Midlife gaining traction, the glucose-brain connection, and noteworthy articles
May midlife roundup [2024]
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It’s May! Which for me has always been one of the busier months, mainly having to do with my kids. And it also means summer is around the corner.
Before we get into the roundup, I have a brief announcement. I’m going to be experimenting with different content here.
It takes a significant amount of time to write research-intensive posts on a weekly basis. Not only that, but I also don’t get to edit them properly.
I plan to mix in personal essays, challenge prevailing claims (one at a time), and showcase interviews. That leaves the research-driven posts to more like 1-2 a month.
Feel free to share your thoughts or respond with ideas about what you'd like to see more in the future. I’m always open to ideas.
Midlife is gaining traction
The Cleveland Clinic announced their new Center for Women’s Comprehensive Health and Research Center in April. This is “Innovative program will address unique health needs of women during midlife and beyond.”
Unique needs. That’s what I always say!
Maria Shriver, founder of The Women’s Alzheimer’s Movement Prevention and Research Center at Cleveland Clinic, will be the strategic advisor. This is such a great step forward. Let’s hope they address some key research gaps in midlife women’s health.
It's great that they're giving attention to midlife and beyond, not just menopause. This clinic primarily caters to women seeking healthcare, but they also emphasize research as a key area of focus.
Cleveland Clinic has announced the launch of its new Women’s Comprehensive Health and Research Center, an initiative dedicated to helping women during midlife and beyond thrive and easily receive the specialized care they need. The center is focused on four key areas: access, connectivity, education, and research and innovation to empower women to navigate their health journey with confidence and clarity.
There was another big midlife announcement, and it’s a pending bill in the senate.
The Advancing Menopause and Midlife Women's Health Act, if approved, will allocate 275 million over five years for research, grants, and education for women experiencing perimenopause, and menopause.
Halle Berry made an emotional speech on capitol hill last week to support it, yelling “I’m in menopause,” as she described some less-than-stellar doctor appointments.
“That is why I’m here doing this work, because it has to be destigmatized. The shame has to be taken out of menopause,” Berry said. “We have to talk about this very normal part of our life. Our doctors can’t even say the word to us let alone walk us through the journey.”
I’m looking forward to hearing more about this!
New study: stress and the brain
The Barcelona Institute's study on stressful events and Alzheimer's in the Annals of Neurology caught my attention.
This study included 1,290 participants aged 48-77 who did brain imaging and then asked about stressful life experiences. The study did not find a link between total stressful life experiences (SLEs) and AD signs (atrophy pathways) and neuroinflammation. On the other hand, SLEs during childhood and midlife had an impact.
“Our study reinforces the idea that stress could play a significant role in the development of Alzheimer’s disease and provides initial evidence regarding the mechanisms behind this effect, but additional research is needed to replicate and validate our initial findings”, said lead researcher, Eider Arenaza-Urquijo, in a press release.
One way chronic stress can negatively affect the brain is by interfering with brain glucose metabolism.
I've been reflecting on what I've learned about what I’m calling “the glucose-brain connection” during aging pause, and I want to share it because it offers clues on how to lower our risk.
Brain changes with Aging Pause
After the age of 35, brain volume decreases 0.2% per year. In fact, women have greater brain volume loss than men between the ages of 34-43.
With an already aging brain, hormonal fluctuations and eventual decline have a major effect on the brain. A woman’s brain is rich in estrogen receptors in the hippocampus and prefrontal cortex (PFC) so it shouldn’t be too surprising that this stage of transition impacts cognition and brain function. These are the areas that control memory and mood.
Transitioning through menopause is considered a neurological transition state where most women experience no long-term effects, but a subset may face the risk of neurological decline. Estrogen is a master regulator of the metabolic system, helping the brain utilize glucose, its preferred source.
Perimenopause causes a hypometabolic state as the brain disconnects estrogen from the bioenergetic system. This is important because the brain is the most energy consuming organ utilizing 25% of energy despite being only 3% of the body.
The brain compensates for this loss by increasing fatty acid metabolism to generate ketone bodies as an alternative fuel source. This can put the brain at risk because it can use brain lipids (white matter) to break down fatty acids.
“The aging brain may compensate for its energy deficit by maladaptively catabolizing lipid-rich myelin to produce fatty acids that can be converted to ketones, inadvertently causing white matter degeneration.”
-Kopogiannis & Averinos, Int Rev Neurobiol. 2020; 154: 79–110
In short, aging pause creates windows of risk for our brains with hypometabolism and subsequent brain volume loss being one of the key factors involved.
A fascinating 2021 study showed changes to brain structure as women transition through menopause. Grey matter, glucose and white matter declined from pre- to post-menopause.
Yet women compensated with increased cerebral blood flow and ATP production. In some women, the declines were temporary and were partially or completely reversed two years after their scans. Better cognitive performance and memory were linked to recovery.
It seems most women will adapt to menopause, but 20% develop dementia later in life.
We know that estrogen helps maintain glucose metabolism in the brain. Yet studies are mixed on estrogen therapy and dementia. I’ve been on the lookout for other ways to increase energy metabolism in the brain.
Increasing brain energy metabolism
So far in my research, brain derived neurotrophic factor (BDNF) stands out as a key to maintaining glucose metabolism in the brain, and it also decreases with age. One key way to increase is with physical activity. In particular, cardiovascular exercise.
Yes, good old cardio. The thing many midlife women are told they don’t need.
In some studies, hormone therapy helps maintain brain volume, but longer duration shows mixed results.
I've been curious about the impact of exercise on hormonal therapy as studies rarely bring up these. I ran across this older study (2007) that looked at hormone therapy’s effect on brain volume over-time and also included levels of fitness.
Quick note. Because this is an older study, it likely used synthetic estrogen and progesterone, which may or may not be a factor. But beggars can be choosers.
Researchers enrolled 54 postmenopausal women aged 58-80 years old in the study, who provided self-reports of their hormone status and duration.
They underwent tests for VO2 max and received MRIs. In the low fit women on hormone therapy, brain volume effects decreased with duration. Yet the fitness level offset this risk considerably.
This is a small study that certainly is not the last word, but what they sum up sure rings true for what I’ve been finding:
In sum, our results reveal that age-related neural atrophy is not an inevitable consequence of aging and there are multiple methods in which neural decline may be reduced, or even reversed, in old age.
Back to stress
Many of the changes women experience–such as how we handle stress–play a role in brain health, as shown in the aforementioned study.
When we hear the results of any study on the effects of health, or in this case, brain health, we need to bring it into the bigger picture.
This is why we need a plethora of tools to help us enhance health and well-being.
May is mental health month, and we sure could use more education–and research–to help midlife women.
Noteworthy articles
The New York Times has a couple of articles, including "In Reversal, Expert Panel Recommends Breast Cancer Screening at 40," about how the United States Preventive Task Force has changed mammogram screenings from 50 to 40. This is because of the rise in breast cancer in younger women.
Another interesting article, “Apparently healthy, but diagnosed with Alzheimer’s,” discusses a blood test that can show if you’re at increased risk. Despite some skepticism about the science and potential fear it may cause, it seems like this is the way forward.
It was a pleasant surprise to find Peter Attia discussing a topic so close to my heart: iron deficiency with and without anemia. Hopefully, this will help it gain traction as so many women suffer in silence.
I'll end there. Next week I got a research-based post for you. I had to leave it out of my gut health series and can't wait to share what I learned about this part of our body. Can you guess what it is?
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