How to Prevent Heart Disease in Postmenopausal WomenFeb 25, 2021
Heart disease is responsible for 28% of deaths among women in America. That’s a pretty startling statistic if you think about it because there are so many things within your control to prevent heart disease and I’m going to share some great tips with you today to reduce your risk not only for cardiovascular disease, but also type 2 diabetes, dementia, and so many more health problems.
Risk Factors for Heart Disease
My first tip is to know the major risk factors for heart disease. Some of these are going to be modifiable, meaning if you change your lifestyle to lower your risk, and some are not modifiable.
Non-modifiable risk factors include being male. Men have a higher risk for cardiovascular disease until women go through menopause, then the risk level evens out. To learn more about how a a decline in estrogen after menopause increases a women's risk for cardiovascular disease, watch this video next.
Other risk factors we can’t control are older age, a family history of heart disease, and your race. African-Americans, American Indians, and Mexican Americans are more likely to have heart disease than Caucasians.
Now onto the things we can control. Smoking, high oxidized LDL cholesterol, low HDL cholesterol, high blood pressure, a sedentary lifestyle, abdominal obesity, diabetes, high C-reactive protein levels (indicating inflammation in your body), high stress, poor nutrition, and excessive alcohol use.
I also like looking at the criteria for metabolic syndrome. These criteria do differ a bit depending on which medical entity you’re looking at, but if you have 3 or more of these criteria, you’re considered to have metabolic syndrome and be at an increased risk for cardiovascular disease:
Abdominal obesity — A waistline that measures at least 35 inches (89 centimeters) for women and 40 inches (102 centimeters) for men.
High triglycerides — 150 milligrams per deciliter (mg/dL) or higher
Reduced HDL cholesterol — Less than 40 mg/dL in men or less than 50 mg/dL in women
Increased blood pressure — 130/85 (mm Hg) or higher
Elevated fasting blood sugar — 100 mg/dL or higher
Notice LDL is not on this list for metabolic syndrome. Nor is it on the extended list of other risk factors for metabolic syndrome. The primary purpose of clinically diagnosed metabolic syndrome is to determine if someone has an increased risk of heart disease.
With the American Association of Clinical Endocrinologists (AACE), the World Health Organization (WHO), and the National Cholesterol Education Program’s Adult Treatment Panel III (ATP III), all leaving off elevated LDL from this list, I believe major parties are beginning to recognize that perhaps we’ve oversimplified LDL, and our energy is better focused on other risk factors to determine cardiovascular health.
Oxidized LDL is a better predictor of atherosclerosis and cardiovascular disease than standard LDL cholesterol. The stronger association between oxidized LDL and cardiovascular disease suggests that a person’s antioxidant status is a far more important determinant than standard LDL levels for the risk of developing plaques, and the rupturing of those plaques leading to heart attacks and/or strokes.
However, there was no association between oxidized LDL and total LDL concentrations. In other words, you can have high LDL and high oxidized LDL with an increased risk of heart disease, or you can have high LDL and low oxidized LDL with a reduced risk of heart disease.
If you currently have high LDL or are taking a statin, I’d really encourage you to watch this interview I did with cardiologist Dr. Nadir Ali. It’s extremely valuable, especially if you’re living a low carb lifestyle and everything else is going in the right direction except your LDL. This interview will explain why.
Dr. Ali also recommends looking into a coronary calcium scan if you’re concerned about your risk for heart disease. This is a CT scan that tells you how much calcified plaque is in your heart’s arteries and a much better indicator of your risk for cardiovascular disease than your standard LDL.
If you don’t know your numbers, now is the time! Turning a blind eye to your own numbers doesn’t do you any good. And the sooner you confront where you really are with your health, the sooner you can start to take more ownership over it and make some healthy lifestyle changes. It is never too late and no change in the right direction is too small.
Now let’s get into some actionable tips that you can use to lower your risk for heart disease. I think it’s helpful to consider things from what I call the four pillars of health.
The first pillar is diet. The second pillar is movement or exercise. The third pillar is stress. And the fourth pillar is sleep.
Nutrition: What & When You Eat
Let’s start with the first pillar: diet. This includes not only what you eat, but also when you eat. If you’re in perimenopause or have already gone through menopause, what and what you eat become crucial components for a healthy lifestyle.
As estrogen goes down, insulin goes up so if we aren’t proactive to keep insulin low, we develop more insulin resistance. Insulin is your body fat storage hormone and the primary determinant of your body set weight.
If you want to learn more about which specific foods I recommend to keep insulin low, download my Ultimate Food Guide.
If you come from a calories or points background like most of my members do, this information may be a little new to you, and it’s okay to re-listen or rewatch this video again. Not all food affects insulin the same. Take a look at this graph. There are three main types of carbohydrates: starch, sugar, and fiber.
Refined starch and sugar cause the biggest blood sugar response, and insulin directly follows blood sugar to help it get into the cells for energy or storage. Protein has a moderate insulin response, and fat has almost none.
If you want lower insulin, eat less sugar and carbs, especially refined sugar and carbs. A diet high in bread, pasta, candy, soda, cookies, cake, all that good stuff, will keep your insulin up and further, it will cause roller coasters with your blood sugars and dopamine in your brain. I like to say sugar begets sugar, the more you have the more you’ll want.
Also, starch and sugar don’t trigger our satiety hormones like fats and proteins do, making them very easy to overeat - that’s why we always have room for dessert even after a large meal.
Fiber is another kind of carb but it’s heart-healthy. Women should aim for about 25 grams of fiber per day, and men for about 35.
Insulin is important, but if we were to only focus on that, we’d be missing another important aspect of how our food choices can increase or decrease our risk for heart disease...and that’s inflammation. From the above graph, one could assume that all fats are okay for us because they have a lower insulin response, but not all fats have a low inflammation response.
I go into more detail about healthy, neutral, and unhealthy fats in this video so be sure to check that one out next, and also download that ultimate food guide for more specific examples.
Earlier I mentioned something called oxidative LDL. This is associated with increased plaque buildup. A couple ways we can use nutrition to reduce oxidation of LDL, and oxidative stress in general, is to eat an antioxidant rich diet including dark chocolate (in moderate of course), fruits, especially lower sugar fruits like raspberries, blueberries, strawberries, and blackberries and non-starchy vegetables.
Get plenty of omega-3 fatty acids from things like salmon, and reduce omega-6 fatty acids from processed vegetable oils like soybean oil or canola oil (and things fried in them). I recommend using olive oil, avocado oil, butter, or coconut oil for cooking instead.
Regarding when to eat, I’m a big proponent of intermittent fasting and recommend everyone fast for at least 12 hours, preferably 14 hours a day. Intermittent fasting for at least 16 hours stimulates something called autophagy, or cellular cleaning. It’s powerful for disease fighting and anti-aging. It can also help lower inflammation and insulin resistance.
Movement: Exercise & Physical Activity
Moving onto the next pillar of health: movement. We live in an increasingly sedentary environment, especially with many of us working virtually from our computers, we need to be mindful to incorporate regular movement throughout the day.
Getting up every hour for a little movement, walking, or stretching is great for your health. Moving right after a meal is also beneficial to lower blood sugars and insulin.
Different forms of exercise have different benefits. We tend to think aerobic exercise is best for heart health...after all that’s why we call it cardio. However, strength training is more important than cardio for healthy aging, and when performed correctly, strength training can double as cardio with an elevated heart rate, so you’re killing two birds with one stone. If you want resources for strength training workouts, let me know in the comments.
If stress is an issue for you, you may want to incorporate activities like walking and yoga into your routine because these specific forms of physical activity help reduce your stress.
Manage Your Stress
Acute stress is not a big deal for your heart, it comes and goes. Way back in the day, our major stressors were to fight or flee from animals. When you’re stressed, the body prepares itself by ensuring that enough sugar is readily available to fight or flee from the stressor. Our bodies are well designed for short bursts of cortisol, especially when it’s a physical stressor and we can put that extra energy to use right away.
But now, our stressors look very different and don’t require a level of physical exertion. Our blood sugars still go up, but we’re just sitting and not moving our bodies and using that extra glucose. As a result insulin levels will rise, and so does our body set weight.
Stress can also negatively impact our sex hormone levels and down-regulate our metabolism, further contributing to weight gain.
Get Enough Quality Sleep
The last pillar of health is sleep. Getting good sleep can be a big problem for women in perimenopause and beyond who have more anxiety, night sweats, depression, and just hormonal changes that make good sleep harder.
I talk about sleep a lot because it’s an overlooked area for weight loss. If you’re sleep deprived, there are a myriad of hormonal shifts that make losing weight all but impossible including but not limited to elevated insulin, increased ghrelin (hunger) hormone, reduced leptin (satiety) hormone, and reduced human growth hormone for reduced muscle mass and metabolism.
Eliminate Smoking & Reduce Alcohol
A couple more notable lifestyle changes you can make to reduce your risk for heart disease is to stop smoking. Smoking greatly increases your inflammation and oxidative stress, contributing to a higher risk for heart disease.
Lastly, limit your alcohol intake. When it comes to alcohol, long-term heavy drinking, and binge drinking appear to be the most detrimental forms of alcohol use. Having one or two drinks on occasion is fine, just remember that if you’re looking to lose weight, alcohol is technically empty calories and servings sizes add up quickly.
Alcohol has also been shown to reduce digestive enzymes, making nutrients harder for your gut to absorb. Alcohol also has an inflammatory effect on your gut and can affect intestinal permeability, causing toxins that should be safely housed and move through and out your body to leak into the bloodstream.