Midlife Fat Loss and Brain Health Principles With Barbie Boules [Ep. 91]

0:00 This is the Eat Well, Think Well, Live Well podcast. I'm Lisa Salsbury, and this is episode 91 midlife fat loss and brain health principles with Barbie Boules. I had someone ask me this past weekend, what my favorite episode was for her to know where to start with on the podcast. And I thought, oh, uh, it's not published yet because this is my new favorite episode. Barbie Boules. AKA the cognition, dietician. Lays out the four pillars of fat loss specifically for the midlife woman and tells us what's different. And what's not in that time. We shift gears midway and get into brain health and how to really prevent. Cognitive decline as much as we can.

0:40 You'll be fascinated to hear as I was how much overlap there is on these two seemingly unrelated topics stay to the end because she gives the best last tidbit to wrap it up. Welcome to Eat Well, Think Well, Live Well; the podcast for women who want to lose weight, but are tired of counting and calculating all the food. I'm your host, Lisa Salsbury. I'm a certified health and weight loss coach and life coach, and most importantly a recovered chronic dieter. I'll teach you to figure out why you are eating when you aren't hungry, instead of worrying so much about what you are eating. I'm delighted to have Barbie Boules here with us today.

1:21 She's a registered dietitian and specifically focuses on taking care of your brain, which I absolutely love. So welcome Barbie. Please tell us all about what you do and how you came into this space. I would love that. Oh, thank you. Well, first of all, thank you for inviting me and helping me spread the word about women's brain health, particularly in the menopause transition. It's a really crucial time. For us to start paying attention. So I really appreciate you having me. Um, I am, like you said, a registered dietitian and, um, I have been for about 25 years in private practice. And, you know, my practice has always focused on women, but over time with my own evolution, uh, you know, getting older, um, and the new challenges that come up, it has evolved my practice has.

2:06 And as when I turned probably around 43, I started. started to really pick home in on the metabolic changes that happened with the menopause transition. Then of course, understanding how that impacts the brain came a couple of years later. So now it really is my focus really is, uh, Alzheimer's in particular risk reduction. and, uh, women's metabolic health because our metabolic health is the foundation of our brain health. There are lots of other things that play into, and a few that have absolutely nothing to do with nutrition or lifestyle that are really important for brain health. And we can get into that too, if you'd like, but that's sort of the evolution of, of how I've come to be where I am right now. Okay.

2:46 Perfect. Let's start with the definition of metabolic health. I think that that seems like foundational for your work and I think is maybe a little misunderstood. absolutely. Um, yes, usually. Thank you for asking. Usually when people think about the hear the word metabolism, what they're thinking about is metabolic rate or how many calories you burn in a 24 hour period. That's mostly what people associate. Well, and also, well, just that, does that help me lose weight? Right. you know, women's question. Okay. Yeah, exactly. We think about, um, our weight when we hear the word metabolism, but metabolism is actually, uh, how your body uses the energy that you give it to perform its daily functions.

3:31 So all of the food that you intake, everything that you provide your body with, and then how does, how efficient is your body at taking all of that energy and using it in appropriate ways? That is your metabolism. It's essentially all of the functions that keep you alive using the food that you've consumed. Metabolic health is represented by blood pressure, blood sugar control, your lipids, so your cholesterol and triglycerides, um, and your body composition. So excess intra abdominal fat is a marker of poor metabolic health, high blood pressure, um, elevated HbA1c, so insulin resistance, prediabetes, type 2 diabetes, and then dyslipidemia, so elevated LDL P.

4:16 cholesterol, or really ApoB, we refer to now, um, low HDL, high triglycerides. Did that answer? Yes, I think that there's going to be some Googling on the part of the listener. I am more than happy to, to piece apart any of that, It's just more, I, I love hearing that though, because it's just way more than the calories you burn, which is, I think what people think of as. You know, their metabolism, it's just so much more your metabolic health effects. So many it's, it's what keeps you alive. It's, it's far more than just, you know, your weight. Mm hmm. Mm hmm.

4:57 So let's talk about this, this menopause transition. Many of my listeners, I believe are in this transition. And I think what's surprising, let me just say that your hormones do start to decrease somewhere around the age of 30, because that's when we, so All of those things that were happening to me at like 35, I had no idea were part of possible coming into perimenopause. So as young as you might be, you're either on the cusp if you're a listener in that age range, or, you know, you're in the forties and fifties and experiencing it. So I think this is just, it's important to every woman, but let's talk about a little bit of the principles of fat loss during this menopause transition, because it's I think getting a lot of good press right now, menopause itself, but there's so much out there that's like, well, if you just balance your hormones, you're just going to be able to drop that weight right off.

5:50 And you and I both know that's not the way it is. So there's, I feel like some things that are going to be the same for the menopausal or pre menopausal woman, as they are for, um, you know, the, the 20 year old or the 75 year old, and then there's going to be some differences. So let's get into some of that. Yeah. So as you alluded to the menopause transition, otherwise known as perimenopause, but the menopause transition is becoming the favorite term begins, um, with this erraticism in, in estrogen and decline and progesterone and then ultimate decline of both with it. being postmenopausal. And it can be, it's usually between four to five years, but it can be as much as 10.

6:35 So if you're in your late thirties and you're starting to feel certain things, hot flashes, vaginal dryness, poor sleep, um, you're, but the very first indication is that your periods are becoming irregular, but for people who have irregular periods to begin with, that might not be a great, you know, classic sign. Also, I have a Mirena IUD right now, and so I a lot of times didn't cycle, and I thought, well, that's because of the Mirena, but now that I'm really tracking it, I'm like, oh, no, I do cycle. It's just sometimes 17 days and sometimes 48 days, which is fun. Mm hmm. Yeah. Yeah. Um, and those changes for many women, it's, it's menstruation cycles getting closer together.

7:17 And for many women, it's farther apart and for some women it's all over the place, but that for women who aren't using hormonal birth control and who have always had regular cycles, that's one of the first indications. Um, and then as you progress, you know, more symptoms and it is this erraticism, this high, low, high, low, high, low with the estrogen, which is what causes a lot of the discomfort that we can experience. but also with this decline in estrogen and progesterone, we lose a lot of the metabolic protection that we had in our teens, twenties and thirties. Um, early thirties and that can impact our metabolic health in terms of our blood pressure. It can be higher, our blood sugar, we can have less control.

7:58 Our elevated LDL is new for a lot of women, even if they've always been healthy and haven't changed anything about the way that they've eaten elevated LDL can happen. Um, and, and of course, uh, one of the things that happens with a decline in estrogen is a redistribution of fat to the belly. So even if you don't gain any weight, the fat from your butt, hips, thighs, arms, face, you know, can start to accumulate in the belly area and any new fat is going to favor that area. And it does become, I want to be very clear about. The fact that menopause and the menopause transition does not directly cause weight gain. It creates an environment where fat gain is more likely because it's easier to get into a calorie surplus, meaning it's easier to to be consuming more calories than our body needs to thrive.

8:50 And that will end up as excess fat. And this can happen because of that decline in muscle mass, which does begin at age 30, between 30 and 35. But by the time you're 50, unless you've been consuming enough protein and strength training, you will have lost a significant amount of muscle. That's going to change your metabolic rate. not favorably. Um, we are, we may also be struggling with energy. We may not have what we used to have, you know, to work out. We're not sleeping very well. That can impact our insulin sensitivity, our appetite and our desire to work out. Uh, we're not, I mean, a lot of women get very upset about this comment, but it kind of It typically bears out that we are, we are less active, um, and that doesn't mean that we're not working out because a lot of us are maybe even more than ever, but our NEAT non exercise activity thermogenesis tends to decrease as we get older.

9:47 We're not chasing around small children. We're not lifting them. We're not going out dancing Friday and Saturday nights. We're not walking on our errands. That's partly modern convenience too. I mean, I remember when I was. 35. I was not ordering things on my smartphone. And, you know, it was I had to move to I go to Target way less than I used to. I know that's silly, but like, I no, it's not out more when they were younger and just having to run them back, you know, run them around, generally speaking, right. And we tend not to think about this, but little moves like that, that unintentional movement can add up to thousands of calories a week. So, and over time, it's very gradual, but it accumulates, and then suddenly we're 10, 15, 20 pounds outside of our comfort zone at 55.

10:36 But, the good news is, we can, you know, combat it, um, with some strategy. Oh, you were asking about kind of the difference. The truth is, there's no real difference in terms of recommendations between your 20s and your 50s. It's just that in your 50s, it becomes that much more important. Does that make sense? So like, we can like kind of get away by with doing like 75 percent in our twenties in our fifties, it's gotta be like 95, a hundred percent with the exercise, the non exercise activity, thermogenesis, getting really high quality sleep, managing our stress in a non food way. Um, and eating in a way that.

11:16 that is going to translate into keeping our cholesterol healthy, keeping our blood sugar healthy, keeping intra, intra abdominal fat at bay. So it's, it's not that it's anything new, all that low hanging fruit still applies very, very much. It's just that you gotta do it and you have to be consistent about it. That's what's different. Does that make sense? Yeah, definitely. Um, I, I have a question on the fat redistribution. When you say that during that time, you know, we have this redistribution, do you mean like that, like actual fat cells that used to reside on our thighs, like travel in the body? Or is it just that we, when new fat cells C come onto the body, they go into the belly area.

12:01 not the fat cells, but the tribe, the fat storage moves to the belly area and then favors the belly area, but the decline in estrogen causes a more androgynous shape because we don't have the estrogen. I mean, for, you know, to, to wet vastly oversimplify, we don't, we lose the hourglass and we are more straight up and down. We become a more. Androgynous in shape. And that is partly what happens that the fat storage moves to the belly area. and, yeah. Yeah. Tell me more also is, do you mean it specifically, is it subcutaneous fat in the belly area or is it that visceral fat?

12:44 Because I know that is also a big concern for the menopausal postmenopausal woman is the visceral fat accumulation around the organs. Yeah. Thank you for asking. I was going to follow up with that. It's both. Okay. Um, but that visceral fat is the highly inflammatory type of fat that we really want to keep at bay. And that can go up to quadruple in midlife. Um, I really do recommend if, if you, um, really want to know where you stand with this, I do recommend getting a DEXA scan, a body composition DEXA scan, not just a bone mineral density DEXA scan, which is what your doctor will order for you. Unfortunately, not, not typically until age 65, which can be way too late for women in identifying osteopenia and osteoporosis.

13:30 I really feel like that needs to be done like 50, but, um, body composition dexa scan. You can just Google it. They're, you know, all over the place, typically costs about a hundred dollars. It's a tiny bit of radiation, kind of like a, dental x ray, but it can tell you, um, your body fat distribution and body fat percentage. And most of them will also tell you your, roughly your visceral fat. It's not perfect, like down to the ounce, but it's, it's good enough to let you know, are you way outside of where you should be, um, in terms of, you know, uh, having good metabolic health. So yeah, it's that visceral fat. That's the main concern metabolically speaking. Yeah.

14:11 I'm, I'm smiling because I literally just had this done Oh, and yes, I found there's a Dexa fit close by me and I actually am having the owner on the podcast in a couple of weeks. And so that'll be a great followup to this conversation because, um, they certainly make it seem like they're measuring the visceral fat to the ounce because it was like 0. 5 blah, blah, blah. Like it was, but I thought. Those kinds of tests also are the kinds that can be compared to themselves. So even if it's not exactly right, if I have it tested again in 3 or 5 years, I can see what the percent of change is and know if I'm going, moving in the right direction, staying steady, because even if it's off some ounces, If it's off the same amount of ounces, you know, the next time.

14:58 But yeah, I, I do think it's really interesting because I, I take my mom to all of her doctor appointments with my podcast listeners. No, I talk about all the time, but, um, we were talking about a DEXA scan for her. She's in her late seventies. And I said something about it to her doctor, like, Oh, I just had a DEXA. And he looked at me and he's like, how old are you? And it was like, super judgy. Like, why would you to do that? And I'm like, Well, I'm 48, but I wasn't really, wasn't really checking on the bone density as much as, you know, the other body composition part and the visceral fat was something I was really interested in learning about. So yeah, I totally recommend that. Yeah, and I agree with you about watching trends because we're each physiologically unique, so we can't even really say with absolute certainty what percent body fat is quote healthy, but you really need to be comparing yourself against yourself.

15:52 I mean, sure, there are parameters for sure, but, what the threshold is on the high and low end. No one can say with absolute certainty. but as minimal as visceral fat as you can possibly get, and to just be looking at trends over time, two things about DEXA. Um, you want to be well hydrated, not over hydrated, but well hydrated, um, for sure. And also, you know, it, it is going to depend on the skill of the technician a little bit too. So just, you know, You know, making sure that you've got someone who's really looking at what they're doing, not kind of like talking to you, you know what I mean? Like really make sure, you know, even if you have to say, hey, listen, can we just like do the test and chat afterwards?

16:34 You know what I mean? You really want to focus. Um, so that's all, you know, that's what I want to say about that. But, um, yeah, I think it's a great idea, especially as a baseline. Yeah. Perfect. Okay. Um, I'm going to go back, rewind a little bit. when we were talking about the principles of fat loss, You said, you know, it's all that low hanging fruit. Let's detail out what that low hanging fruit is because I am just constantly hammering on things like there aren't hacks for weight Right. Right. There are just core principles and they're actually Well known across the board and every diet you've ever been on is feeding on those core principles, but also feeding on your insecurities and trying to make you think it's easier than, than it is, but it is simple, right?

17:24 So tell us, what would you consider the low hanging fruit for weight loss, fat loss? So obviously there's the nutrition piece can't get around that piece, but you are far better off. going slowly than trying to go too rapidly for lots of reasons, but the primary being, it's not going to be sustainable and you're wasting time. You are just wasting a giant chunk of time. If you try to go down to like a 1200 calorie diet or something, you're not going to be able to sustain, sustain that. And you will regain the weight. Secondly, Rapid weight loss also causes muscle loss, and that's antithetical to a healthy body composition and healthy blood sugar metabolism and being strong and functional independence and all the things that we want later on in life.

18:12 So what I always tell people is give yourself a year. at least, you know, and if it's significant amount of weight, maybe two years, stop trying to do the six weeks to your summer body because it's just never going to work. Forget about the timeline and just approach it as if what you're really concerned about is your health and not just your physical appearance. I am all about women looking like whatever they want to look like and rocking bikinis. I'm all about it. I don't have a problem anything against that whatsoever, but you'll get there a lot faster in the long run if what you're focused on is the health of your brain, healthy blood sugar, healthy lipids and healthy blood pressure.

18:53 And really like, if it takes you a year and what you've learned in that year is how to maintain that, those lifestyle far ahead. Yeah. you're you're really like, enjoy it then for the rest of your life. Because once you learn to change your lifestyle, instead of going on that six week diet and then going back to what you were doing, you're, you're just not gaining anything that way. I'm always like, we're, aiming to Like your future self who maintains her weight. Let's eat like she does let's aim towards that goal. And, and then you're way ahead. Way ahead. And you don't even have to, some people want to and it works for them and it is sustainable, but you don't have to majorly overhaul your diet.

19:40 You could just eat less of what you're eating right now. You could change absolutely nothing about what goes on your plate, but just eat less of it. Or you could make more nutrient dense choices or include more plants or whatever you want to do. But it can be that simple as just eating maybe 75 percent of what you're currently eating. Um, so there's the nutrition and we, you know, I've got, we can get super detailed and go down a lot of rabbit holes with that if we want to. But just basically the nutrition piece cannot be avoided. It's so important. super important, not only to your body composition, fat loss, but also your long term health, um, exercise obviously is, is key. It's not going to be enough all by itself.

20:21 especially if significant fat loss is what you're desiring, but it is certainly crucial for maintenance, and, and for your health, you know, for your metabolic health. And we need both, we need both cardio and strength training and about 150 minutes of zone two cardio a week is what I recommend. And about 70 minutes of strength training is what I recommend. And then sprinkle in some high intensity, maybe 30 minutes a week total. We need about twice as much cardio as strength training in terms of minutes. Okay. That's what the research tells us about metabolic health and cardio is what's best for reducing visceral fat. Perfect. So, sleep. I mean, we need to sleep better and that can become such an issue in the menopause transition because with that loss of estrogen, we start sleeping not as well, not as deeply, not as restfully.

21:11 And, um, there's a strong link. Very interesting study came out last year after just six weeks of, um, actually it's really in one night, we are less insulin sensitive. Um, if we have slept. poorly. Now, insulin sensitivity is something that can be transient unless there's actual metabolic illness, you know, poor sleep, um, eating too much in one sitting, you know, late at night. These are all transient situations where we can be less insulin sensitive, but poor sleep is one of them. part of what happens then is you have an increased desire for carb and fat combination type foods. And so you're going to have more cravings on days when you don't sleep. Well, you just are.

21:51 that's absolutely true. You're hungrier. You're less insulin sensitive. Maybe you don't have the energy to exercise. And so it's just kind of this snowball effect, not to mention the fact that sleep is absolutely crucial for the hygiene of your brain. So, sleep is important and then managing stress in a non food way, non food, non booze way, right? Because we all, um, Have stress. There's really no way around it. but we can learn to effectively manage it, And it's especially important if that loss is a goal to do that in a way that doesn't require food or booze. I love the way you say that. Yeah. Managing stress in an on food way. And it's just another way to talk about like the way I coach my clients.

22:35 Like we're way more worried about why you're eating when you're not hungry rather than what you're eating, because it's the why it's that stress. It's that emotion. It's what is going on for you that is driving you to, you know, just driving you to the pantry when you're not hungry. Exactly. And so I I've always thought of it and talked about it and taught about it as four pillars. So nutrition, sleep, exercise, and managing stress. Perfect. is equally important. I think of it like a table with four legs. You know, if any one of these legs is weak, we're not going to be in optimal health. Everything's going to be a little bit shaky because they all impact one another as well. and yeah, that sounds like a lot, especially to someone who kind of everything's a hot mess, which it is for a lot of women, particularly women in midlife, but start small, start with the thing that you think is going to have the biggest impact.

23:25 Um, for a lot of the women that I have, um, worked with, that is stress making sure we've got the stress P yeah, because if you're stressed and you're using food or alcohol, you're not, exercise is not going to be very efficient. You're probably eating things that aren't really in alignment with your goals. And if it's alcohol, you're not going to be sleeping well. So. You know, just getting, getting a handle on stress is, is usually the most important thing if it's an issue or the first move, if it's an issue. Okay. Those are amazing. I'm like taking notes, like thinking I'm going to ask you more questions, but I don't think I think you've covered it, That's great. real quick on the nutrition.

24:06 I would recommend as far as like getting the nutrition piece down, correct me if I'm wrong. Protein is of utmost importance, keeping your fiber intake up and your sugar, your added sugar intake low. Those are kind of my nutrition pillars. How would you, what would you consider there? I absolutely agree. I mean, I think protein and fiber are really of equal importance. and so making sure what I like to say just, and this certainly, these are not perfect numbers for everyone, but just as a starting point, if you just kind of want to get started 20 or more grams of protein at every meal and 10 or more grams of fiber at every meal. So 2010 or more. Ideally more with the protein at every meal prioritizing that when you fix a plate for yourself or you're planning a meal, get those in there first.

24:55 And then I like to always include leafy greens and some color, you know, that's part of your fiber intake, but leafy greens and colors, super important for, um, vital nutrients and, um, disease fighting properties, brain health. Um, and you know, what we can't get, I don't know why calorie Has become a dirty word. It's so bizarre to me. I, you know, I, I actually, that's not entirely true. I think I do know why. And, you know, for, for so long, this is seventies, eighties, and most of the nineties diet culture was rampant and it was really toxic and I mean, it still is in many ways, but, you know, just really telling people they needed to be as thin as possible, not really concerned about strength or health, just thinness.

25:42 Um, and this whole kind of anti diet, um, let's not talk about calories, you know, backlash just kind of swung too far in the opposite direction. And then you've got a whole bunch of people who are trying to sell their own diets and they know people don't want to calorie count or think about calories. And so they're pretending calories don't matter. And the fact of the matter is calories in calories out is the foundation of your body weight. Wait. That's just, that's all there is to it. There's, You can't argue with turbine you cannot. And so, you know, what I generally recommend for women who are, you know, trying to, or starting a fat loss journey or in the midst of one, but it's not going all that well is take the time to use a calc, you know, just use an online calculator to calculate your, your, into your calorie needs.

26:32 It's not going to be perfect. You have to experiment. You have to take a month or two and see, does this actually work? Do I need to drop it lower? Can I, you know, go higher? But then what I recommend is using a tracking app. I personally like Chronometer because it shows micronutrients as well, which I think is important because it helps you understand where you might need to supplement. And initially, don't try to drop your calories. For 30 days, eat exactly as you normally would. Input everything so that you completely understand where you are now. Because if you don't understand where you are now, it will be very difficult to create an effective calorie deficit.

27:16 So, if you think you're eating 1700 calories, And you need to drop it to 1, 300 calories to start losing weight. You might be going way too low because 1, 300 calories is really not sustainable for most people. And the truth is, you might actually be eating 2, 600 calories a day, and you could have dropped it to 2, 100 and been well on your way. Does that make sense? which right there is the key to this so called reverse dieting. Right. Yes. people think like, Oh, well, let's increase your calorie intake so that you know, we're going to reverse diet. But It's actually a decrease, but it's maintainable because you're eating 2600 calories and then you're eating 3600 calories on the weekend.

28:04 And so you're, you're thinking, but then you're also estimating you're eating 2000. It's all over the place when you're guessing. Yeah. Yeah. Research tells us that the average person, and this includes nutrition professionals, underestimate their calorie intake by about 30%, which is pretty massive and definitely can represent, you know, an, an uncomfortable, weight gain. So yeah, that, that's what I would say. Don't try to change anything. It will be very tempting, but don't try to change a thing. And the other thing about tracking, if it's something you decide to do, and it's so It's certainly not appropriate for everyone, but if you don't have a history of eating disorder, you can look at it as just data, not be emotional about it, not feel guilty about it.

28:45 It is so illuminating to be super diligent for about 30 days so you can see where you are and then you'll be in a really comfortable place to just drop it by a few hundred calories and then you'll be well on your way. So that's generally how I like to start. So I, history of eating disorders. I wasn't actually like, Technically diagnosed because I'm not even sure it's in the DSM, but counting calories and counting macros put me well on the way to orthorexia, which is just like the obsession with eating healthy. And, um, for those that don't know, it just creates a lot of anxiety. So I wasn't able to go out to dinner without. an immense amount of anxiety go to people's houses for dinner, not knowing what was in the food, that sort of thing.

29:27 And so I do have like this long history of tracking and it gave me a lot of anxiety. And so I coach people without the tracking, but most of my clients have tracked in the past. And I'm always like, listen, Let's not be mad at our old selves for doing that. Like I'm not mad that I tracked for that long, but I certainly don't discount all that knowledge that I got. I can look at a plate and I'm always telling my clients, I'm like, look at that plate. You know, how much protein is on there because you've weighed and measured in the past so many times. But if you're a person that has never done that. Then, yeah, it's, it's helpful to know how much protein is in a chicken breast. We should just know these things. And if you're like, I absolutely cannot track and reduce.

30:10 Then when you were talking about like, you can eat the same thing and just reduce just commit to leaving two or three bites behind at every meal this week. just reduced your intake Absolutely. Yeah. Tracking is, is not required for success at all. It's just, if I recommend it to people who really can look at it unemotionally and, um, and, learn from it and not as an, as a short term educational tool, not as a long term strategy, because we don't want to rely on it. Which is where I think I went wrong is I was definitely relying on it as a longterm strategy. So I love that you're saying it's a short term tool. It absolutely is. And we should be learning as we're going. And just to speak to the orthorexia component, you know, I had severe orthorexia for a decade.

30:56 And, so I understand that piece really well. And we want to always, whenever we are on a fat loss journey, whatever tools we're using, we always want to constantly be checking in with ourselves. Where is my head with all of this? Am I feeling, um, confident and sure of myself and learning and gaining knowledge and improving my health and kind of feeling stronger and better if not every day, every week, or am I starting to get preoccupied with how many calories are in that? Oh, I can't eat this. I can't eat that. You know, we've got to stay on top of our mental health when it comes to, a fat loss journey. Unfortunately, weight and worth are extremely tied and that it should never have been that way, but it is, and it's so deeply ingrained that we, we have a very difficult time just seeing all of these things.

31:48 It can be very helpful tools. We have a hard time just seeing them unemotionally. Yeah. It's like the scale. I'm always like, that's just your gravitational pull on that moment in time, but most people do not think of it that way. It's, Yes. And thank you for bringing that up because it is just your mass. That's all it is. Um, and what is far more important than the number on the scale is your body composition. I mean it, they're night and day in terms of importance and you can be 110 pounds and Phenomenal and profoundly metabolically unhealthy. So it's really important to maintain your muscle mass and minimize intra abdominal fat.

32:28 Those are the two things about your body composition that you do want to stay on top of, but not get obsessed about. perfect. Okay. I want to definitely talk a little bit more about protecting our brains because that is so much your specialty. So let's shift away from the nutrition and the weight loss piece and really think about our brains. This has been on my mind. Pretty consistently, dementia runs in my family, in my mom's side, and I see my mom forgetting things frequently, memory issues, and then I see myself forgetting things, and I get really afraid.

33:09 Because I'm like, how did I just forget that word? I was describing the Star Wars ride at Disneyland, and I could not come up with the word for their weapons, right? What are those called? What are they called? The lightsabers, I couldn't come up with the word lightsaber and my kids have watched Star Wars. I mean, I've watched Star Wars since the eighties. Like, how did I not know that word? I just, it just sticks in my mind. Like, how did I forget that word? And every time I forget something, I get, really anxious. I get nervous about it. And so, I worry about how to protect my brain. And then I wonder, but what's normal, what is normal? Like there's a normal amount of forgetting, right? Please tell me. Yes. Yeah, of course.

33:50 Of course. And there's a spectrum to normal and it's going to depend on you. Again, this is where you are your baseline. You know, you can't compare yourself to your friends or, or anyone else. so that said in the menopause transition, the brain is rich with estrogen receptors and as we start to lose estrogen and its impact the communication within our brains struggles and suffers for at least for a little while. Usually what happens post menopausally is that there's a leveling off and I don't want to say we return to exactly 25 years old and that's, you know, speed of that lightning speed, you know, um, function, but it definitely, doesn't feel like it does in terms of the brain fog and the forgetfulness and the lack of concentration in those years when the estrogen is up and down and up and down.

34:38 So there is certainly a normal amount of forgetfulness, lack of concentration, walking into a room and having no idea why you're there is super classic. putting things in weird places, not being able to think of a word that you've said a times. That I'm not saying we ignore it entirely, like sit and think like, okay, you know, am I able to usually communicate normally problem solve. You know, I had a client who said to me, I'm really worried. Because she worked in an office building where she needed her, ID to check out. And she's like, every day this week, I have forgotten to bring my ID. I usually just put it on and I leave and I've gotten almost out the door and they won't let me out because she's like, I've never forgotten it.

35:24 And it's just this week. And I said, okay, but did you know what to do? Did you know how to go back and get it? And she said, well, of course. And I said, then we don't want to worry about that. Do you know what I mean? Like, it's not, it's not a, like, it's more the problem solving stuff. And the thing about the problem solving stuff is the person in it doesn't always see it. You're not going to be the best recognizer of that. It's usually when people around you are starting to say, people who know you well, we're starting to say, are you okay? Or, you know. Um, normally you would have known what to do here. Are you, you know, are you feeling all right? Have you been sleeping all right? That's when you would probably want to go to your doctor and have a cognitive evaluation, um, which only takes like 30 minutes.

36:07 It's not a big deal. And then if he or she is concerned, maybe see a neurologist, MRI, neuropsych testing, but that just that, like forgetting a word here and there, were you able to recover it at some point? The Oh yeah. It just took me way longer than I thought, which was any amount of time was longer than I should have taken. I And no, I know I had dinner with a girlfriend not too long ago and she could not for the life of her remember the name Rosé for wine. She's like, the pink wine, the pink wine. What is the pink wine? And I mean, that's her drink, you know, but she's okay. So, yeah, I mean, there is a normal amount of cognitive sort of. Just ebb and flow and weirdness, but it's when we're really struggling or we forget our way to a place where we've we go all the time.

36:53 It's things like that way more significant. That's when you would want to see your doctor. so in terms of protecting your brain. I'm a big fan of the MIND diet philosophy, the approach to eating MIND, M I N D, Mediterranean Dash Intervention for Neurodegenerative Delay is what it stands for. It's basically a combination of the Mediterranean philosophy and the DASH diet, which is Dietary Approaches to Stop Hypertension. So we've got, you know, blood pressure, um, good stuff for blood pressure in there to combining them and then teasing out foods that are particularly beneficial for the brain and like leafy greens, berries, fatty fish, olive oil, nuts, beans, um, All the cough, All the yummy stuff.

37:38 So it's all good stuff. And what I also like about this approach is it's really not about calories or macronutrients. It's about including foods that are high in fiber, low in saturated fat and rich in, phytochemicals. So polyphenols flavonoids in particular. so that is sort of the nutrition approach. And, uh, in terms of exercise, like I mentioned before, getting a nice balance of cardio and strength training, we want to make sure we're doing both. And also to not forget about balance and flexibility, because we want to be focusing on functional movement as well. Like when we're 70, we want to be able to put a box on a shelf. We want to be able to pick up our grandchildren. So making moves like that as well.

38:20 sleep, Eight hours is a sweet spot for most people, but seven to nine high quality hours. and then managing your stress. Of course, I like having just a go to every single day stress hygiene routine. That's either breath work or meditation. It can literally be two minutes. It doesn't have to be this big, long session, and you can do breath work in the car. You don't even need to take time out of your regular routine. But what I like to do is, especially if it's new to somebody, attach it to something you do every day. So like after you brush your teeth, meditate or do breath work for 60 to 120 seconds, or right after you take your shower at night, if that's something you do, do two minutes of breath work. Just so every single day you're doing something to kind of balance yourself so that when you really need it, It's that much more accessible to you.

39:08 And then I mentioned, I alluded to a few things that are not nutrition or exercise related at all that are really important to protecting your brain. Okay. Sorry, before you get into that, I just want to note, and I'm sure that the listeners already realized this, those four pillars for protecting your brain in midlife are the same principles that you gave us for fat loss in the menopause transition. So when we talk about healthy habits, this is, This is what we mean, like these things affect all the things. And I just find it fascinating. Every doctor I've taken my mom to, whether it's her cardiologist, her pulmonologist, her, her regular doctor, her woman's health specialist, every single one of them asks her about her exercise routine.

39:53 Like it matters for all the systems. And I think, and, and we talk about stress. We talk about these four principles. In all of the systems. And so I just wanted to make note when you, gave the last one, I was like, well, there's all four. Yep. It's funny how that works. Right. And, you know, I have to say that I want to just say about exercise or let's just say movement, because, you know, for some people thinking about working out exercise, either they hate it or they haven't done it a long time and they're intimidated or they've got bot, you know, chronic pain and don't want to get started. Here's the thing. The human body is designed to require. Movement and pretty challenging movement and it's part of our problem on the whole globally in terms of metabolic disease that we are so sedentary and being sedentary is not far behind smoking in terms of risk of illness.

40:47 And that's why it's not even because of weight. It's because we're not using our systems and getting the blood flow and the oxygen and the nutrient delivery. The way that we need to and increasing something called BDNF or brain derived neurotropic factor, which gets stimulated when, we are exercising, which is like, kind of cliche now, but it's been likened to miracle grow for the brain. You know, it just, it really helps its function. It's both it's, physical structure and it's, chemical communication. So exercise is crucial. We require it, even if it's a 30 minute walk. If it's doing a couple of minutes of yoga, just move your body. It's so incredibly important. It's not possible to be in good health.

41:29 If you're not exercising, it just isn't. Okay. So back to those other two extra things for the Yeah. Two extra things. And this is, everybody can access this. Okay. I know the nutrition and exercise piece can be like a drag for some people, but everybody can do these two things. One is increasing what's called cognitive reserve. And this term was coined not very long ago by researchers who looked at brains that on autopsy on examination had all of the markers of Alzheimer's disease. So the beta amyloid plaques, the tau tangles, but these people behaved. As if they did not have neurodegenerative disease in life and it's theorized and it's a very strong, you know, supported theory that it was due to the fact that these people had a lot of what we call cognitive reserve, which is.

42:19 learning new information and using it. So really thinking of your brain like a muscle and exercising it. And we're not talking, I mean, brain games like on the computer or on your phone there. That's great. But what we're really talking about is problem solving skills. So, The agility of your brain, you know, doing things that require your brain to really function from a lot of different angles, like a lot of different brain regions active. So, learning a new language and speaking that language traveling, you know, going places and not using your GPS actually having you to use your, your brain to think, you know, I know, but nobody does that.

43:01 We don't even know for sure. I mean, we're really, you know, I worry about our Children. My God. But, you know, so doing things like that, furthering your education, learning to cook, learning all about plants and starting a garden, you know, everybody can do that. Something along these lines, a lot of them don't even cost money, but it's just thinking of your brain like a muscle. It's just as important as your biceps, your abs, your glutes. so that would be cognitive reserve. And the people who have more of that tend to fare better and it reduces the risk of cognitive decline. And then the second is social connection. And this doesn't being the life of the party or having a million friends.

43:44 It means being In safe, healthy, give and take stimulating relationships, and ideally a variety of relationships, so maybe you have your partner, maybe you have your children, you have friends, you have community or church, you have work, so that your brain is being stimulated in different ways, you're having different kinds of conversations, you're solving different problems, you're navigating relationships in ways that challenge change. Your brain does. I mean, we know our children are really good at challenging us, right? If we have them, um, and sometimes our partner and work and do, but do you see what I'm saying? So all of this is about really keeping your brain active and alive and, you know, retirement, like complete.

44:27 Retirement is one of the worst things that we can do. So if you're getting close to the age where you're thinking about, you know, transitioning to something else, transition to something else. And I don't necessarily mean earning an income, but whatever you want, but stay stimulated. Mm hmm. Yeah. I, there's the old adage, We don't stop moving because we grow old, but we grow old because we stop moving, Yes. And it's the same thing with your brain. It starts to, I mean, imagine, you know, and this is part of the reason, oh, I want to say this to take care of your ears, eyes and mouth. There's a hugely strong association between hearing loss and dementia.

45:09 and it's there. It's not exactly known why. But again, it's theorized because of of inappropriate or lack of stimulation. And there was the Lancet Commission, publishes, research periodically about dementia prevention. And in 2020, 12 factors were identified. I have a post on this on Instagram, it's throughout the life cycle and it all added up. Like if you could eliminate all 12 of these factors, you could reduce your risk of dementia by 40%. And the strongest factor, and maybe because it was from early life was hearing loss. It was 8 percent of the 40%.

45:50 So, if you have hearing loss, obviously that can be genetic. That can be because of an injury. That can be because of, you know, I don't know, you were a major concert goer in your teens, whatever, but do something about it is what I'm saying. Wear a hearing aid, get it tested, make sure that you're staying on top of keeping your hearing Okay. So, even if you have hearing loss, a hearing aid, a device can keep you as long as mitigate Okay. Interesting. As part of staying engaged Yeah. Yeah. Especially because people who have hearing loss become sort of more socially distant. Um, so that's probably a big part of it too. Same thing with your eyes, your vision. If you have vision issues, do whatever you can to, you know, wear your glasses, get your contacts.

46:36 exercise your eyeballs, you know, do things that are going to maintain, good eyesight and oral health. you know, oral health is a risk factor for lots of diseases. And so making sure that you're, staying on top of those dental visits. I mean, for women in midlife, we should be seeing our dentist like three times a year for cleanings. And then any issues that come up. That was a lot. No, it's, it's so good. It's so good. And I think, a lot of us don't connect those things, but obviously when you're thinking about this, cognitive reserve, as well as the social connection, if you, we can't hear what's going on, if we can't see and participate, it's going to make it a lot harder.

47:22 More difficult. And even if you are in that situation, macular degeneration runs in my family. And my great grandmother had macular degeneration, my whole growing up years. She passed away when she was a hundred, when I was a junior in high school. So I actually knew her really well. She lived less than a mile from us. We rode our bikes and visited her very often. And. I'm thinking about her and I think how did she stay so sharp, and she didn't let her vision loss, keep her from interacting with us. she still tried to even watch what she called her program which was General Hospital, and, you know, You just turned it up loud and listened to the voices and looked out of the side of her eye where she could see.

48:02 so she's really stayed engaged despite her eye impairment and even cooked her own like breakfast and lunch fixed herself meals as much as she could. So yeah, she's such a great example to me. I'm so glad you had that story to share because that's exactly what I'm talking about. We are all going to bring risk to the world. To your risk factors to dementia, neurodegeneration. I mean, we, we all have some risk factors. It's just how many boxes are you ticking, you know, and to not let whatever, you know, risk factors we may have getting our way to the degree that we can do something about it. And that's exactly it. Just put, push on through and do what you can because it will make a difference.

48:46 Well, I'm just thinking about those autopsies where. It looks like they have Alzheimer's, but they don't. So we aren't doomed. We aren't destined to have that even if it does run strongly in your family as it does with mine. Right. And the only other thing I want to say about that in terms of, you know, potential genetic predisposition. I I, it's not like I think everyone should run out and get tested for the APOE4 gene, but the APOE4 gene, is a gene, that we can have, uh, six different combinations of alleles. And so there's APOE2, is protective against dementia. APOE3, which is what most of us have, is neutral.

49:27 And then there's APOE4, which can confer risk. And you inherit one copy of your alleles from each parent. So you will have two APOEs. And you could have a three and a four, you could have a three and a three, you could have a two and a two, but that's extremely rare. again, most people have a three, three, but if you have one, four, you have a two to three times increased risk of Alzheimer's. If you have two fours, you have an eight to 12 times increased risk of Alzheimer's. So again, it's not like I think everyone should be screened for this, but if. Your mom has Alzheimer's, your grandma has Alzheimer's, that, you know, there's kind of a lot of it. It might be a good idea for you to have your alleles tested, because if you do have, a four or two fours, it's not that you can change that, but you know that you are someone who needs to give extra attention to certain areas, particularly your LDL cholesterol.

50:22 And how do you get that tested? I'm sure that's beyond just like and me no, actually 23andMe tests for it. Oh, really? I mean, that's probably one of the most accessible ways. Yeah. it doesn't tell you what your alleles are if you don't have a four, but it tells you if you have one or two fours. Okay. Where can you get it? Like otherwise, other than 23andMe, you can just get it in order through your doctor. It's usually around 50, but I've seen it be as much as 400. I think it just depends on, you know, your lab. Um, but, but if you are already doing 23andMe and it's not one of the things that you have to pay extra for. Yeah. I just, that seems to be one of those like pretty accessible ones, but it doesn't seem like it has quite as much information as you might want.

51:09 Yeah, yeah. And, and also, you know, if you are, if you do have a four or two, you know, talk to your, have the conversation with your doctor. Don't just start worrying. If you are somebody who, here's what I'll say, if you are someone for whom, kind of like we were talking about earlier, if it's just going to increase your anxiety, Don't bother, because it's not like knowing is going to make this big dramatic difference, but if you're somebody for whom it will motivate you to truly stay on top of, in particular, what we know so far is you've got to really be mindful about your lipids. If it's going to motivate you to do that, then it would be worth testing. But if it's just going to freak you out, don't bother. Yeah.

51:49 That's good advice. Know yourself. Yeah, exactly. Okay. Well, this has been absolutely fabulous. I can't wait to put this in public. glad. Um, I always like to ask my guests if there's anything we miss, like, is there's any one little tidbit that you always love for people to know that you, you know, kind of your mantra, your motto. since I got to talk about the cognitive reserve, I don't think so oftentimes that's missed, but what I will say also is whatever your, you know, health journey is that you are embarking on or on, be kind. To yourself, you know, self compassion always nobody's perfect. There's no perfect approach. You're not missing anything by not staying on top of all the latest and new, everything that you already know is what you just need to be consistent about.

52:39 And it's everything that we talked about and just take, you know, at the end of the day, just be kind to yourself and take really good care of yourself. I love it. Okay. Thank you so much. Really. Thank you. Please tell everyone where they can connect with you online and follow Yeah. and be part of your world. Yeah. So I only, I'm only on one social media and that's Instagram and it's the cognition dietician. And then my website is www.barbieboules.com Okay. if you wanted to actually, you know, get in touch with me. Yeah. We'll put those links in the show notes. Thanks again, Barbie, Okay, great. Thank you. If this episode has helped you in any way, all I ask is for you to share it, share it with one friend or share it on your social media tag me, and I'll give you a shout out.

53:25 I'd also love for you to leave a five-star rating on apple and Spotify and review the show on apple podcasts. Have a great week and as always, thanks for listening to the eat. Well think. Well live well podcast.