00:12
Hey everyone, it's Mikki here. You're listening to Mini Mikkipedia on a Monday. And this Monday I want to chat about cholesterol, heart disease risk, and women in their perimenopause or through their menopause transition. Now, this is a mini Mikkipedia, so this is not going to be a super, super deep dive into all of the things that you need to know. But what I did want to do is provide you with a little bit of background

00:42
context for the importance of cholesterol with regards to cardiovascular disease risk in perimenopause, menopause and beyond. But then also give you some practical strategies if you are worried and do want to lower your cholesterol levels. But also what about lowering overall heart disease risk? And that's the thing which to my mind is probably the most important thing. Obviously cholesterol can for some people come into it.

01:12
But ultimately, it's not the one thing that I think we necessarily need to be really myopic with regards to its importance, because there are other really important things as well, which determine to some extent the risk that you might have with your cholesterol. And then finally, I just wanna chat about when you go to get your cholesterol markers measured at the blood lab, just some things to think about before you go and get it measured.

01:41
Here in New Zealand, we don't have access or easy access to get our sub-particles measured. So we are really sort of left with the total cholesterol, HDL, triglyceride, non-HDL, which is a calculation that people use to determine what LDL is, so LDL cholesterol, and also your total to HDL ratio. So these are the markers that we get measured.

02:09
at the laboratory except of course LDL isn't measured. Anyway, so I want to go into a little bit about setting yourself up for optimal sort of cholesterol readings if you like. Now this all came about because a friend of mine emailed me through her most recent cholesterol markers and she said she's a little baffled by the results that her cholesterol is slightly higher this year despite cutting out red meat and eating a Mediterranean diet.

02:37
And within one year, what she discovered was she had higher triglycerides. She had a reduction in HDL, HDL being high density lipoprotein, which is responsible in amongst other things for sort of carrying off LDL back to the liver to be excreted. She had no change in her LDL cholesterol, which people will know as quote unquote bad cholesterol, but it's not bad at all. It's an innate.

03:06
of our immune system and we need it. And the cholesterol to HDL ratio has increased. So these were sort of the changes in her blood markers from one year to the next, despite cutting out red meat and eating a Mediterranean diet. Both dietary sort of habits that are associated with better indicators for heart health, including cardiovascular disease risk, and of course cholesterol. Now,

03:34
I guess a really important part of this is understanding your risk with cholesterol, which isn't as easy as you would think it is. So what research tells us through menopause transition is that women can experience an increase in LDL cholesterol in addition to other markers that place them at increased risk, such as an increased calcium artery score and a potential increase in the thickening of the carotid artery.

04:01
In addition, other research also shows that there is an increase in LDL in total cholesterol in the menopausal transition, which is 3 years headed into menopause and 1 year post. So you do get this shift, and it's well known, with cholesterol, and potentially this shift in cholesterol is of course due to changes in estrogen. As all signs clearly show this discernible shift in lipid levels following the last menstrual cycle.

04:30
and notably that increased total cholesterol in LDL. However, it is, you know, it's interesting if we look at just this one change in cholesterol and what its actual impact is on cardiovascular disease risk. And I say that because in some research, you see that women who are overweight or who have obesity actually have a lower overall increase in their cholesterol compared to women who are underweight or of a healthy,

05:00
weight as classified by body mass index, which we know isn't great from an individual basis, but at a population level can describe that sort of weight status. So this does play into question, you know, how important is cholesterol anyway, because we know that carrying excess body fat does increase your cardiovascular disease risk, cholesterol levels or not. And when we look at other research, it shows that, you know,

05:28
Whilst there is some research studies to show that a high LDL does increase risk of cardiovascular disease, there are other studies which show that a high LDL is actually protective against cardiovascular disease risk. What we do know is that women through menopause are actually at a higher risk of overall cardiovascular disease risk mortality. And in fact, coronary heart disease is the leading cause of death in women.

05:57
in both high and low income countries. So if it's not the cholesterol then, what other things are going on that are placing women at this increased risk? Now, family history is a big risk factor. And if you have a history of a close relative, like your mother, your grandmother, your auntie, or your sister or something, having a heart attack or having heart disease, then that definitely places you at an increased risk.

06:27
One other interesting risk actually, and I think this is important for us to mention, and if you're listening out there and you are someone of a perimenopause menopause age group, is the underdiagnosis within the doctor's office. And this occurs because we often consider coronary heart disease and cardiovascular disease as a male problem, because right up until that perimenopause menopause age group, they appear to have more heart disease and heart attacks.

06:57
It is only post-apmenopause where women are at an increased risk. And therefore, some of the signs and symptoms, if you look at what research says about it, it's underdiagnosed and it's not dismissed, but it's sort of missed in the doctor's office. So being mindful of this and the potential for not be offered screening or not be flagged as high risk is actually a very real issue within this area.

07:26
If you do have that family history and some of your blood biomarkers are tending to change, then I think these are really important things to consider with your overall risk, even if, for example, it's not necessarily flagged at a doctor's office. But your increased cardiovascular disease risk is not just about cholesterol, might not even be about cholesterol. It's likely due to several other factors that

07:52
also occur with the onset of perimenopause and menopause. So there is an increased accumulation of visceral fat in the stomach. And with that, there's an increase in these pro-inflammatory cytokines that increase inflammation. Increased inflammation will drive your cholesterol levels up because cholesterol is an important part of our immune response. There's increased insulin resistance, and as a result, this can alter the lipid profile with

08:22
getting higher triglycerides and LDL levels and having lower HDL levels. However, this isn't driven by cholesterol per se or your diet with regards to fat or saturated fat. It's driven by excess carbohydrate. When I say excess, I don't mean that you necessarily have to be eating a ton of carbohydrate, but you may be eating more carbohydrate than your body can tolerate, hence this insulin resistance.

08:51
There's a noticeable dysfunction in the endothelial cells. So our blood cells thicken, it can chain, our arteries can stiffen. And one of the biggest risk factors for cardiovascular disease is of course thrombosis and blood clots. So if you get this dysfunction in the endothelial cells, that can definitely increase your risk. And blood pressure also rises along with that enhanced sympathetic response or

09:20
cortisol response that can occur during perimenopause and menopause. So all of these things are going on which impact on the susceptibility towards heart disease but aren't necessarily related to cholesterol. Bearing that in mind, when my friend sort of emailed me her or messaged me her results and she was really baffled by this change in cholesterol and concerned what kind of information is useful for her to help sort of.

09:49
one, alleviate the stress that this might be causing, but actually alleviate the risk as well. So dietary change can impact on your cholesterol levels for sure. There are some people whose cholesterol levels increase when they drop their carbohydrate intake and increase their fat intake, yet their overall lipid profile, including their triglyceride levels, which is a macrovigilance resistance, this improves, which would suggest that a higher total cholesterol isn't a problem.

10:19
Of course, other people drop their carbs, increase their fat, and their cholesterol goes down. So, instead of them having a higher total cholesterol, in fact, everything still improves and their cholesterol drops. These people do tend to be people who might have more excess body fat to lose. So that's something to be mindful of. But in both instances, in these diet changes, it doesn't appear that it's going to be harmful. And in fact, if anything, it's probably lowered their risk overall.

10:49
because of that drop in that triglycerides. And of course, when you drop your carbohydrate, you drop your overall sort of baseline insulin level, which will change that baseline insulin resistance, settle down inflammation, and can also help reduce that sort of visceral adipose tissue that has been accumulating too. Of course though, there are people whose cholesterol levels increase when they drop their carb intake and increase their fat intake.

11:15
and their overall lipid profile deteriorates and gets worse, which suggests that that higher total cholesterol is a problem and their body is unable to use the cholesterol or package it up and dispose of it adequately. Therefore, when you've got excess cholesterol in the bloodstream in this position, you could run the risk of that cholesterol being oxidized if it hangs around in the bloodstream.

11:43
or transformed into very low density lipoprotein, which is another type of lipoprotein which increases your overall atherogenic risk. So in this instance, if you had this diet change to a lower carb, higher fat, and your cholesterol level deteriorates, it's probably a sign that this isn't a good dietary strategy for you. In addition to that, if part of that overall lipid profile deterioration in...

12:12
includes this increase in triglycerides, which can occur. There are people with genetic predispositions that don't handle that higher fat diet well. Their body pushes up their triglycerides, even though this is usually associated with a higher carbohydrate intake and not necessarily a high fat intake. But what it might be is an overall sign of energy excess in general. In the context of high calories, this would be a problem.

12:41
In this instance, that dietary change would not be a favorable one. Now with my friend, she did neither of these things. What she did was she cut out red meat, she increased her beans and increased her lentils, and she altered her dietary pattern and she changed the fat intake in her diet to one that was lower in saturated fat. And therefore she'd assume that in between tests,

13:08
her lipid profile would have improved, but that wasn't the case. Now one thing with her that she also noted, because she's very data driven and she likes to sort of look at things, she was wearing a Dexcom CGM II. And what she noted was that some of her legume choices pushed her blood sugars up to 10 or 11, which is quite high after a meal. This inability to sort of tolerate...

13:36
those particular carbohydrate can have sort of implications, obviously, for insulin resistance and therefore this could impact on the overall cholesterol numbers. Although I didn't actually think looking at our cholesterol numbers that that was the case, I think it's just well worth mentioning that upping your carbohydrate intake at a time of life when your body doesn't tolerate carbohydrate as well is usually not a good strategy.

14:06
terrible at all. It's very health promoting from the literature perspective, even though we don't really know what a Mediterranean diet is, because there are loads of countries in the Mediterranean. I think the strategy to increase legumes probably wasn't helpful in this situation sort of regardless. This is all just sort of setting the scene for the impact that diet can have on your cholesterol levels. And then, you know, do you need to change anything about your diet?

14:34
that then will impact favorably on cholesterol, which then impacts favorably on cardiovascular disease risk. So there are definitely things which impact on your cholesterol level per se. And the first, so two dietary things, if you are concerned about your cholesterol, because some people will be, regardless of whether or not the jury's out as to the risk associated. One thing I would say is, or three things actually I would say is,

15:03
One psyllium husk, so one teaspoon of psyllium husk at each meal in a big glass of water will lower your LDL cholesterol. And over the course of maybe about two or three months, you'll see your LDL level can drop by almost half, which is pretty awesome actually. The other thing too, or the other food that has the same impact would be oat bran. And oat bran has been shown to sort of reduce

15:30
cholesterol absorption and increase excretion so that can drop your cholesterol as well. I would think about your alcohol intake because this will impact on your cholesterol level having higher alcohol and it impacts on triglycerides too. So that would be something else to consider despite the fact that wine is supposed to be heart healthy. And also have a think about your dietary fiber. Do you have a high fiber diet?

15:59
And if you don't, then sort of upping the amount of vegetable fiber in your diet would also be really helpful. I say all of this, and of course my friend, she doesn't drink alcohol. She could definitely put psyllium husk in her diet. That wouldn't be a problem, and oat bran wouldn't be a problem as long as her blood sugar was fine as well. And I know that she has a high fiber diet. So I don't think that these, I think that the psyllium husk could move the needle a little bit.

16:27
There's other things that probably would remain pretty stable for her. Two other things to consider, particularly if we're in perimenopause and menopause, is your gut health and your thyroid function, because both of these impact on your cholesterol level. So, just by virtue of aging, our thyroid can sort of slow down, and this will increase your cholesterol level.

16:56
energy is feeling tanked, you're gaining weight, you're losing hair, your hands are cold, and things like that, then might not necessarily be your cholesterol that's the problem. It could be your thyroid. That would be something to look at. Of course, gut health, because if we're unable to package up that cholesterol and remove it because our gut's not functioning properly, then that is going to increase your cholesterol level as well.

17:25
gut health or poor gut health will promote sort of systemic inflammation and your cholesterol is, as I've said, it's part of your immune system. So when you're inflamed, you have more cholesterol circulating in your body. So that would definitely be something to consider as well. Importantly though, so beyond cholesterol, improving heart health risk and improving our sort of

17:52
ability to remain free of heart disease as we age, particularly because it is like the number one killer, then all of those changes I mentioned that occur through perimenopause and menopause, we want to work on reversing these, which is all of the things that I talk about all of the time. It's things like making sure you're not eating in excess because the calorie is probably the biggest toxin in the diet outside of saturated fat, outside of...

18:20
carbohydrate or anything like that. Eating more calories than you need, promote inflammation and fat storage and things like that. So those are the things that you want to get under control. Reducing your body fat levels, that's really important too. So if you are overweight, it is important to try and reduce that down to improve your overall heart health risk.

18:48
lowering inflammation. So again, that would be getting rid of alcohol for people who tolerate vegetables, making sure you're eating a good amount of vegetables that contain those phytochemicals that help reduce inflammation and improve our own antioxidant system in the body. And then also our nitric oxide capacity, actually. So nitric oxide is a vasodilator, so it helps with our overall circulation.

19:18
It helps with our endothelial function. And our ability to produce it does diminish over time as well. So getting in dietary nitrates, like beetroot and vegetables, getting out in the sun is really important. Breathing through your nose is really important because that helps produce nitric oxide. And this just helps our endothelial function. And also, of course, sleep. Making sure you are looking after your sleep and getting adequate sleep.

19:48
because that has such flow on effects for our ability to recover, reduce inflammation, reduce insulin resistance, reduce stress, everything. You know sleep is our biggest recovery tool. Then of course, in addition to that, ensuring that your body can tolerate the carbohydrates that you're eating, so you're not eating carbohydrates in excess that is then mucking with your blood sugar. Not to mention protein and strength training, which I talk about all the time.

20:18
And then finally, there are so many things I could mention with weight loss, but I've done a number of podcasts and we'll probably do a number more on weight loss. So I'll sort of just stay there and not just weight loss in general, but heart health in general. The other thing to note, which I think is important, which I mentioned to my friend is, it's important that you know that when you get your cholesterol measured, is that it's really labile to change. And you could get it measured five times across a week and it could look very different.

20:48
So that's really important to be mindful of. And when you do get it done, you wanna be weight stable. If you were in a calorie deficit losing weight and you get your cholesterol measured, part of what might be being measured would be fatty acids that have been released from your fat tissue into the bloodstream because you're using it for energy. Thus, it might appear that you have a higher triglyceride level than you actually do because you would.

21:13
burning that triglyceride for energy. So try to get your triglycerides measured when you are weight stable. Go in a fasted overnight state. And for whatever reason, we are told now that this isn't important. And I do wonder to what extent this is just purely sort of a logistics thing. Like not everyone can go and get their cholesterol tested in the morning, for example. So maybe it's like, well, you know, it's better than nothing. So it's fine to get it done.

21:42
in a non-fasted state will know that it's non-fasted, but you're going to get a true reflection of your cholesterol if you get it done in a fasted state. Otherwise, it could just be a reflection of the meal you ate before. But don't go extremely fasted, because what it appears is that if you have a prolonged fast and let's say you've been fasting since 6pm the night before, then you get your cholesterol measured, fasted at 11 or 12, cholesterol can go up.

22:11
So do be mindful of that, like 12 hours is good. Make sure you've had adequate sleep and also that you are, so you're fully, you know, you feel recovered. Make sure you're not injured so you don't have like a sprained ankle or a pulled calf or anything like that, because these things will impact on cholesterol because again, its role is to heal you, so heal your injury, but also it tends to change if you're sleep deprived. And

22:39
The same thing with stress. So if you're really highly stressed, this can also impact on your cholesterol markers. So you sort of have to go, you have to bear all that in mind when you're getting cholesterol measured. Ultimately though, in the big scheme of things, it's one marker and it makes a whole pile of other super important markers. So if you are doing everything right, and I would say outside of the beans and legumes, which I would change with my friend,

23:08
because they gave her that sort of big blood sugar spike, she is just doing everything else right. Hey, look, whether or not she needs to cut out red meat, then you know how I feel about red meat. I enjoy eating it. It's a health food, but you don't have to eat it though. So that's her dietary preference. That's no problem. But if you are doing everything right, you're getting good sleep, you're being active, you're out in the sun, all of these things, then...

23:35
It isn't such an important marker that you necessarily have to be concerned about, to my mind, given all the other sort of caveats that I've provided throughout this podcast. So hopefully that gives you an idea of cardiovascular disease risk, why women might be more at risk postmenopause, how important your cholesterol markers are, what you could do to lower cholesterol, and then bearing in mind what that cholesterol test actually measures.

24:03
Hopefully you've at least gotten something out of today which might spur on some further thoughts or just sort of put your mind at ease. So thanks for listening. As always, you can catch me over on Instagram, threads and Twitter @MikkiWIlliden, Facebook @mikkiwillidenNutrition, or head to my website, mikkiwilliden.com and book a consult and we'll talk more in depth about your cardiovascular disease risk. See you later.