Dr Sarah McKay is a neuroscientist and science communicator who specialises in translating brain science research into simple, actionable strategies for peak performance, creativity, health and wellbeing.

Sarah grew up in New Zealand where she completed BSc(Hons) at Otago University, then headed to Oxford University for her PhD. She sums up her thesis with the words, ‘Nature, Nurture or Neuroplasticity’. After five years of postdoctoral research, Sarah hung up her lab coach to pursue a career in science communications. 

Sarah is the author of The Women's Brain Book—The neuroscience of health, hormones and happiness, and the director of The Neuroscience Academy, which offers professional development program in applied neuroscience and brain health. In 2019, Sarah hosted an episode of ABC Catalyst exploring brain health, bio-hacking and longevity. In 2020, Sarah will take part in Homeward Bound, a women-in-STEMM leadership expedition to Antarctica. 

Sarah has been published extensively for consumers and professional audiences. She’s been quoted in the Wall Street Journal, The Guardian, Grazia, Sydney Morning Herald, The Age, and Body & Soul, and can be seen and heard on SBS Insight, ABC Radio National, Radio National, ABC Catalyst, and Channel 7. 

Sarah lives on Sydney’s Northern Beaches with her Irish husband and together they are raising two surfer dudes.
LEARN MORE AT:

www.theneuroacademy.com
www.yourbrainhealth.com.au
FACEBOOK @yourbrainhealth 
INSTA @sarahmareemckay

The Women's Brain Book: The neuroscience of health, hormones and happiness

SHOWNOTES

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06:40 - Paleo OMAD Biohackers: Intermittent Fasting + Real Foods + Life: Join Melanie's Facebook group to discuss and learn About all things biohacking! All conversations welcome!

10:45 - Sarah's Personal History And Path To The Brain  

The Man Who Mistook His Wife For A Hat: And Other Clinical Tales

17:10 - How The Brain Processes Information 

21:00 - What Determines The Self, Identity, And Consciousness? 

26:15 - The Male Vs. Female Brain: Common Misconceptions And Stereotypes 

34:00 - The Male Vs. Female Experience, And Role Of Hormones   

41:00 - The Critical Period Of Adolescence And Brain Development  

44:15 - Streamlining And Pruning Of The Prefrontal Cortex

46:20 - Anxiety, Trauma, And Other Mental Stress In The Brain

48:45 - The Root Of Strong Emotions

51:00 - Is PMS Real?

58:35 - NATIVE: Get Safe, Non-Toxic, Effective Deodorant! Go To Nativedeodorant.com And Use The Promo Code MELANIEAVALON For 20% Off Your First Purchase!

1:00:55 - The History Of Hysteria 

1:02:25 - Hormone Imbalances And Root Causes 

1:07:35 - Hormonal Fluctuations, Menopause, Hot Flashes, And Hormone Replacement Therapy 

1:16:00 - The Difficulty Of Unlearning Fear

1:18:00 - The Longest Lived Populations: Mindset, Social Connection, And Sense Of Purpose

1:24:00 - Is Meditation Necessary? 

1:31:00 -  Stress And Cortisol In Men Vs. Women

1:32:50 - Brain Changes During Pregnancy

1:36:05 - Brain Change During Menopause

1:38:00 - How Do Orgasms And The Brain

1:38:25 - The Role Of Daydreaming In The Brain

1:42:30 - Are Depression And Mental Issues Natural?

Get Dr. McKay's "The Brain Health Toolkit": Hand-picked tools & strategies give you a head-start on using brain science in your work and life.

TRANSCRIPT

Melanie Avalon:
Hi, friends. Welcome back to the show. So, I am super excited to be here today with, and this is the last time you're going to hear me call her this, but Dr. Sarah McKay, who I will be calling Sarah. We've been talking before the call. Dr. McKay is absolutely amazing. She is a Neuroscientist and a Science Communicator and she specializes in translating brain science research into simple actionable strategies for peak performance, creativity, health, and well-being. So that's the pitch sentence around her but, guys, she has written an amazing book, The Women's Brain Book: The Neuroscience of Health, Hormones and Happiness. And when I got this book, Sarah, from your agent I believe, I wasn't quite sure what to expect and it was amazing.

Sarah McKay:
I didn't design the cover so that's maybe what threw you slightly. I wanted to call it something different.

Melanie Avalon:
So funny you said that, I was actually going to say, I don't know why ... Looking at it, I don't know why, I feel like I thought it was going to be one thing but reading it, it was amazing, not that the cover is misleading or anything.

Sarah McKay:
Yeah, traditional publishing, you don't get a lot of say.

Melanie Avalon:
Don't I know about that one, but in any case, it's a wonder of a book. I think that's what it is. I think the cover looks very simple and approachable, and the book is approachable but it is so in depth. There is so much science. There's so much in there. It's absolutely, it's fantastic and it's fascinating, and all about not just the brain because we were talking before the call about this that there's so much research and published work and books on the brain but specifically women's brains and all the differences and how things like hormones affect the brain, and the differences that happen in every stage of life. I just learned so much in your book, I can't even describe it. And so, I am so thrilled, so thrilled to have you today on the podcast, so thank you so much for being here.

Sarah McKay:
Aw, thank you, and it's very nice words that you've used to describe my little book, so thank you very much.

Melanie Avalon:
Well, I mean it and it's not just me, I mean, Sarah, you've been all over the place. You've been in the Wall Street Journal, The Guardian, TED Talks, ABC, all the places, so this is not just me saying this, but it's all really wonderful things, and listeners may hear your accent. So I just learned Sarah grew up in New Zealand. She currently lives in Australia and I also learned a lot of things about Scottish versus Irish and the differences. I was laughing because she said that us non ... See, I don't even know what to call you, like non Irish, Scottish, New Zealand ... 

Sarah McKay:
Non-Americans? Non-Americans? The rest of the world.

Melanie Avalon:
We all kind of lump it all together and I know it's like not even the same thing and you were saying its kind of like people saying that Canada and the US would be the same thing.

Sarah McKay:
Yeah, yeah. New Zealand and Australia are very, very different.

Melanie Avalon:
Yeah.

Sarah McKay:
We have an amazing Prime Minister in New Zealand and she's very different from the gentleman that we have here in Australia. Let me just summarize it like that. But there's plenty of differences but both countries have their strong points, and, anyway, I live here in Australia at the moment and it's a bit of an unfortunate time to be here because it really does feel like the Climate Emergency Armageddon has descended upon us with a dreadful bushfire season already and we're only just a few days into summer and all we have is smoke, haze over Sydney, so it does make me miss New Zealand and the clean fresh air there.

Melanie Avalon:
Well, thank you for being here with me despite all the environmental craziness. There's so many ways we could go with this conversation. We were talking before the call about what all to go into, but I thought just to start things off, would you like to tell listeners a little bit about your own personal health history? What made you so fascinated in the brain? What led you to where you are today?

Sarah McKay:
Oh, wow. I haven't really thought about it in terms of my personal health history before. That's an interesting one. Look, I was one of these kids that grew up with I was always, always, always really interested in human biology. I did not grow up in a very academic family, my parents both left school at 15 and I just had this real love of learning and in particular about human biology. There were a few nurses in my extended family, and I remember just being very interested in nursing textbooks because there's all these interesting pictures and things to read and to learn and understand, so I always had a long standing interest in human biology and health.

Sarah McKay:
In terms of my personal health history, I mean I think I've had a pretty good ride. I did grow up with, in New Zealand, great outdoors, spent all my time outside growing up, very active, pretty simple meat and three veggies diet. So, I'm incredibly fortunate to have grown up with that very down to earth, healthy, basic outdoor life. I mean I suppose in terms of diet, when you head off to university and you discover alcohol and boys and takeaway food, we all kind of wallow around in that world for a little while. I never really kind of thought too much about diet and I guess once you start, I had kids, I've got two boys who are now 10 and 11 and a half, and you kind of have to get back to basics again when you have kids and think about food and diet. 

Sarah McKay:
But honestly, I've never really thought a lot about what I eat because I think I was brought up with such a basic whole foods healthy diet, but it was never talked about like that. That was just what everyone in New Zealand ate. Fish on Fridays, maybe takeaways once a week if we were really lucky, but there wasn't many takeaways growing up in New Zealand back in the 80s. And I suppose more recently, I have become a whole lot more aware about the food I eat. I'm in my mid 40s so it's harder to stay healthier, you're not healthy by default. You do have to kind of take a little bit of care of your lifestyle. I've really, really, really, in the last few years and the whole family, we've not completely eliminated because I don't ever go hardcore on anything, but we don't really eat a lot of red meat anymore. 

Sarah McKay:
The main reason for that is rather interesting. One of my older sons got bitten by a tick and here in the Northern Beach in Sydney where I live, we have this unusual phenomenon whereby some people are getting bitten by ticks and it causes a mammalian meat allergy. Didn't eat any red meat for a couple of years because he couldn't. The allergy has now abated. I believe that there's somewhere else in the US, somewhere in Virginia, in the mountains or something with people having the same response. It was a really healthy allergy to get and made us feel a little bit smug, quite frankly because it's the kind of the green option, the way to go right now, so much better for the planet, better for our health. So in terms of thinking about diet, I had to just be a bit more creative in what I fed my family. 

Sarah McKay:
But I try not to think too much about what I eat, though I eat salads for lunch and I eat oats for breakfast, and I eat fish, maybe sometimes chicken and vegetables or salad for dinner, so I think my diet is pretty good. Perhaps one downfall is too much red wine, but you know, that's my one short cut to stress relief. 

Melanie Avalon:
So many thoughts. Well, first of all I didn't mean to imply that it had to be diet related. I guess, I meant more like body-mind connection, sense of wholeness was that at all related to your interest in the brain? 

Sarah McKay:
My interest in the brain was just very academic. In my first year of university, I was kind of doing a sort of a biomedical, pre-med, pre-den, pre-pharmacy type first year at uni and was doing the psychology lecture and became very interested in the kind of the biology of psychology. I had never really come across this idea of the brain or neuroscience and I read this book by a neurologist called Oliver Sachs, who some people may have heard of who wrote this amazing book called The Man who Mistook His Wife for a Hat. Really it was exploring different, strange behaviors and ways of thinking and being and feeling that people experienced depending on what was kind of happening in their brain if they had some kind of brain disorder or disease or brain damage. I was so fascinated and captivated by understanding the brain in that way. 

Sarah McKay:
There was a brand new degree, discipline at Otago University in Dunedin where I hit it off turn, that was really the first year that discipline of neuroscience had kind of come together from the departments of physiology and anatomy and psychology and psychiatry. That has always remained for me a very kind of intellectual pursuit. I just think that's really interesting and more so it's that that excites me and interests me. What I do now for my business is try to take that information that we have in the world of research from the lab and help people apply that to their lives. 

Sarah McKay:
But I mean to be perfectly honest, I'm quite selfishly, it really is for me to see the kind of the intellectual excitement that comes from this sort of trying to delve into this enormously broad and deep world of neuroscience. I'm just really interested in it. 

Melanie Avalon:
No, I love. 

Sarah McKay:
Yeah, and in terms of kind of mind, body, health kind of connections, I suppose I've become more interested in that over the years because people have asked me a lot of questions about it and I've got some pretty strong beliefs about based on science, based on the events, on kind of what we can apply and what we can't apply from neuroscience. Because it's become, there's a sort of seductive allure of talking about neuroscience these days and there's a lot of people out there talking neuroscience who have quite frankly, no training in the subject and I think we need to recognize where the gaps still lie and what we can and what we can't make meaning of from that research, too. 

Melanie Avalon:
I think that's such an important point and perspective to have and something that I really, really took away from your book was I felt very, very trusting in your perspective that are really going in and finding what do we know, what do we not know, how shall we evaluate data, what should we be looking for in these studies, in these findings and that was something I really appreciated. So to start things off, because I would love to get into the female brain specifically, but just for listeners, can you start with a general overview of the brain, specifically, the structure and function of the brain, so the lobes and the hemispheres and just the basic how the brain processed information. 

Sarah McKay:
Yeah, oh, my goodness that's like 20 years of study and research to try and explain that. I'm not even sure whether you can kind of summarize the structure and the function of the brain because it's incredibly complex. This organ lives inside our head and it's ... I like to kind of think about the brain as this organ that evolved in our head to be constantly monitoring and communicating with our bottom up biology, what's going on in our body. It's continually sensing and reading signals from our entire nervous system and all of our body. It's kind of evolved to help move us through the world and to connect with the outside world, whether that be nature. We evolved in the forests with this light/dark cycle, on this planet that sort of spins on its axis rotating around the sun and we evolved in tribes of people. 

Sarah McKay:
So our brain is there to be continually sort of sensing and engaging with the world around us and the world around us kind of gets in through our senses, through our eyes, our ears, our skin, the food we eat. The outside world kind of gets in under our skin via our brain, via our nervous system and then we also have this kind of more part of, because like a slippery ball to kind of hold these processes that emerge from the brain doing what the brain does, our thoughts and our feelings and our mindsets and our beliefs. And all of these bottom up and outside and then top down factors sculpt our brain through our lives and in turn our brain influences how our body works, our thoughts and our feelings and also how we interact with the world. 

Sarah McKay:
We've got kind of then take the next step and try to start breaking that down into different structures in the brain. I mean for many years, we had a very strong tendency to say, "This part of the brain does that," and that was simply because we didn't have technology to measure it in any other way. We really for many, many kind of years could only determine which part of the brain did what, by looking at what happened when a certain part of the brain was injured, when someone had a maybe traumatic brain injury or a tumor in a specific part of the brain. We could see what functions had been lost and therefore assumed that function was in that spot. 

Sarah McKay:
Now that still is the case for some aspects of what the brain manages, you know there is a part of the brain which controls the movement of your right hand, for example, and there is another part of your brain which is involved with processing the things that you see and another part of the brain which is involved with processing the sounds that you hear. But when we move on to our thoughts, perhaps the stories that we may be telling ourselves in our mind when we're just kind of drifting off or doing things like paying attention or perhaps doing mathematical tasks in our mind, trying to solve a mathematical problem. 

Sarah McKay:
There's not really any specific part of the brain that does that. We're kind of moving now, I guess, in neuroscience to talking about networks and nodes, and the brain kind of does what it does via networks, but we do have a very strong tendency to describe the brain using the current best language that we have, which is often based on the kind of the technology that we're using at the time so I suspect, perhaps, we're just talking about brain networks at the moment because we live in the world of the Internet. I think that's perhaps as far as I can go trying to sort of describe and summarize the brain, because it's incredibly complex. I say we've barely scratched the surface of the cortex and I've been thinking about this object for 25 years and I'm kind of stumped right now when you say, "Can you explain how the brain works?"

Melanie Avalon:
That's a fantastic foundation. I think you've brilliantly, brilliantly summed it up if it could be summed up. I actually have a question. I didn't anticipate going this way but hearing you say all of that, so having done all of your research in all of the study on the brain and what you were just talking about with the difference between like the spatial locations, with all of your vast knowledge, which I guess is almost ironic because it's all coming from the brain, but the sense of self and consciousness and a person's identity and being, with all of this that you've seen do you feel like it surpasses any one location in the brain? Do you feel like it even resides in the brain? What are your thoughts on that?

Sarah McKay:
Consciousness is called the hard problem for a reason because it's really hard to try and figure out and I mean people have been trying to define what consciousness is for, you know, ever since Aristotle and Plato and those dudes back thousands and thousands of years ago. I think many people try to define consciousness and self. Now again, I guess using their own current belief systems and knowledge, and it's a weird thing and it's a hard problem because we are kind of using the tool itself to try and understand the tool, the brain, and the mind is trying to explain the brain and the mind. Some people might say, perhaps we're not evolved enough to be able to understand ourselves yet. 

Sarah McKay:
I really come from the very neuro biological school of thought that the mind is what the brain does and consciousness is kind of what is in our attention at that time. There's this lovely analogy called the Theater of Consciousness that for me as a neuroscientist really resonates, that you think you've kind of got a theater and a stage and you have different scenes or different characters kind of coming on stage in the spotlight in any particular point in time. It's really what you're paying attention to. It could be something in the outside world. It could be a bird you've just seen flying past or it could be your phone rings and catches your attention or it could be perhaps a memory or a thought or a sensation that kind of comes on stage. Now if you've ever done any work in theater or gone to a theater you'd know there's an awful lot going on in the wings and backstage that sometimes you may never ever see but different characters may come on and off at different times, perhaps prompted by a director or perhaps just randomly arriving on stage. 

Sarah McKay:
So you know, we've got this, people talk about the unconscious or the subconscious mind as if it's some kind of mystical place that if we could only tap into and understand, we could solve all of our own problems. Whereas really it's just what we're not paying attention at that time and there's a ton of stuff that our brain does that we really quite frankly do not need to be thinking about at all. I don't really need to be monitoring my blood glucose levels. My brain's doing that. I don't need to be thinking about gut motility. I don't really need to be thinking about hormone release, the brain can manage all of that and that can be part of the subconscious way up the back stage, kind of really far back stage. So I just tend to think of consciousness as being what is kind of currently in the spotlight of our attention at any one time. 

Sarah McKay:
Now when we go into a deep sleep, we lose consciousness. When we're deeply anesthetized, we lose consciousness, there's not really anything on stage. If we suffer severe brain injury, we lose consciousness and may never ever recover again. So we have pretty clear neuro biological evidence that when you change how the brain is working, you are able to change that state of consciousness and I think for me that that's pretty clear evidence that consciousness emerges from the brain. There may be a school of thought, not mine, that consciousness is something out there in the universe and the brain is kind of the machine that is able to receive information rather like we have light and the retina of the eye can pick up light. Light is there regardless of whether there's a retina. 

Sarah McKay:
Some people might think consciousness is there regardless of whether there's a brain. I don't believe that, but that's a pre-requisite I guess, believing in life after death and spirituality and I guess that's why conversations of consciousness get really convoluted because people are coming at it with their specific belief systems and knowledge and experiences and it's something we all experience and something that we're trying to use to explain the problem. But, look, quite frankly most of it's completely speculative and we really don't understand yet how it works, so I'm happy to use a neuro biological model to explain it. Like I said, it's called the hard problem for a good reason. 

Melanie Avalon:
I have so many follow up questions but I feel like I should stop myself. 

Sarah McKay:
We can do another podcast another day. 

Melanie Avalon:
Do you have a podcast yourself?

Sarah McKay:
No, I don't. I'm quite lazy and I kind of think, "Aw, hm, I don't know." I quite like talking at people, so a podcast would probably suit me quite well, but I haven't got around to that yet, no. I just listen to them. I devour a podcast. You know how you have that thing on your mobile phone that tells you how many hours a day you have been using the phone?

Melanie Avalon:
Mm-hmm (affirmative). 

Sarah McKay:
Mine is always outrageous because I listen to podcasts, because it classifies podcasts as social media, I think. 

Melanie Avalon:
Yeah. 

Sarah McKay:
on Facebook, I was listening to podcasts. 

Melanie Avalon:
Coming back to the matter at hand ... Ugh, I've got to stop myself from saying, "No pun intended," I didn't realize how many time I say things like pick your brain or matter or what are your thoughts on this, so please ignore all puns that happen in this podcast. 

Melanie Avalon:
I really see now how much we've integrated the concept of the brain into our conversational language and our perspective of the world. In any case, with all of that that you just said, going deeper into the set up of the brain, is there a vast difference between the male and female brain or what are some of the common misconceptions or also what might be correct in common perspectives of how the male brain is different from the female brain? I know one of the biggest ones is people will say women's brains, the two hemispheres connect differently so we're better at multi-tasking. I feel like that's one of the ... 

Sarah McKay:
That just gives people an excuse to tell us to do more housework. The vast majority of "claims" made about males versus female brains are strongly related to gender stereotypes, so we'll just put that out there at the front but when I said I was writing, it's interesting when I started writing my book and I was just really interested in writing a book about puberty and periods and pregnancy just taking a look at women's health issues from the perspective of neuro biology, because I'd never before considered those in my entire career as a neuroscientist, because that's a really broad, deep field and those questions had never occurred to me. 

Sarah McKay:
But when I started saying, "I'm writing a book about the female brain," I wanted to call it In Her Head, not the Woman's Brain Book, but the question people would always ask me was, "What is the difference between the male and female brain?" So that frustration, because I'm writing a book about pregnancy, what have men got to do with it? But I mean people really loved this idea that all women have a female brain and all men have a male brain and we can kind of ... We had a room of a 100 men and women and we could sort of split them up into the pink side and the blue side based on what their brain structure and their brain function was like and, you know, "Women have these emotional brains that can't read maps and they can multitask and they prefer people to things and we don't ask for promotions." "Men, you know, can't read emotions and are geniuses and get all the good jobs in the workplace," and those gender stereotypical differences come about because of our brains. 

Sarah McKay:
What's really interesting is we just simply cannot divide a room neatly in half based on the anatomy or the functioning of different parts of the brain in the same way we could if we were to, you know, get everyone to drop their pants and have a look at what was down there. One way to kind of think about it is to think about other parts of the male and female body and the biggest difference that we see in males in females, apart from their genitalia and perhaps, men being slightly hairier is height. So you could probably, maybe divide a room in half based on height but you can pretty much get a sense straight away that you're not going to be able to divide a room to men on one side and women on the other based on height because lots of women are taller than lots of men, but the strongest set of difference that we would see statistically between males and female bodies is height. Already you can see that the differences there are going to be blurred, the averages are always going to overlap. 

Sarah McKay:
So instead we have to be thinking about our brains, the current kind of concept where a lot of the research is pointing towards this idea that we have a mosaic brain, and much like our behavior and our personalities and our likes and our habits, our brain features are made up of lots and lots and lots and lots and lots of differences and they're not all pink in women and all blue in others but they're a symbol of hundreds of little pieces that are colored every sort of shade of pink and blue and violent and indigo and purple. Some women have brains that maybe more slightly pink tinged and some men have brains that maybe more blue tinged but almost all of us have brains that are a complete mosaic of indigo and blue and violet and mauve and bright pink and hot pink and dark blue and navy.

Sarah McKay:
That's really how we have to be thinking about it, they're a complete mix of masculine and feminine and if we start to do what scientists do, which is we start to ask very, very, very careful questions about which is the specific sex difference or gender difference that we're interested in looking at, how different is that different? When it comes down to it, there are very, very, very few anatomical differences. There's no like kind of great sex difference between the brains of men and women in terms of maybe size. That's because men on average have slightly bigger bodies than women, so their brains are slightly bigger but it doesn't mean that they use them in any different way. Their hands might be slightly bigger but it doesn't really mean that they're better at using their hand through anything except maybe got a stronger grip or something like that so we really need to start asking much more sophisticated questions about how different are the differences and what is the specific difference we're interested in exploring and there's some really interesting sort of statistical analysis that is being done around teasing out how different are the differences. 

Sarah McKay:
What I was really interested in was when I started exploring the book with people who were always asking me this, and people seemed to be coming at this question with the assumption that if there was a difference, it was kind of entirely biological and innate. It was a sex difference and it was determined from genes or it was determined that way in the womb, which completely flies in the face of everything that we know about the brain being plastic and what happens the moment children are born, they're born into a gendered world. I know it's your part of the world that are really interested in these sort of gender reveal parties, which I think are just utterly ridiculous. 

Sarah McKay:
Because the children are born into this kind of gendered world, you are a boy and you are a girl and willingly or not, by the parents raised to sort of think and feel and behave and every experience we have sculpts the brain and that's when we can start thinking about if we do see differences emerging in behavior. Often those are learned. They are gender differences, not biological sex differences. So it's been really interesting taking a look at that and throughout the book there were times when I thought I went to have a look at do women have any cognitive differences at different times of the month, it maybe influenced by our hormones and then even if we go and look at all the very careful studies that are being done looking at women's cognitive capacity and compare a group of women to a group of men. 

Sarah McKay:
There are utterly no cognitive differences between males and females. The strongest one that we do see happens to be the ability of men to rotate a 3D object in their mind's eye. The average man is better than the average woman but the difference is sort of similar to height and that there's plenty of women that are really good at it and plenty of men that are hopeless at it just like there's some really tall men and some short women and really tall women and short men. Again, it is simply impossible to look at any specific function of the brain or any specific region of the brain and say, "That is pink and that is blue and they're entirely separate." 

Sarah McKay:
There are a couple of really small areas of the brain which do have very, very different roles. For example, women have a part of their brain in their hypothalamus, in a very deep down part of the brain that's involved in regulating ovulation. Clearly, men do not have a circuit for ovulation in their brain, but when we took at the parts of the brain involved with processing sound or vision or thinking or reasoning or math or anything like that, typically the average differences are so, so small and we see far more similarity than we do difference, much like we do when we start looking at our thoughts and our feelings and our behaviors and our habits and our likes and our dislikes. 

Melanie Avalon:
Wow, so it seems like actual biology of the brain is not a pivotal factor in the difference in the male versus female, I guess, experience or how that manifests in culture today. 

Sarah McKay:
Yeah, yeah, yeah, and I guess that's what's key is we have different experiences but that doesn't necessarily come about because our brains are wired differently from birth, because they're not really at all. 

Melanie Avalon:
So what portion of the female versus male experience, because you spoke to the biology of the brain as well as cultural stereotypes and how that influences things. What about the role of hormones in the female body? How much does that affect the female identity as a female?

Sarah McKay:
Yeah, yeah, yeah, that's really interesting, because of course we have these very different experiences in our lives which are due to our capacity to reproduce as women and to carry a baby so we can look at different sort of hormonal or reproductive transitions ... What I was really interested in doing in the book was ... and the book really kind of takes a look at what happens during when the brain's sort of developing in utero, during childhood, and some really interesting studies, I think might sort of shed a bit of light on that. 

Sarah McKay:
One study I was really interested in was looking at very young children in terms of the experiences boys and the experiences that girls have. We'd all be very familiar with this kind of Sheryl Sandburg Lean in concept now, which I suppose is kind of a few years old now, but this idea that men are very self confident, put their hand up for everything and women are less likely to do so ... Although, I never really felt, feel like I have a problem putting my hand up ... and if we look at this kind of ... we would call it male hubris, this kind of super self confidence, when does it emerge and it turns out it emerges very, very early in childhood development.

Sarah McKay:
So there was a study that was published in the Journal of Science, which is absolutely top flight academic research journal ... and it was looking at the experiences of little boys and little girls in the classroom in the first year or so of being in primary school or elementary school you call it. At around ages five and six and then the researchers will enter and then they would say that the class of boys and girls, "Who here wants to play a game designed for really, really smart people?" And all the little girls would put their hand up and all the little boys would put their hand up and then they might say, tell them a story about an amazing inventor or scientist who's saving the planet from Climate disaster or something. They'd say, "Now do you think that you could grow up to be like that scientist?" And the little girls would go, "Yeah," and the little boys would go, "Yeah." 

Sarah McKay:
Then they went in and looked at children who were a year or two older, who were around sort of ages seven and eight and what they found was, "Who wants to play the game designed for really, really smart kids?" And all the little boys would go, "Yeah, yeah, yeah," and all the little girls would go, "Oh, yeah, that's the game for the boys," and similarly, "Who wants to grow up to be the famous inventor or scientist that saves the planet?" The boys would go, "Oh, I do." And the girls would go, "Oh, that's what the boys will do when they grow up." And there's no hormonal change that happens between ages sort of five and six and seven. These children are starting to develop these completely different perceptions about themselves and their capabilities and who they are and that's got nothing to do with hormones. There's nothing going on there in little girls' ovaries and little boys' testes at that point in life. 

Sarah McKay:
Now I don't know what the answer is. I don't think the answer is don't educate children, because this is what happens when they go to school, but I just think it is such a interesting insight into how powerful people are, you know, the world around us and the messages children are picking up and learning and taking on board. Then those boys will be the ones putting their hands up all the way through adulthood and it's the girls who are defaulting to, "The boys do the smart stuff and we don't." And so, right away, we can see that that's not hormonal. 

Sarah McKay:
The next kind of I guess point in the life span when hormones do really sort of start to be a louder voice in the crowd and I'm really fond of using that term, and I introduced the idea at the beginning of this podcast about our brains are getting constantly monitoring, receiving signals, and sending signals back out to our biology, the outside in world, and their top down thoughts and feelings and hormones are just one voice coming from the bottom up and we see when children enter puberty and that's when we start, you know, girls start releasing estrogen and progesterone from their ovaries and the boys start producing testosterone from their testes and obviously there are quite significant physical changes that take place. 

Sarah McKay:
The children are also moving from primary school to high school or elementary into middle school and high school. There's a whole lot of changes taking place in their brains, in their body, in their social structures. They're moving from being embedded in families to kind of starting to think that their friends are far more important so there's a lot of changes taking place. We have a real strong team that say to blame a lot of the negative emotional shifts that we see at this point in the life span to hormones. 

Sarah McKay:
So there was one fascinating study that was looking at the emergence of anxiety and depression in young people when they entered puberty and what we tend to see is that kids are usually pretty resilient through childhood and even at inter puberty, they're far more likely to develop mental health problems. Girls are far more likely to develop the anxieties and depressions and boys have different kinds of ... They still get anxious and depressed, absolutely, but they're least likely to be diagnosed with that. They might develop anger issues or something else, and again, talking about average populations here. 

Sarah McKay:
But if you look at a little girl who in just puberty, say early but normal, maybe she starts growing breasts, gets her period, maybe say nine, 10. She's not pathologically early, just early but normal, earlier than all of her friends, she is far more vulnerable to go on to develop emotional and mental health issues than the little girl who starts developing at the same age as her friends or slightly later than her friends. But what's really interesting is look at what happens to little boys, if a young boy start developing much earlier than his friends or his testosterone hits, he gets taller, hairier, musclier, his voice deepens and he rises in social stature within his friendship group and he's then protected against developing those kind of emotional problems of adolescents, versus that little guy and we all remember that little guy from the class who developed much later than everyone else. I mean he hits puberty at 15 or 16, he is far more vulnerable to develop mental health problems, than the kid who entered puberty much earlier. 

Sarah McKay:
So we've got these four kids here who have entered puberty at different points in time, all experiencing that same surge of hormones. It's having the same effects on their bodies, it's having the same effect on kick starting teenage brain development but children's experiences depend on the social context in which those changes are occurring. So we've got these bottom up biological changes kick started by hormones but children's emotional experience depend on the outside in world, their thoughts and their feelings and how they fit in with their peer group, that has is a louder voice in the crowd than the hormones. 

Melanie Avalon:
Okay, that is really fascinating and how does that relate then ... Because something that you talked about in your book was this critical period of adolescence. 

Sarah McKay:
Yeah. 

Melanie Avalon:
A time when the brain was most likely to learn and when the identity was shaped, it sounded like there was an opening and a closing of a door almost around it. 

Sarah McKay:
Yeah, yeah, yeah, and we're pretty familiar with these ideas of critical periods or sensitive periods of development in early childhood. You know, children must be spoken to and learn language before about the age of 18 months or two years or it's very, very hard for the to develop speech and language later. They can, but it is much harder. It just doesn't happen naturally, so children who are born profoundly deaf and it's not picked up, really, really struggle with language and development throughout their lifespan. 

Sarah McKay:
We kind of understand those critical periods of development and what we see was when children entered puberty, and on average, girls start a year or so before boys. The girls sort of shoot up before the little guys do and that kick starts adolescent brain development and that's just absolutely critical period of brain development. The brain is growing and changing all the way through childhood but what we see is a lot of the connections become incredibly refined and streamlined when we go through adolescence. 

Sarah McKay:
Now interestingly, if we look at one of the frontal lobes of the brain, the pre-frontal cortex, some of you listeners may be familiar with that, that's that part of the brain that's involved in things like judgment and reasoning and planning, emotional regulation and also social cognition. So really important kind of grown up adult functions of just kind of being an adult and we develop those skills as we're going through adolescence and what we understand now is that that part of the brain that is involved with managing those functions is going through this exquisite period of brain development and it's incredibly sensitive to the experiences that it has. 

Sarah McKay:
That's what we call experience dependent plasticity, because the brain is being wired based on the experiences that it has so while we may think of "Oh, young people are really overly emotional and they can't control their emotions," they're going through a period of brain development where they're learning, they're at the prime point in time to learn how to thoughtfully manage their emotions. Now we see, I kind of mentioned before, we have kids and I have 11 and a half year old son and he would much rather hang out with his little herd of boys roaming the suburb on their bikes than he would have anything to do with mum and dad, which is a completely normal phase of development and his brain is also about to enter that phase of development where social cognition, the ability to think about the thoughts and the feelings of other people is going through this very, very sensitive phase of development and it requires social engagement and the right kinds of social connections and engagement with other people to wire it up in the right way. 

Sarah McKay:
So the experiences that we have during this point in time are incredibly important to develop the brain kind of in the right way, so to speak. Now this brain development is kind of kick started by the hormones of adolescence. It kind of opens up this period of refinement and I think what's really interesting is the pre-frontal cortex has got the gray matter, the kind of wrinkly gray outer layer of the brain that you would see if you were looking at it from the outside, that's going through ... At least, essentially it's thinner, it gets narrower and people freak out when they hear that because they think that means the brain's degenerating during the teenage years, but it's not, it's streamlining and it's getting much better at doing what it does. 

Sarah McKay:
It's getting rid of all the superfluous connections that its grown, that it doesn't need and it's refining and it's pruning away what it doesn't need. And so that's why the experiences that young people have during this point in time, lovely coincidence they happen to be at high school, big time of learning about self and development and learning cognitive skills, learning about judgment and reasoning and problem solving and maths and history. All of these experiences are helping to prune away what it doesn't need and refine those connections and then that kind of period of developmental, most kind of that sensitive period, kind of closes down once you're into your sort of early to mid-20s and then the brain doesn't really change in structure much more if unfortunately you live long enough that you develop some degenerative disease. Although there is another point in the life span in women where it does, during pregnancy, it does change its structure slightly. 

Melanie Avalon:
Yeah, that was one of the things I was fascinated by was your discussion about how even when we're born that half of ourselves that we're born with in the brain are pre-programmed to die. 

Sarah McKay:
Yeah, well, that happens pre-natally, yeah, before you're born. So the brain is very good at kind of ... It's almost as if you imagine you're growing a, you know, one of those big kind of hedges in your garden that you want to then sculpt and refine and prune until it looks like a swan or a reindeer or something, and you're kind of getting rid of all the bits that you don't need. The brain is very, very good at ... There's kind of an overabundance of cells and connections and synapses and that's all kind of there to be then refined and sculpted by life itself, that kind of gives us that capacity for that huge diversity in terms of all the different kinds of people that there are out there in the world. 

Melanie Avalon:
So things like anxiety or rumination or ... I guess, we quality them as mental health issues that people experience and you do mention in the book that negative self-talk even, that women often experience that more than men. How does that relate to that whole, the brain pruning cells or does it even relate ... I guess these things that seem to not be serving us but maybe they have an evolutionary purpose to them? 

Sarah McKay:
Yeah, that's interesting and adolescence and a lot of these sort of life transitions that we go through, the brain goes through these very sensitive phases of development. It's a big of a double edged sword, because if you think of a young child raised with a loving, warm, nurturing family, great education, kind of giving, it's kind of guided through life and given everything that it needs versus a child who grows up with extreme poverty or trauma. Plastic brains are great things if the situation and the environment that it is in is healthy and nurturing, so that's where issues such as trauma or poverty or just living in a family that perhaps didn't give you everything that you needed can cause problems. 

Sarah McKay:
So when we see young people going through their teenage years and adolescence, that is this period of time where one of the skills that you're learning is the capacity to regulate your own emotions. You're learning to recognize other people have thoughts and feelings that are different from yours. We develop this exquisite sensitivity to the imaginary crowd when we're going through adolescence and that we think everyone else is looking at what we're doing, they're judging us, whereas all teenagers are thinking that everyone else is thinking about them, that really they're just all thinking about themselves. So their imaginary audience, the development of that is a very normal part of adolescence. 

Sarah McKay:
What happens is when children aren't learning or aren't given the skills or the knowledge or the right environment in which to learn how to regulate emotions, how to think about what other people are thinking and feeling, how to stand back from your own thoughts and be kind of reframe the thoughts that you may be having and those are sort of skills that we really need to learn. They kind of develop naturally, but we really need them to be modeled and taught to us in the right way and if you haven't learned those skills, then it's that much harder for you to not be able to manage them later in life and that's what we see with these kind of critical periods of development. It can be a bit of a double edged sword. 

Melanie Avalon:
Kind of tying into that as far as like bringing feelings and things that might seems like "issues," so I guess women listening now might bethinking, "Okay, so there's not much of a difference between the male versus female brain, so why as a female do I seem to be experiencing all these intense emotional swings, hormonal changes? Is that experience from society?"

Sarah McKay:
I think that little boys and little girls experience very, very strong and intense emotions and I have two boys and they are entirely different in terms of their emotional make up and in terms of ... One of them we often say has external sort of representation of his emotions as the same as what he must be actually feeling inside. Gosh, it must be like living in an emotional roller coaster inside his little body and mind, whereas my other guy is just sort of very emotionally stable. He's very stoic. He's very together and they are entirely different and so we simply can't say, "Well, girls are highly emotional and boys are stoic and not." Because we all have emotional feelings, we're just socialized to express them very, very differently. 

Sarah McKay:
And there's some evidence that I talk about in the book where mothers are far more likely to use a wider range of emotional words when they're describing emotions and talking about emotions and feelings to little girls, to their daughters than they are to their sons. So guys grow up then with a far narrower range of emotional valence to kind of choose from because the language that we're taught to describe how we're feeling influences the emotions that we're then going on to experience, whereas girls have this far wider valence of emotions that we feel comfortable and socialized to experience and to express. So I don't think that we inside are feeling any differently, we're just, we're told we're women are on this kind of crazy hormonal roller coaster that we can't get off and that our hormones are the loudest voice in the crowd and determining how we think and how we feel and the evidence doesn't stack up to show that. 

Sarah McKay:
So I was really interested in digging into that idea when I was writing the chapter on the menstrual cycle, because I thought, "Well, hey, we've all got this kind of monthly neuroscience experiment, those of us who are between puberty and menopause, aren't pregnant and aren't on some kind of hormonal contraceptive. We've got kind of a monthly neuroscience experiment going on." So do our hormones completely define how we think and how we feel and so I went and looked at some very careful studies that were done on various aspects of cognition so this is what we might talk about thinking and there was absolutely no evidence to show that women had any difference in their cognitive capacity, their ability to think or plan or reason or add up numbers or have verbal memory recall at any different point in the menstrual cycle, so hormones played no role in that, which is kind of good, because that means, you know, whether you've got your period or not or whatever you can have a great career and know that's not going to influence your ability to function in the workplace. So I was quite happy with that finding.

Sarah McKay:
And I thought, "Surely emotions are going to be very different. Emotions are going to be strongly impacted at different times in the month by our hormonal stages." Because we're told that, we're told that women are these hysterical hormonal creatures and that hormones are these things that drive our emotions, although, I've just described the findings around kind of emotional turmoil and puberty. The loudest voice in the crowd wasn't hormones, it was other people and when I went and looked at the very careful studies that were done of specific aspects of measures of emotion that cognitive psychologists would do, so looking at how empathy might change over the, let's say menstrual cycle or our other aspects of emotional recall, but there wasn't really any evidence out there showing that it was influenced by hormonal stages whether that be time of the month or not. 

Sarah McKay:
So I thought, "Well, I know what I would do. I'll go and have a look at PMS, because that's this thing, right?" Pre-Menstrual Syndrome or PMT or whatever we call this kind of emotional anger, this irritability, this hysteria that all women have in this week or so before their periods, there must be evidence for that. I came across a meter analysis which your listeners may know as kind of pulls together lots of different scientific research. Papers on the same topic and kind of pulls all that data together and there's more power. Greater numbers, more power in that and it was really interesting because it was looking at women's experience of PMS in different countries around the world and it turned out that it varied hugely depending on what country you lived in. 

Sarah McKay:
So interestingly, if you went to France or Switzerland and said to the women there, "Who here experiences PMS symptoms?" And in particular they were looking at the emotional symptoms of PMS, not just sore boobs, and about 10 to 15% of women in France and Switzerland put their hand up and say, "Yup, I suffer from PMS." World global average was about 50% and then you went all the way over to Iran, interestingly, how many women there? 95% of women. So somewhere 10 and 15 and 95% of women are experiencing PMS, feeling irritable before their period but it depends where you live in the world, it depends on the society or the country in which you have been brought up. So I thought, "Huh, well, it can't be hormones, solely hormones, because they don't vary that much by your country of birth or the culture in which you were raised."

Sarah McKay:
So does a woman's ... Health psychiatrist in New Zealand called Sarah Romans and she was also really interested in this topic so I've looked at her research and spent time with her, chatting to her on the phone and she was getting a lot of women coming into her psychiatry practice and obviously, she sees a very narrow range of society, women who have very serious emotional problems, because they've gone to see a doctor about them. But she said, "I just didn't believe that every single woman coming in the problem was hormones." They were defaulting to blaming their reproductive capacity, the fact that they have hormones on their ... blaming their emotional state on that.

Sarah McKay:
So she designed this incredibly clever study called the Mood and Daily Life Study and so women had like an app on their phone, popped up every day and they had to record the day of their cycle, they had to record their emotional state and they were given the same number of positive, neutral, and negative emotions to choose from. They weren't just given just negative emotions as if you could have 12 types of sadness, anger or irritability and then just one kind of happy. There were equal positive, negative, and neutral emotions to choose from. They also recorded things like physical health, how socially supported they felt and how, their kind of stress levels and how they were kind of feeling about that. 

Sarah McKay:
Hundreds of women in the study, hundreds and hundreds and hundreds of menstrual cycles, the key was the women were not told it was a study on PMS. The women were told it was a study looking at mood and daily life. When all of the data was crunched and this is lots and lots of women find this ... they get very upset with this finding ... Only one in 20 of the women showed any clear mapping between her emotional state and her hormonal state. 19 out of 20 women in this study, their emotions were far more likely to be influenced by non-hormonal factors. So with their how kind of healthy she was feeling, how stressed out she was, but most significantly the strongest predictor for a woman's emotional state was how socially supported she felt. 

Sarah McKay:
So I kind of talked to Sarah about this and initially we were kind of joking. She said, "It's, you know, it's not hormones. It's whether their husbands put the bins out or not." And I said, "You know, women must really struggle with this, because we are told we're all in hormonal roller coaster and you're going to get PMS and you're going to feel terrible." And it very neatly fits in with the Feminist narrative of PMS being a social construct whereby one week a month we're allowed to express these negative emotions we otherwise keep kind of hidden, and she said that a big part of what she does is just try and re-educate women around the various multi-factorial influences there are on our emotional state and to try and re-educate women away from this default to simply blame hormones. 

Sarah McKay:
Now of course, there one and 20 of the women in this study who did show emotional variation, depending on their hormonal, the time of the month, which is interesting because if you look at clinical definitions of pregnant or dysmorphic disorder, which is more likely to be seen in women who are suffering from depression. Obviously, that woman is, some women are far more vulnerable to the influence of hormones on their hormonal state. So there were women who were influenced but by and large, most women were not and I think that's actually quite good news, because it gives us a great sense of agency over our emotional experiences. We're not beholden to our ovaries. You know, that's the outside world and once again it was people, it was other people it was the social connection that was the greatest influence on women's emotional state.

Sarah McKay:
And this sort of theme came up ... and I went into this book with absolutely no idea, no agenda, just really curious to explore the research. So I was surprised by this research. A lot of women have kind of, you know, they've been brought up, been told hormones will upset you and there's quite a degree of resistance to this finding, but I think, you know, what good news is that, you know we've got great, we've got agency over our emotions. We're not riding a hormonal roller coaster. It's a challenging idea for lots of women but I think it's a wonderful one. 

Melanie Avalon:
Well, I personally am very, very fascinated by this. So in college I actually wrote a paper that I won a scholarship for through the Gender Studies program at USC, but it was actually analyzing the history of hysteria in women and my thesis was that the work of Charcot and Salpetriere in France in the ... It's been a while since I wrote that ... the 1700s, I believe but ... let me double check the dates, but basically that crystallized this idea of the hysterical women and the need for therapy and medication to address. It was really a complicated paper but ... and then I was talking about actually how today I was positing that Lady Gaga was actually ... Because this is right when she became pretty popular and I was saying how she was embracing the female hysteria image and taking back the power and kind of breaking these identity gender ideas that we have in society. 

Melanie Avalon:
I was analyzing her music video and it was very interesting but so when I was reading your book I was loving the part, because you did talk about the history of hysteria and women and how that tied to originally they thought it was about the wandering womb in the body. So hearing everything that you just said, at first I was thinking, "Oh, but there are hormones, like we do feel these things." But then I was thinking, "Would that actually mean that there's a possibility that if somebody feels like they are experiencing intense hormonal fluctuations, be it due to their cycle or due to maybe some other factor." 

Melanie Avalon:
If they think that it's hormonal related, could it possibly be that in some situations there's some other factor setting the body off balance which is also disrupting hormones and we're blaming the hormones as the problem when really it's some other health issue or something like that? 

Sarah McKay:
Absolutely, I mean, and our hormones are under the influence of various aspects of our health and our emotions are ... and we tend to think emotions are these kind of functions of the brain. I guess, again, that emerge fully formed when we are born but our contemporary neuroscience understanding of emotions is that we learn how to experience them. We learn what sensations in our body are. We give words to them and then we kind of categorize them and that becomes happy and that becomes sad and then we learn what that experience feels like going forward. That's very different from having a hard wired emotion that's sort of set from the moment we're born and we can learn to experience a whole range of new emotions and we can learn to experience bodily sensations and give a different word to them or learn a different story or narrative around them and therefore have a different emotional experience based on what is happening in our body and based in the kind of the context the world, the environment that we are embedded in. 

Sarah McKay:
So I think we need to be kind of shifting away from this very much. It's the sort of straight line from hormone to emotion to experience. Our brains and our minds are incredibly powerful and we can influence it incredibly and I think if we just look at the different experiences women have with PMS in different parts of the world, they're entirely embedded in these cultural narratives that we have where we can have incredibly powerful emotional experiences because we expect to have them. 

Sarah McKay:
So I remember sort of saying to my sister, I don't have daughters but when my niece, before she had gone through puberty or before she had her first period, my sister kind of, "Oh, well, I know the time of the month must be coming because she's getting cranky," and I'm like, "But she doesn't have a menstrual cycle yet so she can't be getting cranky at a particular time of the month and again you are teaching her that she should be expecting negative emotions at this point of the month because of her body and removing any agency then she has over having a different emotional experience at time of the month." 

Sarah McKay:
I talked to Sarah Romans about this and she said, "It's just very important that we start to be a bit more nuanced and a bit more thoughtful about where our emotional experiences come from, than just simply defaulting to, 'Oh, it is our hormones.'" Of course in some instances and in some women, that is entirely the case, but for many of us, it is not, but we are having that experience because we have been brought up to expect it. So I think that there's some wonderful, this sort of social media landscape that we're in and this wonderful period positivity and there's a lot more openness and discussion about that, but there's also quite a prescriptive way of describing our emotional experiences at different times of the month and if we expect to experience something, then we're going to experience it. The experience is real, but it may be, we may have learned or primed ourselves to expect it, rather than it being solely driven by something biological. 

Sarah McKay:
So I do think we need to be a bit more skeptical and nuanced and take a bit of agency and control back over our emotional experience. I found that incredibly empowering. 

Melanie Avalon:
That is a huge paradigm shift. 

Sarah McKay:
Yeah, I think we just need too to realize that our brains are not just hormone monitors and hormones are, do play a role with shaping our experiences. They shape our physical experiences. They shape our social experiences and they do shape our emotional experiences but they are not the sole provider of an emotional experience. Simply because we are female does not mean that a hormone is the sole provider of an emotion. And the careful for studies where women are not primed to think, "Oh, this is a study on PMS. I'm going to be sad before my period." 

Sarah McKay:
The other factors came into play when women weren't primed to expect this and we see, we can look at studies that are been done on pregnancy, studies that are being done looking at women on the pill or not. A lot of these, where we can have clear manipulations or shifts in hormonal status, society is telling us that that should map onto an emotional experience and it doesn't necessarily do so, which is good, I think that's great. That means, in New Zealand we have a Prime Minister who could get pregnant and have a baby and manage to run the country almost better than any other country in the world is run. What good news that is, we don't all need to be crying into our whatever, simply because our period is due. I think we need to take more agency over it than that. 

Melanie Avalon:
So what does that imply about things such as hormone replacement therapy or supplementing with things like progesterone and the effects that women seem to experience from that?

Sarah McKay:
That's really interesting because there's a lot of chicken and egg scenarios here. So HRT is different from say the contraceptive pill and there's been not as many studies done on the contraceptive pill as there have been done on HRT, so I would talk about them entirely separately. But HRT is I guess hormonal supplementation for women who are going through perimenopause or have experienced menopause entirely and that their periods have stopped, but of course, there's a phase of maybe up to five, six, seven years before a women has her final period where she's going there perimenopause and I'm in it right now in my mid-40s where some months it's all like clockwork and then you might skip a period or your hormones will be going up and down. One of the most common symptoms of that is a kind of classic hot flash, hot flash all night sweats where you kind of get the surge through your body and you get all it's so hot or you start sweating at night. 

Sarah McKay:
We know that that's the most kind of reliable symptom of this point in the life span. Now especially if you're getting night sweats at night, it has a huge impact on your sleep and if you're not sleeping properly, then we know that there's quite serious effects for your emotional self. So there's a bit of a chicken and egg scenario here. We know that when women are going through this point in the lifespan, it's another one of these transitions where we're vulnerable to developing emotional problems but there's a whole lot more going on than just hormones of course. Hormones are causing our night sweats, which are causing you not to sleep properly, then you're going to be far more emotionally vulnerable. You're also ... it's a real point in lifespan where you start kind of thinking about aging, you're thinking about your body changing. You're thinking about this glorification that we have of youth. 

Sarah McKay:
You know, the world with bio hacking, that kind of world you're immersed in is obsessed with ... not that you think you're going to live forever but you know longevity and saying as healthy as possible, for as long as possible. Is our health span going to match our lifespan. It's a really big psycho-social emotional shift in your life, so there's a lot of things kind of going on, bottom-up, outside and in, top-down. You probably, if you have kids, they're probably somewhere in their teenage years, not always, but often, so you kind of you're dealing with these huge emotional shifts of young people who may be going into high school and dealing with teenage life and often a lot of us, we're at the peak of our careers. So there's a lot going on besides just the emotional shift. 

Sarah McKay:
So one way that many women may choose to deal with this and certainly we know that the very best treatment for hot flashes and night sweats and perhaps the effects that they may have is Hormone Replacement Therapy and it's certainly something that I have chosen, not HRT because I haven't gone through menopause yet, but I've gone back on the oral contraceptive pill and I'm just taking that constantly because I was awake five times a night, drenching in sweat or freezing cold, because it was in winter and quite frankly couldn't be bothered dealing with that. My lifestyle is good enough, I felt like any improvements I could make would be so marginal it wasn't going to help with these hormonal fluctuations so I just went back on the oral contraceptive pill. Hot flashes went away and I'm kind of just carrying on with life now without having all of that kind of burden behind me. It didn't really affect me emotionally but I was sick and tired of not sleeping at night. 

Sarah McKay:
Now there's so many people who are so scared about HRT and it took a really, really, really bad rap back at kind of the turn of the century 2002 and 2003 when there were a few enormous women's health studies being done globally, looking at HRT and it turned out that the report started coming in of quite high rates of women developing heart disease and cancers and various other health issues related to the Hormone Replacement Therapy and perhaps half to two thirds of the women globally who were on HRT stopped almost immediately. 

Sarah McKay:
Now what's been really interesting in the sort of the 15 years or so since those studies have then come out, we've gone back and we've been able to take a really, really careful look at the data. It turns out that a lot of the women who were entered in that study, over half of women who were entered into these clinical trials of HRT were many, many years beyond menopause. Some of the women were in their 60s or even 70s so they could have been 10, 15 or 20 years after menopause were entered into these studies and then a head hormones re-introduced into a body that had weaned off it and what we understand now is that if hormones are re-introduced into a body that's ... and I'm just using word weaned of estrogen as a way of kind of describing what happens after menopause, that is what causes the problems and it was in those women that we're seeing these increased rates of problems. 

Sarah McKay:
When women were started on Hormone Replacement Therapy either right around the time of their last menopause, if they were symptomatic, or in that kind of peri-menopause or window, we're not seeing any increase in rates of any of these heart disease, cancers, et cetera, et cetera. We think that in many cases, it maybe incredibly protective for women's health in particular and brain health and heart health and it certainly has a huge impact on things like hot flashes, which may cause women to not sleep properly and can cause a whole lot of emotional issues if they don't feel that they can kind of maybe manage themselves in the workplace well. 

Sarah McKay:
And a lot of these studies around this kind of window of opportunity of Hormone Replacement Therapy have been verified in a lot of animal studies whereby we've seen a lot of animals that have, they go through ... Well, almost all mammals except for humans and some species of whale ... When you go through menopause, you don't live maybe a month or two and then you die. Whereas if animals are given these hormone replacements, not only do they live longer but they live healthier. Whereas if it's reintroduced into the system that has weaned off it, that's what causes the increase. 

Sarah McKay:
So I think, again, there's a very, very strong and fearful social narrative around HRT causing issues, having negative effects on people's health and it is very, very hard for people who work in kind of science and health communications. Once people have got scared of something, we've seen this with these anti-vaxxers, you know it was very, very hard to wind back fear with re-educating with information. It's a very, very hard thing to do in the face of fear but certainly the most recent evidence that we have around HRT and in terms of the impact that it has on our brains, we're not entirely sure how hormones are working in the brain to kind of reset that thermostat but we understand that there's a bit of a thermostat in our brain in a region called the hypothalamus and when we enter ... and it must be regulated by hormones we believe, because when we enter menopause, it seems to get a whole lot narrower. 

Sarah McKay:
So when you even get slightly hot, pre-menopause, you would just slightly hot. After menopause, your body thinks you've gained two or three degrees and so you have these huge kind of sweats and you want to throw your clothes off. So that thermostat gets a lot narrower after menopause but if you put the hormones back in, before the menopause then the thermostat doesn't narrow down and that's why you see the relief from a lot of these kind of thermo-regulatory issues. 

Melanie Avalon:
I mean this is completely fascinating, it seems like so many of the issues women seem to experience hormonally really do have this ... it's because of a cultural perspective of it or anticipation of what's going to happen based on what we've been told. I'm fascinated by what you're saying about how it's hard to unlearn a fear surrounding something. 

Sarah McKay:
Oh, absolutely, absolutely. Yeah, it's really, really hard and I mean, I use anti-vaxx as an example of there's so much fear there that something negative will happen that it's hard, you can't re-educate people with that information. We only have to ... I don't know whether you have heard what's happening in Samoa recently. They had a measles epidemic and we've had over 60 children, this is a small Pacific Island just off the coast of New Zealand, we've had 60 children die there because they did not have herd immunity because they only had about 40% of the people vaccinated because they had a real strong anti-vaxx narrative there. Now people say, "Measles, this isn't a big deal." Well 60 kids have died there in the last month. 

Sarah McKay:
The public health authorities were up against kind of re-educating this population not to be scared but they all refused the vaccination and look what's happened now and it's going to happen again. Whereas in other islands such as Fiji or Tonga where they had very, very high rates of vaccination, the measles epidemic hasn't taken hold and the kids are doing fine. So Samoa is ... I mean it's, what are we? December 2019, they're right in the middle of that kind of thing and re-educating populations of people when we have these very, very strong stories that are often counter to the science is very difficult and you know, I worked for many years as a Science Communicator, you know, sometimes the best way to change someone's thought is through a feeling and often sometimes the best way to change someone's feeling is by educating them with a bit of thought, but it's so much harder to go that way. 

Sarah McKay:
People's emotions do tend to rule their decision making, even in the face of so much evidence and information otherwise. It's a real challenge, but I think it's kind of interesting. Intellectually that problem in its own way and I suppose, for me writing the book was just totally fascinating and I kept coming across story upon story upon story like this where ... and we haven't talked about pregnancy and those post-natal years that similarly hormones play a huge role in that, but women are far more likely to develop depression after they've had the children. 

Sarah McKay:
The older their children get, they're far more likely to have to have depression when their children are three or four, than those first few post-natal weeks. So the hormones are over and done with, by then it's around the expectations of motherhood and just the daily grind of raising children in this kind of develop this new sense of self which must emerge and develop, much like adolescence, the sense of motherhood, which must kind of develop and expectations around that and that is a much stronger influence over women's emotional stories than just these hormones. They're just one voice in the crowd. 

Melanie Avalon:
Yeah, I mean, it makes me think even more and more, I mean looking at the longest lived populations or trends with longevity that we want to always attribute it to like diet or something that they're eating or not eating when really it seems to be more about the social connection the sense of purpose. What I love in your book, you talked about ... I don't know how you say her name ... 

Sarah McKay:
The French lady Jeanne Calment. 

Melanie Avalon:
I love the quote that you had from her. This might have been the final quote of your or how your book ended, but she was talking about her secret to longevity and she was saying, "Always keep your sense of humor. That's what I attribute my long life to. I think I'll die laughing." That's part of my program. 

Sarah McKay:
We can take health and well being so seriously and it's like removal of a joy out of living sometimes. Just for everyone who's listening that Jeanne Calment was born in 1875 in France and she died in September 1997, just for context, the same month, Princess Diana did so she was 123 or 24 years old when she died. She has a Guinness World Record for that. Now there is a little bit of controversy as there always is around was she actually her daughter faking to be super old or something, but that's just a bit of a conspiracy theory.

Sarah McKay:
But she had an incredibly enriched intellectual life, social life and she was physically very healthy. Now she clearly had biological pre-disposition for a long life because she had a brother who lived into his late 90s and she lived by herself. She outlived her husband and her child who both died of accident and one of food poisoning, I believe. She lived in a second story walk up apartment until she was a 107, when she went into aged care. So she was walking up and down those stairs as well. So I mean keeping physically fit and healthy and having a good diet of course is incredibly important. But I think we can have such this ... 

Sarah McKay:
Nowadays this tendency to kind of ... Health and well being has become so self centered and so there's this strong sense of the answer's inside and if you just eat the right food and look inward for all answers, then you'll live forever and it all seems to be a lot about manipulation of biology and in doing that, we're kind of disconnecting ourselves from nature, the world around us. We evolved as we are wild creatures and the tribes of people that we evolved to be part of as well and I think that the self-help movement and the well being movement has done some good things but in some ways I think it's done a bit of damage because it's disconnected us from certainly what we understand in neuroscience what our brains evolved for and that is connections with other people as social context and being, you know, a bit more back into nature are so, so important. 

Melanie Avalon:
Yeah, I cannot agree more and this may seem ironic coming from me, because I have the Melanie Avalon Biohacking Podcast but I'm starting to just realize and come to exactly these thoughts that you're having right now, because I've personally experienced certain health conditions and health issues and something I keep saying a lot recently is I feel like if I could just forget everything I knew and ... If I could just forget all of these ideas about what I think is happening or what causes water ... all of this biohacking stuff, I think certain things I've been struggling with would most likely ... I mean I don't know this but I feel like they could be gone tomorrow. 

Sarah McKay:
Yeah, these narratives that we have in these stories, we tell ourselves we can powerfully ... and people are very, very happy with this idea of having ... good thoughts can help us live healthier and happier lives but we need to remember that all of our thoughts and all of the stories that we're telling ourselves can impact on our health and positive and negative ways, so we can't just pick and choose which ones kind of work, which ones kind of support our philosophies or whatever and I do think that ... and I'm not against the mindfulness and meditation movement but, one, I've never really gained much success from it. It's a skill I've tried to learn and quite frankly can't be bothered because it doesn't do much for me. I think it's a bit boring. 

Sarah McKay:
I would rather take my dog for a walk or go to the gym or swim in the ocean or read a book, if I'm wanting to ... and I have no problems training my attention but as a way of stress relief or a way of gaining self-awareness or a way of switching my mind off. Because I really feel like those are such isolating activities and they just, it's so much navel gazing involved and so much kind of like the answers are ... and completely fails to address the world that we live in, the culture, the society we live in, the families we live in. We're completely embedded as stories and not one of me, they're one of we. You think about all the important wonderful parts of your life, all good memories you have, they're always about other people. They're not the times that you spent navel gazing. 

Sarah McKay:
Although the times that you ate the right food or did whatever supplement or whatever, what's the cream you put in your coffee. You know, that's not the stuff. I think we just take all that stuff far too seriously and we've completely lost touch and disconnected from what our brains need and we need to be teaching this next generation of young people coming through and I'm so aware of it now with my boys kind of late childhood, kind of on the cusp of adolescence. What I want them to be thinking as important and what's going to be the best ways I can protect there, their physical health most importantly, their mental health and it's not by teaching them how to meditate and seek the right answers within, but to have a good strong tribe of mates that they can just enjoy life with and they can head off into the surf with their surfboards or riding their bikes and running through the bush and just kind of be little humans in the world, instead of isolating themselves off and sitting in some Zen position and thinking that that's where the answers lie. 

Melanie Avalon:
Well, I guess as a follow up to that, because I do think with meditation that there is this concept that ... I mean I guess I think it also gets stereotyped as well, but it is this thing where you have to have no thoughts and be completely silent and ... You know that it's like this thing that has to be done a certain but I think for people who are struggling to reach that state where they can't let go of things ... Because I mean, I think what, arguably what you do, we're talking about going on the beach, taking the dog for the walk or being with the kids, in a way that could almost be "meditation" and just in the fact that it's achieving a state in your brain where ... 

Sarah McKay:
Yeah, you just don't need to do it. You don't need to do a course to learn how to ... 

Melanie Avalon:
Yeah. 

Sarah McKay:
And I nap most days as well and that's my kind of ... I'm strategic napper. Most afternoons, if I get a bit sleepy and I work for myself, so I can, I'm not out somewhere, but I have been known to nap in the car. I get sleepy. I crave having a nap and so I will just kind of indulge myself and let it happen and I don't need to kind of learn how to do that and I guess my struggle, which many people struggle has been the learning some type of mindfulness, meditation and I know evangelists will come after me and tell me I've got my theories wrong, whatever, but really don't care. There's other things that I do instead that achieves the same goal which for me aren't as hard to do and I haven't had to pay someone to figure out. 

Sarah McKay:
You know, I'll still listen to my breath every now and then if I need a bit of kind of a quick First Aid calm down, but I guess part of my problem as it's ... Again, it's quite isolating, you have to kind of be alone and I don't necessarily think that that's ... I prefer a social prescription, having a laugh with friends for me is just as useful if not way more so and way more fun and not as taken as seriously, you know. I guess for me, there's a lot of I don't understand the seriousness with which people approach their health and well being because it seems to have removed a bit of the kind of the freedom and the joy from just living a good life. 

Melanie Avalon:
Yeah, I guess in the end, the goal if we're to use that word goal of any of these practices is to reach exactly what you're talking about, engaging in life and experiencing the moment and not having the emotional attachment to the identity of the worry thoughts or the stress thoughts or things like that. I think, I feel like regardless of the practice and whether or not it does work for somebody or doesn't work for somebody, I feel like maybe in the end the end goal might be the same. It just as far as going back to the natural experiencing self ... 

Sarah McKay:
I like how my cocker spaniel experiences life and a bit like you say, you know, sometimes I wonder if we know too much and we've kind of overthought all of this stuff and you know, the planet's probably going to explode in 10 more years, anyway, so better make sure we make the most of it. I'm going to have that glass of wine and I'm going to read the trashy magazine, and I'm probably not going to meditate.

Melanie Avalon:
You're probably going to live a long time and I'm being completely serious. 

Sarah McKay:
My genes are terri ... and I'm not genetically determinist, but you know, it's probably about 70, 30 but my genetic baseline is pretty low

Melanie Avalon:
I don't know your mindset. ...

Sarah McKay:
I need to work harder at my health. My husband, everyone in his family lives until their late 90s. His parents hale and hearty in their 80s and mine are practically dead in their late 60s. 

Melanie Avalon:
Did they have your approach, like your mentality though?

Sarah McKay:
No. 

Melanie Avalon:
See, see that could be the ... 

Sarah McKay:
My mother has gone through an awful lot of trauma because she's lived in Christ Church and they've had a lot of stuff go on there in the last decade with earthquakes and that terrible massacre they had in the mosques earlier this year and my sister has well. They've had a lot of ... Life has thrown a lot of crap their way and I have just been so fortunate that that hasn't happened to me, so again, it's not just my mindset, it's my life experiences that I've just been incredibly fortunate to have side stepped a lot of the trauma that they have had to deal with. Again, I can tell I have a great mindset but I've also been incredibly fortunate to have not faced any real difficulties. 

Sarah McKay:
So I'm pretty careful with attributing my great fortune in life and my attitude to ... Some of it's just pure luck, right? You know, life has been very, very kind to me. I may not have necessarily always deserved that and that's why I kind of think, "Gosh, well I've seen some pretty horrible things happen to a lot of people that I know well and love," and so I don't want to take it all too seriously, because it's too short, too short to do that. 

Melanie Avalon:
Yeah, if I can even share a vulnerable moment for myself. I mean I really relate to what you're saying because I feel like my life up until pretty recently, very similar. Like very, very blessed in my life experience, nothing really intensely traumatic or anything like that until I experienced some health issues actually, which turned a little bit chronic but it's so interesting to me, because ... and this kind of ties into the whole cultural narrative of things, because before that I never really felt the need for like, "Should I try meditation or should I ..." Because I was just happy in the moment, I was like, "Well, I don't need any of these things because life is great and I can experience things ..." 

Melanie Avalon:
It wasn't until I started experiencing some chronic health issues and then from that anxiety and ruminations from that, that I started feeling the need to search out these modalities to return my brain or detach from these ideas. 

Sarah McKay:
Sort of step back from your own thoughts, I think is such a useful ... yeah. 

Melanie Avalon:
Yeah, yeah, exactly and what's fascinating though is that I'll work with therapists and stuff and people, they'll often ask, "Oh, did you have any trauma growing up? Any life experience?" And I'm like, "No, not really." And they'll be like, "Did you have any of this growing up?" The assumption is that I must have and I must have ... I've got to find it. Like it's got to be there somewhere and I'm like, "Honestly, it's not," and I'm not sure what the benefit is of trying to even create a narrative of that, but I think the wonderful thing is understanding the neuroplasticity of the brain and despite the fact that we might have these stressors or these anxieties or these experiences that we interpret as being one thing, that like you've said all along that they're so much of a cultural aspect to it. There's our own perspective of it. There's what we think it means, when really we just don't even really know. 

Melanie Avalon:
One of the things I love that you said in your book, you were talking about how cortisol for example, like the stress hormone, that we often see that as really, really a negative and a bad thing but you mentioned how it's actually protective in the moment, during stressful events and that reduced cortisol release during a stressful event could actually lead to increased I think anxiety or something afterwards?

Sarah McKay:
Yeah, we can call it the Goldilocks hormone, you know, not too little, not to much, it needs just the right amount and certainly we know that women experience the stressful event on average, not every woman and not every man, but on average women are found more likely to go on to experience maybe some type of post traumatic symptoms, not disorders, but symptoms, versus me on average and part of that maybe be that our stress hormone systems and our reproductive system systems do interact but what we see is that men have a much larger cortisol response to a stressful event in the moment than women do, on average, and that cortisol response does appear to kind of be protective for the ongoing development, kind of almost give you the means to cope with the stressful event and the time versus what we may see in women. 

Sarah McKay:
But of course, we must remember, whenever we talk about any kind of hormone or neuro transmitter or chemical in the body, it's not just the chemical itself, but we also receptors. It's like a key is meaningless unless there's a lock in which it can turn or unlock so our life experiences, our genes, our ... both nature and nurture together can influence the expression of receptors, which are kind of the lock to which the cortisol or the hormones or neuro transmitters unlock. So it's a whole lot more complicated, the human body and the human mind than simply hormone, behavior, experience, and I perhaps have been incredibly clumsy and maybe slightly ranty with explaining that but I've ... people could take away one idea would be perhaps that we just need to take a bit more of a sort of a nuanced approach to voices in the crowd are. More or not it's the voices of the other people around us that are the loudest. 

Melanie Avalon:
I love it. I love it. Do you mind talking about how the brain does change during pregnancy?

Sarah McKay:
Yeah, that's actually one of my favorite pieces of research that came out while I was writing the book and I'm so thankful to the researchers for publishing it when the did. So in this day they were using MRI, which is a brain scan looking at the structure, so if MRI looks it's kind of like takes a movie of the brain in action. This is looking at the structure of women's brains before and after their first pregnancy so they had a whole heap of couples who were trying to get pregnant. I'm sure they had a great time doing this experiment. 

Sarah McKay:
About half of them fell pregnant within the kind of the window that they required them to. Before pregnant their brains were scanned so we had a good idea of the structure of their brains and then within a month or so after the baby was born and they did the woman's and they also did the men's. They did their partners as kind of an interna control and it was fascinating, because in all of the women, exactly the same part of the brain change structure and this is a kind of fits in so neatly with what I've just been saying. And it got thinner, very similarly to how we might see the pre-frontal cortex gray matter in teenagers getting thinner. 

Sarah McKay:
It got streamlined, refined its connections, and it was the same region in all of the women and it was a part of the brain involved in social cognition and theory of mind and empathy, the ability to read other people's thoughts and feelings. So maybe the thoughts and feelings of being able to respond to the baby but also that kind of that tribe, that network of people we need around us and it's interesting because the question as well was it the experience of parenting within that first month or so after the baby was born, but the fathers were also part of the study and they were very involved. This was done in the Netherlands and men over there are very involved with family life and their brains showed absolutely no structural change. 

Sarah McKay:
So in this case, we assume, it must be the biochemical and hormonal changes that take place during pregnancy. Now when we go through a pregnancy, we have about a thousandfold increase in levels of estrogen, which is we get more in one pregnancy than you get the entire rest of your lifespan and every other mammal in the Animal Kingdom, estrogen is a cognitive enhancer. It makes us smarter and sharper and better at what we do but of course, what do we have? A culture around baby brain and becoming dumber and dopier. Well, we'll just look to our New Zealand Prime Minister to counter that argument and I say they don't read books on what to expect on what they're expecting. 

Sarah McKay:
And so what we're seeing is these kind of hormones, this biochemical change that takes place in pregnancy not just gets your body in a state to carry a baby and then to give birth to that baby and nurture that baby, but it also seems to in much the same way it does in all mammals, alters the brain structure such that we've got a bit of a shortcut to motherhood, so it kind of primes our brains for the act of motherhood. Of course, it's not a guarantee that that will be the case, in every woman but certainly this is the greatest structural change we see taking place in women's brains at any point in their lifespan beyond adolescence.

Sarah McKay:
So again, it was the part of the brain of all those other people, in this case, hormones did change the brain, it changed the brain that was involved with social connection. 

Melanie Avalon:
So fascinating and then are there any changes in the brain during menopause?

Sarah McKay:
There hasn't ... and coincidentally, that has not been looked at in any great detail, so we understand a little bit I said about the parts of the brain involved with thermal regulation and there's some kind of narrowing of the thermostat but we don't see any great structural or significant changes taking place there but what we do see after women go through menopause, if they don't choose to then have Hormone Replacement Therapy is we do see that there's greater vulnerability to go on to develop some of the diseases of aging. Women who have had children appear to be slightly more protected against brain aging in some of the dementias probably because of ... Maybe it's to do with all the hormones of pregnancy and breast feeding but also because raising children is quite cognitively demanding, because it's a bit like a kind of a computer game. You're always kind of up leveling. 

Sarah McKay:
So it may be that there's lots of nature/nurture, biological psychosocial aspects. After menopause, women do start to experience brain changes, but some of your reproductive history does appear to be protective or not against that, but certainly right around that point in time you don't see any significant structural changes taking place. 

Melanie Avalon:
Got you. Well, this has been ... I mean this is so many paradigm shifts here. So stepping away from all that we've discussed and like practical implementation of this, so for women who ... and I keep, I guess, bringing this up, but women who feel like they're experiencing hormonal changes that they're finding either unpleasant or maybe that they're enjoying, either way ...

Sarah McKay:
Hormones can have lots of positive effect as well, you know, that's what kind of gets you excited in the middle of your menstrual cycle and makes you want to make babies and things like that. So you know, let's just not think that they just do bad stuff, hormones.

Melanie Avalon:
Oh, true, because that is a whole another section of your book, that the love section and reproduction and the sexual experience and orgasm and all of that. Do we see that affecting the brain or is that all just an experience?

Sarah McKay:
I think orgasm is, like I said, it's the ultimate bottom-up, outside-in, and top-down experience because you've got biological, often, there's someone else involved, not always, and you know, then there's your thoughts and your feelings and your previous life experiences are all going to impact on that experience that you have. 

Melanie Avalon:
So fascinating and then also something you talked about was the role of daydreaming, for example. 

Sarah McKay:
I've just got another ... How many hours more have we got? Daydreams' fascinating, so there's this network in the brain called the default mode network and were only sort of figured out recently and it came about thanks to brain imaging technology, whereby when you do ... If MRI, so functional magnetic resonance imaging, you just kind of looking at changes and levels of activity in the brain, and you can do and get people to do a whole host of physical or cognitive activities, where you're taking what their brain does while it's doing its thing. 

Sarah McKay:
What people started, researchers started noticing was when in between the experiments and people were just kind of lying in their brain scan and doing nothing, they'll be like, "We're going to set this up. We'll start in 10 minutes. Just lie there until then and try not to move." People just kind of sat there and they've got nothing to do except kind of daydream and it turned out that there's this network in the brain that we call the default mode network which sort of started for want of better language lighting up. We started seeing activation in this default mode and people doing nothing. It turns out that this ... and we've got these different networks or different kind of nodes in the brain which we've got the executive function, which is involved with thinking and planning and making decisions when you're kind of very cognitively on task and then we've got other parts of the brain which you may be thinking about what's happening in your body. 

Sarah McKay:
Then there's this part of the brain which kind of does daydreaming and you know, it's where you tell your little stories to yourself, where you remember a conversation you had or you plan the future and it's not really always kind of ... It's not in the moment, it's not in the moment at all. It's daydreaming. What is really interesting is when we look at older people who have certain types of dementia, in particular, frontal temporal dementia and Alzheimer's disease, which are two different types of dementia, the default mode network sort of starts to breakdown and it's one of the first sort of functional networks in the brain that we start seeing breakdown in these disease states and there's fascinating studies done by a friend of mine here in Sydney called Muireann Irish.

Sarah McKay:
She's a professor of neuroscience at University of New South Wales and she wasn't doing this ... She was very aware of the default mode network and this idea that people have to kind of tell themselves stories and to kind of drift away and use their imagination when they're not really on task. So she's sit people in front of computer screen. She had young healthy people and then people with dementia and she'd just present shapes, colored shapes in front of them, totally boring task. So there might be a red square and a green circle and then a yellow triangle and then she'd go and tap them on the shoulder and ask them what they were thinking about at various points in time. 

Sarah McKay:
A young healthy person, so she tells the story, they might be looking at a yellow triangle and the person would go, "Oh," and she'd go, "What are you thinking about?" They'd say, "Oh, well, I was thinking that the shade yellow, it was really unusual shade of yellow, and it kind of reminded me of this beach in Greece where I went and when I was there, I had this fantastic meal. We had this fish and then that reminded me that I was going to cook fish for dinner tonight. So now I'm trying to figure out whether I'd have time to go to the supermarket on the way home ..." and this is the kind of the typical story that people would start repeating back to her. This stream of consciousness that we all have when we're not really, when we're bored or when we're thinking about other things. 

Sarah McKay:
What was interesting was when she went and asked the people with dementia. She'd tap them on the shoulder, "What are you thinking of?" And they'd go, "Well, that's a nice yellow triangle." We tend to think that people with dementia have lost their memories of the past but they've also completely lost the ability to daydream, to imagine, to think about the future and to kind of tell themselves those little stories to keep themselves entertained. I say this tongue in cheek, perhaps they've achieved ultimate mindfulness. They become completely embedded in the moment and they've lost that kind of beautiful ability that we have to go into that default mode and tell ourselves stories to keep ourselves entertained. 

Sarah McKay:
So I don't think we should dismiss daydreaming. I think it's a fundamental part of a healthy brain. 

Melanie Avalon:
One last question, that kind of ... this speaks to that as well. Speaking of what is a ... with daydreaming, like what is a healthy amount of that or any sort of mental experience that we have, what is a healthy amount of that? So things like "mental issues" or depression or anxiety, do you think these are natural states that the brain enters or are they ...

Sarah McKay:
I don't know. I think depression is a tricky one because we use this umbrella word to mean, to cover off so many, as I would say, shades of blue and there are a lot of shades of blue that we could be. We could just have had a couple of pretty bad nights' sleep and so we feel a bit low mood. We just need a good nights' sleep and a good healthy meal to perk us back up. Perhaps we're reacting to a disappointment, you've lost job, you've failed an exam. Perhaps you're deep into grief, you've lost someone that you love. Perhaps you have lost sense of purpose in life, perhaps you are suffering hormonal withdrawal in those first few weeks after you've had a baby and your body's kind of recalibrating and you're questioning who you are as a woman, with this new baby in your arms that you don't know what to do with. 

Sarah McKay:
So I think there's many shades of blue and there's many causes of shades of blue as perhaps there are people and their life experiences, so whether we can say that this is one kind of depressed state that we all end up in, it's not an ideal state to be in and so perhaps there's many reasons why one ends up there. I always like to say, as there are many shades of blue, there are as many approaches to kind of pull yourself up out of that or give someone a hand up out of that and with that be taking a bottom-up biological approach. We have such great evidence for exercise and moving your body as a great treatment for people with a kind of the lighter shades of blue, I should say. 

Sarah McKay:
Sleep, eat, move, getting your basic biology on track. Are you socially supported and connected as I've gone on and on about? That's one of the greatest influences on our emotional state. Do you feel connected with the outside world? Do you feel highly disconnected from it? Are you really lonely and isolated? Feeling isolated is the first step to a deep loneliness, which puts us in a naturally depressed state because we're social creatures, or perhaps you need to approach challenging perhaps negative thought patterns. Perhaps that's, you go down the field of psychotherapy and then perhaps you've got people who are in an incredibly deep shade of blue, who do need ... Whether they need pharmacological therapy, whether they need some kind of ... I don't know ... electro shock therapy is controversial. Electro compulsive therapy is very, very controversial for some people, but still it is a pretty good treatment for some people with very severe treatment resistant depression. It lifts them up out of it long enough to be able to kind of get their lives back on track. 

Sarah McKay:
Like I say, I think we use this word depression to describe a set of symptoms for which there could be many, many reasons that someone is ... as therein could be, just something light and passing. I think it's a pretty normal state for lots of us to enter at different points in our lifespan. I know there's a really well known study that's come out of New Zealand called the Dunedin Longitudinal Study that has looked at people all the way through their lifespan and they've studied about a 1,000 people who were born in the mid-'70s in Dunedin, New Zealand and they've studied them every few years, every aspect of their lives, up until mid-life. 

Sarah McKay:
The study has found that about ... sort of, I think it was something like 73% of people have had some mental health ... using that umbrella, diagnosable mental health condition at some point in their lifespan. It's about one in five people have got up into midlife completely unscathed emotionally. So I think it's probably quite normal to experience depression for want of a better word. The reasons why and how we kind of recover from that are as varied as people, I think.

Melanie Avalon:
So like with everything we've been talking about in this episode that it seems like so much of our experience of life is really about the stories that we tell ourselves and the stories that we're told from society and what we take from that. 

Sarah McKay:
I interviewed so many amazing researchers and people working within health and childcare. You know, early childhood education and working with teenagers and working with new moms and working with people who are older, researchers, doctors, women's health experts and every single one of them talk about we've got these windows of opportunity and vulnerability and the greatest thing that we can do for any person in any kind of vulnerable point in time is just to put, build gray matter infrastructure. It must be built up out of other people and sometimes it can just take the love or the hand of just one other person and that's connection. It doesn't matte whether it's a little baby who fundamentally needs human touch. It doesn't matter whether it's a vulnerable teenager, whether it's a new mom, whether it's a woman going through menopause. She needs her girlfriends around her. 

Sarah McKay:
Whether it's someone old like Jeanne Calment, in the age care home, how many people get no visitors when they move into aged care? About half of people never see a visitor every week so people are the absolute key. There's this really famous Maori proverb in New Zealand that we say. The kind of question is, [Maori 01:38:37] ... "What is the most important thing?" And the answer is, [Maori 01:38:41] ... "It is the people, the people, the people." I think when I was writing my book, I went it with quite a naïve assumption it was going to be this nature niche, a tight book and it was going to be about our biology and it was going to be the Biology of Women and Hormones and Health and how that affects our brain and it ends up being not that at all. 

Sarah McKay:
I thought that was what the book was going to be about, but for me it was a real lesson and as I say, "What is the most important thing?" And it's the people.

Melanie Avalon:
I love that and now it all make sense why the book, the conclusion, the final chapter, you know, does happen to ... This idea of the longest lived people and the themes there and it seems to ... Up until that point, it's been large focus on women's brains specifically, but in the end it does seem to be about the social context and the purpose and I love that final ending that you have, that we talked about with Jeanne ... or what is her name? 

Sarah McKay:
Jeanne Calment. 

Melanie Avalon:
Yeah, well, this is super appropriate, so the last question I ask every single expert on this podcast and it's because I have realized how much our perspective of things influences everything. 

Sarah McKay:
Our expectations of how ... such an important ingredient.

Melanie Avalon:
Yeah, so all biohacking aside, one thing I find to be super, super helpful with everything as far as health, body, life, everything is a sense of gratitude. So what is something that you're grateful for?

Sarah McKay:
I was thinking ... I'd like to say my dog, because, see, she's gorgeous. Look, I think I was so fortunate to be born in the country I was born into and to the family I was born in and I've had the happiest childhood and so did my husband. He was born in Ireland and had the happiest childhood and we both grew up in these wonderful families and we found each other and I think he has been the greatest influence, apart from my mom, he's been the greatest influence in my life. I've been with him for 20 years and they say who you marry is the greatest influence on life and he is just such a good bloke. I am so fortunate that I found him and so today I am grateful for my husband.

Melanie Avalon:
I love that so much. 

Sarah McKay:
And my dog. 

Melanie Avalon:
It's very interesting, I was going to say, I've found ... Because I've asked this question to every guest on this podcast and a trend that I've noticed is people that very much have this mindset similar to yours of ... I don't really know how to say this. These are the people who seem to be living in the sense of gratitude a lot, when I ask the question, their first response is typically something that's right there. Because they can like very quickly, they'll be like, "Oh, my dog." Rather than having to think of the one big thing from all of life. I feel like some people can just naturally gravitate, "Oh, I'm grateful for this pair of scissors right now." I feel like it could be so beneficial to be grateful for all the little things all the time, so I love that you're grateful for your dog and your husband. 

Sarah McKay:
Yeah, yeah. He's definitely number one. 

Melanie Avalon:
That's amazing. Speaking of, thank you so much, Sarah, this has been absolutely wonderful. Your book is just absolutely amazing. I cannot recommend listeners enough to check it out. I'm so grateful for your work, your perspective. I think it's so ... admittedly, I don't know much about your field as far as like how much is studied by different neuroscientists and stuff. 

Sarah McKay:
It's very broad and very deep, I say and we don't really know much at all and perhaps I'm completely wrong about most of it but it's a very ... It's an incredible field to have been part of because if you learning new stuff, there is always something new going on so yeah, so it's a phenomenal place to have spent my career. 

Melanie Avalon:
And I am super grateful, Sarah, because you are offering something to our listeners. So would you like to tell listeners a little bit about that?

Sarah McKay:
I have a tool kit which is kind of like my hand picked tools and strategies that'll give people a bit of a head start on basic understanding of brain science and how they can use it and deploy that in their lives. So they can go to my current website, which is dub, dub, dub, yourbrainhealth.com.au/toolkit and they'll be able to download Brain Tool Kit, which is kind of like my hand picked tools on how to use neuroscience wisely. 

Melanie Avalon:
Awesome. So for listeners, I will put links to all of that in the show notes. The show notes for this episode, by the way, will be at MelanieAvalon.com/womensreign. Thank you so much, Sarah, this has been absolutely amazing. Like I said, so grateful for your work I cannot recommend people enough to check out this book because there is ... I mean, I know we talked a long time, but we only barely even, not even remotely scratched the surface of ... 

Sarah McKay:
I know, [crosstalk 01:43:44]. Thank you for giving me the opportunity to just talk about this stuff, because it has been, it is one of the greatest joys in my life has been ... You know, I get into the science and I get to tell everyone all about it and I just ... and that's just kind of my happy place. So thank you for giving, creating a little place in which I could just talk. 

Melanie Avalon:
This has been absolutely wonderful and I'd love to bring you back on in the future and we can dive deep into some more things [crosstalk 01:44:10] ...

Sarah McKay:
Oh, we have so many things we haven't even touched on yet. 

Melanie Avalon:
So much out there. 

Sarah McKay:
Yeah. 

Melanie Avalon:
I know. 

Sarah McKay:
Absolutely.

Melanie Avalon:
All right, so listeners have to stay tuned for our part two in the future. Thank you so much and I will definitely, definitely talk to you soon. 

Sarah McKay:
See you later. 

Melanie Avalon:
Bye.