Dr Ginni Mansberg on Peri/Menopause, Burnout, and How to Save Your Brain

There was a time soon after having my first daughter, in the depths of sleep deprivation and baby brain, and I was staying at my brother and sister-in-law’s house, and I really needed a cup of tea. So, I somehow put their electric kettle on a gas top stove … and lit it… almost setting their kitchen on fire. (Sorry Tomo and Anj!) I also recall not being able to recall simple words - like looking at a toaster and thinking, “Yeah…what is that called?” and constantly trying to pay for groceries with a Medicare card. 
Right. So, how do we know the difference between cognitive decline and old age… or just a lack of sleep? And what are the simple steps we can take now to save our precious brain. 
Well, Dr Ginni Mansberg is a GP, well-known TV host - you’ve probably seen her on Channel 7's Sunrise and The Morning Show, and a best-selling author. And her new book is called Save Your Brain. 
Ginni interviewed 22 brain experts around the world to find easy-to-implement strategies to keep our brain functioning at its best. Her book looks at the fact that almost half of all cases of cognitive decline could have been prevented or delayed and that dementia is the leading cause of death in women. Plus, the role anxiety, depression, peri and menopause play. 
In true Dr Ginni style, her advice is upbeat, practical and fun. From sleep, to burnout, and the importance of connection and working, Ginni gives us a smorgasbord - an all-you-can-eat buffet - of ways to help save our brain.

And just a reminder, if you ever need it Lifeline's crisis support service is available any time of the day or night on 13 11 14 .

SHOWNOTES
Dr Ginni's book Save Your Brain: https://www.booktopia.com.au/save-your-brain-ginni-mansberg/book/9781922616340.html
Dr Ginni's website: https://www.drginni.com.au
Dr Ginni's Instagram: @doctorginni

Transcript

TRANSCRIPT

“So you interviewed 22 brain experts around the world. Firstly, that sounds like a dream gig anyway. Where did the idea come from? 

DR GINNI: So, you know, I'd written the M word, how to thrive in menopause. And one of the biggest symptoms of perimenopause in particular, which is the lead up to menopause, because menopause is only one day, right? It's one day, 12 months from your last period. And you don't know it was your last period at the time, because whoever knows that it's the last period, right? So it's one of those things that you kind of work out in retrospect. But in some studies, up to 80% of women talk about brain fog. And then there's all this stuff around like COVID and brain fog. And I was just super interested in it. And around the same time, as I was interested in the brain, because I was trying to work out like how it all fit together with the whole menopause hormonal kind of thing. But then on top of that, we had to, I don't know if you remember it now, the Aged Care Royal Commission. And in the middle of that, we went into lockdown. And just as we were hearing just how awful aged care facilities were, and on top of that, lockdown, these poor people isolated from their family, completely locked in their rooms 24-7. I actually could not think of anything worse, broke my heart and all I could think of is, this is the leading cause of death in women. Statistically, I'm more likely to die of this than anything else. What am I going to do? I don't really know what to do, so I'm going to go find out. And I was not writing it as a neuroscientist, as the keeper of all truths. I had no truths, I had no knowledge. And so I had to go do a lot of learning very, very, very quickly. 

STEPH: But I loved it. Your book, it looks at the fact that, as you were touching on then, that 50% of dementia cases could have been prevented or delayed. 

DR GINNI: Isn’t that insane? I think a lot of people think that like dementia is one of those things that inevitably happens as you get older. And when your number's up, your number's up. So just kind of, you know, my husband always says he's going to take up skydiving. And then one day he'll forget how to open the tab. And that'll be the end. But I always think, I always used to sort of think that there was nothing you could do. I was a bit fatalistic about it. And now when you kind of read that you can do so much. So I think to unpack that a little bit, I think a lot of people think that Alzheimer's disease and dementia are interchangeable terms. In fact, Alzheimer's disease is a type of dementia, but it very rarely happens on its own. There's usually something else going on where one plus one equals 50. So the other thing that is going on, the most common thing is what we call vascular dementia. And what that is, is vascular pertains to the arteries. And the same things that block off your arteries in your brain and cause a stroke or block off your arteries in your heart and cause a heart attack, block off the small arteries to your brain and gradually cause brain decay. Now, if you couple that vascular dementia with Alzheimer's disease, it brings it on earlier and it makes it more severe. And while you're right, there's not a lot we can do about Alzheimer's disease. There's so much that we can do about vascular dementia and delay the whole thing. And that was what I was really, really interested in having settled, which there's a lot that's going to happen in the Alzheimer's space too. So I'm super excited.

STEPH: And as you said, women are more likely to have dementia than men. 

DR GINNI: Yes, it's the leading cause of death in women, while heart disease is the leading cause of death in men. Dementia is second in men. Which is, I think a lot of people don't realize that. And partly, you know, the older you are, the more likely you are to get dementia, and women live longer than men. So we just got more time to go and catch it, right? But at the same time, even proportionally for our ages, we still get more. And so the thinking is that the hormones play a role, and not the hormones that we have while we're young and keep us ovulating and bringing in egg of the month to go and get you pregnant. It's actually the loss of those hormones that seems to turbocharge both deterioration of bones, so we know that osteoporosis is a women's disease, but also the brain as well. So it's something about having girly hormones and then losing them that seems to be responsible, at least in part. And how do we know that? It's because the earlier you are, the younger you are when you go into menopause, the worse your chances of having dementia. And taking HRT, not late. You know, you got to take it either when you're still in peri or just as soon as you've gone into menopause, seems to prevent it. So there's just a lot that just in that tells us that it's the loss of hormones that is the problem. 

STEPH: Okay, we're going to run through some really good ways, good tips to try and prevent cognitive decline. But before that, I was just reading an article about Chris Hemsworth coming out and saying that he has two copies of the APOE4 gene. So what does that mean? 

DR GINNI: So there are lots of APOE genes. There's one, two, three and four. And in fact, two reduces your risk of dementia. But the four, if you have both parents with the APOE4 gene, it increases your risk by a factor between five and eight. So that is really quite significant. Now, if we knew that you had it like Chris, what is the advice we would give you? It would be at this point, not to get anything else that's going to turbo charge that process. So if you get kind of dementia when you're 95, I think most of us agree that like I can kind of accept that at 95, because you're probably not missing out on a lot of life anyway. Oh, that's not true. I mean, there's a lot of 95 year olds who are just nailing it. But I think that I could kind of deal with that, but it's just getting it in my 70s and 80s that I don't want, right? But we would give you the same advice right now if you have that gene versus if you don't have that gene, just like really, really, really do this stuff rather than really, really do it, right? However, I can see a time when knowing it is going to be really vital because these days we've seen so much progress on what we call monoclonal antibodies. So what they are is we can actually create antibodies like your own immune system would have made against proteins that are causing you harm and they are already in use today. So we use those both for chronic migraine and also for osteoporosis. So in the case of osteoporosis, we have little cells that build up bone and then other little cells that eat away at bone and kind of refine the shape of your bones that actually sort of looks more like a normal bone, right? As you get older, your bone building cells are now outnumbered by a bone destroying cells and that's partly why you get osteoporosis. We can actually give you a monoclonal antibody against the cells that eat away bone. So it keeps it more in balance and that actually dramatically reduces your risk of a fracture. We can see a time where eventually we could give you a monoclonal antibody against the protein that we know is very likely to be causing Alzheimer's disease and we have one now. And in that study, what we've been able to show of the study of that drug is that if we give it to you, you almost get rid of all of that beta amyloid protein that causes so much dementia. The problem is we've been giving it to people who already have dementia. And so as a result, so much brain has been lost, so much damage has been done that it is a bit irretrievable. But what if we could give you a test for this, this gene, and say, hey, you're really likely, we're going to give you either a vaccine against dementia, or we're going to give you a monoclonal antibody against beta amyloid, but not in your 60s and 70s, but in your 40s. We're going to prevent it from happening. And if we could do that, then that would be a game changer, particularly for people like Chris Hemsworth. And I don't know if it will happen in his lifetime. It won't happen in mine. Probably stuff won't happen in yours. But I think for our kids, there is a chance they don't get dementia, which is just mind blowing. 

STEPH: There are other ways that we can certainly help our brain to be in top form and avoid dementia. So in your book, you go, it's like a smorgasbord. There's all these wonderful ways. It's really positive. It's good. So diet, exercise, sleep and circadian rhythm. You talk a lot about sleep. This is big, isn't it? 

DR GINNI: I don't think that I really appreciated the impact of circadian rhythms on brain health and also what causes circadian rhythms. Like I think a lot of us have been told, switch your phone off because it keeps your, like the blue light keeps your brain all like buzzy and so you can't sleep. And I think we've been really obsessed about circadian rhythms in the context of having a good night's sleep. But now we know that it's not just what time you go to bed, it's not just switching your screens off before bed, but what time you eat breakfast, what time you eat lunch, what time you eat dinner, what time you shower, what time you exercise, that doing those things in a routine manner actually not only improves your sleep, it improves your brain health. And we're starting to do a lot of research now, and it's so early days, but into the gut microbiome and how that affects your circadian rhythms and how circadian rhythm dysfunction actually affects your gut. So it seems to be like a two-way street, but so many people You talk a lot about sleep. This is big, isn't it? I don't think that I really appreciated the impact of circadian rhythms on brain health and also what causes circadian rhythms. Like I think a lot of us have been told, switch your phone off because it keeps your, like the blue light keeps your brain all like buzzy and so you can't sleep. And I think we've been really obsessed about circadian rhythms in the context of having a good night's sleep. But now we know that it's not just what time you go to bed, it's not just switching your screens off before bed, but what time you eat breakfast, what time you eat lunch, what time you eat dinner, what time you shower, what time you exercise, that doing those things in a routine manner actually not only improves your sleep, it improves your brain health. And we're starting to do a lot of research now, and it's so early days, but into the gut microbiome and how that affects your circadian rhythms and how circadian rhythm dysfunction actually affects your gut. So it seems to be like a two-way street, but so many people but so many people know you get on a plane, you go to the other side of the world, and your gut just goes, OK, I'm on strike. See you later. I'm like, I'm out of here. And we all think it was all that like dodging lasagna on the plane, right? But actually, there's a lot that changes as you disrupt your circadian rhythms, your gut bugs completely change, and you just don't go to the toilet. And instead of just having like the best time on holiday, you're just feeling bloated and farty and really self-conscious. Not good on a Contiki tour, but it turns out that this stuff is really complicated. But once you know it, you're empowered, right? And we think that just part of the reason why every single expert I spoke to wanted to stay in the workforce as long as possible. And a lot of that is to do with using your brain. A lot of it is to do with socializing. And you don't just need to be a professor to stay in the workplace. I don't care what you do. As long as you go and work in a shop because you have to serve people and talk to people every day. But also it keeps you in a circadian rhythm. It keeps you getting up at the same time every day. And you have to have your breakfast by 6.30, because you're going to be on the bus to go to work. That kind of thing is so good for your brain. And who knew that that was just going to be a game changer. And honestly, so exciting, because it also means that if you can't go to work, for whatever reason, you're retired to the bush or whatever, you can keep maintaining your circadian rhythms, and you can keep staying engaged and being as social as you can and maybe reap all the same benefits. As long as you know that you're doing this informed, as exactly as you said, this book is a buffet of options for you to pick what you like. It's an all-you-can-eat buffet. Which also takes the pressure off as well, because it's not like, right, these are the three things you must do if you fail on the second thing, forget it. It's not like that at all. I think especially, you know, being a doctor, I feel like a lot of what doctors do when we get in front of people is just scold. You're eating too much, you're eating the wrong things, drink less, have more salad, move more, don't smoke. You know, it's all like we're all just big Debbie Downers, right? And I don't do what I say, right? You know, I'm like as guilty as the next person. You know, fantasy me goes and does yoga at five in the morning, reality and me stumbles around and pours a coffee. I definitely don't want to be in that judgmental space. But I think by providing so many options, it means that, you know, if you just say, I am not the person who can do intermittent fasting, I am not the person who can go vegetarian, vegan, you know, keto, whatever you don't want to do, it's not game over, you know, Red Rover. It's actually, okay, move on. Oh, this one I could do, this one I could definitely do it. And that's how I wanted it to be, was just to give people options and information so that they could choose their own path. 

STEPH: I love that. I love that. That’s positive. It’s empowering. We can make choices and we can actually make it happen. What about this - it’s big isnt it. Stress and burnout. Blah!

DR GINNI: Yeah, it's really huge. So, and that's particularly big. You know, I feel like we went in Australia from bushfires to floods, to pandemic, to what the hell does happen to my interest rate and how is this going to work or my rent or whatever it is. That's it. And I feel like people in Australia and probably around the world have been in just this state of perpetual stress for a very long time now. Stress is really hard to examine in a scientific study. We do have biomarkers and stress, but what will happen with stress is that your body will initially put out the fight or flight neurochemical called noradrenaline. And it's when you run out of noradrenaline that your body will switch over to the cortisol that is easier to measure. I mean, I do measure a lot of cortisol and it's a really unreliable marker of stress and anxiety. What's easier to measure is depression. There are so many tests for depression and they're bedside questionnaires that take you literally 20 minutes to do. And we can put people into mild, moderate and severe cases of depression and then look what happens to them. So the absolute no brainer that we know for sure is brain destroying is depression. And interestingly, it's depression in midlife. It's depression for women in their 40s and 50s. Now that's a problem because it happens to be the peak time for depression and anxiety in a woman's life. We all think it's postnatal. It's absolutely not postnatal. And it is not for teenage girls. The highest risk time for women to have both anxiety and depression but also to have suicide is in midlife. It is absolutely hormonal. It is absolutely driven by perimenopause. And it is under recognized, under funded, under researched. I can't even tell you. And yet it is a huge risk for dementia later on, which costs our government squillions.

And so you think that we should be doing far more research to actually help women in midlife avoid depression and avoid and get treatment for it. But I want to ask everyone, I guess, who's listening to us today to say, if this is you, and I think there's still a lot of stigma and shame about coming out as being depressed, please don't hate yourself for it. It's not a person who doesn't cope with stuff that happens to them in life. It is a biological brain eating disorder and antidepressant medications, which are not right for everybody and they're not right for all depression, definitely not. But if you need them, they are brain saving and brain regenerative. They actually regrow parts of the brain that you will need to avoid dementia, things around memory, things around processing. So please forgive yourself and allow yourself to get the help you need because it won't just save you, it'll save your brain.

STEPH: Ginni, yes. What's the best way? Go to your doctor? 

DRI GINNI: Yeah, I think it's worth going to your GP, especially if your GP has an interest in mental health. We know that for mild to moderate depression, you are just as likely to get better from doing lifestyle things like getting enough sleep, fixing your circadian rhythms, going to see a psychologist, doing some exercise every day, fixing up your diet, having enough B12 and folic acid in your diet. The evidence for supplements is a bit shaky, but there are things that we can do in that space. Once you get to the more severe end, not only are you at risk of suicide and we have to talk about it because too many women do suicide in midlife. It's a horrible thing. And often leaving behind partners, parents, siblings, children who never get their lives back after that's happened. And for those people, we know that there is such a clear advantage to antidepressant medications over not taking them. None of them are perfect. None of them are a guaranteed fix. We're talking about 75% efficacy. But what if it just reduced your depression by half to the point where we can then give the job to the psychologist and the exercise in your circadian rhythm management? I would just beg everybody, let us help you because this is a brain shrinking disease and it's not your fault. You didn't ask, nobody asked for this. This is just your brain not doing well. And we've got to help you out. And look at it like you would look at asthma. You would take an asthma puffer and you wouldn't hate yourself for it. And I'm just begging everyone to take what is the right thing for them. And push back if someone wants to give it to you for mild depression. But for severe, I think you might need it. 

STEPH: Yeah, thanks Ginni. You've spoken a lot about peri and menopause. There's not enough study, not enough attention, but in a way menopause is having a little bit of a moment, a mini moment perhaps. So I know that you and Shelley Horton, you're very vocal, you're trying to break the taboo around Perry and menopause. You were involved in the first parliamentary roundtable into menopause as well, which was fantastic. Yeah, so we teamed up. So Shelley and I, who started Don't Sweat at Menopause in the workplace, so it's very much specifically focused on workplace, just because it's really hard to have one spot where you get all your information, and it has fallen a bit to workplaces now. We used to have churches and no one goes to church anymore, and it's just the most communal space now, it seems to be around work. Plus, you know what, 10% of women leave the workforce, another 14% drop their hours, and that's partly why the Institute of Superannuation Trustees actually said that in Australia, women are losing $15 billion a year and lost super and lost earnings because of menopause, because they're leaving the workplace. So what we did was we combined with the Jean Hales Foundation and also the Australasian Menopause Society and Monash University, Royal Australian College of General Practitioners. There was a big group of us, and we went to speak to parliamentarians who were amazing. They were incredibly receptive. There were some parties that didn't want to turn up, but that is what it is. And they were so keen, so keen to hear, so keen to get involved. And we know there are a lot of demands on the budget, and it's a really tough time to be asking for money. And all we asked for was a national menopause strategy. So just to have an actual strategy that sets goals around what happens for women going through peri-menopause, whether it's access to doctors or access to treatment through work, workplace policies, better access to more evidence-based treatments, which at the moment, the best form of hormone replacement therapy are so expensive. They're not even listed on the PBS. And the PBS listed ones are maybe less effective. That just really makes menopause an issue. You can only go through menopause if you're rich, which is just that for a country like Australia, is just not on. And so we have a whole lot of asks, but we've got some ideas if they want to come to us or share them for what we just want is a national menopause action plan. And if we can get that, that will make life better for midlife women. And with that, we can help their mental health. With that, we can get them more active, we can get them healthier. We can have less women who are just so depressed and so hot that they can't exercise anymore. And that should reduce the burden of illness of dementia, which will cost the government absolute fortunes. 

STEPH: Dr Ginni, you are a national treasure. I adore you. We all adore you. Thank you so much. And so much great advice across so many different crucial and important topics. Save Your Brain, your new book, out now. Everyone, go and grab it, read it. 

DR GINNI: Amazing. Love you, Steph. Thank you. And just a reminder, if you ever need it, Lifeline's Crisis Support Service is available any time of the day or night on 13 11 14. And We're Rolling is produced by Habari Productions and Stephanie Hunt Media and is recorded on Darug Country. Head to our website stephaniehuntmedia.com for our extra bits and pieces. And if you haven't already, you can sign up to my newsletter on Substack and join a very supportive and friendly community. Just head to Rolling with stephaniehunt.substack.com And as always, if you like this episode please share it with someone - anyone - who might need it too. Until next time, be true and kind to yourself. Thanks for listening."