Midlife Health in the News: Sleep, Exercise, and Cholesterol

November Midlife Roundup [2024]

Photo by Priscilla Du Preez 🇨🇦 on Unsplash

November is here, and I'm happy to report that my daughter is almost finished with her college applications. If you missed it, I wrote about this crazy process here.

While there aren't as many updates on midlife as in the last roundup, a few studies and articles have caught my attention, and, of course, I have some thoughts to share.

Brain Aging and Sleep in Midlife

First up is a study in the journal Neurology on how sleep affects brain aging in midlife.

Researchers analyzed data from the CARDIA study, which included 589 participants (half women) with an average age of 40. They examined sleep patterns at the start of the study, again after 5 years, and finally through MRI scans after 15 years to evaluate brain aging.

The sleep questionnaire assessed four key characteristics of poor sleep (PSC):

1. Short sleep duration

2. Poor sleep quality/waking up often

3. Early morning waking

4. Daytime sleepiness

The researchers grouped participants into three categories based on the number of poor sleep characteristics they reported:

• 0-1 PSCs

• 2-3 PSCs

• More than 3 PSCs

Compared to those with 0-1 PSCs, those with 2-3 PSCs had brains estimated to be 1.9 years older, while those with more than 3 PSCs showed a brain age 3.5 years older.

"Our findings highlight the importance of addressing sleep problems earlier in life to preserve brain health, including maintaining a consistent sleep schedule, exercising, avoiding caffeine and alcohol before going to bed, and using relaxation techniques," author Kristine Yaffe, MD, University of California San Francisco, said in a press release

While this study shows the importance of resolving sleep issues at midlife, I’m not a huge fan of generic sleep advice. Sleep problems at midlife can be complex, and many women struggle with getting quality sleep, even when they do all "the things.”

The bottom line: sleep is crucial for our overall health and well-being. I'll be writing more about sleep soon, but in the meantime, feel free to share your questions or challenges in the comments.

Exercise and the Health of Body Fat

How many times has a midlife woman started exercising, only to stop because she didn’t see any weight loss?

A recent study caught my eye, and it addresses an important point we don’t hear enough about at midlife—the general health of body fat matters, and exercise plays a key role in improving it.

To examine the effects of long-term exercise on body fat, researchers studied 16 people who had been exercising at least four times a week for at least two years, with an average of 11 years of consistent exercise. They then compared these exercisers with a matched group of inactive individuals of the same age, body fat percentage, weight, and sex.

The team collected fat tissue samples from just under the belly (subcutaneous fat) in both groups. They found that the long-term exercisers had healthier fat than the non-exercisers. For example, the fat tissue in the exercisers contained more blood vessels, more mitochondria, and fewer fat cells that cause inflammation.

As study lead Jeffrey Horowitz, professor of movement science at the University of Michigan School of Kinesiology, put it in this press release:

Our findings indicate that in addition to being a means to expend calories, exercising regularly for several months to years seems to modify your fat tissue in ways that allows you to store your body fat more healthfully if or when you do experience some weight gain -- as nearly everyone does as we get older

While the participants in this study were in their 30s (not midlife), the findings are still relevant and reinforces the idea that not all body fat is created equally.

In my own research, I've found that fat cells take about 7-8 years to be replaced. With the average exercise duration of 11 years in this study, it’s clear that regular exercise can lead to healthier body fat over time.

I write about how I came to terms with own midlife weight gain, deciding that my fat was likely pretty healthy. (ha, ha!)

Another important aspect of this study is its ability to look at the long-term effects of exercise, something that’s difficult to do with intervention trials.

As Horowitz points out, “Compared with our previous study, in which we examined the effects of just three months of training on fat tissue, we see that the differences are more robust in people who exercise regularly for years versus those who don’t.”

Yay for the Portfolio Diet

I came across an article in The New York Times titled "Can I Lower My Cholesterol Without Taking a Statin?" and was pleased to see the mention of the Portfolio Diet, as it's often overlooked.

While research on reducing total fat or saturated fat is limited, there is stronger evidence supporting the cholesterol-lowering effects of the foods included in the Portfolio Diet.

The Portfolio Diet is a "portfolio" of four types of foods that research has shown can help lower cholesterol. These foods include:

• Nuts

• Plant-based proteins (like soy, beans, pulses)

• Phytosterols

• Viscous fiber (oats, psyllium, barley)

Here’s a nice little handout if you’re interested

One older randomized controlled trial (RCT) found that increasing these foods can reduce cholesterol levels as effectively as first-generation statins. A 2021 cohort study following 123,330 postmenopausal women for 15 years also found that women who consumed more of these foods had a lower risk of heart disease.

I had a comment on my Facebook post from someone with a family history of high cholesterol, saying that diet hadn't been effective for them. This can certainly be the case, especially for people with a genetic predisposition to high cholesterol.

However, it’s still important for women to be aware of cholesterol changes around menopause. If you're premenopausal, you might not want to wait until later to address it—because as cholesterol levels tend to rise during and after menopause, you’ll likely need some wiggle room.

Mary Claire Haver - the Queen of Menopause

Another recent article in The New York Times highlighted Dr. Mary Claire Haver and the impact she’s had on raising menopause awareness.

That said, menopause experts point out that some of her claims about hormone therapy do not align with current science and guidelines from the Menopause Society.

As the article explains:

But in her efforts to help women navigate menopause today, she has also drawn criticism from menopause medicine’s longer-serving guard of doctors for recommending hormones for uses that stray from official medical guidelines and, they say, risk harming women. And she has built a multimillion-dollar wellness business, The ’Pause Life, selling supplements and diet plans in a way that some of her colleagues find ethically questionable.

I really wish Dr. Haver would use her platform to call for more research—because that’s the real issue. In my opinion, the solutions to the health challenges faced by midlife women will never come from hormone therapy alone.

In fact, when I read reviews of books like Haver’s The New Menopause, the critical ones often make an important point: “Lots of hormone replacement science. Not how to live with this.”  [Hint: That’s what my focus is all about.]

Forgive yourself

I’ll leave you with a post from Ann Marie at Hotflash Inc about forgiving yourself.

I want you to forgive yourself. I’ll go first.

I’ve had to do this lately as life has been so darn crazy.

Sometimes we can’t be or do all the things we would like to. By actively forgiving ourselves, we show self-compassion. And realize that we are simply human.

I wanted to include one more news item in this newsletter, but stopped here and forgave myself for falling short.

Oh and one last thing. My interview with Jennifer Authurton on the Old Chicks Know Shit Podcast is out. We talk about how the nervous system changes at midlife. Don’t miss it!

Let me know what you think in the comments!