In our household we sometimes talk about the “toothache syndrome”, meaning–it’s easy to not think about our dental health unless you have a toothache. We tend to ignore things that feel fine. It’s easy to take this approach to our overall health, too, and to take for granted the important organs that keep us ticking every day if they feel “fine.” Menopause and long-term heart health are related, and we should pay attention long before there is a problem. Accordingly, preventative action is key! Heart disease is the number one killer of women and represents 35% of women’s deaths worldwide. In our 50s and beyond, we are at greater risk for heart-related disease, and menopause is listed as an independent, female-specific cardiovascular risk by the American Heart Association. For many of us, about a year before our final menstrual period, our total cholesterol goes up, our LDL cholesterol goes up, and our protective HDL cholesterol can become less efficient. In midlife, we have a window of opportunity to make heart-healthy changes that will promote longevity, and to adopt a diet for menopause and heart health.

The Positive Effects of Anti-Inflammatory Diets and Heart Health

A new meta-analysis shows that the anti-inflammatory Mediterranean diet can lower women’s cardiovascular risk by almost 25% and all-cause mortality by 23%. While the anti-inflammatory mechanisms are not yet fully understood, the Mediterranean diet’s antioxidant and microbiome effects are associated with lower inflammation and reduced cardiovascular risk (Pant, 2023.) This is the first study to look at the connection between diet, cardiovascular risk, and women, and means that we can be more specific with anti-inflammatory recommendations for women in menopause.

Inflammation plays a central role in the development of high cholesterol, atherosclerosis (the thickening and stiffening of our arteries), cardiovascular risk, and poor heart health. Inflammation drives the production of cortisol and raises blood sugar, which over time can damage blood vessels and the nerves of the heart, and cause blood clots. Stress, lack of exercise, obesity, genetic predisposition, smoking, exposure to toxins, and fast food all contribute to chronic inflammation. Furthermore, he Standard American Diet unfortunately plays a significant role in keeping us inflamed and our hearts at risk. Eating an anti-inflammatory diet, however, creates a strong foundation for minimizing menopausal symptoms and promoting heart health. In essence, eating an anti-inflammatory diet means eating lots of veggies, plant-based proteins like nuts and beans, fruit, and wild-caught fish, while limiting processed meat, dairy, gluten, and sugar. 

Anti-Inflammatory Foods Include:

• Berries – blueberries, organic strawberries, sour cherries
• Olive oil (never heated above 350)
• Onions, scallions, shallots, garlic
• Cruciferous vegetables – broccoli, cauliflower, Brussels
• Dark green leafy vegetables – collards, kale, spinach
• Nuts and seeds 
• Wild-caught fatty fish – salmon, sardines, mackerel  – great sources of omega-3’s
• Bone broth

More Dietary Suggestions for Heart Health in Menopause

Omega-3s

Omega-3s are an integral part of an anti-inflammatory diet. The omega-3s from high-quality fish oil supplements have been shown to reduce inflammatory pathways and can reverse atherosclerosis, the “hardening” of our arteries (Simonetta et al., 2019) To that end, establishing healthy levels of our protective HDL cholesterol is particularly important for menopausal women in the prevention of heart disease. Particularly, taking 4g of omega-3s/day has been shown to raise our protective HDL significantly (Institute for Functional Medicine, 2022.) In food, we find our omega-3s in wild fish, chia seeds, flax, walnuts, and hemp seeds. 

Fiber

The fiber found in plants lowers LDL and total cholesterol and thereby reduces the risk of cardiovascular disease. Studies over the last 20 years have shown that of all the forms of fiber, beta-glucans from mushrooms (reishi, maitake, shiitake, chaga), algae, and oats, may be the most effective at decreasing LDL cholesterol. Beta-glucans appear to modulate cholesterol gene expression. They act as PREbiotics, changing our gut ecosystems in ways that benefit our physiology, reducing inflammation and improving cardiovascular health (Sima, 2018.) 

Vitamin K2 and D3

Moreover, both vitamin K2 and D3 play a role in heart health by helping calcium find its way into our bones rather than accumulating on the artery walls. During perimenopause and even more so after menopause, it is worth looking at whether you are getting enough of these two key nutrients. Vitamin K2 is found in fermented foods and some animal foods. It is also produced by bacteria in our gut (another reason to keep the gut healthy and balanced) and has been shown to improve various measures of cardiovascular wellness. In the same fashion, Vitamin D3 is also a critical piece of the heart health puzzle because it actually directs the calcium out of the arteries and into the bone. 

Nitric Oxide

Let’s also look at a fascinating molecule called nitric oxide. Nitric oxide is produced by the cells lining our blood vessels and is required for red blood cells to deliver oxygen to our tissues. After the age of 40, our production of nitric oxide drops and blood flow is reduced, often resulting in cardiovascular issues. (Nitric oxide is also a neurotransmitter associated with memory, improved immunity and balanced levels of serotonin and dopamine.) Healthy nitric oxide levels are supported by:

• Green leafy vegetables and colorful veggies in general
• Nuts are a rich source of a nitric oxide precursor
• Regular exercise
• Green Tea
• Positive thoughts and emotions. (It is important to note that anything that tightens our blood vessels, including depression, anxiety and grief, makes more work for the heart and can create vascular damage.) 
• Not using antiseptic mouthwash. Friendly oral bacteria support nitric oxide production.

Garlic

Finally, garlic is a superstar when it comes to heart health. It produces a unique antioxidant molecule which relaxes vascular muscles, increases the flexibility of blood vessels, and lowers blood pressure, all critical for the heart. Garlic’s properties also support our cardiovascular health by absorbing the plaque-forming molecules on our blood vessel walls. 

In Closing

In conclusion, during menopause our risk of heart disease increases. It is an important moment to introduce an anti-inflammatory diet and take charge of our heart health. Above all, we all want to live a long and vibrant life!

Recipes for Reduced Inflammation and Heart Health in Menopause

Coconut Mushroom Stew

Ingredients:

1 recipe cooked brown rice
1 pint cherry tomatoes
3 Tbsp. Extra Virgin Olive Oil
1 lb. mushrooms, chopped (or pre-sliced)
1.5 large yellow onions, diced
1.25 tsp. sea salt
1 Tbsp. smoked paprika
3 cups water or mushroom broth (boil dried mushrooms in water and strain)
1 cup well-mixed full fall coconut milk
Juice of 1 lemon
Plain Greek Unsweetened yogurt (coconut or cashew-based; not dairy)
dill or parsley for garnish

Instructions:

1. Place the cherry tomatoes, doused with olive oil and sea salt, in the oven and roast at 350 for about 15 minutes.
2. Pre-cook brown rice and have it ready.
3. Meanwhile, heat the oil in a large pot over medium-high heat and add the mushrooms and onions and salt and sauté on low heat until mushrooms release their liquid and it evaporates, about 10-15 minutes.
4. Then, stir in the paprika and cook for another minute. Add the water/broth and coconut milk, bring to a simmer, and cook for 3 minutes. Stir in the lemon juice, taste, and add more salt as needed.
5. Scoop the rice into bowls and ladle soup over top. Add a dollop of yogurt and the cherry tomatoes and dill or parsley.
6. One final option: you can add a handful of shredded cabbage to the pot after cooking mushrooms.

Ingrid’s Coconut Miso Salmon

Serves 4

Ingredients

3 Tbsp. coconut oil
1 red onion sliced 1/2 inch thick
3 Tbsp. fresh ginger minced
4 garlic cloves thinly sliced
1 dried red chili (whole)
1/4 cup white miso
1 cup unsweetened coconut milk (reserve remaining for chia pudding!)
1-1.5 cup water
1.5 lbs. wild salmon filet cut into large, 2 inch pieces
5 ounces baby spinach (about 5 packed cups)
1 Tbsp. lime juice plus lime wedges for serving1/4 cup fresh basil for serving1/4 cup cilantro for servingpinch sea saltpinch black pepper

Serving Options

2 bags cauliflower rice (for dinner)
2 cups brown rice (for lunch)
1 tsp. turmeric
1 bay leaves
4 whole cloves
1 cinnamon stick
5 cardamom pods

Instructions

1. In a large pot, heat oil over medium heat and add onion, ginger, red chili, and garlic, and season with salt and pepper. Cook until softened, for about 3 minutes. Once fragrant, add miso and cook, stirring frequently.
2. When miso is caramelized (about 2 minutes), add coconut milk and 1 cup water and bring to low boil over high heat.
3. One liquid is reduced (after maybe 5 minutes), stir in salmon, and reduce heat to medium-low and simmer gently until just cooked through–about 5 minutes. Turn off heat and add in spinach and lime juice. Remove dried chili.
4. You will be serving the salmon over cauliflower rice or brown rice. For the cauliflower rice, sauté the cauliflower in olive oil on low, adding the spices mentioned, and cook for about 15 minutes. For rice, cook according to package instructions, bringing the water to a boil and adding the rice and all the spices, covering, and reducing heat to low. At the end of either process, remove the spice pods, and serve.
5. Finally, serve salmon over a bowl of rice, and garnish with cilantro, basil, and a lime wedge.

Check out more of the recipes on www.littlegreen.me and see Sage+Sisters recipe and nourishment page here.

Sources

Institute for Functional Medicine. (2022). Institute for Functional Medicine Livestream 2022 Advanced Practice Conference: Cardiometabolic module. https://www.ifm.org

Pant, A., Gribben, S. et al. (2023). Primary prevention of cardiovascular disease in women with the Mediterranean diet: systematic review and meta-analysis. Heart, 1-8. http://heart.bmj.com

Sima, P. Vanucci, L. Vetvicka, V. (2018). Beta-glucans and cholesterol. International Journal of Molecular Medicine 41 (4), 1799-1808. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810204/#!po=25.0000
Simonetta, M., Infante, M & Della-Morte, D. (2019). A novel anti-inflammatory role of omega 3 PUFAs in prevention and treatment of atherosclerosis and vascular cognitive impairment and dementia. Nutrients, 11(10), 2279. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835717/