Understanding Your Brain Through Perimenopause and Menopause with Dr. Louisa Nicola

An estimated 7.2 million Americans age 65 and older are currently living with Alzheimer's dementia. The part that should alarm every woman listening is this: almost two thirds of them are women. In this episode, Dr. Mary Claire Haver sits down with neurophysiologist and Alzheimer's researcher Dr. Louisa Nicola to unpack what's really happening to women's brains during perimenopause and menopause and what we can do about it. Louisa Nicola is a neurophysiologist, human performance coach, and founder of Neuro Athletics, a consulting firm that works with elite athletes and high-level professionals to optimize brain health and performance. A former world class triathlete, she transitioned into neuroscience and earned her Master of Medicine in neurophysiology from the University of Sydney. Dr. Nicola is currently pursuing her doctorate studying the effects of resistance exercise on brain health. She focuses on optimizing brain function and longevity, particularly in women, through sleep, nutrition, and exercise interventions. Dr. Nicola reveals how Alzheimer's disease doesn't suddenly appear at 70 but starts quietly in our thirties and forties, building up over a 30-year progression. She explains what's happening in the brain as amyloid beta proteins and tau tangles accumulate, why the hippocampus is the first area to go, and the critical role that sleep plays in clearing these proteins through the glymphatic system. The conversation explores why women are more predisposed to tau protein accumulation than men and how estrogen, progesterone, and prolactin inhibit the enzyme that causes tau proteins to become hyperphosphorylated and toxic. Dr. Nicola explains the connection between declining estrogen during perimenopause and increased Alzheimer's risk, including how estrogen helps mediate glucose metabolism in the brain, supports synaptic connections, and why the loss of this hormonal scaffolding leaves women vulnerable to cognitive decline. Guest links: Louisa Nicola https://www.instagram.com/louisanicola_/?hl=en (Instagram) Louisa Nicola https://www.facebook.com/louisanicola/ (Facebook) Louisa Nicola, MMed, PhD(c) https://www.linkedin.com/in/louisanicola (LinkedIn) Louisa Nicola https://www.youtube.com/c/LouisaNicola (YouTube) Louisa Nicola https://x.com/louisanicola_?lang=en (X) Neuro Athletics https://www.neuroathletics.com.au/ The Neuro Experience Podcast https://podcasts.apple.com/us/podcast/the-neuro-experience/id1274468842 (Apple Podcasts) The Brain Code https://go.neuroathletics.com.au/sales-page-1312 Books “Joyspan,” https://drkerryburnight.com/joyspan by Dr. Kerry Burnight “The New Perimenopause,”⁠ https://thepauselife.com/pages/the-new-perimenopause-book by Dr. Mary Claire Haver ⁠"The New Menopause"⁠ https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/059379625X/ref=sr_1_2?adgrpid=190238689390&dib=eyJ2IjoiMSJ9.djG88jtefTqLpTg36Li8QMNmXkpzLIfbFdY438Vro2vit_rKymy65UpF10hk_VTrxmazFUemwk7ywlmqHYY80j-V3LaeSD824-02PCtdlS8Fzp1XPcZs68nYHCL4V_ZdZBTJya---9Ng5PtKdOf-U3ENtuDXbDw68ULSk2wNk6Lt6mEhIPkuLM7FhztUzBJZ0wNBUQCSs6Pk1ZhoV2JDlzRapnMjnZgOq7PBA7Wy2KM._ZZSn21KJ43AyMvvSvI9_Hs3q74tpMBoCJ2zwi9enkc&dib_tag=se&hvadid=779626799212&hvdev=c&hvexpln=0&hvlocphy=9004331&hvnetw=g&hvocijid=16430100151400627515--&hvqmt=e&hvrand=16430100151400627515&hvtargid=kwd-2465259580440&hydadcr=15551_13558570_10211&keywords=perimenopause+book+mary+claire&mcid=ab159bad5384301d948e659e4b52f68d&qid=1774909744&sr=8-2 by Dr. Mary Claire Haver <p ...

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Let me tell you, for every woman listening, and by the way, women represent seventy percent of all Alzheimer's disease cases, so two out of three cases are female of Alzheimer's disease. The small percentage that isn't is like Betty, if you have been given a, you've got a genetic mutation in three genes, the presenil in one, presenil in two, and the amyloid precursor protein, that's only like two to three percent of the population. Tiny percent. Very percent, okay, small percent. So the other ninety-five percent, why are they getting it? It's, it's through lifestyle interventions, life's the way that you live your life. So we know that we have agency over it. So the seventy percent, and then the, the rest of, you know, there's another very small portion that then has to care for, they're becoming caretakers.

• 0:44Speaker 00

  So really, women are at the mercy of this disease.

• 0:57Dr. Mary Claire Haver?

  The views and opinions expressed on Unpass are those of the talent and guests alone, and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. As many of you know, I am obsessed with the science of women's midlife health. But there's one piece that keeps women up at night more than anything else: the fear of losing themselves, the fear of cognitive decline, and the fear of dementia. The facts are shocking. Around fifty to fifty-five million people worldwide are living with

• 1:36Dr. Mary Claire Haver?

  Alzheimer's disease today, and we expect that number to triple by the year 2050. But the part that rattles me the most is that only three to five percent of those cases are caused by genetic mutations, which means ninety-five percent or more of Alzheimer's disease is influenced by something else. Women ask me constantly, what can I do now to protect my brain? And my guest today, Louisa Nicola, is one of the clearest, most compelling voices in neuroscience, helping us understand the answers to this question. Luisa is a neurophysiologist, an Alzheimer's expert on a mission to eradicate this destructive disease. She is the founder

• 2:18Dr. Mary Claire Haver?

  and head performance advisor of NeuroAthletics, a human performance education platform that has certified over 2,000 coaches, and also a former world champion triathlete.

• 2:30Dr. Mary Claire Haver?

  I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to UnPaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.

• 2:53Speaker 02

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• 3:28Dr. Mary Claire Haver?

  Dr. Nicoleette, welcome

• 3:30Speaker 00

  Hi.

• 3:30Dr. Mary Claire Haver?

  to UnPaused.

• 3:31Speaker 00

  I'm so excited to be here.

• 3:32Dr. Mary Claire Haver?

  Walk me through your training. You grew up in

• 3:36Speaker 00

  Sydney, Australia. Well, actually, I grew up in Australia, two hours north of Sydney. So my training, I did an undergraduate degree. I actually became a high school teacher.

• 3:44Dr. Mary Claire Haver?

  Really?

• 3:44Speaker 00

  Yes. So I was

• 3:45Dr. Mary Claire Haver?

  That was like my backup plan.

• 3:47Speaker 00

  Really? Well, I did that because I was an elite triathlete and I was training six hours a day and I wanted to

• 3:52Dr. Mary Claire Haver?

  In high school?

• 3:52Speaker 00

  I was training in high school and then after high school. I wanted to compete and go to the Olympics and my mother said, the best way to do that is to become a high school teacher. You get your degree and you can do casual hours. And so I did. I ended up becoming a math teacher. So I was teaching senior boys. I went on to do a master's of mathematics and I was actually looking at neuron signaling. So I was doing algorithmic work with neuron signaling. I became fascinated by the human brain. I couldn't believe the trillions of cells that were communicating with each other during that time. And there's a mathematical equation for it. And I then went on, I did a masters of medicine and then furthered into a PhD.

• 4:36Speaker 00

  So quite extensive, but very analytical. And I love what I do because I have both clinical and a research side. So I work half of my week in neurosurgery, which gives me a really broad overview of looking at patient cases from tumors to, I mean, neuroplastic neurosurgery. So looking at reconstruction of skulls. And then I have the research side of my.

• 5:02Dr. Mary Claire Haver?

  So how did you end up in the US?

• 5:04Speaker 00

  Well, I came here because I wanted to work with the world's best neurosurgeons. And in Australia, we've got a population of 25 million. It's not the same as the US and I thought I could broaden my understanding by coming here.

• 5:18Dr. Mary Claire Haver?

  What made you particularly interested in, in, you know, this area?

• 5:24Speaker 00

  So I'm looking at right now, I'm really an Alzheimer's disease researcher. And this comes from being a neurophysiologist. So that is my.

• 5:34Dr. Mary Claire Haver?

  Okay, for our listeners, what is a neurophysiologist?

• 5:36Speaker 00

  So it's a subspecialty of neurology. So it's somebody who is looking at the brain, but a specific area of the brain. You would see a neurophysiologist if you've had, maybe you're suspected of having multiple sclerosis or epilepsy. If you've had a seizure, you're going to see a neurophysiologist. And what they'll do is they'll scan your brain using an EEG. And it's one of those caps that you put on your head with all the wires that come out of it. And it assesses the functionality of the brain. And so that's primarily what I've done. I've done thousands, thousands of thousands of EEG scans ranging from epilepsy, sleep study scans. And then I was put, just by chance, and this was in 2017.

• 6:18Speaker 00

  I was put to primarily scan the brains of mild cognitive impairment patients.

• 6:24Dr. Mary Claire Haver?

  And for our listeners, what is mild cognitive impairment?

• 6:27Speaker 00

  So mild cognitive impairment is a pre dementia state. We're going to talk a lot about dementia. And so I was tasked with, hey, Louisa, we've got all these patients coming in with memory complaints and they're having all of these. Difficulties with words and I was like, okay. So I started to scan their brains, which was very new to me. And we were able to come up with a clinical diagnosis of mild cognitive impairment. Okay, combining an EEG and a Q EEG. And over that time in 2017, I had so many questions. I kept asking my superior, who was a double board certified neurologist and neurophysiologist. Every time I asked him, why do we have so many women getting mild cognitive impairment compared to the men?

• 7:11Speaker 00

  And he said, it's just how it is. No one gave me answers. I didn't have the answers. I didn't know what caused Alzheimer's disease.

• 7:19Dr. Mary Claire Haver?

  And how old were these patients in general?

• 7:21Speaker 00

  The one who really changed the course of my career was fifty two.

• 7:24Dr. Mary Claire Haver?

  Okay.

• 7:24Speaker 00

  But most of them ranged from fifties to eighties.

• 7:29Dr. Mary Claire Haver?

  Okay.

• 7:29Speaker 00

  Right? But I was, I was really dumbfounded too. I couldn't understand why we were getting fifty year olds. And I used to think that this was a disease of your seventies and eighties. Which is what I was being told in a hospital setting, in a neurology clinic, which was what I was being told. But when I was looking at these scans and you were looking at the demographics, you know, very like high socioeconomic status females getting this, having these complaints. And when you talk to them, and I'll give you the example of, let's call her Betty, fifty two year old female, mother, three kids. She saw me over the course of two years and she went from saying, hi Louisa, to over two years asking me if I'm her daughter.

• 8:12Speaker 00

  And that was a very, very fast progression into early onset Alzheimer's disease. So she did have a genetic mutation in the presynal and one gene, but that's what really formulated, okay, this is, I need to research this, this is what my PhD will be on, everything.

• 8:29Dr. Mary Claire Haver?

  Amazing.

• 8:29Speaker 00

  Yeah.

• 8:30Dr. Mary Claire Haver?

  So when you went to your thesis advisor, you know, I guess that's how that works for the PhD. With this idea of I want to study, I guess, sex specific.

• 8:40Speaker 00

  Sex specific differences.

• 8:41Dr. Mary Claire Haver?

  Differences in Alzheimer's. Did you get pushback? Or were they excited?

• 8:45Speaker 00

  No, I got a lot of pushback. My mentor and advisor is a male, but he's phenomenal. There was just not a lot of work being done. 2017, you know, I knew actually about Lisa Moscone, I read a lot of her work. And we didn't really understand sex specific differences in really any broad category, whether it was pharmacokinetic, any broad category.

• 9:05Dr. Mary Claire Haver?

  Dysglottic.

• 9:06Speaker 00

  Exactly.

• 9:07Dr. Mary Claire Haver?

  It's just like multiple things.

• 9:08Speaker 00

  Yeah, but as the years went on, we started to accumulate all of this, all of these research papers that showed that 70% of all Alzheimer's disease cases were women. And that just kept like really knocking me, knocking me, knocking me.

• 9:24Dr. Mary Claire Haver?

  So you, you know, have this advanced incredible degree in neuroscience and you are hitting the clinical floor.

• 9:32Speaker 00

  Yeah.

• 9:32Dr. Mary Claire Haver?

  You doing scans as part of your job. Suddenly you get put on a project where you're doing early cognitive decline and noticing they're all. It's just dumbfounding to me that less than a decade ago, you know, you were shocked by this.

• 9:46Speaker 00

  I was shocked by this. And every time I asked for answers as to what causes Alzheimer's disease, what is dementia? What is the difference? Are there different forms of Alzheimer's? Like, what are we doing for these women? Now let's go back to Betty. When you interview Betty and you ask her about her lifestyle, she was never asked, she didn't know about, she didn't know if she was in menopause or not. She didn't, she had never in her life had a doctor ask her for her genetic profile. So she never checked her genetic profile. She rarely did blood tests, maybe once a year at her PCP annual. It wasn't deep, like the biomarkers were just skimming the surface, vitamin D, metabolic panel, wasn't going deep into cholesterol panel.

• 10:29Speaker 00

  She had the standard American diet because that's what she was told. She was doing what she was told as per government guidelines. And she still ended up in this position.

• 10:39Dr. Mary Claire Haver?

  Wow.

• 10:40Speaker 00

  Where she was given, by the way, the end diagnosis of Alzheimer's disease is comparable to end stage cancer. And that's quite scary and people don't see it that way still today in 2025.

• 10:52Dr. Mary Claire Haver?

  And. I, my mom has Alzheimer's. I don't know if you knew this. And she's in her eighties. Her mother most likely had it. There was no diagnosis back then. She just was an old lady who laid in a bed for at least five years. You know, completely bedridden, yelling out, having lots of hallucinations and just drooling on herself. You know, at the very end.

• 11:15Speaker 00

  Yeah.

• 11:15Dr. Mary Claire Haver?

  And extremely frail.

• 11:17Speaker 00

  Yeah.

• 11:17Dr. Mary Claire Haver?

  And then my mom, I think, just kind of considered it her turn.

• 11:21Speaker 00

  Mm hmm.

• 11:21Dr. Mary Claire Haver?

  You know, and now she's in a memory care. Like, we have better options. She's in memory care. But again, I thought she heard my father calling her in the middle of the night on New Year's Eve. Got out of bed, fell and broke her hip. You know, then went through the surgical repair and she's never walked again. And so it's just as a family member and, you know, my sister's the primary caretaker because she's a nurse and logistically she's closer to mom. I live out of state.

• 11:48Speaker 00

  Mm hmm.

• 11:48Dr. Mary Claire Haver?

  And like, it is, it's life changing. And it's devastating. And it is not what my mother would have wanted. And so I love these conversations because I can't wait to dig into this more.

• 11:59Speaker 00

  Yeah.

• 12:00Dr. Mary Claire Haver?

  Because I am refusing for this to be the future for my children. I have two daughters and they're 21 and 25. I don't want this to be their future.

• 12:09Speaker 00

  No, and this is the disease, the only disease that robs you of who you are.

• 12:13Dr. Mary Claire Haver?

  Yeah.

• 12:14Speaker 00

  You know, you spend your whole life, I keep thinking about, I'm like, you spend your whole life getting to know yourself, getting to know your children. And having that all taken away from you isn't life's greatest gift to really understand who you are. And finally, once you get there, it takes a very long time, I can only imagine. Once you finally get there and you're okay with who you are, it's taken away from you.

• 12:36Dr. Mary Claire Haver?

  One of the most painful things for me to watch is that it leaves her, not just her memory is gone, right? She's angry. She's, she's, she's, you know, paranoid.

• 12:48Speaker 00

  Yeah.

• 12:49Dr. Mary Claire Haver?

  She's in this horrible state of mind most of the time that seems like her brain is torturing her.

• 12:55Speaker 00

  Yeah.

• 12:55Dr. Mary Claire Haver?

  You know, and she's, she's just unhappy.

• 12:58Speaker 00

  It's downsized. Her brain has downsized because it's basically at a point where she's like, I've, the brain has said, we've given up, we give in, now we're going in and that's it. And it's, you know, I'd love to just ask, did you check your status?

• 13:12Dr. Mary Claire Haver?

  So we're negative. There's no genetic component. She did have plaques. So that's how they made the diagnosis.

• 13:18Speaker 00

  Of course, yeah.

• 13:18Dr. Mary Claire Haver?

  She's in her eighties and lifestyle like had to have had a huge part of this. You know, when my father died about six years ago, she really kind of gave up on healthy habits and her, she was dealing with grief, I think through excessive alcohol ingestion. She was, most of her caloric intake, probably in the last year as she was at home, was from alcohol.

• 13:42Speaker 00

  Yeah.

• 13:43Dr. Mary Claire Haver?

  And so, you know, my sister and I talk about, these are the things we have to avoid so that we cannot do this to our children.

• 13:51Speaker 00

  Absolutely. And it's a long progression, which is why people don't really pick up on it. And when it's too late, it's too late. So when you're given the diagnosis, there is no reversal, although some doctors claim there is, I don't believe there is. There is no reversal of the disease. There's no backtracking and there's no real, there's no real prevention other than lifestyle.

• 14:13Dr. Mary Claire Haver?

  Our audience is filled with mostly women. Our listeners are mostly women, though we do have about, you know, we have several men that listen, but you know, this caring for aging parents, are you seeing this in your?

• 14:24Speaker 00

  Oh, yeah.

• 14:24Dr. Mary Claire Haver?

  Population? My patients are coming in with no cogni-, you know, with the usual brain fog, and we'll talk about that, but they are looking at what's happening to their mothers and especially with their mental health and their cognitive changes in their parents and saying, okay, absolutely not. This is not what I want. You know, how can we get ahead of this? And you're saying in your work, we're figuring out the path to decrease this risk.

• 14:49Speaker 00

  Correct. And let me tell you, for every woman listening, and by the way, women represent seventy percent of all Alzheimer's disease cases, cases, so two out of three cases are female of Alzheimer's disease. The small percentage that isn't, is like Betty. If you have been given a, you've got a genetic mutation in three genes, the presenilin one, presenilin two, and the amyloid precursor protein, that's only like two to three percent of the population.

• 15:13Dr. Mary Claire Haver?

  Tiny percent.

• 15:14Speaker 00

  Very percent, okay, small percent. So the other ninety-five percent, why are they getting it? It's? It's through lifestyle interventions, life's the way that you live your life. So we know that we have agency over it. So the seventy percent and then the the rest of, you know, there's another very small portion that then has to care for, they're becoming caretakers. So re- really, women are at the mercy of this disease.

• 15:37Dr. Mary Claire Haver?

  Let's, let's talk about brain fog.

• 15:39Speaker 00

  Yeah.

• 15:40Dr. Mary Claire Haver?

  And how is it different than dementia? Like, when should someone be worried?

• 15:44Speaker 00

  So first of all, let's, let's just do some terms. Dementia is the umbrella term that's used to describe the you're starting to have a decline in your, your cognition. So your cognition is your thinking, your reaction time, your information processing speed. This starts to decline, which a lot of your listeners, if they're in there, maybe they're mid forties, early fifties, they kind of feel like, you know, that's what brain fog really is. It's like a you, it's like a mismatch in, oh, memory, you know, memory loss, like what's short term memory? Like what was his name? What was that thing? You know, in the surgical, in the O R, could be, could you pass me that thing?

• 16:22Dr. Mary Claire Haver?

  The long one with the handle.

• 16:23Speaker 00

  Yeah, the long one with the handle. You're starting to forget. That's all brain fog, right? And it's, it's exasperated through the loss of estrogen. We'll get there in a second. So dementia is the umbrella term.

• 16:33Dr. Mary Claire Haver?

  How do we diagnose dementia? This is a medical diagnosis.

• 16:36Speaker 00

  This is a medical diagnosis. Now, you're not going to get dementia per se. You're going to get Alzheimer's dementia, dementia with Lewy bodies. So we have to really figure out which one it is. The reason why we know Alzheimer's disease is because most of the cases of dementia is Alzheimer's disease. So there's Alzheimer's disease, then underneath it is vascular dementia.

• 16:55Dr. Mary Claire Haver?

  Okay.

• 16:55Speaker 00

  Okay. So I've got different forms of dementia. So if you get diagnosed, you're getting diagnosed with vascular dementia and Alzheimer's disease is made up of two proteins. This is how you'll see it on pathology and on a report. You'll do a C S F, like a spinal tapping, you'll see that you've got an accumulation of amyloid beta and tau proteins. If you've got vascular dementia, you've got a problem with the vessels in the brain. Okay. Or you might get Parkinson's dementia. Maybe first you had Parkinson's disease. It's exasperated and caused some form of dementia. So that's. That's how you're diagnosed, usually needing urologists to do that through imaging.

• 17:32Dr. Mary Claire Haver?

  And then how is this different than brain fog?

• 17:34Speaker 00

  So, brain fog is a symptom, okay? Now, brain fog is some, like I mentioned to you, it doesn't mean that you have dementia. It's a cognitive complaint. It could be exacerbated by stress, right? So what we know is that we have estrogen receptors that flood the frontal part of the brain. The frontal part of the brain is where we hold our executive functions, thinking, processing speed. When those estrogen receptors die because there's no circulating estradiol, we don't have enough estrogen. What happens? Well, our thinking is not the best, but it can also happen in a hypercortisol state. So if you are severely stressed, you may not have your short-term memory, but that could also be brain fog as well.

• 18:18Speaker 00

  So it doesn't mean that you have Alzheimer's disease or dementia just because you have brain fog. It's just a symptom and we can fix that.

• 18:26Dr. Mary Claire Haver?

  You've said that Alzheimer's doesn't suddenly appear at 70.

• 18:30Speaker 00

  No.

• 18:30Dr. Mary Claire Haver?

  That it is actually starts quietly in our 30s and 40s.

• 18:34Speaker 00

  It does.

• 18:35Dr. Mary Claire Haver?

  Walk our listeners through, you know, what is actually happening in the brain?

• 18:39Speaker 00

  So we've got this 30-year projection, right? And Alzheimer's disease, if we think about it, it really starts in the 30s because what tends to happen? Well, this is when our brain has fully formed. We're already there. So the only thing evolutionarily is, okay, great, I've, I've formed and now it's time for me to decompress. And what tends to happen, just due to the natural brain aging process, we get thinning of the gray matter. So we've got gray matter and white matter. And if we don't look after our brains, we get little lesions in the white matter of the brain. And as we're getting older, we've got more things, time is of the essence. We don't have, we're not looking after ourselves as much.

• 19:22Speaker 00

  So all of the things that we're meant to be doing that build a high-performing brain and that stave off Alzheimer's disease, we're not engaging in these activities. We're not exercising. We're sleep deprived, whether that's due to kids, whether that's due to work-related, stress-related, all of these things. So we're not doing the things that are there to serve and protect our brain. And over the course of 20 years, if we don't do that, what happens in the brain, these plaques, okay, these amyloid beta proteins and these tau tangles, they start to build up and they compound and you don't realise it in your 30s. I may scan your brain right now and I could scan my brain, we've probably got amyloid built up in the brain and some tau residue. We probably have because I don't

• 20:05Speaker 00

  know if you're sleep deprived, but we're in New York City, there's a lot of toxins in the air and then we wash it out at night. But if we don't do that, as we, you know, if we don't sleep every night and we don't wash out those amyloid beta proteins, they compound, they accumulate, they start to take over the brain. It causes losses of synapses and that over time causes Alzheimer's disease.

• 20:31Dr. Mary Claire Haver?

  Is there a threshold? Like, how much accumulation do you need before you start having, this is Alzheimer's?

• 20:38Speaker 00

  So amyloid beta, okay, we'll, we'll talk about it. It's a, it was demonised as this toxic protein. We know now it's not a toxic protein.

• 20:44Dr. Mary Claire Haver?

  I was taught that, that, that.

• 20:46Speaker 00

  Yes, because we used to think of Alzheimer's disease as the amyloid cascade hypothesis. That's what it was, right? But we know that that's not it. Okay. Amyloid is actually a protective molecule, right? It actually is served to protect your brain. So when you-

• 21:00Dr. Mary Claire Haver?

  I've never heard this.

• 21:01Speaker 00

  Yes. So when we activate our innate immune system and we get stressed, the neurons start releasing amyloid as a way to shield the neurons to protect them. But what happens is we have to have a good clearance system at night, which is when we go into deep sleep to clear it out. That's amyloid beta. It lives outside of the neurons, okay, in the cerebral spinal fluid. And then we have tau proteins. Now, I don't think you, I don't know if you know this, but- The one of the reasons that I hypothesize that seventy percent of women have Alzheimer's disease is because we are more predisposed to tau proteins than men.

• 21:36Dr. Mary Claire Haver?

  Okay.

• 21:36Speaker 00

  Yeah.

• 21:37Dr. Mary Claire Haver?

  Walk me through this.

• 21:38Speaker 00

  So tau protein lives in the microtubules. Let's neuroanatomy right now, we have around eighty seven billion neurons. Okay, each neuron has around fifteen thousand connections.

• 21:50Dr. Mary Claire Haver?

  Okay, I think of neuron as a star with a long tail and a little star at the bottom.

• 21:54Speaker 00

  There you go, I love that. So that star, I could think about it like a tree. Okay, so that star is the neuron cell body and then you've got the axon. Okay, so that's the trunk. And that axon within that live these highways, if you will. And this is where we send information. Information processing speed goes up, that conduction velocity. That's where the microtubules live and that's where tau protein lives. Now, tau protein, once it is phosphorylated.

• 22:20Dr. Mary Claire Haver?

  Uh huh.

• 22:21Speaker 00

  Okay, it breaks off the microtubules and it starts to aggregate. And when it starts to form clumps in that, in that part of the brain, that's when we get collapses of the axon. This is really interesting. So there is an enzyme responsible, GSK three beta. It's an enzyme that actually phosphorylates the tau protein. Okay, so it causes it to become hyper phosphorylated within that. And when it becomes hyper phosphorylated, it causes the collapse of the axon. Get this, estrogen, progesterone and prolactin.

• 22:58Dr. Mary Claire Haver?

  I was gonna say, like, does hormones have anything to do with those?

• 23:02Speaker 00

  Estrogen, progesterone and prolactin inhibit that enzyme, so it shuts it off. So estrogen and progesterone and prolactin actually stop the phosphorylation of that tau.

• 23:14Dr. Mary Claire Haver?

  Okay.

• 23:15Speaker 00

  So what happens during perimenopause? We don't have the support of the estrogen, so we are now hyper fixated on that. So we have a, an increased risk of getting hyperphosphory because we don't have the support anymore.

• 23:28Dr. Mary Claire Haver?

  And does the, the, the sleeping, the glymphatic system, um, you know, the nightly washout? Does it clear the tau proteins or just the amyloid?

• 23:36Speaker 00

  Just the amyloid. Because during sleep, we activate. Yeah. So we activate the glymphatic system. We've got a lymphatic system in our body. But what happens is the glial cells, that's where it comes from. Now, glial cells comes from the Greek word glue. They stick between neurons and they shrink in size during deep, slow wave sleep. So when they shrink, what happens, we can get all of the cerebral spinal fluid to wash through the brain and clear out the amyloid. So it clears out the amyloid, but it doesn't clear out the tau. This is what I'm hypothesizing right now. I'm doing a meta-analysis, which you can understand is a really, really big statistical analysis of all of the available evidence. But I'm hypothesizing that this tau protein that we accumulate more so than men

• 24:22Speaker 00

  has something to do with the fact that eighty percent of all autoimmune diseases are female. Because if you think about autoimmune diseases, let's talk about multiple sclerosis, for example. What is that? It's a demyelinating disease and I have done a lot.

• 24:35Dr. Mary Claire Haver?

  So far listeners, demyelization, so the myelin sheath is the insulation around the neurons. It allows, the more insulation you have, the faster the electrical impulses travel between neurons. Okay. When we demyelinate, we remove the insulation and there's an autoimmune disease that will cause that to happen. And then those nerve transition, transduction times will slow down. So people with MS will have these physical defects, you know, or they can't feel or they're struggling.

• 25:07Speaker 00

  They get foot drop or ptosis in the eye. And what we see on an EMG is conduction slowing or complete conduction block. And I always think, and if that's happening.

• 25:17Dr. Mary Claire Haver?

  And what's an EMG for the listeners?

• 25:19Speaker 00

  Electromyography. So it's a needle which you'll stick into one of the nerve fibers and we can check the, the, the speed of impulses.

• 25:27Dr. Mary Claire Haver?

  And is that how we diagnose MS?

• 25:29Speaker 00

  Yeah, it is. And other neuroimaging studies. And I, I hypothesize that this is some, you know, because we still don't know why. Why don't, why, why are eighty percent of all autoimmune diseases women? We still don't know why.

• 25:42Dr. Mary Claire Haver?

  Why do you think that is?

• 25:44Speaker 00

  Well, this is, uh, this is one of my hypotheses. It hasn't been, this is just me speculating.

• 25:48Dr. Mary Claire Haver?

  No, why, why haven't we studied it to the point that we would know the answer?

• 25:52Speaker 00

  Because women are understudied, under researched.

• 25:56Speaker 00

  Because they have a hormonal cycle, which is

• 25:59Dr. Mary Claire Haver?

  Makes them hard.

• 26:00Speaker 00

  Yes, makes them hard to deal with. So we've got the accumulation of tau

• 26:03Dr. Mary Claire Haver?

  Yeah.

• 26:03Speaker 00

  And amyloid beta in the brain. And so there's several mechanisms too. So then you think, okay, well, is the whole process of Alzheimer's disease not getting it just to stop the amyloid and tau protein? Well, no, because what happens in Alzheimer's disease, that amyloid, when it builds up, it stops the connections between neurons. Okay. So that's what Alzheimer's disease really is. You've got these connections in the neurons and these connections go from 15,000 connections to 5,000. And those connections are responsible for everything we do, your actions, the way that you feel, the way that you think. And that causes memory complaints, short-term memory loss. And the first area to go in Alzheimer's

• 26:43Speaker 00

  disease is the hippocampus, which is this seahorse shaped structure. We all have one. It's deep in the temporal lobe, just behind the ears. And got the name, it's a Latin name for seahorse, because that's what it looks like. And that holds our memories, memory formation, memory consolidation. And that is the first thing to go as we, as we get older, but also during the disease.

• 27:09Dr. Mary Claire Haver?

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• 27:50Dr. Mary Claire Haver?

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• 28:17Speaker 03

  I'm neuroscientist and actress Mayim Bialik.

• 28:19Speaker 04

  And I'm Jonathan Cohen.

• 28:20Speaker 03

  On our podcast, Mayim Bialik's Breakdown, we explore the biggest questions about consciousness, quantum physics, healing, and what it means to be human.

• 28:27Speaker 04

  Featuring conversations with Neil deGrasse Tyson, Michio Kaku, and other leading scientists and experts, our podcast is where science and spirituality meet.

• 28:37Speaker 03

  Listen to new episodes of Mayim Bialik's Breakdown every week. Follow the show on Apple Podcasts, Spotify, or wherever you listen to podcasts. Watch full video episodes of Mayim Bialik's Breakdown at youtube.com/mayimbialek.

• 28:50Dr. Mary Claire Haver?

  So a lot of the naysayers, when we talk about the possible connection with mental health, and especially in cognitive decline, will try to negate hormones having anything to do with this and say, this is just aging.

• 29:06Speaker 00

  No, dementia and Alzheimer's disease is not part of the natural brain aging process. You can get to 100 years old and have your cognitive functions intact. It is possible. It is hard, but it is possible. Hormones are one factor. There are many pathways to getting Alzheimer's disease if you're a type 2 diabetic.

• 29:27Dr. Mary Claire Haver?

  Because men get it, right?

• 29:28Speaker 00

  Men get it, but men are more protective, okay? They have greater cognitive reserve. They go through andropause that are at a much later stage.

• 29:37Dr. Mary Claire Haver?

  Slower rate.

• 29:37Speaker 00

  Slower rate, but they also have more testosterone. And testosterone aromatizes into estrogen.

• 29:43Dr. Mary Claire Haver?

  And estrogen is protective.

• 29:44Speaker 00

  Estrogen is protective, and estrogen is very protective.

• 29:46Dr. Mary Claire Haver?

  So walk me through a premenopausal brain, a perimenopausal brain, and a postmenopausal brain.

• 29:53Speaker 00

  So the premenopausal brain has everything functioning adequately, right? Depending on lifestyle, but let's just say you're living just, you know, a really great, healthy life. You've got, your brain is getting fed with estrogen, that's the first one. Progesterone, prolactin, and testosterone. These are, I wouldn't say they're like fertilizer for the brain, but they are mediating many pathways. So you've got proper glucose metabolism in the brain. The brain's primary fuel source, it's a hungry organ, okay? 2% of your total body weight, but consumes 20% of the total energy that you take in.

• 30:29Dr. Mary Claire Haver?

  Fascinating to me.

• 30:29Speaker 00

  Why is that? Because it takes so much to power.

• 30:32Dr. Mary Claire Haver?

  It never stops.

• 30:33Speaker 00

  It's going 24/7. It's such a hungry organ, so it needs fuel. Where does it get its fuel from? It uses glucose. Estrogen helps mediate glucose that's in your, that's in your blood. Get into the neuron so we can use it, get into the cell body. And what happens as we, so we can use, that means we have our cognitive functions intact. We've got a lot of energy. We can go out and, and in our twenties and, and, and write ourselves off and wake up and do a marathon the next day.

• 31:01Dr. Mary Claire Haver?

  Mm hmm.

• 31:03Speaker 00

  I know I did that at, at twenty two. So when we start to see this dip in estrogen, that means our brain isn't as supported as what it once was. Okay, so our glucose metabolism isn't working as well. We name.

• 31:19Dr. Mary Claire Haver?

  In the brain.

• 31:19Speaker 00

  In the brain.

• 31:20Dr. Mary Claire Haver?

  Actually, in, in all parts of the body, yeah.

• 31:22Speaker 00

  Yeah. Some women get hot flashes at night, which is waking them up during the night. And therefore you get sleep disruption, which is also accumulating amyloid beta. We have higher, we have a lower tolerance to stress. Okay, because of hormones. And then when we get to that stage, like you've, you've said it yourself, and it's not my wheelhouse. But you said that we've got a window of opportunity to intervene. And when I look at the studies, especially for APO E four carriers, which represents twenty percent of the population, homozygous. These are the women who are, who are most vulnerable to that window of opportunity.

• 31:59Dr. Mary Claire Haver?

  That, that study came out of Scandinavia, right?

• 32:01Speaker 00

  Yes, it did.

• 32:01Dr. Mary Claire Haver?

  Yeah.

• 32:02Speaker 00

  Yeah, which showed that women who are, who have one.

• 32:04Dr. Mary Claire Haver?

  So they're high risk?

• 32:05Speaker 00

  Yeah.

• 32:05Dr. Mary Claire Haver?

  Yeah.

• 32:06Speaker 00

  One copy of APO E four.

• 32:07Dr. Mary Claire Haver?

  Mm hmm.

• 32:08Speaker 00

  Have a two to four fold increase in getting Alzheimer's disease.

• 32:14Dr. Mary Claire Haver?

  And then what did the HRT do for them, or the estrogen replacement do for them?

• 32:18Speaker 00

  Well, it lowered their risk. And that is, and that's only during that, that window of opportunity.

• 32:22Dr. Mary Claire Haver?

  Then what is the window, early?

• 32:24Speaker 00

  It's early.

• 32:24Dr. Mary Claire Haver?

  Yeah.

• 32:25Speaker 00

  Yeah, depending, it's like ten years prior to.

• 32:27Dr. Mary Claire Haver?

  So.

• 32:28Speaker 00

  Menopause.

• 32:28Dr. Mary Claire Haver?

  When, and then this is shown in cardiovascular data. We knew for observational studies for years and the WHI did prove this for the younger patients. We have a cardiovascular window of opportunity.

• 32:39Speaker 00

  Yes.

• 32:40Dr. Mary Claire Haver?

  Too, where it is. For the plaque, you know, accumulation calcification. If you get it started before the plaques form.

• 32:48Speaker 00

  Yeah.

• 32:49Dr. Mary Claire Haver?

  It's not really helpful to the plaques once they're already formed, as far as we understand.

• 32:53Speaker 00

  Yeah, basically, think of your brain like a Formula One car, right? And if you're not fueling the Formula One car with proper gas and you're doing the the cheap gas and then eventually it just stops working, you just don't put the gas in anymore. It's not going to go efficiently. When we're talking about estrogen and estrogen replacement therapy and hormone replacement therapy. What you're doing is, I don't call it, it's not a miracle, it's an adjunct to help you do other things that are necessary for the brain. It's going to help you go to the gym. Okay, push more, it's going to help with bone mineral density. It's going to help with lowering fat mass. It's going to help lower inflammation. All of these things that if are heightened can exasperate neural inflammation and Alzheimer's disease.

• 33:37Dr. Mary Claire Haver?

  Okay, so like a secondary.

• 33:38Speaker 00

  Correct.

• 33:39Dr. Mary Claire Haver?

  Yeah.

• 33:39Speaker 00

  Yeah.

• 33:40Dr. Mary Claire Haver?

  Many of our listeners know what hot flashes are.

• 33:42Speaker 00

  Yeah.

• 33:42Dr. Mary Claire Haver?

  You know, and understand that and mood swings, but they don't understand really why cognitive function shifts. So you've talked about the nerves and nerve conduction. Where do neurotransmitters play here?

• 33:53Speaker 00

  Oh, my God, so this is actually really fascinating. I'm not sure if you've heard of this. Did you know that the hypothalamus has a cluster of neurons called KINDY neurons?

• 34:02Dr. Mary Claire Haver?

  Keep going.

• 34:03Speaker 00

  Yeah, so K I N D Y, but it's pronounced candy. And it stands for kisspeptin, neurokinine six and dynorphin.

• 34:12Dr. Mary Claire Haver?

  Okay.

• 34:12Speaker 00

  Okay, and these.

• 34:13Dr. Mary Claire Haver?

  I've heard of neurokinin only because the new neurokinin receptor agonists that have come out finally isn't stuff to treat hot flashes.

• 34:21Speaker 00

  So this cluster of neurons actually are, they help regulate reproduction and temperature. So what happens when we have low estrogen during perimenopause and menopause? Estrogen actually regulates these. So when we don't have any estrogen there, these candy neurons, I love the name, by the way. These candy neurons, they're hyperactive.

• 34:44Dr. Mary Claire Haver?

  Okay.

• 34:44Speaker 00

  Okay, they don't know what's going on. There's no estrogen's not there, they're looking and estrogen's not there to control it. Right, so these neurons, these clusters start going crazy. Crazy. They go all, and this is why we get hot flashes. This is one of the, you know, one of the the hypothesis as to why we can't regulate temperature correctly. And when we get hot flashes, we get a rush of blood because your brain is also, by the way, glucose metabolism also plays a role.

• 35:08Dr. Mary Claire Haver?

  Uh huh.

• 35:08Speaker 00

  Okay. When the brain is starved of glucose and it doesn't know what to do, many things happen. Okay. We know that we start to metabolize fats, but in relation to hot flashes, we get a rush of blood that goes through our body because the brain is sensing, oh, my God, I'm starving. I don't know what to do. So we get this rush of blood, which ends up becoming a hot flash.

• 35:30Dr. Mary Claire Haver?

  Okay.

• 35:30Speaker 00

  They showed on FMRI studies that the brain stem lights up just before a hot flash happens. The brain stem is responsible in that area for temperature control, regulation, but also this is where it controls breathing and sleep. So this is probably why a lot of women are having these hot flashes during sleep. Then we get this sleep disruption, which is where the cascade of problems happen. Yeah.

• 35:58Dr. Mary Claire Haver?

  And then talk to me about serotonin, norepinephrine, these these little chemicals that

• 36:04Speaker 00

  Yeah.

• 36:05Dr. Mary Claire Haver?

  you know, signals from neuron to neuron.

• 36:06Speaker 00

  Yeah. So when our brain cells are communicating with one another, we use something called a sodium potassium pump. Yeah. So it releases these these neurotransmitters, which are just chemicals, okay, that are responsible for many things. Happiness, you know, serotonin, dopamine, motivation, it's a neuromodulator. Funnily enough, they live in two areas, but most predominantly in the frontal lobe. And what's what's the frontal lobe predominantly filled with there out where our estrogen receptors are? And also the hippocampus. So when we see a decline in that, we see a decline in the inefficiency of the neurons to communicate with one another.

• 36:45Dr. Mary Claire Haver?

  Okay. And can you talk a little bit about the mental health changes we're seeing? I see this in clinic acutely.

• 36:50Speaker 00

  The SSRIs being prescribed.

• 36:53Dr. Mary Claire Haver?

  So in my clinic, you know, and the data holds this up. Actually, it's a great data coming out of Australia that looked at at using. HRT in perimenopause for new onset anxiety or depression and seeing how well those patients were doing, much better than than putting them on an SSRI. But most doctors haven't learned how to prescribe hormone therapy or uncomfortable doing it because they were never taught. And as a default, they are prescribing a lot of SSRIs to treat hot flashes.

• 37:22Speaker 00

  Yeah.

• 37:23Dr. Mary Claire Haver?

  Hopefully, we can get everybody educated and and get some better options out there. But the fact of the matter is about 10% of women in the US are on or getting their prescriptions filled for an SSRI up until about age 40.

• 37:37Speaker 00

  Mm hmm.

• 37:38Dr. Mary Claire Haver?

  And then across the perimenopause transition, that doubles.

• 37:40Speaker 00

  Yes.

• 37:41Dr. Mary Claire Haver?

  Doubles. And then at 65, it goes up another 5%.

• 37:44Speaker 00

  When you're saying that it could be replaced or monitored better if maybe they got on hormone replacement therapy?

• 37:51Dr. Mary Claire Haver?

  There is, at least for a new onset, mental health change in perimenopause, or someone who was previously well-controlled on her medication and now suddenly is not manageable, adding in and, you know, starting on HRT or adding in HRT to that regimen will probably benefit her better than adding in a second SSRI or starting her new start.

• 38:12Speaker 00

  Yeah. I think what's important to understand is that when your brain doesn't function adequately the way that it's supposed to, meaning like the both structural and functional changes and the white matter lesions that we discussed earlier, it can cause an array of different issues. If your brain doesn't know how to function properly, it starts to think to itself, you've got to think evolutionarily. Okay, well, I'm under attack, sympathetic nervous system out of control, neural inflammation, which is literally the inflammation that you see in your body, but it's in the brain. And it starts to inflame your brain. Okay, and this is what's causing depressive-like symptoms. And they can be confused if they're not downregulated by hormone replacement therapy or other

• 38:57Speaker 00

  forms of therapy as well. Exercise is a great mediator, by the way. Creatine is a fantastic mediator, which we'll go into. So if you're not taking care of that thing, yeah, she could be mistaken to just have an SSRI and let's just calm you down.

• 39:10Dr. Mary Claire Haver?

  Just garden variety depression. Um, let's go back to sleep.

• 39:14Speaker 00

  Yeah.

• 39:15Dr. Mary Claire Haver?

  The girls are not sleeping. Like, like, my patients don't sleep.

• 39:18Speaker 00

  Why?

• 39:19Dr. Mary Claire Haver?

  And so they almost, not universal, but, oh, gosh, I would say 70% are coming in with some kind of a sleep disruption.

• 39:26Speaker 00

  Yeah.

• 39:27Dr. Mary Claire Haver?

  If it's hot flashes that are disrupting their sleep, we can fix that.

• 39:31Speaker 00

  Mm hmm.

• 39:32Dr. Mary Claire Haver?

  You know? But even if we have their vasomotor symptoms controlled, women are still struggling. There's still that 2 a.m. They're going to bed, okay, it seems like, but they're having that 2 a.m., 3 a.m. wake up.

• 39:43Speaker 00

  Yeah.

• 39:44Dr. Mary Claire Haver?

  Um, and it's, it's consistent.

• 39:45Speaker 00

  Yeah.

• 39:46Dr. Mary Claire Haver?

  You know, everybody's gonna do that once in a while, but you know, walk me through why do you think this is happening?

• 39:51Speaker 00

  And that's interesting because I've actually seen a lot of female patients getting prescribed amitriptyline.

• 39:55Dr. Mary Claire Haver?

  Mm hmm.

• 39:56Speaker 00

  You know, in replacement of poor sleep, which I think is crazy because it's a tricyclic antidepressant. Um, and so insomnia is occurring for a number of different reasons, but what tends to happen is the reason why you're waking up more often is because you've run out of melatonin.

• 40:13Dr. Mary Claire Haver?

  Right. And that is what Andrea Matsumura, who's a sleep medicine specialist, he says.

• 40:18Speaker 00

  And so your brain wakes you up and this could be a disruption in your circadian rhythm.

• 40:22Dr. Mary Claire Haver?

  Where did the melatonin go? Like, why, why do we not have melatonin?

• 40:26Speaker 00

  The pineal gland is just disrupted and it's just waking you up. And then what happens is you can't get back to sleep. You've got the racing thoughts. And then we've got a really big one is because the loss of progesterone, which is activating GABA. And GABA is the chief inhibitory neurotransmitter. So oftentimes what you see is women have got two complaints. I'm having trouble falling asleep. I'm having trouble staying asleep. Okay. One may be a temperature control problem. One may be racing thoughts. If it is the racing thoughts at night, I'm having trouble falling asleep. That is okay. It's progesterone. I know that progesterone therapy helps, but also gamma aminobutyric acid, GABA, in the form of a supplement could help as well.

• 41:06Dr. Mary Claire Haver?

  Oh, good.

• 41:07Speaker 00

  Yeah.

• 41:07Dr. Mary Claire Haver?

  And I think this is where maybe cognitive behavioral therapy.

• 41:10Speaker 00

  Cognitive behavior health therapy could help, but let's go and switch to the fact that we actually need our core body temperature in order to fall asleep and stay asleep. Our core body temperature needs to drop at least two degrees.

• 41:23Dr. Mary Claire Haver?

  Don't understand this. You know, we throw out the word sleep hygiene.

• 41:26Speaker 00

  Yeah.

• 41:26Dr. Mary Claire Haver?

  Like it's candy and everybody can do it, but this is hard.

• 41:30Speaker 00

  Yeah, to to drop your core body temperature. Oh, it's very hard. And so I've got a number of different techniques. But in order to fall asleep, so what what is happening is your body can be raising its core body temperature and waking you up. So what happens is our cortisol rises according to the sun. Okay. So if the sun, okay, our core body temperature rises. And that's what actually wakes us up. Cortisol wakes us up in the morning. But if you're waking up at two AM, then we have to think, is it cortisol? Is it the activation of your sympathetic nervous system? Or is it core body temperature? Because the moment that your body senses that it's getting warmer, it'll wake you up. And a lot of women do struggle with getting hot at night.

• 42:10Speaker 00

  So to cool the body down, there is many things you can do. Really easy hack is having your feet outside of the sheets at night.

• 42:17Dr. Mary Claire Haver?

  I I was self-regulating, doing that without thinking, that one leg out of the, out of the, I would do it without thinking. I'd wake up and one leg would be out.

• 42:24Speaker 00

  Really?

• 42:25Dr. Mary Claire Haver?

  Okay, yeah. Of the bed. Because now we have the mattress that cools automatically.

• 42:29Speaker 00

  A temperature controlled mattress.

• 42:31Dr. Mary Claire Haver?

  And not everyone can afford this. So yeah.

• 42:32Speaker 00

  And you don't have to, okay. Funnily enough, having a hot shower prior to going to bed raises your core body temperature really high. And then in order to compensate, it brings your core body temperature really, like it plumbers it down to the point that you cool off.

• 42:48Dr. Mary Claire Haver?

  Oh, that's amazing. That's easy.

• 42:50Speaker 00

  Can do, but that may be one reason why you're waking up. And I have to say, if you are waking up at two AM, definitely don't look at your phone.

• 42:56Dr. Mary Claire Haver?

  That is so hard.

• 42:57Speaker 00

  Yeah.

• 42:58Dr. Mary Claire Haver?

  Yeah, it is really hard. I'm like, at least I just want to check the time. And then, of course, the rabbit hole opens and I fall in sometimes.

• 43:05Speaker 00

  Yeah.

• 43:06Dr. Mary Claire Haver?

  How much sleep is enough?

• 43:07Speaker 00

  So there was a really phenomenal study printed in PNAS, which showed that even one night of sleep deprivation can raise amyloid beta circulating levels in the brain, which is crazy, right? Because how many new mothers are getting sleep deprived? You know, so, I mean, I get sleep deprived, okay. And they showed that it was six hours.

• 43:26Dr. Mary Claire Haver?

  Wow.

• 43:27Speaker 00

  Yeah.

• 43:27Dr. Mary Claire Haver?

  A lot of women feel. Like six hours is enough.

• 43:29Speaker 00

  Yes, it's not. From all of the data that I've seen, I boil it down to seven hours and thirty minutes. Okay, between seven, I usually, the reason why we say eight hours is to give you that thirty minute buffer time of falling asleep and, you know, waking up as well. So I think you definitely want to be asleep for at least seven to seven and a half hours every single night.

• 43:53Dr. Mary Claire Haver?

  Do you feel like women are going to bed too late?

• 43:58Speaker 00

  Well, so that's another thing. So what we're seeing in the sleep studies is one of the biggest ways to stave off all cause mortality, that is dying of any cause like hypertension, getting hit by a bus, whatever that is, is actually sleep regularity. Going to sleep at the same time every day and waking up at the same time every day is actually more important than sleep time itself. And that is because that dictates our circadian rhythm. And remember, what is your brain like? It likes safety.

• 44:25Dr. Mary Claire Haver?

  It likes.

• 44:25Speaker 00

  It likes rhythm and it likes a schedule. So I know that we're not robots. So a good rule of thumb is to think of sleep regularity as eighty percent of the week, to give you a buffer time of like two nights a week. Yeah.

• 44:38Dr. Mary Claire Haver?

  So one of the things that I made the choice to do, which was hard, because this was a profession I went into on purpose, like I went in with eyes wide open, was obstetrics. I've given up obstetrics as part of my medical practice, not because I don't love the process of taking care of pregnant people and delivering babies. I mean, I just, I miss it so much, but the hours were literally killing me.

• 45:03Speaker 00

  Yeah.

• 45:03Dr. Mary Claire Haver?

  And I realized it. And as this new research was coming out and I'm reading, I'm like, I am constantly sleep deprived because of my job. I'm tearing years off of my life because I'm not able to, because I'm on call three nights a week, you know, able to get into a sleep pattern that's going to keep me healthy.

• 45:21Speaker 00

  And because it's, sleep doesn't just represent how good you feel the next day, it's actually something that is going to help you. Get up in the morning, go to the gym and you've got this flow on flow effect. So if you're sleep deprived, you accumulate those amyloid beta plaques, you get up late, you are more insulin resistant. So it's

• 45:43Dr. Mary Claire Haver?

  You're hungrier.

• 45:43Speaker 00

  You're hungrier, leptin, ghrelin out, you know, it's going crazy, you eat more, then you go to, then you disrupted going to sleep that night. You've got the accumulation of amyloid beta that you haven't cleared out, that amyloid beta actually prevents you from going to sleep. This is why maybe your mother and people with mild cognitive impairment and Alzheimer's disease actually have trouble falling asleep because of the accumulation of amyloid beta.

• 46:05Dr. Mary Claire Haver?

  Mm hmm.

• 46:06Speaker 00

  So it's a, it's this cycle that just keeps going and going.

• 46:10Dr. Mary Claire Haver?

  I hear a lot about the sleep hygiene and the wind down routine.

• 46:13Speaker 00

  Yeah.

• 46:13Dr. Mary Claire Haver?

  How important is that?

• 46:14Speaker 00

  Wind down routine is so important because you want to start down regulating and getting your brain primed to sleep. So generally we start to see a secretion or a release of melatonin at around eight P M. According to when the sun goes down, wherever you live. And you have to understand that our brain senses that we're awake via this little area in the brain called the suprachiasmatic nucleus. Okay. And that is activated via the cells on the bottom of our retina. So if they sense any type of light, any type of light, at the end of the day, they're very susceptible to light because they're weaker, because they've been open all day working.

• 46:56Speaker 00

  So if you're watching the television, it senses light, it senses that you're awake. So it sends a signal to that area of the brain, it tells the brain, hey, we're awake. Stop the melatonin, increase cortisol. So you're getting all of this cortisol throughout the night and you're not down regulating. And this is why we're having trouble falling asleep. So wind down routines that involve dimming the lights at night, not looking at your email, trying not to respond or having heavy conversations with your partner, whoever that is.

• 47:26Dr. Mary Claire Haver?

  What about reading? I'd love to read.

• 47:28Speaker 00

  I love to read, but it excites me.

• 47:30Dr. Mary Claire Haver?

  Ah.

• 47:30Speaker 00

  So it gets me all worked up and then I think about things.

• 47:33Dr. Mary Claire Haver?

  Be so into a novel and all of a sudden it's one in the morning and I can't go to bed.

• 47:37Speaker 00

  Yeah. Um, I don't know if this is the placebo effect or not, but I wear really great blue light blocking glasses.

• 47:42Dr. Mary Claire Haver?

  Okay.

• 47:42Speaker 00

  Okay. They're orange.

• 47:43Dr. Mary Claire Haver?

  What about red light therapy?

• 47:45Speaker 00

  Red light therapy is phenomenal. Um, I have a red light panel as well. Everybody's different. Okay. I've got some women soaking their feet in warm water just to calm them down at night.

• 47:55Dr. Mary Claire Haver?

  So I was gifted a. Um sauna blanket.

• 47:59Speaker 00

  Oh, good.

• 48:00Dr. Mary Claire Haver?

  Like a sleeping bag.

• 48:01Speaker 00

  Yeah.

• 48:01Dr. Mary Claire Haver?

  That is a red light sauna. And that is when I'm home, which I've been traveling a lot lately. That is part of my routine at night is to get in that thing.

• 48:09Speaker 00

  Whatever.

• 48:09Dr. Mary Claire Haver?

  For twenty minutes.

• 48:10Speaker 00

  Whatever calms you down is what you should. No one should stick to the same wind down routine.

• 48:14Dr. Mary Claire Haver?

  Okay.

• 48:15Speaker 00

  Yeah.

• 48:15Dr. Mary Claire Haver?

  Find out what works for you.

• 48:16Speaker 00

  Correct.

• 48:17Dr. Mary Claire Haver?

  Keep experimenting. What do you do?

• 48:19Speaker 00

  I take a sleep stack of supplements um to help me twenty minutes.

• 48:23Dr. Mary Claire Haver?

  What is it in them?

• 48:24Speaker 00

  Twenty minutes before bed. But my wind down routine is really like dark house. I wear my um red light blocking glasses. I actually have this incredible device that I place on my um abdomen. It wraps around, it vibrates, and it's got red light therapy on it.

• 48:39Dr. Mary Claire Haver?

  Amazing.

• 48:40Speaker 00

  Yeah, it's so insane. And then um twenty minutes prior to sleep, I'm having magnesium L three and eight. I'm having GABA because I've got a racing mind. Sometimes when I travel, I do have two milligrams of melatonin. I'm not against it. I think it's fantastic, especially as it relates to immunity. I'm in bed at ten.

• 49:01Dr. Mary Claire Haver?

  Non-negotiable.

• 49:02Speaker 00

  Non-negotiable. Lights out is ten P M. And we know that the hours prior to midnight are really what counts when it relates to sleep as well.

• 49:10Dr. Mary Claire Haver?

  That's when I deep sleep.

• 49:11Speaker 00

  Yeah.

• 49:11Dr. Mary Claire Haver?

  Is in the early part of the night.

• 49:12Speaker 00

  Exactly, yeah. Deep, slow way sleep. So I try and be asleep by ten thirty.

• 49:18Dr. Mary Claire Haver?

  How do you feel about sleep trackers or, you know, nearables and wearables?

• 49:22Speaker 00

  Love them, but I I know that they're not one hundred percent reliable. I have an Oura ring and I wear that religiously and I check my data and you do too. What I'm checking for is regularity and I'm checking for patterns. So. And the most noticeable pattern is your heart rate variability. If it is a certain amount.

• 49:39Dr. Mary Claire Haver?

  Please.

• 49:40Speaker 00

  Yeah.

• 49:40Dr. Mary Claire Haver?

  What is heart rate variability?

• 49:42Speaker 00

  I know, it's so insane. Yeah. So basically, it's the variation between your sympathetic nervous system and your parasympathetic nervous system.

• 49:50Dr. Mary Claire Haver?

  And what are those?

• 49:51Speaker 00

  So your sympathetic nervous system is that fight or flight. So it gets activated in response to a threat. Evolutionarily, it was to run away from the tiger and hunt and do what we needed to do. It shuts down all of the blood flow to the organs, it sends it to the brain and makes us really focused, right? There's some pluses and minuses to that, right? Pluses is we become super focused, minuses, we increase the amount of inflammation in our body. The other one, the parasympathetic nervous system is the rest and digest one, the one that we want. Yeah, our heart rate variability, we don't want to be all day in sympathetic or in parasympathetic. We want a really high variation of the two. We want to be in sympathetic nervous system.

• 50:35Speaker 00

  We also want to be in parasympathetic nervous system. So if you have a high heart rate variability, it means that you have really great flexibility of going from sympathetic to parasympathetic.

• 50:47Dr. Mary Claire Haver?

  You know, I'll get dinged on my ring from having low heart rate variability from time to time. Like, how do you fix that?

• 50:54Speaker 00

  Well, alcohol plummets your HRV and it also plummets your REM sleep, right? So one of the worst things you can do is drink alcohol, okay? But I have a standard rule for anyone that I work with, and that is I will promise you that I will increase your heart rate variability by at least 10 points, right? How do you do that? The best known way is resonance frequency breathing or breath work.

• 51:22Dr. Mary Claire Haver?

  Really?

• 51:22Speaker 00

  I want you to try it if you try, and you know, you have to do it.

• 51:25Dr. Mary Claire Haver?

  It's part of my wind down, like the box breathing?

• 51:28Speaker 00

  If you do 20 minutes a day, usually if you do 40 minutes a day, that's great, separated by two by two. But if you do 20 minutes a day of breath work, I don't care which one, just do breath work. You will see a change in your heart rate variability tomorrow. Okay, you'll see it. So that's one of the best ways to increase it. Another way is sleeping earlier.

• 51:48Dr. Mary Claire Haver?

  Teach our listeners really quick, a quick and simple breath work routine.

• 51:51Speaker 00

  Okay, one of the best ways, just close your eyes and you do want to do breath, you want to do the four in and then the four out. You can do four by four, you can do box breathing.

• 52:01Dr. Mary Claire Haver?

  I do box breathing.

• 52:02Speaker 00

  But it's not about that, it's about the time. So you want to do it consistently for at least 20 minutes.

• 52:07Dr. Mary Claire Haver?

  Okay.

• 52:07Speaker 00

  Yeah.

• 52:08Dr. Mary Claire Haver?

  Amazing.

• 52:08Speaker 00

  Best way to increase your heart rate variability.

• 52:10Dr. Mary Claire Haver?

  Okay.

• 52:16Dr. Mary Claire Haver?

  All right, let's move on to exercise.

• 52:18Speaker 00

  Okay, great. That's my favorite part.

• 52:19Dr. Mary Claire Haver?

  Wait, so let's go back to your history. You were a triathlete.

• 52:22Speaker 00

  Yes.

• 52:22Dr. Mary Claire Haver?

  I've done two sprint triathlons.

• 52:25Speaker 00

  Oh, really?

• 52:25Dr. Mary Claire Haver?

  That is all. And that is all I will do.

• 52:27Speaker 00

  What was the time?

• 52:28Dr. Mary Claire Haver?

  It doesn't matter.

• 52:30Speaker 00

  I'm so competitive.

• 52:32Dr. Mary Claire Haver?

  I finished.

• 52:32Speaker 00

  You finished it.

• 52:33Dr. Mary Claire Haver?

  I started running after, there was a big hurricane in Galveston where I live and it kind of wiped out our community. And as I therapy, my girlfriends and I, we were about 40, started jogging together. And that turned into a 5K and 5K turned into a 10K. And then we're like, let's sign up for the Houston Half Marathon.

• 52:48Speaker 00

  Wow.

• 52:48Dr. Mary Claire Haver?

  Which we ended up doing, it's in January, so the weather's cool, every year for about 15 years. Our knees started getting, as we hit our 50s. So, but you know, that was kind of our thing. And every fall, we'd start training and run together. And that kind of like led into what else can we do? And so we started doing these small triathlons that were actually in Galveston. And so I'm not a great swimmer, you know, swimming was the hardest leg for me. And I bought, my first triathlon was with like a Schwinn, like my daughter's bike with a basket on it.

• 53:18Speaker 00

  Yeah.

• 53:18Dr. Mary Claire Haver?

  And then I got a tri bike, you know, and so, but I was never like hardcore, but I did it.

• 53:24Speaker 00

  Yeah.

• 53:24Dr. Mary Claire Haver?

  And it was fun.

• 53:25Speaker 00

  That's phenomenal.

• 53:26Dr. Mary Claire Haver?

  Yeah.

• 53:26Speaker 00

  Oh, my God. Yeah, no, I, I lived and breathed it all through my 20s.

• 53:29Dr. Mary Claire Haver?

  So, yeah, amazing.

• 53:30Speaker 00

  Yeah. And three legs, people think you have to be the best in three legs. So I was the best at swimming. I was first out of the water. I was great on the bike. What let me down was my run. I love running, but I was heavier than the other girls. So they would just fly past me. But people don't realize that it's actually four legs because we consider the transition as an actual leg as well.

• 53:50Dr. Mary Claire Haver?

  Yeah. And you're a performance coach on top of everything else you do?

• 53:53Speaker 00

  Well, I was, I mean, right now. So I've got some clients as well that when I say performance, I'm doing everything from blood work. I'm doing EEG scans. I'm trying to get people to their absolute peak. And everyone's peak is different.

• 54:06Dr. Mary Claire Haver?

  Amazing. Okay, back to exercise.

• 54:08Speaker 00

  Yes.

• 54:09Dr. Mary Claire Haver?

  So, because you are the expert. Women aren't really connecting. I think I'm doing a lot of messaging on social media right now about the importance of muscle health, because that is definitely one thing I never, never, never, never, never, never, never thought about this time. I only thought about. My weight and the weight was to be as small as possible and as thin as possible and muscle weight a lot. So why on earth would I want that? So all of my time in the gym was aerobics. I mean, I grew up in the eighties, you know, doing step aerobics and doing all this cardio, which is great for my heart health, running marathons in my forties, never picked up a weight seriously until fifty something.

• 54:46Speaker 00

  The Jane Fonda era.

• 54:47Dr. Mary Claire Haver?

  Yeah.

• 54:47Speaker 00

  Yeah.

• 54:47Dr. Mary Claire Haver?

  And so walk me through exercise and brain health.

• 54:51Speaker 00

  Oh, my God, it is so beautiful. Okay. And this is what I I I published. I was the first author for this really beautiful narrative review, which looked at exercise and mind cognitive impairment. But let's think, you know, I honestly think that the biggest reason why muscle is so good for longevity and brain health is because of the process that it takes to get the muscle. So it is the muscle itself. Yes, because it's a storage sink for glucose, but I think it's the the process. So exercise is by far the best elixir for your brain. Did you know that women who have a high peak respiratory fitness as measured by a VO two max test can lower their risk of getting dementia by eighty percent?

• 55:35Dr. Mary Claire Haver?

  I did not know that.

• 55:36Speaker 00

  So the fitter you are, ladies, the greater that you will stave off all cause dementia and Alzheimer's disease.

• 55:43Dr. Mary Claire Haver?

  So how do you improve your VO two max? And what is VO two?

• 55:46Speaker 00

  VO two. So let's talk about exercise. Okay. And I'm going to split it into two categories. We've got resistance training. Okay, that's your strength training. And then we've got your cardio metabolic training.

• 55:57Dr. Mary Claire Haver?

  So I'm seeing all of this drama all over the internet. Don't do cardio. Yes, do cardio.

• 56:01Speaker 00

  I know it's.

• 56:02Dr. Mary Claire Haver?

  Lift weights, da, da, da, da. What should women be doing?

• 56:04Speaker 00

  Have to be that hard either. So let's talk about aerobic fitness and what that does for the brain. So when we're engaging in long runs, you've probably heard of it. It's your zone two, right? It's around sixty percent of your maximum heart rate. Your maximum heart rate is as hard as you can go until your your heart rate reaches its maximum. Okay, to the point where you may pass out afterwards. So sixty percent of that, which looks like you and I going for a. Depending on how fit you are, a brisk walk or a light jog and we can hold a conversation. What you're doing in that zone is you are getting a massive release of something called B D N F, brain derived neurotrophic factor.

• 56:44Speaker 00

  And some, you know, back in the early two thousands, neuroscientists would call this fertilizer for the brain. But what it's actually doing is, once it's in the blood, it goes up to the brain, it crosses the blood brain barrier. And it actually can create new neurons, grow new neurons in the hippocampus of the brain. That area that goes during Alzheimer's disease. In fact, there was one study, this is actually what propelled me to studying this. It was a study done by Eric Sonatal, which showed that you can decrease your risk of Alzheimer's disease by at least forty percent by engaging in aerobic physical activity. And not just that, he found that you can grow the hippocampus by two percent.

• 57:29Speaker 00

  Two percent, a two percent growth in the hippocampal subregions from aerobic physical activity. Only thirty minutes.

• 57:37Dr. Mary Claire Haver?

  Yeah, I was like, how much were we talking marathon training?

• 57:38Speaker 00

  You only need thirty minutes to get that massive release. Three times a week.

• 57:43Dr. Mary Claire Haver?

  Wow.

• 57:44Speaker 00

  Okay, so that's not much, right? When you engage in aerobic physical activity, you are having an effect on thirteen types of cancer. So aerobic exercise at thirty minutes, this is thirty minutes a day, can decrease your risk of thirteen types of cancer.

• 58:02Dr. Mary Claire Haver?

  So many women have only heard about exercise as a way to master some number on the scale.

• 58:09Speaker 00

  Yep.

• 58:09Dr. Mary Claire Haver?

  And talking about it, I think there's some lady, I always talk about our little sweet lady on the couch in Ohio, who is listening to this saying, because to me, you know, using exercise, one, it was social, doing the training with my girlfriends, that was great. But, you know, really, it was like, I want to be a certain body type, I want to look a certain way. And when you're not seeing the results, it's very demotivating that I'm not thin and I'm not this and I'm not that. But then when you're thinking about it, I'm decreasing my risk of dementia.

• 58:38Speaker 00

  Yeah.

• 58:38Dr. Mary Claire Haver?

  I'm growing bones and muscles, you know, I am.

• 58:40Speaker 00

  You are growing the hippocampus of your brain and not just that. So my narrative review showed that what we can do is we can actually have an effect on the white matter portion of the brain.

• 58:53Dr. Mary Claire Haver?

  Wow. And what is white matter for our listeners again?

• 58:55Speaker 00

  So we've got white matter and gray matter. The gray matter is the cortex on the brain, the outside of it. The white matter is the myelinated neurons, okay, which is involved. It's the fat. Okay. And actually 70% of the brain is myelinated, right? So it's the fatty portion of the brain. So what happens is we get women, especially during the perimenopause stage, but also as we age, we get something called white matter lesions. Okay, these little lesions on the white matter. What we showed was that exercise, yeah, exercise can improve those white matter lesions.

• 59:28Dr. Mary Claire Haver?

  So what exercise in this study were your patients doing?

• 59:31Speaker 00

  We primarily looked at the smile. This was more resistance training.

• 59:33Dr. Mary Claire Haver?

  Okay.

• 59:34Speaker 00

  Okay. So let's move on to resistance training. By the way, I do want to point out something that is not happening right now. Women are anxiously afraid of zone five. I call it the death zone. It's that high pace. It's that 90% of your maximum heart rate. And this is so, so, so important. In my opinion, it's actually even more important.

• 59:54Dr. Mary Claire Haver?

  For brain health?

• 59:55Speaker 00

  For brain health.

• 59:56Dr. Mary Claire Haver?

  And it doesn't take much, right?

• 59:58Speaker 00

  Well, what you're really primarily engaged in is something called the four by four principle. Okay, this is to predominantly increase your VO2 max. Okay, so zone five, we should be training and you only need to train in it 20 minutes a week. What you're doing in that zone is you're producing lactate, right? We used to think that lactate or lactic acid was the burning.

• 1:00:20Dr. Mary Claire Haver?

  The bad.

• 1:00:20Speaker 00

  Yeah. And it's not causing that burning sensation in your, in your muscles. Okay, that's not what lactic acid buildup is. Lactate is a byproduct of working out at that really hard zone. Lactate is fuel for your brain. Okay, we need it. Your brain prefers lactate as a fuel source over. Glucose. This is, it's such a miracle molecule. I'm obsessed with lactate. It's so amazing. But we can only get it when we're working out at that hard intensity. So what does that look like? It looks like going to the gym or doing anything really hard out for four minutes. Four minutes on, four minutes off, repeat that four times.

• 1:01:01Speaker 00

  Okay, you will increase or maintain your VO two max by going at that hard stage.

• 1:01:07Dr. Mary Claire Haver?

  Okay. Okay. All right. So what else do we need to do?

• 1:01:10Speaker 00

  We need to resistance train. Okay. Resistance training at least three times a week. Okay. When we do resistance training, we release something called myokines. Okay, they're muscle based proteins that live inside the muscle. And when they go into the bloodstream, that we have receptors for them, just like we have estrogen receptors. We have myokine receptors all over our body and in our brain. And they can improve the functioning of your frontal lobe, improve your executive functions. So you can actually, this is one of the best ways of staving off neurodegeneration is by resistance training. And this is what we found in our study, which is from if you combine resistance training with cognitive training. Okay, doing something cognitively, maybe you're throwing, doing reaction training drills.

• 1:01:55Speaker 00

  Three times a week is all that's needed.

• 1:01:57Dr. Mary Claire Haver?

  So what would that look like?

• 1:01:59Speaker 00

  Getting a tennis ball, okay, throwing a tennis ball to the wall twenty times. Okay, throwing it like left and right, left, right, left, right, maybe standing on one leg. Because what you're doing there is you've got to think about it. You're doing reaction time, you're doing balance, cerebellum. You're doing spatial processing, visual, yeah, hand eye coordination, visual processing. You're doing so much. And your brain is having to think at the same time. I've got to think, where's the ball? What's it look like? Move back further. It's hard. It's challenging. Your brain needs stimulus and it needs supply.

• 1:02:30Dr. Mary Claire Haver?

  Okay.

• 1:02:30Speaker 00

  Right? So stimulate your brain. You've got to do hard things or it won't grow and it won't adapt.

• 1:02:36Dr. Mary Claire Haver?

  What is neuroplasticity?

• 1:02:38Speaker 00

  Neuroplasticity is the way that the brain wires together. When neurons wire together, they wire together, meaning that you can learn something new by doing it repetitively.

• 1:02:47Dr. Mary Claire Haver?

  See, I was always under the impression and probably taught, and was wrong, that, you know, we have our neurons in the brain and we can't grow more.

• 1:02:55Speaker 00

  Correct, we can't. Adult neurogenesis doesn't exist.

• 1:02:58Dr. Mary Claire Haver?

  To destroy them with alcohol and smoking and, you know, bad things, but you can't grow new nerves, but that doesn't mean you can't change the brain.

• 1:03:09Speaker 00

  Correct.

• 1:03:09Dr. Mary Claire Haver?

  And rewire the brain.

• 1:03:10Speaker 00

  That's the functioning of the brain. So, yeah, so those connections I spoke about, you can't grow new neurons, but you can grow new synapses.

• 1:03:17Dr. Mary Claire Haver?

  Okay.

• 1:03:18Speaker 00

  So you have to think every time you see something new for the first time or do something challenging, you've created a new synapse. You've created a new pathway for the brain to connect. Your brain needs hard stimulus in order for it to grow and repair. Okay, so adult neurogenesis doesn't exist, but it doesn't mean through neuroplasticity that you can't help and grow new synapses.

• 1:03:41Dr. Mary Claire Haver?

  Okay.

• 1:03:41Speaker 00

  Yeah, the functioning of the brain exists. Global functioning, 80% of brain gray matter is modifiable by physical activity.

• 1:03:52Dr. Mary Claire Haver?

  There's a study that shows the hearts of 50-year-olds

• 1:03:56Speaker 00

  Yeah.

• 1:03:56Dr. Mary Claire Haver?

  can look 20 years younger.

• 1:03:57Speaker 00

  Oh, yeah.

• 1:03:58Dr. Mary Claire Haver?

  After two years of cardiovascular training, and that it literally remodels the heart. And why is this important for the brain?

• 1:04:05Speaker 00

  The brain is like a mini-heart. Did you know that we've got 43,000 neurons in the adult heart?

• 1:04:12Dr. Mary Claire Haver?

  No.

• 1:04:12Speaker 00

  Yeah, yeah, we've got these clusters, and they're actually sensory neurites. So they're responsible for sensing things, which is why you sense something in your heart and it translates to your brain. But this was a study done by Ben Levine, where he took a group of 50-year-olds and he took photos of their heart, really did all these images and looked at their hearts. Then he put them under a two-year intense protocol, okay, of vigorous

• 1:04:41Speaker 00

  Intensity exercise, around that, you know, eighty percent to ninety percent of your maximum heart rate, he exposed them to that five times a week, which was a rigorous exercise. But what he found over the course of two years, he scanned their, he scanned their hearts again and found that they looked thirty years old. Mm hmm. So he reversed the age-related decline in their heart by twenty years. Wow. Yeah. So if you have a better performing heart, stronger chambers, you have more blood there's being able to be delivered to the brain. Your brain is the most vascular-rich organ in the entire body. It's comprised of vessels such as veins, arteries, capillaries. The capillaries are the first things to go in hypertension. Okay? But what are all these vessels do?

• 1:05:26Speaker 00

  They supply the brain. They bring things to the brain and they take things away. Nutrients, oxygen, exactly. So if you've got a better performing aorta, okay, we've got branching off the aorta, we've got the vertebral arteries, the carotid arteries, that's what supplies the brain with blood. When these, when these are working well, the pump is working well and our chambers of the heart is working better, more efficiently, what happens? If we've got left, what we, what happens is we have more blood that goes into the left ventricle that can go throughout the body and into our brain. Okay. Yeah. Amazing. Um, so back to exercise a little bit, you know, a lot of chatter and myself included talking about estrogen and its loss of estrogen, loss of sex hormones in general and their effects on muscle. Yeah. And we know the effects on bones.

• 1:06:11Speaker 00

  You know, that resistance training might be the single best thing that they can do. The single best thing that you can do. For bone health. For bone health, for overall longevity is exercise. You know, we're so worried about supplements and we're so worried about all these, these little gimmicks of what can I do? You know, can you do a jump squat? Can you do a box squat? Can you, you know, can you do plyometrics? These are arguably the most important thing. And I'll tell you what, if you want to focus on one thing, focus on lower body strength. Because one of the things that we lose as we get older, especially, it's more pronounced in women, is we lose power first. Mm hmm. Okay, so the ability to.

• 1:06:50Speaker 00

  Uh lift force, you know, in a certain amount of time. So really fast. That's what power really is.

• 1:06:57Dr. Mary Claire Haver?

  Yeah.

• 1:06:58Speaker 00

  They showed this in a twin study. Okay. They tracked twins. Okay. They got many sets of twins. And they, you know, same genetic makeup and they got, they put one.

• 1:07:06Dr. Mary Claire Haver?

  Identical twins.

• 1:07:07Speaker 00

  Identical twins. Okay. And they put one twin under a lower body training session. Okay. Over the course of, I think it was like a few years. And they found that the twin who had larger leg muscles, okay, and more lower body power, especially in their legs. They had larger brains. So the larger the legs, the larger the brain.

• 1:07:29Dr. Mary Claire Haver?

  All right. Let's go to nutrition.

• 1:07:30Speaker 00

  Yeah.

• 1:07:31Dr. Mary Claire Haver?

  Everyone's dying to know. Um. If you're on the interwebs, you are bombarded with nutrition advice.

• 1:07:38Speaker 00

  Yeah.

• 1:07:38Dr. Mary Claire Haver?

  And it's often conflicting. Um. What is your clear message to our listeners?

• 1:07:45Speaker 00

  Nutrition is just information and I see nutrition as biomarkers.

• 1:07:50Dr. Mary Claire Haver?

  Okay.

• 1:07:50Speaker 00

  So we've got this, we've got wars happening on Instagram, vegan versus carnivore. And it doesn't have to be that way. The best known uh diets for brain health and cognitive impairment is the mind diet.

• 1:08:04Dr. Mary Claire Haver?

  Okay.

• 1:08:04Speaker 00

  Okay. The Mediterranean Interventional Dash Diet, which consists of little amounts of, you know, meat, poultry, fish, and large amounts of fiber, fruits, vegetables, et cetera. I don't see it that way. I, you know, that is really good for the brain, but why? It's because that we really want to lower our APOB and LDL cholesterol. So if you're maintaining a really good LDL, right? Your brain doesn't want to be filled, the arteries in the brain don't want to be filled with cholesterol.

• 1:08:34Dr. Mary Claire Haver?

  Cholesterol.

• 1:08:34Speaker 00

  And these plaques. If you've got that, then you can have your steak. Okay. But I look at nutrition as, instead of what should you take out, you should be thinking about what aren't you having?

• 1:08:46Dr. Mary Claire Haver?

  Mm hmm.

• 1:08:47Speaker 00

  You know, do you have adequate green leafy vegetables because that contains magnesium, okay, within the chlorophyll? Are you having omega three fatty acids? Are you having enough protein? Because these are the things that we need to be focusing on. Instead of just subscribing to a certain diet because somebody on the internet told you to.

• 1:09:04Dr. Mary Claire Haver?

  And what about supplements? Do they have any effect or?

• 1:09:06Speaker 00

  Omega three fatty acids, probably the best thing that you can take for your brain. We have, um, we have receptors on the outside of our brain. That allows for DHA and EPA to pass through it and they get leaky during um, the brain. When we're inflamed or during the brain aging process, but it turns out that most of the fat in our brain. About seventy percent of the, the total fat composition in our brain is made of DHA. Which comes from fatty fish. So feeding our brain with at least two grams of DHA per day and EPA is phenomenal.

• 1:09:41Dr. Mary Claire Haver?

  So how much fish would that be?

• 1:09:42Speaker 00

  Well, it's, it's a lot of fish. Okay. So if you've seen that documentary Seaspiracy. You'll see that if we're eating fish, we're probably stripped of all the nutrients. So I actually like to think about it. It's probably like three or four salmon steaks a day. We can't do that. So you should be supplementing.

• 1:09:59Dr. Mary Claire Haver?

  Okay.

• 1:10:00Speaker 00

  Yeah.

• 1:10:00Dr. Mary Claire Haver?

  So you would recommend supplementation here?

• 1:10:02Speaker 00

  Recommend, yes, one hundred percent. I recommend supplementation with EPA, DHA.

• 1:10:06Dr. Mary Claire Haver?

  How would someone find a good supplement? Like what, what's your, you know, you're sending someone off to, where would they buy it? What are they looking for?

• 1:10:14Speaker 00

  There is, I'm not affiliated, but there is a really great app called SupCo, S U P P dot C O. And that is the only, the only place I know that actually does all of the quality control testing. And they give all of the brands a score. So you can go in there and you can type creatine. And it comes up with the best creatine on the market and it gives you a link to go and buy that from a certain brand.

• 1:10:39Dr. Mary Claire Haver?

  That's good advice.

• 1:10:40Speaker 00

  Yeah.

• 1:10:41Dr. Mary Claire Haver?

  Do you test omega indexes?

• 1:10:43Speaker 00

  Yeah, omega three index, which is the measure of omega three fatty acids inside the red blood cell. I check it every year in January. It's like a, a new year thing I do. This year, um, I got eleven point three percent.

• 1:10:56Dr. Mary Claire Haver?

  And what's a good level?

• 1:10:57Speaker 00

  So in the U S alone, most women are actually below four percent, which is raising your risk of all cause mortality. And sudden cardiac death, by the way. So you want to get at least an omega three index of at least eight percent or more. And you can get from four percent to eight percent just by supplementing with two grams of EPA and DHA a day.

• 1:11:19Dr. Mary Claire Haver?

  Any other supplements? That you would consider.

• 1:11:21Speaker 00

  Creatine.

• 1:11:22Dr. Mary Claire Haver?

  Creatine.

• 1:11:22Speaker 00

  Yes, one hundred percent.

• 1:11:23Dr. Mary Claire Haver?

  Tell me about creatine.

• 1:11:25Speaker 00

  Creatine helps with cell energy metabolism. We naturally produce it, but we don't produce enough of it. And we used to think of it.

• 1:11:31Dr. Mary Claire Haver?

  And is that an age-related decline?

• 1:11:33Speaker 00

  No, it's not age-related. It's just that we just, uh, men and women, we don't produce enough of it. And we used to think that it was a bodybuilding supplement, but we now have substantial evidence to show that women can greatly benef- benefit from taking creatine. But here's the thing. We used to think that five grams a day of creatine was enough, but five grams of creatine just saturates the muscle. Okay, so once the muscle takes up, that's where ninety-five percent of the stored creatine that we have lives inside the muscle. Around five percent lives inside of the brain. So the, the muscle soaks up all of the creatine that you take. Right? So five grams, it's taken it all. So now we need more. Okay, we need more in order to raise our brain creatine levels. Let me tell you something.

• 1:12:17Speaker 00

  The best, the best times to take creatine is times of sleep deprivation.

• 1:12:23Dr. Mary Claire Haver?

  I've heard that, I've heard that, like, um, when you're traveling overseas, like when you, they're doubling on their, you know, the creatine experts are doubling on their dose. When they're in, sleep deprived, you know, from travel usually.

• 1:12:35Speaker 00

  You can eliminate a lot of the symptoms that occur and all the devastating effects that occur from sleep deprivation by supplementing with creatine.

• 1:12:43Dr. Mary Claire Haver?

  How much?

• 1:12:45Speaker 00

  Caveat, it is twenty grams.

• 1:12:47Dr. Mary Claire Haver?

  That's a lot.

• 1:12:47Speaker 00

  Yes. But this is where it also affects, it really affects with giving you more energy, cell energy metabolism. We know that there's hypermetabolism in these mental health disorders. And.

• 1:12:59Dr. Mary Claire Haver?

  A lot of people are worried about kidney function, though.

• 1:13:01Speaker 00

  It's not going to damage your kidneys. It's not going to make your hair fall out. Uh, it doesn't degrade in hot water, so you can have it with your coffee. It doesn't taste bad.

• 1:13:10Dr. Mary Claire Haver?

  I've even seen, um, people are worried because they have a history of breast cancer, or they're high risk for breast can- uh, but everything's on the internet.

• 1:13:16Speaker 00

  The latest study that came out this year, it's phenomenal. They're now showing the effect of creatine on cancer. To showing that it's actually down-regulating the effect. Yeah, so you can actually help cancer diagnosis from creatine.

• 1:13:30Dr. Mary Claire Haver?

  Wow, okay.

• 1:13:30Speaker 00

  Yeah.

• 1:13:31Dr. Mary Claire Haver?

  What are the three? The most important things that a woman today can do to decrease her risk of dementia or improve her brain health.

• 1:13:40Speaker 00

  First thing is get tested. I know that some people may tell you not to, but you want to know where you are. Twenty percent of the population does have the APOE four gene, the risk gene. Go and get tested so you know where you're at.

• 1:13:54Dr. Mary Claire Haver?

  Where would they go get tested?

• 1:13:55Speaker 00

  You can ask your doctor and just push for it, or you can go and there's blood work that you can do everywhere.

• 1:14:01Dr. Mary Claire Haver?

  Okay.

• 1:14:01Speaker 00

  Really. Go and get tested. The second thing is.

• 1:14:04Dr. Mary Claire Haver?

  So it's a blood test?

• 1:14:05Speaker 00

  It's a blood test. Sorry. Yes. Okay. Uh, lipid control. You really want to maintain a low LDL and a low APOB. The next thing is, I don't know what is going to get you off the couch, but if you are not exercising, you are doing yourself and your future self a disservice.

• 1:14:23Dr. Mary Claire Haver?

  Is walking helpful?

• 1:14:24Speaker 00

  Walking is great. Get your 10,000 steps a day, but that should just be incidental.

• 1:14:29Dr. Mary Claire Haver?

  But what if you're sedentary? Is walking helpful? So say she's on the couch.

• 1:14:33Speaker 00

  Okay. If you go from sedentary, completely sedentary to walking, then yes, you're going to see a huge increase. But the thing is, it's going to stop right there.

• 1:14:42Dr. Mary Claire Haver?

  Okay.

• 1:14:42Speaker 00

  Because you're not getting the release of the BDNF and the myokines. You want to get into a habit of first get yourself a personal trainer if you have to. If not, anything, just start calisthenics, body weight exercises, and then move into weights.

• 1:14:57Dr. Mary Claire Haver?

  There's so much available on YouTube, you know, with just basic body weight exercises. Yeah, that you can start there. You start where you are.

• 1:15:05Speaker 00

  Just raise that heart rate.

• 1:15:08Dr. Mary Claire Haver?

  Okay.

• 1:15:08Speaker 00

  Okay. Stimulate it. From there, you want to go into good sleep hygiene. Fix your sleep because if you don't fix your sleep, everything else will just come falling down.

• 1:15:18Dr. Mary Claire Haver?

  Okay.

• 1:15:19Speaker 00

  The next thing is start to look at the nutrition. Okay? Eliminate anything ultra-processed. You don't want to be having processed foods. A lot of fruits, a lot of vegetables, and if you can, try supplementing with EPA, DHA, and creatine.

• 1:15:33Dr. Mary Claire Haver?

  Okay. Do you use fish oil for that typically?

• 1:15:36Speaker 00

  Oh yeah, it actually says EPA, DHA on the bottle.

• 1:15:39Dr. Mary Claire Haver?

  Okay.

• 1:15:39Speaker 00

  Yeah.

• 1:15:39Dr. Mary Claire Haver?

  Awesome. One last thing I want to touch on is social connection.

• 1:15:43Speaker 00

  Oh, yeah.

• 1:15:45Dr. Mary Claire Haver?

  The, I don't know if you've read it yet, but the gerontologist, she's on Instagram. I just love her, Carrie Bernwright. And she wrote Joyce Band.

• 1:15:54Speaker 00

  Yes.

• 1:15:55Dr. Mary Claire Haver?

  And really, so she takes care of the super ultra geriatric population and has done studies on what makes these people function better. And her mother's like the best example. She's 96, she's independent, she's beautiful, you know, she's aging, but she still has her brain, you know, she's incredible, she has friends and they, social connection is so important.

• 1:16:16Speaker 00

  So important for the brain and not just that. Yes, so what she found, it was a, it was an 80 year follow up study and they found that those with the greatest brain health benefits at the, the greatest functioning brain were those ones who maintained a good social connection. Okay, and that doesn't mean romantic partners, right? It could mean close friends, okay? Okay, so maintaining good, close friendships, but also there's an amazing study that shows that being kind to yourself can decrease your risk of mortality and dementia.

• 1:16:50Dr. Mary Claire Haver?

  And what would that look like?

• 1:16:51Speaker 00

  So, and it was a really beautiful study. I'll have to put it up on Instagram. It basically showed that if you are kind to yourself and you're not telling yourself bad things and you're, it could be in the form of affirmations or journaling, you sense to your brain that you are safe and it down regulates cortisol and it makes you just happier and it actually makes you appreciate your day to day. So you're more likely to go to bed not stressed, eat well for yourself. So being kind to yourself is actually physiology.

• 1:17:24Dr. Mary Claire Haver?

  Well, thank you so much.

• 1:17:25Speaker 00

  Thank you.

• 1:17:26Dr. Mary Claire Haver?

  For sharing all of your incredible knowledge with our audience and I'm sure you're going to change some lives today.

• 1:17:30Speaker 00

  Thank you so much for having me.

• 1:17:34Dr. Mary Claire Haver?

  You can find Luisa on Instagram at Louisa Nicola and on YouTube at Louisa Nicola. And you can listen to her podcast, The Neuro Experience, wherever you get your podcasts. You can find full episodes of UnPaused on YouTube at Dr. Mary Claire. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest, accurate information on health, fitness, and navigating midlife at thepauselife.com. My upcoming book, The New Perimenopause, is available for preorder on Amazon. If you're loving this podcast, I have an important request. Please take a moment to follow UnPaused on your favorite podcast app.

• 1:18:17Dr. Mary Claire Haver?

  Following and listening is what pushes this information forward to more women who need it. So if this podcast has helped you feel seen, understood, or supported, hit follow right now so you never miss an episode. Thank you for being here with me. Let's keep going. UnPaused. UnPaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on UnPaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.