Her arms lifted high in the air and the smile on her face, in celebration of her hike to the very top of this hiking trail in BC, Canada, is a testament to what Donna has achieved over the past few months. The attention she has paid towards restoring her sleep, improving her cardiac health and fitness as well as her sore joints, as she navigates her post-menopause years, has rewarded her with a newly found confidence in her physical abilities.
“I’m at the viewpoint of the M. Gurr Lake Trail in the Central Coast of BC near Bella Coola” she wrote. “I find your programs so interesting. My joints used to feel so sore all the time too. I really get the theory behind the science as I am a medical laboratory technologist. Thanks so much for all your research and information. There’s no other program out there like it!”
This is why I’m always reminding women that our menopause changes involve the whole body.
Our declining levels of the reproductive hormones (including our master pituitary hormones) affects organs throughout the body … and when it comes to our changing energy levels, one of the most important organs to look after is our 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 in the heart and the arteries that circulate blood throughout the body.
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). This is especially true for women whereby thickening of the blood vessel walls, happens more rapidly compared to similar aged males asyou can see in the image below.
As such, women in their menopause and early post-menopause transition may experience changes to their ability to cope with exercise, their ability to sleep or manage their temperature, blood pressure may increase along with cholesterol increases and palpitations may arrive as well.
Over many years, 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 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 Donna in Canada, and others on my 12 week coaching programmes who love their physical activity, but exhaustion, palpitations, not sleeping and sore joints are affecting their ability to remain active as they move 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 as 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 my programmes and in my coaching community, because they are important for your cardiac health as you move through menopause.
The women’s health literature is replete with studies reporting the changes in cardiac function as we age. And I’m not talking about when you are over 70 years. I’m talking about your menopause transition – the time when your biological and reproductive ageing is occurring. With the decline in oestrogen levels as we move through menopause, risk factors for coronary heart disease (CHD) become more apparent in women, especially hypertension or high blood pressure.
If your blood pressure has shot up as you approached mid-life, you’ll know what I mean. Furthermore, the onset of hypertension can cause a variety of symptoms that are often attributed to the menopause – if you are experiencing fatigue, hot flushes, aching muscles after exercise, migraines, tinnitus and/or palpitations, then join the club – it could well be your changing blood pressure and blood vessels. So please, go to your Doctor and get your heart and blood pressure checked out when you can, because there’s a little statistic I want to share with you.
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]
That’s why getting the right nutrients into you as you move through menopause matters and it’s why I help women to focus on magnesium, sodium and potassium, especially if they are regular exercisers or you are sweating a lot – you may also be losing vital electrolytes due to sweat losses, although this has rarely been studied (Amabebe, et al. 2016). Whilst too much potassium may be dangerous to the heart, having some in our diet is important – especially for those who exercise adn sweat a lot.
Bananas give you potassium as do berries. Berries, bananas and oats are all foods that help you manage your energy levels, exercise recovery and of course, help to regulate your heart and cardiovascular system. Bananas are one of nature’s best sources of potassium with each fruit providing around 300mg. One a day is fine.
Women who eat foods rich in potassium help to lower their blood pressure and as I mention, in my GUT HEALTH module which is part of my Health Restoration Series, then you would also discover the incredible effect that a banana has on the gut microbiome too. Bananas contain pectin, which is a soluble fibre that acts like a sponge in the digestive tract, absorbing fluid and helping to keep our bowel motions in check.
There is such an emphasis on women taking all sorts of supplements to help them with their menopause symptoms, but as I discovered too, real food that gives you the nutrients that your ageing body needs, are cheaper and just as effective.
For post-menoausal 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 too, (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.
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 AFib, 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!
I talk about protein intake in my 2 hour Masterclass on Menopause too and in the 12 week programmes, I give you specific information relating to your changing cardiac health in mide-life and your nutrition and sleep. That’s what you learn in the MyMT™ programmes where 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 12 week programmes to you.
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.
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.
Khoudary, M., Aggarwal, B., Beckie T. et al. (2020). Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 142:e506–e532
Ko, D., Rahman, F., Schnabel, R. et al. (2016). Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis. Nat Rev Cardiol 13, 321–332.
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.
Pettee K., Storti K., Conroy M., & Ainsworth B.. (2008). A Lifestyle Approach for Primary Cardiovascular Disease Prevention in Perimenopausal to Early Postmenopausal Women. American Journal of Lifestyle Medicine. 2(5):421-431.