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[Book Summary] The XX Brain: The Groundbreaking Science Empowering Women to Maximize Cognitive Health and Prevent Alzheimer’s Disease

The XX Brain (2020) is a practical guide to improving women’s brain health and preventing Alzheimer’s disease. Women are suffering from an Alzheimer’s epidemic, but so far the medical industry isn’t doing much about it. The XX Brain shows you how to take your health into your own hands, demand the medical treatment you deserve, and take concrete steps to help prevent the onset of Alzheimer’s.

[Book Summary] The XX Brain: The Groundbreaking Science Empowering Women to Maximize Cognitive Health and Prevent Alzheimer's Disease

Content Summary

Genres
Introduction: Take your health into your own hands.
Women’s health is in crisis because of inequality in the medical field.
Hormonal transitions like menopause radically affect brain health.
Alzheimer’s isn’t a natural part of getting older or necessarily hereditary – it’s usually preventable.
To determine your risk of Alzheimer’s, take stock of your overall health.
Menopause hormone therapy has its detractors, but we shouldn’t rule it out.
Eating a balanced, nutritious diet is the way to optimize your brain health.
Regular, low-intensity exercise is essential for brain health. And the older you get, the slower the better.
It’s time to tackle the stress epidemic that is harming women’s health.
Intellectual stimulation will help your brain to thrive.
Final Summary
About the author
Video and Podcast

Genres

Psychology, Health, Nutrition, Medicine, Mars, Dementia, Cognitive Psychology, Science, Self Help, Biology, Neuroscience, Medical, Brain, Womens, Feminism

Introduction: Take your health into your own hands.

Did you know that more women die from Alzheimer’s disease than breast cancer in the UK and Australia? Or that a 45-year-old woman has a one in five chance of developing Alzheimer’s before she dies, compared to a man’s one in ten chance?

If these statistics are new to you, you’re not alone. Women are suffering from an Alzheimer’s epidemic, and it’s getting worse. Unfortunately, so far, the problem’s received little media attention and only limited focus from the medical establishment.

What’s causing this epidemic? And more importantly, what can we do to stop it? These summaries shed light on these questions and offer an inspiring, practical toolkit to ensure that your brain health thrives – at any age.

In these summaries, you’ll learn

  • why moderate exercise is more beneficial than pumping iron till you drop;
  • how learning to play an instrument can help your brain; and
  • why women are routinely misdiagnosed when having a heart attack.

Women’s health is in crisis because of inequality in the medical field.

Imagine a meteor is hurtling toward the Earth. Thirty million people in the impact zone are about to be wiped out. You’d expect there to be a flurry of space research, urgent headlines in all the newspapers, and a concerted effort to do anything possible to stop the oncoming disaster.

Now consider that a similar number of women will die from Alzheimer’s disease within the next 30 years, yet no one’s doing anything about it.

The reason? Well, there’s a very specific type of discrimination at play, and it has very real consequences.

The key message is: Women’s health is in crisis because of inequality in the medical field.

Historically, medicine has been dominated by men. Male doctors consulted male scientists who conducted experiments on overwhelmingly male subjects. Medicine has come to see the human body as de facto male.

The problem is that the makeup of women and men’s bodies is different. For example, a woman having a heart attack doesn’t present with the same symptoms as a man. Instead of chest pain, women typically have flu-like symptoms such as sweating and nausea. And that means they’re seven times more likely to be misdiagnosed and sent home, mid-heart attack.

Women metabolize medicine differently to men as well. Researchers found that the recommended daily dose of the sleeping pill Ambien is actually harmful to women because – you guessed it – the dose was tested on men.

The medical establishment has long treated women’s health with what’s known as “bikini medicine”: seeing women as different in terms of their reproductive organs, but otherwise physiologically identical to men. But that overlooks one vital area of difference: the brain.

Women are twice as likely as men to experience depression or anxiety. They experience four times as many migraines and are three times more at risk of autoimmune diseases like multiple sclerosis. Most worrying of all, two out of three Alzheimer’s patients are women. In fact, a woman of 45 has a one in five chance of developing the disease over the course of her life. A man of the same age has only a one in ten chance.

Addressing women’s health goes far beyond the “bikini.” More than a medical issue, it is an equality issue. Women deserve to have their health treated as an urgent priority – as urgent as a meteor, silently hurtling its way toward Earth.

Hormonal transitions like menopause radically affect brain health.

If you’ve experienced the ups and downs of premenstrual syndrome, or PMS, you won’t be surprised to hear that hormones affect your brain. You may be surprised to hear just how much.

The hormone with the most influence is estrogen. Known as the “master regulator,” estrogen affects just about every important brain function. It helps with the production of energy, keeps cells healthy and sparks activity in the parts of your brain responsible for memory and attention.

It also helps protect your brain by boosting your immune system and keeps your mood on an even keel by helping the brain release endorphins. Which is why it’s so devastating when women hit menopause and their estrogen levels fall off a cliff.

The key message here is: Hormonal transitions like menopause radically affect brain health.

Menopause happens when a woman has her last menstrual period and is no longer fertile – usually around her forties or fifties – although a woman who’s had a hysterectomy will experience menopause sooner.

Apart from the typical symptoms like hot flashes, the drop in estrogen has an enormous impact on the brain. Many women find they struggle with depression and anxiety. Some even experience bipolar or schizophrenic symptoms for the first time. On top of that, menopause makes women more susceptible to heart disease, obesity, and diabetes.

Studies of brains pre- and post-menopause show that activity decreases as estrogen levels drop. At the same time, a key indicator of Alzheimer’s disease – the level of amyloid plaques in the brain – increases. Memory centers in the brain also shrink. It turns out that menopause increases the risk of dementia in 80 percent of women.

It can seem like Alzheimer’s comes on suddenly, but the disease is decades in the making. While the clearest symptoms may only be visible in old age, the groundwork is laid when we’re young. For many women, menopause is when it begins.

So, what does this mean? That you have a hormonal target on your back that you just have to accept? Emphatically, no. You need to know about the implications of these hormonal transitions and how to deal with them.

With the right preventive strategies, the effects of menopause can be managed so your brain stays healthy through menopause and beyond.

Alzheimer’s isn’t a natural part of getting older or necessarily hereditary – it’s usually preventable.

Think back to the fairytales of your childhood and all the fantasies and myths that you freely believed. Although you’ve grown up, many of the stories will have stuck with you. Myths are pervasive like that. And women’s health is full of them. But, unlike a harmless fairytale, these myths are damaging because they affect how we approach women’s healthcare and treatment.

One of the most common misconceptions about Alzheimer’s is that women get the disease because they have a special Alzheimer’s gene. This belief makes it seem like getting Alzheimer’s is natural or predestined, and there’s nothing you can do to prevent it.

That’s wrong.

The key message here is: Alzheimer’s isn’t a natural part of getting older or necessarily hereditary – it’s usually preventable.

The truth is complicated. Certain genes do increase your risk: 1 to 2 percent of Alzheimer’s cases are caused by a rare genetic mutation, and other genes can make you more susceptible.

Ethnicity is a risk factor. If you are an African American woman, your chances of getting Alzheimer’s or having a stroke are twice those of a white woman. If you’re Hispanic, you’re one and a half times more likely to develop Alzheimer’s.

But a genetic susceptibility isn’t the same as a foregone conclusion. Studies show that at least one-third of all Alzheimer’s cases could be prevented by improved health and lifestyle choices.

A second myth that we need to tackle says that women get Alzheimer’s more often because they live longer. This myth holds that it’s a disease of the elderly. Seeing as women live longer, it stands to reason that they’ll also develop Alzheimer’s more often.

On the surface, this seems logical, but on closer inspection the facts don’t stand up. For one thing, women don’t live that much longer than men – only three to five years on average. And they usually get Alzheimer’s at a younger age than men. On top of that, women aren’t more susceptible to other age-related diseases like Parkinson’s or strokes. It stands to reason that something else must be causing this devastating epidemic.

It’s time to abandon the fairytales that would have us believe that Alzheimer’s is natural or predestined, and instead treat this as the crisis it is – a crisis that can be prevented.

To determine your risk of Alzheimer’s, take stock of your overall health.

If you’re playing a game of poker and you get dealt a hand of kings and aces, you might think you’re on to a winner. But if you’ve ever been dealt a surefire hand and lost anyway, you’ll know that nothing’s for sure until you play your cards.

The same is true for risk factors and Alzheimer’s. You could have a number of risk factors but none of those mean that you’ll definitely go on to develop the disease. They’re simply flags to watch out for and manage.

With the advent of precision medicine, treatments can even be tailored to your specific needs – so whatever hand you’ve been dealt, you can now improve your odds.

The key message here is: To determine your risk of Alzheimer’s, take stock of your overall health.

By looking at your genetic makeup, environment and lifestyle you can start to assess your risk of developing brain disease. Your brain and body are intimately connected. Are you obese? Do you have a heart condition, or diabetes? These are all risk factors.

Traumatic brain injuries are a further factor, because blunt force trauma can reduce blood supply to the brain and cause inflammation. While this is a normal, healthy reaction, sometimes the body is unable to turn off its inflammatory response. This leads to chronic, low-grade inflammation that depletes brain hormones.

Other risk factors are found in your environment. There are toxic chemicals in the food you eat, the containers you eat from, and the products you put on your skin. Carefully evaluating the toxins in your environment is an important aspect of assessing risk.

Of course, one of the most effective ways to get toxins into your body is by smoking. Women who smoke are at a much higher risk of developing heart and brain conditions.

Considering these risk factors can be an alarming exercise. But risk isn’t the same as destiny. Be proactive in asking your doctor to do a full physical and test for things like cholesterol, blood pressure, thyroid function and infections.

Knowing the precise hand you’ve been dealt means you can be forewarned – and forearmed – in the fight against Alzheimer’s.

Menopause hormone therapy has its detractors, but we shouldn’t rule it out.

We put a huge amount of faith in the pharmaceutical industry to cure all our problems. If Alzheimer’s is such a big issue for women, surely there must be a pill to fix it?

Unfortunately, it’s not so simple. Alzheimer’s medications have the highest rate of failure in clinical trials – at a staggering 99.6 percent! And as we’ve seen, women’s unique experiences with Alzheimer’s have received little attention in the medical research.

But there is one treatment that has shown promise: hormone replacement therapy, also known as menopause hormone treatments or MHT.

If Alzheimer’s is aggravated by falling hormones at menopause, it seems logical that replacing estrogen and progesterone artificially could help solve the problem. But these treatments are controversial.

The key message is: Menopause hormone therapy has its detractors, but we shouldn’t rule it out.

Back in 1993, a clinical trial was launched to examine the effects of MHT. The study observed 160,000 women and was planned to last for 15 years. But ten years in – in 2003 – it was abruptly called off. The study had found that women who used MHTs were at an increased risk of stroke, blood clots, cancer, and dementia. Understandably, people were alarmed, and women abandoned these therapies in droves.

But there were some flaws to the trial that call these results into question. For one thing, it only tested women in their sixties and seventies who were well into menopause. Many of these women probably had conditions like thickened arteries – which cause heart disease – already. Also, the study only focused on long-term use of MHTs at high doses. It didn’t shed light on whether shorter-term use at low doses could be effective or safe.

These concerns have never been addressed in a large-scale study, so lots of questions about MHT still remain. But there have been some promising results from smaller studies with women who take MHT for limited periods before the age of 60 and within five years of menopause. And for women who’ve had hysterectomies, MHTs have been shown to decrease their risk of heart disease and improve brain health.

So, the burning question is: should you take them? As should already be clear, this is a complex question and one that’s best discussed with your doctor, who can examine your personal risk factors and weigh up the possible benefits.

Eating a balanced, nutritious diet is the way to optimize your brain health.

If you’ve ever found yourself reaching for a cup of coffee when you’re sleepy, you’ll know that what you eat and drink directly affects your brain.

Our minds depend on food to replenish energy and to help essential functions. If you want to keep your brain healthy, diet is the first thing you need to work on.

Popular wisdom about what we should eat is always changing. In the early 1990s, low-fat diets were gospel; today high-fat “keto” diets are all the rage. The truth is, no extreme diet is healthy for your brain. Instead, focus on the quality of the food you eat.

The key message here is: Eating a balanced, nutritious diet is the way to optimize your brain health.

Some fats are bad for you; others are essential. Take trans fats. They’re highly processed and toxic for your body in any amount. On the flipside, the unsaturated fats found in avocados, nuts, and fish help your heart and brain to flourish, especially if you eat them every day.

The same is true of carbohydrates. Foods which are high in sugar, like white bread, pasta, and cakes, cause your blood sugar to spike and then crash, making it hard for your body to regulate energy. But complex carbs like those found in vegetables, brown rice, and quinoa are high in fiber that balances estrogen and the sugar levels in your bloodstream.

Chickpeas, flaxseeds, and apricots are all good foods to help regulate your estrogen levels. And if you want to actively boost your brain’s health, then you should be regularly eating superfoods full of antioxidants. At mealtimes, half your plate should be stacked with vegetables – the more colorful the better.

To support your body in processing all these nutrients, you also need to optimize the good bacteria in your gut. That means eating lots of prebiotics like onions, bananas, and garlic that act as a kind of “fertilizer,” as well as probiotics found in food like yogurt.

But even with the best diet you might sometimes need extra support. If you’re feeling down or unusually tired, ask your doctor to check your level of B vitamins and Omega 3 fatty acids, which are essential for your mental and emotional wellbeing and brain health.

By eating a balanced diet of high-quality foods and supplementing where you need to, you’ll allow your body – and brain – to flourish.

Regular, low-intensity exercise is essential for brain health. And the older you get, the slower the better.

You know the story of the tortoise and the hare: the hare sprints past the tortoise in a race and it looks like he’s winning, but he quickly gets exhausted, and then the slow tortoise, who just keeps going at a steady pace, ends up crossing the line first?

Well, it turns out that when it comes to exercise, as a woman you should behave much more like the tortoise than the hare.

Doing regular exercise of low to moderate intensity offers enormous benefits for all aspects of your health – especially the wellbeing of your brain.

The key message is: Regular, low-intensity exercise is essential for brain health. And the older you get, the slower the better.

Exercise has wondrous benefits for your health. It supports your heart by reducing plaque buildup in your arteries and makes you feel great by prompting the release of endorphins. But importantly, it also helps your brain stay young.

When you exercise, you release growth hormones which help your neurons to repair and build new connections, so perhaps unsurprisingly, women who exercise regularly have a very low chance of developing dementia later in life.

But if the thought of exercising brings up daunting images of pumping iron in the gym, then never fear: women’s bodies thrive on regular exercise of low to moderate intensity.

There is no one-size-fits-all workout, but it’s a good idea to adapt your exercise regimen depending on your age. For women in their twenties and thirties, a mix of more aerobic workouts can help slow the ageing process and maintain optimum levels of estrogen. Ideally, women of this age should exercise for around 45 minutes three times a week.

Post-menopause, you’re advised to up the frequency but lower the intensity, aiming to exercise for around 30 minutes five times a week. This approach is most effective for a number of reasons.

First, high-intensity workouts raise cortisol levels – the stress hormone – which could increase inflammation and muscle or joint problems. Second, tough workouts need more recovery time, which depends on getting good sleep – something menopausal women often struggle with. And last, high intensity exercise can damage muscles and risks bone fractures in older women.

Instead, try doing yoga, pilates, some gardening, or going for a half-hour bike ride. The best exercise is daily and mundane. And your brain will thank you for it!

It’s time to tackle the stress epidemic that is harming women’s health.

Have you ever been in a situation where multiple people were asking different things of you at once, and you ended up spinning around in a froth trying to meet everyone’s needs? Then you’re like most modern women, who often balance the demands of a full-time job with the demands of their children and families.

Add caring for aging parents into the mix, and you’ve got a stressful cocktail. And that’s bad for the brain.

The key message is: It’s time to tackle the stress epidemic that is harming women’s health.

Equality in the workplace has not translated into equality in the home. Women are overworked and under-supported. Being chronically stressed has become the norm, but it shouldn’t be. Stress leads to poor sleep, low mood, and an increased risk of depression. It can even make your brain shrink!

So we need to get stress levels under control. But how? One way is to allow our brains to have a break from constant mental stimulation. These days, we’re connected to distressing news and work emails all day. Practice having digital detoxes and limiting how much you use your phone and check work email out of hours.

If your mind is racing all the time, a great skill to practice is meditation or mindfulness. There are many different kinds, but the end result is the same: you allow your mind to rest. And the health benefits are enormous: one study found that people who meditated regularly over a few years reduced their mortality risk from heart disease by 48 percent!

Of course, the very best way to give your mind some rest is through sleep. Deep sleep is essential for allowing your body and brain to regenerate and heal. But many of us survive on a minimal amount of sleep, leading to brain fog, depression, and irritability.

To improve sleep, try a wind-down period of half an hour before you go to bed, without electronics or other stimulation. Darken your bedroom and make sure it’s not too warm. If none of these tactics work, the author suggests talking to your doctor about melatonin supplements, as well as eating foods like pistachios – which are naturally high in melatonin – before bed.

Stress has come to seem like a natural part of our lives, but there’s nothing natural about it. In fact, it’s a deadly killer. So, we need to make tackling it a priority.

Intellectual stimulation will help your brain to thrive.

When was the last time that you learned something new? Or took the opportunity to do something outside of your comfort zone?

When we’re younger, it seems like we’re trying out new things all the time. But as we get older we often get stuck in tired old routines and stop branching out.

That’s bad news for our brain health. To put it simply: in order to keep your brain healthy you need to use it.

The key message here is: Intellectual stimulation will help your brain to thrive.

A study that followed 900 people over the course of 15 years found that those who had interesting jobs, or a degree, had a much larger cognitive reserve. A study of 400 seniors had similarly positive results: those who were intellectually engaged had a 54 percent lower risk of mental decline. Even people with the rare gene mutation that causes Alzheimer’s can delay the onset of the disease if they’re intellectually stimulated.

A well-stimulated brain has stronger connections between brain cells, meaning that it is more versatile and resilient and can respond faster to stimuli.

Unfortunately, women have historically had far fewer opportunities to get an advanced degree or stimulating job, meaning that many have been unable to enjoy these brain-boosting benefits. That’s changing slowly, but it remains unequal today.

Luckily, there are other ways to stimulate your brain. And, whereas the recent boom in online games hasn’t been scientifically proven to help, there are lots of offline ways that do work.

Reading the newspaper or a good book will get your neurons firing. So will going to the theater, watching a documentary, or playing a board game with friends. But remember, you want to give yourself – and your brain – a challenge. If you’re already a chess whizz, try a different strategy game. If your usual books are light-hearted romances, pick up a classic novel for a change.

One of the very best ways to exercise your brain is to learn something new. Have you always wanted to learn how to make delicate pastry? Or to play the violin? Then this is the perfect time.

The earlier you start eating well, exercising, reducing stress, and stimulating your mind, the better. It’s time for the world to sit up and take notice of women’s brain health but, until then, you have the power to take your health into your own hands, starting right now.

Final Summary

The key message in these summaries:

Women’s brain health is in crisis, but the Alzheimer’s epidemic is preventable. And by proactively assessing your overall health you can delay or even head off the onset of the disease completely. Diet, exercise, stress-reduction, and intellectual stimulation are the most important lifestyle changes you can make if you want to significantly improve the health of your brain.

Actionable advice: Feeling woozy in the morning? Drink a glass of warm water.

Our brains are 80 percent water. So even mild dehydration has a big impact on them. In fact, studies have shown that drinking enough water improves brain function by 30 percent! And warm water can be absorbed even more effectively by our bodies. So, if you want to start the day on a good note, drink a glass of warm water as soon as you get up in the morning.

About the author

Lisa Mosconi, PhD, is an Associate Professor of Neuroscience in Neurology and Radiology at Weill Cornell, and the Director of the Alzheimer’s Prevention Program at Weill Cornell Medicine/NewYork-Presbyterian Hospital. A world-renowned neuroscientist with a PhD degree in Neuroscience and Nuclear Medicine from the University of Florence, Italy, Dr. Mosconi was listed as one of the 17 most influential living female scientists by The Times and called “the Mona Lisa of Neuroscience” by ELLE International. She is the author of Brain Food.

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Lisa Mosconi

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