Summary of Dr. Gundry Podcast EP 375

Title: Alzheimer’s Isn’t Inevitable: What Science Says You Can Control Starting Now
Date: January 6, 2026
Host: Dr. Stephen Gundry
Guest: Dr. Lisa Mosconi, neuroscientist and author

Episode Overview

In this episode, Dr. Stephen Gundry interviews Dr. Lisa Mosconi about Alzheimer's disease, focusing on why women are disproportionately affected and the powerful, evidence-based steps individuals can take—especially women—to reduce their risk. Dr. Mosconi shares the latest science on menopause, hormones, lifestyle interventions, and prevention, dispelling myths and providing practical guidance for brain health.

Key Discussion Points & Insights

1. Why Alzheimer’s Affects More Women

• Women are at Higher Risk: Contrary to popular belief, more women develop Alzheimer's than men, despite women generally being healthier.
  • “Alzheimer's disease is the only age-related neurodegenerative condition that affects more women than men.” (Mosconi, 01:31)
• Hormonal Differences: Female hormonal health, particularly the dramatic drop in estrogen during menopause, plays a critical role in increasing risk.
  • "Hormones are actually incredibly powerful allies that protect you against Alzheimer's and brain aging at large… but they have different lifespans." (Mosconi, 02:05)

2. The Critical Role of Menopause & Hormones

• Men experience a slower decline in testosterone, while women have a sudden estrogen drop in midlife.
• Brain scans show some women start developing Alzheimer’s plaques during menopause, far earlier than previously thought.
  • "...drops in estrogen levels correlate with the formation of Alzheimer's plaques…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." (Mosconi, 03:34–04:15)

3. Rethinking Hormone Replacement Therapy (HRT)

• HRT may help some women, but it’s not a blanket recommendation; more research is needed.
  • "I would not say that…I'm very cautious in recommending medications for Alzheimer's prevention...there are many risk factors for Alzheimer's that we can control..." (Mosconi, 06:12)
• Individual responses to estrogen therapy can vary dramatically.
  • "For some women is a godsend. Some women really swear by it. Other women swear at it." (Mosconi, 08:24)

4. What Can Women Do to Lower Their Risk?

• Lifestyle Factors:
  • Diet:
    • Fish-rich, Mediterranean diets delay menopause and support brain/hormonal health.
    • Processed foods and high sugar accelerate menopause and may increase risk.
    • "A healthy diet is a big deal...the more fish you have in your diet, the later the onset of menopause." (Mosconi, 14:13)
  • Exercise:
    • Consistent, even low-intensity, exercise is strongly protective—more so for women.
    • Fitness in midlife predicts later Alzheimer's risk.
    • "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." (Mosconi, 25:25)
  • Stress Reduction:
    • Chronic stress can accelerate menopause and may impact brain health.
    • "High level of chronic stress…is the number one cause of early menopause." (Mosconi, 11:30)
• Avoiding Smoking:
  • Smoking is the top cause of early menopause and increased Alzheimer's risk.

5. Menopause Myths & Genetic Factors

• Menopause timing is partly genetic but modifiable by lifestyle.
• "There are things that are known to precipitate menopause and other things that are known to delay the onset of menopause..." (Mosconi, 10:10)
• Education about menopause is lacking; starting in the brain, menopause is often misunderstood.
  • "Menopause starts in the brain, and so many women are not aware of that, and they feel so relieved when I mention that..." (Mosconi, 10:44)

6. Surgery and Menopause

• Surgeries like hysterectomy or oophorectomy (removal of uterus/ovaries) before menopause can drastically increase Alzheimer’s risk.
  • "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." (Mosconi, 16:45)

7. Pregnancy and Alzheimer’s

• Research is inconclusive about the link, if any, between number of pregnancies and Alzheimer's risk.
  • "The number of pregnancies is just not associated with Alzheimer's risk..." (Mosconi, 19:02)

8. Alzheimer’s Prevention: Feasible but Not Guaranteed

• "Reversing" Alzheimer's is not currently possible, but reducing risk/prevention is.
  • "Reversing Alzheimer's means that you're getting rid of the symptoms and you're getting rid of the pathology...So far, I haven't seen that happen. The hope is that it will." (Mosconi, 29:05)
• At least one third of Alzheimer's cases are considered preventable.
  • "There's a lot of data showing at the very least, one third of all Alzheimer's cases are potentially preventable." (Mosconi, 30:35)

Notable Quotes & Memorable Moments

• On women’s unique risk:
  "Alzheimer's is the only age-related neurodegenerative disease that affects more women than men. That's something specific to women." (Mosconi, 01:31)

• On estrogen and brain health:
  "Hormones are very powerful...they really keep Alzheimer's plaques at bay. They're anti-inflammatory, they support neuronal growth and plasticity..." (Mosconi, 02:26)

• On prevention timeline:
  "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." (Mosconi, 04:32)

• On personalized HRT:
  "We need better tools to really predict whether each individual woman will benefit...We can measure hormones in blood but there is no correlation between those and the hormones inside the person's brain." (Mosconi, 08:24)

• On mythbusting menopause:
  "Menopause starts in the brain. Many women don’t know that and feel relieved when I mention it...there’s a lot of stigma, it’s still quite a taboo." (Mosconi, 10:44)

• On exercise as medicine:
  "Slow and steady wins the race as long as it's consistent." (Mosconi, 25:25) "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." (Mosconi, 25:00)

• On the importance of prevention:
  "One third of all Alzheimer's cases are potentially preventable. So I do believe in prevention." (Mosconi, 30:43)

• On surgery and increased risk:
  "If you go to your doctor because you have fibroids and they're like...let's talk about keeping the ovaries." (Mosconi, 17:55)

• On women putting themselves last:
  "We're just so good at putting everybody else and everything else before us...the downside is that we don't get to move our bodies as much as we could." (Mosconi, 23:35)

Timestamps for Major Segments

• 01:09 – Stats: More women get Alzheimer's than men
• 02:05–04:44 – Hormones, menopause, and Alzheimer’s onset in women
• 05:04–08:24 – Hormone therapy controversies and individualized responses
• 10:00–12:21 – Menopause myths and genetics
• 14:05–15:39 – Diet’s impact on menopause and brain health
• 16:15–19:43 – Earlier menopause, surgical risks, and implications for Alzheimer’s
• 22:44–26:12 – Exercise, consistent movement, and direct health outcomes
• 29:05–30:51 – Prevention vs. reversal and what’s genuinely possible

Practical Takeaways

• Prevention is possible: At least one-third of Alzheimer’s cases could be prevented with lifestyle changes, especially for women.
• Focus on diet, exercise, and stress management: These are central to brain and hormonal health.
• Start young: Women should be proactive about brain health in their 40s and 50s.
• Personalize HRT decisions: Don’t consider hormone therapy without proper evaluation; it’s not “one size fits all.”
• Be aware of surgical impacts: Avoid unnecessary ovary/uterus removal before menopause whenever possible.

Guest Contact Information

• Instagram: @drmascone
• Website: lisamoscone.com
  "I actually answer direct messages...all the questions really inform my research." (Mosconi, 30:55)

Final Thoughts

Dr. Gundry and Dr. Mosconi emphasize the crucial, often overlooked reality that Alzheimer’s is not solely a disease of old age nor is it “fated.” With a better understanding of hormonal and lifestyle influences, women can take tangible steps for brain health far earlier—and more effectively—than previously thought.

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