Menopause can bring increased cholesterol levels and other heart risks. Here’s why and what to do about it
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Menopause is a natural biological process that marks the end of a woman’s reproductive years, typically between 45 and 55. As women approach or experience menopause, common “change of life” concerns include hot flushes, sweats and mood swings, brain fog and fatigue.
But many women may not be aware of the long-term effects of menopause on the heart and blood vessels that make up the cardiovascular system. Heart disease accounts for 35% of deaths in women each year – more than all cancers combined.
What should women – and their doctors – know about these risks?
Hormones protect hearts – until they don’t
As early as 1976, the Framingham Heart Study reported more than twice the rates of cardiovascular events in postmenopausal than pre-menopausal women of the same age. Early menopause (younger than age 40) also increases heart risk.
Before menopause, women tend to be protected by their circulating hormones: oestrogen, to a lesser extent progesterone and low levels of testosterone.
These sex hormones help to relax and dilate blood vessels, reduce inflammation and improve lipid (cholesterol) levels. From the mid-40s, a decline in these hormone levels can contribute to unfavourable changes in cholesterol levels, blood pressure and weight gain – all risk factors for heart disease.
4 ways hormone changes impact heart risk
1. Dyslipidaemia– Menopause often involves atherogenic changes – an unhealthy imbalance of lipids in the blood, with higher levels of total cholesterol, triglycerides, and low-density lipoprotein (LDL-C), dubbed the “bad” cholesterol. There are also reduced levels of high-density lipoprotein (HDL-C) – the “good” cholesterol that helps remove LDL-C from blood. These changes are a major risk factor for heart attack or stroke.
2. Hypertension – Declines in oestrogen and progesterone levels during menopause contribute to narrowing of the large blood vessels on the heart’s surface, arterial stiffness and raise blood pressure.
3. Weight gain – Females are born with one to two million eggs, which develop in follicles. By the time they stop ovulating in midlife, fewer than 1,000 remain. This depletion progressively changes fat distribution and storage, from the hips to the waist and abdomen. Increased waist circumference (greater than 80–88 cm) has been reported to contribute to heart risk – though it is not the only factor to consider.
4. Comorbidities – Changes in body composition, sex hormone decline, increased food consumption, weight gain and sedentary lifestyles impair the body’s ability to effectively use insulin. This increases the risk of developing metabolic syndromes such as type 2 diabetes.
While risk factors apply to both genders, hypertension, smoking, obesity and type 2 diabetes confer a greater relative risk for heart disease in women.
So, what can women do?
Every woman has a different level of baseline cardiovascular and metabolic risk pre-menopause. This is based on their genetics and family history, diet, and lifestyle. But all women can reduce their post-menopause heart risk with:
- regular moderate intensity exercise such as brisk walking, pushing a lawn mower, riding a bike or water aerobics for 30 minutes, four or five times every week
- a healthy heart diet with smaller portion sizes (try using a smaller plate or bowl) and more low-calorie, nutrient-rich foods such as vegetables, fruit and whole grains
- plant sterols (unrefined vegetable oil spreads, nuts, seeds and grains) each day. A review of 14 clinical trials found plant sterols, at doses of at least 2 grams a day, produced an average reduction in serum LDL-C (bad cholesterol) of about 9–14%. This could reduce the risk of heart disease by 25% in two years
- less unhealthy (saturated or trans) fats and more low-fat protein sources (lean meat, poultry, fish – especially oily fish high in omega-3 fatty acids), legumes and low-fat dairy
- less high-calorie, high-sodium foods such as processed or fast foods
- a reduction or cessation of smoking (nicotine or cannabis) and alcohol
- weight-gain management or prevention.
What about hormone therapy medications?
Hormone therapy remains the most effective means of managing hot flushes and night sweats and is beneficial for slowing the loss of bone mineral density.
The decision to recommend oestrogen alone or a combination of oestrogen plus progesterone hormone therapy depends on whether a woman has had a hysterectomy or not. The choice also depends on whether the hormone therapy benefit outweighs the woman’s disease risks. Where symptoms are bothersome, hormone therapy has favourable or neutral effects on coronary heart disease risk and medication risks are low for healthy women younger than 60 or within ten years of menopause.
Depending on the level of stroke or heart risk and the response to lifestyle strategies, some women may also require medication management to control high blood pressure or elevated cholesterol levels. Up until the early 2000s, women were underrepresented in most outcome trials with lipid-lowering medicines.
The Cholesterol Treatment Trialists’ Collaboration analysed 27 clinical trials of statins (medications commonly prescribed to lower cholesterol) with a total of 174,000 participants, of whom 27% were women. Statins were about as effective in women and men who had similar risk of heart disease in preventing events such as stroke and heart attack.
Every woman approaching menopause should ask their GP for a 20-minute Heart Health Check to help better understand their risk of a heart attack or stroke and get tailored strategies to reduce it.
Treasure McGuire, Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and as Associate Professor (Clinical), The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Eat More, Live Well – by Dr. Megan Rossi
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Often, eating healthily can feel restrictive. Don’t eat this, skip that, eliminate the other. Where is the joy?
Dr. Megan Rossi brings a scientific angle on positive dieting, that is to say, looking at what to add, rather than what to subtract. Now, the idea isn’t to have sugar-laden chocolate cake with berries on top and call it a net positive because of the berries, though. Rather, Dr. Rossi lays out how to include as many diverse vegetables and fruits as possible, with tasty recipes so that we’re too busy with those to crave junk food.
Speaking of recipes, there are 80, and they are easy to follow. She describes them as “plant-based”, and by this what she really means is “plant-centric” or such; she does include the use of some animal products.
This is important to note, because general convention is to use “plant-based” to mean functionally vegan, but being about the food rather than the ideology; a relevant distinction in both society and science. In the case of this book, it’s neither, but it is very healthy.
Bottom line: if you’d like to introduce more healthy diversity to your diet, rather than eating the same three fruits and five vegetables, but you’re not sure how, this book will get you where you need to be.
Click here to check out Eat More, Live Well, and diversify your diet!
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‘I keep away from people’ – combined vision and hearing loss is isolating more and more older Australians
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Our ageing population brings a growing crisis: people over 65 are at greater risk of dual sensory impairment (also known as “deafblindness” or combined vision and hearing loss).
Some 66% of people over 60 have hearing loss and 33% of older Australians have low vision. Estimates suggest more than a quarter of Australians over 80 are living with dual sensory impairment.
Combined vision and hearing loss describes any degree of sight and hearing loss, so neither sense can compensate for the other. Dual sensory impairment can occur at any point in life but is increasingly common as people get older.
The experience can make older people feel isolated and unable to participate in important conversations, including about their health.
bricolage/Shutterstock Causes and conditions
Conditions related to hearing and vision impairment often increase as we age – but many of these changes are subtle.
Hearing loss can start as early as our 50s and often accompany other age-related visual changes, such as age-related macular degeneration.
Other age-related conditions are frequently prioritised by patients, doctors or carers, such as diabetes or heart disease. Vision and hearing changes can be easy to overlook or accept as a normal aspect of ageing. As an older person we interviewed for our research told us
I don’t see too good or hear too well. It’s just part of old age.
An invisible disability
Dual sensory impairment has a significant and negative impact in all aspects of a person’s life. It reduces access to information, mobility and orientation, impacts social activities and communication, making it difficult for older adults to manage.
It is underdiagnosed, underrecognised and sometimes misattributed (for example, to cognitive impairment or decline). However, there is also growing evidence of links between dementia and dual sensory loss. If left untreated or without appropriate support, dual sensory impairment diminishes the capacity of older people to live independently, feel happy and be safe.
A dearth of specific resources to educate and support older Australians with their dual sensory impairment means when older people do raise the issue, their GP or health professional may not understand its significance or where to refer them. One older person told us:
There’s another thing too about the GP, the sort of mentality ‘well what do you expect? You’re 95.’ Hearing and vision loss in old age is not seen as a disability, it’s seen as something else.
Isolated yet more dependent on others
Global trends show a worrying conundrum. Older people with dual sensory impairment become more socially isolated, which impacts their mental health and wellbeing. At the same time they can become increasingly dependent on other people to help them navigate and manage day-to-day activities with limited sight and hearing.
One aspect of this is how effectively they can comprehend and communicate in a health-care setting. Recent research shows doctors and nurses in hospitals aren’t making themselves understood to most of their patients with dual sensory impairment. Good communication in the health context is about more than just “knowing what is going on”, researchers note. It facilitates:
- shorter hospital stays
- fewer re-admissions
- reduced emergency room visits
- better treatment adherence and medical follow up
- less unnecessary diagnostic testing
- improved health-care outcomes.
‘Too hard’
Globally, there is a better understanding of how important it is to maintain active social lives as people age. But this is difficult for older adults with dual sensory loss. One person told us
I don’t particularly want to mix with people. Too hard, because they can’t understand. I can no longer now walk into that room, see nothing, find my seat and not recognise [or hear] people.
Again, these experiences increase reliance on family. But caring in this context is tough and largely hidden. Family members describe being the “eyes and ears” for their loved one. It’s a 24/7 role which can bring frustration, social isolation and depression for carers too. One spouse told us:
He doesn’t talk anymore much, because he doesn’t know whether [people are] talking to him, unless they use his name, he’s unaware they’re speaking to him, so he might ignore people and so on. And in the end, I noticed people weren’t even bothering him to talk, so now I refuse to go. Because I don’t think it’s fair.
Dual sensory loss can be isolating for older people and carers. Synthex/Shutterstock So, what can we do?
Dual sensory impairment is a growing problem with potentially devastating impacts.
It should be considered a unique and distinct disability in all relevant protections and policies. This includes the right to dedicated diagnosis and support, accessibility provisions and specialised skill development for health and social professionals and carers.
We need to develop resources to help people with dual sensory impairment and their families and carers understand the condition, what it means and how everyone can be supported. This could include communication adaptation, such as social haptics (communicating using touch) and specialised support for older adults to navigate health care.
Increasing awareness and understanding of dual sensory impairment will also help those impacted with everyday engagement with the world around them – rather than the isolation many feel now.
Moira Dunsmore, Senior Lecturer, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, University of Sydney; Annmaree Watharow, Lived Experience Research Fellow, Centre for Disability Research and Policy, University of Sydney, and Emily Kecman, Postdoctoral research fellow, Department of Linguistics, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Things Many People Forget When It Comes To Hydration
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Good hydration is about more than just “drink lots of water”, and in fact it’s quite possible for a person to drink too much water, and at the same time, be dehydrated. Here’s how and why and what to do about it:
Water, water, everywhere
Factors that people forget:
- Electrolyte balance: without it, we can technically have lots of water while either retaining it (in the case of too high salt levels) or peeing it out (in the case of too low salt levels), neither of which are as helpful as getting it right and actually being able to use the water.
- Gastrointestinal health: conditions like IBS, Crohn’s, or celiac disease can impair water and nutrient absorption, affecting hydration
- Genetic factors: some people simply have a predisposition to need more or less water for proper hydration
- Dietary factors: high salt, caffeine, and alcohol intake (amongst other diuretics) can increase water loss, while water-rich foods (assuming they aren’t also diuretics) increase hydration.
Strategies to do better:
- Drink small amounts of water consistently throughout the day rather than large quantities at once—healthy kidneys can process about 1 liter (about 1 quart) of water per hour, so drinking more than that will not help, no matter how dehydrated you are when you start. If your kidneys aren’t in peak health, the amount processable per hour will be lower for you.
- Increase fiber intake (e.g., fruit and vegetables) to retain water in the intestines and improve hydration
- Consume water-rich foods (e.g., watermelon, cucumbers, grapes) to enhance overall hydration and support cellular function (the body can use this a lot more efficiently than if you just drink water).
- Counteract the diuretic effects of caffeine and alcohol by drinking an additional 12 oz of water for every 8 oz of these beverages. Best yet, don’t drink alcohol and keep caffeine to a low level (or quit entirely, if you prefer, but for most people that’s not necessary).
- If you are sweating (be it because of weather, exercise, or any other reasons), include electrolyte fluids to improve cellular hydration, as they contain essential minerals like magnesium, potassium, and in moderation yes even sodium which you will have lost in your sweat too, supporting fluid regulation.
For more details on all of these, enjoy:
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Want to learn more?
You might also like to read:
- Water’s Counterintuitive Properties
- Hydration Mythbusting
- When To Take Electrolytes (And When We Shouldn’t!)
- Keeping Your Kidneys Healthy (Especially After 60)
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The No-Nonsense Meditation Book – by Dr. Steven Laureys
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We’ve reviewed books about meditation before, and when we review books, we try to pick ones that have something that make them stand out from the others. So, what stands out in this case?
The author is a medical doctor and neurologist, with decades of experience focusing on neuronal plasticity and multimodel neural imaging. So, a little beyond “think happy thoughts”-style woo.
The style of the book is pop-science in tone, but with a lot of hard clinical science underpinning it and referenced throughout, as one would expect of a scientist of Dr. Laurey’s stature (with hundreds of peer-reviewed papers in top-level journals).
You may be wondering: is this a “how-to” book or a “why-to” book or a “what-happens” book? It’s all three.
The “how-to” is also, as the title suggests, no-nonsense. We are talking maximum results for minimum mystery here.
Bottom line: if you’d like to be able to take up a meditative practice and know exactly what it’s doing to your brain (quietening these parts, stimulating and physically growing those parts, etc) then this is the book for you.
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Synergistic Brain-Training
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Let The Games Begin (But It Matters What Kind)
Exercise is good for brain health; we’ve written about this before, for example:
How To Reduce Your Alzheimer’s Risk ← there are many advices here, but exercise, especially cardiovascular exercise in this case, is an important item on the list!
Today it’s Psychology Sunday though, and we’re going to talk about looking after brain health by means of brain-training, via games.
“Brain-training” gets a lot of hype and flak:
- Hype: do sudoku every day and soon you will have an IQ of 200 and still have a sharp wit at the age of 120
- Flak: brain-training is usually training only one kind of cognitive function, with limited transferability to the rest of life
The reality is somewhere between the two. Brain training really does improve not just outwardly measurable cognitive function, but also internally measurable improvements visible on brain scans, for example:
- Cognitive training modified age-related brain changes in older adults with subjective memory decline
- Functional brain changes associated with cognitive training in healthy older adults: A preliminary ALE meta-analysis
But what about the transferability?
Let us play
This is where game-based brain-training comes in. And, the more complex the game, the better the benefits, because there is more chance of applicability to life, e.g:
- Sudoku: very limited applicability
- Crosswords: language faculties
- Chess: spatial reasoning, critical path analysis, planning, memory, focus (also unlike the previous two, chess tends to be social for most people, and also involve a lot of reading, if one is keen)
- Computer games: wildly varied depending on the game. While an arcade-style “shoot-em-up” may do little for the brain, there is a lot of potential for a lot of much more relevant brain-training in other kinds of games: it could be planning, problem-solving, social dynamics, economics, things that mirror the day-to-day challenges of running a household, even, or a business.
- It’s not that the skills are useful, by the way. Playing “Stardew Valley” will not qualify you to run a real farm, nor will playing “Civilization” qualify you to run a country. But the brain functions used and trained? Those are important.
It becomes easily explicable, then, why these two research reviews with very similar titles got very different results:
- A Game a Day Keeps Cognitive Decline Away? A Systematic Review and Meta-Analysis of Commercially-Available Brain Training Programs in Healthy and Cognitively Impaired Older Adults
- Game-based brain training for improving cognitive function in community-dwelling older adults: A systematic review and meta-regression
The first review found that game-based brain-training had negligible actual use. The “games” they looked at? BrainGymmer, BrainHQ, CogMed, CogniFit, Dakim, Lumosity, and MyBrainTrainer. In other words, made-for-purpose brain-trainers, not actual computer games per se.
The second reviewfound that game-based training was very beneficial. The games they looked at? They didn’t name them, but based on the descriptions, they were actual multiplayer online turn-based computer games, not made-for-purpose brain-trainers.
To summarize the above in few words: multiplayer online turn-based computer games outperform made-for-purpose brain-trainers for cognitive improvement.
Bringing synergy
However, before you order that expensive gaming-chair for marathon gaming sessions (research suggests a tail-off in usefulness after about an hour of continuous gaming per session, by the way), be aware that cognitive training and (physical) exercise training combined, performed close in time to each other or simultaneously, perform better than the sum of either alone:
See also:
❝Simultaneous training was the most efficacious approach for cognition, followed by sequential combinations and cognitive training alone, and significantly better than physical exercise.
Our findings suggest that simultaneously and sequentially combined interventions are efficacious for promoting cognitive alongside physical health in older adults, and therefore should be preferred over implementation of single-domain training❞
~ Dr. Hanna Malmberg Gavelin et al.
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Not all ultra-processed foods are bad for your health, whatever you might have heard
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In recent years, there’s been increasing hype about the potential health risks associated with so-called “ultra-processed” foods.
But new evidence published this week found not all “ultra-processed” foods are linked to poor health. That includes the mass-produced wholegrain bread you buy from the supermarket.
While this newly published research and associated editorial are unlikely to end the wrangling about how best to define unhealthy foods and diets, it’s critical those debates don’t delay the implementation of policies that are likely to actually improve our diets.
What are ultra-processed foods?
Ultra-processed foods are industrially produced using a variety of processing techniques. They typically include ingredients that can’t be found in a home kitchen, such as preservatives, emulsifiers, sweeteners and/or artificial colours.
Common examples of ultra-processed foods include packaged chips, flavoured yoghurts, soft drinks, sausages and mass-produced packaged wholegrain bread.
In many other countries, ultra-processed foods make up a large proportion of what people eat. A recent study estimated they make up an average of 42% of total energy intake in Australia.
How do ultra-processed foods affect our health?
Previous studies have linked increased consumption of ultra-processed food with poorer health. High consumption of ultra-processed food, for example, has been associated with a higher risk of type 2 diabetes, and death from heart disease and stroke.
Ultra-processed foods are typically high in energy, added sugars, salt and/or unhealthy fats. These have long been recognised as risk factors for a range of diseases.
Ultra-processed foods are usually high is energy, salt, fat, or sugar. Olga Dubravina/Shutterstock It has also been suggested that structural changes that happen to ultra-processed foods as part of the manufacturing process may lead you to eat more than you should. Potential explanations are that, due to the way they’re made, the foods are quicker to eat and more palatable.
It’s also possible certain food additives may impair normal body functions, such as the way our cells reproduce.
Is it harmful? It depends on the food’s nutrients
The new paper just published used 30 years of data from two large US cohort studies to evaluate the relationship between ultra-processed food consumption and long-term health. The study tried to disentangle the effects of the manufacturing process itself from the nutrient profile of foods.
The study found a small increase in the risk of early death with higher ultra-processed food consumption.
But importantly, the authors also looked at diet quality. They found that for people who had high quality diets (high in fruit, vegetables, wholegrains, as well as healthy fats, and low in sugary drinks, salt, and red and processed meat), there was no clear association between the amount of ultra-processed food they ate and risk of premature death.
This suggests overall diet quality has a stronger influence on long-term health than ultra-processed food consumption.
People who consume a healthy diet overall but still eat ultra-processed foods aren’t at greater risk of early death. Grusho Anna/Shutterstock When the researchers analysed ultra-processed foods by sub-category, mass-produced wholegrain products, such as supermarket wholegrain breads and wholegrain breakfast cereals, were not associated with poorer health.
This finding matches another recent study that suggests ultra-processed wholegrain foods are not a driver of poor health.
The authors concluded, while there was some support for limiting consumption of certain types of ultra-processed food for long-term health, not all ultra-processed food products should be universally restricted.
Should dietary guidelines advise against ultra-processed foods?
Existing national dietary guidelines have been developed and refined based on decades of nutrition evidence.
Much of the recent evidence related to ultra-processed foods tells us what we already knew: that products like soft drinks, alcohol and processed meats are bad for health.
Dietary guidelines generally already advise to eat mostly whole foods and to limit consumption of highly processed foods that are high in refined grains, saturated fat, sugar and salt.
But some nutrition researchers have called for dietary guidelines to be amended to recommend avoiding ultra-processed foods.
Based on the available evidence, it would be difficult to justify adding a sweeping statement about avoiding all ultra-processed foods.
Advice to avoid all ultra-processed foods would likely unfairly impact people on low-incomes, as many ultra-processed foods, such as supermarket breads, are relatively affordable and convenient.
Wholegrain breads also provide important nutrients, such as fibre. In many countries, bread is the biggest contributor to fibre intake. So it would be problematic to recommend avoiding supermarket wholegrain bread just because it’s ultra-processed.
So how can we improve our diets?
There is strong consensus on the need to implement evidence-based policies to improve population diets. This includes legislation to restrict children’s exposure to the marketing of unhealthy foods and brands, mandatory Health Star Rating nutrition labelling and taxes on sugary drinks.
Taxes on sugary drinks would reduce their consumption. MDV Edwards/Shutterstock These policies are underpinned by well-established systems for classifying the healthiness of foods. If new evidence unfolds about mechanisms by which ultra-processed foods drive health harms, these classification systems can be updated to reflect such evidence. If specific additives are found to be harmful to health, for example, this evidence can be incorporated into existing nutrient profiling systems, such as the Health Star Rating food labelling scheme.
Accordingly, policymakers can confidently progress food policy implementation using the tools for classifying the healthiness of foods that we already have.
Unhealthy diets and obesity are among the largest contributors to poor health. We can’t let the hype and academic debate around “ultra-processed” foods delay implementation of globally recommended policies for improving population diets.
Gary Sacks, Professor of Public Health Policy, Deakin University; Kathryn Backholer, Co-Director, Global Centre for Preventive Health and Nutrition, Deakin University; Kathryn Bradbury, Senior Research Fellow in the School of Population Health, University of Auckland, Waipapa Taumata Rau, and Sally Mackay, Senior Lecturer Epidemiology and Biostatistics, University of Auckland, Waipapa Taumata Rau
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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