Why Are Depression, Anxiety, and Alzheimer’s More Common in Women?
Dr. Caroline Leaf – Science is science, right? Unfortunately, this is not always the case, especially when it comes to women’s health. Our understanding of the human brain and body has been clouded by years of gender bias—for decades many scientists and doctors have assumed that men and women are really the same, except for the bits and bobs that can be covered by a bikini. Yet, as this week’s podcast guest and renowned researcher Dr. Lisa Mosconi points out, this kind of “bikini science” has dramatic implications for women’s mental and physical health that go beyond our reproductive organs, affecting every part of the brain and body.
Dr. Lisa Mosconi, PhD, is the Director of the Women’s Brain Initiative and Associate Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College (WCMC)/NewYork-Presbyterian Hospital, where she serves as an Associate Professor of Neuroscience in Neurology and Radiology. She is also an adjunct faculty member at the Department of Psychiatry at New York University (NYU) School of Medicine, and at the Department of Nutrition at NYU Steinhardt School of Nutrition and Public Health. Dr. Mosconi holds a PhD degree in Neuroscience and Nuclear Medicine, and is a certified Integrative Nutritionist and holistic healthcare practitioner.
Her expertise lies in examining the way gender impacts the health of the brain and body, and in overcoming the massive gender gap in the world of medicine. As she describes in her amazing book, The XX Brain, since the time of Darwin there has been a long-held assumption that women’s brains are inferior because they are smaller, but women are generally smaller than men, which was not taken into account for decades, and still persists subconsciously in many areas of medicine and neuroscience.
Moreover, in the 1960s, after the drug thalidomide had terrible effects on the babies of pregnant women, the FDA ruled that all women of childbearing age must be excluded from research trials. Although this ruling was made to protect vulnerable populations, it excluded women from research, which has had dramatic implications for the way we understand the female brain and body. Decades of research focusing only men, based on the incorrect assumption that, apart from our reproductive organs, a woman’s heart, brain and body are basically the same as a man’s heart, brain and body. Yet even the way we metabolize drugs is different!
A woman’s heart, for example, may look the same as a man’s heart, but it is not, which means that we experience heart attacks in different ways to men, such as intense nausea. Yet, because there is this underlying assumption that our hearts are for all intents and purposes the same, this means that many doctors do not recognize that a woman complaining of nausea in the ER may actually be having a heart attack—they not trained to see gender specific symptoms! No wonder research shows that women are 7 times more likely discharged from ER while having heart attack! In fact, women are 3 times more likely to have an autoimmune disorder, are 2 times more likely to have anxiety and depression, are 4 times more likely to suffer from intense headaches and migraines, are more likely to die of stroke, and are more sensitive to infections and inflammation. This is a disaster at the heart of medicine!
The same can be said for female brains and cognitive decline. As Lisa points out, nobody talks about women’s brains, even when we are talking about women’s health. Yet there is direct, two-way communication between female reproductive systems and the brain, which impacts how we build memories, our mood, our energy levels and so much more through the production of estrogens like estradiol and other gender-specific hormones. Yet, because we do not understand these differences, many scientists, researchers and doctors assume that women are more likely to get Alzheimer’s and the dementias because they live longer than men.
Yet, as Lisa notes, this conclusion is based on two incorrect assumptions: that women live much longer than men, and that Alzheimer’s and the dementias are associated with aging. First, it is important to note than women generally only live a few more years than men. Second, Alzheimer’s and the dementias are not the inevitable result of aging, or our genes. Alzheimer’s actually starts in mid-life, although we often only see physical symptoms later on—it is not a disease of old age. Nor is it predominantly genetic in origin, as was originally thought to be the case. We now understand that only around 2% of Alzheimer’s cases are based on specific genetic mutations! When it comes to cognitive decline and memory loss, a lot more than our DNA is involved, as I discussed in a recent blog and podcast(#87). Early onset Alzheimer’s, which starts roughly in the 40s, is largely inherited and the result of genetic mutations, but late onset dementia, which begins roughly in the 60s, is unlikely to be associated with specific gene mutations.
The question remains: why are women more likely to get Alzheimer’s and the dementias? Lisa, based on her ground-breaking research, has shown how there is a close relationship between the female brain and reproductive system. As a result, when women go through mid-life changes during menopause, or if they have surgeries that remove parts of the reproductive system like the ovaries, their brains can be affected, which can contribute to memory loss and cognitive decline. As mentioned above, estrogens have a lot of roles in brain health through the HPG axis—they are not just important for fertility. Estradiol, for instance, is a master regulator in the brain, and helps increase energy production, allows for better plasticity and memory formation in the brain and can even boost immunity!
In fact, the symptoms we commonly associate with menopause are a result of changes in the female brain. Hot flashes, night sweats, brain fog, sleeplessness, mood swings and so on start in the brain—these are the neurological symptoms of menopause.
Thankfully, there are things we can do now to prevent and combat these changes in the brain and body, as Lisa notes in The XX Brain and in her book Brain Food. As women, we can give ourselves time to change and allow our brain and body to adapt through:
1. Hormone Replacement therapy. Although we need to understand this therapy better, it has been shown to help mitigate the negative effects of menopause. Lisa prefers bioidentical hormones, which may be safer because they are more natural and come from plants, but we need more clinical trials to assess this.
2. Diet. We can also get low doses of hormones from the phytoestrogens in foods like dark chocolate, soy products, dried fruits like prunes, fruits such as berries and cantaloupe, and so on, which have fewer side effects than hormone replacement therapy. Lisa has some great diet plans in her book Brain Food, so check them out!
3. Exercise. Not only is exercise great for our brain health, but also helps keep the brain and body strong and healthy, giving you more energy and increasing your capacity to deal with the negative effects of hormonal changes, and helping you manage toxic stress, which also impacts the communication between the reproductive system and the brain in women.
4. Mind management. As mentioned above, chronic stress can really impact brain health, decreasing estrogen levels and accelerating brain shrinkage and memory loss in women. Stress can literally steal our hormones! This is why it is so important to manage our mind and how we react to what happens to us. We need to remember that the brain is a muscle and needs to be strengthened and exercised through mindfulness, meditation and learning, just like the body needs exercise and training.
My SWITCH app is a great tool for helping you learn how to manage your mind, deal with the roots of your stress and anxiety, and overcome negative thought patterns and behaviors that impact gut health through the mental process of reconceptualization. It is now on sale less 50% for a 3-month subscription!
I also recommend taking a lot of “thinker moments” throughout the day, where you switch off to the external and just let your mind wander and daydream. These moments give your brain a rest and allow it to reboot and heal, which increases your clarity of mind and ability to problem-solve when faced with a tough situation. So, be intentional about creating “thinker” breaks throughout your day by taking a few moments every day, or when you are feeling stressed out! To learn more about thinker moments and how to make them a part of your daily routine, see my book, Think, Learn, Succeed.
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