 Welcome to the Dr. Gundry podcast. You know, it's widely believed that Alzheimer's disease and whether or not we get it is beyond our control. But my guest today begs to differ. On this episode of the Dr. Gundry podcast, I'll speak with Lisa Mosconi, the director of the Women's Brain Initiative at Wild Cornell Medical College in New York City. In her new book, The XX Brain, or if you're trying to remember it, the XX Brain, Lisa says genetics don't affect women's chances of developing dementia nearly as much as her hormonal status, lifestyle, and medical report card. And she's working to get the word out. Lisa, welcome to the program. Thank you so much for having me. So what inspired you to write The XX Brain? What kind of research went into writing this? Oh, a lot of research. Yes. So I got inspired, for lack of a better word, by my family because I have a family history of Alzheimer's disease that really affects the women in my family. So my grandmother was one of four siblings, three women and one man, so three sisters and one brother, and all three sisters developed Alzheimer's disease and died of dementia, whereas the brother did not, even though they were the same age. So that was quite a shocking experience for us as a family. And I really wanted to better understand what causes dementia in general and what causes dementia specifically in women. And of course, my family is a very small data set, but then I started looking at the bigger picture and it turns out that statistically, this seems to be the case all over the world. So today, two thirds of all Alzheimer's patients are women, which means that for every man suffering from Alzheimer's, there are two women. And that is something we just don't talk about enough. And all my research has been really focused on women's brains and better understanding how brain health plays out differently in women and the men. But the focus of my research is really on women because we have just been excluded from research for so long and we have been under investigated and there's so much stigma around anything that could potentially happen to a woman's brain that that was really a big part of my research, if not the biggest part of my research. Yeah, I think that's really important. I know Maria Shriver and I have talked about this that most people, I think the general public assumes that men get dementia more than women. But in fact, the opposite, like you say, is completely, you know, it's exactly the opposite. It's exactly the opposite, yeah. The vast majority of people who get dementia, Alzheimer's, are women. And you guys are so much healthier than us men. I mean, you would assume, right? And also what I think is really interesting is that Alzheimer's disease, the only age-related neurodegenerative condition that affects more women than men, like Parkinson's, more men, vascular dementia, 50-50. So there seems to be something specific to women that increases risk of Alzheimer's. Now, in your book, you make it clear that your DNA is not the sole deciding factor in whether you get dementia or not. So can you elaborate on that? Can you tell us about the apoE4 gene? What's your thoughts on all this? For sure. Because of my family history, I started, I approached Alzheimer's first in terms of genetics. And my PhD was about genetics. Also for context, I have a PhD in neuroscience, but also in nuclear medicine. I have a dual PhD. So I've been doing brain imaging since I was like 19. And that really convinced me that genetics are incredibly important, but they're not as deterministic as most people think. Like for me, I was really worried that a genetic mutation was running in my family and about my mom's risk and my own risk. But all this work and everybody else's work has shown that no more than 2% of all Alzheimer's cases are caused by a genetic mutation. So for the vast majority of Alzheimer's patients, risk is genetically mediated. If you will, of course, your DNA is a huge component of your health and being, but it's not as causative of Alzheimer's as most people fear. And that for me was incredibly empowering because at first I was really like, if I have these mutations that were not, what do I do? But then it turns out that your chances of actually carrying a genetic mutation are very, very small. Whereas everything else, all the choices you make in your life, everything else that happens to you in your life in terms of lifestyle and medical history and your environment, these factors are also incredibly important for brain health and Alzheimer's risk with the difference that we can't change your DNA or a family, but we can change your lifestyle and their environment and their medical report card. Thank you. So what is it about women's brains that are so unique that this seems to be a problem more for women than for men? Yes, there are many things that make women's brains really unique and I think a big determining factor is really hormonal health because I think it's very helpful to think of brain health as impacted by a number of factors. Like you have your genes, you have your DNA, you have a lifestyle, you have your medical health, you have your environment, you have your hormones. And all these factors really act synergistically to determine a person's risk of Alzheimer's, but at the same time, a person comes with allies. There are things that reduce your risk and other factors that can increase your risk like the Apolypo protein E, the ApoE for gene you mentioned before. And hormones are actually incredibly powerful allies that protect you against Alzheimer's and brain aging at large. The difference is that men have a lot more androgens like testosterone. Women have a lot more estrogens like estradiol. All these hormones are very powerful. They're very energizing and they really keep Alzheimer's plaques at bay. They're anti-inflammatory, they support neuronal growth and plasticity, but they have different lifespans. Testosterone levels don't really decline that much until later on in life, whereas female estrogens really drop pretty dramatically during menopause, and menopause is midlife. So when we started looking into that, we found that women's brains change quite a bit in midlife during menopause, and therefore some women, and we looked at their brains using their brain scans once, twice, over time, over the years, what we found is that for some women, the drops in estrogen levels correlate with the formation of Alzheimer's plaques, which is counterintuitive because we associate Alzheimer's with old age and menopause with middle age. So that is a little bit like a paradox. But it is true, and what my work and other people's work has shown is that Alzheimer's disease starts with changes in the brain years, if not decades, prior to clinical symptoms, and for women, that crucial time seems to overlap with menopause. So you don't start worrying about your risk of Alzheimer's when you're 70 as a woman. You better start thinking about it when you're 40 and 50. Okay, so... That's the bad news. That's the bad news. So are you saying that, let's just generalize, that every woman should think about hormonal replacement to prevent Alzheimer's, or what are you saying? What I'm saying is that there are many things that one can do to reduce risk of Alzheimer's and hopefully prevent it, and what our data is giving us is a timeline. So we now know that women tend to develop Alzheimer's earlier than men in their brains, and that we can catch these signs of increased risk very early on in life, that we're looking at women who are what in their 40s, and we can really find signs of an increased risk of Alzheimer's. And then I think that's really the key to prevention. I think it gives us a timeline, and it also suggests that perhaps hormonal replacement therapy, which you mentioned, could be helpful. We don't know for sure. We don't know for sure. And I think a lot more research is needed to test the preventative potential of hormonal therapy. Okay, so nobody should go away from this saying, Dr. Masconi says I have to get on hormonal replacement therapy when I'm 40, or it's the end. No, no, no. I would not say that. Actually, I'm very cautious in recommending medications for Alzheimer's prevention. I believe in clinical trials. I believe that drugs should be tested very thoroughly for efficacy, but also side effects, and we really need to understand who's eligible for it and who would benefit from these drugs. So something I want to clarify is that not all women who go through menopause develop Alzheimer's plaques, and not all women with the plaques develop dementia later in life. So I think phenotyping is very important. It's very important to have a solid baseline, and it's important to understand our own risks. And like what we were saying before, there are many risk factors for Alzheimer's that we can control that can also really help improve hormonal health. So instead of jumping to a pharmacy with a prescription in hand, there are other things that I would recommend doing first, which really speak to lifestyle, diet, exercise, other things that we know impact our hormone's stress reduction as a big one. So that's a good segue into this, because everyone who comes into my office does not get a prescription for estradiol and progesterone and testosterone, quite frankly. In fact, most don't. And I agree with you, and I actually just did a podcast on this. There are certainly well-recognized effects of estrogen on women, particularly vascular reactivity. And I have a subset of women who, even small amounts of estrogen replacement as a patch, make a huge difference in the way their brain functions. And I was taught this by a gynecologist. He said, you know, believe it, you know, there are women who absolutely have to have a small amount of estrogen or their brain will not work. And their vascular reactivity will not work in their brain. Is that what you guys are finding? I think the response to estrogen replacement therapy is variable. For some women, it's a godsend. Some women really swear by it. Other women swear at it. So the response is very highly individualized. And I think that we need better tools and better tests to really predict whether or not each individual woman will benefit from the therapy. And we're working on developing that. And it's something that is very dear to my heart as a scientist because in clinician, because we can measure hormones in blood, but there is no correlation between those peripheral hormones and the hormones inside the person's brain. So we need to be able to quantify estrogen levels in the brain to really dose the therapy correctly and to refine the timing so that we can better understand when to start and when to stop. Do we want to wait until a woman is menopausal to give her the patch, which is kind of common practice? Or would it be better to perhaps start earlier and see we can delay menopause? Would that be better? So I think there's a lot of research that really needs to happen and hasn't happened yet, which is honestly offensive. We might have been going through menopause forever and everybody's complaining of hot flashes, night sweats, depression, mood swings, brain fog, memory lapses. And we haven't really done the research that we need yet. And that's half of the population. So you say in your book that the idea that women have no control over menopause is a myth. Can you elaborate on that? Yeah, there are many myths surrounding menopause. There are many things that we don't fully understand or that perhaps are not being explained thoughtfully or accurately to women. So many women don't actually know how menopause works. And I find it endearing in some ways when I do explain that menopause starts in the brain. And so many women are not aware of that and they feel so relieved when I mention that because any woman can tell you that, like you were saying before, that something is happening inside their heads and they're worried that they might be going crazy or that maybe it's happening only to them and not to the other 850 million women around the planet who are not going through menopause and they're experiencing exactly the same level of confusion or changes. So that's something that really made a point to clarifying in the book. Then there is a lot of stigma around menopause in 2020 is still quite a taboo. But there is so much that we understand now that we really need to talk about and discuss with women and between women and with men, honestly, because it's a family thing in the end. And going back to your point, menopause is partially genetically mediated in that if your mom went through menopause when she was 43 chances are you're also going to menopause at the same age. If your mom went through menopause at 55, then you're very fortunate because there's a good chance you may also go through menopause later than average. However, there are things that are known to precipitate menopause and other things that are known to delay the onset of menopause. The bad things are definitely smoking, which is the number one cause of early menopause and unhealthy diet in the very high level of chronic stress. So if your mom went through menopause at 58, right, but you've been smoking for 20 years, chances are that you'll go through menopause much earlier than she did. And then there are all the good things that actually delay menopause, which are the good things we always talk about. Let's hear it. So well, a healthy diet is a big deal. There are many studies including an examination of hundreds of thousands of people showing that the more fish you have in your diet, the later the onset of menopause as a woman, of course. And on the other side, if you eat a lot of refined sugar and refined grains, that seems to accelerate the hormonal decline that leads to menopause. So it's good to think about diet in terms of something that can actually impact the health of your hormones, as well as the health of your brain. And there's evidence that dietary patterns like the Mediterranean diet, for example, also really promote hormonal health in women, also support fertility, and they're associated with fewer hot flashes in the later onset age of menopause, as well as a number of other things. So better cognitive health, reduce cardiovascular issues, reduce depression in women. So a healthy diet is very crucial, I think, for overall health. Everybody's on a different diet, but I think that on average, just staying away from processed foods would be a really good positive change in everybody's life. So let me back up for a second. Is there any evidence, then, you're the expert on this, that if you go into menopause early, let's say in your 40s, early 40s, versus going into menopause in your 50s, that you're better off the later you go into menopause? Number one. And number two, if you go into menopause early, do you throw up your hands and say, I'm screwed? Oh my gosh, now what do I do? The first answer is yes. The second answer is no. Ah, okay. Okay, good. So there is increasing evidence that a longer reproductive lifespan is protective against dementia in women, especially in women. And by longer reproductive lifespan is kind of a metaphor for the longer your body is exposed to your estrogen. So women who develop and go through puberty at the average age, or a little bit earlier, like when you're 12 and go through menopause later on, like maybe around age 55, 56, they really seem to have the lower risk of dementia as compared to women who have a shorter reproductive lifespan. So they start menstruating later in life and to go through menopause earlier, whether genetically or because of medical interventions. And I would like to mention hysterectomies and operectomies are the number one cause of early menopause for American women. And those are surgical procedures in which the uterus and or the ovaries are removed. And unfortunately, there is evidence that having the uterus and more so the ovaries removed prior to menopause correlate with a much higher risk of dementia later in life for women. So I think it's really important to talk about this and it is depressing news and it is upsetting news, but it's really important that we talk about it because so many women are not aware and so many doctors are not aware. So many OBGYNs just don't know. And so if you go to your doctor because you have fibroids and they're like, well, you know, you're suffering so much, maybe we should take out the uterus. Let's talk about keeping the ovaries because one of the major reasons for removing the ovaries is that they just happen to be there. Wow, we're in there. Yeah. Yeah. So I think it's really important to raise awareness of the fact that reproductive organs are there for a reason and they can't just be taken out that easily because there's a connection with your brain that is not the inner conversation material, but it's true. Your brain is in constant interaction with your ovaries as a woman and the ovaries talk back to the brain, influencing brain health in return. So it's a network that we really need to nourish. And that's a big part of my book is really about understanding the system and these interactions and how to really nurture them. Now, another part of that is, okay, so what about pregnancy? Where does that come in in the picture? It's a very good question. It looks like the number of pregnancies is just not associated with Alzheimer's risk. There are some studies that show that the more children you have, the higher your risk of Alzheimer's, whereas other studies have shown absolutely the opposite. So at this point, we don't know. What we do know is that the more the number of pregnancy does not correlate with your age and menopause. It doesn't seem to, because some people think, well, I haven't had my cycle for nine months, so I'm going to catch up later. It's going to be menopause is going to be delayed by at least nine months, but that doesn't seem to happen. Ah, interesting. So is there any correlation between pregnancy or no pregnancy and developing Alzheimer's or dementia? I think the research is not clear on that. And this is something that we're looking into right now, clearly at the women's brain initiative, because it's such a big deal for women's brains. And then my friend, one of my friends, she's a psychiatrist, and she got pregnant years ago when having kids was not even a thing for me, not even on the radar. And she was telling me that she felt like she had postpartum dementia, that she couldn't, she could not remember things. She was having such a hard time just getting through the day mentally. She's one of the smartest, most capable women on this planet. And that was like, yeah, yeah, yeah, you just need to sleep. Then I had my baby and he was like, Oh my God, what is happening to me to my head? And so I think this is something I really want to look into. There's, there's this beautiful study in natural neuroscience that came out just a few years ago showing that women's brains after pregnancy, throughout pregnancy and after pregnancy really goes through remodeling where the brain kind of loses gray matter that you can see on MRI scans, which sounds like a negative thing, right? I'm losing something inside my head. But a lot of people believe that these changes reflect a maturation process, like something that like, what happens in puberty, that the brain just starts going through this pruning phase where a lot of connections are discarded because you don't need them anymore. And it's much more efficient to have a very efficient, very compact brain. And it looks like something similar might happen to women's brains as we become moms, because all the attention needs to be on the baby. That is better from an evolutionary perspective. And that leads to discarding other connections that are no longer needed. And I, I finally had to be very insightful and I wonder if something like that can also explain menopause because you know, women, we actually humans were just one of the very few species that go through menopause at all. There are just two species on the entire planet that go through menopause. And these are women and killer whales. And I find that so cool. But if you think that all other species in all other species, the female dies when she's no longer fertile. Whereas for us is an advantage to become grandmothers at some point, or at least that would that's what nature intended for us. And no longer be fertile, but still be around and help the family really thrive and grow. So I find that very, I find it beautiful in some ways. So you, you have a PhD in imaging and help me with this there. We've had Dr. Dr. Amon on our program and also Dr. Dale Bradison. And I consider both of them my friends. Give me your thoughts. Do we need PET scans of the brain? Do we need MRIs of the brain? Do we need spec scans of the brain? Come on, you're the world expert. What do you like? I do them all. So the women's brain initiative, we would do, I believe 11 brain scans. And we have a very interesting MRI sequence where so we have all our patients receive an MRI scan that is mandatory. And during the MRI scan, I do seven different sequences. So we're looking at blood flow, we're looking at inflammation, we're looking at gliosis, we're looking at obviously brain shrinkage and neuronal density. We look at mitochondrial activity. We do a spectroscopy as well. And then I do two PET scans to participants who are willing to receive the procedure, of course. And one is to measure brain metabolic activity. It's called FDG, Positron Emission Tomography or PET. And the other one is called PIB or Pittsburgh Compound B, which is a tracer that looks at amyloid plaques or Alzheimer's plaques. So we try to do all the scans to all of our participants and we also repeat them over time. Every two years is the recommended time to follow up. And do they need to get all those scans? Well, we're doing that mostly for research. But the point of doing this is to really validate brain imaging as a diagnostic tool, but also as a preventative tool. So my thought is women get mammograms, right? As soon as you get to age 40, perhaps 42, if you don't want to do it so early, but you do get a mammogram so that you have a good baseline. And then with age, your risk of breast cancer increases. But then you can do another mammogram and go back to your baseline and compare. PAP tests, they keep doing either ear or it depends on your doctor. My doctor says every five years, even colonoscopies, same exact theory, right? So you want to have a strong solid baseline and see the predictive value of these procedures. And we're trying to determine that for brain imaging. I don't think that everybody needs to do 10 brain scans. And we're really working to find out which brain scans are most helpful and most predictive of future health risks. So you've got all these scans. So which food should women be eating the most frequently for the brain? And which you kind of touched on this, which should we just avoid at all costs? I don't know that there is one specific type of food. In terms of nutrients, I find that women's brains really benefit from three main nutrients. Can I do three? Three? Okay. Or maybe two. Polyunsaturated fatty acids are really, really important for women's health. There are plenty of studies showing that a diet rich in polyunsaturated fatty acids, especially the omega three type, is associated with a 25% reduced risk of heart disease in women, a much lower risk of depression as well as menstrual pain and infertility. And even a 70% lower risk of dementia for those who consume more than four grams of polyunsaturated fatty acids every day. So I think this is really good news. Well, now wait a minute. Corn oil and soybean oil are polyunsaturated fatty acids, for the most part. They're more omega six, no? Yeah, they're omega sixes. I would hope you'd mean things like fish oil or plant-based fish oil replacements. Yes, most certainly omega fish. Yes, fish, shellfish. And also... No, no, no, no, no soybeans. But also omega three is from plant-based foods like olive oil, which are just almonds, chia seeds. There are many plant-based foods that contain omega three fatty acids. You made a phase. I think chia seeds are not on your list. Yeah, the problem with chia seeds... Actually, Professor Lauren Cordain, who was the original author of the Paleo Diet, and I were talking years ago. And chia seeds are a source of short chain omega three fats. And I was a big proponent of them. And we were talking on the phone one day. He says, don't you read the literature? And I said, what are you talking about? Yes, I do. And he says, well, there's two studies in humans where chia seeds promote inflammation. I said, you're kidding. He says, no, the studies were done to prove that chia seeds increase your level of omega three fats in your blood. And so just as part of it, they wanted to show that chia seed consumption decreased, in this case, C-reactive protein. And so they did a blinded study. And it turns out that the chia seed group, they did increase their omega three fats, but their C-reactive protein went up. And so ever since that day, I've stopped recommending chia seeds. So even though they are a source of short chain omega three fat. Oh, so I find them to be kind of trendy. Yeah. What I recommend is basil seeds. They will actually make the same sort of jelly-like stuff, but they actually promote health rather than perhaps. Good. I love basil. I'm Italian, so basil everywhere. Yeah, that's right. Basil on everything. I agree. So, you know, that brings up a good point. What are your thoughts on lectins? Because there is some interesting research on lectins and their effect on the brain, particularly in Parkinson's disease. In Parkinson's. And what kind of negative effects, I'm assuming. Yeah, negative effects. It turns out that lectins have been shown to climb the vagus nerve and actually cause neuro-inflammation. And there's really interesting studies in people who've had vagotomies, where their vagus nerve has been cut for ulcer disease back in the good old days, that people who've had vagotomies actually have a 50% less incidence of Parkinson's than people whose vagus nerve is intact. And this has actually been reproduced in animal studies that lectins can climb the vagus nerve and actually lodge in the substantia nigra, which is fascinating to me. So, needless to say, as a kind of an anti-lectin guy, I'm not big on lectins in the brain. Yeah, for sure. And I think diet is so personal, right? It's good to know what possible risks and possible stressors might be. And it's in part genetically driven. So, I think it's really important to know your stressors. For some people, gluten is a big issue. For other people, I guess the lectins are a big issue. For people like meat, it's hard to digest. So, I think it's really important to understand what kind of foods and nutrients work for each individual patient or person and how to maximize brain health. And I'm a big proponent of flexibility, like a flexible diet, as long as it's overall healthy. We have some patients who are keto, some patients who are paleo, many patients who are vegan. And I respect all diets. We just try to really incentivize and motivate people to make the healthiest possible choices that they can make. And I really think that eliminating processed foods from the diet is something that everybody agrees is good for you. And it's the one thing that nobody does. Like everybody's eating frozen pizza, they go to McDonald's, they do takeout all the time. So, I think that that's really the number one thing that I would recommend. Just really try to minimize the amount of processed foods and packaged foods and preservatives in your diet. And your brain can only rejoice and so will your heart. So, why not? Yeah, exactly. Speaking of keeping your brain in tip-top shape, and we talked off camera a little bit about this. So, are there any supplements? Give me three supplements that women and men, for that matter, should be taking for optimum brain health. There is no real agreement or consensus on which supplements are really supportive of brain health and could potentially reduce risk of Alzheimer's. So, my take on this is that we need to get tested. Because if you have a subclinical deficiency or obviously a deficiency, then taking supplements makes a lot of sense. So, assuming that a person benefits from these supplements, I would say my number one would be polyunsaturated fatty acids, the omega-3s, in case one is deficient or subclinically deficient, especially for people with high homocysteine levels, in which case B vitamins seem to be also very important for brain health and to reduce risk of Alzheimer's, especially B6, B12, and folate. And then antioxidants, especially for women. Antioxidants are so important because the brain is the number one organ that is really affected by oxidative stress. And the only way to reduce the oxidative stress is through the diet, by really importing all these antioxidant nutrients from our diet. So, I'll just mention here that everybody thinks about blueberries, but blackberries have a much higher antioxidant power than the blueberries. So, whenever possible, I personally go for blackberries because they're also really yummy. Yeah, I'm glad you brought that up. So many people don't know, and I'm glad you said that, that blackberries carry a much more potent punch than blueberries. Plus, as I tell anyone who will listen, our blueberries, particularly here in the United States and now around the world have been bred for sugar content. And when I was growing up, blueberries were these little bitty, bitter things. And now, you know, they're the size of grapes. And they're enormous in the States. And usually, we still have the little ones. They're called wild blueberries here, right? You find them frozen. Yeah, you can get them at Trader Joe's. That's not an endorsement, but that's where you can find them. So, yeah, whole foods usually have some frozen ones. But yeah, blackberry and even a raspberry, the gallic acid in raspberries is fantastic as polyphenol. Right. And shall we mention espresso? Yeah, of course, an Italian PhD has got to mention espresso. Yeah, well, it is their beverage with the highest antioxidant capacity of all beverages. So a freshly brewed espresso goes a long way. And I think it's good to mention that one espresso a day has also been associated with a much lower risk of dementia later on in life. Whereas no coffee at all, and more than that, has been shown to not be really as effective. It looks like there's an inverted U shape. So I think that's good news. We're talking blueberries, blackberries, coffee, and dark chocolate, of course. It's also a good antioxidant. And have a bite of dark chocolate with your espresso. Right. But don't put a bunch of milk in it and make it a latte. Or sugar. Yeah, or sugar, you know. I put a little milk, actually. We do that's exactly what I do. And I try to convince my patients to change over to just a little macchiato. Preferably with A2 milk. I'll get a plug in for A2 milk. Okay, so let's talk about exercise. Since we've been talking about food, how important for women is working out for brain health? It is very, very important. And I think there's quite enough convincing research showing how women don't exercise nearly as much as they could or should. And they most certainly exercise less than men do for a number of reasons, which is not to blame women for it. But it's really a number of reasons that go from, you know, just being a mom and holding full-time jobs and taking care of their family and taking care of your parents and your husband's parents. Perhaps there's just so much that's going on in a woman's life and the men's life as well. But for some reason, women, and I think any woman would acknowledge that we're just so good at putting everybody else and everything else before us. And then the downside is that we don't get to move our bodies as much as we could. But there's a lot of evidence that exercise is not just good for overall health. It's also specifically helpful for your brain. And it's really a well-established preventative against Alzheimer's and dementia. So the fact that women don't exercise as much as they should raises concerns because that could also be one of the reasons that more women than men end up with dementia later in life. And there is very encouraging research showing that exercising reduces the risk of dementia for both men and women, but more so for women than for men. There was just this wonderful study published where it was over 200 women that were followed for over 40 years, which I found was incredible. And they showed that your cardiovascular level, your fitness level in midlife is really predictive of future risk of Alzheimer's disease. So the women with the highest level of fitness basically did not decline to Alzheimer's disease. The decline rate was close to 0%. Whereas women in the lowest percentile of fitness declined to Alzheimer's at the rate of 30%, which means of every three women who don't exercise, at least one is going to get Alzheimer's disease. So it does not convincing enough. I don't know what it could be. And I also want to mention because I don't want anyone to feel bad about not exercising. We have so much guilt around not doing every single thing we could, which is clearly unsustainable. You only have that much time in a day or a week. But there's very encouraging evidence that you don't have to run a marathon. We think about exercise mostly in terms of running, jumping, aerobic exercise. And a lot of women just can't do them. Maybe they're too tired or they're going through menopause, they're going, there's so much else going on. But there's a lot of evidence that lower intensity exercise if done consistently is just as good as high intensity exercise done once in a while. And it's also less likely to cause inflammation in the body for women who are going through menopause or perimenopause and have a lot of cortisol and have trouble sleeping. So slow and steady wins the race as long as it's consistent. Yeah, I agree. In fact, I write prescriptions for many of my patients to get a dog because dogs actually make you exercise twice a day, whether you want to or not. Yeah, that's a lovely idea. And don't say they keep you company. Lower your stress level. Yeah, it's really interesting. I have a number of people who come back with that prescription frame that it was the best prescription a doctor had ever written for them. So I'm going to keep doing it. I love that. If it's okay, I'm going to mention that you do that because it's such a good idea. Yeah, no, it please. So can you reverse dementia? Reverse is an interesting word for a scientist. You know, I know that's been used with books, podcasts and magazines. For me, reversing Alzheimer's means that you're getting rid of the symptoms and you're getting rid of the pathology. So the Alzheimer's plaques are gone, the tangles are gone, the inflammation are gone, your nerves are growing back, and your symptoms are gone. So far, I haven't seen that happen. The hope is that it will. Right now, I think we are as a field that the Alzheimer's field is coming together in finally accepting that prevention is feasible. We got so much pushback for so long that we couldn't even publish a paper with the word prevention in it. Just recently, we had to cross it out of the title. Really? Yeah, absolutely. There were, I think we had six reviewers, which is a lot of reviewers, and at least three raised concerns about the word prevention. And so we had to cross it off and just replace it with risk reduction. You know, you do what you're going to do, but the point is a lot of people still don't believe that prevention is feasible. The risk reduction is more, you know, it's more like, oh, okay, it's not a strong word. But obviously, I'm the associate director of the Alzheimer's prevention clinic, Walter Cornell, which I thought was kind of brave. So obviously, I believe that prevention is feasible. And there's a lot of data showing that at the very least one third of all Alzheimer's cases are potentially preventable. So I do believe in prevention, and I most certainly hope that Alzheimer's disease will be reversible. All right. Well, that's a good place to end all this. So Dr. Moscone, how can you, how can people find you and follow your work and get the book, obviously? So the book is available in all stores. And of course, it's on Amazon and Barnes and Nobles and online everywhere. And I really hope that you like it. I really put my heart and soul into that book. And it's such an important part of me, really, that went into the book. As we're getting in touch with me, I'm on Instagram. I'm not big on social media, but I am on Instagram at Dr. Moscone, dr underscore Moscone. And I have a website, which is lisa Moscone.com. And I actually answer direct messages. Wow. For now, I really do my best to really respond and make friends and to really be in touch with everybody because it's so informative. I find that all the questions really inform my research because as a scientist, there are a lot of questions that I have on my mind and a lot of things I wouldn't think about. So this feedback is incredibly enriching for us. No, it's very true. And in fact, one of my books I dedicated to my patients for asking me questions I did not have the answer to, or telling me about something that I didn't know. And so I'm always thankful for any question and all my patients keep me informed. So all right, we've got an audience question. And I'm going to ask you to participate in this, if you don't mind. John Gault one on YouTube asks, is olive leaf extract better than olive oil since it's more potent? Well, actually, I'm going to make you start and I'll finish up. What do you think? Well, I think it's an interesting question. Again, I'm Italian, so olive oil is a big deal for me. I love it. And I think it's really, one is a supplement, right, the extract, and the other one is a condiment. So I think they're both really helpful, could be very, very helpful. Olive oil has been shown to be, well, it's obviously at the core of the Mediterranean diet, which is a very brain healthy and heart healthy diet. And why not taking the supplement as well? Yeah. And interestingly enough, we know that the, the polyphenol content of leaves is actually much higher than the polyphenol content of the fruit of that tree. For instance, there's far more polyphenols in apple leaves than there are in apples. And there's actually far more polyphenols in raspberry leaves or blackberry leaves than there are in raspberries or blackberries. So I agree with you. I, as you know, or maybe no, I think the only purpose of food is to get olive oil into your mouth. And yeah, but I, I use both olive leaf extract and I use a ton of olive oil. And the more polyphenols in the olive oil, the better, right? Absolutely. All right. Well, thanks for joining us. Good luck with the book. I know it's going to be great. And thanks for, you know, bringing this attention to women. For some obscure reason, we've got to get the word out that, you know, women are the main sufferers of Alzheimer's disease. Yes. All right. Thank you so much. Thank you for having me. And that's all for the Dr. Gundry podcast. We'll see you next week. Before you go, I just wanted to remind you that you can find the show on iTunes, Google Play, Stitcher, or wherever you get your podcasts. Because I'm Dr. Gundry, and I'm always looking out for you.