The following is a transcript of this episode. It has been edited for clarity.
Maryann: We all want to keep our mind sharp well into old age. But the fact is, two out of three Alzheimer’s patients are female, and more than 10 million cases of dementia crop up every single year. Today on the More Beautiful Podcast, I sit down with Barbie Bowles, a registered dietician and health coach who focuses on the unique needs of women over 40. Barbie and I talk about what you should be eating and how you should be exercising to keep your brain in tip-top shape. We discuss the link between metabolic health and brain health and what you can do to reduce your risk of neurodegenerative diseases like dementia. Barbie also tells us about two very different types of stress and how you can use one of them to your advantage in building a healthier brain.
Intro: Welcome to More Beautiful, the podcast for women rewriting the midlife playbook. I’m Maryann LoRusso, and I invite you to join me and a guest each week, as we strive for a life that’s more adventurous, more fulfilling, and more beautiful than ever before.
Maryann: Welcome back to the More Beautiful Podcast. I’m here today with Barbie Bowles, a registered dietician, certified health coach, cognitive wellness specialist and healthy aging enthusiast. Barbie’s private work with clients focuses on brain and metabolic health. Barbie, welcome to the show. So great to have you here.
Barbie: Thank you so much. I’m really glad to be with you.
Maryann: Can you tell us a little bit about yourself, your background and why you are so passionate about helping clients maximize their brain and metabolic health?
Barbie: Absolutely. So I have been a dietician for going on 22 years now. And I’ve always been interested in women’s health, it was always just sort of my area of focus. And as I’ve evolved, my research has evolved. As I’ve gotten older myself, it became more focused on women in midlife. And, you know, through my work with clients, through noticing things in my own body, and knowing what I have a family health history of, it just kept emerging that brain health and metabolic health were sort of the foundation that everything rests upon. We really need to talk about metabolic health in order for it to be a truly healthy body composition shift, and for it to be sustainable. And then when you’re talking about your metabolic health, you’re also addressing your brain health. And, you know, it also just started to occur to me that as women were conditioned, whenever we’re thinking about our health, we’re conditioned to focus on our bodies, right? We’re conditioned to approach our health in terms of, how does this benefit my appearance, as opposed to how does this ensure better longevity? How does this ensure that when I’m 85, I’m still able to chat with my friends, enjoy a movie, socialize, hang out with my grandkids and make them laugh, and we sort of forget about that, at least at this age. So this is sort of our window of opportunity to really impact what we have to come in the years ahead. I also just think that a woman’s brain is her sexiest feature and most valuable asset. So I just want to help women recognize the value of prioritizing it.
Maryann: I so agree with that about the brain. I also agree that not until something happens—like we get an injury or we start to feel sick, or we have a condition—do we even think about longevity or something besides our weight and appearance. Can you tell us how brain health and metabolic health are intertwined?
Barbie: As you know, our metabolic health, which includes blood pressure, blood sugar and blood fats—so, your cholesterol and triglycerides—as well as your metabolic fat storage…Those four functions of your metabolic health are sort of the foundation upon which the health of your brain rests. And so oftentimes—in fact, it’s unusual if a client doesn’t present to me with one of the four that’s out of whack: elevated LDL cholesterol, low HDL, high triglycerides, high blood pressure, elevated A1C and/or excess belly fat storage. And we want to address that, particularly in my clients who come to me who have a family history of dementia. Now there isn’t necessarily a super strong genetic link. I mean, if you have a primary relative with Alzheimer’s or any form of dementia, you are at increased risk. If you have more than one, you’re at a greater risk, but you’re not guaranteed, is what I’m saying. But if we can heal your metabolic health, we are significantly reducing your risk of neurodegenerative disease. And so I hope that answers your question. But you know, the link is just very direct. We do not understand the mechanism yet. But we believe, especially when it comes to type two diabetes, that elevated blood sugar and chronically elevated insulin definitely have a negative impact on the health of the brain—and certainly when it comes to heart disease, which is our number one killer of women, so we do need to pay certainly attention to that. That puts us at greater risk of vascular dementia, but all dementia as well, including Alzheimer’s. And you know, when we’re looking at our metabolic health, elevated LDL is a risk factor for heart disease, elevated blood pressure is a risk factor for heart disease, elevated A1C is a risk factor for type two diabetes and increased visceral fat storage can create insulin resistance, which is then a risk factor for type two diabetes. So it’s sort of this funnel effect that can increase your risk for dementia.
Maryann: And one thing that unfortunately, you and I have in common is that both of our mothers are battling Alzheimer’s, which is the most common form of dementia. It’s such a devastating illness. And so first of all, I’m so sorry that you are you’re dealing with that.
Barbie: For you as well.
Maryann: Thank you. And this disease affects more women than men, right? What are some of the statistics? And what are some of the risk factors for dementia?
Barbie: Yeah, so it does. About 6 million people in the U.S. alone have been diagnosed with Alzheimer’s, and about two thirds of those are women. So two out of three. And while we don’t completely understand it yet, there’s an obvious theory that there must be some sort of link between a decline in estrogen. And we certainly know that estrogen has a positive impact on the brain, it is neuro protective. And so it is safe to assume that when estrogen declines that it would become problematic for brain function. There are some very specific ways that we do know that estrogen works on various areas of the brain, and there are very few areas of the brain that it doesn’t touch. And so with a decline in estrogen, it would make sense that our that our brain function would be compromised. And that could be part of the problem. But we don’t really know why it affects more women than men. But we do also know that the earlier the onset of menopause, the greater your risk. So you know, the average age is 51 for transitioning to menopause. So we are at risk with a transition to menopause. But if we transition under 40—that would be premature menopause—we are at a significantly increased risk. And then at risk also with under 45. It’s like sort of these three levels: Average would be 51. Early would be 45. And premature would be 40. And so with the earlier we go through menopause, the greater our risk for Alzheimer’s.
Maryann: That is so interesting, because I’m hearing from some women that their doctors are telling them that the later onset of menopause then puts them at risk for cancer. I feel like there’s just always this battle between cancer and brain health, like do I take the HRT or not?
Barbie: Right. The good news is…when it comes to lifestyle interventions—nutrition, sleep, exercise, managing stress—fortunately, most of those strategies are the same. So obviously HRT is is a very personal choice that should be made between a woman and her doctor. But in terms of lifestyle, there is quite a bit you can do that targets…all of it: your metabolic health, your brain health and your cancer risk.
Maryann: Right, and in just a minute we’ll get into some of the stuff that everybody can do to optimize their health. But first I want to mention that even if we don’t have a high risk for dementia, as we get older, a lot of us are concerned about this thing called brain fog during perimenopause or post-menopause—this feeling that, you know, oh, God, I just can’t remember. Where am I? Why am I in this room? Where are my keys? I mean, a lot of us complain about it. Can you tell us what brain fog actually is? And is it harmful? And how do we know it’s brain fog and not something else?
Barbie: So it is very common. I don’t want to say normal because it isn’t normal, and it certainly doesn’t feel normal. But it is common to experience—it’s sort of this cluster of undesirable cognitive experiences, right? It’s poor concentration, poor memory, poor attention span, just sort of not feeling sharp, I have a client who refers to it as her chip speed being slow…It just sort of feels like your brain needs a good cleaning. And it is very common in various stages of our life for various reasons. It’s also very common during pregnancy. But with the transition of menopause, and the decline in estrogen in particular…The estrogen helps the various parts of the brain communicate. And if not enough of it is there, the brain is just not communicating the way it normally does, you know, with the hypothalamus, which is our temperature regulator, and that could lead to hot flashes, not communicating well in the brainstem, that could be sleep issues, the amygdala, anxiety, hippocampus, that’s where our memory center is. So there are all these areas of the brain that estrogen works with to maintain healthy good function. And if it’s not there, or if it’s not in good supply, various parts of our brain are going to be affected. And that can feel like brain fog. Of course, there are lots of other potential causes of brain fog as well.
Maryann: One thing I love about your strategy is that you help your clients manage their health to prevent illness before it strikes. What are some of the tests you can take to find out where you stand in terms of your brain health? And do we go even further like maybe with brain scans if we’re experiencing some serious memory issues?
Barbie: So there’s our standard testing that everybody pretty much gets every year, our metabolic panel, which is going to include cholesterol, triglycerides, glucose…and A1C is much more common now. So definitely get your metabolic function. So understand your A1C, your LDL, HDL, cholesterol, your triglycerides. Lipoprotein B is another good one, it’s more of a genetic risk factor, but it is very closely associated with risk for heart disease…I also like my clients to get C reactive protein. There are two forms of C reactive protein: the high sensitivity or HS CRP is what I recommend; it just kind of measures inflammation in the body and cardiac risk. Obviously [you should get your] blood pressure [tested], as well as additional testing for B12, vitamin D and iron. I like for my clients to get B12 and iron because they can cause brain fog if you are deficient. And that is such a quick fix.
Maryann: Yes. My iron was recently a little low. And I took some supplements and my levels went back to normal.
Barbie: Right, an inexpensive and quick fix. And, you know, the other very important thing about brain fog or memory issues—and I know we will get into when to see your doctor later in this conversation—is, make sure you are really attending to your nutrition, your sleep, your exercise and managing your stress before you get too freaked out. Do you know what I’m saying? You know, if any of these factors is out of balance it can lead to brain fog and other cognitive difficulties. So really look at your habits before you concern yourself with any medications, HRT or really start getting scared. Does that make sense?
Maryann: I totally agree, 100 percent. Is there a risk between certain illnesses like diabetes and brain disorders? I know you talked about the correlation between the brain health and metabolic health but is there a tendency to get more than one illness if if these things are all out of whack?
Barbie: When you say tendency to get more than one illness, do you mean is like diabetes a risk factor for heart disease? And vice versa?
Maryann: Yes.
Barbie: Oh, yes, absolutely. It’s your metabolism, so it all works together. Type 2 diabetes puts you at a 60 percent increased risk of dementia. And type 1, unfortunately, puts you at 93 percent increased risk.
Maryann: Just to go back to these blood tests for a minute. I’d sometimes see my numbers on the lab work, and a doctor will say these numbers are all in range, they’re perfect. But then, you know, if you look them up even further—or I once had a nutritionist actually look at the numbers, and she said, this could be a pre-pre-condition, so let’s do something about it now. Do you think there’s this discrepancy between the thresholds with Western doctors and that of other [healthcare] professionals?
Barbie: Right, and first, let me just say, I have deep respect for Western medicine and physicians and pharmaceuticals. It all saves lives every single day. But the training is less about lifestyle and prevention, and more about what do we do once disease is in action. So someone like a dietician…this is why I ask to see my clients’ labs, because I will see them differently than their medical provider, particularly if their medical provider is an MD. I will see pre-pre diabetes because I’ll connect the dots between the markers of your metabolic health, even if everything is within normal range. So I think if you are someone who…really wants to be proactive around this age or in your 40s or early 50s, I really do recommend seeing a dietician who is trained in metabolic health and brain health or longevity, to take a look at these numbers, and maybe see something or started addressing something from a lifestyle perspective, that perhaps your doctor doesn’t think is a big deal. Again, I wouldn’t contradict medical advice ever, ever. That’s not my job. But I sometimes I often want to start addressing something that your MD might might think is just fine.
Maryann: Right. And you have to manage your own health. For instance, my mom has diabetes and Alzheimer’s. And I’m looking at those numbers, like I don’t even want to be in the pre-diabetes range, you know? Just get on it.
Barbie: Right. Again, just to make that point, there is so much you can do to manage those numbers and manage your metabolic health. First of all, there’s so much wellness, nutrition confusion out there. And, you know, oftentimes a medical provider’s advice will just be to lose weight. First of all, that’s not that easy. For very many people, they don’t really understand how to do it. So there’s a lot we can do. And I say we do it.
Maryann: I say we do it, too. And we’re gonna get to that right now! So in your practice, optimizing brain health is approached through four pillars of health that you work to establish with your clients. And you say that in order to truly be in good health, all four of these must be in alignment, I’d love to talk about how we can maximize each of these areas and how doing so may improve our brain health. The first pillar of good health is nutrition. Can you give us some tips on how we should be eating after age 40 In order to keep our brains sharp?
Barbie: Absolutely. And to be clear, I really honestly believe all four pillars are equally important. And one could argue that sleep has an advantage over nutrition…But I really do look at it like a table with four legs, each of the legs is of equal size, equal strength, equally importance. And when any one of them is weak, our health is simply not optimal. So that’s the way I like to look at it. But obviously, we have to talk about things separately. So, there are two things that are really important to metabolic rate. Now, metabolic health are those things that I mentioned: blood pressure, blood sugar, blood lipids, and visceral fat. Metabolic rate is just number of calories burned, amount of energy burned, and it’s usually measured in a 24-hour period—like how many calories, quote, do you need in a day. That’s metabolic rate. There are so many factors to metabolic rate, but the two things that are primarily responsible are muscle mass and liver health. With a decline in in hormones during perimenopause, and certainly menopause, and because women tend to lose a little bit of muscle mass now (it’s not this giant change that happens overnight, although it feels like it!)…It’s a very slow process, but it can be up to 30 percent fewer calories that we require, once we get into menopause, and if we’re not changing anything, that can very easily manifest as belly fat, because with a loss of estrogen…fat storage is favored in the belly area; more of an androgynous look, as opposed to hourglass, which is what estrogen does. So I would say, prioritize building muscle mass. So get after that strength training. And I know we’re going to talk about exercise later. But it is actually important for this piece, because muscle mass piece is really important to metabolic rate. Keep your liver nice and healthy. This is one of the reasons that I really encourage my clients to be super mindful about alcohol. Women start out with less of the enzyme that metabolizes alcohol to begin with: alcohol dehydrogenase or ADH. We don’t have as much of it to begin with, then certainly our livers are not 25 anymore. So when you combine those factors, it really is a good idea to start being very, very mindful about your alcohol intake. To keep your liver nice and healthy. The other thing that’s really excellent for overall health, brain health and liver health is eating cruciferous vegetables. So the family of vegetables that includes broccoli, cauliflower, kale, cabbage, Brussels sprouts. I like to say leafy greens every day and a rainbow throughout the week, so we’re getting that beautiful spectrum of phytonutrients that is disease fighting and especially helpful for brain health…Then, prioritizing lean protein, and omega threes—we gotta get our omega threes. And I want to make a quick point about omega threes: There’s a lot of variation in the recommendation about how much, but probably a minimum of 1,000 milligrams of EPA and DHA, it goes up to recommendations go up to 4,000.
Maryann: Is it possible to get that in food alone?
Barbie: So about eight ounces of salmon contain about 2500 2800 milligrams, so you would have to be eating quite a bit. But if you’re eating it regularly—let’s say you have 12 ounces of salmon a week—you’re pretty covered. Fatty fish, and you know, caviar is super high in omegas…
Maryann: Oooh…
Barbie: [Laughs] …And you don’t even have to get the expensive stuff, but it’s super high in omega threes. Here’s the thing, when it comes to getting omega three from plant sources, the type of omega three, EPA and DHA, that the human body uses very readily that is anti-inflammatory and beneficial for brain health, that is really, that is readily available in marine life: fish, algae, fish eggs. But the type of Omega three that is in plant foods is ALA, and only about five to 15 percent of that ALA is converted to EPA and DHA. So when it comes to plant ALA, it has its own benefits, but you’re not getting a ton of the type that is beneficial for brain health.
Maryann: Oh, interesting.
Barbie: You need to check with your doctor for sure, obviously, but that’s where supplementation could be really beneficial.
Maryann: Anything else regarding nutrition?
Barbie: Vitamin D. Make sure you’re getting your vitamin D. Even if you’re taking a supplement, get some sun exposure, about 10 minutes, face and hands. And then there are other kinds of more, I don’t know hacky, tweaky supplements, one being NAC, which is a precursor to glutathione, that you could look up if you’re interested and creatine monohydrate seems to have…usually it’s used for muscle mass integrity, but a lot of people are using it for cognitive function too. So just something for you to look up on your own.
Maryann: What does NAC do exactly?
Barbie: It’s a precursor to the antioxidant glutathione, which is probably, at least from what we’ve studied and what we know, the most important antioxidant in in the human body. So NAC is a precursor to it and you can take NAC supplements. The other thing I want to point out is eating breakfast. I’m a huge fan. And even if you’re intermittent fasting, I believe it’s a great idea. I have just seen it change things dramatically in terms of cognitive function for my clients to shift their intermittent fasting window to include breakfast and have an earlier dinner. Just saying.
Maryann: I know so many women who skip breakfast because of intermittent fasting.
Barbie: I would say, just experiment. I don’t have any actual data to back this up. I have anecdotal evidence from the women I work with and myself. Just experiment. Everything is an experiment because you are physiologically unique and what is going to work for you may not necessarily work for your friends or for me or for anyone else. But I just encourage you, especially if you’re struggling a bit, try having breakfast—something that’s nicely balanced with carbohydrate, protein and fat—and see if it changes anything.
Maryann: And does breakfast depend on your level of activity? Like if you’re gonna go for a run in the morning, you should eat something?
Barbie: Yeah, well, I’m a big believer in having a pre-workout snack. I like a piece of fruit or a bowl of berries, and make sure you’re really well hydrated. If you’re someone like me who experiences muscle cramps–it’s kind of a genetic thing–take electrolytes before a workout. But save the light breakfast for after the workout. Just because you don’t want to get a cramp. You know, digestion and exercise are two major processes that you expect your body to perform, and it may not exercise well or perform well during exercise if it’s working on digestion. So if you’re going to eat before, keep it light, and then worry about you know, replenishing your protein and carbohydrates afterward.
Maryann: What is your take on caffeine? Is it beneficial?
Barbie: I’m a fan…
Maryann: As you’re sipping your coffee…
Barbie: [laughs] I think caffeine will always be a slightly controversial subject. But there is no doubt that it increases alertness. Again, everybody is physiological unique. So if you are sensitive to caffeine, and you know that your heart races, you feel uncomfortable, you feel twitchy after having coffee, or any form of caffeine, it’s not for you. And always we should stick to less than 200 milligrams of caffeine per sitting, and no more than 400 milligrams of caffeine in a day. Those are the general guidelines for caffeine not considered harmful. But if you are someone who’s sensitive, even 100 milligrams may be way too much. So again, you’ve got to play with it. There are certainly experts who don’t think any drug—and caffeine is a drug—is appropriate when it comes to keeping your brain nice and protected and healthy. I am personally a fan of caffeine based on my research, but I think you know, “do you” on the caffeine.
Maryann: Yeah. I mean, particularly when it pertains to preventing Alzheimer’s. I’m very interested in that.
Barbie: There is some evidence for that. And also for protecting the liver. There is more evidence in favor of coffee in particular being liver protective,
Maryann: There’s a lot of hype right now about sprouts. I’m growing broccoli sprouts in my kitchen because I love them and they’re amazing. They have like hundreds of times the benefits of normal broccoli.
Barbie: Yeah, particularly the sulforaphane, which again, is why I recommended the cruciferous vegetable family. It has—and I can’t remember the exact number now—but like at least 10 times, maybe 50 times as much sulforaphane as regular broccoli. So yeah, anytime you can eat sprouts, you’re getting tons of benefits that you don’t get from the mature plant. The one thing I would say about sprouts is make certain make sure they are super fresh because all those little tangles you know, bacteria can hide in there. So just make sure there isn’t any brown fluid in the bottom of the container. Make sure they smell good. They shouldn’t really smell like anything; if anything they should smell maybe like grass. Spread them out on a paper towel and give them a little rinse and a pat and just pick out the ones that are kind of turning brown. But otherwise routes are amazing. Also, I have a lot of clients who grow their own sprouts so there’s that.
Maryann: Me too. I’m a kitchen sprout grower. I put them on avocado toast. So good.
Barbie: Avocados are rich in monounsaturated fat. That family of fats, [which includes] olive oil, avocado oil and avocados, is very beneficial for reducing inflammation in the body and is really good for your heart. Anything that’s good for your heart is good for your brain. So that’s where the avocado comes in.
Maryann: Great. OK, moving on to the second pillar exercise. As you know, women tend to get frustrated at this stage of life, because of the belly fat, or they can’t keep their weight stable. And you talked a little bit about the muscle training, right? Do you have other exercise tips for women who are now in a different metabolic stage?
Barbie: So a couple things about exercise…I would say sleep is my favorite subject. But exercise is a very close second. A lot of experts agree that exercise is the number one preventative measure for dementia. So, more than any other pillar when it comes to dementia, exercise appears to be the most beneficial for prevention. Not that the others are in any way not important; they are. But exercise appears to be the most important. Here’s the thing: Especially at this phase of life—and when I had this mindset shift, and started encouraging my clients with this mindset shift—my attitude about exercise dramatically changed. I now love it. And I believe I’m in the best shape of my life now. Because I stopped thinking about exercise in terms of my weight and muscle mass, and I certainly stopped thinking about it in terms of compensation for calories that I have eaten or will eat. And I started thinking about it more in terms of the health of my brain, my immediate mood, getting a better night’s sleep and the level of energy that I will have throughout the day. When I started seeing exercise as for those reasons, not only did it make me more excited about it, but it kept me motivated. We kind of go through this little transition period when we’re starting to exercise and at first it really sucks. And then finally when we’ve been doing it for a while, it’s like, oh, this is really great, I’m feeling this because I see the change. [But shifting your mentality about why you exercise] gets you through that [hard initial] period. Because it takes a while to notice a real physical change from exercise, whereas your mood literally improves during the workout, you will get a better night’s sleep that night, and you will handle stress better that day. So if we can look at exercise like that, I think a lot more of us would be exercising and benefiting our brains. And again, we got to do something about our muscle mass if we don’t want to accumulate adipose tissue that could become metabolically harmful.
Maryann: Yeah, we hear so much about muscle mass now. I mean, how many minutes of weight training per week would you recommend?
Barbie: Generally, 75 minutes is what’s recommended. But honestly, I would tell you and about 150 for cardio, but I would say what ever you’ll do. Five minutes of that you’re doing now is five minutes you were not doing before and it is benefiting you. I like to look I like to approach actually exercise from three vantage points, cardiovascular, so benefiting your cardiovascular system, which benefits the brain by increasing blood flow, bringing nutrients in helping the volume stay where it should be. And then we’ve got strength training, so that we are building muscle mass, it also helps us increase our insulin sensitivity. So we’re benefiting our blood sugar levels. And then finally, I encourage my clients to find a form of exercise that is challenging to your brain in the sense that it requires coordination. So because you’re also not only are you benefiting your brain in terms of in cognitively, but you’re probably also getting balanced and flexibility in with that type of exercise too. So something like yoga, dance barre, pilates, even just balancing exercises, which I really do recommend. Again, we don’t tend to think about this stuff. But the brain that we’ve been developing the brain, we’re going to have our whole lives. So it’s already in process. And if we are in our 40s, the changes that will either help protect us from dementia or lead towards dementia are happening right this minute. It’s not so it doesn’t start to happen. You know, five minutes before we’re diagnosed, it starts to happen now. So anything that we can do now is going to be beneficial. But yeah, so the the cardiovascular, the strength training, and then something that challenges your brain in terms of coordination,
Maryann: What a great tip. Is HIIT (high intensity interval training) good for us at this age? I hear mixed things.
Barbie: The research bears that one out in terms of being really beneficial for metabolism and for brain health. But not everybody can do it. And not everybody wants to do it. And if HIIT the gold standard but you don’t want to do it, well then we’re still not exercising, right? If walking is your jam, do the 45-minute walk. But if you are a person who is up for anything, and you really just want to know what’s most recommended, then yes, HIIT is very strong. But I like restorative exercise too—something like a more gentle yoga, a nice long walk where you’re getting fresh air. You know, I think that’s really important too. When it comes to sleep, which I know we’ll get to, your body likes consistency. When it comes to exercise, your body likes a challenge. So just make it hard enough that you’re enjoying it, but do be challenging your body. I honestly am a just a believer that as long as you’re moving, you are doing some good for your brain.
Maryann: OK, let’s talk about sleep. We know it’s important, but a lot of us aren’t getting enough of it for various reasons. Just how important is sleep for our brains? And how do we get more?
Barbie: It’s everything. I mean, I know I said exercise is the best the most preventative pillar, but I would say exercise is the most preventative thing that we can actually actively do—each and every one of us. Sleep is really important. This is when memories are stored. And I don’t just mean like what happened yesterday, I mean, this is when the memory storage in your brain is activated. So that’s going to affect your long-term dementia risk too. I believe less than seven hours of sleep a night [equates to a] 20% increased risk of Alzheimer’s—and of course these statistics vary a little bit, depending upon the study that you’re looking at. But it wouldn’t surprise me if it were an even greater risk. You know, we have our lymphatic system that’s part of our immune system; it cleans things out, destroys pathogens, and stores information about how to fight these pathogens in the future. And then we have our glymphatic system, which is what happens during those deep layers of sleep; it gets up into our brain and clears it of harmful proteins, toxins, things that don’t belong that can compromise its function, particularly the amyloid plaques. So if we are not getting sleep, particularly that deep sleep, we’re not getting that detoxifying phase of sleep for our brain. So we’ve got the short-term effect of of fatigue—you know, just kind of being distracted and foggy headed for attention. But then we’ve got the long-term compromise from poor sleep because we’re not getting that detoxifying phase, and we’re not getting those memories stored.
Maryann: OK, so everybody needs to get more sleep.
Barbie: Yes, and it needs to be good quality. You know, I give a lot of talks about sleep, exercise, nutrition, stress…They’re all their own hour. But, yeah, I would just whatever you can do to make sleep a priority in your life. I strongly encourage it for your brain health.
Maryann: Yeah, no drinking late at night.
Barbie: Right. In terms of that, like alcohol and food, ideally we’re putting about three hours in between the last thing we ate or drank—other than water or tea—and sleep. Because again, like exercise, sleep and digestion are two major processes that you ask your body to perform. And if you’re trying to digest and sleep at the same time, it’s not going to do either one well.
Maryann: So very closely related to sleep is stress. Tell us about managing stress, because being stressed is so hard on our brains, right?
Barbie: Yeah, it really is. Chronically elevated cortisol actually shrinks your brain and can cause neuronal death. I mean, this is it is a quite a big deal.
Maryann: I think you need to say that again. Chronic stress shrinks your brain. I mean, just let that sink in for a second.
Barbie: Yeah, it’s not good. It’s a very complex, complicated, elegant cascade of hormones that happens when you have a stress response. But the two main hormones that we pay attention to are adrenaline and cortisol. And cortisol, when allowed to linger, really impacts every area of your health. It impacts your sleep, your risk of heart disease, your immunity, your appetite, your blood pressure, your ability to lay down new muscle, your blood sugar, fertility, and certainly cognition and fat storage. So chronically elevated cortisol is a real problem for your whole body, not just your brain. But it’s a beautiful system that is actually really efficient and amazing when you look at why we have the reactions that we do, like the pupils dilating and the sweating and the heart racing and the glucose flowing out of the muscles. But this system was designed a very long time ago, to help us basically outrun predators. And we’re not really doing that anymore, at least I hope we’re not in most cases. What we’re doing is we’re sitting on our bums and worrying about our bank account, or our children or our parents…It’s just this chronic low hum of stress and we are not using the body in the way it was designed to be used during a stress response. So that’s why this cortisol is not a bad thing. It’s a good thing, we need it. But when we have it constantly humming throughout our bodies, it’s really detrimental. And again, stress, much like sleep, has very short-term implications, and then long-term implications. If you’re stressed out or you suffer from anxiety, like I do, it is very distracting. You can’t think straight, you almost feel frozen at times. So that’s very clearly going to impact your cognition. But long term, it absolutely puts you at an increased risk of dementia.
Maryann: Well, since our bodies are expecting us to run from that saber-toothed tiger, I mean, what happens if you go for a run if you’re feeling stressed?
Barbie: I think that’s a brilliant idea. If you can muster it, exercise is one of the most effective efficient ways to reduce stress, particularly in the moment. And this is also why I really recommend daily exercise. I know a lot of people are more accustomed to three, four times a week. And I think that’s awesome. But especially if you are just starting out, just in terms of stress and stress management, if you’re somebody who’s just kind of beginning and getting it back together with exercise or getting it together for the first time, I really recommend you make an appointment with yourself every day. The same way you would never dream of canceling on someone else, don’t cancel on yourself. Make it for the same amount of time, start small, and make it impossible to fail—maybe do 15 minutes every morning, and do whatever you want. Be intuitive, you know, have a plan A, plan B, plan C. That’s what I do. Like if I’m well rested, feeling great, I do one type of workout. If I’m kind of dragging or if I don’t have like a whole lot of time, I do a different type of workout. And if I’m really limited on time or not feeling great. I just take a walk or do some stretches. But I always keep that appointment with myself.
Maryann: It’s such a great thing to do for yourself. So what about meditating too? That’s another solution to combat stress.
Barbie: Yes, and you know, I’ve had panic disorder since I was 9. Of course, it wasn’t diagnosed until college. But I now realize I’ve been struggling with it since I was nine. And I just went the extra mile in terms of trying to deal with it. And I became a meditation teacher. But that is meditation and several different forms of breath work is how I how I deal with it in the moment. But I make sure I exercise daily too, because it just helps me both on a chemical level and on a more emotional level. I do want to make one quick point that I think is super important, though: There are two kinds of stress. There’s a type of stress we’ve just been talking about that chronically elevates cortisol and is very detrimental. And then there’s good stress, the kind of stress that actually improves brain function and keeps our brains working. I think that in this world today we are chronically under stressed physically and overstressed emotionally. And I know that some mental health professionals would probably take issue with my distinction between mental and emotional, but what I mean by that is that we don’t move enough. We’re not stressing in a positive way. We don’t challenge ourselves enough in a good way, in a way that we’re passionate about. Or even something as simple as cold exposure [offers] the kind of beneficial stress that I’m talking about. And we are overstressed emotionally with all of this worry. And if we could flip that, and start expressing ourselves more in a positive way with exercise and various things like cold exposure, things like learning a new language, things like really getting into cooking, you know, then we’re challenging our minds and our bodies. And we’re giving ourselves a break emotionally. I think that if we could flip those two things, we our brains would be a lot healthier.
Maryann: I love that. And you have to come back and talk more about cold stress, because I’m hearing so much about that. I’m assuming you’re talking about cold baths and cold showers…Everyone’s talking about that.
Barbie: Yeah, it’s it’s really cool. I want you to think of your brain like a muscle that needs exercise. So that’s that mental stress that we’re talking. It’s called EU stress. And we need to engage in that more often for our brain, so we can work our brain out like we work out our body.
Maryann: Right. OK, one other thing. I’m hearing a lot about [infrared] saunas in terms of possibly preventing Alzheimer’s or dementia.
Barbie: I am not an expert on the mechanism. I just know that infrared saunas, as well as cold exposure to the extreme—and some people do both, but you have to be very careful doing both, because it’s a huge shock to the system…
Maryann: You mean going back and forth between the sauna and the cold shower/bath?
Barbie: Yes, but I’m not recommending it, be very careful. Do your research before you do both. You don’t have to fill a tub with with ice, just spend the last 30 seconds to five minutes in your shower, at the coldest temperature you can tolerate without feeling like you’re gonna pass out. There’s a threshold there where you’re too uncomfortable. But it shouldn’t be like, you’re hopping around and you just kind of want to move and you can’t wait to get out. But you’re also kind of enjoying it, because it’s this weird challenge. Like that’s how you should be feeling about it.
Maryann: Someone I once had on the show just posted on her social that she did an ice bath for six minutes.
Barbie: See, I have no tolerance. It’s perimenopause, I have no tolerance for cold. So I don’t do the cold shower thing. And I only last maybe 45 seconds. But I don’t think I could bring myself to get get into a full tub of ice.
Maryann: I’m gonna challenge myself to just up the shower time and see how that goes.
Barbie: That’s with everything in your approach to wellness: Do it incrementally. Trying to make all of this change overnight doesn’t usually lead to success. Make little incremental changes. And you know, when it comes to the four pillars, what I always tell people is whatever pillar that is going to have the biggest, most immediate impact, start there. Say it’s sleep. If you get your sleep in order, you’re going to have the energy to exercise, your appetite is going to be better regulated, and then we can tackle some cooking and some really good nutrition. Whatever is going to impact you most immediately is where you should begin. And go slow—baby steps. We get little hits of dopamine with every tiny thing we accomplish. So in terms of getting more dopamine, baby steps are very effective.
Maryann: Barbie, we talked earlier about how so many women are taking prescription drugs. Now we don’t want to downplay the fact that they’re very much needed if you have serious depression or illness and we don’t want to downplay HRT for serious menopausal symptoms. But you say that to some extent in Western culture, medicine has become a bandaid for common health ailments when it sometimes can be avoided, that when given a choice between taking a pill and doing the work, it often seems easier to take the meds. Can you elaborate on that?
Barbie: Yeah. And again, to be clear, I mean, pharmaceuticals, when used appropriately, are nothing less than miraculous for a great many people. But I don’t think it’s a controversial statement to say that we do over-prescribe in this country in particular, when lifestyle measures or interventions could be used first. And I think those a good idea anyway, even if you are taking a medication. Because medication is rarely curative. I wouldn’t go so far as to say it’s always a bandaid, but medication does change your chemistry. But it’s not curative. For something like high blood pressure, elevated A1c and elevated LDL cholesterol and not high enough HDL, we can actually literally cure that. We can change that, as long as the needle hasn’t moved too far. I’ve done it with my clients. I’ve seen them significantly reduce their risk for meds, or go off them entirely with lifestyle intervention. In a doctor’s office….it often isn’t about that; it’s about whether or not you need medication. And God bless it when you need it, but there are other ways to approach it. So I wish the rather than immediately handing out a prescription, or saying, go lose weight, or go keto, or try fasting, doctors would give you the number for a dietician.
Maryann: When should we see a doctor and advocate for ourselves if we think our brain issues are more than just brain fog?
Barbie: I think people do know when something is significantly off, when it’s not just, I couldn’t remember someone’s name. When it’s starting to impact getting through your day, keeping your appointments, being able to communicate your thoughts. We’ve gotten past, my memory isn’t great, but it’s before we’re having issues with problem solving, being irrational or getting mood swings, forgetting how to cook a meal we’ve made 500 times. It’s that in-between. We want to catch it before the latter half of what I said…we’re gonna catch it in that place where it feels like it’s impacting your day and you think something is going on. You’re gonna start with your primary care physician and you’re gonna ask them for a cognitive test; it’s a couple questions, not that big of a deal. And most people, even in the early stages of dementia, would pass that test. It’s kind of like, what year is it, what day is it, who’s the present. If you feel like you passed that test with flying colors but something still isn’t right, find a neurologist and have a deeper conversation that they are qualified to have with you. Next steps would probably be neuro-psych testing and/or an MRI, but those are probably likely only going to be ordered if your neurologist thinks something is happening.
Maryann: Barbie, are you excited about any promising research or medical news that is on the horizon:
Barbie: Well, unfortunately the scandal with a lot of the 30-some years of research targeting beta-amayloid plaques (the sticky substance found in the brains of dementia patients; it’s usually how Alzheimer’s is diagnosed). But there’s a study that should begin [soon] that hopes to once and for all answer the beta-amyloid hypothesis question. They’re going to give beta-amayloid-attacking medications to people as young as 18. The study will take years, but hopefully something good will come out of it…I will say that oftentimes people are diagnosed with Alzheimer’s type dementia without a neurologist seeing the plaques. But those plaques are hallmark characteristics in the brain of Alzheimer’s patients. I always like to say I’m evidence based, but I take it with a grain a salt. A lot of studies are flawed…It also comes down to self-advocacy and common sense as well.
Maryann: Barbie, we want people out there—especially those with a family history of dementia—to stay positive. We don’t want them to be paralyzed with fear. Is there anything else they can be doing to safeguard their brain health without worrying so much, because that exacerbates the situation, right?
Barbie: Yes, absolutely. The number-one thing I would say is, use your brain on a daily basis in a way that brings you joy, lights you up and engages that feeling of passion in you. Because using your brain is one of the top things we can do to be preventative. But when we can add emotion to it, even better. It’s even more impactful. Often I’ll start out with a client by asking, what brings you joy? And a lot of women—myself included, several years ago—don’t know the answer to that question. I really encourage you to answer that question for yourself and to engage in it as often as possible—especially if it’s something that involves a complex task. And if it isn’t at the moment, then find a way to make it a complex task because it will do amazing things for your brain.
Maryann: What is your joy right now?
Barbie: My absolute therapy is cooking…Because here’s the other thing I want to say about that. It’s, of course, wonderful to spend time with family and engage with people—because socializing is also incredibly important and significantly reduces your risk. And it doesn’t mean having this giant circle of friends, it means having at least a few supportive, give-and-take relationships and interacting with other people. Just communicating is good for your brain. But when I talk about finding your joy, I’m taking about something that is uniquely yours, something that is just about you, something you produce or think about or create. And for me that ‘s cooking. And one day, hopefully not in the too-distant future, it will be traveling.
Maryann: Yeah, a lot of people have travel on their bucket list.
Barbie: Yeah, and I mean it very literally: the planning of the trip, the coordinating, the logistics…it’s all good for your brain. And then experiencing things and learning. Even better if you can throw a new language in there.
Maryann: Yeah, I’m doing a language. I’m teaching myself how to salsa. And I’m doing Wordle, which my 17-year-old gets in a minute flat. It takes me much longer.
Barbie: I also want to recommend a book, the XX Brain by Dr. Lisa Moscone. It’s outstanding.
Maryann: Great, I’m going to add that to my reading list…Barbie, his was such a great conversation. First of all, you should be on CNN; you’re so good.
Barbie: That’s really nice. Thank you.
Maryann: I learned so much, so thank you. Barbie, please tell everybody out there where they can reach you online.
Barbie: I’m on Instagram @thecognitiondietician, and you can also email me at hello@barbieboules.com. My website is Barbieboules.com.
