Heart Health in Menopause with Dr Rhona Creegan
Estimated reading time: 5 minutes
It’s World Menopause Day on the 18th of October and the theme is “heart health”. In this article, we share some of an interview between Melanie White and Nutritional Biochemist Dr Rhona Creegan, who talks through risk factors for cardiovascular disease, contributing factors, lifestyle interventions, individual uniqueness, and guidance on testing.
Fact: Cardiovascular Disease in Women is Often Under-Diagnosed
RC: Cardiovascular disease and heart disease in women is often under-diagnosed. There is a lower perception of risk, because a typical heart disease patient is an overweight, middle aged man. This often means there is a delayed diagnosis and a failure to recognize risks and symptoms in women.
Contrary to what people believe, it is not a disease of cholesterol, it's actually caused by inflammation of the arteries, where oxidised cholesterol builds up. Cholesterol is a component, but it's not the cause.
Women tend to develop heart disease later than men because we have the protection given by oestrogen in the reproductive phase of our lives. Oestrogen is cardioprotective, in other words, we have lower cholesterol levels when we have lots of oestrogen around. Oestrogen has anti-platelet activity, so you have less risk of blood clots, and it's also an antioxidant.
Risk Factors for Cardiovascular Disease in Menopausal Women
RC: When we reach menopause, there is a significant increase in blood cholesterol, blood pressure, body fat distribution (central weight gain) and body mass index. An increase in adipose (fat) tissue at this time of life causes systemic inflammation which in turn increases the risk of cardiovascular disease and heart disease.
Contrary to what people believe, it is not a disease of cholesterol, it's actually caused by inflammation of the arteries, where oxidised cholesterol builds up. Cholesterol is a component, but it's not the cause.
There are several risk factors for developing cardiovascular disease or heart disease.
Metabolic syndrome is a risk factor, and this is induced by poor diet, lifestyle choices, lack of sleep, stress, hormone imbalances, and even disruption of the gut microbiome (a huge risk factor for developing heart disease).
High blood pressure is a very known, well documented risk, and it's part of the metabolic syndrome.
In menopause, there's also an increased sensitivity to salt which can cause fluid retention in the arms and the legs.
When I consult with a patient, I always look at lifestyle, excess alcohol, and other risk factors mentioned.
Then we have the genetics. There's no one gene, but multiple genes are involved with fat metabolism, nutrient processing, and detoxification pathways. Fortunately, now, we have really good tests available to assess our genes and so we can provide tailored, personalised approaches to an individual's risk or reducing the risk of cardiovascular disease.
Another really important thing in the hormone space and heart disease risk which is often overlooked is the exposure to endocrine disrupting environmental chemicals, which can lead to menopausal symptoms, and a whole raft of health consequences. At the end of this article you will find the link to the EWG skin deep® cosmetics database, where you can find information on skincare and other products that contain endocrine disruptors.
Of course, we're constantly learning about the importance and power of sleep. And, you know, it's becoming so important for overall health to actually address sleep as part of our overall approach to reducing the risk.
Overall, the most obvious change with menopause is our levels of oestrogen decline. This is associated with the typical symptoms like hot flashes, weight gain, digestive system issues, and brain fog.
During the reproductive years, most oestrogen comes from the ovaries and it acts on distant sites and tissues within the body. And oestrogen is really important for growth, development, repair and protection of tissues and it's also an antioxidant.
Remember, cardiovascular disease is caused by oxidised cholesterol being deposited in inflamed arteries. And so when our ovarian production of oestrogen declines, our body uses a different form of oestrogen produced by tissue such as adipose tissue or fat tissue of the brain, in our bones, and in the lining of the arteries itself. And this type of oestrogen acts sort of locally in the tissues where it's made. After menopause, this is the major source of oestrogen.
It's nature's way of giving us some oestrogen back by making us fat around the middle!
Lifestyle Interventions for Cardiovascular Disease
MW: What are some of the things women can do, aside from hormone replacement therapy or any of those sorts of interventions? In other words, what can an individual do for themselves to lower inflammation, to lose weight and give better protection to the heart?
RC: There is so much we can do and practitioners like myself try to steer people in the right direction. We have the best opportunity to reduce the risk of heart disease and menopause with diet, lifestyle and targeted supplements.
We have the best opportunity to reduce the risk of heart disease and menopause with diet, lifestyle and targeted supplements.
If we first consider diet, there's no one diet that suits or works for everyone. People often say to me, oh, you know, Rhona, what's the best diet for this? And I say it depends. It depends on so much. It depends on your genetics, your overall health, your metabolic hormone balance. If you have food intolerances, which is also a part of menopause, a lot of women develop digestive system problems post menopause.
We need to also consider your digestive system and the health of your microbiome, which are the trillions of bacteria that live in your gut. They carry out lots of functions in our body that our own genes can't. It's very important that we address the microbiome.
An unhealthy diet can disrupt our microbiome, which is basically our gut bacteria, which have a crucial role in so many aspects of health. Research is developing on this all the time. But not only in overall health and especially in heart health. The microbiome is involved with nutrient production, amongst many other things, including some nutrients that are vital for heart health.
So if we have a disrupted gut microbiome, then we're not producing some of these vital nutrients that we need. And the other important part is that 75% of our immune system is located in our gut. When the immune system is constantly being activated by poor food choices, this can cause systemic inflammation in the body, and that can cause inflammation in the arteries including those leading to the heart.
The microbiome is also important for detoxification, interestingly, especially with our estrogens, and those environmental estrogens mentioned earlier. If our microbiome is not doing its job of eliminating these environmental estrogens, then we're going to have hormonal havoc in the body, which will contribute more to the symptoms of menopause, and the deleterious effects.
In terms of dietary approaches, some people use time-restricted feeding, other people use intermittent fasting, some people use ketogenic diets. And these are all options, but they aren't suitable for everyone.
I think it's about being very simple and basic about what type of food that you eat. The key is to maintain a healthy body weight, body composition, in particular. You need to eat adequate protein to maintain your muscle mass, which is your fat burning machinery. Adequate muscle mass and metabolism makes you sensitive to insulin, which helps you to control your blood lipids.
It’s important to eat natural foods such as lean meats, fish, fruits and vegetables that are full of phytochemicals and fibre, which are antioxidant, anti-inflammatory, and also support a healthy gut bacteria.
Obviously, some people are sensitive to certain foods and that's something that we work with, with people to identify any food intolerances. Depending on the person, we may have to give people very specific diets, until we can fix what's causing the food intolerances in the first place. One of the key things is to limit processed foods, which are high in fat, high in simple sugars, and contain synthetic chemicals that your body doesn't recognize.
I always say to people that you should get away from thinking about food as just calories and energy. Food actually sends signals, the components within that food send signals to every cell of our body to reflect the environment, and they tell your body whether to burn or store the energy that's coming in, depending on what the environment is telling us from these foods. It's a fascinating topic.
Dietary fibre is very, very important. It is what those gut microbiome biota or the bugs in your gut, feed on that fibre, they need it to survive. If you don't feed the gut bacteria the fibre they need, the bacteria will “turn on you”, as in the intestinal lining. That just makes you prone to food sensitivities, and to chronic systemic inflammation. So we need to keep them happy. Fibre also lowers cholesterol.
Other lifestyle factors are also important such as physical activity, not only for maintaining metabolic and mental health, but it’s also vital for detoxification in the body because most of our toxins are removed via the lymph system. And the only way the lymph system moves, (unlike the circulatory system with a heart and blood vessel) and the only way the lymphatic system is activated is by muscle contraction. So that helps you remove toxins from the body.
Sleep is the time where our bodies heal and repair. When we sleep, a process called autophagy is activated, which in simple terms means our cellular housekeeping. And this helps to remove damaged and inflammatory components from our cells and our bodies.
Stress management is also important. We talk a lot about that because chronic stress disrupts our metabolic health. It's inflammatory, it causes inflammation in our digestive tract, and it causes brain fog because it causes inflammation in the blood brain barrier. Lots of things can help to reduce stress, whether it's meditation, whether it's yoga, whether it's infrared saunas, cold baths, whatever people do stress management.
MW: Also, going fishing?
RC: Some people find that stressful!
Individuality and Testwork
RC: I think we must appreciate that prevention of cardiovascular disease and heart disease should begin early for women because it generally is silent or asymptomatic. In particular, if the transition to menopause is early, then the risk for cardiovascular diseases is higher and it should be assessed and monitored.
I would encourage people to work with a practitioner and work with a doctor to have regular blood tests to look at your lipid profiles, blood cholesterol, blood sugar, and homocysteine which is an independent risk factor for cardiovascular disease as it inflames the arteries.
I would encourage people to work with a practitioner and work with a doctor to have regular blood tests to look at your lipid profiles, blood cholesterol, blood sugar, and homocysteine
A really simple thing you can do - it's affordable- is to get a coronary calcium score done, which is something that is not covered on Medicare, but you can get your doctor to write a referral, and it takes about 10 minutes and costs about $120.
This test looks at how much calcium is actually built up in the artery. So it's much more of a functional measure of whether you have got any buildup of plaque in the arteries. Because some people can have high cholesterol, but the cholesterol that they've got is not doing them any harm. So do you need to know it?
The final thing is the good news is that, you know, there's so much that we can do, if we know and identify the risks and are proactive about identifying these issues before they become a problem.
Summary
RC: As mentioned at the beginning, in women, cardiovascular and heart disease are very, very underrecognized because the typical cardiovascular disease patient is a male and they do usually have problems earlier.
As soon as women lose the protective effects of oestrogen as we transition through menopause, then we're at the same risk as men, but not so much attention is paid to postmenopausal women and heart health and I think that's something that needs to change.
There are several risk factors for heart disease including high blood pressure, high cholesterol, poor microbiome, environmental toxins, genetic traits, body fat distribution and inflammation.
An individual can get testwork done to identify their personal risk profile and opportunities for change, and can consider dietary changes, supplementation, exercise, reducing alcohol, quitting smoking, and improving sleep.
References/Citations
EWG skin deep® cosmetics database EWG. Available at: https://www.ewg.org/skindeep
To get in touch with Rhona: www.omeganutrition.com.au and Cellf GP and Wellness in Mosman Park, WA - Cellfsolutuons.com.au.
Dr Rhona Creegan is a Nutritional Biochemist and Registered Nutritionist (NSA) with extensive experience in clinical biochemistry, molecular genetics and nutrition.
Omega Nutrition Health is a nutrition medicine consulting business that operates adjunct to conventional medicine to optimise health. Specific functional testing, targeted nutritional supplementation and diet and lifestyle programs are tailored to your unique biochemistry. Dr Creegan is a specialist in addressing complex health issues including: Gut health, Food sensitivities, mood disorders, toxicity, methylation, hormone Imbalances, cholesterol and metabolic disorders.
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