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Bye!

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Hey everyone, it's Mikki here. You're listening to Mini Mikkipedia on a Monday. And I today want to chat about cholesterol management as you are transitioning into menopause. So yes, this is a female specific topic, but if you are male listening to this, I would continue to listen because these are things which you may want to pass on to...

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people around you, women around you that may be experiencing some challenges with cholesterol management as they get older. The reason for this particular podcast is because I've been having a number of conversations over the last probably six or so months with women who come to me panicked about their cholesterol numbers.

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you know, the doctor's clinic or a nurse suggesting that they need to do something about it. Or also they've just seen in themselves the cholesterol is increasing and they're not quite sure what it is. Or I would say worst case scenario, they've been put on a statin by their doctor because the cholesterol has increased. And whilst I'm not saying that there is no use case for statin use,

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cholesterol management for sure. What I wanted to highlight in this episode was one, the reason why our cholesterol management changes through menopause, but also what else could be contributing to the issue. And so, you know, sometimes when people go to their doctor, they may well get put on a statin for something which might not necessarily be a cholesterol problem. It could actually be related to other nutrients,

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that might not be optimized or other hormones that need to be investigated. As far as I understand the research, there isn't good evidence to suggest that a woman under the age of 60 actually bodes really well on statin medication, unless they've had previous coronary events. But I have seen multiple people, women on statins who are certainly under the age of 60.

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were put on it under the age of 60 with no coronary issues, but cholesterol management was deemed to be an issue. So that's why I thought I would just sort of mention some influencing factors related to cholesterol management that might necessitate further investigation actually. So that's why we're talking about it here. And you know, I'm getting older, not 60, I haven't hit menopause yet, but these are things that I think about.

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And so even if you're not at menopause age, again, this might still be relevant for you to consider. So first of all, what I want to highlight is that cholesterol management is influenced by our estrogen levels. So estrogen plays a key role in maintaining healthy levels of cholesterol. It helps by increasing the amount of high density lipoprotein cholesterol and by decreasing the amount of low density lipoprotein cholesterol.

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And HDL cholesterol is known to be beneficial because it helps remove LDL from the arteries. Thereby, it reduces the risk of heart disease. And the reason why this is important isn't because LDL cholesterol per se is an issue. It's just if you have LDL cholesterol parked up in your bloodstream, then it leaves it much more vulnerable to be transformed.

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into something called very low density lipoprotein or VLDL cholesterol, or it is oxidized. Both of these increase the risk of atherosclerosis or artery damage and plaque in the arteries. And that's the beginning process for heart disease. Now most people have atherosclerosis, it's almost like a function of aging, but having

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high amounts of LDL cholesterol that are either transformed or oxidized in the bloodstream certainly does increase that risk. And HDL cholesterol, and this is often referred to as good cholesterol, but I just want to highlight there is no good or bad. But HDL cholesterol helps by removing that LDL cholesterol out. A good analogy to think about this is when you have high levels of LDL in your bloodstream, think about it like a traffic jam on the motorway.

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No cars can move anywhere, leaving them all vulnerable. When you've got good amounts of HDL that deal with the LDL, you've got much more free flowing traffic. So it's like driving an off-peak. And who doesn't love driving at off-peak times? And obviously this is important that estrogen plays a role in maintaining these levels of cholesterol where we want them to be.

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It's important at menopause because that's when estrogen starts to decline. And so when estrogen through perimenopause does fluctuate, but it sort of is on its way out, that will change these ratios of LDL and HDL and increase the amounts of sort of total cholesterol that will be sort of available. With the decline in estrogen during menopause, we do lose that protective effect and it can, as I said, lead to that increase in LDL.

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which can accumulate in the artery walls if transformed or if oxidized. A further sort of more indirect impact that menopause has on cholesterol levels is related to changes in body composition. So the increased sort of fat around the middle and fat distribution is linked to higher levels of LDL cholesterol and triglycerides as well as lower levels of HDL cholesterol.

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do increase the risk of cardiovascular disease, particularly the increase in triglycerides. You also get an increase in inflammatory cytokines or inflammatory molecules. Inflammation is one of the factors which causes that LDL to become oxidized. Across the menopause transition, we do have an increase in insulin resistance. The body is less responsive to insulin and

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that insulin resistance is associated with increased LDL cholesterol, decreased HDL cholesterol, and elevated triglycerides. So it further increases the risk of heart disease. So these are the mechanisms whereby cholesterol management can change through menopause, and it can appear in if you get your cholesterol numbers done, and suddenly they start to look less favorable. That LDL increases. The total cholesterol increases.

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HDL drops and triglycerides increase. So therefore, in a panic situation, you might think that, okay, I'm going to need to manage this. I need to go on a statin, or that might be a recommendation. However, if we think about it, and I've heard some doctors talk about this as well, is that it might not be that the medication required is a statin, but potentially talk to your doctor about the appropriateness of looking at

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hormone replacement therapy. Some people like to call it menopausal hormone therapy, but it doesn't really matter what you call it. It's looking at these body identical hormones as a way to offset this increasing cholesterol. And this is particularly so if you have other symptoms associated with the menopausal transition that you're unable to resolve through lifestyle alone.

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The first point I want to make then around that cholesterol management is that because estrogen does change the lipid profile in the cholesterol management, have a think about how appropriate body identical hormone replacement therapy is going to be for you. And that may be a far better strategy than just looking at a statin to help with cholesterol. Because what I will say, I'm not suggesting that dietary change or diet doesn't influence your cholesterol management.

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but I just know from so many people that it doesn't really move the needle. And going down the rabbit hole of whether or not managing your cholesterol is even important, I'm just gonna leave that for another day. I'm focusing in on cholesterol management. So estrogen is one hormone that can impact on your cholesterol numbers, but I would be remiss if I wasn't going to mention thyroid because as we age, and this is true of both men and women, your thyroid function does

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decrease and this changes cholesterol management as well. So first of all, the hormonal changes that occur during menopause impact on thyroid function. So both estrogen and progesterone which can fluctuate during perimenopause have been shown to influence thyroid hormone levels indirectly. So estrogen can affect the levels of the thyroid binding globulin TBG, a protein that carries thyroid hormones in the blood.

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So an increase in TBG can lead to changes in the amounts of free thyroid hormones available in the body. And so you're less able to utilize the thyroid hormones for what they're supposed to do. And it does go without saying that many of the symptoms of menopause, such as fatigue and weight gain and mood swings and changes in menstrual patterns, can mimic those of thyroid disorders and vice versa, particularly hypothyroidism.

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And this overlap can make it challenging to discern whether symptoms are due to menopause, a thyroid issue, or a combination of both. And both the risk of developing thyroid disorders in the onset of menopause increase with age, obviously. So, you know, it's not uncommon that both of these go hand in hand. And both of these do change cholesterol management. Now, I did already talk about estrogen, obviously, but-

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Hypothyroidism, a condition where the thyroid gland does not produce enough thyroid hormones, can lead to elevated cholesterol levels. Thyroid hormones help stimulate the liver to break down cholesterol, thus it regulates the cholesterol levels in the blood. With insufficient thyroid hormone production, the body's ability to process and remove LDL cholesterol decreases, and that does lead to these higher levels of LDL cholesterol.

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implications of a suboptimal thyroid function or hyperthyroidism, so a thyroid metabolism, which is running too quickly. I think that's the main one that I really want to sort of talk about. So if you are noticing increases in your cholesterol patterns and you are in the throes of perimenopause or menopause, absolutely get your thyroid checked as well because that could be

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further either exacerbating the problem or it could be the cause of the issue. So it is really important to sort of screen properly for thyroid and not just look at your thyroid stimulating hormone, which is a common marker for thyroid function, but actually go a little bit deeper and look at T3 and T4 as well. And whilst you may not be able to do this through your doctor, there is a company called MyTests in New Zealand where

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whilst its user pays, you can get your T3 and T4 measured. So you can assess the function of your thyroid in addition to your cholesterol numbers and obviously what's happening at your sex hormone level. And two other areas where I want you to be aware of that could be contributing to cholesterol management during this peri space is vitamin D and iron.

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So vitamin D is obviously known for its role in bone health, and I did talk about it last week as well in a different context, but there is also evidence to suggest that vitamin D influences cardiovascular health and may impact cholesterol levels, although I will say that the research findings have been mixed. Some studies have shown that a low level of vitamin D is associated with a higher level of total cholesterol. And this relationship may be influenced by baseline vitamin D status.

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dosage of supplementation if you're supplementing vitamin D, and other individual health conditions. And whilst it's not known how vitamin D might influence cholesterol levels, what we do know is that when you synthesize vitamin D from the sun, that synthesis of vitamin D requires cholesterol to convert one form of vitamin D into the active form of vitamin D. So we need cholesterol for that.

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sort of occur. So if you don't get out in the sun, for example, it might have that indirect effect of reducing our vitamin D production, and thus we're not using cholesterol to the same extent as we would be. There are also potential effects on insulin sensitivity with a low vitamin D status, so that can also indirectly influence lipid metabolism.

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So if you're worried about your cholesterol management, you're seeing it increase, I would definitely get vitamin D status tested and make sure that you have appropriate amounts of vitamin D. And lastly, of course, I mentioned iron status. So the first one is iron overload or hemochromatosis. So hemochromatosis, which is a hereditary condition, which affects more men than women, but women certainly are

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still impacted by this, it can lead to oxidative stress and damage to various organs, including those involved in lipid metabolism. So there is some evidence suggesting that iron overload may be associated with alterations in cholesterol metabolism, which may lead to higher levels of LDL cholesterol and lower levels of HDL cholesterol. And when it comes to iron deficiency, it's a little bit of a mixed bag actually when it comes to lipid metabolism.

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So some studies suggest that iron deficiency may be associated with an unfavorable lipid profile, which does include those elevated levels of triglycerides and LDL cholesterol. However, the clinical significance of these findings and their mechanisms do require further investigation. And iron is involved with cholesterol in several pathways, which may include effects on liver function, which is the main site of cholesterol and lipid metabolism.

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oxidative stress and inflammation. So both iron deficiency and iron overload can disrupt these pathways, which does potentially impact cholesterol levels and cardiovascular disease risk. What I'll also say is that iron status directly impacts on thyroid function, actually. And so people with low iron status can have suboptimal thyroid function. And as I noted before, suboptimal thyroid function.

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does impact on cholesterol management. So there's that indirect link as well. And low iron is not uncommon during perimenopause, particularly as those fluctuating estrogen levels can lead to heavy bleeding. And even if your diet hasn't necessarily changed or you've typically had adequate iron status, that can change in that perimenopause sort of cycle. And I've seen numerous.

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iron levels being reported by females that are well below where they would want to be. So I guess I just wanted to highlight some of these points because cholesterol is debated as to how important looking after your cholesterol is for cardiovascular disease risk health, for sure. But I think cholesterol management can speak to other underlying sort of pathophysiology, which does impact on cardiovascular disease risk.

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like thyroid function, like iron status, like vitamin D status, and of course, our lower estrogen levels. All of these things can impact directly or indirectly on cardiovascular disease risk. Cardiovascular disease risk is increased as we head into menopause, particularly, and is the leading cause of death for women. That's why I do look more closely at cholesterol numbers.

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But also I don't think that it's just a bandaid approach and stick someone on a statin, you know? Like that's definitely not, to my mind, the answer, given what we know about how statins impact women, particularly under the age of 60. Now, I don't just wanna leave you with, just think about these things. What I will say is, if you are concerned about your cholesterol management, there is one particular thing which I wanna highlight, which can help, and I may have mentioned it before, because I've mentioned it several times across my social media.

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But psyllium husk. So psyllium husk is effective at lowering LDL cholesterol and it reduces cholesterol in several related processes. First of all, is with bile acid recycling. So bile acids are made from cholesterol in the liver and stored in the gallbladder. And they're released into the small intestine to aid in digestion and absorption of fats.

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Normally, a significant portion of these bile acids are reabsorbed back into the bloodstream and recycled by the liver. Psyllium husk, as a soluble fiber, binds to bile acids in the intestine, and the binding reduces the reabsorption of the bile acids, so it leads the liver to produce new bile acids, and the liver requires cholesterol to do that. So this process of requiring more cholesterol to make bile acids

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reduces the level of cholesterol circulating into the blood. Another benefit of psyllium husk is that in the large intestine, bacteria ferment soluble fibers like psyllium which produces these short-chain fatty acids as byproducts. And these short-chain fatty acids influence lipid metabolism in several ways, including the inhibition of cholesterol synthesis in the liver, improving insulin sensitivity, and that

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does indirectly affect cholesterol levels by influencing how the body processes and stores fats. And this is a little bit indirect, but psyllium husk can absorb water and expand in the stomach. So it can increase the sensation of fullness and potentially reduce overall calorie intake. So while this is not directly lowering cholesterol, weight management definitely influences overall metabolic health, including the improvement of our lipid profiles. And finally,

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Acilium husk may contribute to the health of our gut microbiota by promoting the growth of beneficial bacteria. So these gut microbiota or bacteria are associated with a better cholesterol metabolism, potentially through mechanisms involved such as that altered bile acid metabolism and that short chain fatty acid production that I mentioned earlier. Now just so you know, because some people I'm sure are thinking, well, I don't have my gallbladder. So this doesn't necessarily going to help me.

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It will help you because the gallbladder is just where we store bile acids, but the bile acids are made in the liver. So you can still see a benefit of psyllium husk on your cholesterol even if you don't have a gallbladder. Look, you probably knew that and picked that up, but I just thought I'd point that out. So in summary then, yes, cholesterol management changes as we age, and this is largely influenced through that menopausal transition. However, getting appropriate hormone support.

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looking at vitamin D status, looking at your iron status, and also investigating what your thyroid is doing are mechanisms by which you can all improve your cholesterol management if you need to. And all of these things require investigation if you get red flagged at the lab tests or the doctors for having a higher cholesterol level. And then psyllium husk can acutely reduce that synthesis of cholesterol or I'm sorry the yeah the

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to reduce the available cholesterol by influencing the synthesis of our bile acids. So that is definitely one thing to consider. And dosage, you would want a teaspoon of psyllium husk in water about three times a day with your meals for that to sort of take effect. So these are all things which I hope you find useful. And I will just finish off by saying a healthy body weight for you, being appropriately active.

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sleeping properly, minimizing your alcohol, and having an awesome diet are all obviously super important as well. And if all of these things are already in place, yet your cholesterol is still high-ish, then I mean just ask yourself how important is that really? It might not be as important as what you think, but that's when you book a consultation with someone like me and we can discuss all of this stuff further. So with that then,

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You can catch me over on threads, Twitter and Instagram @mikkiwilliden, Facebook @mikkiWillidenNutrition or head to my website, mikkiwilliden.com and book a call. All right team, have the best week.