Episode Details

Your brain has its own immune cells, and the way you live each day helps decide whether they protect you or turn on you.

Two-thirds of Americans living with Alzheimer's are women. Living longer doesn't explain that gap, girlfriend. So what does?

I'm so happy to welcome back my dear friend Dr. David Perlmutter, board-certified neurologist and author of the New York Times bestseller Brain Defenders. He explains microglia, the immune cells that make up about 10% of your brain. On a good day, they're like firefighters in the firehouse, quietly repairing the blood-brain barrier and helping your brain build new connections. Under pressure from high blood sugar or inflammation, they can flip into what he calls the evil twin.

Dr. Perlmutter walks me through what happens in the brain when estradiol drops in perimenopause and menopause, and how estrogen and your mitochondria, the energy makers inside your cells, keep each other going. He makes the case for caring about metabolic health in your 30s and 40s, long before memory changes show up.

He shares the labs he wants on your radar, including hemoglobin A1C, homocysteine, fasting insulin, vitamin D and the p-tau217 blood test, plus why normal isn't the same as optimal. You'll hear why carrying the APOE4 gene is a predisposition, not a destiny, and exactly where he stands on hormone therapy for women.

My favorite part was how oxytocin, my Queen Mother hormone, and time with the people you love help keep your brain's immune cells in their supportive state.

You get to be the architect of your brain's destiny. This conversation shows you where to start.

This episode is for educational purposes only and is not medical advice. Guest views are their own. Talk with your healthcare provider before making changes to your health routine or medications.

Key Timestamps

• 00:00 Welcome back Dr. David Perlmutter and Brain Defenders

• 05:25 How blood sugar and inflammation create the evil twin

• 10:25 Falling estradiol and the loss of brain connections

• 12:50 How mitochondria and estrogen support each other

• 14:50 Blood sugar and brain risk

• 15:55 Why brain health starts in your 30s and 40s

• 16:45 Common medications and brain health

• 18:30 The labs you can ask for

• 20:05 A1C and why normal isn't optimal

• 22:55 The p-tau217 blood test

• 23:40 APOE4 is a predisposition, not a destiny

• 31:35 Oxytocin, connection and your brain's immune cells

• 33:20 Where Dr. Perlmutter stands on hormone therapy

• 38:10 Cortisol, sleep and your daily rhythm

• 41:35 What FSH may be telling you after menopause

Memorable Quotes

1. "It's really all about agency, about each of us being the architect of our brain's destiny." — Dr. David Perlmutter

2. "Hormone imbalan