Menopause: Female brains & nutrition with Dr. Lisa Mosconi

Hello Lisa, thank you for taking the time for this interview.

You specialize in both nutrition science and neuroscience and have already published three books: Brain Food, The XX Brain, and most recently The Menopause Brain. In Brain Food, you compellingly illustrate how our diet impacts the health of our brain. The XX Brain focuses specifically on women’s brain health, and in your latest book, The Menopause Brain, you examine the phenomenon of “brain fog” during menopause. Where are very excited to learn more about your research

Bio

Dr. Lisa Mosconi is a neuroscientist and nutritionist. She leads the Women’s Brain Initiative at Weill Cornell Medical College in New York. As the author serveral books around neuroscience. She has specialized in researching and communicating the connections between nutrition, hormones, and cognitive health. Her third book, The Menopause Brain, has just been released. Through her interdisciplinary expertise, she shows how a healthy lifestyle can especially support women facing challenging hormonal phases.

Lisa, how did you become so deeply involved with the topic of “brain and nutrition”? And who can benefit most from the concept of “eating for a healthy brain”?

L: I realized early on that what we eat each day has a profound effect on our thinking and emotions. The brain is extremely sensitive and requires a very specific mix of nutrients. If we continually consume unhealthy fats and sugar, we risk not only short-term issues like loss of concentration and mood swings, but also long-term changes to the brain’s structure.
Basically, this topic is relevant to anyone who wants to remain mentally sharp. A balanced, “brain-friendly” diet can help prevent dementia, counteract memory problems, and stabilize mood swings. Women in menopause especially benefit, since their cognitive abilities often change noticeably during this phase. It really helps to nourish the brain optimally so that every nerve cell gets exactly what it needs.

You say that our brain has different nutritional needs than the rest of the body. Why is that?

L: The brain is incredibly demanding when it comes to nutrients. It requires different amounts and types of vitamins, minerals, and most importantly, a stable glucose level. While we often focus on getting enough protein, carbohydrates, and fats, we neglect the fact that the brain is highly sensitive to changes in hydration. Even mild dehydration can make you feel tired and unfocused. In addition, certain micronutrients—like B vitamins, omega-3 fatty acids, and antioxidants—are essential for cognitive performance. Simply counting calories often overlooks these fine details.

What distinguishes the XX Brain – the female brain – from that of men?

L: "The XX Brain – the female brain – differs from the male brain in many ways, and this has significant implications for our health. First, hormones like estrogen play a central role. Estrogen is not just a reproductive hormone but also a powerful neuroprotective hormone that protects the brain, promotes blood flow, and supports synaptic function. During menopause, women lose this protection, which may explain why women have twice the risk of developing Alzheimer’s compared to men.

Second, women’s brains are structurally and functionally different. For example, we have stronger connections between the two hemispheres of the brain, which often makes us better at multitasking and helps us combine analytical and intuitive thinking.

However, these differences also mean that we respond differently to stress and illnesses, such as depression or neurodegenerative diseases, compared to men. This underscores the importance of considering gender-specific differences in research. For too long, women have been ignored, leading to the use of medical diagnoses and treatments that are not optimal for us.

The XX Brain is unique, and it’s time we give it the attention it deserves – for our health, our well-being, and our future." – Lisa Mosconi

You’re an expert on “brain fog,” and you’ve focused particularly on women experiencing menopause. What are the most important insights from your research in that regard?

L: First of all, one needs to understand that many menopausal symptoms are governed by the brain. Therapies often focus only on the ovaries, yet it’s the declining estrogen level that strongly affects the brain and can trigger typical symptoms like hot flashes, sleep disturbances, or “brain fog.” In fact, these changes can be seen on MRI scans—similar to the “mommy brain” some women experience during and after pregnancy.

Studies show that two out of three Alzheimer’s patients are women. What role do menopause and declining estrogen levels play here?

L: Our research suggests that falling estrogen levels make the female brain particularly vulnerable. Estrogen has a neuroprotective effect and supports numerous processes essential for our brain cells’ health. In addition to experiencing typical menopausal symptoms such as hot flashes or sleep disturbances, women also undergo significant changes in the brain. The combination of hormonal fluctuations and aging processes can impair nerve cell metabolism and increase the risk of Alzheimer’s. That is why our studies focus on gaining a better understanding of these hormonal shifts and figuring out how we can respond preventively or therapeutically to lower the risk of Alzheimer’s.

What are the implications for prevention and therapy, especially regarding the heightened risk of Alzheimer’s?

L: We are studying how to better understand these hormonal fluctuations and intervene early. Through PET scans, for example, we have found that declining estrogen levels mean the loss of an important neuroprotective factor, thereby increasing Alzheimer’s risk. Now it’s a matter of developing preventive and therapeutic approaches—whether through hormone therapies, targeted lifestyle measures, or other interventions tailored to the specific needs of women in menopause.

Does that mean that hormone replacement therapy could protect the brain?

L: I want to emphasize that I’m not a clinical physician but a researcher. Our findings indicate that estrogen in the brain carries out a neuroprotective function. When estrogen levels drop, the risk of cognitive impairment rises. In this context, hormone replacement therapy (HRT)—if individually tailored—can help slow down or mitigate certain changes in the brain.

However, any decision for or against HRT should always involve medical guidance. Personal risk factors, such as family history or existing conditions, must be taken into account. Treatment should also be viewed holistically: HRT alone is by no means a solution to everything, but one component in a broader plan that may include nutrition, lifestyle adjustments, and other hormonal or non-hormonal interventions.

The right dosage and timing for HRT are also crucial. Studies indicate that starting therapy early—ideally right after menopause begins—can be more effective and carry fewer risks than starting later.

What’s the best way to “feed” our brain? What’s your number one piece of advice?

L: Achieving a healthy balance is key.

• Stay hydrated: The brain is largely made of water. Even slight dehydration causes fatigue and irritability.
• Avoid glucose spikes: That means not consuming too many sugary foods at once. It’s better to rely on complex carbohydrates, along with fiber, healthy fats, and proteins.
• Mediterranean diet: Lots of fresh vegetables, legumes, whole grains, some fish, and high-quality olive oil. Women in menopause benefit enormously from this because hormonal changes affect cognitive processes.

You developed a self-assessment. How does it work?

L: The questionnaire explores your eating habits, lifestyle, and any symptoms you might be experiencing. Afterwards, you get an assessment of your brain health, and based on your results, I recommend certain steps—drinking more water, adding more omega-3 fatty acids, or perhaps restructuring your meals altogether. Everybody is different, which is why I delve into individual needs in Brain Food.

You often mention that many dietary recommendations are based on “pseudoscience.” Which concepts do you consider problematic?

L: Right now, a gluten-free diet is very trendy. Of course, for those with celiac disease or a real gluten intolerance, that’s absolutely necessary. But for most people, cutting out gluten entirely isn’t required and can even be detrimental because it removes vital fiber, B vitamins, and minerals.
Another issue is the demonization of carbohydrates. Our brain needs them, but they should come from complex sources like whole-grain products, fruits, or vegetables rather than heavily processed, sugar-rich foods.
Lastly, there’s the paleo diet. It’s often touted as a cure-all, but it can be extremely restrictive, eliminating entire food groups. That can ultimately harm the brain.

What do you think about supplements, and which would you recommend?

L: I’m not generally opposed to dietary supplements, but I do think many people take them without a plan, not knowing if they have a deficiency.

• First: Proper diagnostics (e.g., blood tests) and professional advice are crucial.
• Second: Supplements aren’t a substitute for a healthy baseline diet; they’re only helpful if there’s an actual deficiency.
  For instance, omega-3 might be beneficial for those who rarely eat fish, and vegans or vegetarians often need to watch their vitamin B12 levels. Even then, a balanced diet and regular check-ups remain the foundation.

What can women in menopause specifically do about concentration problems?

L: “Brain fog” often stems from a mix of stress, lack of sleep, and poor eating habits. If essential nutrients such as omega-3, vitamin B12, or antioxidants are missing, the brain can’t function properly. Making sure you stay hydrated, get a good balance of macro- and micronutrients, and reduce highly processed foods can already make a big difference. The brain generally responds quickly and positively to better care.
In my new book, The Menopause Brain, I view menopause as a time of transformation but also an opportunity to strengthen women’s brain health and dispel common myths.

Thank you, Lisa, for sharing these fascinating insights. Do you have any final advice for readers who want to do more for their brains?

L: My pleasure. My main piece of advice is this: Don’t just focus on calories or diet trends—focus on what your brain truly needs. Healthy eating benefits not only your heart or your waistline but especially your mind—and thereby your overall quality of life.

If you’d like to watch Dr. Mosconi’s TED Talk, you can find it here:
Dr. Mosconi’s Talk: How Menopause Affects the Brain (TED)