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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Magnesium Glycinate vs Magnesium Citrate – Which is Healthier?
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Our Verdict
When comparing magnesium glycinate to magnesium citrate, we picked the citrate.
Why?
Both are fine sources of magnesium, a nutrient in which it’s very common to be deficient—a lot of people don’t eat many leafy greens, beans, nuts, and so forth that contain it.
A quick word on a third contender we didn’t include here: magnesium oxide is probably the most widely-sold magnesium supplement because it’s cheapest to make. It also has woeful bioavailability, to the point that there seems to be negligible benefit to taking it. So we don’t recommend that.
Magnesium glycinate and magnesium citrate are both absorbed well, but magnesium citrate is the most well-absorbed form of magnesium supplement.
In terms of the relative merits of the glycine or the citric acid (the “other part” of magnesium glycinate and magnesium citrate, respectively), both are also great nutrients, but the amount delivered with the magnesium is quite small in each case, and so there’s nothing here to swing it one way or the other.
For this reason, we went with the magnesium citrate, as the most readily bioavailable!
Want to try them out?
Here they are on Amazon:
Magnesium glycinate | Magnesium citrate
Enjoy!
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High-Protein Plant-Based Diet for Beginners – by Maya Howard with Ariel Warren
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Seasoned vegans (well-seasoned vegans?) will know that getting enough protein from a plant-based diet is really not the challenge that many think it is, but for those just embarking on cutting out the meat, it’s not useful to say “it’s easy!”; it’s useful to show how.
That’s what this book does. And not just by saying “these foods” and leaving people to wonder if they need to eat a pound of tofu each day to get their protein in. Instead, recipes. Enough for a 4-week meal plan, and the idea is that after a month of eating that way, it won’t be nearly so mysterious.
The recipes are very easy to execute, while still having plenty of flavor (which is what happens when one uses a lot of flavorsome main ingredients and then seasons them well too). The ingredients are not obscure, and you should be able to find everything easily in any medium-sized supermarket.
As for the well-roundedness of the diet, we’ll mention that the “with Ariel Warren” in the by-line means that while the book was principally authored by Maya Howard (who is, at time of writing, a nutritionist-in-training), she had input throughout from Ariel Warren (a Registered Dietician Nutritionist) to ensure she didn’t go off-piste anyway and it gets the professional stamp of approval.
Bottom line: if you’d like to cook plant based while still prioritizing protein and you’re not sure how to make that exciting and fun instead of a chore, then this book will show you how to please your taste buds and improve your body composition at the same time.
Click here to check out High-Protein Plant-Based Diet for Beginners, and dig in!
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Pistachios vs Almonds – Which is Healthier?
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Our Verdict
When comparing pistachios to almonds, we picked the almonds.
Why?
It was very close! And those who’ve been following our “This or That” comparisons might be aware that pistachios and almonds have both been winning their respective comparisons with other nuts so far, so today we put them head-to-head.
In terms of macros, almonds have a little more protein and a little more fiber—as well as slightly more fat, though the fats are healthy. Pistachios, meanwhile, are higher in carbs. A moderate win for almonds on the macro front.
When it comes to vitamins, pistachios have more of vitamins A, B1, and B6, while almonds have more of vitamins B2, B3, and E. We could claim a slight victory for pistachios, based on the larger margins, or else a slight victory for almonds, based on vitamin E being a more common nutritional deficiency than vitamin A, and therefore the more useful vitamin to have more of. We’re going to call this category a tie.
In the category of minerals, almonds lead with more calcium, magnesium, manganese, and zinc, while pistachios boast more copper, potassium, and selenium, though the margins are more modest for pistachios. A moderate win for almonds on minerals, therefore.
Adding up the sections gives a win for almonds, but of course, do enjoy both, because both are excellent in their own right.
Want to learn more?
You might like to read:
- Why You Should Diversify Your Nuts!
- Pistachios vs Walnuts – Which is Healthier?
- Almonds vs Cashews – Which is Healthier?
Take care!
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How to Fall Back Asleep After Waking Up in the Middle of the Night
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Dr. Michael Bruce, the Sleep Doctor, addresses a common concern: waking up in the middle of the night and struggling to fall back asleep.
Understanding the Wake-Up
Firstly, why are we waking up during the night?
Waking up between 2 AM and 3 AM is said to be normal, and linked to your core body temperature. As your body core temperature drops, to trigger melatonin release, and then rises again, you get into a lighter stage of sleep. This lighter stage of sleep makes you more prone to waking up.
Note, there are also some medical conditions (such as sleep apnea) that can cause you to wake up during the night.
But, what can we do about it? Aside from constantly shifting sleeping position (Should I be sleeping on my back? On my left? Right?)
Avoid the Clock
The first step is to resist the urge to check the time. It’s easy to be tempted to have a look at the clock, however, doing so can increase anxiety, making it harder to fall back asleep. As Dr. Bruce says, sleep is like love—the less you chase it, the more it comes.
It may be useful to point your alarm clock (if you still have one of those) the opposite direction to your bed.
Embracing Non-Sleep Deep Rest (NSDR)
Whilst this may not help you fall back asleep, it’s worth pointing out that just lying quietly in the dark without moving still offers rejuvenation. This revujenating stage is called Non-Sleep Deep Rest (otherwise known as NSDR)
If you’re not familiar with NSDR, check out our overview of Andrew Huberman’s opinions on NSDR here.
So, you can reassure yourself that whilst you may not be asleep, you are still resting.
Keep Your Heart Rate Down
To fall back asleep, it’s best if your heart rate is below 60 bpm. So, Dr. Bruce advises avoiding void getting up unnecessarily, as moving around can elevate your heart rate.
On a similar vain, he introduces the 4-7-8 breathing technique, which is designed to lower your heart rate. The technique is simple:
- Breathe in for 4 seconds.
- Hold for 7 seconds.
- Exhale for 8 seconds.
Repeat this cycle gently to calm your body and mind.
As per any of our Video Breakdowns, we only try to capture the most important pieces of information in text; the rest can be garnered from the video itself:
Wishing you a thorough night’s rest!
Do you know any other good videos on sleep? Send them to us via email!
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Debate over tongue tie procedures in babies continues. Here’s why it can be beneficial for some infants
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There is increasing media interest about surgical procedures on new babies for tongue tie. Some hail it as a miracle cure, others view it as barbaric treatment, though adverse outcomes are rare.
Tongue tie occurs when the tissue under the tongue is attached to the lower gum or floor of the mouth in a way that can restrict the movement or range of the tongue. This can impact early breastfeeding in babies. It affects an estimated 8% of children under one year of age.
While there has been an increase in tongue tie releases (also called division or frenotomy), it’s important to keep this in perspective relative to the increase in breastfeeding rates.
The World Health Organization recommends exclusive breastfeeding for the first six months of life, with breastfeeding recommended into the second year of life and beyond for the health of mother and baby as well as optimal growth. Global rates of breastfeeding infants for the first six months have increased from 38% to 48% over the past decade. So, it is not surprising there is also an increase in the number of babies being referred globally with breastfeeding challenges and potential tongue tie.
An Australian study published in 2023 showed that despite a 25% increase in referrals for tongue tie division between 2014 and 2018, there was no increase in the number of tongue tie divisions performed. Tongue tie surgery rates increased in Australia in the decade from 2006 to 2016 (from 1.22 per 1,000 population to 6.35) for 0 to 4 year olds. There is no data on surgery rates in Australia over the last eight years.
Tongue tie division isn’t always appropriate but it can make a big difference to the babies who need it. More referrals doesn’t necessarily mean more procedures are performed.
chomplearn/Shutterstock How tongue tie can affect babies
When tongue tie (ankyloglossia) restricts the movement of the tongue, it can make it more difficult for a baby to latch onto the mother’s breast and painlessly breastfeed.
Earlier this month, the International Consortium of oral Ankylofrenula Professionals released a tongue tie position statement and practice guideline. Written by a range of health professionals, the guidelines define tongue tie as a functional diagnosis that can impact breastfeeding, eating, drinking and speech. The guidelines provide health professionals and families with information on the assessment and management of tongue tie.
Tongue tie release has been shown to improve latch during breastfeeding, reduce nipple pain and improve breast and bottle feeding. Early assessment and treatment are important to help mothers breastfeed for longer and address any potential functional problems.
The frenulum is a band of tissue under the tongue that is attached to the gumline base of the mouth. Akkalak Aiempradit/Shutterstock Where to get advice
If feeding isn’t going well, it may cause pain for the mother or there may be signs the baby isn’t attaching properly to the breast or not getting enough milk. Parents can seek skilled help and assessment from a certified lactation consultant or International Board-Certified Lactation Consultant who can be found via online registry.
Alternatively, a health professional with training and skills in tongue tie assessment and division can assist families. This may include a doctor, midwife, speech pathologist or dentist with extended skills, training and experience in treating babies with tongue tie.
When access to advice or treatment is delayed, it can lead to unnecessary supplementation with bottle feeds, early weaning from breastfeeding and increased parental anxiety.
Getting a tongue tie assessment
During assessment, a qualified health professional will collect a thorough case history, including pregnancy and birth details, do a structural and functional assessment, and conduct a comprehensive breastfeeding or feeding assessment.
They will view and thoroughly examine the mouth, including the tongue’s movement and lift. The appearance of where the tissue attaches to the underside of the tongue, the ability of the tongue to move and how the baby can suck also needs to be properly assessed.
Treatment decisions should focus on the concerns of the mother and baby and the impact of current feeding issues. Tongue tie division as a baby is not recommended for the sole purpose of avoiding speech problems in later life if there are no feeding concerns for the baby.
A properly qualified lactation consultant can help with positioning and attachment. HarryKiiM Stock/Shutterstock Treatment options
The Australian Dental Association’s 2020 guidelines provide a management pathway for babies diagnosed with tongue tie.
Once feeding issues are identified and if a tongue tie is diagnosed, non-surgical management to optimise positioning, latch and education for parents should be the first-line approach.
If feeding issues persist during follow-up assessment after non-surgical management, a tongue tie division may be considered. Tongue tie release may be one option to address functional challenges associated with breastfeeding problems in babies.
There are risks associated with any procedure, including tongue tie release, such as bleeding. These risks should be discussed with the treating practitioner before conducting any laser, scissor or scalpel tongue tie procedure.
Post-release support by a certified lactation consultant or feeding specialist is necessary after a tongue tie division. A post-release treatment plan should be developed by a team of health professionals including advice and support for breastfeeding to address both the mother and baby’s individual needs.
We would like to acknowledge the contribution of Raymond J. Tseng, DDS, PhD, (Paediatric Dentist) to the writing of this article.
Sharon Smart, Lecturer and Researcher (Speech Pathology) – School of Allied Health, Curtin University; David Todd, Associate Professor, Neonatology, ANU Medical School, Australian National University, and Monica J. Hogan, PhD student, ANU School of Medicine and Psychology, Australian National University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Disordered Mind – by Dr. Eric Kandel
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We don’t generally include author bios in these reviews, but it’s worth mentioning that Dr. Kandel won the Nobel Prize in Physiology/Medicine, for studies related to the topics in this book.
The premise in this book is as per the subtitle: what unusual brains tell us about ourselves. He assumes that the reader has a “usual” brain, but if you don’t, then all is not lost, and in fact he probably talks about your brain in the book too.
Examining the brains of people with conditions ranging from autism to Alzheimer’s, schizophrenia to Parkinson’s, or even such common things as depression and anxiety and addiction, tells us a lot about what in our brain (anatomically and physiologically) is responsible for what, and how those things can be thrown out of balance.
By inference, that also tells us how to keep things from being thrown out of balance. Even if the genetic deck is stacked against you, there are still things that can be done to avoid actual disease. After all, famously, “genes load the gun, but lifestyle pulls the trigger”.
Dr. Kandel writes in a clear and lucid fashion, such that even the lay reader can quite comfortably learn about such things as prion-folding and inhibitory neurons and repressed transcription factors and more.
Bottom line: if you’d like to understand more about what goes wrong and how and why and what it means for your so-far-so-good healthy brain, this is the book for that.
Click here to check out The Disordered Mind, and understand more!
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