The Ageing Heart
“What worked in the past for your energy and recovery, may no longer work during and after menopause.” [Dr Wendy Sweet]
This was the statement I made to a group of Exercise Instructors from both Australia and New Zealand in a recent workshop.
I was asking what they did to recover their cardiovascular system after exercise, as they transitioned from menopause to post-menopause. The blank looks on their faces told me that this was a new consideration for them – the ability of the heart to recover after more intense acute exercise and placng this against the numerous classes that many of them were teaching over a week, was a topic that not many of them had thought about.
Our declining levels of the reproductive hormones (including the master reproductive hormones produced in the pituitary gland) affects organs throughout the body … and when it comes to exercise recovery, one of the most important organs to look after is the heart.
Cardiovascular disease remains essentially an age-related condition in both men and women. Ageing of the cardiovascular system involves changes that begin in middle age. So, for women who are working in physically-active jobs, understanding this is important.
Progressive age-related changes in cardiac and vascular anatomy and physiology— collectively referred to as ‘cardiovascular ageing’— interact with cumulative exposure to traditional risk factors to impact an individual’s increasing likelihood of developing cardiovascular disease over the life course. (Merz & Cheng, 2016).
For women who have had a life-time of intense exercise, these age-related changes can accelerate during the transition from menopause to post-menopause, especially if they aren’t sleeping.
Heart disease during and after menopause is gendered as you can see in the image below. Thickening of the blood vessel walls happens more rapidly in women as they move into post-menopause, compared to similar aged males, whether women choose to go on HRT or not. This condition is known as ‘vascular or arterial stiffening’ and it is one of the most important risk factors for hypertension during menopause.
As such, women in their menopause and early post-menopause transition may experience changes to their ability to cope with exercise, or recover afterwards, and to sleep or manage their temperature.
For active women who are instructing exercise classes, blood pressure responses may become altered due to the vascular stiffening too.
Heart Palpitations During Menopause
Over many years of lecturing, I’ve encouraged university students to look at the data from the famous Framingham Heart Study.
Research has been accumulating from these studies for over 35 years – the duration of most of our lifetime.
Whilst much of the early studies were mainly undertaken on males, this has now changed as it has become evident that women and men experience changing cardiac health in different ways. Especially as they move through mid-life and into their older years.
My own challenges with menopause symptoms that lingered despite being on HRT, and my concerns with heart palpitations, hypertension, low energy and changing cholesterol in my mid-50s was confusing. Especially because numerous medical tests found ‘nothing wrong’.
This experience reminded me to go back to cardiovascular studies and explore the science of our ageing cadriovascular system (the heart and the blood vessels) and why, when it comes to how our heart works for us to help with our energy levels, the nutrients we give it matters!
Women aged 55 years and older have a risk ratio of 1:3 of developing atrial fibrillation (Vinter, Huang et al, 2020).
Atrial fibrillation (AF) is a common arrhythmia (disruption to cardiac rhythm), with increases in the worldwide incidence and prevalence, especially in women entering their post-menopause years.
During the past century, a range of risk factors has been associated with AF, severe complications from the arrhythmia have been identified, and its prevalence has been increasing steadily – especially in post-menopausal women.
Whereas evidence has accumulated regarding sex-specific differences in coronary heart disease and stroke, the differences between women and men with AF has received less attention. (Ko, Rahman et al, 2016).
However, menopausal palpitation distress is common and associated with demographic, clinical, symptom, and quality of life (QOL) factors, states a relatively new report released by the Journal of Women’s Health (Carpenter, Tisdale et al, 2020).
For those of us who have experienced the frightening feeling of a racing heart or missed heart beats (ectopics), especially just after intense exercise or as I found, when we have just gone to bed, I’m not surprised at what this study shares,
‘Compared with the abundance and breadth of research on menopausal vasomotor symptoms [hot flushes] and sleep, there is a relative scarcity of research on menopausal palpitations. Menopausal palpitations are described as loud, racing, or skipped heart beats, flip-flops, fluttering, or pounding that occurs with or without dizziness and/or light-headedness. Prevalence rates by sample were:
- 18.6% of 12,425 American women
- 28.7% of 300 Spanish women
- 28.8% of 293 American women
- 34.1% of 299 Moroccan women,
- 38.0% of 81 Brazilian women
- 46.8% of 243 Brazilian women, and
- 46.9% of 301 Lebanese women.
I wonder what the prevalence is in New Zealand, Australian and British and Irish women? I’m sure the prevlance is similar.
The conclusion that the report comes to, is that given that every woman around the world who reaches mid-life will experience menopause, these prevalence rates indicate that millions of women could be experiencing menopausal palpitations. (Carpenter et al., 2020, p. 2).
I know myself how distressing these are and also, when it comes to exercise, how we need to manage our recovery better in order that our heart (which is a muscle), and our circulation recovers well.
This was the missing link for me and I know that this is true for hundreds of women, like Wendy from Australia, a Les Mills Master Trainer, as well as others on my 12 week coaching programmes who love their physical activity.
However, exhaustion, palpitations, not sleeping and sore joints were affecting their ability to remain active as they transitioned from menopause into post-menopause. Does this sound like you?
If so, then first and foremost, get to your Doctor for a check-up. Ask for Vitamin D, calcium, magnesium, potassium and of course, B12 and iron levels to be checked – all of these nutrients are affected by menopause, especially for those of you who do a lot of exercise.
I talk about these nutrients in the globally Certified Practitioner programmes, because they are important for your cardiac health as you move through menopause.
Nutrients for Cardiac Health
The women’s health literature is replete with studies reporting the changes in cardiac function as we age – changes which commence during menopause.
With the decline in oestrogen levels as women move through menopause, risk factors for coronary heart disease (CHD) become more apparent, especially hypertension or high blood pressure.
Furthermore, the onset of hypertension can cause a variety of symptoms that are often attributed to the menopause.
Worldwide, 25% of adult women are hypertensive, and in the United States, more than 75% of women older than 60 years of age are hypertensive. [Lima et al., 2012]
Whether you are doing a lot of exercise or not, the dietary nutrients you include matter to your recovery.
These nutrients include:
- Calcium – 1200mg daily. Important for the support of myocardial contractility.
- Magnesium – 400mg daily.
- Selenium – prevents vascular inflammation and LDL oxidation.
- Vitamin D – maintains optimal myocardial contractility
- Zinc – influences production of nitric oxide to reduce vascular stiffness.
Women who eat foods rich in potassium also help to lower their blood pressure and as I mention, in the Gut Health information in the courses, then you would also discover the incredible effect that a banana has on the gut microbiome too.
Bananas contain pectin. This is a soluble fibre that acts like a sponge in the digestive tract, absorbing fluid and helping to keep bowel motions in check – another important aspect of blood pressure management, as straining when constipated applies internal forces which can elevate blood pressure.
There is such an emphasis on women taking all sorts of supplements to help them with their menopause symptoms, but real food which provides specific nutrients that the ageing body needs, are cheaper and in reality, ust as effective.
For post-menopausal women experiencing atrial fibrillation, especially those who are thinner or leaner (or those of you doing higher amounts of exercise) then new research also suggests looking at your protein intake, (Gerber, 2020) – not too much and not too little, perferably from plants and not too much red meat … exactly what I tell women on my 12 week programmes, especially if they want to turn around their sleep and joint health too.
Protein for Heart Health Recovery After Exercise - it's not as much as you think!
The analysis of over 99,000 post-menopausal women (median age of 64 years) from the Women’s Health Initiative Randomized Controlled Trials and Observational Study found that those who ate 58-74 grams of protein a day were 5-8% less likely to develop Atrial Fibrillation, but there seemed to be a ceiling effect after eating more than 74 grams, at which point the benefit was no longer statistically significant.
According to the lead author (Gerber, 2020), this doesn’t translate to too much protein. “It’s not a huge amount” he stated.
“We’re talking about eating 10-20 more grams of protein per day—that’s only four ounces of healthy protein. Of course, when we talk about increasing protein intake, it needs to be with heart-healthy foods and lean proteins, not with cheeseburgers and other foods that are high in saturated fat, cholesterol and sugar.”
Women in this study had an average protein intake of 60 grams/day. This is slightly less than what I recommend on the MyMT™ programmes which supports this study’s findings that women who ate between 58 and 74 grams a day have significantly less risk of AFib.
This is a salient point for women who lift weights or do endurance exercise as they move through menopause – you need to examine your protein intake so it is not too high and not too low.
I’m always focusing on this aspect of protein intake for cardiac health in the women who join me who are regular exercisers.
Our protein needs change as we move through menopause and some women are having too much, whilst other’s may not be having enough.
Interestingly, in the American College of Cardiology report, women typically underestimated their daily protein intake by about 10 grams and caloric intake by 600-700 calories, which speaks to the need for more nutritional awareness and education, researchers said. I agree!
If you are interested in learning more about menopause for the clients you are seeing, then start with my free Masterclass on Menopause for Practitioners.
That’s what you learn in the MyMT™ Certified Courses, including the Menopause Weight Loss Coach Course. In the 12 week Practitioner Course, (complete with live zoom calls), I’ve taken every symptom and placed the strategies into Lifestyle Medicine science. When you have time, I invite you to listen to the video below where I explain the courses to you.
References:
Amabebe, E. Osayande, I., Nzoputam, O., Ugwu, A. (2016). Sweat potassium decreases with increased sweating in perimenopausal women. British Journal of Medicine and Medical Research, 14(10), 1-10.
Babiker F., De Windt L., van Eickels M, Grohe C, Meyer R, Doevendans P. (2002). Estrogenic hormone action in the heart: regulatory network and function. Cardiovasc Res. 53(3):709-719. doi:10.1016/s0008-6363(01)00526-0
Chugh, S. S. et al. (2014). Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129, 837–847.
Colpani, V., Baena, C.P., Jaspers, L. et al. Lifestyle factors, cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis. Eur J Epidemiol 33, 831–845 (2018). https://doi.org/10.1007/s10654-018-0374-z
Gerber, D., Stefanick, M. et al. (2020). Dietry protein and incidental atrial fibrillation in post-menopausal women from the Women’s Health Initiative. J. Am Coll Cardiol. Mar, 75 (11, Supplement 2) 5.
Lima, R., Wofford, M., & Reckelhoff, J. F. (2012). Hypertension in postmenopausal women. Current hypertension reports, 14(3), 254–260.
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Ko, D., Rahman, F., Schnabel, R. et al. (2016). Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis. Nat Rev Cardiol 13, 321–332.
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Nieman, D. C., Gillitt, N. D., Henson, D. A., Sha, W., Shanely, R. A., Knab, A. M., Cialdella-Kam, L., & Jin, F. (2012). Bananas as an energy source during exercise: a metabolomics approach. PloS one, 7(5), e37479.
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