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Why are 70% of Alzheimer's patients women? · (MIS)Treated

• 0:00
  Speaker 1: You're listening to (MIS)Treated. I'm Nam Kiwanuka. Brain health is
• 0:03
  Speaker 1: a women's issue. Those are the words of Lynn Posluns,
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  Speaker 1: the founder and president of the Women's Brain Health Initiative,
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  Speaker 1: which recently hosted Canada's inaugural Women's Brain Health Summit in Toronto.
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  Speaker 1: So why is brain health a women's issue? Women get
• 0:19
  Speaker 1: migraines 3 times more than men, and studies show that
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  Speaker 1: for women aged 18 to 49, migraines are the leading
• 0:27
  Speaker 1: cause of disability around the world.
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  Speaker 1: Some studies show that women are twice as likely to
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  Speaker 1: be diagnosed with anxiety and depression. According to CAMH, women's
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  Speaker 1: symptoms for depression are more severe. And would it surprise
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  Speaker 1: you that some 70% of Alzheimer's patients are women? Why
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  Speaker 1: is that? Is it genetics? Is it age? Historically, women
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  Speaker 1: have lived longer than men.
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  Speaker 1: But studies show that, quote, of every 3 patients with Alzheimer's,
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  Speaker 1: 2 are women, even after accounting for their greater longevity
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  Speaker 1: relative to men. And that, quote, postmenopausal women account for
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  Speaker 1: over 60% of all those affected.
• 1:14
  Speaker 1: In short, we are only now learning the importance of
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  Speaker 1: hormones in brain health. In a TED Talk that quickly
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  Speaker 1: went viral in 2019, Lisa Mosconi, author of The Menopause Brain,
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  Speaker 1: broke down how in menopause, we
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  Speaker 1: associate hot flashes, brain fog, depression and anxiety with changes
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  Speaker 1: in our hormones. But she states, those changes are all
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  Speaker 1: neurological symptoms, and they begin in the brain. She explained,
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  Speaker 1: Why are our brains impacted by menopause?
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  Speaker 1: Our brains and ovaries are part of the neuroendocrine system.
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  Speaker 1: So the health of the ovaries is linked to the
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  Speaker 1: health of the brain, and the other way around. Because
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  Speaker 1: estrogen is very important to our brains, Alzheimer's researchers are
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  Speaker 1: investigating whether estrogen therapy could help to ward off dementia
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  Speaker 1: in women. And since the FDA removed the black box
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  Speaker 1: off hormone replacement therapy, scientists are hopeful that this will
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  Speaker 1: help to foster more research.
• 2:17
  Speaker 1: Canada recently approved a new drug to treat Alzheimer's, and
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  Speaker 1: research shows that the shingles vaccine could slow the progression
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  Speaker 1: of dementia. On today's episode, we speak to Professor Natasha
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  Speaker 1: Rajah about how menopause and hysterectomies can impact our brain
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  Speaker 1: health and why menopause is not a monolithic experience. We
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  Speaker 1: also talk about the work collab is doing to better
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  Speaker 1: understand this and more. Professor Rajah joins me now.
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  Speaker 1: Thanks so much for being here. Uh, could you please
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  Speaker 1: start by introducing yourself and what you do?
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  Speaker 2: Sure. Uh, my name's Professor Natasha Rajah. I'm a full
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  Speaker 2: professor and Canada Research Chair Tier One in sex, gender
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  Speaker 2: and diversity at Toronto Metropolitan University, and I do research.
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  Speaker 2: The current main research project from my lab is called
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  Speaker 2: the Brain Health and Midlife and Menopause Study, and we're interested.
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  Speaker 2: And looking at how menopause affects brain health and might
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  Speaker 2: be a window to understanding if certain females might be
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  Speaker 2: at risk for dementia later in life.
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  Speaker 1: It
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  Speaker 1: seems like we don't know a lot and um the
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  Speaker 1: thing that I learned this year was that women weren't
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  Speaker 1: included in clinical trials until 1993, which is just like,
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  Speaker 1: I remember rap songs like uh I remember Sir Mix
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  Speaker 1: a Lot.
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  Speaker 1: Baby, get back. That song is from 1993 and uh
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  Speaker 1: we're learning so much about the differences between men and women.
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  Speaker 1: When we're talking about brain health, how is brain health
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  Speaker 1: different from men compared to women?
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  Speaker 2: So, we're still learning, but we do know that developmentally,
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  Speaker 2: like the body and the brain are connected systems, right?
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  Speaker 2: So I think one of the things that have come
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  Speaker 2: about is really people studying the brain without really considering how.
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  Speaker 2: Endocrine function, physiological function of the body will influence brain
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  Speaker 2: development as well. What do you mean by that? Um,
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  Speaker 2: so how your gonatal and your sex development will influence
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  Speaker 2: like the hormones that are in your body and how
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  Speaker 2: hormones have effects throughout the body, both in the body
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  Speaker 2: and in the brain. And so it will lead to
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  Speaker 2: different differentiation and different patterns of development.
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  Speaker 2: Um, both in development and then also potentially as we age. So,
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  Speaker 2: the reason historically people haven't really looked at, you know,
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  Speaker 2: whether or not the neural correlates of brain aging differ
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  Speaker 2: by sex is because behaviorally.
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  Speaker 2: Often the patterns are similar. So, males and females will
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  Speaker 2: show memory-related declines with aging. And because the patterns of
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  Speaker 2: behavior are the same, people assume that the underlying mechanisms
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  Speaker 2: must be the same. But something that my lab started
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  Speaker 2: to do is challenge that and look at whether or
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  Speaker 2: not um there are sex differences in the underlying mechanisms
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  Speaker 2: of age-related memory decline. And what we noticed was, we
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  Speaker 2: were shocked because we were using a data-driven method.
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  Speaker 2: And um we, all the results pointed to sex differences.
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  Speaker 2: And it wasn't something I was anticipating. I've been doing
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  Speaker 2: this research in aging for quite a while. Um, and
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  Speaker 2: I never really explored sex myself thinking, oh, behaviorally, they're similar,
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  Speaker 2: so there probably isn't any sex differences. But then when
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  Speaker 2: we looked at the neural mechanisms, it was just a
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  Speaker 2: wake-up call to me. It was just, wow. So, in females,
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  Speaker 2: what we noticed was a lot of the results that
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  Speaker 2: were been out there as far as the cognitive aging literature.
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  Speaker 2: Might have been driven by females because females tend to
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  Speaker 2: volunteer for research more than males in the older adult population,
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  Speaker 2: but no one disaggregated the data by sex, so we
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  Speaker 2: didn't know. So everything was in the same pool. Yeah,
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  Speaker 2: everything was in the same pool. What we noticed was
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  Speaker 2: only in females do we see age-related differences in frontal
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  Speaker 2: and parietal function.
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  Speaker 2: Um, in males, there wasn't any age-related differences and that
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  Speaker 2: implied to us that perhaps females are using different types
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  Speaker 2: of cognitive processes to maintain memory function and to try
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  Speaker 2: and do the memory task that we were challenging them with.
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  Speaker 2: And so, that really was like a wake-up call saying, oh,
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  Speaker 2: so all of these effects that we've been looking at
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  Speaker 2: in the front.
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  Speaker 2: cortex, are they driven by females or, you know, what?
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  Speaker 2: So we decided to go in and, you know, deep
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  Speaker 2: dive into looking at sex differences, brain health equity in
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  Speaker 2: my lab at that point.
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  Speaker 1: When I was younger, you know, I don't think I
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  Speaker 1: really thought about my brain health. It was more like, OK,
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  Speaker 1: how do I look on those sheets.
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  Speaker 1: Don't judge me. Um, but as I've gotten older, it's
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  Speaker 1: something that I'm thinking about a lot. Um, is it
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  Speaker 1: true that approximately 70% of those suffering from Alzheimer's in
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  Speaker 1: Canada are women? Yes,
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  Speaker 2: so 2/3 of Alzheimer's disease cases are in females in Canada.
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  Speaker 2: That's shocking. It's shocking. Why is that?
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  Speaker 2: So, historically, the assumption was that it's cause females live
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  Speaker 2: longer than males on average and Alzheimer's as all dementias
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  Speaker 2: are diseases of aging and that's why there's such a
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  Speaker 2: disproportionate effect. But what a lot of researchers started noticing
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  Speaker 2: is that in um
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  Speaker 2: When you look at individuals with Alzheimer's disease, there's a,
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  Speaker 2: a genotype called the Apolipoprotein E epsilon 4, which puts you at, it's
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  Speaker 2: a genetic risk factor for late onset Alzheimer's disease. And
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  Speaker 2: what people started noticing that there's a disproportionate portion of
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  Speaker 2: females with that genotype compared to males in these Alzheimer's clinics.
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  Speaker 2: And so that pointed to, OK, it's not just age,
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  Speaker 2: perhaps there's something about this genetic risk factor.
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  Speaker 2: For Alzheimer's disease that has a greater effect in females.
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  Speaker 2: And then the research started coming out in the 90s
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  Speaker 2: and in the 2000s and it's still coming out right
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  Speaker 2: now that what does this gene do differently in females
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  Speaker 2: and males. And in females, what we know is that,
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  Speaker 2: it leads to earlier accumulation of some of the neuropathologies
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  Speaker 2: associated with Alzheimer's disease and a steeper decline in females. So,
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  Speaker 2: this is something
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  Speaker 2: That seems to be female-specific. This gene is important for
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  Speaker 2: cholesterol transport. It's important for vascular health. It's important for inflammation.
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  Speaker 2: So it's, you know, this gene is a risk factor
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  Speaker 2: for Alzheimer's disease, but the mechanism by which it acts.
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  Speaker 2: You know, we're still studying and we're still trying to
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  Speaker 2: determine the details, but it seems to interact with all
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  Speaker 2: of these health factors that are modifiable as well at midlife.
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  Speaker 2: So that's why it's a really interesting result.
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  Speaker 1: Um, I think it also shows the importance of studying, uh,
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  Speaker 1: with different sexes, because if it's impacting majority women and
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  Speaker 1: you're not studying it that way, then I'm sure there's
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  Speaker 1: gaps
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  Speaker 1: that fall.
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  Speaker 2: Exactly. And so like historically people just did not consider.
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  Speaker 2: How biological sex might be and gender-related, you know, factors
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  Speaker 2: such as social determinants of health, which are also very gendered, um,
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  Speaker 2: how they might interact with our biology and contribute to
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  Speaker 2: different profiles of risk and outcomes. And so in the
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  Speaker 2: case of Alzheimer's disease, exactly, the assumption was, oh, females
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  Speaker 2: are living longer and that's why.
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  Speaker 2: And then these kind of other findings were popping up
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  Speaker 2: and then people decided, yes, it's time to look at
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  Speaker 2: sex differences, like we can't really hide this. There was a,
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  Speaker 2: a lot of strong advocates for it and people started listening,
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  Speaker 2: but it takes advocacy and it takes, you know,
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  Speaker 2: The scientist that wants to ask the question,
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  Speaker 1: what roles do hormones play in brain
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  Speaker 1: function?
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  Speaker 2: Hormones play a huge role in body and brain function.
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  Speaker 2: And so we know that within the brain, there's multiple
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  Speaker 2: different types of estrogens. So, estrogen is not a single chemical.
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  Speaker 2: There's many types and they have different, yeah, so there's
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  Speaker 2: different factors and different ways in which they function in
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  Speaker 2: the brain. And the primary one that most of us
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  Speaker 2: study are interested in is estradiol, 17 beta or E2.
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  Speaker 2: Um, and that type of estrogen has receptors in the brain,
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  Speaker 2: in two key brain areas important for memory and cognition.
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  Speaker 2: The hippocampus, which is a critical area of the brain
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  Speaker 2: from memory, so damage to the hippocampus leads to amnesia.
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  Speaker 2: Some of you might have heard of a scientist named
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  Speaker 2: Brenda Milner. So she did a lot of research on
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  Speaker 2: this patient, HM who had damage to the hippocampus, and
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  Speaker 2: he could not learn new information and he had really
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  Speaker 2: poor memory.
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  Speaker 2: Um, and so the hippocampus is a key, uh, part
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  Speaker 2: of the brain for learning new things and remembering things.
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  Speaker 2: And then the prefrontal cortex, which is very important for
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  Speaker 2: organizing behavior, predicting the future, perspective, planning, um, our sense
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  Speaker 2: of self, things like that. So, it's very important for
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  Speaker 2: what neuroscientists will call cognitive control.
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  Speaker 2: And so, here are two brain regions that are really
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  Speaker 2: enriched for estrogen receptors and so, and they're really important
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  Speaker 2: for a lot of types of cognitive behaviors as well.
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  Speaker 2: So when there's estrogen-related fluctuations, you could imagine how the
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  Speaker 2: way that these regions function and communicate with other areas
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  Speaker 2: of the brain because the brain is a large scale
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  Speaker 2: neural network. Um, it has profound effects across many different
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  Speaker 2: behavioral domains.
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  Speaker 1: I, when I was going through my health issues, I
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  Speaker 1: kept hearing from friends, oh, it could be perimenopause and
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  Speaker 1: something that comes up a lot. Well, I think there's
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  Speaker 1: a lot of confusion about perimenopause and menopause. They're two
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  Speaker 1: different things different
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  Speaker 1: stages. Can you explain to us?
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  Speaker 2: Sure, so in midlife, most of us enter midlife and
• 11:02
  Speaker 2: we're pre-menopausal. I say most of us because some people do.
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  Speaker 2: Enter perimenopause in their thirties,
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  Speaker 1: as early as 35,
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  Speaker 2: right? Yeah, some people menopause before the age of 40, right? So,
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  Speaker 2: but on average, spontaneous menopause, if you have ovaries occurs
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  Speaker 2: in Canada on the at the average age of 51.
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  Speaker 2: And so you're pre-menopausal, meaning you're having regular cycles, you're still,
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  Speaker 2: you know, reproductively fertile.
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  Speaker 2: Um, and you still have like the menstrual cycle, like
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  Speaker 2: the luteal phase, the follicular phase. It's very stable and
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  Speaker 2: it happens. And then things start to change in your body,
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  Speaker 2: your ovaries and your eggs are getting fewer. Your estrogen
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  Speaker 2: starts to increase and kind of fluctuate. And so it
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  Speaker 2: is fluctuating during perimenopause, but it is on the slow decline.
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  Speaker 2: So it's jumping around, but it's slowly declining.
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  Speaker 2: Um, and so perimenopause is a time where females might
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  Speaker 2: experience night sweats, difficulties in sleeping, um, start to have
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  Speaker 2: urinary tract infections, have, you know, dryness down there, itchy ears,
• 12:02
  Speaker 2: itchy ears, itchy frozen shoulder, yeah, frozen shoulder, all sorts
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  Speaker 2: of interesting, um, side effects of this natural phase in
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  Speaker 2: human aging, like female aging. I do like to like
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  Speaker 2: highlight that it is a natural process, but some females.
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  Speaker 2: Females do experience, um, you know, 60% of females report
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  Speaker 2: having brain fog and memory complaints. And so it is
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  Speaker 2: a phase of a lot of change. You know, your
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  Speaker 2: body is really rewiring its system, like your body and
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  Speaker 2: brain is rewiring as there's this slow decline in a
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  Speaker 2: primary sex hormone in the female body. And then eventually,
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  Speaker 2: it declines to the point that it's not been measurable
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  Speaker 2: by like traditional techniques that we use in the lab
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  Speaker 2: called Eliza.
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  Speaker 2: And you, and you stop having periods altogether. You no
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  Speaker 2: longer are releasing eggs. You're no longer reproductively, you know, healthy,
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  Speaker 2: I guess, or I don't like to use the word tall,
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  Speaker 2: but reproductively fit, right? So, and you enter menopause. So
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  Speaker 2: menopause is technically defined medically as one year of no,
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  Speaker 2: you know, no cycling.
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  Speaker 2: Um, so if you're spotting after menopause, it's often important
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  Speaker 2: you go visit your doctor because it's not a nat
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  Speaker 2: that's not a natural part of menopause to spot after
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  Speaker 2: you've menopaused, but you do spot, you know, here and
• 13:17
  Speaker 2: there until you reach menopause, and then it's one year
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  Speaker 2: of no cycling, no spotting, no periods, and
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  Speaker 1: that's menopause. That's menopause. Thank you for
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  Speaker 2: to that point, you're perimenopausal.
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  Speaker 1: Thank you for explaining that because I think, uh, we're using,
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  Speaker 1: we're seeing a lot of, um, things online.
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  Speaker 1: Where it's the same thing and it's two different things.
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  Speaker 1: It's two different things. Perimenopause can last 10 years and this,
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  Speaker 1: you know, circus of horrors goes on. But one of
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  Speaker 1: the things that people always say when you're going through
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  Speaker 1: the change is the night sweats and the brain fog,
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  Speaker 1: and it's got like cute words, but it's actually quite
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  Speaker 1: scary when you are in the prime of your life
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  Speaker 1: and your brain is not working.
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  Speaker 1: Uh, the way, and I, I should also mention that
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  Speaker 1: studies do show that even though we're going through perimenopause
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  Speaker 1: and have brain fog.
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  Speaker 1: It doesn't mean that women are less capable
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  Speaker 1: in the workplace,
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  Speaker 2: not
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  Speaker 2: at all.
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  Speaker 1: But I think that also leads to people not talking
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  Speaker 1: about it because you also don't want people to think
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  Speaker 1: like you're not as capable as
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  Speaker 1: you used to be.
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  Speaker 2: Yeah, I think that's an important point. I think historically,
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  Speaker 2: there's been a hesitance to talk about women's health because
• 14:25
  Speaker 2: of this concern about how we are perceived and how
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  Speaker 2: we will be treated because the history of womanhood on,
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  Speaker 2: you know, in the society, and so we've been hesitant
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  Speaker 2: to talk about it.
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  Speaker 2: But aging is related to a lot of things as well.
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  Speaker 2: And I always like to frame menopause within the context
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  Speaker 2: of healthy aging because we're all aging, males and females, and,
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  Speaker 2: you know, there are differences in our cognition as we
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  Speaker 2: age and in our bodies as we age, and we
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  Speaker 2: study that because we want to optimize our aging.
• 14:53
  Speaker 2: And make sure people age as well as possible. So
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  Speaker 2: why not do the same with menopause? Like we're just,
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  Speaker 2: we need to optimize how females experience this very natural
• 15:03
  Speaker 2: part of endocrinological aging, right?
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  Speaker 1: Well, explain to
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  Speaker 1: us how it works because, um, as we've been talking about,
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  Speaker 1: estrogen tends to fluctuate throughout a woman's life, but never
• 15:13
  Speaker 1: more so, I guess, during menopause. What happens to a
• 15:16
  Speaker 1: woman's brain at this time?
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  Speaker 2: So, we're just starting to understand what's happening to the
• 15:22
  Speaker 2: women's brain during menopause transition. Um, and that's the primary
• 15:26
  Speaker 2: focus of what the, the research in my lab is, um, doing.
• 15:30
  Speaker 2: And there's two things that we're trying to address. So, first,
• 15:33
  Speaker 2: there's a big debate of whether or not some of
• 15:35
  Speaker 2: these changes that females experience subjectively, can we objectively, you know, validly, yes,
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  Speaker 2: this is true. You are experiencing memory decline, like it's not,
• 15:45
  Speaker 2: cause a lot of times females will go to the
• 15:47
  Speaker 2: doctor and they'll be told, it's just, you know, it's,
• 15:51
  Speaker 2: that's fine. Like it's just subjective. You're not really showing
• 15:54
  Speaker 2: any decline and many tests are insensitive to showing an object.
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  Speaker 2: measure. And so one of the things that my um
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  Speaker 2: lab designed was a memory task that really does objectively
• 16:04
  Speaker 2: show that at menopause, there is an age-related decline. So
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  Speaker 2: we use this task called the spatial context memory task.
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  Speaker 2: It's very like scientific, you know, something you do in
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  Speaker 2: a lab, um, but it's something we actually do in
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  Speaker 2: real life as well. So we ask people to memorize
• 16:18
  Speaker 2: spaces and the place they are on a screen, and
• 16:20
  Speaker 2: it's something you do day to day. You park your car,
• 16:23
  Speaker 2: where is it in the parking lot? I forget exactly.
• 16:26
  Speaker 2: Photo now, just to know exactly where it is. But,
• 16:29
  Speaker 2: you know, so we test this uh ability, the the
• 16:32
  Speaker 2: ability to memorize a face and its facial location. What
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  Speaker 2: we notice is this type of task, which is a
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  Speaker 2: very challenging task, is sensitive enough to validate that, yes, objectively,
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  Speaker 2: females at menopause show an age-related decline on average. And
• 16:46
  Speaker 2: I always like to, like stress the on average because
• 16:49
  Speaker 2: not all females show this decline and the level of
• 16:51
  Speaker 2: decline varies across females. And so what
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  Speaker 2: We're trying to understand is what accounts for that variation.
• 16:57
  Speaker 2: Is it their vascular health? Is it inflammatory biomarkers in
• 17:01
  Speaker 2: their blood? Is it having genetic risk factors for Alzheimer's disease?
• 17:05
  Speaker 2: And then what we need to follow up with is,
• 17:08
  Speaker 2: is it transient or is it something that is chronic?
• 17:11
  Speaker 2: And we hope that for the vast majority of females,
• 17:14
  Speaker 2: it is something transient, right? As the system is neuro,
• 17:18
  Speaker 2: you know, pla the plasticity of the system during this transition,
• 17:21
  Speaker 2: it's rewiring it.
• 17:22
  Speaker 2: Itself and as it adjusts, things will kind of better,
• 17:27
  Speaker 2: get better. And we might even adopt new ways of
• 17:30
  Speaker 2: being that are healthier in the long term as we age. Um,
• 17:34
  Speaker 2: but for some females, it might not be transient, it
• 17:36
  Speaker 2: might be chronic, and they might be the females that
• 17:38
  Speaker 2: really need intervention and attention to kind of promote healthy
• 17:42
  Speaker 2: aging and prevent or delay the onset of dementia and
• 17:45
  Speaker 2: that's what the research is focused on.
• 17:47
  Speaker 1: Something I've been seeing a lot online is that um
• 17:50
  Speaker 1: When women get to a certain age, they stop doing the,
• 17:54
  Speaker 1: you know, the people pleasing, which I'm very much looking
• 17:56
  Speaker 1: forward to. But, um, you know, a, a surgery that
• 17:59
  Speaker 1: seems to be the go to for a lot of
• 18:01
  Speaker 1: females who are experiencing gynecology illnesses like fibroids is hysterectomy.
• 18:06
  Speaker 1: Hysterectomy is the second most common surgery for women behind
• 18:09
  Speaker 1: a C-section.
• 18:11
  Speaker 1: Um, but I recently found out that getting a hysterectomy,
• 18:14
  Speaker 1: depending on your age, if you're too young, can actually
• 18:17
  Speaker 1: increase the likelihood for women developing Alzheimer's later in life.
• 18:21
  Speaker 1: Why is that and why aren't we talking more about that?
• 18:25
  Speaker 1: Because of what
• 18:25
  Speaker 1: the,
• 18:26
  Speaker 2: yeah, and you know, I, I too was offered hysterectomy
• 18:30
  Speaker 2: because of fibroids and opted not to get it.
• 18:33
  Speaker 2: Um, for these reasons. Um, and so, and it always
• 18:36
  Speaker 2: depends on how extreme your fibroids are and how much
• 18:39
  Speaker 2: it's affecting your quality of life, uh, your decision.
• 18:43
  Speaker 2: But it's because the blood supply to the ovaries are altered,
• 18:46
  Speaker 2: so you're, you know, if you do get a hysterectomy,
• 18:49
  Speaker 2: you need to have a conversation with your doctor about
• 18:52
  Speaker 2: keeping your ovaries if possible just because they are the
• 18:55
  Speaker 2: primary source of your, you know, um, peripheral estrogens.
• 18:59
  Speaker 2: And if it's not possible, then you do need to
• 19:03
  Speaker 2: have a conversation with your doctor about the options of
• 19:06
  Speaker 2: doing menopause hormone therapy to prove, to kind of mitigate
• 19:10
  Speaker 2: the loss of estrogen suddenly after a oophorectomy. But if you,
• 19:14
  Speaker 2: even if you do keep your ovaries, the blood supply
• 19:17
  Speaker 2: to the ovaries can be altered. It really depends on
• 19:19
  Speaker 2: the surgeon, right? Like it's
• 19:21
  Speaker 2: It's, there are surgeons that are better at surgery and
• 19:26
  Speaker 2: others that aren't, and sometimes they do nip some blood
• 19:28
  Speaker 2: supply and sometimes there is a lack of blood supply
• 19:31
  Speaker 2: to the ovaries which will lead to it not functioning optimally.
• 19:34
  Speaker 2: And so that's why, um, some females that, you know,
• 19:37
  Speaker 2: even if they maintain the ovaries and uh have their hysterectomy, um,
• 19:42
  Speaker 2: the uterus removed.
• 19:44
  Speaker 2: May still show some cognitive decline with aging, especially if
• 19:47
  Speaker 2: they're not treated appropriately with hormone replacement therapy.
• 19:50
  Speaker 1: And so that's how it's related to the brain health
• 19:51
  Speaker 1: because of the estrogen. Yes, exactly. Um, my health went
• 19:55
  Speaker 1: downhill after I got COVID for the first time, and
• 19:59
  Speaker 1: again it was kind of like, what's going on? Do
• 20:01
  Speaker 1: I have perimenopause? Is it long COVID?
• 20:04
  Speaker 1: Um, and a lot of my girlfriends were having similar
• 20:07
  Speaker 1: conversations and talking about the brain fog, uh, which can
• 20:10
  Speaker 1: be a side effect of long COVID or perimenopause, and
• 20:13
  Speaker 1: now we're seeing more studies that show that women are
• 20:16
  Speaker 1: actually more likely to be impacted by long COVID. Do
• 20:19
  Speaker 1: we know why that is?
• 20:21
  Speaker 2: I do not know why that is and that needs
• 20:23
  Speaker 2: to be studied. There are many mechanisms that are potential
• 20:25
  Speaker 2: like vascular health and inflammation, especially if you're going through
• 20:28
  Speaker 2: perimenopause and menopause during that time because the decrease in
• 20:32
  Speaker 2: estrogen does relate to an increase in vascular risk and
• 20:35
  Speaker 2: an and an increase in inflammatory response or immune reactivity.
• 20:39
  Speaker 2: Um, so there are, if you're going through perimenopause and there's,
• 20:44
  Speaker 2: you know, a disease that affects the inflammatory system like
• 20:47
  Speaker 2: COVID does, um, you might have this double kind of pit,
• 20:50
  Speaker 2: but we need to, like, this is ongoing research and
• 20:53
  Speaker 2: I am not a specialist in COVID, so I would
• 20:55
  Speaker 2: not want to say something that, you know, may not
• 20:58
  Speaker 2: translate or may not hold up in the long run. Yeah,
• 21:01
  Speaker 1: um, I wanna, uh, talk again about perimenopause and menopause.
• 21:05
  Speaker 1: According to reporting from the New York Times.
• 21:07
  Speaker 1: Women of color experience perimenopause differently. Black women experienced it
• 21:12
  Speaker 1: earlier and more severely. Asian American women, women, a group
• 21:16
  Speaker 1: that includes women who are of Chinese, Korean, South Asian
• 21:19
  Speaker 1: and Filipino backgrounds, studies have found that they were more
• 21:22
  Speaker 1: likely to experience chronic pain and anxiety as opposed to
• 21:26
  Speaker 1: hot flashes. Um, why is it important to recognize that perimenopause,
• 21:30
  Speaker 1: menopause impacts different populations differently?
• 21:34
  Speaker 2: Because the treatments that you offer are different and also
• 21:36
  Speaker 2: the health, the lifestyle approaches might differ for these different communities.
• 21:40
  Speaker 2: All females around the world who have ovaries experience menopause
• 21:45
  Speaker 2: and we need to understand the experiences within the context
• 21:49
  Speaker 2: of these cultures cause we don't know how much is
• 21:52
  Speaker 2: related to physiology and actual, you know, cultural differences in physiology.
• 21:57
  Speaker 2: Uh, cultural differences in communication style, cultural differences in the
• 22:01
  Speaker 2: language that is used, you know, certain cultures might not
• 22:05
  Speaker 2: even have the words for hot flashes, right? And so,
• 22:09
  Speaker 2: they may not use that term, but it's because, and
• 22:12
  Speaker 2: so we might not think they have hot flashes, but
• 22:14
  Speaker 2: they might, they just might use a different term. So
• 22:16
  Speaker 2: we really need to understand um how menopause is experienced
• 22:21
  Speaker 2: across the world and also what the average age of
• 22:23
  Speaker 2: menopause is across the world. Cause another thing.
• 22:25
  Speaker 2: That um you hear a lot of is how, you know,
• 22:28
  Speaker 2: the age of menopause matters and a younger age of
• 22:31
  Speaker 2: menopause might be a risk factor for poorer health outcomes
• 22:34
  Speaker 2: as we age.
• 22:36
  Speaker 2: But we don't know if that's true for all females
• 22:39
  Speaker 2: in all communities. That, that is based on Western standards
• 22:43
  Speaker 2: and results that have happened in studies that have not
• 22:46
  Speaker 2: represented um more diverse populations. The average age of menopause
• 22:51
  Speaker 2: in India is 47, right? 46, 47. So, and that
• 22:55
  Speaker 2: means the average, that means females are entering menopause on
• 22:58
  Speaker 2: average younger as well.
• 23:00
  Speaker 2: Um, does that mean that Indian women are more likely
• 23:05
  Speaker 2: to have poor health outcomes as we age? I don't know.
• 23:08
  Speaker 2: We have to study that. Same, the average age in
• 23:11
  Speaker 2: African-Americans is a bit younger, like 48, I believe.
• 23:16
  Speaker 2: Um, so, what is that? You know, how does that
• 23:18
  Speaker 2: translate these concepts of average age and early onset of
• 23:22
  Speaker 2: menopause being poor health outcomes? And how do we disentangle menopause, right?
• 23:27
  Speaker 2: Which is, um, a biological phenomena from the context in
• 23:31
  Speaker 2: which
• 23:31
  Speaker 2: These female females were born and raised, so the social
• 23:34
  Speaker 2: determinants of health. Because the social determinants of health are
• 23:37
  Speaker 2: the biggest modifiable factors for preventing dementia, delaying dementia, and
• 23:43
  Speaker 2: for aging well. And for health in general, optimizing health
• 23:46
  Speaker 2: in general.
• 23:47
  Speaker 2: Um, and so we know that, but, you know, to
• 23:50
  Speaker 2: implement changes in social determinants of health, it really is
• 23:53
  Speaker 2: a policy, you know, these are policies that need to
• 23:55
  Speaker 2: be adopted at a governmental level and, you know, to
• 23:59
  Speaker 2: help people age better. And by age, I mean not
• 24:02
  Speaker 2: just older age, I mean age like the set you're
• 24:05
  Speaker 2: developing and then you're aging, and we need to start
• 24:07
  Speaker 2: thinking of aging as a life course, um, as well.
• 24:11
  Speaker 2: We're aging from the time we're young adults.
• 24:13
  Speaker 1: My daughter, my
• 24:14
  Speaker 1: daughter says we're born to die. I'm like, you're too
• 24:16
  Speaker 1: wise to be 12 years old. And I guess also
• 24:19
  Speaker 1: too the dangers if you have this idea of the
• 24:21
  Speaker 1: age of when females are supposed to go through menopause
• 24:24
  Speaker 1: is if you're younger, and if you are from a culture,
• 24:28
  Speaker 1: a background that might go through it younger, if you
• 24:31
  Speaker 1: go to get help, they might dismiss your symptoms as
• 24:34
  Speaker 1: being nothing to worry about. You mentioned the social determinants
• 24:38
  Speaker 1: of health.
• 24:39
  Speaker 1: What role do they play when it comes to our
• 24:42
  Speaker 1: brain health, cause I don't think um a lot of
• 24:44
  Speaker 1: people realize how we live or where we live can
• 24:47
  Speaker 1: impact how we age.
• 24:49
  Speaker 2: So, this concept in cognitivization called cognitive reserve, it comes
• 24:53
  Speaker 2: from the literature in dementia where we observed that
• 24:57
  Speaker 2: There's some individuals, as they age, they seem to maintain
• 25:00
  Speaker 2: their cognitive health later in life, but then once they
• 25:05
  Speaker 2: are diagnosed with dementia, they show a steeper decline. And so,
• 25:08
  Speaker 2: individuals start looking at their brains using PET imaging and
• 25:11
  Speaker 2: then autopsy.
• 25:12
  Speaker 2: And what we noticed was these individuals actually had more
• 25:16
  Speaker 2: neuropathology in their brain when they hit ag when they
• 25:19
  Speaker 2: got diagnosed, but were able to maintain their cognitive function
• 25:23
  Speaker 2: despite the presence of these neuropathologies. And so this implied
• 25:27
  Speaker 2: to us that
• 25:28
  Speaker 2: You know, there is this ability in in the human
• 25:31
  Speaker 2: brain to kind of compensate and make up for this,
• 25:35
  Speaker 2: this damage that's accumulating in the brain and this concept
• 25:38
  Speaker 2: is cognitive reserve. And so cognitive reserve is related to
• 25:41
  Speaker 2: social determinants of health. So we know that higher education,
• 25:45
  Speaker 2: you know, leads to a more cognitive reserve. People that
• 25:48
  Speaker 2: have a more, more educated tend to age well and
• 25:51
  Speaker 2: maintain cognitive function longer.
• 25:53
  Speaker 2: Um, we know that eating healthy, having a good lifestyle
• 25:57
  Speaker 2: and maintaining, you know, um.
• 26:00
  Speaker 2: Lower body mass, like lower uh hip to waist ratio
• 26:03
  Speaker 2: is good for aging as well. So, we know these
• 26:06
  Speaker 2: kind of cognitive reserve variables are good. Living in an
• 26:09
  Speaker 2: area that's not polluted, has a lot of green spaces. We,
• 26:13
  Speaker 2: there's a lot of research coming out that these social
• 26:15
  Speaker 2: determinants of health, help bolster cognitive reserve and help maintain
• 26:20
  Speaker 2: healthy aging for individuals. And so, we're starting to kind
• 26:23
  Speaker 2: of tease apart.
• 26:24
  Speaker 2: How does this relate to different communities around the world?
• 26:27
  Speaker 2: Is it just in North America, Things like, you know,
• 26:30
  Speaker 2: and in Europe. So, we're starting to understand that. But
• 26:33
  Speaker 2: in general, there is this concept of social determinants of
• 26:35
  Speaker 2: health and its relationship to cognitive reserve and brain resilience.
• 26:39
  Speaker 2: And so, this is something that needs to be studied, um,
• 26:42
  Speaker 2: to identify what social determinants of health are the most impactful. So,
• 26:46
  Speaker 2: you know, education policies, is that where we should be.
• 26:49
  Speaker 2: Be putting money as a government, as a country to,
• 26:53
  Speaker 2: you know, to make education more accessible and less costly
• 26:56
  Speaker 2: for people because it really does help people as they
• 26:59
  Speaker 2: age as well. So things like that, that's what social
• 27:02
  Speaker 2: determines why they're important.
• 27:03
  Speaker 1: I've
• 27:03
  Speaker 1: also heard like even racism can play a role in
• 27:06
  Speaker 1: your brain
• 27:06
  Speaker 1: health,
• 27:07
  Speaker 2: yeah. And so that's like there's social determinants of health
• 27:09
  Speaker 2: and then structural determinants of health where systems are built
• 27:13
  Speaker 2: to kind of
• 27:15
  Speaker 2: Uh, support certain communities and hinder other communities and then
• 27:18
  Speaker 2: the structural effects of that. So the racism that you
• 27:21
  Speaker 2: see in society, the stress. So, stress is an interesting
• 27:25
  Speaker 2: thing cause it's a biological phenomenon, like it's how you
• 27:28
  Speaker 2: experience the world and then how it translates into your body.
• 27:31
  Speaker 2: And stress itself is not a social determinant of health,
• 27:35
  Speaker 2: but it probably is one of the major mechanisms by which,
• 27:38
  Speaker 2: you know, having poor social determinants of health, so living
• 27:41
  Speaker 2: in poverty, not having good access to high-quality foods, not, um,
• 27:46
  Speaker 2: you know, being able to sleep well at night because
• 27:48
  Speaker 2: it's noisy out or you're scared.
• 27:50
  Speaker 2: Um, for your safety, things like that, all of these
• 27:53
  Speaker 2: things accumulate stress in your body, and that will have
• 27:56
  Speaker 2: negative outcomes on brain health and aging, starting from young
• 28:00
  Speaker 2: adulthood and mental health,
• 28:02
  Speaker 1: um, because even we know that, uh, groceries are very expensive.
• 28:06
  Speaker 1: Uh, we have a lot of food deserts. Um, some
• 28:09
  Speaker 1: people just don't have, if you're living in an environment
• 28:14
  Speaker 1: where you don't have access to that, it's pretty much,
• 28:16
  Speaker 1: it seems as if you're, when you think about how
• 28:19
  Speaker 1: you're getting older, how you're aging.
• 28:21
  Speaker 1: It's already determined how your brain health is gonna be
• 28:24
  Speaker 1: when you get older. It just seems so
• 28:25
  Speaker 1: unfair.
• 28:25
  Speaker 2: It's unfair and you know, this is why in some
• 28:29
  Speaker 2: ways people are like, well, you need to exercise, you
• 28:31
  Speaker 2: need to eat well, and it's a very, it's coming
• 28:33
  Speaker 2: from a place of privilege to say that cause not
• 28:36
  Speaker 2: everyone can afford to take the time to exercise. Not
• 28:40
  Speaker 2: everyone has the money in their bank to eat healthy.
• 28:43
  Speaker 2: Um, so really, um, we, we as researchers can come
• 28:48
  Speaker 2: up with, this is the ideal lifestyle like the Mediterranean diet,
• 28:51
  Speaker 2: getting cardiovascular training, doing strength training.
• 28:54
  Speaker 2: Um, but the ultimate question is how do we make
• 28:58
  Speaker 2: society more equitable so everyone can access these things, um,
• 29:02
  Speaker 2: because if we, we might know the solutions, but then
• 29:04
  Speaker 2: to enact them into policy, that goes beyond the researcher, right?
• 29:09
  Speaker 2: That's the research, what we do as researchers is we
• 29:11
  Speaker 2: find these results and then we communicate to the public.
• 29:14
  Speaker 2: And then some of us will, you know, become advocates
• 29:17
  Speaker 2: or go that advocacy route to really push for policy change, um,
• 29:22
  Speaker 2: to integrate what we know from research, but that needs
• 29:24
  Speaker 2: to happen for that translation. If that, if that doesn't happen,
• 29:28
  Speaker 2: it doesn't translate and we, we, we might sit on a, uh,
• 29:31
  Speaker 2: you know, mountain of knowledge.
• 29:33
  Speaker 2: That cannot actually be implemented because that's beyond our power.
• 29:37
  Speaker 1: I wanted to, uh, talk about solutions and a way forward.
• 29:42
  Speaker 1: You've mentioned policy. What should our governments be doing to
• 29:44
  Speaker 1: support women's brain health?
• 29:46
  Speaker 2: Invest in it. Like they're really.
• 29:49
  Speaker 2: Canada is not investing in women's brain health at this moment.
• 29:54
  Speaker 2: Like there are, there are researchers like myself who are
• 29:56
  Speaker 2: funded and well funded by tri-council, uh, grants that are, um,
• 30:01
  Speaker 2: so there's NSIC, SHRC, and CICRA. They're the three major
• 30:04
  Speaker 2: funding bodies in Canada.
• 30:06
  Speaker 2: Um, they have not had, uh, a significant increase in
• 30:10
  Speaker 2: funding from the federal government for many, many years, um,
• 30:14
  Speaker 2: and the cost of doing research has increased. So in
• 30:17
  Speaker 2: some ways, by not increasing funding to these uh funding agencies,
• 30:21
  Speaker 2: you're actually hurting researchers. You're actually reducing the amount of
• 30:24
  Speaker 2: funding available because the cost of research has gone up.
• 30:27
  Speaker 2: We're all encouraged to pay our students a living wage, right?
• 30:31
  Speaker 2: We're encouraged to pay our staff a living wage. That
• 30:33
  Speaker 2: living wage is increasing, as we all know.
• 30:36
  Speaker 2: And so, and as researchers, you know, a lot of these, um,
• 30:39
  Speaker 2: we want to take care of our staff and our students,
• 30:42
  Speaker 2: but that money then is going away from the research.
• 30:45
  Speaker 2: And then the cost of actually like purchasing the equipment, um, purchasing,
• 30:49
  Speaker 2: you know, doing the tests that we need to do
• 30:51
  Speaker 2: to do our research, those costs are going up too.
• 30:54
  Speaker 2: Everything's going up, but our funding line has not. And
• 30:57
  Speaker 2: so this really hurts research in general in Canada and
• 31:00
  Speaker 2: as a result.
• 31:01
  Speaker 2: You know, people see women's health research as a niche
• 31:04
  Speaker 2: thing and that needs to change. It's not a niche thing.
• 31:08
  Speaker 2: Women's health is health for all because by studying women,
• 31:13
  Speaker 2: we actually learn a lot about men as well and
• 31:15
  Speaker 2: what works for women and what works for men.
• 31:18
  Speaker 2: And if we, we always hear about precision medicine and
• 31:21
  Speaker 2: using AI tools, well, AI only works if you have
• 31:24
  Speaker 2: the base data to, you know, develop the AI tools,
• 31:28
  Speaker 2: but we don't have the data on women and we
• 31:30
  Speaker 2: don't have the data on diverse populations. So, in order
• 31:33
  Speaker 2: to really get to a precision health in our, in
• 31:36
  Speaker 2: our society, which is what everyone wants, we need to
• 31:39
  Speaker 2: study women and then we need to study the intersectional
• 31:42
  Speaker 2: identities of people.
• 31:44
  Speaker 2: As
• 31:44
  Speaker 1: well. And hello, we make up 50% of the population.
• 31:47
  Speaker 2: Exactly. And you know, we need, and the, what most
• 31:50
  Speaker 2: researchers can do is recruit women into your studies if
• 31:54
  Speaker 2: you're doing human subject studying and if you're doing animal studies,
• 31:57
  Speaker 2: test female animals as well and disaggregate your data like we, we,
• 32:02
  Speaker 2: a lot of people have the data. They just haven't
• 32:05
  Speaker 2: looked at it through a sex and gender-based analysis lens.
• 32:08
  Speaker 1: Well what can individuals do for to protect their own
• 32:11
  Speaker 1: health because systems, uh, you know, I think we're all exhausted.
• 32:15
  Speaker 1: We're all just trying to do the best that we can.
• 32:17
  Speaker 1: What can individuals do to, um, make sure that when
• 32:21
  Speaker 1: they do get to a certain age, because a lot
• 32:23
  Speaker 1: of our brain health, the diseases don't just happen, uh,
• 32:27
  Speaker 1: they take
• 32:28
  Speaker 1: decades to develop,
• 32:30
  Speaker 2: right? Exactly. And so there are many things that you
• 32:32
  Speaker 2: could do starting at a like young adulthood like.
• 32:34
  Speaker 2: You know, I don't, you know, trying your best to
• 32:38
  Speaker 2: adopt a healthy lifestyle. One thing you can do is
• 32:41
  Speaker 2: quit smoking. Like that's a modifiable risk factor that will
• 32:44
  Speaker 2: save you money, right? So, smoking is, we know that
• 32:48
  Speaker 2: that's one of the biggest risk factors for late life dementia,
• 32:51
  Speaker 2: and it's modifiable, and so you could quit smoking. Uh,
• 32:54
  Speaker 2: you could reduce your alcohol intake again, saving some money, um,
• 32:58
  Speaker 2: but we do know that, you know, high levels of
• 32:59
  Speaker 2: alcohol intake is detrimental to aging. So there are things
• 33:03
  Speaker 2: you could do that.
• 33:05
  Speaker 2: Will actually save you money. Um, so, you know, quit smoking,
• 33:09
  Speaker 2: quit drinking, um, not quit but like reduce the amount, uh,
• 33:14
  Speaker 2: and you could also like prioritize sleep. So sleep is
• 33:19
  Speaker 2: doesn't cost you anything, but if you have night flashes,
• 33:22
  Speaker 2: you can't sleep. I know, I know, I know.
• 33:24
  Speaker 2: Prioritizing sleep. There are new medications on the market that
• 33:27
  Speaker 2: are purely for hot flashes. I'm not an advocate. I
• 33:31
  Speaker 2: am not paid by the drug companies or anything, but
• 33:33
  Speaker 2: I'm curious about how this will, you know, work. Um,
• 33:36
  Speaker 2: and whether that's a good alternative, especially for females that
• 33:39
  Speaker 2: are concerned because they do have, um,
• 33:42
  Speaker 2: You know, counter, contraindications for taking menopause hormone therapy. So
• 33:46
  Speaker 2: that's another thing. Women can approach the doctor and advocate
• 33:49
  Speaker 2: for themselves um to consider menopause hormone therapy, but you
• 33:54
  Speaker 2: really need to, you know, talk with your doctor, find
• 33:56
  Speaker 2: a doctor that's open to these conversations and consider your,
• 34:00
  Speaker 2: your personal history.
• 34:01
  Speaker 2: Um, you know, whether or not you have a history
• 34:03
  Speaker 2: of heart attack and stroke cause these, uh, hormone replacement therapy,
• 34:07
  Speaker 2: it does increase risk of these things. And so cardiovascular
• 34:11
  Speaker 2: health is important to consider your family history of cancer.
• 34:14
  Speaker 2: But when it comes to family history of cancer, I
• 34:16
  Speaker 2: will say that the original scare from the Women's Health
• 34:19
  Speaker 2: Initiative study, um, it was, you know, the percentage of
• 34:24
  Speaker 2: risk was not as high.
• 34:26
  Speaker 2: As people were led to believe, and there are, I
• 34:30
  Speaker 2: know a person that has, you know, had personally had
• 34:33
  Speaker 2: a breast cancer scare and, you know, was treated for
• 34:36
  Speaker 2: breast cancer and was on menopause hormone therapy afterwards. So
• 34:39
  Speaker 2: it is possible you just need a doctor that's willing
• 34:42
  Speaker 2: to walk that walk, you know, path with you and
• 34:46
  Speaker 2: treat you and see you regularly to make sure that
• 34:50
  Speaker 2: you can make.
• 34:50
  Speaker 2: Maintain menopause hormone therapy while still maintaining the rest of
• 34:53
  Speaker 2: your body's health. Taking HRT right now, it's, you know,
• 34:57
  Speaker 2: thought that it's best to take it when you enter
• 34:59
  Speaker 2: perimenopause and into menopause, but then to stop taking it,
• 35:03
  Speaker 2: like not to stay on menopause hormone therapy long term
• 35:06
  Speaker 2: cause we still don't know about the long-term effects and
• 35:09
  Speaker 2: there's mixed results as far as um the cost and benefits.
• 35:12
  Speaker 2: There are some studies from the UK Biobank.
• 35:15
  Speaker 2: Um, led by Claudia Barth and others that show that
• 35:18
  Speaker 2: women that have a history of staying on menopause hormone
• 35:21
  Speaker 2: therapy long term, they showed more hippocampal volume loss and,
• 35:26
  Speaker 2: you know, more gray matter loss. So there are, it,
• 35:30
  Speaker 2: we don't know why, because because we don't study women's health, yeah,
• 35:33
  Speaker 2: we don't study women's health, and this is like just
• 35:34
  Speaker 2: like a cross-sectional data like what we need is a
• 35:37
  Speaker 2: large scale longitudinal study that really considers.
• 35:41
  Speaker 2: Historically, the different sex-specific experiences of females. Like we want
• 35:45
  Speaker 2: to understand women's body health and brain health. We need
• 35:48
  Speaker 2: to study from menstruation to through parity pregnancies, through menopause,
• 35:54
  Speaker 2: like longitudinally, at least cross-sexually, put a bunch of studies
• 35:58
  Speaker 2: together that are longitudinally.
• 36:00
  Speaker 2: to really get a full map of how do women age, right?
• 36:04
  Speaker 1: It just makes me really upset to think of all
• 36:07
  Speaker 1: the millions of women who've had to suffer as we
• 36:10
  Speaker 1: just play catch up to, you know, the lack of funding,
• 36:13
  Speaker 1: the lack of research, um, for you, what makes you hopeful?
• 36:18
  Speaker 2: Um, what makes me hopeful is that there's a lot
• 36:21
  Speaker 2: of female scientists and male scientists that are advocating for
• 36:24
  Speaker 2: this in Canada, in Europe, in the US. Um, I
• 36:27
  Speaker 2: think we realized how much biological sex and sex-specific experiences, um,
• 36:33
  Speaker 2: shape our brain health and our body health, and people
• 36:36
  Speaker 2: are understanding more and more that the brain is not
• 36:39
  Speaker 2: living in isolation, that things that happen in our
• 36:42
  Speaker 2: Our body and in our environment affect our brain health.
• 36:46
  Speaker 2: And so there is this growing awareness of brain-body interactions and,
• 36:50
  Speaker 2: you know, social context and its effects on brain health.
• 36:53
  Speaker 2: And there is a movement, I think within the neuroscience
• 36:55
  Speaker 2: community to really invest in research uh that looks at
• 36:59
  Speaker 2: this and that puts women's brain health at the forefront.
• 37:01
  Speaker 2: Like that is the first thing we should be doing
• 37:04
  Speaker 2: in order to get a bigger picture of how the brain.
• 37:07
  Speaker 2: Um, how brain health evolves over the lifespan. Women that
• 37:10
  Speaker 2: are considering taking menopause hormone therapy, and I've said this, um,
• 37:16
  Speaker 2: on some, on social media and sometimes get backlash for it,
• 37:19
  Speaker 2: but it is important to find a doctor that listens
• 37:24
  Speaker 2: to you, um, and not to just follow the advice
• 37:28
  Speaker 2: of individuals on social media that may not have the training.
• 37:32
  Speaker 2: And I understand that there's frustration in the space because
• 37:35
  Speaker 2: a lot of females are talking to their doctors and
• 37:37
  Speaker 2: are being like shut down or told, you know, you're
• 37:40
  Speaker 2: being
• 37:40
  Speaker 2: You're being silly, right? Just lose 5 pounds. Yeah, exactly.
• 37:44
  Speaker 2: And that's, that's not cool either. Like you have to find,
• 37:47
  Speaker 2: you have to keep, sadly, we have to be our
• 37:50
  Speaker 2: own advocate and listen to our own bodies. And so
• 37:53
  Speaker 2: that's the other thing I'd like to, I'd like to say.
• 37:55
  Speaker 2: If you do go on menopause hormone therapy, listen to
• 37:57
  Speaker 2: your body, you know, if your body doesn't feel right,
• 38:01
  Speaker 2: you should talk to your doctor about that, not just,
• 38:03
  Speaker 2: oh well.
• 38:04
  Speaker 2: You know, I, I wanted to do this, so I'm
• 38:06
  Speaker 2: just gonna stick to menopause hormone therapy because from my
• 38:08
  Speaker 2: personal experience, right, I went on menopause hormone therapy because
• 38:12
  Speaker 2: I was having hot flashes, and then I start to
• 38:14
  Speaker 2: feel tightness in my chest. And so I had to
• 38:17
  Speaker 2: listen to that and I went and I went through,
• 38:19
  Speaker 2: visited a cardiologist, got my heart checked, OK, and they
• 38:22
  Speaker 2: gave me the green light to keep staying on it.
• 38:25
  Speaker 2: And so I went back on it, but there was
• 38:27
  Speaker 2: a moment like where you have to listen.
• 38:28
  Speaker 2: and say, OK, is my heart healthy enough to be
• 38:30
  Speaker 2: on menopause hormone therapy, especially if you have a family
• 38:33
  Speaker 2: history of heart attacks or strokes like my family does.
• 38:36
  Speaker 2: And so you need to listen to your body. So you're, you're,
• 38:39
  Speaker 2: you're the best advocate for yourself.
• 38:41
  Speaker 1: Professor Rajah, it's been such a pleasure. I've learned so much.
• 38:44
  Speaker 1: You make a complicated subject, quite, uh, you know how
• 38:47
  Speaker 1: to communicate really well. Thank you so much.
• 38:49
  Speaker 2: Thank you so much. I
• 38:50
  Speaker 1: appreciate you being on the podcast.
• 38:51
  Speaker 2: Thanks for having me.
• 38:53
  Speaker 1: That was Mistreated. Thanks for listening. You can follow our
• 38:55
  Speaker 1: show wherever you get your podcasts so that you can
• 38:57
  Speaker 1: get notified each time a new episode is available. We
• 39:01
  Speaker 1: would love to hear your feedback. You can write me
• 39:03
  Speaker 1: an email at mistreatedpodcast@tvo.org or reach out on my social channels.
• 39:09
  Speaker 1: We've got some reaction to our last episode on cranial
• 39:11
  Speaker 1: cervical instability and Ehlers‑Danlos Syndrome. Thank you so much for interviewing
• 39:16
  Speaker 1: Sydney and bringing attention to cranial cervical instability, CCI.
• 39:20
  Speaker 1: What patients are facing across every province in Canada is
• 39:24
  Speaker 1: devastating and can have lifelong impacts. We lack trained experts,
• 39:29
  Speaker 1: accessible care, and clear diagnostic criteria. Uh, one of the
• 39:33
  Speaker 1: shocking things I've learned about these conditions is how few
• 39:35
  Speaker 1: people are in the country who can help to diagnose
• 39:39
  Speaker 1: and to treat cranial cervical instability and Ehlers‑Danlos Syndrome.
• 39:43
  Speaker 1: So a lot of people end up fighting for care,
• 39:45
  Speaker 1: and if they have the financial means, they travel outside
• 39:49
  Speaker 1: of Canada to get that care, and it shouldn't be
• 39:51
  Speaker 1: that way. We have another comment from last week's episode.
• 39:54
  Speaker 1: There's so many underdiagnosed and mistreated citizens in Canada. Canadian
• 39:58
  Speaker 1: healthcare and governments need to take care of its people,
• 40:01
  Speaker 1: and it is clearly doing a failing job despite being
• 40:04
  Speaker 1: a wealthy country.
• 40:05
  Speaker 1: Thank you TVO for your professional journalism, and kudos to
• 40:08
  Speaker 1: Sydney for articulating a very complex topic. CCI and EDS
• 40:13
  Speaker 1: are incredibly complex issues, and as we mentioned last week,
• 40:17
  Speaker 1: Mistreated will be investigating what is going on with treatment, diagnosis,
• 40:20
  Speaker 1: and how patients are being impacted. Look for that in
• 40:23
  Speaker 1: early 206. We've got one more comment. Healthcare is a
• 40:27
  Speaker 1: human right. Governments need to step up more to unburden
• 40:30
  Speaker 1: citizens from this healthcare tragedy.
• 40:33
  Speaker 1: We really appreciate all of those comments and my deepest
• 40:36
  Speaker 1: appreciation to Sydney for using her voice to bring attention
• 40:39
  Speaker 1: to this. This is our last episode of the year,
• 40:43
  Speaker 1: but we will be back in January 2026. Thank you
• 40:46
  Speaker 1: so much for all the support on this podcast. And
• 40:49
  Speaker 1: as mentioned, email us your suggestions, your comments, and we
• 40:53
  Speaker 1: will try to incorporate them into the podcast. This week's
• 40:57
  Speaker 1: episode was produced by Matthew O'Mara and me, edited by
• 41:00
  Speaker 1: Colin Kish, camera work by Max Stussi.
• 41:03
  Speaker 1: Digital shorts by Ariana Longley, prompting by Cristy MacLeod. Production support
• 41:07
  Speaker 1: from Jonathan Halliwell and TVO's digital media services team. Laurie
• 41:11
  Speaker 1: Few is the executive producer of Digital. John Ferri is vice
• 41:15
  Speaker 1: president of programming and content. Thanks so much for listening,
• 41:18
  Speaker 1: and we'll see you in 2026.