But we've also got what's happening around us, like the sort of the outside in social world. The experiences that we're having and then we've also got we're humans. We've got our psychology around mind, which is also shaping and sculpting the brain. So why would the brain react and respond because hormones are, you know, the role of co-stering and then flat lining, although maybe if you're taking HRT, you're perhaps leveling that out. So the brain simply reacts and responds to the hormonal kind of milieu it's in. But it also reacts and responds to everything that it's all of the data that's making its way into the brain. It's perhaps not, I wouldn't like to say it's the loudest voice in the crowd as always hormones. But there's perhaps different points and times in the lifespan when that hormonal signal is louder or quieter. And depending on who you are, we know this, some women like ride this rollercoaster of their hormonal fluctuations emotionally. Other women just don't even notice a thing. So the brain is always reacting and responding and that's simply what it's doing during the menopause. And so in that moment, what I heard and what you're saying is when estrogen is high, we have these very active dendrites. We have a very receptive extension of the neuron that's trying to grab information and carry information. But when estrogen goes low, they're not as receptive. And in times of big hormonal swings like puberty, pregnancy and paramanopause, we are going to see the effects of that more than we typically do. Yes, because those are much bigger shifts of hormones. But there's a bit of a ushaked curve sometimes. So it's not linear, it's not like more and more and more estrogen, more and more and more dendrites. Because if we think about it, it's cyclical and it's responsive and it's adaptive. So actually, if you look at increasing the con and studies have been done looking at this, we can do this in rodents and the research lab, we can do this in humans, but less well because living human women don't want to give up bits of their hippocampus or bits of their brain for us to look at under the microscope. And in those days, why not? But there's actually a ushaked relationship there. So the more you get across the kind of the course of the menstrual cycle, we'll get kind of flourishing and then pruning and then flourishing and pruning. But in pregnancy, it's something different because we've got these sky high levels of all of the estrogens because the placenta is also making them and the kind of the HPO axis is kind of the brakes are off. So the ovaries are also pumping a lot out. So we're getting a bigger dose of estrogen across the course of one pregnancy than we would get in the total of the rest of our lifespan. And the kind of the net result of that is actually pruning because there's a bit of a ushaked relationship there. So the brain is never really straightforward. There's always a feedback loop in there to kind of throw us into a bit of a loop when we're trying to explain that. So then would it be fair to say that there's also this, I'm going to call it expansion of the dendrites and contraction of the dendrites throughout the menstrual cycle because of estrogen levels changing. Yes, that's partly because of estrogen, but we've also got producerone in there. So we understand this most well and like shout out to kind of one of the sort of, you know, the queens of neuroscience research, Catherine Willie, who was the first person to show that the brain actually reacted and responded to these fluctuations of sex hormones. This is back in the 90s and she got a bit of pushback when she first presented this research at a neuroscience research conference. But now I mean, I could, if I was to take my textbook out from underneath my microphone here, I could show you the pictures in the neuroscience textbook now. So across the course of a menstrual cycle and particularly within the hippocampus of the brain, we see this in the estrus cycle and the little mammals that we study in the research lab, where it's far easier, or at least they sacrifice themselves for us to be able to do the research in the way that humans aren't going to. Animal, you know, the people have got different thoughts about animal research, but that's where we get most of our data from. So in a particular region of the hippocampus she was able to see these little neurites flourishing when estrogen went up and then kind of retracting when estrogen went down. If we do very, very, very careful studies of human brains and brain imaging, we put someone in an MRI scanner and then we do precision imaging and we're really only getting to the point with the resolutions enough for us to be able to sort of see, let's look at the hippocampus of living human women across the course of the cycle. We see some parts of the hippocampus kind of getting slightly bigger, probably due to flourishing of neurites and then other parts kind of retracting and there's a bit of a relationship there between levels of estrogen and levels of progesterone. But it's very kind of, it's very complicated and we're really only getting to the point where we can map this very carefully, but still quite roughly I would say in human women at the moment, where technology is going through great leaps and bounds. That's beautiful. But it's probably only been in the last five years that we've started to get any decent data through from living human women's brains and because we've got all of these amazing women in the neuroscience kind of a space now who are asking the questions and getting the funding in and there's some really cool research groups around the world that are driving this research for ordinates asking these questions. So would it be fair to say then we may have noticed that our brain was working differently when we had a menstrual cycle, but the swings were very subtle and because the highs and lows of estrogen within 28 to 32 days, it's just not enough for us. I mean we might be like, I'm not quite myself today, but then five days later if estrogen's higher we might feel more in sync, but since we're not culturally talking about that brain change, we may not have been aware of it. But once we get to menopause because estrogen is declining by a natural state, are we noticing it more? It's always been there, but we're just noticing it more because of the decline being so consistent and so steep. Yeah, I think well firstly I would say different women have very very different experiences as I said across the, you know if we just look at naturally cycling women across the lifespan as I said, some women will react incredibly, they're riding the rollercoaster, you know they've got PMS, they've got PMDD, they're really noticing these shifts. Other women are just like, I don't, I'm just carrying on, I don't really notice everything and then we've got lots of different people sort of in between. Perimenopause is different because we've not necessarily just got declining levels of hormones, we've got rollercoastering levels of hormones, particularly in that perimenopause, because as our ovaries run out of eggs, you know one month there may not be a lot of estradiol released from our ovaries, so the hypothalamus and the pituitary are going, hey next time, louder, more we can't hear you when the ovaries go, oh my god okay, and then there's more estrogen and then the next month the brain's going, no not that much, so we get this real rollercoastering and we've got the ratios between your estrogen and your progesterone, a shifting in shaping and changing. We mostly understand from a neurobiological kind of mechanistic perspective, which is what I kind of like, the neuro science, what is happening in terms of the vasomotor symptoms and how they are a neurological consequence of these changing levels of hormones, whereby in our hypothalamus, which is a part of the brain, which does things like regulate body temperature and it receives information about hormones and you know heart rate and blood pressure, etc. for some reason, and I'm not entirely sure why Mother Nature had this in mind, when you know we evolved this way, the hypothalamic thermostat, which really lets our body temperature, is tweaked in set in women by levels of estrogen. And when you've got these rollercoastering levels of estrogen, the neurons involved in that thermostat get much more hyperreactive, so it's almost as if the level of a thermostat gets much narrower or the kind of happy, healthy range is much narrower. So your body temperature only needs to rise very slightly for it to kind of hit the top level and your hypothalamus to go, oh my god it's hot in here panic stations, and it sets off this massive kind of heat dissipation response, which is both physiological and that we sweat, we vasodilate, part of that is controlled by a sympathetic nervous system. So we get this massive kind of sympathetic nervous system discharge and lots of women can feel that, particularly if you are asleep, you can feel it because your brain might have tried sweating a bit, but you've got your covers on, and then the brain's like, girl we need to wake up just throwing the covers off and you'll get this kind of, you can almost feel this kind of discharge go through your body and you kind of wake up. So you've got this massive sympathetic nervous system response, which is an attempt to call you down because the brain's panicking thinking you were overheated. So we've kind of got the involvement of our autonomic nervous system and there as well. So why the estrogen is involved with this process? Yeah, it's quite a question. I'd like to know, I'm not entirely sure whether anyone has got there yet, apart from the fact that everything is kind of interrelated. And why that heart of the brain is so, takes so long to kind of, because some women can have these vasomotosyptoms for seven, eight, 19 years. Some women don't notice them, some women don't have any other women do and why it takes the brain so long to respond, because sometimes the brain adapts and responds quite quickly. And you know, it will adapt and within a year you'll find others, it takes a much longer time, not in time, they're short, it's going on here. There's probably loads of different components. So we understand that quite well. That's, those vasomotosyptoms can have knock on, effects based physiologically, neurologically and also psychologically, particularly if they're responsible for waking you up multiple times in the next. Right. Right. There's a neuroscience researcher, Pauline Mackie, you should totally get her on your podcast. She has tracked how many times, if we're getting vasomotor hot flashes overnight, how many times the woman waking up, you know, how many are getting at night, how many are getting during the day. And we know that, you know, if you go through the course of a night and you're healthy and well, you've got this beautiful sleep architecture where you're going to deep sleep and up again and down, back down into deep sleep. You go through all of those cycles and stages of sleep. Vazomotosyptoms are completely disrupting that, whether you remember waking up or not. And we've kind of got that. So we've got this massively disrupted sleep architecture, whether or not you remember waking up. On top of that, and this is, there are not very many research labs studying this around the place, perhaps one or two, one I know is in Santiago and Chile, we're interested in this autonomic nervous system response. So we tend to focus in on the brain, but we've got a brain and nervous system. If you are repeatedly activating your sympathetic nervous system over and over and over again to call you down, well, we start becoming, we get more, and there's less parasympathetic nervous system kind of bringing you kind of back to baseline, the parasympathetic and the sympathetic nervous system are always kind of working kind of in harmony together. So the sympathetic nervous system, well then you kind of become hyper vigilant on why. Right. Right. And you start noticing, oh, I'm kind of waking up with a fright, like what's going on. And I don't know about you, but if you get woken up at night and you can't get back to sleep, it doesn't take very long to find something to just worry about. Oh, it's not like you said there go, I'm just going to lie here and think about awesome stuff. No! You can immediately go directly to the catastrophe, whether that be, you know, thinking about, oh, and I've got teenage sons and I've got parents, and you know, whether it's immediately what's in front of you or whether it's that silly thing you said when you're in high school, it will be something. And because we're kind of hyper vigilant, our brain's going, oh, we're feeling anxious for some reason, we must fill in the gaps. So we've kind of got that playing out as well. That happens, that happens one night, I'm sure if there's happening days or weeks or months, we're not finding any way to kind of modify or react or respond or adapt. It's almost inevitable that some people are going to start feeling anxious and lots of women might say that these kind of growing levels of anxiety, not necessarily clinical anxiety, but feeling anxious might be one of the earlier signs of going through perimenopause. We've also got, you know, some women, you know, it's a kind of a window of kind of vulnerability for women starting to experience depression. Particularly women who have had prior experiences of depression, it's a really, particularly if, you know, they were the women who had PMS or they were the women who struggled postnaturally, you know, they kind of feel like they know their woman least sensitive, this might be another window of vulnerability to experience depression. If we're looking at a woman where it's first time, they've experienced depression, but most commonly it's women with these prior experiences. So we've kind of got this perfect storm, right? Unpacking what's underlying all of these negative neurological symptoms, you know, we're not quite there. Is it directly due to how estrogens act doing neurons in the brain or is it like we've got these dominoes lined up, you know, with those immodus symptoms and the sleep and perhaps a bit of anxiety and perhaps depression And then have we got some knock on effects in terms of overall metabolic health, overall immune health, overall cardiovascular health, because if you're not sleeping and then you, it's much harder to exercise the next day and manage your diet well. And perhaps you've got a lot of social concerns, you've got chaos in the family or something. We've got all these dominoes, so what's like the first domino to fall? Yeah, right. It's a bed of a perfect storm time. And it's so, it's hardly surprising. Lots of women struggle when we go through this phase of life. And I have 50. And so I can kind of put my hands up and say, I kind of, I do my damn just to do all of the things, but I'm familiar with her feelings. Yeah, which is beautiful. You teach it from that place, which is so helpful. The two in the morning wake up, I used to call it, I would do a worry scan. And it was like, I would wake up and then my brain would be like, okay, which topic do you want to try to fix right now? Yeah, it's a bit like that. And I think, you know, we haven't talked about how we can kind of manage this, but there's hormone therapies, et cetera. You know, pickle, choose what you're going to use here, but cognitive behavioural therapy for insomnia is a really great kind of holistic kind of, I call it bottom up outside and top down or biopsychosocial way to help address this because we need to get to the point where we're just not kind of giving in and going, well, I've woken up at night before I will worry. It can become very habitual. What techniques and tools do you have that you can kind of intervene and convince yourself to not worry and be able to go back to say, sounds easier said than done, but there are resources and tools and support out there if this is the kind of situation you find yourself in. It can become, it's a very easy feedback loop to kind of lean into, particularly because you've got this autonomic nervous system involvement as well as your mind. Right, right. Yeah, like those two start. That's kind of how we end up with people with kind of anxiety and or depression. We need to kind of roll that back and kind of intervene as early as possible and protecting sleep is one of the most important ways to do that. Of course. That's what I always hear when they're like, here are the lifestyle tools you should do as you go through parry and manopause. And one of them is like, get a good night's sleep. And I think whoever created that list never went through parry and manopause because it's not the easy one. Well, it's a great idea. It's a great idea if you knew how to, if you knew how to do it. Yeah. But we do have tools and resources there for people. So I think cognitive behavioral therapy. I've heard that. And I at being is this, that's, that's your goal. Amazing. Well, let's go back to the metabolic piece of this because, you know, one of the things that Lisa and I geeked out on is that the brain is less receptive to glucose as it goes through this experience. And you know, my, my following and, and my background is in teaching fasting for women and how you can use a tool like fasting to balance your hormones. And I've watched everything from somebody getting their metabolic health in order and all of a sudden they get pregnant. I've watched depression and anxiety go away and I've watched all the hot flashes, the sleep, all of that change. And so I'm wondering if the brain is less sensitive to glucose does, is that play plane in to this brain function that you're talking about as far as raising temperature and trouble sleeping? Yeah, 100%. And this may be part of what is happening in the hypothalamus in terms of this kind of glucose insensitivity. And the brain reacts and responds and kind of tries its best to compensate for that. And I was, it's not just cells in the brain, it's just neurons in the brain, it's every cell in our body can, and people, some people, not everyone can become more kind of insulin resistant and, you know, kind of metabolize and process glucose and make ATP and all of that in the same way. And I'm not, you know, expert on cellular metabolism, just kind of, I just want to shut my eyes and have a nap, but that's my, that's my, that's my TED talk on that. But you haven't been able to sell in the body, right? You haven't been able to be familiar with that. Yeah, you haven't been up late at night studying the crem cycle. I don't understand. Oh gosh. I'm sure there's a textbook around here somewhere with the, with the diagrams. And I think I actually tagged a good diagram the other day that I saw on, on somewhere on social media. I should save that to revise and that I never did. But we see the brain and the cells in the brain react and respond in the same way that cells in the brain do everywhere we've got. And I, and it's hard to kind of tease out, you know, all of these different body systems because they're all, all interconnected and the brain's in the nervous system, aren't separate from the rest of the body. And I often, we can talk about metabolic health, so we've got neurons in the brain, perhaps, finding it harder to do the job that they used to. But luckily the brain adapts, if it is healthy, adapts and reacts and responds and we sort of see this and I believe some of Lisa Morskoney's work has shown that, I mean, we're in such early stages of imaging menopause and women's brains. So interesting. But she has shown that adaptation and that response to, and we've got, you know, different people have got different kind of health profiles and genetic profiles and susceptibility etc. underlying that. But the brain does have to work harder as to other cells in our body when metabolism kind of shifts. I think what we know about the brain, as the brain gets older, regardless, sort of menopause aside, if we just look at all humans as we get older, as the brain starts to perhaps struggle metabolically, what it starts to do is it kind of recruits more neurons on board to get the job done. So what may have been quite a specific, well-defined, well-functioning, efficient network that was required, perhaps just on one side of the brain to solve a problem and we can image people doing different types of problem solving, say in the FMRI scanner. The brain will start to recruit more neurons and more networks to get that job done. So the brain's pretty cool and that it goes from being, I mean, there's very well-defined, quite segregated networks. And as you age, we know that sometimes those networks get what we would call more integrated or they tend to cooperate and we might go from having one side of the brain doing the job to both or perhaps more brain activated to get the job done. So the brain's adapting and reacting and responding in its own way to find kind of work around to get the same solution. That process of perimenopause perhaps speeds that process up. It speeds up that kind of, I don't want to say it speeds up aging, but it does alter. The brain's metabolism does alter over this point in time and it's possible that the shifts that we are seeing and that their feelings are part of the feeling of brain fog and me in particular because my sleep is pretty well managed. Asked my husband, he's just like, I did 10 hours the other night and didn't wake. Wow! It's like a 93 score on my foot, but I'm working my hands like always. He's like the one lying awake every night. I'm like, just asleep for 10 hours. But I still, so I feel pretty good, but my words like, man, I'm like, replacing, I will just say stupid things like one of the kids walked in the other day with a cap on and I went, you've got a nice lid and I was like, no, I mean hat or I might, I will use words that are kind of similarly related semantically but not quite correct. Or I'll say, oh, that's a nice soft apple instead of a nice hard crunchy apple. I'm like, what, right, soft instead of crunchy? Just stupid things. Interesting, but a little word flips and maybe we don't know. Maybe this is this process of different networks becoming recruited in this sort of change for pre-menopause to post-menopause. That shift may play out in terms of, you know, for me it's this kind of like verbal problems or this verbal recall or sometimes just pulling a complete blank on someone's name. Apparently, and the research shows that lots of women struggle with this during the pre-menopause and menopause and then it kind of recovers, perhaps as the networks react and adjust. But of course, to ensure that happens, you want to be doing a lot of things that you probably talk about all the time, making sure your metabolic health is right, making sure your cardiovascular health is part of that. And people often think about the heart, but the blood vessels, the vascular part, cardiovascular health is so important because we couldn't do brain imaging studies if we didn't have this massively fine network of brain capillaries, of blood vessels in the brain that react and respond to the brain's energy demands because that's how we do brain imaging. And if your capillaries aren't healthy, we know that capillaries are kind of the first things to go. That's why people with metabolic and cardiovascular problems, their kidneys go because of the fine vascular. Their retinas go. Your brain is the same as that. Why the brain is quite vulnerable as well, like if you've got heart super high blood pressure or heart failure or type 2 diabetes, etc. Is there a way to increase blood flow to the brain? Well, by managing your cardiovascular health. Yeah, so just so like a workout, like a good workout would be, yeah, a workout does, but the brain doesn't just get more blood going to it because the heart is pumping faster because those capillaries react and respond to the neural demands. So brain imaging is like if MRI, a lot of those beautiful kind of rainbow images you see with this part of the brain lights up, well that part kind of dulls down, comes about by looking at shifts in blood flow, not necessarily shifts in neural activity, we're kind of looking at a proxy. And so that process is very, very tightly regulated and managed by the neural activity. It's like saying, hey, we need more blood here. It's not just like make the faster and push more blood in. It's much more kind of keyfuly coordinated. Neutristic net, which is why we need to take care of it. Right, exactly. Okay, let's talk about staying at the neuronal level here. Let's talk about neurotransmitters. So one of the studies I saw, this is like seven years ago, was about estrogen's impact on dopamine serotonin, glutamate, GABA, acetylcholine, oxytocin, BDNF, melatonin. And I call them estrogen's girl gang. I'm like the first time I read this study, I was like, wait, she had like a gang of neurochemicals that helped her do this miraculous job. So if she goes away or she declines what happens to these neurotransmitters, do we need, do they do what you're talking about where they create an upsurge? So because they're having to compensate for a loss or do we need to use our lifestyle to try to coerce these other neurotransmitters to keep pulsing through our brain? Neutrism is the neurotransmitter systems that are incredibly complicated. And again, it's very hard to look at this and living humans because most of the information that we would have comes from animals in the research lab. And I would say that estrogen, all hormones that can cross the blood-brain barrier, of course, and get from the blood into the brain will react and respond with, you know, there's receptors for estrogen throughout the brain, but it is localized in certain areas of the brain at higher density. The main receptors that we understand for estrogen are actually nuclear receptors. So they're not necessarily working at the level of the synapse where we've got. Estrogen can make a neuron automatically dial up or dial down the amount of neurotransmitter it's being released. Typically what we would see would be, it's not so much about the neurotransmitter that's being released, whether that's glutamate or gabar or serotonin or dopamine. It's about the receptor where we're probably going to see most of the action taking place. Because you've got one neuron, almost always, just makes one type of neurotransmitter. The next neuron on the chain with the receptors for that neurotransmitter, which determine how the brain will react and respond. And the hormones themselves are probably because they go into the nucleus and they act on transcription factors on DNA to promote or speed up or slow down protein synthesis. And that would be the synthesis of different types of receptors. So we're kind of seeing a knock on effect here. I think the language I would use myself would be on the neurotransmitter systems versus simply thinking we're going to get more or less, if we haven't got estrogen, we've got we're getting less serotonin release. For example, what we are probably more likely seeing is shifts over time and perhaps different shifts in different directions in different parts of the brain in terms of how the receptors are reacting and responding to perhaps initially that rollercoastering level of estrogen and then the lowering levels. Bearing in mind, of course, that estrogen is just one of many thousands of signals that our brain is making meaning of and processing. So it gets a lot of attention right now, which is cool and good, but there's a lot of other things that the brain is making meaning of and is reacting and compensating to over time. I'm mostly familiar with some of the work that's been done looking at one at dopamine until it's serotonin and I believe actually in my woman's brain book, I can't remember if you were to write it in it. That happens. I was looking at the role of a variant hormones on serotonin, that serotonin neurotransmitter system because we've got the receptors as well. You could increase the level of estrogen and in some parts of the brain, you would see that that might dial up certain serotonin receptors, but another part of the brain at exactly the same point in time that might dial it down. So again, it's never linear. Like it, and as I said, even when it comes to that, the flourishing and pruning of dendrites, there's a ushaped relationship when we look at levels of estrogen. So it's super complicated. Estrogen will be one of the signals that are that's involved with these neurotransmitters and these signaling and we can see that play out when we zoom out a bit of course because we're seeing the networks react and flux and change. I'm not sure whether we've got enough of a clear story, the yet. Yeah, that makes sense. But calling it a girl gangs like, that's fun. That's what I'd like to keep it all fun. I actually, the first time about 20 years ago when I started learning hormones, a friend was walking me through a Dutch test, you know, the Dutch test. It's like a ovarian, it's a urine test. It's a dried urine test to see what your hormones are and it shows you all the hormonal pathways. And I said to her, these pathways are so, these clinical names, nobody's ever going to remember. And she's like, yeah, they should be the names of nail polish, shouldn't they? And I was like, I don't know about that. I was like, people would know it then. If you gave it a nail polish name. I think if we educate people carefully and thoughtfully, we can use the appropriate words. That's what I try and do. But I don't know. Nobody says that. No, I'm not. I just call those verses now. There we go. There we go. So I want to go back to what you said, though. You said that estrogen's not the only thing stimulating these neurons. Oh gosh, no. So one of my thoughts, when I saw this study on how estrogen impacted and what I love the way you said the neurotransmitter system is, okay, so here we sit. Like I look at my 86 year old mom and she'll tell you she went through and met a pause with no problems at all. And I would say what I'm witnessing is a very sharp brain. Of course, she had a few moments. So like what was going on with her lifestyle? Then I look at somebody like my sister, my older sister, who was a couple years ahead of me. And she didn't make it through metapause as well as she thought she did with her brain just very quick to react to stress. And I start seeing that every woman is having a very different brain experience. And you've mentioned it a couple of times. So we're all different. We all understand that. The same as pregnancy, right? We all have completely, and we can all have wildly different experiences of pregnancy, and of the biological shifts of the same, and between pregnancies. You know, you can have two completely different pregnancies yourself. That's true. So then where do you think lifestyle fits into this? Like the thing that has been really like weighing heavy on my heart is that the main message that's being brought to the public right now is just get on HRT and everything's going to be okay. The metapause conversation is wild, right? Yes. Thank you. I have a lot of things I could say about this. Oh boy, I was even reading a paper this morning that was published from some researchers here in Australia talking about the, they've surveyed Australian women about their reactions to the massive commercialisation of metapause and how the conversations are being played out. And it was very interesting to me, and you can get pushed back for this, and I've been, you know, there's all kinds of factions at the moment for one to verbatim a word. There was some lines in this paper, which I might even have it up on my computer. It's actually called all about the money, if you can believe. Women were talking about the catastrophising narratives about metapause, whereby commercial actors seek to connect with women and capitalise on their concerns for financial gain. So we're in this particular moment in time right now where the conversations around metapause are an active ingredient in the experiences that we have. And when it comes to the brain, the brain isn't prioritising, the brain is making sense of information from our biological body and how we, you know, the food we eat and how we sleep and how we exercise and our hormones and a million signals coming in from our body that we're not even aware of, that your brain is making meaning of, but also from the outside world, from what we see and hear from the rising and setting of the sun to the messages that we are getting from our social media feeds as well. There's also an active ingredient. And I'm really fascinated by these. There's also a really interesting paper as well. I was reading a couple of days ago looking at the relationship between, I have all these papers. I was just going to say you're the true scientist over there pulling out. This is like, this is my life. I love it. I wish I was your next talk. This was talking about, although you might not like this one as much, this was talking about no SIBO effects inside of that experience is based on the conversations that women have about oral contraceptive use. And that's not to say HIT pro, we should be on the pill, we shouldn't, we should be on HIT, we shouldn't. Rather that the conversations that we are having and where our attention goes will also influence the experience that we have. Oh my God. And we need to also understand that our brain is making meaning of these signals. And where we are getting our information from, it's just so great that we have all of these opportunities and options and tools available. But to just keep in mind that a conversation can shift an experience that you have of your own physiology. I've written a whole book called Baby Brain because I was so interested in this kind of social cultural narrative we have. I mean, and honestly, Mindy, I don't know whether you think this, I feel like as soon as a girl hits puberty, the conversation is about her broken female brain as soon as you add some hormones on it's broken. Puberty, puberty blues, you know, baby brain, brain fog. It's not negative. There's never any upside. Yeah. And there's this incredibly strong cultural narrative that has also driven the research whereby women are going the end stages of pregnancy, perhaps early motherhood on my brain. I have baby brain, mummy brain. My brain isn't working. You can't do what I want it to do. But what's happened in pregnancy is that it has been reorganized to focus on the baby. Your social cognition networks have been focused, are there to adapt and respond and react to your baby because that's kind of the mother nature's intention is that you're focusing on your baby and your memory and your cognitive function depends on your attention. So what information you take in and what you filter out. We've now got mobile phones which are almost like a baby as well sucking our attention. And so you can't do everything. Your brain is trying to multitask and task switch and everything doesn't work as well. It's not, it's not, I always say it's not women's brains that are letting them down when it comes to baby brain. But the way that women have been primed is like, well, if my brain's not working something wrong with me neurologically and so then that's driven the research when there's probably more of a social support issue there for motherhood. So now we've gone from this pendulum swing from, and the 90s woman were taking hormones therapy to the Women's Health Initiative study and this has been talked about endlessly. I was working at a breast cancer research center when that study came out in 2002 and it was like, it was kind of like a war room panic station type situation. They were trying to like dampen down the fear around hormone therapy cause and cancer. We're seeing a shift back now and then the last few years this massive shift back massive. So metapause is starting at like, I've got friends in their 30s like, it's perimenopause and I'm like, you're still breastfeeding. Yes. Maybe it's maybe it's maybe it's like a trend everybody wants. And I understand that when we have gaps, we have swings and conversations shift to fill that narrative. But I think that it's a bit of a, I don't want to use, I'm going to say ball in a China shop. Sometimes the information is not necessarily being imparted thoughtfully in a way that we know from public health communications, from health literacy communications, the kind of space I come from. If we've got research, how do we talk about that in a really thoughtful, careful way, whereby we communicate absolute risk, we're very cautious and careful understanding that how we describe something can influence someone's experience. Yeah. And I don't know. And my God, that's so great. So metapause isn't quite, isn't quite in that space. And there are researchers out there that are saying, if we're going to be talking about metapause in the workplace, is that going to have knock on effects for gendered ages and perhaps, or is that enabling women to be able to talk to their manager in a way without stigma? Yeah. We need to be using exactly the same approaches and health about health communications and risk communication and treatment options and tools that we've always done within public health communications. But right now, it's glitzy and it's having its moment and all the celebrities are getting on board and there's a massive, you know, what does that paper say all about the money? So it's just this kind of crazy, perfect storm at the moment. Which I actually find quite interesting because the brain is going to be, the brain is making meaning of all of this. Oh, that's interesting. So, yeah. So go back to that because, so let's start off with like social media because it's interesting, it's like the Wild Wild West when it comes to metapause in social media. And what I'm hearing you say is, so let's use, do you know about the Do Not Care? We Do Not Care Club that has been started. Oh, yeah, yeah, yeah. And that woman is hysterical. Yeah, so funny. But what you're saying, if I take that and I put it in the context that you're talking about, if I'm watching this woman and I'm laughing and then I'm like, wait a second, I don't care. That's right. I don't care either. So it's, is it now all of a sudden we get on the bandwagon of what? Because the brain is constantly trying to make sense of its environment and if it's environment, your brain has been told, oh, you're not supposed to care. Then are we really starting a whole generational of women that do not care? Right. Yeah, maybe, maybe. I'm not, I don't think we've, I mean, it's been having its moment just really in the last few years. So I'm not sure whether we can see knock on effects yet. Yeah, certainly. Like if we looked at data from the UK, which is looked at prescribing of say hormone therapy, that's kind of gone up and that's tracked alongside, you know, the media and the conversations around this, which is really great for lots of women who need that help. But is it, but are there more women paps over identifying or attributing other health issues or other issues in their life to be a hormone shifts when it might just be, you know, they've got a, you know, a very stressful life. And so the narrow focus on the hormones being part of the conversation, we're not looking at, you know, this kind of holistic approach to what's happening in our, in our whole life. And so that's where the lifestyle has to come in. And I think genuinely most people are, are not just saying the only thing you do is take hormone therapy that you should also address all of these other parts of your life. But to be fair, well, I mean, hormone therapy is kind of the main tool that we've got right now. And it's, and if everything, you've only got a hammer, everything looks like a nail right? And that's the, I keep saying that exactly. And all we've, and all we've got, and with, you know, if we look back across like your life span, say, and you were naturally cycling, you went on the pill, you didn't have an ID, you didn't have many pregnancies, you know, your brain learned to react and respond to your ovarian cycles. When you reach perimenoplas, all we can do is kind of add an exogenous estrogen. And all we can do is add in a bit more, and then add in a bit more. We can never really kind of mimic that. True. Yeah. Which is not necessarily a bad thing or a good thing. It's, it's just this is the tool that's currently having its moment and some, which is excellent, but perhaps we should also be looking at what else is available and what else we can do. And I, but then I also say that with the caveat that I, you know, have, you know, I've had a great education. I live in a very healthy, wealthy part of Australia. It's very easy for me to implement lifestyle change. I know how to go about that. There's lots of women in the world that just don't have any access to any of these tools or resources. And it's very easy for us to go, oh, well, you should just exercise more and manage your sleep when, you know, they can't manage to feed their kids a healthy meal or pay the power bill. You know, so the shiny, celebrity messages are great for, you know, healthy, wealthy white woman who are living in, you know, was not in poverty and don't have a lot of, you know, might just have a shitty husband. But it's not addressing it from a public health perspective. And I, and I feel like we need to zoom out a little bit more and kind of look at how can this message land across populations? And that's what public health does. Right now there's just, there feels like there's a little bit of a clash between the careful cautious, thoughtful approach of how can we help everyone and ensure access and, you know, justice for all versus HRT because it all... Everything will be better. What you want, what you want. Oh, you know, social media is having it's having it's having it's moment out. And anti-second real is very different from a broad-scale public health campaign that's looking across socioeconomic kind of strata. Yeah, it's really, it's really well said and it's funny because I've been teaching metabolic health and hormonal health on social media for about 15 years now. And I always feel like my job is to bring information and help people make the best decision for them. And the trends in social media have strongly gone towards do this or you will get Alzheimer's, do this or you will get dementia. And that kind of fear mongering is not one that I would like to participate in. So I think what you're saying is the most accurate statement I've heard anybody say because I think you both, we both agree like it's a really cool tool, but we've made it the center of the conversation now. And it's time to broaden that out. I think it will shift back. But what I just wish was happening is that the, perhaps this is because of the world I come from and what I've spent years talking about and going to conferences to is how we talk about these things, Matt really matters in terms of the decisions that people go on about the health care decisions. And when we talk about, well, this is going to increase your risk or decrease your risk. We don't, what does that even mean? We say, well, it's got a 30% increased risk. What does that even, no one knows what that means. We've got to talk about absolute risk and absolute numbers and in a woman like you, if you were to take this therapy or treatment or not, this is how many more women or how many less women would go on to develop risk cancer or not to develop dementia or would see their hot flashes fade away. We, we need more careful thought for, and we've got evidence on how to do that. Conversations around, around risk. And I mean, I don't know whether we're going to, have we got time to talk about it? Yeah, yeah. Well, my therapy and dementia and Alzheimer's, does that mean it's like a whole? Yeah, no, I was going to say, I want to talk about that and then I want to talk about, yeah, because you said that and I was like, we need to talk about that. And then I want to talk about societal stuff here in a moment before. Yeah, yeah, yeah, yeah. So, so, okay, so explain why HRT won't prevent dementia. Right now the data is very mixed. So there are lots and lots of different types of studies that have been looking at this over many decades. And some studies are saying, well, it looks like it might slightly increase risk or women who are taking hormone therapies, brains look slightly older than women who don't or have never taken it. Other studies are saying, if we look across the population, we see slight increases in risk. And then we've got a whole lot of other studies that go on, look, we're not really seeing anything, doesn't matter whether you've taken it or not, that's not what's really changing dementia risk profiles in people. It's a whole lot of other risk factors which we can get into. And then we've got other studies saying, oh, actually, if you take it at the right age and you take it and this sort of formulation, it might decrease your risk. So right now if we look at the consensus, we look at all of the studies that have been done. And I often say another way to think about risk is, you know, those old fashioned like weighing scales. And so you want to tip the scales in your favour towards not getting dementia. Of course. So what can you do as a preventative and what can you, you know, what's the kind of the harms and what are the kind of actions that we do to alleviate risk, to tip it in your favour. But sometimes tipping something in your favour doesn't make any difference. I mean, people can get lung cancer if they've never smoked a cigarette right. Yeah, well, so right now, we've got all of these little, you know, weights. That we can put on the side of prevention and weights that we can put on the side of risk. And hormone therapy, we're like, oh, we don't know whether we're putting it on the side or this side or this side. And how big that weight is. Right now it's quite tiny. And there's some studies put it on one side of the scales and some studies put it on the other. So until we've got a clearer story and scenario where we can say, if you are this particular age and this is your particular risk, like the, this is your kind of current health status this is perhaps, you know, have you got the types of genes that would increase or decrease your risk for Alzheimer's disease and there's lots of different genes that may be involved. If you start taking hormone therapy at this time for this long and this kind of formulation and combination and method of delivery, then we might see your risk tweaked slightly in your favour. Mm hmm. We're not really at that point even yet. Interesting. What we know is what the, and I'm not a clinician so I would just stick to the clinical practice guidelines because that's where the consensus has, we've looked at all of the studies, we've put all of that together and we've reached a consensus. There's no menopause society nor any dementia society or association in the world says, take HRT to prevent dementia because the data doesn't support that conclusion. Interesting. And it would be unethical to say that. And that's fine. Okay, I'm fine with that because there's a whole host of other things that we know, no, absolutely will make more of a difference. But right now, this is the toll that's kind of got the shiny sort of attention. Yeah. What are some of those things? There's a whole host of other things. Gosh, and we can look across like the lifespan in terms of where does kind of what was going to increase or decrease your risk. So we, some studies have come out looking and it's somewhere kind of around between 40, 50, 50, and 50% of cases, there are modifiable risk factors. And this is across the global population. If we were to manage all of these, we would see these declining numbers, this declining prevalence and people who are old, but we've got to go all the way back to early life and look at one of the risk factors is how much education you have during childhood and adolescence. So the more years you stay in formal education, the more exposure you have, the more exposure you have to complex and rich educational environments. That kind of almost builds up what we call kind of brain kind of reserve. It's almost like then you've got further to fall once your brain starts aging. So, and if you're talking to women who are 50, there's not a lot of point to talking about what education and the years of education they had when they were a kid. Right, they're not thinking like that. They're not thinking like that. They're not thinking like that. They're not thinking like that. They're not thinking like that. They're not thinking like that. You're not looking at what a education patch on and increased years of education. What would it be your learning? If it could be your learning. You're learning. So new information is coming in. Yeah, so perhaps staying engaged and learning, but the risk profile and old age does appear, there's some of that is around early life education. And this is particularly in parts of the world where many girls don't stay and score beyond ages 12. You know? stay in education up until you're mid-twenties if you were doing a PhD. So we've got these kind of big gaps there depending on where you live in the world. Then we can look at mid-life and this is where all of the factors that you kind of work at, you know, the space you work in around metabolic health and cardiovascular health and your cholesterol and your blood pressure and, you know, the type of lifestyle that reduces your risk of type 2 diabetes, all of those types of things like you diet and you exercise and you sleep and you stress and all they all cover less. But then we've also got factors which are incredibly unsexy, for example, untreated hearing loss. I heard this. You've heard this. Yeah, lots of people have perhaps industrial related hearing loss. You know, you worked in a factory or you were a farmer or you were, you know, you were a roadie for a, I don't know, tailors swift maybe. You're hearing losses started to be impacted by mid-life and particularly back in the days when you used to have those massive being hearing aids. There was a lot of stigma around that. They're much more discreet now. People weren't getting hearing loss treated and that's an incredible burden in terms of brain aging and, and risk for dementia because when you can't hear, you can't communicate, you can't interact, you just kind of withdraw from the world and then your brain is an in, as an enriched stimulating engaged environment. You're losing your social connections, you're perhaps losing that ability to stay educated and engaged in an employment etc. So your world shrinks down. And as this, things happen where your world shrinks, your brain isn't being stimulated and we see the same later in life with visual loss as well. So I believe around 7% of cases globally about Alzheimer's disease could be kind of eliminated if everyone in mid-life had hearing loss treated. Of course. In the world that I've got access to this or not, vision loss in late life is the same because again your world shrinks. And even if you've got your hearing and your vision and all of this, there's a real tendency I think when you go to this, I've seen this in some people I know who are a bit older, was the world just gets really small? It's almost like they kind of live within the walls of their own house or their own garden and the most exciting thing that happened was the neighbor didn't pick up their mail. There's some kind of like, they've got a very small wheel they're not out in the world and engaging and reacting and responding and using our brain to explore and navigation and engage in employment. So all of these things, there's other factors in their depression, mental health issues, head injuries and we think a lot about brain injuries or head injuries when we think about. Kids playing sport or rugby players or hockey players and head injuries. But there's kind of an uptick and head injuries particularly around men above the age of 60 who have climbed ladders. Oh that's interesting. Because of course your balance is a little bit off but particularly men are still, I'm still going to empty the gutters. I'm still capable of doing all of this and they fall off of that or in the head. So we've got different types of risk factors in here which go far and above and beyond simply, I mean a poor small month. Yeah, oh my god. Yes, if you just listen to that little clip, that exactly is, you went, that was so beautiful and I was reminded of my parents. They were in their early 80s when we went into COVID and I was really clear that they were my top priority. They lived in the same area and we used to, like I would have them come into my office, we had everybody masked up and doing all the protocols because I was like you have to get out of the house, you have to come in and get some kind of interaction. We got the nasal swab tests really early on at we were able to get them. And so I would nasal swab everybody and then we would have them come over because but you could see that they were incredibly social humans before the pandemic and there was a significant brain decline afterwards. 100%. We see and we can all remember what that was like. It was like because if you leave your house and you see other people, you might kill them. Right, exactly. I mean it was a very frightening message that has well intent. Perhaps it was very well intentioned then and now we are seeing some of the consequences and as you said for older people whose worlds shrunk and they haven't been able to kind of grow that world again and then we saw this with you know kids and young people as well particularly those kids who were a little bit like socially awkward or going through adolescence and adolescence is a time when the social cognition networks require social experiences to guide and and and wire up appropriately and and again they were told if you leave the house or you go to school you know terrible things will happen. So the messaging there was incredibly confusing and when people's worlds shrunk there of course there's going to be knock on consequences and perhaps an older people we might say this in terms of brain aging and in younger people we saw this play out in terms of mental health sequences and I even know myself being very aware of this and and thinking about it it felt like your social fitness you lost social fitness and then it was easy and I noticed people it was easy for people to opt out like you'd organise an event. I remember organising like a book event before covid and everyone go oh I'm coming and then everyone that said they were going to come along would come along and then after covid people would say they were going to come along and then they just wouldn't because they've been told that they can opt out and they don't need to show up and so then that would be like this really tiny little event and I'd feel a little bit sad because people have lost their social fitness and just go oh I'm not going to bother anymore. Yeah, hopefully hopefully we're seeing that. Yeah it would be interesting to see what the long term consequences of the brain health are going to be like it would be and we'll be able to perhaps look maybe you'll not be able to look back and go well this state or this city or this part of the world you know was more restrictive and this wasn't and we may be able to see see that play out who knows that would be interesting to study those kinds of things. So would it be would it be fair to say then one of the key things you want to do with your brain as you age is to put itself in different environments. Yes, 100% 100% because each new environment is going to create new neuronal pathways. So this idea of shrinking your world is a classic age problem. You know, oh I can't go to the gym. I can't do the things. I'm not going to work and your world gets smaller, smaller, smaller but what I mean is we need to put the brain in as many different environments whether you're 85 or you're 25 to keep its neuroplasticity at its best. And represents trying to expand your world and some people may need support to do that. Yeah, and you know and we and I even think about I had a family member who moved my she was living with my mum and stepdad for quite a while and then she moved into an aged care facility and her world opened up and expanded because there's not just like my mum and stepdad going in a couple of times a day to see her and but she's got all of these different people coming in and we often see people when they move into aged care not everyone you know they see a bit of an uptick in their health because suddenly they're in a new environment. They're probably being fed well yeah maybe better you know there's more people as more interactions as this whole new environment and so the life has opened up a little bit and you sometimes see a bit of an uptick and their health for a little while. So our brains evolved because we move and because we navigate through the world there's some really cool research looking at different types of occupations people have and how that provides resilience to aging and resilience to dimensions and other types of Alzheimer's disease and the occupations which provide the most protection are taxi drivers not Uber drivers with their mobile phone navigation but like the old style taxi drivers and ambulance drivers are because they're constantly navigating and decision-making and having to make a complex cognitive decisions will they move through the world and then they were like oh was it just driving vehicles so they've like compared them with like pilots who don't have to make the same pilots aren't turning corners up in the sky right they're just flying in a straight line. So we have to make some adjustments right and they'll like say a ship's captain but it's definitely that constant challenging decision-making say imagine an ambulance driver like you watch those TV shows right there's a lot of information coming in that they're like making meaning are very quickly they're having to kind of think ahead they're having to you know talk to the hospital they're having to navigate they're not they're not going where they've been before like a bus driver driving back on Ford and our brains evolved to navigate and find our way through the world and that's reasonably cognitively demanding if you you know cast back you want to take an evolutionary perspective we had to hunt and we had to gather and we had to remember where the berries were and how to you know socially coordinate to hunt down the animals and you know find our way through the world and when we stop moving not only is you know that the biological consequences of not moving our bodies but we haven't got that same visual and auditory and sensory input kind of streaming in and challenging our brains so far this is why I've seen some studies on travel you know you go and put yourself in a different country maybe even with a different language like the amount of brain energy that that is needed is has to be tremendous so and then if you go to a country where the cars drive on the opposite side of the road and steering goes on the opposite side of the car I think I do not think that there's anything more cognitively demanding yes navigating from the airport picking up the car hire at the airport yes to like you know your first night stay and like the everything's on the opposite side it's very good it's very good for you yeah it's stressful though I bet you have to have a lot of emotional regulation with a family that's true that's true so talk to me about societal impact there recently I about a year ago I learned of a woman named Carol Gilligan and she was a feminist psychologist who studied teenage girls back in the 1980s and what she discovered there was that before a girl's hormones come in if you ask a boy and a girl a question they'll give you very direct answers like what do you want to eat at eight or nine they'll tell you exactly what they want to eat when you get to about eleven if you ask that same question the boy will tell you exactly what he wants to eat by the time the woman the girl will be like oh she'll hesitate a little bit by the time you ask that question at 13 at 414 the boy will tell you what he wants to eat but the girl will say to you I don't know what are you going to eat and so what Carol Gilligan came out of that research and said that there was a conditioning of the female brain that occurred because of social messaging and the social messaging that a lot of girls got was you are worthy if you are selfless you are worthy if you don't rock the boat and one of the theories I have right one the theories I have is that menopause is actually the unwinding of that I like that yeah yeah yeah I like that yeah give me your neuroscience perspective I'm not sure I'm not sure oh gosh I'm not sure whether I could neuroscience my way through that but I think it's a cool idea and I've looked a little bit at the at what happens to girls and boys when they go through puberty because I think that's a that's really fascinating because really that's when you know we've got the in utero the the brain kind of at and up ready to react and respond to the hormones of puberty and boys that's testosterone and girls that's estrogen but also progesterone and we know that pubertal and adolescent brain development tracks more closely to pubertal stage than chronological age so you know there's a bit of a narrative that all girls brains are more developed than boys at the same chronological age but that's just on average the girls have gone through puberty a little bit earlier than the boys but you could get an early pubertal girl boy say an elate pubertal girl who's you know so the boys brain would be slightly more further along that developmental track than the girls so we're typically we're talking about averages and I think it's always useful to think about individual trajectories. I'm familiar with this research that's come out of work here at Australia looking at how girls start to react and respond socially and emotionally both to other people but also their perceptions of themselves going through puberty based on the social context in which they experience puberty so we've got girls perhaps who they might get their period at 9 or 10 which is early but it's still on the normal curve they're not five. So it would say early but normal because someone's going to be on one side of the distribution curve and someone's going to be later and what happens when a girl goes through puberty early she's going to be feel very different from her you know her cohort her friends around her she's going to be one noticing about her her body has changed and comparison to her friends other people are going to start reacting and responding to her very very differently. And then you've got a girl who goes through puberty you know she gets a period at 12 and a half like most of her friends or on average and then girl goes through later. So those girls who go through puberty earlier than their friends are much much more vulnerable particularly to go on to develop perhaps anxiety and depression through that puberty transition but also later in life now kind of compounding that in some girls but not all is what drove that perhaps earlier but normal puberty transition could perhaps be earlier life stress or trauma or abuse not always some girls are just like on the early early side of normal. Someone has to be first but those girls are more vulnerable but it's interesting because if you look at boys going through puberty depending on you know early average or later a boy who goes through puberty earlier than his friendship group or what happens to him it's all big and tall and her in his voice. And everybody wants to be the alpha alpha in the group and he's almost and they're never all of the baller the little dudes cluster around him and he's like the alpha and he's kind of protected in a way now how might go on and and has the parts of his brain in particular we see this more so in boys and it's hard to know whether it's testosterone or whether it's society as a you know mother nature or the patriarchy he will seek out more sensations and do kind of risky business which teenage boys and I've got I know I know all about teenage boys slightly earlier so he might get up to more mischief with older older friends but typically he's going to be less vulnerable to the mental health you know issues that feeling like not part of the group versus the little dude who still hadn't grown at 16 and we all remember them from from school there would always be someone that was kind of on the far end of the distribution curve so we've got here kids going through puberty at different ages and stages but the vulnerabilities come about by the social context in which that is happening so it's not simply just the hormones in the brain interacting it's the hormones the brain interacting with the social context and then you know how well supported like you've got an early puberty girl maybe she's got an incredibly supportive aware you know the mum and her dad kind of can see this happening and they provide all of the right supports and nurturing around her and she goes to a great school and she's got good friends and she's just is going to be okay but perhaps there's a girl who's just neglected and just really struggles and you know she had puberty early and doesn't really kind of know how to cope so that's social cultural context around the biology of puberty is as incredibly important and I did speak to one researcher in my book Jane Mendel who's a who researches puberty and she said particularly in girls puberty kind of provides an emotional blueprint for how you all react and respond particularly and those reproductive transitions later in life because one you've had that psychological experience of perhaps it was just traumatic unhorrible and maybe your first period was it was a it was a scary frightening experience and maybe it was like cool and awesome could be anywhere in between right but girls who go through puberty early often then maybe their brain becomes sensitized and then they're more likely to have PMS symptoms and then maybe then that kind of compounds them will likely develop depression then they're going to struggle you know perhaps through pregnancy and early motherhood so we kind of see a snowballing right now I think it's very hard and it would be perhaps unwise of me to say well there's there's a hormonal basis there's a biological basis right there's always going to be this collision of the biological and the psychological one of the social so well said yeah and and you know it when I heard about Carol Gilligan's work I was like okay if that's what happens when hormones come in then is the opposite happening when hormones go out that was the hypothesis that I was thinking through I actually try to get get hold of her to see it likes but she only studied teenage girls but go ahead but what do your thoughts on that yeah I mean I guess you get more funky and irritable when your hormones are kind of on the decline or some woman you know don't notice other women just you know feel that very very deeply I would be I think it's really hard to to say all it's just the hormones that are driving perhaps that I don't care anymore the I don't care club um perhaps in Australia we might use different language so yeah I do call it I'm curious I perhaps you just give less the give less fucks yeah but how much it's it's kind of hard to tease that out because perhaps you know and I think about myself I turned 50 at the beginning of the year my oldest son is doing his final high school exam starting in 10 days and he's going off to universe you know going the way to college he's going traveling in Asia over the summer holidays then he's going away to university you know I've written all of these books and I'm kind of having a year to just kind of suit myself and go to loads of parties and go with friends around the world and and you know and I and I turned 50 and on there's so many things going on as a very hormone that have changed or is it just as you get older and you're in a different place and space and stage of life and I and some people I know but I I think I feel like I see more people struggling or at least people that are struggling are talking about it more maybe and so then maybe then everyone goes oh perhaps I should have a terrible time too so we'll be able to get together in my own versus the the as if you talk about there was there was a there was a this is this whole like the conversations that we see around us how they influence and shape us there was a menopause kind of inquiry or kind of conversation and and parliament here in Australia last year and one of the parliamentarians who was talking about this said this isn't about woman who've had a great time and they've gone through menopause and and it's been fine and we're packing them on the back and say well done you this is about the woman who's struggled and I was like I don't think that we should only ever listen to and describe the stories about the terrible times yes it's well done we should also look at well hey what about those women who did have yes like instead of packing them on the back and being a bit snarky and going well done you how about we go well what have you done like is this your mindset like what have you done to have this great time yeah can we learn from you because surely yeah that's what you want yeah can we like learn from the wisdom of those who've gone before us um I think like I said I feel like at every reproductive life stage we have this very strong tendency just to focus on all of the things that go wrong yeah so I don't think that as our daughter's a entering puberty where they're catastrophizing it and you know you're going to hemorrhage every month and yeah you're going to have terrible period pains and it's going to be awful and it's going to be humiliating and people are going to start looking at you and hypersexualise you and la la la la la we're kind of trying to provide I don't have daughters but I imagine that's not the messages that people know the daughters know that's going to be much more positive and empowering yes of course and we're going to be using wisdom to educate and I would like to think that that was what we were doing at this stage in life but I just don't feel like all of the conversations are there yet but I'm very optimistic that they will get there and I'm very optimistic also that on neuroscience research that comes through that sort of shows the upsides and the benefits and what kind of peaks at midlife and cognitive functions that we see continue to improve into old age because I feel like all we do is grieve and talk about what we've lost so well and not what we're potentially gaining that is so beautifully said and that was actually the whole a big premise of my book age like a girl was to talk about what's right with menopause because supposed to talking about what's wrong with menopause but what you have offered me is a deeper context today on the environments that we keep putting our brains in are going to have a direct influence on our experience of menopause and I too have been struggling with the direction the conversations gone just because it's so limited and wanting to open that up a little bit more is so important so talk about your five day course I know you are doing incredible work educating and you have a course coming up where everybody can look from you so how do I find you yeah I have a suite of professional development courses and applied neuroscience and brain health so some of them are kind of like the basics of neuroscience and brain health kind of a 101 type course and I've also got one around women's brain health across the lifespan I could say womb to tomb which is so it's it's a credit that of people want to get their you know professional development hours for the different associations and organizations and I look through the the female lifespan so a new to row childhood puberty, menstrual cycle, adolescence, pregnancy, oh and then I wrote it it kind of tracks along the chapters of my book Norman's Brain book which I first wrote in 2017 and I just did a second edition update which got out this year because so much has changed even in the last five or six years it was quite funny though because when I first put the when I was writing the book and the and the and the course maps along maps along the chapters of the book through the lifespan but it was funny because I I think I went from adolescence menstrual cycle I think I had a chapter on anxiety depression and mental health and then pregnancy and I was like oh I forgot the bit about how you get pregnant so there's a chapter and they're on sex sex love and relationships. Amazing. I was like oh you've got to talk about that's a problem how that that's the problem with writing a book it's so it's so stagnant it's like you put it there and you can't go change it and then when you get a change it you got it and then when I was like oh need a chapter on how you get pregnant and I know I I still find that a little bit embarrassing to talk about and aging so the so the the the courses designed there's online lectures where I kind of teach the basics there's various kinds of tasks which enable people to take a closer look at various kind of academic articles are gone listen to webinars or explore the neuroscience underlying each of these life stages and a little bit more depth and then we have lots of time for life Q and A and then it culminates in this always scares people but then people end up loving it giving a little five minute presentation on a topic of their choice that's relevant to the work that they do so I have teachers and I have psychologists and coaches and therapists and I've had people from so many different professions come in and then they kind of pick one of the topics and then like what have I learned about the neuroscience of maybe you know you work in a girls private school and you want to talk about the neuroscience of puberty and then they'll give like a little five minute talk which is fascinating and it's so good for me because that's how you iterate and learn professionally yourself is by what meaning has someone made all this neuroscience and how they integrated that into into the work they do so I've tried I'm not just teaching theory I've tried to make it as practical and applied as possible for lots of people from different kind of professional backgrounds and disciplines and we have people from all over the world I want to do it I know I just I've got a little presentation I'm good I'm happy to I find neuroscience just fascinating I've actually thought about going back and getting my PhD in it that you just do one of my course exactly I've got more time efficient for me yeah yeah yeah so some of them I've got two I've got a 17 lesson curriculum which is applied neuroscience and brain health to be kind of go through all we've been talking about about neuroplasticity and neurons and synapses and transmitter systems but we talk about cognition emotion motivation goal setting brain aging diet exercise you know sleep stress social connection etc and I teach that across it's there's a 10 day intensive it's like really full on or there's a 12 week slow version and so I just have all these incredible people from all around the world come and do these courses and and for me that's how I've learned how to teach as well as by just interact you know you learn to teach well and explain the brain by getting feedback from other people about what's landed and what hasn't yeah I just and the me my favorite thing in the world is talking about neuroscience to people sister so it's a little venn diagram of all my favorite things how how do people sign up for the course we'll leave a link but is it do they just go to your yes so doctor go to doctor Sarah macaie dot com and if you sign up to like my newsletter I have like a little I kind of mini email course that'll just get you in the system and then the enrollments for it's called in her head actually I wanted to call this book the women's brain book I wanted to call it in her head you're published as we like me sounds and this is in 2017 they were like aren't might and they're all in her head might sound like the girl in the train or the window they might think it's domestic noir like novel not yeah brain health and so in Australia they like what you see it's what it says on the can is what's in the can so it got called the women's brain like yeah it says it's what it says yeah and then I still really liked all in her head so I called the course good good all in it in her head yeah so yeah that's what the course is called it's running for the first time it's been on ice for the last two years and I'm just done a massive update based on the research but like honestly there was research that came out you know today research you came out a couple of months ago I'm constantly iterating and updating because there is just so much work being done and shout out to all of the scientists who are the ones at the call face doing all of the hard work there's some really amazing research groups around the world that are driving this woman's brain health yeah field forward so my I can only do what I do because they are all doing amazing well doctor Sarah McCuy this was an incredible conversation I can see when you're like I could go three hours I'm like I could go three hours like we've already done many polls like I've got yeah so we'll bring you back we'll bring you back to do more I'm very interested in your course and I just think it there's never been a greater time to understand yourself than this moment and you know that's what I love about neuroscience is you really start to understand human behavior in a new way so yeah thank you endlessly fascinating yeah thank you for giving me the opportunity to talk about it of course of course and we'll leave all the links and send everybody your way and I'll see you in your course so and I'll bring you back so thank you for your time I really appreciate it thank you thank you so much for joining me in today's episode I love bringing thoughtful discussions about all things health to you if you enjoyed it we'd love to know about it so please leave us a review share it with your friends and let me know what your biggest takeaway is