Why cholesterol goes up during the menopause transition
If you’re eating your same diet, but you notice your LDL cholesterol is inching up while your HDL is inching down, you’re not alone.
Every midlife woman needs to know that hormonal changes affect cardiovascular biomarkers. After menopause the risk of heart disease increases significantly. The sooner women understand this the better.
The fact is estrogen plays a role in lipid metabolism and with less estrogen LDL and triglycerides increase. This shouldn’t be too surprising as cholesterol is needed to make estrogen. But the point is midlife women need to be mindful of their cholesterol.
In my 40s my LDL was consistently around 80, below the 100 recommended. Now that I’m in perimenopause and my cycles are irregular —a sign estrogen is on the decline—it’s gradually gone up to 90 (went from 80, 87 to 90). So, I’m keeping an eye on it. If it had been more like 95 at baseline, then I wouldn’t have had as much wiggle room.
If you still have regular cycles, understand that this is coming down the pike. If your cholesterol is on the border, now’s a good time to work on it.
To some degree this "estrogen effect" even happens with regular cycles. In a study in the Journal of Clinical Endocrinology and Metabolism, HDL cholesterol increased as estrogen went up in the follicular phase. In contrast, total cholesterol and low-density lipoprotein (LDL) cholesterol levels — as well as triglycerides — declined as estrogen levels rose.
Total cholesterol, LDL cholesterol and triglyceride levels reached their lowest just before menstruation began in the luteal phase. So it makes sense to get levels checked the same time during your cycle, preferably before your period starts.
If your blood lipids shoot up out of nowhere for no apparent reason, look further into other reasons such as subclinical hypothyroidism or high homocysteine. A good endocrinologist can help.
Now what to do about it. There’s so much confusion out there on lowering cholesterol but I personally like the portfolio diet. This is a “portfolio” of four types of food researchers have found to lower cholesterol – so you simply add those foods in. They include nuts, plant protein (soy and pulses), phytosterols and viscous fiber.
One RCT found increasing these foods can reduce cholesterol as much as statins. A recent cohort study following 123,330 postmenopausal women for 15 years found women who ate more of these foods had a lower risk of heart disease.
Today we’re focusing on the viscous fibers what I refer to as “sticky fibers.” They help slow down digestion and increase the excretion of cholesterol. On the portfolio diet, the goal is to get between 10-25 grams a day of sticky fibers. A sticky fiber is high in soluble fiber including foods like oats and beans, two of my fave foods! I aim for two major sources of sticky fibers a day and add in others where I can (below).
Two sticky fibers a day may be oatmeal in the morning and beans topped on a salad at lunch. It could also be beans added to scrambled eggs in the morning and oat balls for a snack that day. Add an orange and some avocado and you’re well on your way. I love power salads at lunch which I throw in chickpeas, sweet potatoes, and avocado.
One of my favorite ways to get beans is in chilis. I frequently make turkey chili, chicken tortilla soup and white chicken chili. This ham and white bean soup is a keeper too. They are all great leftover.
And I always have bean and cheese burritos in my freezer for busy weekends when lunch has to be fast!
Another benefit is sticky fibers are filling, helping keep you full for longer. Additionally, these foods also contain phytoestrogens which help with hormonal changes at midlife, something I’ll talk about more when I get into nutrition.
I don’t like being a downer, but heart disease is the number 1 killer in women and according to the CDC, only about half (56%) of women know this. Midlife is the perfect time to invest in heart health because heart disease develops slowly over time.
Have you seen changes in your cholesterol?