Lipid (Fat) Metabolism and Cardiovascular Risk in Women
It took me a long time to turn my back on the popular Keto diet and the high intensity exercise mantra that pervades the fitness and dieting industries today.
There’s a few women on my programme who have now learnt to do this too, especially those who have moved into their post-menopause years and are on the 12 week Beyond Menopause™ program.
After exploring the influence that menopause hormonal changes have on the health of the liver and gallbladder as women age, it suddenly made sense as to why all that exhausting exercise, high fat and high protein eating, simply made me put on more weight and sent my energy levels crashing.
All of my clothes felt tight and I felt exhausted. It was depressing.
But my angst about my body weight paled in comparison to the arrival of new concerns – sore joints, aching muscles, heart palpitations, high blood pressure, daily fatigue and cholesterol levels that were climbing through the roof. I could see my Doctor reaching for the prescription pad ready to write ‘statins’.
My only thoughts were of my mother in her early 60’s who put on lots of weight, developed hypertension and hyper cholesterolemia and then took statin medication for years. She ended up having a stroke in her early 80’s.
Suddenly the ‘healthy ageing’ trajectory that I thought I was on, seemed hopeless. Not only due to my family history, but because of what I was learning in my doctoral studies – the cardiovascular and women’s health and ageing research, presented similar declining-health trajectories for women living in western societies.
However, acquainting myself with this research was also my savior.
It allowed me to better understand lipid or fat metabolism and why the liver and gallbladder matter to weight loss in midlife. The liver acts as the central hub for lipid metabolism, responsible for the uptake, synthesis, breaking down fats, and exporting fats to regulate energy homeostasis.
The liver also converts excess carbohydrates to fatty acids, performs fatty acid oxidation to generate ATP, and synthesizes lipoproteins (VLDL) and cholesterol. I discuss all of this in the Certified Menopause Weight Loss Coach Course for you.
The marked decrease in oestradiol levels at the cessation of menstruation during menopause, is associated with significant changes to lipids, causing a metabolic shift towards a more atherogenic lipid profile. This contributes to a higher risk of cardiovascular disease in women compared to men.
Specifically, newly published research suggests that there are increases in total cholesterol – [up to 30-50% increase during menopause], low-density lipoprotein cholesterol (LDL-C) and triglyerides (blood fats), as well as changes in the (good) High-density Lipoprotein Cholesterol (HDL-C) which changes the cardiovascular protection associated with HDL-C. [van Oortmerssen et al., 2025].
This makes sense when we consider the higher risk of cardiovascular and cardiometabolic problems in western women after menopause.
These metabolic risk factors are part of the reason that menopause weight gain, liver health and changing fatigue levels shouldn’t be ignored. Simply because, the liver plays a vital role in balancing lipid storage and mobilization, with imbalances often leading to metabolic dysfunction during the menopause transition.
Liver function, fats and menopause - what the research tells us
Learning that the liver and gall-bladder both change in structure and function as women move through menopause towards post-menopause, is an important understanding for Practitioners and Coaches working with midlife women and their weight management.
This is where the work of Professor Carla Brady matters. Her research on the liver and the effects of menopause on this important organ remains pertinent today. As she mentions,
“There is an interplay of hormonal issues and ageing that create a unique path for development of liver problems and liver disease in menopausal women, making chronic liver disease a significant burden on women’s health in their post-menopause years.” [Brady, C., 2015].
Because of normal structural and functional changes as women age, the emphasis on a diet high in saturated fats and animal proteins (with many of these also high in saturated fats), as are popular today, may not be helpful for many women who experience abdominal weight gain, bloating and increasing cholesterol levels.
If women are also on oral hormone replacement therapy (HT) rather than transdermal patches, there may be additional liver clearance of these synthetic oestrogens occurring, which may place additional burden on the liver.
Furthermore, research out of Greece, also suggests that those women with a fatty liver, may experience worsening hot flushes, despite being on HRT. (Armeni et al, 2024).
Health chaos as women move through menopause may arrive slowly.
Not sleeping, poor temperature regulation, changing weight, high total and LDL cholesterol, bloating, worsening fatigue and joint pain may send numerous women into further health chaos as they move through menopause – whether they are on HRT or not.
Whilst the focus is usually on cardiac health when women visit their Doctor with changing cholesterol and weight gain during menopause, how many of your clients are being told that the health of their liver matters too?
I’ll let you reflect on that.
Nonalcoholic fatty liver disease (NAFLD) or its newly termed Metabolic Fatty Liver Disease (MAFLD) is recognized as a cause of liver disease globally – particularly in Australia, (Adams et al, 2020). This condition is defined as the presence of excessive liver fat accumulation in the absence of other causes such as excess alcohol.
Menopause and Liver Health: Factors to Consider
In the MyMT™ Practitioner Course and the Menopause Weight Loss Coach Course, I talk a lot about the health of the liver and evidenced detoxification pathways.
The liver is a remarkable organ. It has a unique capacity among organs to regenerate itself after damage and can achieve this (within reason) in a systematic way over at least 6 weeks.
For example, food based nutrients continue to be investigated for their role in changing metabolic pathways involved in the detoxification process not only in the liver, but throughout the body (Hodges & Minich, 2015).
If your clients are paying for expensive supplements that ‘detox’ the liver, then please know that allium foods (onions, garlic and leeks) top the list of foods that have known detoxification actions in the body.
Liver Changes With Age and Fatty Liver Disease (NAFLD/ MAFLD)
The positioning of the menopause transition in women’s health and ageing studies changed my life and I know from Practitioners who join me, that it is changing the life of their clients as well.
Understanding that the liver is the hero in the story of your mid-life client’s weight loss, energy and health as they age is important.
The liver plays a central role in all metabolic processes in the body, especially in fat metabolism.
In fat metabolism the liver cells break down fats for energy production.
Hepatic (liver) cells also produce about 800 to 1,000 ml of bile per day. This yellow, brownish or olive green liquid is collected in small ducts and then passed on to the main bile duct, which carries the bile to a part of the small intestine called the duodenum.
Bile is important for the breakdown and absorption of fats. If women have had a cholecystectomy, then they don’t have this storage capacity role, so the type and amount of fats matter to them.
As women age, their liver is changing.
It shrinks in size and the gall-bladder produces less bile. Bile is the substance that helps to emulsify or break down fats. If the diet is high in fats (including animal fats), then the gallbladder cannot cope with the volume of fats that it has to emulsify.
During menopause, bile production decreases by around 20%.
Menopause and Fatty Liver Disease In Women
Changes in diet and lifestyle have led to a dramatic increase in the prevalence of obesity and metabolic syndrome in Western countries and many Asian countries.
This has resulted in a significant increase in the incidence of non-alcoholic fatty liver disease (NAFLD), [Watanabe, et al, 2015). Non-alcoholic Fatty Liver Disease (NAFLD) doubles in incidence in women as they move through menopause. This condition increases inflammation in the liver.
Liver Detoxification Pathways
Liver tissue is made up of lots of smaller units of liver cells called lobules. Many canals carrying blood and bile run between the liver cells. Blood coming from the digestive organs flows through the portal vein to the liver, carrying nutrients, medication and also toxic substances.
Once they reach the liver, these substances are processed, stored, altered, detoxified, and passed back into the blood or released in the bowel to be eliminated.
In this way the liver can, for example, remove alcohol from the blood and get rid of by-products from the breakdown of medications.
But here’s the thing – with the amount of fats, processed carbohydrates, toxins and animal proteins that the liver has to process in a day, then other vital nutrients and mineral salts may not be able to be readily absorbed into the blood.
Women who have a high-fat and high protein diet and may be doing lots of high-intensity exercise or have a lot of stress in their lives, must also be cautious about their liver health. During heavier exercise, the liver is working harder to turn over glucose to supply to working muscles.
When women are continually stressed, the liver is also over-burdened with having to turn over glucose to fuel the ‘fight or flight’ adrenaline response.
Thousands of women become confused about why their cholesterol is increasing and end up on statins or endless supplements, but what they may be missing is how to adjust their diet or exercise to match the scientific evidence on detoxification of the liver as they move through menopause.
This is where women can be supported by Coaches and Practitioners to better understand food-based liver detoxification pathways. Food-based nutrients have been and continue to be investigated for their role in the modulation of metabolic pathways involved in detoxification processes (Hodges & Minich, 2015). I talk about some of these below.
MyMT™ Liver Detoxification: An insight into dietary and exercise strategies.
I have numerous liver-health strategies in the MyMT™ Practitioner Course and the Level 2 Menopause Weight Loss Coach Course, but here are two of my favourites:
- Eat mainly plant fats and decrease animal fats. For women to improve their liver health, decreasing total fat intake to around 15% of their diet is important. Although if they are undertaking a lot of endurance exercise, then this can increase to 20-25%. Many foods act as either inducers or inhibitors of enzymes that have bioactive compounds in detoxification of the liver and other organs, but the amount women eat is also important. Too much kale for example, as well as other cruciferous vegetables, such as broccoli and brussel sprouts, can either activate or inhibit the enzymes that help to detoxify the liver – we need some, but not a lot it seems.
- Stretch in ways that help to lengthen the diaphragm. If your clients are overweight and have diaphragmatic fat, then this is sitting above the liver, hence, the ways in which your clients move and stretch out the torso during and at the end of the day is important.
The ageing of all of the organs offers a ‘perfect-storm’ when menopause arrives.
As Practitioners and Coaches the lifestyle adjustments must be evidenced to accommodate these age-related changes, especially in the liver, gallbladder and gut.
With increased weight gain, cardiac and metabolic health, including cholesterol levels change as women move into post-menopause. For too many women, what ensues is frustration and confusion, as, instead of feeling healthy and vibrant, they may feel exhausted, sick and overweight instead.
Health and medical researchers already know from research on our mother’s generation, that weight gain around the trunk at this time of life sends women into post-menopause heart disease, obesity and Type 2 diabetes.
That’s why I’ve developed the MyMT™ Menopause Weight Loss Coach Course for Practitioners, Coaches, Trainers and anyone else working with weight loss clients. It’s certified with a range of global organisations.
I’m looking forward to hearing how you get on with your learning on it.
References:
, , , , , , , and (2020) Nonalcoholic fatty liver disease burden: Australia, 2019–2030. Journal of Gastroenterology and Hepatology, 35: 1628– 1635. https://doi.org/10.1111/jgh.15009.
Armeni E. et al. OR25-02. Presented at: ENDO annual meeting; June 1-4, 2024. Hot Flash Severity Predicts Metabolic-Associated Liver Disease.
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