I purchased this book, The XX Brain, by Lisa Morconi, PhD on the recommendation of a number of the “brain” doctors I follow. The “XX” part of the title represents the XX chromosomes of women. So yes, this book provides women with a plan for alleviating brain risks specially females as we age. But my real interest came from its subtitle — “…Empowering Women to Maximize Cognitive Health and Prevent Alzheimer’s Disease.”
Before you read any further I want to warn you that this is a LONG review. I don’t normally write this much, but I wanted to measure her recommendations alongside following a well-formulated ketogenic diet/protocol.
With two generations of Alzheimer’s having inflicted my family, I am working hard to not become a third generation of lost memories of family and life. Watching my mom steadily lose her ability to recall names and events and sink into another reality is not something I desire to leave as part of my legacy.
Mosconi explains that women have largely been viewed as “men with breasts and tubes” neglecting that our hormones and physiology make us different and our bodies doing things differently. Our brains respond differently. In the XX Brain Mosconi reveals that our female brains are impacted by the very hormone connected with what makes us women — estrogen. Estrogen is brain-protective, but as women progress through peri-menopause, menopause and into post-menopause, we no longer “make” estrogen in our ovaries.
The book is broken into three parts:
- Part 1: Take In: The Research Behind the Practice
- Part 2: Take Action: Get Tested
- Part 3: Take Charge: Optimize Your Brain Health, Minimize Your Risks
I found several chapters informative and well worth the book’s read. For example, chapter four, “The Brain’s Journey From Pregnancy to Menopause,” opened my eyes to hormonal influence and risk factors that may put me at greater risk for cognitive decline. Mosconi explains that “as long as our hormones support and regulate one another in harmony” all moves along smoothly until “two major events have the power to disrupt this fine-tuned balance: pregnancy…and its nemesis, the onset of menopause…” [p 45] Having had five pregnancies and successfully navigated my way through menopause, I wanted to know what risks I have no control over. During several of my pregnancies had high blood pressure, which required hospitalization, is one of the conditions that can have “long-lasting implications for the health of your heart — and therefore your brain–and need to be taken very seriously.” [p 48]
Okay, that part of my life is undoable, so how can I protect myself on the other side of menopause? Although I read the book from cover to cover, I re-read Part 3 on taking charge to optimize my overall brain health. As with most books, I agreed with some of the action steps and not so much on others.
Chapter nine, “Food Matters For Your Gray Matter,” was one chapter that I had to weigh some of her recommendations against my other research and disregard other aspects suggested. I do agree that “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.”  And I do agree that choosing our foods well will influence how well our brain functions. , but I disagree that women have to be “fat-accumulating, carb-running machines”  with added weight and increased waistlines as we age. I do realize that post-menopausal women do “require” some visceral adipose (fat that wraps around abdominal organs) to produce our estrogen replacement with estrone, our backup estrogen, but I don’t agree that that gives women a license to eat carb-heavy lifestyles to satisfy this particular need. I use to be that carb-heavy and thickened waisted post-menopausal woman. Then I learned about keto and how ketones are an alternate fuel for the brain. In fact, Dr Dale Bredesen’s research and books support a ketogenic lifestyle for improved brain health and reducing Alzheimer’s symptoms and progression.
Women’s bodies do need healthy fat in their diets for healthy hormones and brains, but she states that “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.”  I disagree about PUFAs being okay and supportive for our brains. A few lines later she unveils her biased — “Too much saturated fat can also be harmful in excess, mostly when coming from animal sources.” [158, italics are mine] Anecdotally, I have seen a number of post-menopausal women successfully embrace a higher animal based diet by eating keto and be relieved of their symptoms of brain fog, cognitive decline, obesity and diabetes. Here you will need to pick your battle. Mosconi advocates that the Mediterranean Diet is the “only diet scientifically proven to work for women.”  Hum… The research used never looked at how well-formulated “high fat low carb” diets as suggested by Dr Stephen Phinney and Dr Jeff Volk have researched — yes, I realize that their studies may not have included many women, but I feel their research is valid and worth looking more closely at. For me, I believe that unhealthy cells and unhealthy bodies need health-giving foods to reduce inflammation, restore hormone health and renewed vitality and following a well-formulated keto diet has worked for me to achieve hormone, mental and physical balance.
Enough of that, time to get off of my soapbox…
In the remainder of the book, Mosconi lists eight steps to a well-nourished mind, appropriate supplementation, and movement/exercise supportive of brain and body health. Below I’ve taken her eight steps and look at how a well-formulated keto diet can meet most, if not all, of them.
The XX Brain’s Eight Steps to A Well-Nourished Brain
- Step 1: Manage Your Carbs — my recommendation is to follow a well-formulated ketogenic diet and you will be managing your carbs well.
- Step 2: Meet Ms. Phytoestrogen –– Mosconi suggests the plant-estrogens — isoflavones mostly found in soy and lignans found in seeds, grains, legumes, fruits, and vegetables — however, this does not take into consideration the number of women that negatively react to these phytoestrogens. She does add “One caveat: soy is a very allergenic food for many…”  I am one of those individuals. Additionally, I do not tolerate legumes, seeds/nuts, or very many fruits or starchy veggies. For more information, check out Maria’s blog post on phytoestrogens — HERE. Another blog post of hers on estrogen dominance HERE.
- Step 3: Protect Your Brain With Antioxidants — Of all your body’s organs, the brain is most affected by oxidative stress (free radicals that result in cellular damage). According to healthline.com, “When there are more free radicals present than can be kept in balance by antioxidants, the free radicals can start doing damage to fatty tissue, DNA, and proteins in your body.” Think diseases like diabetes, Alzheimer’s, high blood pressure, cancer, and heart disease. Antioxidants are “vitamin warriors” that help to rebalance any potential damage from naturally produced free radicals from normal bodily functions. Mosconi states that “the most powerful antioxidants are vitamins C and E, beta-carotene (the precursor to vitamin A) [Note: not everyone can convert beta-carotene (proactive vitamin A) to active vitamin A], selenium, and a variety of plant-made nutrients…”. No problem, on a well-formulated keto diet, you can eat leafy greens, cruciferous/brassica veggies, onions, tomatoes and fruits like berries (think blueberries here). Furthermore, “herbs, spices and, powders like cocoa and coffee have the highest antioxidant potency of all foods.” No problem — these can be eaten on a keto diet too.
- Step 4: Choose the Right Fats — this goes without saying, but I do disagree about her suggestion of using PUFAs and reducing saturated fats from animal products. I would rather that you read The Fatburn Fix by Dr Catherine Shanahan. Read my book review HERE. Dr Cate suggests avoiding the 3Cs (cottonseed, canola, and corn oils) and the 3Ss (soy, sunflower, and safflower oils). Keto healthy oils include olive oil, avocado oil, butter/ghee, and coconut oil, to name a few. For a more comprehensive list go HERE.
- Step 5: Feed Your Microbes — Mosconi is an advocate of consuming adequate fibre to feed your gut flora. Although that may be fine for some people, it is my experience that those with gut issues like Crohn’s, IBS, and SIBO/IMO do not do well with fibre, in general. Additionally, the use of prebiotics can be problematic for these conditions. As for probiotics, different ones are used for different gut conditions. For example, lactobacillus strains can cause issues for SIBO/IMO, but bifiobacterium usually doesn’t. Dr Stephen Phinney has an excellent article on “Fiber and Colon Health on A Well-Formulated Ketogenic Diet” published in 2019 — check it out HERE. Additionally, Dr Jockers writes that “it appears that the keto diet alters the microbiome in a way that:
- favours known bacteria in the gut
- improves neurological function
- increases fat burning capabilities
- facilitates an overall anti-inflammatory effect, especially in the brain.”
- Step 6: Alcohol and Coffee … Make Way for Spring Water — Alcohol and coffee do influence your health. Nothing new there, but Mosconi points out that an aging liver “begins to slow down, not processing alcohol as well as it used to.”  And she also suggests if you are going to drink coffee to limit it to “less than 300 mg of caffeine per day, which is the equivalent of a single espresso or two small cups of regular coffee (6-8 ounces.”  The healthiest drink is … drumroll … you guessed it, water. The brain is 80 percent water, so this recommendation makes sense. So stay well hydrated with good, clean water to avoid “symptoms like brain fog, fatigue, dizziness, confusion, headache, and most alarmingly, brain shrinkage.” 
- Step 7: Go Organic As Much As Possible — Mosconi believes that our environment may expose us to hormone disrupters in our food. This can be true. But many of us cannot afford to eat organic foods. I lean on the Environmental Working Group’s “Clean 15 and Dirty Dozen” to figure out which produce should be organic and which ones do not need to be (if you can peel it, you are usually safe). I buy organic for dairy, meat, and other “fat” type foods. Chemicals and hormone disrupters like glyphosate are stored in the fats of animals and the structures of plants. So choose wisely.
- Step 8: Eat Less — “New research indicates that reducing our caloric intake can boost cognitive capacity, reduce cellular aging, and promote longevity,” writes Mosconi. . This is supported by researchers like Valter Longo, author of The Longevity Diet. Personally, I like how Dr Daniel Pompa puts it — it’s not about eating less but eating less often [Daniel Pompa, Beyond Fasting, (Revelation Health, 2019) 73]. Just think about it, if you only eat 2-3 meals per day and no snacks, you are eating less often than the “average” North American. Dr Dale Bredesen, author of The End of Alzheimer’s Program, suggests eating three hours between meals and twelve hours of fasting (dinner to breakfast) in KetoFLEX 12/3 for Alzheimer’s prevention. [65-69]
Whew! Thanks for sticking with me to the end!
Next Steps — It’s Your Turn
Schedule a free Discovery Chat with Brenda to figure out how or perhaps why this way of eating may benefit you. To get started, email to schedule your free 20-minute Discovery Chat. During this continued season of COVID restrictions, these sessions will be done either by phone or online using platforms like Zoom or FaceTime. No excuses now, as you can do this from your home or wherever you would like.