The XX Brain: Inside a Woman's Brain

Lisa Mosconi, PhD, holds a dual PhD degree in neuroscience and nuclear medicine and is a board certified integrative nutritionist and holistic healthcare practitioner. Her new book, The XX Brain, explores how lifestyle factors affect how the brain ages, with a focus on women's brain health.

S&H: Less is known about women's health than men's health. Who decides what medical studies are conducted and what steps can be taken to ensure that future studies focus more on women’s health?

Lisa Mosconi: Historically, the FDA recommended excluding women of childbearing age from experimental clinical trials. This led to severe consequences for women, as women were no longer informing research either. Whatever knowledge we acquired in those years, which is quite a lot, was based on studies in males—and male animals, which are easier to study as they don’t have menstrual cycles.

At the same time, historically, medical professionals believed that women were essentially smaller men with different reproductive organs, which led to “women’s health” being confined to those organs, i.e., our breasts and reproductive organs. So basically, modern medicine is based on a reductive understanding of what a woman actually is. Women were eventually reintegrated into clinical trials, and today we scientists are required by law to include both men and women in our studies (unless there’s an actual reason not to). However, most studies now lump men and women together, and then typically use statistical procedures to remove any gender effects.

So we went from medical research being focused on males to being focused on an arbitrary, average gender-less person. At the moment, it is up to the P.I. (principal investigator, like myself) to decide whether or not to focus on differences between men and women. What can we do to focus more on women’s health—for once, raising awareness that gender differences matter, and educating both the public and the medical community to appreciate these differences, is a great first step. It is also imperative that women step up and demand evidence-based, female-specific information. That’s what we need—solid, rigorous, data in women to replace the plethora of websites telling us to buy more supplements.

Do you think that “precision medicine”—medicine customized for a particular group—will ever be accessible to everyone, or will it be something only wealthy patients can afford?

I sure hope so. In some ways, it depends on who is in charge. For example, at the Weill Cornell Alzheimer’s Prevention Clinic, which I am Associate Director of, we use a precision medicine approach to reduce risk of Alzheimer’s and work on assignment, which means we take medical insurance. This way, most people can afford treatment. So far, we are quite unique—most healthcare programs in the U.S. can be very expensive.

Clearly diet, rest, and exercise are all very important when it comes to brain health. For someone who leads a sedentary lifestyle with a typical western diet but who is looking to make meaningful changes, what would be the three most significant things they could do to start?

There are many things one can do that are all worthwhile and important for brain health. I review them in detail in my book The XX Brain, but for now, these are my top three:

1. Diet. We all eat three times a day, and the foods we eat impact our brains and hormones. So improving our diet is an excellent opportunity to effectively support our brains fairly quickly. There are many diets out there, but the Mediterranean diet in particular has been shown to be supportive of women’s health. Women on this diet have a much lower risk of cognitive decline, heart disease, stroke, and depression—and also fewer hot flashes. If the Mediterranean diet is not your cup of tea, then just make sure you eat enough fiber.
2. Exercise. A healthy body is a healthy mind, and the benefits of exercise are endless. A large body of literature shows that women who exercise have a lower risk of future dementia as compared to those who lead sedentary lives. For example a study of 200 women followed for over 40 years shows that a higher level of fitness at midlife was associated with very low rates of future dementia, as compared to women in the lowest level who showed a 30 percent rate of decline to dementia. But the important thing is that you don’t have to become a professional athlete—there is plenty of evidence that mild to moderate intensity activity is protective enough for most women.
3. Stress reduction. Stress is a major medical issue and contributing factor in all leading causes of death, including heart disease, cancer, lung disease, and Alzheimer’s. Plus, prolonged periods of stress, and the subsequent surge in cortisol levels, decreases overall cell function while sending our estrogen levels plummeting. There is evidence that women’s brains are more vulnerable to long-term stress than men’s. A recent study of more than 2,000 middle-aged people showed that if you lead a high-stress life, you could experience memory loss and brain shrinkage before you even turn 50. But these effects were found only in postmenopausal women. So reducing stress doesn’t just save your day—it also saves your brain!

You touch upon this in the book, but what are some of the differences you’ve noticed between mothers and non-mothers who are going through menopause? How do their challenges differ?

It’s interesting, I never fully understood how hard and demanding it is to be a mother until I had my daughter. Sleep deprivation alone can have dramatic effects on the rest of your life, and this is not something you can fully appreciate until you experience it for yourself. For example, the average mom tends to accumulate up to 700 hours of sleep debt in the first year that the baby arrives. But also, just keeping track of things can take up so much of a mom’s mental space that lost keys, forgotten appointments, and misplaced bags all become daily things.

The good news is that, even though most new moms don’t feel as sharp as they used to, their brain’s capacity is definitively unaltered. Your IQ hasn’t changed a bit—your priorities have. My best advice is to have respect for and awareness of this newfound role, and be gentle with yourself. Ask for help whenever possible to simplify any other areas of your life that can withstand it.

What advice can you give to the loving male partners of peri- and postmenopausal women?

Give her a break! She is not making stuff up. Our research shows that many women undergoing menopause experience actual changes in their brains. These changes can range from minor to pretty dramatic adjustments, which can in turn result in hot flashes and night sweats, but also mood swings, depression, anxiety, and forgetfulness. While lifestyle changes, and sometimes medicines, can definitely help, nothing beats having a supportive, loving partner who is willing to not only believe that you are having a hard time, but also to help you out.

So many peri- and postmenopausal women report feeling downright exhausted. Wouldn’t it be wonderful if they could just lay down and relax while their partners make dinner, or put the kids to bed, or do the laundry? It’s the little things that really matter at the end of the day.