Midlife Brain Aging , the Menopause Wars & Oatmeal
March Midlife Roundup [2025]
I started off March with a colonoscopy on the 4th. That’s also the morning I published my post on women and heart disease.
The procedure went fine and later we were sitting down to dinner. Earlier at lunch, my husband swallowed a kind of big piece of chicken that went down weird. So, once he started eating, he experienced a bad case of heartburn.
Having just wrote an article on chest pain, I asked him questions that to be honest; he didn’t want to answer.
“Is it a burning or squeezing/heavy feeling?”
“Burning,” he said.
“Is the pain radiating from your arm or jaw? Are you nauseous or dizzy?
“No!” he said loudly. “It just feels like something is stuck in my throat.”
Because I couldn’t drive, my daughter made an emergency run to get some Tums. And our son, who was waiting for his dad to drive him somewhere, had to stay home.
Once the episode was over, I had him do some slow breathing to calm down (which also helps with heartburn).
This was an interesting way to begin the month. But using what I’m learning is always a bonus.
For this month’s roundup, I’m highlighting an important study showing midlife is a critical window for brain aging, along with some articles that caught my eye.
Midlife, the critical window for brain aging
In a study published in the Proceedings of the National Academy of Sciences, researchers analyzed brain networks in over 19,000 people from four large datasets, including UK Biobank and Mayo Clinic Study of Aging.
Communication between brain regions starts to weaken in early midlife (around age 44), accelerates around age 67, and levels off by age 90, according to their research.
Because of this, the researchers mapped this trajectory, calling midlife 40-60ish a critical window for prevention.
Implicated in these aging patterns are GLUT 4, an insulin-dependent transporter and the APOE gene, with the primary driver being neuronal insulin resistance. Researchers also call this brain insulin resistance (BIR).
In short, aging decreases the ability of people to utilize glucose because of decreased insulin sensitivity in the brain.
“We’ve identified a critical midlife window where the brain begins to experience declining access to energy but before irreversible damage occurs, essentially the ‘bend’ before the ‘break.’ During midlife, neurons are metabolically stressed due to insufficient fuel; they’re struggling, but they’re still viable,” said lead author author Mujica-Parodi, on msn news.
A little background info
After the age of 35, brain volume decreases 0.2% per year.
With an already aging brain, hormonal fluctuations and eventual decline have added effect on the brain in women.
That’s why transitioning through menopause is referred to as a neurological transition state because estrogen aids the brain in utilizing glucose, its preferred source. During perimenopause, the brain disconnects estrogen from the bioenergetic system.
The aging brain compensates for this loss during by increasing fatty acid metabolism to generate ketone bodies as an alternative fuel source.
This can put the brain at risk because it uses brain lipids (white matter) to break down fatty acids.
Many women do rebound, but a smaller percentage are at increased risk. Back to the study…
The intervention part of the study
The researchers found MCT2, a ketone transporter, playing a protective role in the brain. This is because ketones offer an alternative fuel source that doesn’t require insulin.
So they set up an intervention study with 101 of the participants at different ages. Some got a glucose drink while ketone drink.
Ketones stabilized the brain, showing the best results in the 40–59-year-old group. The effects were modest in the young group (20-39) and even less effective in the older group (60-79).
“This represents a paradigm shift in how we think about brain aging prevention,” said Botond Antal, on msn news, Ph.D., Postdoctoral Associate in Biomedical Engineering at Stony Brook. “Rather than waiting for cognitive symptoms, which may not appear until substantial damage has occurred, we can potentially identify people at risk through neurometabolic markers and intervene during this critical window.”
Although we need more studies, the concept of a critical window is very important in midlife. That’s why recognizing it as a developmental stage is vital.
I don’t think means we need to start downing ketones, as we need a lot more research. The truth is we may not get concrete answers in our midlife.
But there’s a lot we can do to decrease insulin resistance and reduce our risk of dementia, from cardio to preventing micronutrient deficiencies and managing stress. I’ll be talking more about in future posts.
Questions or comments?
More brain stuff, the Menopause Wars and oatmeal
Ann Marie at Hot Flash Inc is also talking about midlife brain stuff. I love her roundups because they are full of the latest research. She’s mentions the strong link between exercise and brain health. This relates to brain insulin resistance, too, because physical activity helps to reverse it.
In this week’s Midlife Morning Show, Ann Marie and I discuss the “Menopause Wars,” which is topic of this article by The Guardian. This is the ongoing conflict among menopause doctors about how they prescribe menopausal hormone therapy and communicate its risks and benefits. This disagreement can be confusing for women who are struggling to find clear answers.
The issue is also highlighted with the popular documentary The M Factor: Shredding the Silence on Menopause. Jen Gunter at the Vajenda has reviewed the documentary and recently posted about its CME (Continuing Medical Education) accreditation being revoked because of unsubstantiated claims.
In November 2024, 16 researchers, clinicians, and women’s health experts wrote a letter on PharmedOut urging the removal of the CME accreditation.
This documentary film makes numerous unsupported claims, including recommendations for off-label uses of menopausal hormone therapy (MHT) that are unsupported by evidence, and is rife with misinformation, including statements that directly contradict warnings in FDA-approved product labeling. A major concern is that this film could lead to unsafe and ineffective prescribing.
I’m for or against this, per se, but I do think we need research to show that alternative MHT prescribing is safe and effective. And everyone should push for this!
There are a lot of menopause myths out there. Peri Professional Shelby Tutty fact checks the content from 50 websites. She also links to my heart health post : )
Last is a summary of the benefits of oatmeal on the Midlife Feast Substack: 5 Reasons to Ignore Oatmeal Deniers. I love oatmeal and eat it almost every single day. But the haters gonna hate.
The Midlife Morning Show
Join us Mondays at 7amPST/10EST for our live discussion of all things midlife. Want us to discuss a certain topic? Email it to either of us.
I’ll release the recorded version to paid subscribers on Fridays. At least that’s the plan for now.
How’s your March treating you so far? I hope it’s better than how mine started.
Maybe it’s my aging menopause brain, but I had a hard time following your section on the Menopause Wars. Here’s what I think I read. Others wanted its CME accreditation removed because of unsupported claims, especially regarding HRT off-label uses. Then you say, if I understood correctly, not in support or against HRT off-label, but just that it needs more scientific study? Or were you supporting off-label uses?
I want to hate oatmeal, because of the potential glyphosate exposure. I haven’t given it up. It never, ever upsets my stomach. One of the most digestible foods I’ve found