IN OUR SOCIETY, WE TEND to focus more on using our diet to whittle our waistline than caring about how it’s impacting our health. We often lose track of the fact that what we eat will determine if we have the vitality to enjoy our lives unimpeded or shoot us in the foot instead. While worrying about how to achieve a “good body” on the outside, we often lose sight of the fact that our diets are busy creating our state of health on the inside, our brain included. Food is intended to support all of our systems and, whether or not we’re conscious of it, directly affects the health of our brain, day in, day out.
We all intuitively use food to soothe our moods and clear our heads. Feeling blue, we may reach for chocolate; when we’re tired, we pour another cup of coffee. There are endless examples of how the food we eat impacts our frame of mind, thereby creating a domino effect that affects our thoughts, memories, and actions.
As it turns out, of all the organs in the body, the brain is the one most vulnerable to the ravages of a poor diet. From its signature architecture to the unusual means by which it performs, the brains cries out for the proper fuel like no other entity in our body—a topic I explored in great detail in my first book, Brain Food. More briefly, the brain is the most metabolically active organ we possess, and consequently the hungriest, demanding over 20 percent of your body’s total energy haul. But what sets it apart even further is that the cells inside our brains are irreplaceable. Unlike those in the rest of the body, where cells continuously renew and replace themselves, the vast majority of our brain’s cells remain with us from start to finish. This certainly sheds some light on why extra care and nourishment is paramount for the brain to successfully deliver a lifetime of performance on our behalf.
Meal after meal, the foods we ingest are broken down into nutrients, absorbed into the bloodstream, and drawn up into the universe of our nervous system. Once they arrive, their job is to replenish depleted storage, trigger the proper cellular reactions, and, finally, to become themselves part of the very fabric of our brain. This is something to consider the next time you reach for a candy bar instead of an apple. Whichever one you choose will become part and parcel of how your brain will function.
A slew of new research, including my own, shows an important correlation between a healthy diet and a healthy brain. When consumed in the right amounts and from the right sources, food has marked and measurable beneficial effects on brain health and function. The right diet does ensure that our brain remains stronger longer, and shows more resilience and activity, regardless of age. In addition, a healthy diet can be a powerful ally in boosting our energy levels, supporting heart health and hormonal harmony while warding off the wide range of common ailments that affect the majority of adult women, from slow metabolism to insomnia and anxiety. Further, what we eat is a powerful epigenetic lever for switching hundreds of thousands of genes on and off, which can help minimize the genetic risk of developing a mind-destroying disease like Alzheimer’s.
Unfortunately, though, the field of nutrition suffers from the same shortsightedness as does scientific research in general. There is a chronic lack of acknowledgment regarding how gender affects our distinct needs and requirements when it comes to adequate nutrition—unless a woman is pregnant, that is. Not only do men and women differ in the way their bodies and brains function on a day-to-day basis, but these differences sometimes demand different dietary requirements as well. In this chapter, we will review the research on gender disparities in diet and nutrition for brain health. In chapter 10, you’ll find specific guidelines as to which foods and nutrients to focus on, and what to avoid at all costs!
The fact that diets don’t deliver the same results for a man as for a woman is probably obvious to any woman who’s ever tried to lose weight. When a woman says, “I’m going on a diet,” she’s usually not messing around. You might catch her increasing her intake of everything and anything remotely green, from raw broccoli to wheatgrass juice. She might even go so far as to completely give up sugar, bread, and butter. Watch her shrink the portion sizes upon her plate while she devises new and healthy meals for her entire family. She then hops on the scale hopefully, only to find there’s little to no change at all. Maybe a few ounces or pounds have come off, but not the much-anticipated and well-deserved weight loss she’s slaved over. Meanwhile, her husband quit drinking soda for a week and it looks like he’s dropped ten pounds. Oh, the injustice. Do men really have an advantage in the diet department, or is it just an optical illusion?
As it turns out, it might be a bit of both. Men and women have rather different metabolic requirements that influence not only their general health and well-being but also the way they respond to diets. Not to mention, our shape.
It is well known that genetic and hormonal factors are implicated in how body fat distribution differs between the genders. Generally, men tend to have more visceral fat, which is stored around the organs in the belly, while women tend to have more peripheral, subcutaneous fat, stored along the hips and backsides. This gives rise to the “apple” and “pear” shapes. Men’s apple physique may make it easier to notice when they trim down since it’s so localized. On the downside, the apple shape is more dangerous since too much belly fat is a risk for heart disease, stroke, diabetes, and even certain cancers.
Although women’s pear physique is less risky from a health perspective, from puberty to menopause, women generally have a higher percentage of body fat than men. That’s even when we take in fewer calories by eating less. A healthy range of body fat for women is 20 to 25 percent, as compared with the 10 to 15 percent recommended for men. In other words, the body fat percentage of a normal-weight woman is similar to that of a man who would be classified as overweight. Men tend to be leaner than women because they generally have more muscle. The more muscle you have, the more fat you burn. Furthermore, the predominantly male hormone, testosterone, increases protein synthesis and lean body mass, which in turn raise a man’s metabolism. Like it or not, guys are burning more calories than us all day long, even while doing nothing at all. It is this accelerated metabolism that is also responsible for their bodies responding faster and more noticeably to diets.
A woman’s estrogen, on the other hand, is not doing her any favors in the weight-loss department. Not only do women have a higher percentage of body fat than men, but on top of that, estrogen reduces a woman’s ability to burn that fat. In fact, we are particularly talented at gathering and storing it!
When we were hunter-gatherers, and even later as an agrarian society, our bodies developed the ability to store energy as fat, knowing that the next famine could very well be our last. This ability was most likely intended to assist us in having a healthy pregnancy and for the nursing that comes afterward. With food dangerously scarce, that was indeed a great advantage to the prehistoric woman. This is much less of an asset for us as modern women. We now face a dense oversupply of energy-laden foods and endless opportunities to eat them, but we are still saddled with bodies that haven’t yet made the evolutionary adjustments necessary to burn off such “abundance.”
Women’s bodies, as a result, are fat-accumulating, carb-running machines. This is in part thanks to estrogen’s positive effects on insulin, the hormone that helps remove sugar from our circulation, granting us the ability to maintain steady blood sugar levels. Even when eating healthy high-carb diets, most women tend to burn these extra carbs right away (whereas men will store them in their muscles, in the form of glycogen).
Everything goes pretty well until a woman approaches her forties and hormone levels begin to flag. Then two things become more likely: her metabolism slows down at the same time that her insulin goes wonky. Interestingly, in this case, her brain is just as much to blame as her diet. The decrease in estrogen is also working its mischief inside the hypothalamus, reducing the brain’s ability to burn carbs and regulate adipose tissue distribution. This all adds up to increasing weight and a thickening waistline. As a result, many women end up with a five-to-ten-pound weight gain as they transition into menopause. This is not a random event that happens by accident. This happens quite fatefully in the female body, as it’s programmed to store even more fat as soon as estrogen begins to decrease. This time around, belly fat’s the answer. Why’s that? Because visceral adipose fat produces estrone, the backup form of estrogen for post-menopausal women.
Wait, is this a good thing, then?
Sometimes the road to hell is paved with good intentions. This increase in belly fat goes hand in hand with an increased risk of heart disease, diabetes, and obesity—all observed after menopause. I’m sure the irony of this is not lost on you. In the same moment our brains and bodies are demanding an increase in calories and nutrients, many women end up struggling to shed the additional weight instead.
The challenge for women is to keep a steady metabolism—no small feat. It is of utmost importance, then, that we find a means by which to provide ourselves with the most plentiful supply of energy while at the same time making sure things don’t get out of control. This is where paying attention to our diet becomes more critical than ever.
It goes without saying that weight gain is an issue for the entire human race, not just women. However, a woman’s body is literally built to change far more than a man’s. Let’s face it, it downright metamorphoses. After assuming its childhood form, it sprouts a dramatically new body at puberty, one that continues to develop and differentiate itself before turning into nothing short of a mobile home during pregnancy. It rapidly reconfigures itself into yet another physical form post-pregnancy in service to the baby, and then does so again, once it’s not. At menopause, it’s time to do so all over again, and as if all that were not enough, it happens once more, in old age.
However magnificent we are in this respect, it’s not always fun being such a shapeshifter. Superpowers such as these require respect and attention that often go ungarnered. It’s high time to be kind and caring to ourselves as we better address how to undergo each of these peculiar twists and turns in the healthiest way possible.
Hats off to model, designer, and entrepreneur Iman for this famous quote, pointing out that the latest trends often fall short of those that stand the test of time. This is just as true in the field of nutrition. Society tends to swing from one extreme diet to another, sometimes for no apparent reason at all, other than a celebrity or the media advocating for yet another diet craze to sweep the nation. Whether it’s veganism or gluten-free, fat-free or keto, the search for the “miracle diet” is never-ending. We need to be alert to the fact that many trendy diets are not based on actual science—unless, of course, we’re talking about the science of marketing.
Worse still, hardly any of these diets, and perhaps none at all, adequately consider the female physiology. If there’s one thing we’ve learned from clinical trials, it’s that when it comes to women, diets that are based on going to extremes don’t work in the end. Not only will they not produce the results they promise, but they may also tamper with the delicate integrity of our highly specialized bodies and brains.
We return once again to a now familiar study, the Women’s Health Initiative that generated so much confusion around MHT all those years ago. Ironically, much of what we know about which diets don’t work for women comes from the same study. Among its various branches, the trial also included a dietary modification arm (WHI-DM), which remains the largest clinical trial of dietary interventions in women.
The study started in 1993, during the peak of the low-fat, high-starch diet craze. You could not walk down a single supermarket aisle without seeing the terms “low-fat” or “fat-free” emblazoned across the vast majority of products. The powers that be declared fat was evil, and as a result, low-fat was “the only way to go,” the latest cure for all that ailed us whether it was heart disease, cancer, or the obesity epidemic. As a product of the times, WHI-DM researchers applied this low-fat approach in their studies.
Over 48,000 post-menopausal women enrolled in the trial. Of these, about 40 percent were randomly assigned to a low-fat diet. The rest of the women continued their usual diets. For the low-fat group, the intervention was designed to lower a participant’s total fat intake to only 20 percent of their total calories. Eight years later, the researchers looked at how many women in each group had developed heart attacks, strokes, and other forms of heart disease. In addition to totaling the occurrences of breast and colorectal cancer, they looked at things such as weight gain, cholesterol levels, and, of course, hot flashes. The results were once again disappointing. Women on the low-fat diet had no increased resistance against cancer or heart disease. Also, they persisted in having the usual frequency and degree of hot flashes, and not unremarkably, they had not lost any appreciable amount of weight.
However, the WHI-DM was controversial from the start. Among other concerns, the vast majority of women were in their sixties and seventies when the study began. At this point in their lives, it may have been too late for dietary changes to reduce the risk of heart disease and other chronic conditions. But mostly, the diet plan in and of itself was called into question. Back then, going low-fat usually meant going very high carb, ingesting a total of six servings of grains a day. Worst still, in the hope of reducing their fat intake, these poor women had most likely loaded up on the latest low-fat and fat-free foods, which we now know to be highly processed and loaded with hidden sugars and additives.
In my experience, it is also unwise to go on a strictly low-fat diet around menopause, the moment when a woman’s body is deliberately calling for more fat to make more estrogen. It is now known that when women adopt very low-fat diets, their estrogen levels often dramatically drop.
In the end, this expensive trial did highlight an important truth: beware of following trends! The WHI-DM was another nail in the coffin for the low-fat, high-starch trend that so dominated the American diet during that era. However, rather than using the new knowledge to promote regaining balance in our diets, the media made much of these disappointing results, spurring the advent of yet another trend, with the famous Atkins Diet. That was but a predecessor to the high-fat diets trending today.
Women in particular were to suffer the ill effects of this extreme change in recommendations, as it is not safe and certainly not a good idea to load up on fatty foods like bacon and butter. Given the fact that a woman’s body is limited in its ability to put fat to good use (versus our innate talent for turning it into a muffin top, among other things), there are clear biological reasons why women should not eat fatty foods indiscriminately.
However, many women are now trying out high-fat or “ketogenic” diets, hoping for both quick weight loss and increased health. These diets are based on the principle that if you eat a very low-carb diet or go completely off carbs, you will force your body to burn extra fat, which may or may not result in a smaller waistline or improved athletic prowess.
Concerning brain health, though, there is no clear evidence that high-fat diets support cognition. As of today, there are only five studies on the effects of keto diets on cognition in humans, each one with a fairly small sample. The largest clinical trial, with about 100 patients, was discontinued in 2017 when supplementing with tricaprylin (a ketone source) failed to improve cognition in mild Alzheimer’s patients. At the moment, there are no clinical trials in younger people, and no observational studies linking high-fat diets to improved cognitive performance or a reduced risk of Alzheimer’s either. So for now, there is no reason to believe that eating more fat than necessary will do your brain any good.
So what should we eat?
Let’s be clear that body and brain alike need all kinds of nutrients for health, carbs and fats included. When a diet is advising that you avoid one of these nutrients entirely, think twice. Not only is it unwise, but it could be detrimental to your health in the long term. In fact, we don’t really need a “diet.” Most diets focus on restricting food or nutrients, which makes them impossible to stick to, not realistic for your life, and lead to crashes and even weight gain. We need a new way of eating and nourishing ourselves that we can comfortably stick with throughout our lives.
In the next chapter, we will explore a dietary plan that is balanced, well-rounded, and meticulously designed to secure meaningful, long-lasting results for women. But first, let’s settle the debate over carbs and fats and review what a healthy diet looks like if you’re a woman.
All the evidence points to the fact that what matters is not a focus on “carbs” and “fat” as if they were unique entities, but rather a focus on the types of carbs and fats we’re eating, as well as their sources. For example, some carbs support female metabolism, while others will derail your insulin levels instead. Likewise, some fats promote brain function, while others can wreak havoc on your brain and your hormones, especially when consumed excessively. In other words, the quality of your diet—and its ability to fulfill your nutritional requirements—is what really makes the difference.
High-fat diets are currently all the hype, so I’ll start by dispelling some myths around fat and women’s health. First off, there are many kinds of fat, each with its distinct effects not only on the body but also on the brain. Many lines of evidence indicate that the type, rather than the overall amount of fat in the diet, is key when assessing health risks in women.
Put most succinctly, fat is either saturated (as in butter, meat, dairy, and certain oils like coconut oil) or unsaturated. Unsaturated fat can be monounsaturated, as in olives and avocados, or polyunsaturated (PUFAs), as in fish, shellfish, and various nuts and seeds. While nature provides us with versions of these fats we can trust, commercial preparations often tamper with them, for example by hydrogenating unsaturated oils—a procedure used to make trans fats.
Research focused specifically on women reveals that unsaturated fat, especially PUFAs, is very supportive of women’s health, showing a reduced risk of dementia, heart disease, cancer, obesity, and diabetes. On the other hand, trans fat is especially bad news, showing the exact opposite effect. Too much saturated fat can also be harmful in excess, mostly when coming from animal sources.
To give you a sense of the magnitude of the problem, the Nurses’ Health Study, one of the largest prospective dietary investigations in women, showed that, among over 75,000 participants, those consuming higher levels of trans fat had a 33 percent increased risk of heart disease. Eating more PUFAs had the opposite effect, reducing the risk by over 25 percent. These effects were particularly marked in women under sixty-five, for whom trans fat intake increased the risk of heart attack by as much as 50 percent. These findings indicate that maximizing PUFAs and minimizing trans fat is an excellent first step toward optimal fat consumption. In fact, these studies estimate that, in the context of a typical 1,500-calorie diet, swapping out 3 grams of trans fat for the equivalent amount of unsaturated fat can lower the risk of heart disease in women by up to 67 percent. In concrete terms, that’s the equivalent of replacing the average serving of potato chips with a handful of almonds. Likewise, swapping 8 grams of saturated fat (2 ounces of bacon or 1 slice of cheddar cheese) with the same amount of unsaturated fat (4 ounces of salmon) is all you need to do to cut your risk of heart disease in half.
The type of fat you eat has a substantial impact on whether or not you develop Alzheimer’s, too. A large body of studies showed that people who consumed 2 grams or more of trans fat per day had twice the risk of dementia as those who ate fewer than 2 grams. Although it may seem like a small amount, most people in these studies ate at least 2 grams a day, with the majority of participants eating more than double that on a regular basis. Similar findings were revealed regarding saturated fat, especially when from red meat and dairy. Those who consumed more than 13 grams per day were almost twice as likely to develop cognitive impairment than those who ate half that amount.
On the contrary, people who consumed at least 2 grams of PUFAs per day had a 70 percent lower risk of Alzheimer’s than those who ate less. This is consistent with reports of thousands of dementia-free elderly people showing that a diet poor in PUFAs increases the speed at which the brain ages, while a diet rich in PUFAs protects our brain cells in the long term. If you need more of an incentive, our brain imaging studies show that women whose diets are more abundant in PUFAs in their early-to-late-middle-age years not only have the highest levels of brain activity but also the lowest levels of Alzheimer’s plaques. This is in contrast to those whose diets were higher in trans fat and saturated fat showing reduced brain activity and increased brain atrophy instead.
So unsaturated fat is in, and trans fat is definitely out. For saturated fat, moderation is important, as is keeping an eye on the source. Most studies that reported negative effects of saturated fat focused on intake from animal sources. There is increasing evidence that vegetable fat, including both saturated and unsaturated types, is more supportive of women’s health through its beneficial effects on our hormones. For example, replacing animal fats like butter with certain vegetable oils like olive oil has been linked to a greatly reduced risk of heart disease, diabetes, and breast cancer in women.
The effects of dietary fat on breast cancer deserve a special mention. There is a general misconception that patients should go on low-carb diets to “starve” the cancer. This idea can be misleading, as it suggests that high-fat diets may be beneficial. For one, the type of cancer needs to be considered. It has long been known that diets high in animal fat can increase the risk of cancer linked to sex hormones, including breast, uterine, and ovarian cancer. In the Nurses’ Health Study, women who consumed large amounts of animal products, especially during their early adult years, had three times the risk of developing breast cancer of those who consumed higher amounts of vegetable oils. Red meat and high-fat dairy were once again the major culprits. In the Women’s Health Initiative, even though a low-fat diet wasn’t the answer, it was noted that post-menopausal women in the low-fat intervention group did seem to tend toward a lower risk of breast cancer and also had better cancer-survival rates.
These effects are probably due to the fact that animal fat can suppress the action of a particular carrier molecule called SHBG (sex hormone binding globulin). SHBG circulates in the blood and has the job of making sure that estrogen levels are kept in check. SHBG not working well can lead to an overproduction of estrogen, though not in a good way, especially for cancer patients. Studies have shown that women with estrogen-receptive cancers who follow high-fat diets tend to have lower SHBG levels and unusually high levels of “bad” estrogens in their bodies.
In the end, we should take a new approach when it comes to our fat consumption. Rather than avoiding fats like the plague or stuffing our face silly with them, let’s be more selective. Our goal is to have the advantages of beneficial, healthy fats while minimizing the less healthy ones. In the next chapter, we’ll see how to do exactly that.
Now on to carbs. Carbs are currently getting a bad rap, so let’s address some concerns you may have, right off the bat. Research shows that if you are a woman, diets that favor carbs over (bad) fats also distinctly favor your health.
If you recall from above, swapping trans and saturated fat for PUFAs leads to much better health outcomes in women. Well, it turns out that replacing even more of those fats with carbohydrates is an excellent idea, significantly reducing a woman’s risk of heart attack and stroke later in life. In the context of a 1,500-calorie-per-day diet, simply replacing 3 grams of trans fats with 7 grams of carbs was associated with a 93 percent risk reduction of heart disease in women. That’s trading out another serving of potato chips for 1 ounce of brown rice. Additionally, replacing 8 grams of saturated fat with 19 grams of carbs further reduced the risk by another 17 percent. A real-life example of this would be trading three slices of bacon for a small apple. Many other studies have shown that increasing your carb intake while minimizing these fats also reduces the risk of type 2 diabetes, cancer, and dementia.
However, the type of carbs you choose again makes a huge difference. Looking at this more closely, we see that while favoring carbs over fats generally led to improved health outcomes, it is consuming “good carbs” that showed the best results.
You probably already have a hunch of what “good” versus “bad” carbs are. These attributes reflect the effects each of these carbs have on our blood sugar levels. Good, or complex, carbs, have a low-glycemic load, which means they are lower in sugars and higher in fiber. Plus, the sugars are typically natural, rather than refined white sugar. A good example would be a handful of strawberries or a slice of whole-grain bread. This balance of natural sugar and fiber is ideal when it comes to supplying your brain with the fuel it needs, while at the same time stabilizing your blood sugar levels.
On the contrary, bad, or high-glycemic, carbs, contain plenty of sugars (more often than not refined ones) and low to zero fiber. This imbalance triggers spikes in blood sugar levels, making it hard for your body’s insulin to metabolize all that sugar. At the same time, bad carbs also stimulate your appetite thanks to the blood sugar “crash” that occurs after you consume them. So even though women’s bodies are generally efficient at burning carbs, too many high-glycemic foods can eventually wear out your pancreas. This leads to chronic high blood sugar levels that cause cells to become insulin resistant. Aging and menopause further reduce insulin sensitivity, making these kinds of foods a serious threat to our bodies, brains, and hormones, especially as we pass age forty. As we already discussed, insulin resistance causes inflammation and is a risk factor for metabolic disorders, type 2 diabetes, and heart disease—all of which raise the risk of dementia in turn. Research shows that the higher the amount of sugar in the blood, the higher the risk of dementia, even in people without diabetes. Even though there are meds that help manage high blood sugar and insulin resistance, they don’t deliver the benefits that following a healthy diet does.
So there’s no sugarcoating anything—literally and figuratively. To optimize our health as women, it’s out with the bad carbs and in with the good ones. To be sure there’s no mistaking one for the other, foods with a high-glycemic load include anything that’s processed, including refined sugar itself and processed grains like white “sandwich” breads, bagels and rolls, all sodas and sweetened drinks, and sugary foods and snacks including commercial candy, cookies, cakes, pastries, and crackers. These foods should be minimized and replaced with low-glycemic foods rich in fiber. We will get better acquainted with the carbs we’re looking for in the next chapter. But first, I want to draw your attention to a specific dietary pattern that not only maximizes both the good carbs and the good fats, but also happens to be the only diet scientifically proven to work for women.
Extensive research points to the Mediterranean diet as an excellent example of a dietary regimen exquisitely suited to women’s health. It is telling that this diet has been around for thousands of years. Unlike so many other diets, it wasn’t concocted by a celebrity chef or popularized by a media frenzy. It is instead a millennia-long culmination of the enduring lifestyle behaviors of a variety of Mediterranean civilizations. From the ancient Egyptians, Greeks, and Romans to the Arabs and Turks, each left their mark on the development of this delightful cuisine. By interacting with and learning a few tricks from one another, these peoples learned to utilize the best food sources of the rich Mediterranean basin to grow and prosper their cultures while at the same time enriching their health. The women of these cultures are excellent examples of these benefits, to this day ranking at the very top of our world’s life-expectancy charts.
Some of the most convincing evidence for the Mediterranean diet comes from studies that looked at its effects on telomere lengths. Telomeres are repetitive DNA sequences found at the ends of our chromosomes, their lengths acting as markers of cellular aging. It turns out that, in a study of close to 5,000 healthy women, the greater the adherence to the Mediterranean diet, the longer the telomeres, a positive sign for longevity. In a nutshell, the women who followed the Mediterranean diet were biologically younger than those who didn’t.
Perhaps as a result, women who follow a Mediterranean diet are less likely to develop diabetes, obesity, and heart disease, and also have a much-reduced risk of cognitive impairment and Alzheimer’s as they age. One example, a large-scale study of over 78,000 women, showed that those who followed a Mediterranean-style diet enjoyed a 24 percent lower risk of heart disease and a 26 percent lower risk of stroke than those who ate a Western diet high in processed foods, meat, sweets, and sugary beverages. Additionally, when the Mediterranean dieters combined healthy eating with regular exercise, they boasted an outstanding 83 percent risk reduction.
Clinical trials also support the Mediterranean diet as a substantial aid in disease prevention. For example, PREDIMED (Prevención con Dieta Mediterránea), the largest trial to date, randomly assigned 772 asymptomatic people at risk for heart disease to follow one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with nuts, or a low-fat diet. Three years later, both Mediterranean diet regimes had reduced the patients’ risk of heart attack and stroke, improved blood glucose levels, stabilized blood pressure, and lowered cholesterol levels. The icing on the cake? These patients also had much less cognitive decline than those on the low-fat diet.
Thanks in part to its beneficial effects on the heart, the Mediterranean diet does a whole lot of good for your brain, too. In a series of brain imaging studies gathering hundreds of participants, we found that those who followed a Mediterranean diet had healthier and younger-looking brains than people of the same age who had been eating a Western diet. The brains of the Western dieters seemed to shrink more rapidly, at an estimated rate of five additional years’ worth of aging. Even more striking was that although none of the participants had yet to demonstrate any outward sign of cognitive impairment, the Western dieters were already carrying more Alzheimer’s plaques than was usual for their age, whereas the Mediterranean dieters showed none. These beneficial effects were more evident in women than in men, but were clear in men as well, consistent with many studies showing a reduced risk of dementia for both genders. Men may be from Mars and women from Venus—but here on Earth both still benefit from eating right.
The Mediterranean diet has also been consistently linked with a reduced risk of breast cancer in women. This is in part thanks to its high fiber content. Where animal fat impairs the action of the SHBG molecule that keeps estrogen in check, fiber promotes its action, properly balancing estrogen in our favor. This is particularly important not only for reducing the risk of breast cancer, but also for alleviating the menopausal symptoms often experienced as a consequence of cancer therapy. The PREDIMED trial mentioned above demonstrated that, in a group of 4,152 women without a prior history of breast cancer, long-term adherence to the Mediterranean diet cut the risk of breast cancer occurrence in half. In other reports, the Women’s Healthy Eating and Living Study showed that among 2,198 women treated for early-stage breast cancer, those who consumed a high-fiber diet showed a decreased severity of hot flashes in as little as one year.
In more good news, women who follow the Mediterranean diet seem to experience fewer and milder menopausal symptoms. In an extensive study of 6,040 women age fifty to fifty-five, those who followed the diet had a 20 percent decrease in hot flashes and night sweats. Interestingly, those who ate more fruits, especially strawberries, pineapple, and melon, were even less likely to report any symptoms. (We’ll find out why in the next chapter.) On the contrary, women who consumed a Western-style diet were 23 percent more likely to experience both hot flashes and night sweats as they progressed through menopause.
While you probably get the biggest payoff from adopting such a diet early in life, research shows that it is never too late to reap the benefits of a healthy shift toward better choices. A study of over 10,000 women showed that those who began the Mediterranean diet during middle age were much more likely to live past the age of seventy than those who did not eat as healthily—and were able to do so without the now commonplace burden of chronic and mental illnesses.
You may be wondering: What is so exceptional about this diet?
Although it is called the Mediterranean diet, it is not a diet in the same sense that deprivation-based weight-loss plans are. It is, in fact, more a lifestyle than a diet, one that includes certain daily practices and perspectives that are sustainable and, in point of fact, nourishing. Additionally, this lifestyle promotes lower stress levels than are usual in Western countries. One clear example of this is the Mediterranean point of view regarding the act of eating itself. Meals aren’t grabbed and eaten in passing but are shared with the family, seated at a table where nobody would dream of watching TV with so much beautiful food in front of them.
Then, naturally, the quality of the food is key. In Brain Food, I described the Mediterranean diet as “fresh and sun-kissed.” I stand by that. The Mediterranean table is a food feast. One day you might find artichokes drizzled with olive oil, or cremini mushrooms sautéed with garlic and parsley. Perhaps it’s braised Swiss chard instead, topped with basil and pine nuts, spread over freshly baked bread. The everyday dishes you find on the menu are invariably colorful, fragrant, and vegetable-centric. If you were thinking pizza and pasta—never fear, we get our fill. But it’s the vegetables and legumes, the whole grains, fruits, and nuts, all brimming with extra-virgin olive oil, that are the real stars of the meal. Fish and shellfish are also a primary focus, while other forms of lean protein, such as poultry, are eaten in moderation. Red meats and fancy cheeses make appearances on occasion, like for a special Sunday lunch. Meals, often accompanied by a glass of red wine, are finished off with an inky espresso. I would be lying if I said chocolate, cakes, and pastries never crossed our path (hello, gelato!), but a fresh fruit salad is the more likely after-dinner dessert choice.
From a nutritional perspective, the Mediterranean diet is high in fiber and complex carbohydrates, moderate in fats (mostly unsaturated, and of vegetable origins), and plentiful in vitamins and minerals—all of which seem to suit a woman’s needs exceptionally well. And frankly, you don’t have to move to Italy or Greece to eat like your Southern European counterparts. I’ve been in New York for half of my adult life and managed to stick to the diet’s principles without problems, while at the same time enjoying nutritionally dense foods like avocados and sweet potatoes that were totally new to me. The beauty of the Mediterranean diet is that it’s accessible no matter what country you live in, and can be easily adjusted to suit everybody’s needs and tastes. The next chapter will help you do just that—and appendix B provides a weekly diet plan with delicious recipes to get you started. All it takes is eight easy steps.