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Notes from midlife

Menopause: why you need to take care of your heart

When you read 'heart problems' you're probably imaging an older man or one with less-than-favourable food and lifestyle habits, right? And you'd be right BUT if you're reading this and you're a woman of perimenopause age or beyond (think any time after the age of 40), you need to be mindful too.


The number one killer in women of menopausal age is cardiovascular problems but this isn't really spoken about. I bet you've read the social media posts and heard the radio ads about breast cancer and, while you might or might not be unlucky in this area, you are far more likely to be killed by heart problems.

In this blog I'll explain exactly why that is and what you can do to protect your heart in midlife.





Why does cardiovascular risk increase in perimenopause?

The long and short of it is this: declining oestrogen is largely to blame.

In your younger years, it has a protective effect on the heart. Low levels in midlife increase the risk of arteries narrowing and plaque forming. Narrowing of the arteries is also associated with stroke.

There are other risk factors, too, outside of smoking and drinking in excess. These include being diabetic, having high cholesterol and being overweight. All of these are more likely (but not inevitable) in women as they get older.

What I want to talk to you about today is which dietary changes you might start to make from today, to protect your health and that of your loved ones. There’s fantastic news in this regard because a number of huge studies point to diet and lifestyle change being IT when it comes to prevention.


The INTERHEART study, published in the Lancet in 2004, followed 30,000 people in 52 countries. Researchers found that lifestyle changes could prevent at least 90 percent of all heart disease.


This was another big one: the EPIC study in 2009 looked at how 23,000 people adhered to 4 simple behaviours: not smoking, exercising 3.5 hours a week, eating a healthy diet, and maintaining a healthy weight. Sticking to these four behaviours alone seemed to prevent 93% of cases of diabetes, 81% of cases of heart attacks, 50% of cases of strokes, and 36% of cases of all cancers.

A SIMPLE STRATEGY FOR GOOD HEALTH

Of course, everyone is individual, and there is no official ‘single diet’ that all humans should eat. But if there were, this would be it because it handles what the essence of the problem is – overweight and a highly inflammatory internal environment.

Before I dive in with some of the answers, I want to say a little something about fat because chances are, if you’ve heard one thing about staving off a heart attack, it’s ‘cut back on fat’ (and especially the saturated kind).


The success of some low-fat dietary models in weight loss is thought to be more likely due to the simultaneous reduction of sugar, refined carbohydrates and processed foods.

Dietary fat actually turns off fat production in your liver. Unlike carbohydrates and protein, dietary fat does not trigger your pancreas to secrete insulin.


There is one type of fat everyone should avoid, and it’s trans fats, a kind of Frankenstein fat added to food to improve shelf life and mouthfeel of products. One study actually found that the risk of coronary heart disease doubled with each 2 percent increase in calories from trans fats (Iqbal, 2014). Another researcher even concluded: “On a per-calorie basis, trans fats appear to increase the risk of CHD more than any other micronutrient.” (Mozaffarian et al., 2006).


The real villains

The real villains in the piece are refined grains and sugar. During processing, refined grains are stripped of the bran and germ, two parts of the grain kernel that contain a wealth of nutrients. The final product is starch with next to no nutritional value, providing little more than carbohydrates and calories.


Refined carbohydrates can be found in a wide variety of foods, including white bread, pasta and rice, muffins, cakes, cookies, crackers, and bagels. Unfortunately, these foods make up a pretty good chunk of the modern Western diet and may be linked to a higher risk of heart disease. One study from China found that a higher carbohydrate intake, mainly from refined grains, was associated with an increased risk of coronary heart disease among 117,366 adults (Yu et al., 2013).


Sugar is one of the main culprits of heart disease. Added sugars from foods like sweets, desserts, juice and soft drinks can spike blood sugar levels, damaging the blood vessels, overloading the liver and increasing the risk of heart disease.

Interestingly, a study from Harvard School of Public Health actually found that participants who drank the highest amount of sugar-sweetened beverages had a 20 percent higher relative risk of developing coronary heart disease than those who drank the lowest amount (de Koning et al., 2012).




What's the best diet for heart health for women?

A lower carbohydrate diet is recommended to balance blood sugar and therefore reduce insulin and blood glucose levels. Elevated insulin is a major risk factor for heart disease and promotes inflammation. You’re also likely to lose weight on a blood sugar balancing diet, and that in itself will reduce the risk for many chronic diseases, including heart disease and high blood pressure.

  1. PROTEIN: Eat a source of protein at every meal and snack. This can be any fish/ seafood, poultry, meat, nuts, seeds, tofu, eggs. Given you probably eat enough meat already and many people don’t eat nearly enough vegetable protein, see if you can bring in more fish and more vegetable sources of protein over the week. Ideally, eat two to three vegetable-based protein meals weekly. Replace animal-based protein meals with lentils, legumes, tofu, quinoa or nuts and seeds, for example. If you’re a fish eater, get in wild-caught fish, which are rich in omega-3 fatty acids, twice a week.

  2. FRUIT & VEG: Get plenty of fruit and veg but focus specifically on eating veg that grow above the ground and fruit that can be grown in this country. These foods naturally contain either less natural sugar or lower amounts of carbohydrates, which have an impact on hormones. At each meal, have this cover at least half of your plate. The aim is 7 a day and ideally 5 from veg. Over the course of a week, aim to eat all different colours - span the rainbow to enjoy a diverse intake of nutrients. Enjoy berries, citrus fruit, peppers and leafy greens.

  3. FIBRE is a great addition, the soluble kind you’ll find in oats, lentils, split peas, flaxseed, citrus fruits and apples. All of those are heart-healthy choices. From the insoluble category, eat nuts and whole grains.

  4. FAT: Some fats are healthy, and let’s not forget that fat is actually essential for life. Get your fat from avocados, oily fish, nuts and seeds.

  5. CARBS: Think carefully about the quality (what kind) and the quantity (how much) of starchy carbs like bread, pasta, cereals, potato, rice. Focus on wholemeal over white, sweet potato over regular white potato, basmati or brown rice over long grain. You can also try throwing in a few ‘faux carbs’ like cauliflower or broccoli rice, courgetti (courgette spiralised into noodle shapes), butternut squash waffles, and so on.

  6. PROCESSED MEAT: In recent years, there have been numerous studies connecting processed meats, like hot dogs, salami and tinned meat, to a range of adverse effects on health. Not surprisingly, processed meats can also negatively affect heart health, so best to give them a wide berth.

  7. VEGETABLE OILS can be very damaging for heart health. Recent studies show that oils like rapeseed are not helpful (even though the supermarkets are brimming with these options). In fact, the linoleic acid they contain has been linked to cardiovascular disease and cancer.

  8. SUGAR: Remove as much sugar as you can from your diet as this is the real villain in the tale. That means saving sugary treats for high days and holidays and, most of the time, ditching breakfast cereals, cakes, cookies, pastries, and so on, and checking the label of jarred sauces, where sugar often lurks.

  9. FIZZY POP: Avoid fizzy soft drinks. Eliminating soft drinks is one of the best things that everyone can do for their heart. Besides being laden with controversial chemicals and unhealthy ingredients, soft drinks are also brimming with added sugars.



Do you notice a trend in my diet tips? What’s to focus on is real food. What you would benefit from decreasing is the processed stuff most people kid themselves is OK for them to eat. Truly, your body doesn't know what’s going on when you shovel in heavily processed or chemically altered foods.


Eating this way - sometimes referred to as a low GL (glycaemic load) diet - will also help, providing your body with a steady supply of energy through the day, rather than a high-octane rollercoaster of energy spikes and troughs.


Putting the food work into your life alongside the commitment to regularly de-stress, move your body and prioritise sleep is not always easy to do on your own. It is always helpful to have someone – like me – in the wings helping you fit what you already know about eating well into your life and keeping you motivated to follow your plan for long enough that you really see a shift in your health.


You can book in for a free 30-minute discovery call to see if a personalised nutrition and lifestyle plan might help. You can book yourself directly here and we can hop on a call. It’s not a sales call, it’s a mini strategy session that will help get you out of the starting blocks. You’re not tied to anything.

Salt and heart health

Salt has long been considered a major contributor to high blood pressure, and the high salt content of processed foods and junk food has been given at least some of the blame for the high incidence of hypertension and heart disease. However, even this recommendation has recently come under scrutiny and may change in the future.


Recent research has cast doubt on the role of salt intake in hypertension (DiNicolantonio, Lucan et al., 2014). However, the WHO and most countries still recommend less than 2g sodium/day, equivalent to <5g/day salt in adults, which is equivalent to 1 teaspoon. Until this changes, we should stick to the guidelines, yet recognise that other factors also contribute to high blood pressure (such as sugars). Salty snacks like potato chips, pretzels and microwave popcorn are full of added ingredients as well as salt, that can take a serious toll on heart health - they are best avoided. Where possible choose natural sea salt, which is rich in trace minerals. The healthiest forms of sea salt are the least refined with no added preservatives.


Pink Himalayan salt is widely regarded as the ultimate mineral-rich seasoning and the purest of the natural salt family.




Regarding health benefits, sea salt is plentiful in trace minerals due to its marine derivation, delivering many of the same nutritional compounds that make superfood seaweed so nutritious. The healthiest forms of sea salt are the least refined with no added preservatives (which can mean clumping in the fine variety).


If we’ve not met before, my name is Ailsa Hichens, and I’m a Registered Nutritional Therapist & Health Coach and I help midlife women get their glow back. I help them reach their happy weight by rebalancing their midlife hormones (and it’s not just oestrogen that gets out of whack at this stage of life) and help them create a life they love.


I run reasonably regular live programmes for women in their 40s and beyond, I have a (very small) handful on self-study courses you might like to explore. And, as clients finish their programmes with me, each month one or two spaces become available to work with me one to one. If you want to find out a bit more about how nutrition and lifestyle medicine can help with what you’re going through, please take a tour around my website. You are also very welcome to download one of my free e-books. You'll find these on my blog page and on most pages on my website. And, of course, follow the link to book a free call to discuss your needs.


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