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

Summary

Podcast Summary: unPAUSED with Dr. Mary Claire Haver

Episode: Understanding Your Brain Through Perimenopause and Menopause with Dr. Louisa Nicola
Release Date: February 3, 2026
Host: Dr. Mary Claire Haver
Guest: Dr. Louisa Nicola

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Episode Overview

This episode dives deep into women's brain health through the lens of perimenopause and menopause, focusing particularly on understanding and mitigating risk factors for Alzheimer's disease and cognitive decline. Renowned neurophysiologist and Alzheimer's expert Dr. Louisa Nicola joins Dr. Haver to demystify why women are disproportionately affected by dementia, what happens in the female brain during hormonal transitions, and the latest actionable science on prevention, brain fog, mental health, lifestyle interventions, and optimizing cognitive longevity.

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Key Topics and Insights

1. Why Are Women More at Risk for Alzheimer's Disease?

[00:00, 15:14, 29:52]

• Women make up 70% of Alzheimer’s cases (“two out of three cases are female” — Nicola, 00:00).
• Only about 2-3% of cases are due to known genetic mutations (presenilin 1/2, amyloid precursor protein); 95% are influenced by lifestyle.
• Many women are caretakers for those with dementia, further increasing the impact on women.
• “So we know that we have agency over it.” (Nicola, 00:24)
• The field long lacked sex-specific research; only recently has data shown this stark disparity.

2. Understanding Brain Fog vs. Dementia

[16:03, 17:59]

• Dementia: Umbrella term for a decline in cognition (thinking, reaction time, processing speed); Alzheimer’s is the most common form.
• Brain Fog: A symptom, not a disease; driven by factors like hormonal loss (notably estrogen) and/or high stress (cortisol).
• “It's exasperated through the loss of estrogen ... but it can also happen in a hypercortisol state.” (Nicola, 16:48/17:59)

3. The Biological Cascade: Hormones, Plaques, and the Female Brain

[18:51, 21:02, 23:27]

• Alzheimer’s starts “quietly in our 30s and 40s,” not suddenly at old age.
• Estrogen, progesterone, and prolactin protect the brain by inhibiting tau protein phosphorylation, which causes damaging tangles. Loss of these hormones increases risk.
• Sleep is crucial: the glymphatic system clears amyloid-beta plaques at night but does NOT clear tau.
• “Estrogen, progesterone, and prolactin inhibit that enzyme [GSK3 beta], so it shuts it off.” (Nicola, 23:27)

4. Autoimmunity and Female Vulnerability

[25:01, 26:07]

• 80% of autoimmune diseases are female. Nicola hypothesizes a link between immune mechanisms and increased tau accumulation.
• Research is lacking because “women are understudied, under researched, because they have a hormonal cycle... makes them hard to deal with.” (Nicola, 26:17)

5. Progression and Pathology of Alzheimer’s

[27:34, 29:52]

• Alzheimer’s damages neural connections, especially in the hippocampus — the “memory consolidator.”
• Dementia is not an inevitable part of aging. “You can get to 100 years old and have your cognitive functions intact. It is possible. Hormones are one factor.” (Nicola, 29:52)

6. Hormones and Brain Metabolism: Premenopausal vs. Perimenopausal Brain

[30:33, 32:07]

• Estrogen is vital for efficient brain glucose metabolism.
• Hormonal dip in perimenopause leads to cognitive sluggishness, problems with glucose metabolism, and poor resilience to stress.
• Loss of estrogen narrows the “window of opportunity” for preventive hormone interventions, particularly in women with ApoE4 risk genes. HRT must start before/during early menopause for brain/cardiovascular benefit.

7. Neurotransmitters, Hot Flashes, and Sleep

[34:26, 35:30, 41:12]

• Loss of estrogen dysregulates “candy neurons” in the hypothalamus, causing hot flashes, temperature dysregulation, and impacts on mood.
• Sleep disruption becomes rampant—often due to hot flashes, but also early morning awakenings as melatonin and progesterone decline.
• “The loss of progesterone, which is activating GABA...could help as well.” (Nicola, 41:12)

8. Mental Health: SSRIs vs. HRT

[37:32, 39:56]

• Perimenopausal women are overprescribed SSRIs for symptoms that may respond better to HRT.
• “Adding in ... HRT ... will probably benefit her better than adding a second SSRI.” (Haver, 38:37)
• Exercise and creatine can mediate depressive symptoms.

9. Sleep Hygiene and Optimization

[43:12, 44:12, 45:24]

• Stay asleep 7–7.5 hours per night minimum.
• Sleep consistency (same wake/sleep time) is even more critical than total hours.
• “Wind down routines that involve dimming the lights ... crucial.” (Nicola, 47:01)
• Tools: blue light blockers, red light therapy, hot showers before bed.

10. Heart Rate Variability and the Brain

[50:08, 51:33]

• HRV is a marker of resilience between “fight/flight” and “rest/digest.” Improve via sleep, avoid alcohol, and breath work (“box breathing,” 20 min a day).

11. Exercise: The Ultimate Brain Elixir

[54:07, 64:25]

• Aerobic/resistance exercise strongly tied to lowering dementia risk.
• “Women who have a high peak respiratory fitness ... can lower their risk of getting dementia by 80%.” (Nicola, 57:25)
• Aerobic exercise: 30 minutes, 3–5 times/week (zone 2 or higher), grows the hippocampus and improves BDNF.
• High-intensity intervals (zone 5): Only 20 minutes/week needed; lactate produced here is “fuel for your brain.”
• Resistance training: At least 3x/week to release “myokines” for brain/cognitive health.
• Incorporate cognitive drills (throwing a ball while balancing) for “neuroplasticity.”
• “If you want to focus on one thing, focus on lower body strength ... larger legs, larger brain.” (Nicola, 68:55)

12. Nutrition for Brain Longevity

[69:20, 70:53]

• Mediterranean/MIND diets show best evidence (“large amounts of fiber, fruits, vegetables ... lower LDL”).
• Reduce ultra-processed foods; focus on omega-3 fatty acids (DHA, EPA), magnesium.
• “Nutrition is just information... instead of what should you take out, what aren’t you having?”
• DHA/EPA: 2g daily via high-quality supplements; check Omega-3 Index (>8% ideal).

13. Key Supplements

[73:09, 73:14]

• Omega-3s (DHA/EPA): Crucial for healthy brain structure
• Creatine: Supports energy metabolism in muscle and brain—especially beneficial during sleep deprivation (recommend up to 20g when sleep-deprived)
• Use third-party tested products (e.g., via sup.co app); test Omega Index annually.

14. The Power of Social Connection and Self-Kindness

[77:20, 78:06]

• Social connection is strongly linked to cognitive longevity and lower mortality (close friendships, not just romantic).
• “Being kind to yourself can decrease your risk of mortality and dementia.” (Nicola, 78:22)
• Practices: affirmations, journaling, self-compassion.

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Memorable Quotes

• “This is the disease, the only disease that robs you of who you are.” — Louisa Nicola [12:33]
• “Dementia and Alzheimer’s disease is not part of the natural brain aging process.” — Louisa Nicola [29:52]
• “You can get to 100 years old and have your cognitive functions intact. It is possible.” — Louisa Nicola [29:55]
• “Women who have a high peak respiratory fitness ... can lower their risk of getting dementia by 80%.” — Louisa Nicola [57:25]
• “Your brain needs hard stimulus in order for it to grow and repair.” — Louisa Nicola [64:12]
• “If you want to focus on one thing, focus on lower body strength ... the larger the legs, the larger the brain.” — Louisa Nicola [68:55]
• “Being kind to yourself can decrease your risk of mortality and dementia.” — Louisa Nicola [78:22]
• “It’s not enough to just walk—add resistance, intensity, and complexity for maximum protection.” — Louisa Nicola [76:19–76:57]

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Actionable Takeaways & Recommendations

• Get tested for ApoE4 and standard biomarkers (LDL, ApoB, Omega-3 index)—know your risk.
• Optimize sleep: 7–8 hours, regular schedule, dim lights at night, avoid screens; create personalized wind-down routines.
• Exercise: Aim for both aerobic and resistance training; add high-intensity intervals and coordination drills.
• Prioritize nutrition: Mediterranean/MIND diets, increase omega-3s (supplement as needed), more vegetables/protein, less processed food.
• Consider key supplements: Omega-3s (DHA/EPA, 2g daily), creatine (5g daily for muscle, 20g for brain during extreme sleep deprivation).
• Build and maintain social connections—friendships matter as much as family.
• Practice self-kindness: Self-talk, stress management, and self-compassion affect physiology.
• Protect your cognitive reserve: Stay intellectually engaged, physically active, and emotionally connected throughout midlife and beyond.

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Essential Timestamps

• 00:00 Why women are at greater risk
• 06:00 Introduction to neurophysiology and MCI
• 12:16 Personal stories of Alzheimer’s in family
• 16:03 Brain fog vs. dementia
• 19:04 Alzheimer’s progression starts early
• 23:27 Hormones and tau pathology
• 29:52 Dementia is not normal aging; men vs. women
• 35:30 Sleep problems, neurotransmitters, and perimenopause
• 37:32 Mental health: SSRIs vs. HRT
• 43:12 Sleep hygiene strategies
• 50:08 Heart rate variability and breathwork
• 54:07 Exercise as cognitive medicine
• 56:35 Overcoming the “thin at all costs” mentality
• 61:17 White matter, resistance training, and cognitive drills
• 69:20 Nutrition, omega-3, supplements
• 73:09 Creating a supplement routine
• 75:30 Top three things women can do right now
• 77:20 Social connection and kindness

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By maintaining the authentic tone and depth of discussion, this summary gives non-listeners a rich, actionable map for navigating women’s midlife brain health, with clear attributions and timestamps for further exploration.

Transcript

[Luisa Nicola]

Let me tell you, for every woman listening, and by the way, women represent 70% 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 at the presenilin one, presenilin two, and the amyloid precursor protein, that's only like 2 to 3%.

[Dr. Mary Claire Haver]

Tiny, tiny, very percent.

[Luisa Nicola]

Okay, small percent. So the other 95%, 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 70% 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 really, women are at the mercy of this disease.

[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. 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 50 to 55 million people worldwide are living with 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 3 to 5% of those cases are caused by genetic mutations, which means 95% 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, Luisa Nicola, is one of the clearest, most compelling voices in neuroscience, helping us understand the answers to this question. Louisa is a neurophysiologist and Alzheimer's expert on a mission to eradicate this destructive disease. She is the founder and head performance advisor of Neuroathletics, a human performance education platform that is certified over 2,000 coaches and also a former world champion triathlete. 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. This episode is brought to you by Peloton Break through the busiest time of year with the brand new Peloton Cross Training Tread plus. Powered by Peloton iq. With real time guidance and endless ways to move, you can personalize your workouts and train with confidence, helping you reach your goals in less time. Let yourself run, lift, sculpt, push and go. Explore the new peloton cross training Tread.

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[Dr. Mary Claire Haver]

Dr. Nicola, welcome. Hi To Unpaused.

[Luisa Nicola]

I'm so excited to be here.

[Dr. Mary Claire Haver]

Walk me through your training. You grew up in Sydney, Australia?

[Luisa Nicola]

Well, actually. Well, 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. Really? Yes. So I was.

[Dr. Mary Claire Haver]

That was like my backup plan.

[Luisa Nicola]

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

[Dr. Mary Claire Haver]

In high school.

[Luisa Nicola]

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 master's of medicine and then furthered into a PhD. 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.

[Dr. Mary Claire Haver]

So how did you end up in.

[Luisa Nicola]

The U.S. 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.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

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 okay for our listeners.

[Dr. Mary Claire Haver]

What is a neurophysiologist?

[Luisa Nicola]

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 a suspected of having multiple sclerosis or epilepsy. If you've had a seizure, you'll go and 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. 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, I was put to primarily scan the brains of mild cognitive impairment patients.

[Dr. Mary Claire Haver]

And for our listeners, what is mild cognitive impairment?

[Luisa Nicola]

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 QEEG. 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? 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.

[Dr. Mary Claire Haver]

How old were these patients in general?

[Luisa Nicola]

The one who really Changed the course of my career was 52, but most of them ranged from 50s to 80s. Right. But I was really dumbfounded too. I couldn't understand why we were getting 50 year olds in. I used to think that this was a disease of your 70s and 80s, which is what I was being told. In a hospital setting, in a neurology clinic, which I 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. 52 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. And that was a very, very fast progression into early onset Alzheimer's disease. So she did have a genetic mutation in the presenilin 1 gene. But that's what really formulated. Okay, this is. I need to research this. This is what my PhD will be on. Everything.

[Dr. Mary Claire Haver]

Amazing.

[Luisa Nicola]

Yeah.

[Dr. 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.

[Luisa Nicola]

Sex specific differences.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

No, I got a lot of pushback. My. 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.

[Dr. Mary Claire Haver]

Cardiovascular disease. Like multiple things. Yeah, but that.

[Luisa Nicola]

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.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

Yeah.

[Dr. 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 that, you know, you were shocked by this.

[Luisa Nicola]

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 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 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. 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. She. 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.

[Dr. Mary Claire Haver]

Wow.

[Luisa Nicola]

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, and my mom has Alzheimer's.

[Dr. Mary Claire Haver]

I don't know if you knew this. And she's in her 80s. Her mother most likely had it. There was no diagnosis back then. She just was an old lady who laid in 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.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

And extremely frail.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

Know.

[Dr. Mary Claire Haver]

And now she's in a memory care. Like we have better options. She's in memory care. But again, 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 and like it is. It's life changing.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

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 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.

[Luisa Nicola]

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

[Dr. Mary Claire Haver]

Yeah.

[Luisa Nicola]

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.

[Dr. 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. Of course, she's. She's, you know, paranoid. She's in this horrible state of mind most of the time that seems like her brain is torturing her.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

You know, and it is. She's just unhappy.

[Luisa Nicola]

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?

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

She's in her 80s 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. She was at home, was from alcohol.

[Luisa Nicola]

Yeah.

[Dr. 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.

[Luisa Nicola]

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.

[Dr. 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 population? My patients are coming in with no cognitive, 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?

[Luisa Nicola]

Correct. And let me tell you, for every woman listening, and by the way, women represent 70% 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 presenilin one, presenilin two, and the amyloid precursor protein. That's only like 2 to 3%.

[Dr. Mary Claire Haver]

Tiny percent. Very percent.

[Luisa Nicola]

Okay, small percent. So the other 95%, why are they getting it? 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 70%, and then the rest of. There's another very small portion that then has to care for. They're becoming caretakers. So really, women are at the mercy of this disease.

[Dr. Mary Claire Haver]

Let's talk about brain fog. And how is it different than dementia? Like, when should someone be worried?

[Luisa Nicola]

So, first of all, let's just do some terms. Dementia is the umbrella term that's used to describe the. You're starting to have a declining 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 their mid-40s, early-50s, 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. Oi. It could be. Could you possibly.

[Dr. Mary Claire Haver]

Yeah, the long one with the handle.

[Luisa Nicola]

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.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

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 body. 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. Okay, so we'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 csf, like a spinal tapping. You'll see that you've got accumulation of amyloid beta and tau proteins. If you've got vascular dementia, you've got a problem with the vessels in the brain. Or you might get Parkinson's dementia. Maybe first you had Parkinson's disease. It's exasperated and caused by some form of dementia. So that's how you're diagnosed. You usually need a neurologist to do that through imaging.

[Dr. Mary Claire Haver]

And then how is this different than brain fog?

[Luisa Nicola]

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 exasperated 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. 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.

[Dr. Mary Claire Haver]

You've said that Alzheimer's doesn't suddenly appear at 70. No, that it is actually starts quietly in our 30s and 40s. Walk our listeners through, you know, what is actually happening in the brain.

[Luisa Nicola]

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 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. 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, these amyloid beta proteins and these tau tangles, they start to build up and they compound. And you don't realize 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 towel residue we probably have because I don't 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.

[Dr. Mary Claire Haver]

Is there a threshold, like how much accumulation do you need before you start having. This is Alzheimer's?

[Luisa Nicola]

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

[Dr. Mary Claire Haver]

I was talking bad, bad, bad.

[Luisa Nicola]

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. Yeah, so when we activate our innate immune system and we get stressed and 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 in the cerebral spinal fluid. And then we have tau proteins. Now, I don't know if you know this, but one of the reasons that I hypothesize that 70% of women have Alzheimer's disease is because we are more predisposed to tau proteins than men, okay? Yeah, walk me through this. So tau protein lives in the microtubules. Let's neuroanatomy. Right now we have around 87 billion neurons, okay? Each neuron has around 15,000 connections.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

There you go. I love that. So that star, I 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, okay, it breaks off the microtubules and it starts to aggregate. And when it starts to form clumps 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, GSK3 beta. It's an enzyme that actually phosphorylates the tau protein, okay. So it causes it to become hyperphosphorylated within that. And when it becomes hyperphosphorylated, it causes the collapse of the axon. Get this. Estrogen, progesterone, and prolactin.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

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. 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 an increased risk of. Of getting hyperphosphorylate because we don't have the support anymore.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

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 has something to do with the fact that 80% 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. We do emt.

[Dr. Mary Claire Haver]

So for our listeners, demyelinization. So the myelin sheath is the insulation around the neurons and 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.

[Luisa Nicola]

Cause that to happen.

[Dr. Mary Claire Haver]

And then those nerve transition transduction times will slow down. So people with Ms. Will have these physical defects.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

You know, they can't feel or they're struggling.

[Luisa Nicola]

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.

[Dr. Mary Claire Haver]

And what's an EMG for the listeners?

[Luisa Nicola]

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.

[Dr. Mary Claire Haver]

And is not how we diagnose Ms. Yeah, it is.

[Luisa Nicola]

And other neuroimaging studies. And I hypothesize that this is some. You know, because we still don't know why. Why don't. Why. Why are 80% of all autoimmune diseases women. We still don't know why.

[Dr. Mary Claire Haver]

Why do you think that is?

[Luisa Nicola]

Well, this is, this is one of my hypothesis. It hasn't been. This is just me speculating why.

[Dr. Mary Claire Haver]

Why haven't we studied it to the point that we would know the answer?

[Luisa Nicola]

Because women are understudied, under researched, because they have a hormonal cycle which is.

[Dr. Mary Claire Haver]

Makes them hard.

[Luisa Nicola]

Yes, Makes them hard to deal with. So we've got the accumulation of tau 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 disease is the hippocampus, which is this seahorse shaped structure. We all have one. It's deep in the temporal lobes, 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.

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[Dr. 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.

[Luisa Nicola]

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 two men get it. But men are more protective, okay? They have greater cognitive reserve. They go through andropause at a much later stage, slower rate, but they also have more testosterone. And testosterone aromatizes into estrogen and estrogen. Estrogen is protective and estrogen is very protective.

[Dr. Mary Claire Haver]

So walk me through a premenopausal brain, a perimenopausal brain, and a post menopausal brain.

[Luisa Nicola]

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, 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 organization. Okay, 2% of your total body weight, but consumes 20% of the total energy that you take in.

[Dr. Mary Claire Haver]

Fascinating to me.

[Luisa Nicola]

Why is that? Because it takes so much to power. It just, 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 in our 20s and ride ourselves off and wake up and do a marathon the next day. I know I did that at 22. So when we start to see this dip in estrogen, that means our brain isn't as supported as what it once was. So our glucose metabolism isn't working as well.

[Dr. Mary Claire Haver]

We name in the brain actually in.

[Luisa Nicola]

The parts of the body. 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 because of hormones. And then when we get to that stage, like 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 Apoe 4 carriers, which represents 20% of the population homozygous, these are the women who at who are most vulnerable to that window of opportunity.

[Dr. Mary Claire Haver]

That study came out of Scandinavia.

[Luisa Nicola]

Yes, it did, yeah. Which showed that women who are. Who have one.

[Dr. Mary Claire Haver]

So they're high risk.

[Luisa Nicola]

Yeah. One copy of Apoe 4 have a two to four fold increase in getting Alzheimer's disease.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

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

[Dr. Mary Claire Haver]

What is the window? Early.

[Luisa Nicola]

It's early. It's. Yeah, depending. It's like 10 years prior to menopause.

[Dr. Mary Claire Haver]

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 too, where it is preventative for the plaque. You know, accumulation, calcification. If you get it started before the plaques form.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

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 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.

[Dr. Mary Claire Haver]

Okay, so like a secondary correct.

[Luisa Nicola]

Yeah, yeah.

[Dr. Mary Claire Haver]

Many of our listeners know what hot flashes are. Yeah, 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?

[Luisa Nicola]

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

[Dr. Mary Claire Haver]

Keep going.

[Luisa Nicola]

Yeah. So K I N D Y, but it's pronounced candy, and it stands for kisspeptin, neurokin 6, and dynorphin. Okay, okay.

[Dr. Mary Claire Haver]

And these I've heard of neurokinin, only because the new neurokinin receptor agonists that have come out to treat hot flash.

[Luisa Nicola]

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.

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

Okay. They don't know what's going on. There's no.

[Dr. Mary Claire Haver]

They're looking.

[Luisa Nicola]

Not there. They're looking. And estrogen is not there to control it.

[Dr. Mary Claire Haver]

Right.

[Luisa Nicola]

So these neurons, these clusters start going crazy. They go, oh, and this is why we get hot flashes. This is one of the, you know, one of 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. 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 tabolize 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.

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

They showed on FMRI studies that the brain stem lights up just before a hot flash happens. The brainstem 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.

[Dr. Mary Claire Haver]

And then talk to me about serotonin, norepinephrine, these little chemicals that jump signals from neuron to neuron.

[Luisa Nicola]

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 that are responsible for many things. Happiness, serotonin, dopamine, motivation. It's a neuromodulator. Funnily enough, they live in two areas, but most predominantly in the frontal lobe. And what's the frontal lobe predominantly filled with? They're out where our estrogen receptor 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.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

SSRI is being prescribed.

[Dr. Mary Claire Haver]

So in my clinic, you know, and the data holds this up. Actually some 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 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.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

Hopefully we can get everybody educated 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. And then across the perimenopause transition, that doubles.

[Luisa Nicola]

Yes, doubles.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

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

[Dr. 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 an HRT to that regimen will probably benefit her better than adding in a second SSRI or starting her new start.

[Luisa Nicola]

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 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 down regulated by hormone replacement therapy or other forms of therapy as well. Exercise is a great mediator, by the way. Creatine is a fantastic media, which we'll go into. So if you're not taking care of that, then, yes, you could be mistaken to just have an ssri and let's just calm you.

[Dr. Mary Claire Haver]

Just garden variety. Yeah. Depression. Let's go back to sleep.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

The girls are not sleeping. Like. Like, my patients don't sleep. And so they almost not universal, but, oh, gosh, I would say 70% are coming in with some kind of a sleep disruption. If it's hot flashes that are disrupting their sleep, we can fix that. You know, but even if we have their vasomotor symptoms controlled, women are still struggling. There's still that 2am they're going to bed. Okay. It seems like, but they're having that 2:00am, 3:00am Wake up.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

And it's. It's consistent.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

You know, everybody's going to do that once in a while. But, you know, walk me through, why do you think this is happening?

[Luisa Nicola]

And that's interesting because I've actually seen a lot of female patients getting prescribed amitriptyline, you know, in replacement of poor sleep, which I think is crazy because it's a tricyclic antidepressant. 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.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

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

[Dr. Mary Claire Haver]

And where did the melatonin go? Like, why. Why do we not have melatonin?

[Luisa Nicola]

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 amino butyric acid GABA in the form of a supplement could help as well.

[Dr. Mary Claire Haver]

Oh, good.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

And I think this is where maybe cognitive behavioral therapy.

[Luisa Nicola]

Cognitive behavioral 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 2 degrees.

[Dr. Mary Claire Haver]

A lot of women don't understand this. We throw out the word sleep hygiene like it's candy and everybody can do it. But this is hard.

[Luisa Nicola]

Yeah. 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 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. 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 2am 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. So to cool the body down, there's many things you can do. Really easy hack is having your feet outside of the sheets at night.

[Dr. Mary Claire Haver]

I, I was self regulating doing that without thinking that one leg out of the.

[Luisa Nicola]

Yes.

[Dr. Mary Claire Haver]

Out of the. Like I would do it without thinking I'd wake up and one leg would be out.

[Luisa Nicola]

Really? Okay. Yeah.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

Temperature.

[Dr. Mary Claire Haver]

But it's very expensive and not everyone can afford this, so.

[Luisa Nicola]

No. 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 corporate body temperature really like, it plumbers it down to the point that you cool off.

[Dr. Mary Claire Haver]

Oh, that's amazing.

[Luisa Nicola]

That's another that you can do. But that may be one reason why you're waking up. And I have to say, if you are waking up at 2am, definitely don't look at your phone.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

How much sleep is enough?

[Luisa Nicola]

So there was a really phenomenal study printed in PNAS which showed, 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.

[Dr. Mary Claire Haver]

So, yeah, A lot of women feel like six hours is enough.

[Luisa Nicola]

Yes. It's not. From all of the data that I've seen, I boil it down to seven hours and 30 minutes. Okay. Between seven, I usually. The reason why we say eight hours is to give you that 30 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.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

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 does your brain like? It likes safety, 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 80% of the week to give you a buffer time of like two nights a week. Yeah.

[Dr. 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.

[Luisa Nicola]

Yeah.

[Dr. 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.

[Luisa Nicola]

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 you're hungrier, you're hungrier. Leptin, ghrelin out, it's going crazy. You eat warm, then you're 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, 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. So it's a, it's this cycle that just keeps going and going.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

How important is that?

[Luisa Nicola]

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 8pm 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. 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 or whoever that is.

[Dr. Mary Claire Haver]

What about reading? I'd love to read.

[Luisa Nicola]

I love to read you, but it excites me.

[Dr. Mary Claire Haver]

Ah.

[Luisa Nicola]

So it gets me all worked up.

[Dr. Mary Claire Haver]

And then I think sometimes I'll be so into a novel and all of a sudden it's one in the morning and I can't go to bed.

[Luisa Nicola]

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

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

Okay. They're orange.

[Dr. Mary Claire Haver]

What about red light therapy?

[Luisa Nicola]

Red light therapy is phenomenal. 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.

[Dr. Mary Claire Haver]

So I was gifted a sauna blanket.

[Luisa Nicola]

Oh good.

[Dr. Mary Claire Haver]

Like a sleeping bag. 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. Whatever, 20 minutes, whatever calms you down.

[Luisa Nicola]

Is what you should. No one should stick to the same wind down routine.

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

Find out what works for you.

[Luisa Nicola]

Correct.

[Dr. Mary Claire Haver]

Keep experimenting. What do you do?

[Luisa Nicola]

I take a sleep stack of supplements to help. 20 minutes, 20 minutes before bed. But my wind down routine is really like dark house. I wear my red light blocking glasses. I actually have this incredible device that I place on my abdomen. It wraps around, it vibrates and it's got red light therapy on it.

[Dr. Mary Claire Haver]

Amazing.

[Luisa Nicola]

Yeah. It's so insane. And then 20 minutes prior to sleep, I'm having magnesium L threonate. I'm having gaba because I've got a racing mind. Sometimes when I travel. I do have 2 milligrams of melatonin. I'm not against it. I think it's fantastic. Especially as it relates to immunity. I'm in bed at 10.

[Dr. Mary Claire Haver]

Non negotiable, non negotiable.

[Luisa Nicola]

Lights out is 10pm and we know that the hours prior to midnight are really what counts when it relates to sleep as well.

[Dr. Mary Claire Haver]

That's when I.

[Luisa Nicola]

Deep sleep. Yeah.

[Dr. Mary Claire Haver]

Is in the early part of the night.

[Luisa Nicola]

Exactly. Yeah. Deep slow wave sleep. So I try and be asleep by 10:30.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

Love them. But I know that they're not 100% 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.

[Dr. Mary Claire Haver]

So.

[Luisa Nicola]

And the most noticeable pattern is your heart rate variability. If it is a certain amount.

[Dr. Mary Claire Haver]

Please.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

What is heart rate variability? Why does it matter?

[Luisa Nicola]

Yeah. So basically it's the variation between your sympathetic nervous system and your parasympathetic nervous system.

[Dr. Mary Claire Haver]

And what are those?

[Luisa Nicola]

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

[Dr. 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?

[Luisa Nicola]

Well, alcohol plummets your HRV and it also plummets your reds, your. 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.

[Dr. Mary Claire Haver]

Really?

[Luisa Nicola]

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

[Dr. Mary Claire Haver]

Part of my wind down, like, oh.

[Luisa Nicola]

If you do tweeting is that 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 heart rate variability tomorrow. Okay? You'll see it. So that's one of the best ways to increase it. Another way is sleep.

[Dr. Mary Claire Haver]

Really quick, quick and simple breath work routine.

[Luisa Nicola]

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.

[Dr. Mary Claire Haver]

I do box breathing, but it's not about that.

[Luisa Nicola]

It's about the time. So you want to do it consistently for at least 20 minutes.

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

Amazing.

[Luisa Nicola]

Best way to increase your heart rate variability.

[Dr. Mary Claire Haver]

Okay. If you want a styling solution that actually makes getting dressed easier, DailyLook is it. DailyLook is the number one highest rated premium personal styling service for women, designed to make looking stylish completely effortless. Every box comes from a real personal stylist, the same stylist each time who curates up to 12 premium pieces based on your body, style and lifestyle. Everything is delivered right to your door. Try on what you love. Send back the rest with free shipping both ways. Boxes are flexible, too. Every 30, 60, or 90 days, the process starts with a detailed style quiz so the stylist knows exactly what works for your wardrobe. Daily look is the easiest way to upgrade your closet. Save time and feel confident in what you're wearing every day. Once you try it, you'll see why this is more than a styling service. It's a smart, effortless way to look and feel your best without the guesswork. Take your style [e-mail] and use the code UNPAUSE to get 50% off your first styling fee. All right, let's move on to exercise.

[Luisa Nicola]

Okay, great. That's my favorite part.

[Dr. Mary Claire Haver]

Wait. So let's go back to your history. You are a triathlete.

[Luisa Nicola]

Yes.

[Dr. Mary Claire Haver]

I've done two sprint triathlons.

[Luisa Nicola]

Oh, really? That is all? Yeah.

[Dr. Mary Claire Haver]

And that is all I will do.

[Luisa Nicola]

What was the time?

[Dr. Mary Claire Haver]

It does.

[Luisa Nicola]

It matters.

[Dr. Mary Claire Haver]

I was competitive. I finished.

[Luisa Nicola]

You finished it?

[Dr. 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 our therapy, my girlfriends and I 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.

[Luisa Nicola]

Wow.

[Dr. 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.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

Yeah. And it was fun. That's phenomenal.

[Dr. Mary Claire Haver]

Yeah.

[Luisa Nicola]

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

[Dr. Mary Claire Haver]

Yeah. Amazing.

[Luisa Nicola]

Yeah. And three legs. People think you have to be the best in three legs, so I. 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.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

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.

[Dr. Mary Claire Haver]

Amazing. Okay, back to exercise.

[Luisa Nicola]

Yes.

[Dr. 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. 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 80s, you know, doing step aerobics and doing all this cardio, which is great for my heart health. Running marathons in my 40s never picked up a weight. Seriously. Until 50 something.

[Luisa Nicola]

The Jane Fonda era.

[Dr. Mary Claire Haver]

Yeah.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

And so walk me through exercise and brain health.

[Luisa Nicola]

Oh, my God, it is so beautiful. Okay. And this is what I published. I was the first author for this really beautiful narrative review which looked at exercise and mind cognitive impairment. But. 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 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 VO2 max test, can lower their risk of getting dementia by 80%.

[Dr. Mary Claire Haver]

I did not know that.

[Luisa Nicola]

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

[Dr. Mary Claire Haver]

So how do you improve your VO2 max? And what is VO2 max?

[Luisa Nicola]

VO2 max. 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.

[Dr. Mary Claire Haver]

So I'm seeing all of this drama all over the Internet. Don't do cardio. Yes, do cardio. I know it's lift weights. What should we do?

[Luisa Nicola]

It doesn't 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 60 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 60% 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 bdnf, Brain derived neurotrophic factor. And some, you know, back in the early 2000s, neuroscientists would call this fertilizer for the brain. But. 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 into studying this. It was a study done by Erickson et al, which showed that you can decrease your risk of Alzheimer's disease by at least 40% by engaging in aerobic physical activity. And not just that, he found that you can grow the hippocampus by 2%, 2%, a 2% growth and the hippocampal sub regions from aerobic physical activity only. 30 minutes. That's.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

30 minutes to get that massive release three times a week. Wow. Okay, so that's not much, right? When you engage in aerobic physical activity, you are having an effect on 13 types of cancer. So aerobic exercise at 30 minutes, this is 30 minutes. A day can decrease your risk of 13 types of cancer.

[Dr. Mary Claire Haver]

So many women have only heard about exercise as a way to master some number on the scale. 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. I'm growing bones and muscles, you know, I am.

[Luisa Nicola]

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. Wow. Okay.

[Dr. Mary Claire Haver]

And what is white matter for our listeners, again?

[Luisa Nicola]

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. 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.

[Dr. Mary Claire Haver]

So what exercise in this study were your patients doing?

[Luisa Nicola]

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

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

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 5. 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.

[Dr. Mary Claire Haver]

Important for brain health.

[Luisa Nicola]

For brain health.

[Dr. Mary Claire Haver]

And it doesn't take much. Right.

[Luisa Nicola]

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 at 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?

[Dr. Mary Claire Haver]

Yeah.

[Luisa Nicola]

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. Okay. You will increase or maintain your VO2 max by going at that hard stage.

[Dr. Mary Claire Haver]

Okay. All right, so what else do we need to do?

[Luisa Nicola]

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 three times a week is all that's needed.

[Dr. Mary Claire Haver]

So what would that look like?

[Luisa Nicola]

Getting a tennis ball. Okay. Throwing a tennis ball to the wall 20 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 gotta 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, right? So stimulate your brain. You've got to do hard things or it won't grow and it won't adapt.

[Dr. Mary Claire Haver]

What is neuroplasticity?

[Luisa Nicola]

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

[Dr. 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 and.

[Luisa Nicola]

Correct. We can't.

[Dr. Mary Claire Haver]

Adult neurons, there's lots of things to, to destroy them. Yeah, 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.

[Luisa Nicola]

Correct. And rewire the brain functioning of the brain. So, yeah, so those connections I spoke about, you can't grow new neurons, but you can grow new synapses. Okay. 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. The functioning of the brain exists global functioning. 80% of brain gray matter is modifiable by physical activity.

[Dr. Mary Claire Haver]

There's a study that shows the hearts of 50 year olds can look 20 years younger after two years of cardiovascular training and that it literally remodels the heart. And why is this important for the brain?

[Luisa Nicola]

The brain is like a mini heart. Did you know that we've got 43,000 neurons in the adult heart? No. Yeah, yeah, we've got these clusters and they're actually sensory neurites. So they're responsible for sensing things, which is why you, 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 intensity exercise around that, you know, 80% to 90% 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 30 years old. So he reversed the age related decline in their heart by 20 years.

[Dr. Mary Claire Haver]

Wow.

[Luisa Nicola]

Yeah. So if you have a better performing heart, stronger chambers, you have more blood that is 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 they supply the brain?

[Dr. Mary Claire Haver]

They bring things to the brain and.

[Luisa Nicola]

They take 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.

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

Amazing. So back to exercise a little bit. You know, a lot of chatter, and myself included, talking about estrogen, and it's loss of estrogen, loss of sex hormones in general and their effects on muscle, and we know the effects on bones, you know, that resistance training might be the single best thing that they can do.

[Luisa Nicola]

The single best thing that you can do, 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, do. 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. Okay. So the ability to lift force, you know, in a certain amount of time, so really fast. That's what power really is. And 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.

[Dr. Mary Claire Haver]

They put identical twins.

[Luisa Nicola]

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.

[Dr. Mary Claire Haver]

All right, let's go to nutrition.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

Everyone's dying to know. If you're on the interwebs, you are bombarded with nutrition advice, and it's often conflicting. What is your clear message to our listeners?

[Luisa Nicola]

Nutrition is just information, and I see nutrition as biomarkers. Right? 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 diets for brain health and cognitive impairment is the mind diet. Okay. Okay. The Mediterranean interventional dash diet, which consists of little amounts of meat, poultry, fish, and large amounts of fiber. Fruits, vegetables, et cetera. I don't see it that way. 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. Okay. 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. You know, do you have adequate green leafy vegetables? Because that contains magnesium. Okay. Within the chlorophyll, are you having omega 3 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.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

Omega 3 fatty acids, probably the best thing that you can take for your brain. We have. We have receptors on the outside of our brain that allows for DHA and EPA to pass through it, and they get leaky during 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 70% 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 2 grams of DHA per day and EPA is phenomenal.

[Dr. Mary Claire Haver]

So how much fish would that be?

[Luisa Nicola]

Well, it's. It's a lot of fish. Okay. So if you 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.

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

So you would recommend supplementation here?

[Luisa Nicola]

Recommend. Yes, 100%. I recommend supplementation with EPA, DHA.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

There is. I'm not affiliated, but there is a really great app called sapco sup.co. 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.

[Dr. Mary Claire Haver]

That's good advice.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

Do you test omega indexes?

[Luisa Nicola]

Yeah, omega 3 index, which is the measure of omega 3 fatty acids inside the red blood cell. I check it every year in January. It's like a new year thing I do this year I got 11.3%.

[Dr. Mary Claire Haver]

And what's a good level?

[Luisa Nicola]

So in the US alone, most women are actually below 4%, 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 3 index of at least 8% or more. And you can get from 4% to 8% just by supplementing with 2 grams of EPA and DHA a day.

[Dr. Mary Claire Haver]

Any other supplements that you would consider creatine? Creatine, yes, 100%. Tell me about creatine.

[Luisa Nicola]

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.

[Dr. Mary Claire Haver]

And is that an age related decline?

[Luisa Nicola]

No, it's not age related. It's just that we just, 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 benefit from taking creatine. But here's the thing. We used to think that 5 grams a day of creatine was enough. But 5 grams of creatine just saturates the muscle. Okay? So once the muscle takes up, that's where 95% of the stored creatine that we have lives inside the muscle. Around 5% lives inside of the brain. So the, the muscle soaks up all of the creatine that you take. Right. So 5 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. The best, the best times to take creatine is times of sleep deprivation. I've heard that.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

Usually you can Eliminate a lot of the symptoms that occur and all the devastating effects that occur from sleep deprivation by supplementing with creatine. How much caveat it is? 20 grams.

[Dr. Mary Claire Haver]

That's a lot.

[Luisa Nicola]

Yes, but this is where it also affects. It really affects with giving you more energy, cell energy metabolism. We know that there's hypometal metabolism in these mental health disorders. And a lot of people are worried about kidney function, though it's not going to damage your kidneys, it's not going to make your fallout. It doesn't degrade in hot water, so you can have it with your coffee. It doesn't taste bad.

[Dr. Mary Claire Haver]

I've even seen people are worried because they have a history of breast cancer or they're high risk for breast cancer. Look, everything's on the Internet.

[Luisa Nicola]

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. Wow.

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

First thing is get tested. I know that some people may tell you not to, but you want to know where you are. 20% of the population does have the APOE4 gene, the risk gene. Go and get tested. So you know where you are.

[Dr. Mary Claire Haver]

Where would they go? Get tested.

[Luisa Nicola]

You can ask your doctor and just push for it, or you can go and there's blood work that you can do everywhere. Really. Go and get tested. The second thing is.

[Dr. Mary Claire Haver]

So it's a blood test.

[Luisa Nicola]

It's a blood test. Sorry. Yes. Okay. 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.

[Dr. Mary Claire Haver]

Is walking helpful?

[Luisa Nicola]

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

[Dr. Mary Claire Haver]

Like I would say, what if you're sedentary? Is walking helpful? So say she's on the couch.

[Luisa Nicola]

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 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.

[Dr. Mary Claire Haver]

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

[Luisa Nicola]

Just raise that heart rate.

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

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 would just come falling down.

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

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.

[Dr. Mary Claire Haver]

Okay. Do you use fish oil for that? Typically, yeah, I.

[Luisa Nicola]

It actually says EPA DHA on the bottle.

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

Yeah.

[Dr. Mary Claire Haver]

Awesome. One last thing I want to touch on is social connection. Oh yeah, the. I don't know if you've read it yet, but the gerontologist, she's on Instagram. I just love her. Carrie Burnbright and she wrote Joyce Band.

[Luisa Nicola]

Yes.

[Dr. 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, so important.

[Luisa Nicola]

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 brain functioning brain with those ones who maintained a good social connection.

[Dr. Mary Claire Haver]

Okay.

[Luisa Nicola]

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.

[Dr. Mary Claire Haver]

And what would that look like?

[Luisa Nicola]

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.

[Dr. Mary Claire Haver]

Well, thank you so much for sharing all of your incredible knowledge with our audience. And I'm sure you're going to change some lives today.

[Luisa Nicola]

Thank you so much for having me.

[Dr. Mary Claire Haver]

You can find Louisa on Instagram @luisanicola and on YouTube luisanicola 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. Maryclaire. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram @Dr.maryclair and get honest, accurate information on health, fitness and navigating [e-mail] My upcoming book, the New Perimenopause is available for pre order 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. 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.