Your Brain On

Menopause hormone therapy and your brain: what the evidence says vs. what the algorithm is selling you.
Two-thirds of Alzheimer's patients are women. That statistic has fueled a social media narrative that hormone therapy can prevent dementia, but the current evidence doesn't support that claim. In this episode, Drs. Ayesha and Dean Sherzai sit down with OBGYN Dr. Jen Gunter and neuroscientist Dr. Sarah McKay to separate the science from the soundbites.
Your Brain On... Menopause Hormone Therapy [Season 7, Episode 1]
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In this episode:
Why menopause hormone therapy is the gold standard for hot flashes and night sweats but not a proven tool for dementia prevention
The Women's Health Initiative: what it actually found, how the press conference distorted the findings, and what we've learned since
Why "bioidentical hormones" is a marketing term, not a medical one, and what that means for the products being sold to you
How the hypothalamus drives vasomotor symptoms and why sleep disruption may explain much of the cognitive fog women experience at midlife
The high placebo response rate with hormone therapy and why dose escalation can mask a missed diagnosis
Why the simplistic narrative of "women get more Alzheimer's, so it must be menopause, so give hormones" falls apart under scrutiny
How over-testing, unregulated lab panels, and wearable hormone data can create more anxiety than answers
The case for perimenopause as a life stage, not a disease, and why medicalizing normal midlife stress upholds harmful structures
What the aging brain actually gains: vocabulary, emotional processing, wisdom, complex problem-solving, and the capacity to hold nuance
7 evidence-based actions you can take this week for your brain health, no prescription required
Why the FDA's removal of the black box warning on hormone therapy was released without context and what happened next on social media
The new neurokinin receptor antagonists and why they could change how we study the relationship between hot flashes and brain health
00:00 Intro
01:09 Why the menopause hormone therapy conversation matters
07:10 Dr. Jen Gunter: the dangerous dichotomy around MHT
10:20 The Women's Health Initiative, revisited
16:25 Who is menopause hormone therapy actually for?
18:20 The placebo response nobody talks about
22:33 When does perimenopause actually start?
26:00 Does MHT actually prevent dementia?
29:11 "Bioidentical" is not a medical term
36:27 The problem with unregulated hormone testing
41:08 How to advocate for yourself at the doctor
44:36 New drugs that could change menopause research
47:17 The pTau217 study and what it means for women on MHT
52:20 Dr. Sarah McKay: what happens in your brain during menopause
59:34 The oversimplified estrogen-Alzheimer's story
1:04:13 When social media primes your symptoms
1:11:18 What the aging brain actually gains
1:21:35 Grandmothers rule the world!
1:25:43 What MHT is actually good for
1:26:28 7 things to do for your brain
Dr. Jen Gunter is an OBGYN, pain medicine physician, New York Times columnist, and bestselling author of The Menopause Manifesto, The Vagina Bible, and Blood. She writes The Vajenda on Substack and is one of the most prominent voices challenging misinformation in women's health.
Dr. Sarah McKay is a neuroscientist, science communicator, and author of The Women's Brain Book. She is the founder of The Neuroscience Academy and Think Brain training programs.
References: North American Menopause Society 2022 Hormone Therapy Guidelines: menopause.org Australasian Menopause Society: menopause.org.au The Vajenda (Substack): jenssubstack.com
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Most people think dementia starts with memory loss. But for millions, it actually begins decades earlier: in the blood vessels.
Long before someone forgets a name or misses an appointment, the brain is being quietly damaged by high blood pressure, cholesterol imbalance, poor sleep, inflammation, and chronic stress, day after day, year after year.
This kind of damage doesn't look dramatic. There's no big stroke, no clear warning sign. It happens slowly and silently, which is why it's so often missed until it's too late.
But here's the good news: vascular dementia is one of the most preventable and manageable forms of cognitive decline. When caught early, lifestyle changes and medical interventions can help slow the onset and manage the effects.
In this episode, we explore:
What vascular dementia and vascular cognitive impairment are, and how they differ from Alzheimer's disease
Why most dementia cases involve both vascular damage and neurodegenerative pathology (mixed dementia)
How blood vessel damage begins in childhood and accumulates silently for decades
The role of high blood pressure, cholesterol, diabetes, sleep disorders, and chronic stress in damaging brain vasculature
Why slowed thinking, movement, and processing speed are hallmark signs of vascular cognitive decline
The critical importance of the endothelium: the thin lining of blood vessels that controls brain health
How lifestyle factors like nutrition, exercise, sleep, and stress management protect and repair vascular health
Why managing blood pressure early is one of the most powerful interventions for long-term brain health (and why everyone should have a blood pressure monitor at home!)
How vascular damage can be slowed, even in midlife
Practical steps for prevention across the lifespan, from childhood through older adulthood
Our guest for this episode is DR. COLUMBUS BATISTE, a board-certified interventional cardiologist, an incredible science communicator, and author of 'Selfish: A Cardiologist's Guide to Healing a Broken Heart'. Dr. Batiste brings deep expertise on how cardiovascular health shapes brain health, and why protecting the endothelium (the inner lining of blood vessels) is foundational to longevity. His work emphasizes that all roads to longevity are paved by the heart, and what's good for the heart is good for the brain!
'Your Brain On…' is hosted by neurologists, scientists, and public health advocates Drs. Ayesha and Dean Sherzai.
SUPPORTED BY: NEURO World, a science-based brain health community designed to help you protect your brain long before problems begin. Learn more at https://neuro.world/ 
'Your Brain On… Vascular Dementia' • SEASON 6 • EPISODE 8
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LINKS
Dr. Columbus Batiste: https://drbatiste.com/ 
Instagram: @HeartHealthyDoc
Facebook: https://www.facebook.com/drbatiste 
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FOLLOW US
Join NEURO World: https://neuro.world/  
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REFERENCES
Core Definitions & Diagnostic Framework
• Diagnostic and Statistical Manual of Mental Disorders (5th ed.) - American Psychiatric Publishing
• Vascular contributions to cognitive impairment and dementia - https://doi.org/10.1161/STR.0b013e3182299496
• Classifying neurocognitive disorders: The DSM-5 approach - https://doi.org/10.1038/nrneurol.2014.181 
Epidemiology & Public Health Burden
• Neuropathological diagnosis of vascular cognitive impairment and vascular dementia with implications for Alzheimer's disease - https://doi.org/10.1007/s00401-016-1571-z
• Vascular dementia - https://doi.org/10.1016/S0140-6736(15)00463-8 
• Risk reduction of cognitive decline and dementia: WHO guidelines - WHO Press
Small Vessel Disease & Subcortical Vascular Dementia
• Small vessel disease: Mechanisms and clinical implications - https://doi.org/10.1016/S1474-4422(19)30079-1 
• Cerebral small vessel disease: From pathogenesis and clinical characteristics to therapeutic challenges - https://doi.org/10.1016/S1474-4422(10)70104-6 
• The clinical importance of white matter hyperintensities on brain magnetic resonance imaging - https://doi.org/10.1136/bmj.c3666 
Mixed Dementia & Alzheimer–Vascular Overlap
• Mixed brain pathologies account for most dementia cases in community-dwelling older persons - https://doi.org/10.1212/01.wnl.0000271090.28148.24
• Early role of vascular dysregulation on late-onset Alzheimer's disease - https://doi.org/10.1016/j.neurobiolaging.2016.04.009
• The pathobiology of vascular dementia - https://doi.org/10.1016/j.neuron.2013.10.008 
Cerebral Amyloid Angiopathy (CAA)
• Cerebral amyloid angiopathy and Alzheimer disease—one peptide, two pathways - https://doi.org/10.1038/s41582-019-0281-2
• Emerging concepts in sporadic cerebral amyloid angiopathy - https://doi.org/10.1093/brain/awx047
Genetics, Inflammation, and Repair
• Apolipoprotein E controls cerebrovascular integrity via cyclophilin A - https://doi.org/10.1038/nature11087
• TREM2—A key player in microglial biology and Alzheimer disease - https://doi.org/10.1038/s41582-018-0072-1 
Prevention & Vascular Risk Factors
• Dementia prevention, intervention, and care: 2020 report of the Lancet Commission - https://doi.org/10.1016/S0140-6736(20)30367-6 
• Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease - https://doi.org/10.1038/s41582-018-0070-3 
Further Reading
• The role of vascular risk factors in Alzheimer's disease - https://doi.org/10.1038/s41582-021-00530-4

Cold plunges are everywhere, and the way people talk about them, you'd think they're a miracle cure for your brain, body, and soul.
But in an age of algorithm-fueled evangelism, when a ritual becomes this ubiquitous and loud, we have to ask: how much of the buzz is backed by science… and how much is just marketing?
In this episode, we explore the neuroscience of cold exposure: what's real, what's overstated, and why this "discomfort" has become a billion-dollar industry.
We discuss:
Why cold plunges went viral, and how wellness movements often devolve into identity-driven cultures
The difference between cold exposure itself and the monetized "cold plunge movement"
What constitutes a "cult" (and how pseudoscience forms around partial truths)
The real physiological cold shock response
Why the mental "high" after a plunge doesn't automatically equal long-term brain benefit
The cardiovascular risks that rarely get discussed, especially for people with underlying heart disease
What the research suggests about soreness, pain reduction, and muscle growth (including why cold immersion can blunt hypertrophy)
The real story behind brown fat
Who should avoid cold plunges altogether (asthma, arrhythmias, coronary disease, vascular conditions)
Joining us for this conversation is investigative journalist and bestselling author Scott Carney (What Doesn't Kill Us, The Wedge), who has spent years inside the cold exposure world, first as a skeptic, then as a believer, and eventually as a critic of the culture that formed around it. His work reveals what happens when discomfort becomes identity, and when unfounded "social media science" outruns real science.
Your Brain On... is hosted by neurologists, scientists, and public health advocates Drs. Ayesha and Dean Sherzai.
SUPPORTED BY: the 2026 NEURO World Retreat. A 5-day journey through science, nature, and community, on the California coastline: neuroworldretreat.com
Your Brain On... Cold Plunges • SEASON 6 • EPISODE 7
REFERENCES
Cold Water Immersion, Muscle Adaptation, and Recovery
Roberts, L. A., Raastad, T., Markworth, J. F., Figueiredo, V. C., Egner, I. M., Shield, A., Cameron-Smith, D., Coombes, J. S., & Peake, J. M. (2015). Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. Journal of Physiology, 593(18), 4285–4301. https://doi.org/10.1113/JP270570
Bleakley, C. M., McDonough, S. M., & MacAuley, D. C. (2004). The use of ice in the treatment of acute soft-tissue injury: A systematic review of randomized controlled trials. American Journal of Sports Medicine, 32(1), 251–261. https://doi.org/10.1177/0363546503260757
Leeder, J., Gissane, C., van Someren, K., Gregson, W., & Howatson, G. (2012). Cold water immersion and recovery from strenuous exercise: A meta-analysis. British Journal of Sports Medicine, 46(4), 233–240. https://doi.org/10.1136/bjsports-2011-090061
White, G. E., & Wells, G. D. (2013). Cold-water immersion and other forms of cryotherapy: Physiological changes potentially affecting recovery from high-intensity exercise. Sports Medicine, 43(8), 695–706. https://doi.org/10.1007/s40279-013-0055-8
Kellmann, M., Bertollo, M., Bosquet, L., Brink, M., Coutts, A. J., Duffield, R., Erlacher, D., Halson, S. L., Hecksteden, A., Heidari, J., Kölling, S., Meyer, T., Mujika, I., Robazza, C., Skorski, S., Venter, R., & Beckmann, J. (2018). Recovery and performance in sport: Consensus statement. International Journal of Sports Physiology and Performance, 13(2), 240–245. https://doi.org/10.1123/ijspp.2017-0759
Inflammation, Pain, and Perceived Recovery
Hohenauer, E., Taeymans, J., Baeyens, J. P., Clarys, P., & Clijsen, R. (2015). The effect of post-exercise cryotherapy on recovery characteristics: A systematic review and meta-analysis. PLoS ONE, 10(9), e0139028. https://doi.org/10.1371/journal.pone.0139028
Costello, J. T., Culligan, K., Selfe, J., & Donnelly, A. E. (2012). Muscle, skin and core temperature after –110°C cold air and 8°C water treatment. PLoS ONE, 7(11), e48190. https://doi.org/10.1371/journal.pone.0048190
Brown Adipose Tissue (BAT) – Human Imaging & Metabolism
van Marken Lichtenbelt, W. D., Vanhommerig, J. W., Smulders, N. M., Drossaerts, J. M., Kemerink, G. J., Bouvy, N. D., Schrauwen, P., & Teule, G. J. (2009). Cold-activated brown adipose tissue in healthy men. New England Journal of Medicine, 360(15), 1500–1508. https://doi.org/10.1056/NEJMoa0808718
Virtanen, K. A., Lidell, M. E., Orava, J., Heglind, M., Westergren, R., Niemi, T., Taittonen, M., Laine, J., Savisto, N. J., Enerbäck, S., & Nuutila, P. (2009). Functional brown adipose tissue in healthy adults. New England Journal of Medicine, 360(15), 1518–1525. https://doi.org/10.1056/NEJMoa0808949
Betz, M. J., & Enerbäck, S. (2015). Human brown adipose tissue: What we have learned so far. Diabetes, 64(7), 2352–2360. https://doi.org/10.2337/db15-0146
Autonomic Nervous System, HRV, and Cold Exposure
Mourot, L., Bouhaddi, M., Regnard, J., Tordi, N., & Rouillon, J. D. (2008). Cardiac autonomic control during short-term exposure to cold water in humans. European Journal of Applied Physiology, 104(3), 541–547. https://doi.org/10.1007/s00421-008-0810-3
Janský, L., Pospíšilová, D., Honzová, S., Uličný, B., Šrámek, P., Zeman, V., & Kamínková, J. (1996). Immune system of cold-exposed and cold-adapted humans. European Journal of Applied Physiology, 72(5–6), 445–450. https://doi.org/10.1007/BF00242276
Cardiovascular Stress and Cold Shock
Tipton, M. J., Collier, N., Massey, H., Corbett, J., & Harper, M. (2017). Cold water immersion: Kill or cure? Experimental Physiology, 102(11), 1335–1355. https://doi.org/10.1113/EP086283
Tipton, M. J., & Bradford, C. (2014). Cold water immersion and cold shock response. Extreme Physiology & Medicine, 3(1), 1–10. https://doi.org/10.1186/2046-7648-3-7
Whole-Body Cryotherapy (Distinct From Cold Plunges)
Costello, J. T., Baker, P. R., Minett, G. M., Bieuzen, F., Stewart, I. B., & Bleakley, C. (2015). Whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults. Cochrane Database of Systematic Reviews, 2015(9), CD010789. https://doi.org/10.1002/14651858.CD010789.pub2
LINKS
Scott Carney's website: https://www.scottcarney.com/
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Around the start of 2026, a study sparked viral headlines claiming that cheese could reduce dementia risk.
But... nutrition science almost never works like this. One study can't "prove" a food is protective or harmful, and viral health claims often miss the most important details of research: how the data was gathered, what was actually measured, what variables were controlled for, and what it means in real life.
In this episode, we unpack what the 'viral cheese study' (PMID: 41406402) actually found, what it DOESN'T mean, and why critical thinking around nutrition headlines matters more than ever.
We discuss:
• Why viral food headlines are so persuasive (and so often misleading)
• What the cheese study REALLY reported
• The difference between correlation and causation in nutrition research
• Why long-term dietary recall data can be unreliable
• How bias (including our personal food preferences) shapes interpretation of research
• What "show me the data" really means in a world of clickbait science
• How to interpret food and brain health studies without falling into extremes
We also speak to Emily Sonestedt, research group leader and associate professor at Lund University, and one of the authors of the viral study.
"Your Brain On..." is hosted by neurologists, scientists, and public health advocates Drs. Ayesha and Dean Sherzai.
SUPPORTED BY: the 2026 NEURO World Retreat. A 5-day journey through science, nature, and community, on the California coastline: https://www.neuroworldretreat.com/ 
'Your Brain On... Cheese' • SEASON 6 • EPISODE 6
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LINKS
The study, 'High- and Low-Fat Dairy Consumption and Long-Term Risk of Dementia: Evidence From a 25-Year Prospective Cohort Study': https://pubmed.ncbi.nlm.nih.gov/41406402/ 
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Chemotherapy saves lives. But for millions, it also comes with side effects of cognitive fog, memory lapses, slowed thinking, and emotional flattening.
In the past, 'chemo brain' has sometimes been dismissed as anecdotal. But, as science has evolved, we've come to understand the very real shifts in attention, memory, processing speed, and emotional regulation underpinning the impairment.
In this episode, we break down what's happening in the brain during treatment, why these changes arise, and how healthier lifestyle choices can support our recovery.
In this episode, we explore:
• What 'chemo brain' really is (and why chemotherapy itself isn't the only thing contributing to it)
• How inflammation, hormonal shifts, anesthesia, sleep disruption, and chronic stress impact cognition during cancer
• The latest research on structural and functional brain changes during treatment
• Why many cognitive effects are temporary (and how neuroplasticity supports recovery)
• How cognitive fog intersects with identity loss and grief
• The role of nutrition in supporting clarity, energy, memory, and mood during chemotherapy
• How to navigate food fears, misinformation, and "miracle cancer diets"
• The importance of gentle movement, sleep consistency, and stress management
• How patients can advocate for themselves (including tips on what to discuss with their care team)
Bringing their perspectives and expertise to this episode are two wonderful guests:
• DR. LIZ O'RIORDAN: retired breast surgeon, author, and three-time breast cancer survivor, whose personal and clinical experience offers a rare, deeply human insight into cancer-related cognitive change.
• NICHOLE ANDREWS, RDN: oncology dietitian, educator, and advocate for evidence-based, fear-free nutrition during and after cancer treatment.
"Your Brain On..." is hosted by neurologists, scientists, and public health advocates Drs. Ayesha and Dean Sherzai.
SUPPORTED BY: the 2026 NEURO World Retreat. A 5-day journey through science, nature, and community, on the California coastline: https://www.neuroworldretreat.com/ 
'Your Brain On... Parkinson's' • SEASON 6 • EPISODE 5
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LINKS
Dr. Liz O'Riordan:
Website: https://liz.oriordan.co.uk/ 
Instagram: https://www.instagram.com/oriordanliz/ 
YouTube: https://www.youtube.com/channel/UC_t0jGeR8M4vCPSb68itjRQ 
Nichole Andrews, RDN:
Website: https://theoncologydietitian.com/ 
Instagram: https://www.instagram.com/oncology.nutrition.rd/ 
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More info and episodes: TheBrainDocs.com/Podcast